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Resumo Objetivo Avaliar o desfecho funcional dos pacientes submetidos ao reparo de Bankart artroscópico no longo prazo. Métodos Avaliação retrospectiva de 41 pacientes (45 ombros) operados entre 1996 e 2009 acompanhados por um período médio de 14,89 anos. Foram feitas análises das pontuações funcionais de University of California, Los Angeles (UCLA) e Carter-Rowe, exame físico e análises de prontuários. Resultados O escore Carter-Rowe apresentou melhora média de 46,11 pontos, com média final de 85,89 pontos, e o UCLA apresentou melhora de 31,33 pontos. Um total de 10 pacientes (22,22%) apresentou recidiva, sendo o número de luxações pré-operatórias o fator mais correlacionado. Conclusão Foi demonstrado que o número de luxações pré-operatórias influenciou negativamente na taxa de falha.

Introduction The use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity. Methods We retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded. The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups. Results A total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old. The overall major surgical morbidity (Clavien-Dindo 3–5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p = 0.643). There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p = 0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p = 0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed. Conclusions Perioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.

Exposure to heavy metals has been documented to induce changes in the expression of plant proteins. Phaseolus vulgaris L., represents a great source of nutrition for millions of people, and is the second most important legume crop. The present study aimed to investigate the effects of Hg stress on germination rate and identify the gene expression profiling of U1-70 kDa by using SDS-PAGE analysis. Seeds of black beans (P. vulgaris L.) variety Jamapa were used. The study was performed in the municipality of Guadalupe in Zacatecas, México; August 2009 to 2011. Embryos were exposed to 10 µmol L-1 HgCl2. Expression and detection of U1-70 kDa was affected by mercury. It was possible to amplify the cDNA for U1-70 kDa in all tested samples, there were also found variations in the mRNA of embryos bean seeds for western blot analysis. Mercury does not affect the germination of bean seeds P. vulgaris L.; there is variation in the expression of the U1-70 kDa protein at different hours of exposure to 10 µmol L-1 of mercury. The presence of U1-70 kDa is identified for the first time in early stages of germination of bean seeds P. vulgaris L.

Objective To evaluate the functional outcome of patients submitted to arthroscopic Bankart repair in the long-term. Methods Retrospective evaluation of 41 patients (45 shoulders) operated between 1996 and 2009 followed-up for a mean period of 14.89 years. Functional scores were analyzed by the University of California, Los Angeles (UCLA) and Carter-Rowe scores, physical examination, and analysis of medical records. Results The Carter-Rowe score showed an average improvement of 46.11 points, with a final average of 85.89 points, and the UCLA score showed an average improvement of 31.33 points. Ten patients (22.22%) relapsed, with the number of preoperative dislocations being the most correlated factor. Conclusion It was demonstrated that the number of preoperative dislocations negatively influenced the failure rate. Resumo Objetivo Avaliar o desfecho funcional dos pacientes submetidos ao reparo de Bankart artroscópico no longo prazo. Métodos Avaliação retrospectiva de 41 pacientes (45 ombros) operados entre 1996 e 2009 acompanhados por um período médio de 14,89 anos. Foram feitas análises das pontuações funcionais de University of California, Los Angeles (UCLA) e Carter-Rowe, exame físico e análises de prontuários. Resultados O escore Carter-Rowe apresentou melhora média de 46,11 pontos, com média final de 85,89 pontos, e o UCLA apresentou melhora de 31,33 pontos. Um total de 10 pacientes (22,22%) apresentou recidiva, sendo o número de luxações pré- operatórias o fator mais correlacionado. Conclusão Foi demonstrado que o número de luxações pré-operatórias influenciou negativamente na taxa de falha.

Made available in DSpace on 2020-12-10T20:07:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Urea is the most used nitrogen fertilizer in tropical agriculture, but when applied to the soil surface, it can promote nitrogen (N) losses by volatilization of ammonia (NH3). The present study aimed to evaluate, under controlled laboratory conditions, the N-NH3 losses from conventional N sources and compacted urea. Fertilizers were applied on the surface of a eutrophic Red Latosol of clayey texture (Oxisol), previously moistened to 60% of its maximum water-retention capacity. Conduction of the experiment was in a completely randomized design with six replicates. The treatments were four N sources in doses equivalent to 100 kg ha(-1) of N (urea, urea + N-(N-butyl) thiophosphoric triamide (NBPT), ammonium nitrate and urea compacted with additives and polymers), and the additional control groups (soil with no fertilizer and empty chamber). We evaluated the N-NH3 losses by volatilization for a period of 20 days with the aid of hermetically sealed chambers. The results demonstrated the importance of using compacted urea for reducing nitrogen losses via volatilization. These results suggest that choosing the N source can reduce its volatilization and thus improve the harnessing of N from the nitrogen fertilization, when performed with a urea basis. Univ Estadual Paulista, Dept Prod Vegetal, Jaboticabal, SP, Brazil Univ Estadual Paulista, Botucatu, SP, Brazil Kimberlit Agrociencias, Dept Fertilizantes, Olimpia, SP, Brazil Univ Estadual Paulista, Dept Prod Vegetal, Jaboticabal, SP, Brazil Univ Estadual Paulista, Botucatu, SP, Brazil

This article seeks to cover the Dynamics between China and the United States of America through the perspective of Power Transition Theory. This analysis aims to dispute the notion that the nature of Power Transitions has a tendency towards bellicism between the Actors in question. Through the study of the theoretical matrix behind China’s internal and external politics, this article establishes how Beijing has accumulated a power that’s as deep and prolific as it is dependent on the very international order that its precepts appear to denounce. Keywords: Power Transition; Balance of Power; World Order; Pluralism; Solidarism

Einstein-Cartan theory is an extension of the standard formulation of General Relativity characterized by a non-vanishing torsion. The latter is sourced by the matter fields via the spin tensor, and its effects are expected to be important at very high spin densities. In this work we analyze in detail the physics of Einstein-Cartan theory with Dirac and Maxwell fields minimally coupled to the spacetime torsion. This breaks the $U(1)$ gauge symmetry, which is suggested by the possibility of a torsion-induced phase transition in the early Universe. The resulting Dirac-like and Maxwell-like equations are non-linear with self-interactions as well as having fermion-boson non-minimal couplings. We discuss several cosmological aspects of this theory, including bounces, acceleration phases and matter-antimatter asymmetry in the torsion era, as well as late-time effects such as the generation of an effective cosmological constant, dark energy, and future bounces within cyclic solutions., Comment: 20 pages, 4 figures

The Echelon circular™ powered stapler (ECP stapler) obviates the need for manual firing of conventional circular staplers during the construction of a colorectal anastomosis, but has not been evaluated clinically. The aim of this study was to perform a clinical evaluation of this stapler. A retrospective review of the initial clinical experience of a single surgeon using the ECP stapler for left-sided colorectal anastomosis construction during elective colorectal resections for benign and malignant disease was conducted by analyzing results from a prospectively maintained study database. Additionally, four attending colorectal and/or general surgeons who had performed ≥ 5 colorectal operations with the ECP stapler were invited to complete an anonymous online survey to subjectively assess the user experience with the device. Statistical analysis was conducted using Microsoft Excel Version 15.33. Seventeen patients underwent left-sided anastomotic reconstruction using the ECP stapler. All donuts (proximal and distal) were intact. Anastomotic integrity was evaluated using the air-leak test utilizing flexible video sigmoidoscopy. No leaks were observed, although one patient (5.9%) developed a postoperative pelvic abscess. The anonymous survey was completed by all four surgeons. Subjective evaluation of the ECP stapler suggests that the overall stapling quality, overall device ease-of-use, and the overall perception of anastomotic quality as above average when compared to manual ‘end-to-end anastomosis’ (EEA) stapling devices. In an initial clinical evaluation of the ECP stapler, the safety and ease-of-use of the device appears to be satisfactory. Powered stapling and the design of ‘3D stapling’ may provide advantages over manual systems, and may improve the construction quality of left-sided colorectal anastomosis.

We address the implementation of the cosmological principle, that is, the assumption of homogeneity and isotropy in the spatial distribution of matter in the Universe, within the context of Einstein-Cartan theory including minimal couplings of both Dirac and Maxwell fields to torsion. This theory gives rise to new physical effects in environments of high spin densities while leaving the vacuum dynamics unaffected. Our approach is to impose the cosmological principle from the onset to the geometrical degrees of freedom (metric and torsion functions), which constrains the torsion components and the corresponding correction terms in the Friedmann-like equations and in the resulting fermionic and bosonic (non-linear) dynamics. We derive the corresponding cosmological dynamics for the geometrical and matter degrees of freedom and discuss the validity of this approach., Comment: V2: 11 pages, published version

Gravity can be formulated as a gauge theory by combining symmetry principles and geometrical methods in a consistent mathematical framework. The gauge approach to gravity leads directly to non-Euclidean, post-Riemannian spacetime geometries, providing the adequate formalism for metric-affine theories of gravity with curvature, torsion and non-metricity. In this paper, we analyze the structure of gauge theories of gravity and consider the relation between fundamental geometrical objects and symmetry principles as well as different spacetime paradigms. Special attention is given to Poincar\'{e} gauge theories of gravity, their field equations and Noether conserved currents, which are the sources of gravity. We then discuss several topics of the gauge approach to gravitational phenomena, namely, quadratic Poincar\'{e} gauge models, the~Einstein-Cartan-Sciama-Kibble theory, the teleparallel equivalent of general relativity, quadratic metric-affine Lagrangians, non-Lorentzian connections, and the breaking of Lorentz invariance in the presence of non-metricity. We also highlight the probing of post-Riemannian geometries with test matter. Finally, we briefly discuss some perspectives regarding the role of both geometrical methods and symmetry principles towards unified field theories and a new spacetime paradigm, motivated from the gauge approach to gravity., Comment: 33 pages. Invite review to the Special Issue "80 Years of Professor Wigner's Seminal Work "On Unitary Representations of the Inhomogeneous Lorentz Group"". Matches published version

Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF. RESUMO A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI.

Ante la fluctuación de precios y el agotamiento de los combustibles fósiles, así como de sus efectos negativos en el ambiente, el desarrollo y aprovechamiento de biocombustibles representan una alternativa potencialmente viable. No obstante, los insumos empleados en la producción de bioenergéticos, son altamente cuestionados por su sostenibilidad energética. Debido a ello, es prioritaria la búsqueda de fuentes alternativas a partir de plantas resistentes a factores climáticos adversos, alta capacidad de adaptación, bajo requerimiento de insumos y que no compitan con los alimentos. Considerando lo anterior, se realizaron muestreos en el centro-norte de México para colectar especies silvestres, a fin de determinar su potencial productivo, el contenido de aceite de las semillas, y analizar las características físico químicas del aceite. Se colectaron semillas de 19 especies de plantas. Agave sp., registró el potencial productivo de semilla más alto con 24 305 kg ha-1; sin embargo, presenta la limitante de tener un largo periodo de fructificación y su contenido de aceite es bajo. Cinco de las especies de semillas colectadas (Cucurbita ficifolia, Cucurbita foetidissima, Proboscidea louisianica, Jatropha dioica y Apodanthera undulata) alcanzaron contenidos de aceite superiores a 30%. A. undulata podría producir potencialmente hasta 1 315 kg ha-1 de aceite, lo que la hace tan competitiva como los insumos disponibles comercialmente. La caracterización físico química de los aceites mostró una amplia variación, que permitió identificar aceites con cualidades alimenticias, bioenergéticas y otros usos potenciales.

The Asteroid Impact Mission (AIM) is an ESA small mission of opportunity that intends to travel to the binary asteroid Didymos to assess planetary defence capabilities in the context of the AIDA program, in collaboration with NASA, to demonstrate new technologies for future exploration missions to asteroids and to perform scientific observations. The AIM spacecraft is described in the paper, focusing on the vision-based GNC strategy that reached a high level of maturity at the end of the Consolidation Phase (post B1). Ground navigation analyses pointed out that for close proximity operations (distances under 20 km) a certain degree of autonomy is required. A semi-autonomous attitude guidance has been developed to guarantee that the asteroid will always be kept in the camera Field of View. This algorithm will apply a delta quaternion to the reference attitude profile provided by ground control in order to correct the pointing to the body. This technology has been designed to be easily validated and, at the same time, constrained: the delta quaternion can be limited and in case the thresholds are crossed or any failure occurs, the ground-based reference attitude profile will be used. The AIM GNC prototype was updated to use Line of Sight measurements provided by a centroiding algorithm designed and autocoded in Matlab/Simulink, then validated up to Processor-in-the-loop tests using a flight-representative processor (AT697E LEON2-FT @ 80 MHz). The algorithm is based on the correlation of the image with a Lambertian sphere, taking advantage of the almost spherical shape of Didymain. When relative distance to the binary system is below 8 km, the feature tracking algorithm is used. In this paper a specific case is assessed: the close fly-by for MASCOT-2 delivery (lander included in the payload for AIM's phase B1), tested up to Hardware-in-the-loop with the AIM Framing Camera.

Einstein-Cartan theory is an extension of the standard formulation of General Relativity where torsion (the antisymmetric part of the affine connection) is non-vanishing. Just as the space-time metric is sourced by the stress-energy tensor of the matter fields, torsion is sourced via the spin density tensor, whose physical effects become relevant at very high spin densities. In this work we introduce an extension of the Einstein-Cartan-Dirac theory with an electromagnetic (Maxwell) contribution minimally coupled to torsion. This contribution breaks the $U(1)$ gauge symmetry, which is suggested by the possibility of a torsion-induced phase transition in the early Universe, yielding new physics in extreme (spin) density regimes. We obtain the generalized gravitational, electromagnetic and fermionic field equations for this theory, estimate the strength of the corrections, and discuss the corresponding phenomenology. In particular, we briefly address some astrophysical considerations regarding the relevance of the effects which might take place inside ultra-dense neutron stars with strong magnetic fields (magnetars)., Comment: 15 double column pages; v2: removed one section and added content to other sections. Version accepted for publication on EPJC

In this work, we investigate the effects of the torsion-fermionic interaction on the energy levels of fermions within a Riemann-Cartan geometry using a model-independent approach. We consider the case of fermions minimally coupled to the background torsion as well as non-minimal extensions via additional couplings with the vector and axial fermionic currents which include parity-breaking interactions. In the limit of zero-curvature, and for the cases of constant and spherically symmetric torsion, we find a Zeeman-like effect on the energy levels of fermions and anti-fermions depending on whether they are aligned/anti-aligned with respect to the axial vector part of the torsion (or to specific combination of torsion quantities), and determine the corresponding fine-structure energy transitions. We also discuss non-minimal couplings between fermionic fields and torsion within the Einstein-Cartan theory and its extension to include the (parity-breaking) Holst term. Finally we elaborate on the detection of torsion effects related to the splitting of energy levels in astrophysics, cosmology and solid state physics using current capabilities., Comment: 12 pages; v2: minor corrections and additions

We explore the intimate connection between spacetime geometry and electrodynamics. This link is already implicit in the constitutive relations between the field strengths and excitations, which are an essential part of the axiomatic structure of electromagnetism, clearly formulated via integration theory and differential forms. We briefly review the foundations of electromagnetism based on charge and magnetic flux conservation, the Lorentz force and the constitutive relations which introduce the spacetime metric. We then proceed with the tensor formulation by assuming local, linear, homogeneous and isotropic constitutive relations, and explore the physical, observable consequences of Maxwell's equations in curved spacetime. The field equations, charge conservation and the Lorentz force are explicitly expressed in general (pseudo) Riemanian manifolds. The generalized Gauss and Maxwell-Amp\`{e}re laws, as well as the wave equations, reveal potentially interesting astrophysical applications. In all cases new electromagnetic couplings and related phenomena are induced by spacetime curvature. The implications and possible applications for gravity waves detection are briefly addressed. At the foundational level, we discuss the possibility of generalizing the vacuum constitutive relations, by relaxing the fixed conditions of homogeneity and isotropy, and by assuming that the symmetry properties of the electro-vacuum follow the spacetime isometries. The implications of this extension are briefly discussed in the context of the intimate connection between electromagnetism and the geometry (and causal structure) of spacetime., Comment: 21 pages

Breast fibromatosis is a benign fibroblastic proliferation accounting for less than 0.2% of breast tumors. It presents sporadically or as a manifestation of familial adenomatous polyposis (FAP). Fibromatosis in FAP may develop in patients with adenomatous polyposis coli (APC) gene mutations at any location through the gene. Notably, there is an increased risk if mutation is downstream codon 1400. The present case report described a 33-year-old woman with recurrent bilateral breast fibromatosis after breast implants in a context of classic FAP. APC mutation (codon-935) was detected at the age of 16. In the same year, a thyroidectomy for a cribriform-morular papillary thyroid carcinoma (pT1) was performed. Seven years later, a prophylactic total colectomy with >100 adenomas without invasive carcinoma was performed and the patient was kept under surveillance. At the age of 30 years old, she underwent breast silicone implantation for cosmetic reasons. One year later, bilateral breast tumors were diagnosed in core biopsy as fibromatosis (nuclear β-catenin+, estrogen receptors-). After no success with medical treatment with tamoxifen, bilateral mastectomy was performed. The patient relapsed one year later and a fibromatosis lesion in the right thoracic wall was excised again. The patient demonstrated no signs of relapse 24 months after the surgery. This rare case illustrates that the increased risk of developing fibromatosis in patients with FAP, even in the classic form, should be considered before deciding to place breast implants.

After a brief review of the foundations of (pre-metric) electromagnetism, we explore some physical consequences of electrodynamics in curved spacetime. In general, new electromagnetic couplings and related phenomena are induced by the spacetime curvature. The applications of astrophysical interest considered here correspond essentially to the following geometries: the Schwarzschild spacetime and the spacetime around a rotating spherical mass in the weak field and slow rotation regime. In the latter, we use the Parameterised Post-Newtonian (PPN) formalism. We also explore the hypothesis that the electric and magnetic properties of vacuum reflect the spacetime isometries. Therefore, the permittivity and permeability tensors should not be considered homogeneous and isotropic a priori. For spherical geometries we consider the effect of relaxing the homogeneity assumption in the constitutive relations between the fields and excitations. This affects the generalized Gauss and Maxwell-Amp\`{e}re laws where the electric permittivity and magnetic permeability in vacuum depend on the radial coordinate in accordance with the local isometries of space. For the axially symmetric geometries we relax both the assumptions of homogeneity and isotropy. We explore simple solutions and discuss the physical implications related to different phenomena such as: the decay of electromagnetic fields in the presence of gravity, magnetic terms in Gauss law due to the gravitomagnetism of the spacetime around rotating objects, a frame-dragging effect on electric fields and the possibility of a spatial (radial) variability of the velocity of light in vacuum around spherical astrophysical objects for strong gravitational fields., Comment: 20 pages. Applications of the general formalism developed in arXiv:1602.01492. V2: typos corrected and references added. V3: 15 pages; revised version to appear in The European Physical Journal Plus

Relatamos o caso de um paciente de 69 anos com trombose tardia de stent farmacologico, admitido com infarto agudo do miocardio anterior, tratado com sucesso com o uso de cateter de aspiracao de trombos (ProntoTM V3).

ResumoIntroduçãoA infecção por HTLV‐ 1 é endêmica no Japão, nas Caraíbas, na África e na América do Sul. A transmissão ocorre de mãe para filho, por contatos sexuais, transfusões de sangue ou partilha de agulhas. A essa infeção está associada uma doença neurológica degenerativa crônica, a paraparésia espástica tropical (TSP). Essa resulta de uma degeneração simétrica da espinal medula em nível torácico. Caracteriza‐se por diminuição progressiva da força nos membros inferiores, hiperreflexia, alterações de sensibilidade, incontinência urinária e disfunção vesical.Caso clínicoMulher de 53 anos, infecção por HTLV‐1 e TSP. Apresentava diminuição da força nos membros inferiores e hiperreflexia, tinha uma marcha parética, espasticidade e sintomas de bexiga neurogênica com infecções urinárias de repetição. Foi proposta para cistectomia. Foi monitorada de acordo com o padrão da ASA. Devido à coagulopatia grave e à possibilidade de agravamento neurológico, não se colocou cateter epidural. A indução da anestesia geral foi feita com midazolam e fentanil seguidos de etomidato e cisatracúrio. Foi entubada com um tubo sete e mantida com desflurano e oxigênio. A anestesia decorreu sem intercorrências, a cirurgia terminou em uma hora e 50 minutos. Não houve quaisquer complicações no pós‐operatório imediato, durante a internação, nem deterioração do exame neurológico. A doente teve alta 20 dias depois.Discussão/ConclusãoHá relatos de diminuição da resposta eletromiográfica e deterioração neurológica associadas ao propofol nesses doentes, razão para uso de etomidato. A metabolização hepática do rocurônio representava um risco e se optou pelo cisatracúrio. Conclui‐se que o plano anestésico escolhido não teve qualquer interferência no curso da doença.AbstractIntroductionHTLV‐1 infection is endemic in Japan, Caribbean, Africa, and South America. It is transmitted from mother to child, sexual contact, blood transfusions, or sharing needles. Tropical Spastic paraparesis (TSP) is a chronic degenerative neurological disease associated with this infection. It results from a spinal cord symmetrical degeneration at the thoracic level and is characterized by progressive motor weakness in the lower limbs, hyperreflexia, sensitivity changes, urinary incontinence, and bladder dysfunction.Clinical caseFemale, 53 years old, HTLV‐1 infection and TSP. She had decreased strength in the lower limbs and hyperreflexia, paretic gait, spasticity, and neurogenic bladder symptoms, with recurrent urinary infections. She was scheduled for cystectomy. The patient was monitored according to standard ASA. Due to severe coagulopathy and the possibility of neurological worsening, epidural catheter was not placed. The induction of general anesthesia was performed with midazolam and fentanyl, followed by etomidate and cisatracurium. She was intubated with a tube size seven and maintained with desflurane and oxygen. Anesthesia was uneventful; the surgery lasted 1 hour and 50minutes. There were no complications in the immediate postoperative period, during hospitalization, nor deterioration of the neurological examination. The patient was discharged 20 days later.Discussion/ConclusionThere are reports of decreased electromyographic response and neurological deterioration associated with propofol in these patients, etomidate was used. The hepatic metabolism of rocuronium posed a risk, we chose to use cistracurium. It was concluded that the anesthesia chosen did not affect the course of the disease.

We analyse the quantum behaviour of the "Little Sibling" of the Big Rip singularity (LSBR) [1]. The quantisation is carried within the geometrodynamical approach given by the Wheeler--DeWitt (WDW) equation. The classical model is based on a Friedmann--Lema\^{i}tre--Robertson--Walker Universe filled by a perfect fluid that can be mapped to a scalar field with phantom character. We analyse the WDW equation in two setups. In the first step, we consider the scale factor as the single degree of freedom, which from a classical perspective parametrises both the geometry and the matter content given by the perfect fluid. We then solve the WDW equation within a WKB approximation, for two factor ordering choices. On the second approach, we consider the WDW equation with two degrees of freedom: the scale factor and a scalar field. We solve the WDW equation, with the Laplace--Beltrami factor-ordering, using a Born--Oppenheimer approximation. In both approaches, we impose the DeWitt (DW) condition as a potential criterion for singularity avoidance. We conclude that in all the cases analysed the DW condition can be verified, which might be an indication that the LSBR can be avoided or smoothed in the quantum approach., Comment: 17 pages, 2 figures, RevTex4-1