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ABSTRACT At the end of the 1970s, the People’s Republic of China (PRC) promoted policies to attract investments from the developed capitalist world, aiming for technological transfer and offering a profitable environment in exchange. Although the TNC capital, know-how, and technology have been key factors for Chinese development, the State has planned and regulated those investments, so they can be aligned with an autonomous project of development, avoiding the classic centre-periphery dependency relationship. This paper analysis focuses on the Five-Year Plans, and the regulation policy laws for inward investment. At the end we analyse the FDI data, which allowed us to identify the main changes and distinct phases of the development of FDI and the State policy.

Abstract The laparoscopic approach represents the standard of treatment for renal and adrenal diseases, and its use is increasing even outside referral centres. Although most procedures are routinely performed, intraoperative complications do not occur, and the rate and predictive factors of these complications have not been established. The aim of this study was to evaluate the incidence and type of intraoperative complications and to identify predictive factors in patients undergoing laparoscopic renal and adrenal surgery. This was a cohort, multicentre, international retrospective study. Patients who underwent laparoscopic renal and adrenal surgeries between April 2017 and March 2022 were included in the study. Bivariate analysis was performed using contingency tables and the χ2 test for independent samples to compare qualitative variables and the T test and Mood test for continuous variables. Multivariate analysis was performed using a logistic regression model to obtain adjusted odds ratios. A total of 2374 patients were included in the study. Intraoperative complications were reported for 8.09% of patients who underwent renal surgery, with the most common complications reported being hollow viscus and vascular complications, and for 6.75% of patients who underwent adrenal surgery, with the most common complication reported being parenchymatous viscous complications. Multivariate analysis revealed that both adrenal and renal surgery radiological preoperative factors, such as invasive features during adrenalectomy and the RENAL score during nephrectomy, are predictive factors of intraoperative complications. In contrast to existing data, surgeon experience was not associated with a reduction in the incidence of perioperative complications.

Background: Abdominal tuberculosis comprises all forms of tuberculosis that involve the gastrointestinal tract. Controversies exist regarding the surgical approach and timing and type of intervention for complicated forms of abdominal tuberculosis. The aim of this systematic review is to define the rate of surgical treatment, the type of surgical procedures performed and the role of minimally invasive surgery in the management of abdominal tuberculosis. Methods: The literature in MEDLINE, Scopus and Google Scholar and forward and backward citations for studies published between database inception and July 2022 were searched without language restrictions. All prospective and retrospective studies were included. The electronic database search yielded 2440 records. Additionally, eight records were identified through snowball searching. Following duplicate removal (45 duplicates found), 2403 records were screened for titles and abstracts. After screening for titles and abstracts and exclusion criteria, 38 reports were included for systematic review, 27 retrospective studies and 11 prospective studies. Data extracted included the general and demographic characteristics of the studies, diagnostic methods used, clinical presentation, site of involvement and details on surgical treatment. Results: In total, 2870 patients with a diagnosis of abdominal tuberculosis were included, and 1803 (63%) underwent a surgical procedure. The majority of patients underwent an open surgical procedure (95%). The most commonly performed procedures were adhesiolysis (21%) and small bowel resection with primary anastomosis (21%). Conclusions: The results of this review suggest that whenever surgery is required, there is a tendency to perform open surgical procedures in patients with complicated abdominal tuberculosis, both in emergency and elective settings, despite advances in minimally invasive surgery. The study protocol was registered on PROSPERO (CRD42022354322).

This article analyzes the role of Latin American state-owned oil companies in the energy transition. Latin America presents great potential for replacing fossil fuels with renewable energies and possesses important reserves of critical minerals, such as lithium. However, there are several obstacles to overcome. Among them, the lack of financial resources for decarbonisation investments, low economic growth, and fiscal austerity policies in the face of the transition’s cost are prominent. In this context of energy industry transformation, state oil companies play a crucial role as they possess productive and financial capacities. These companies face the challenge of balancing oil and gas (petróleo y gas – P&G) production to ensure domestic supply and export potential while making investment decisions in clean energies to gradually replace fossil fuels. Most countries in the region lack medium and long-term strategies to address these challenges. While transnational oil companies from the global North, particularly European ones, have sought to reconfigure themselves as “energy companies” and invest in renewable sources, the main Latin American state-owned companies – such as Petróleo Brasileiro S.A. (Petrobras), Petróleos Mexicanos (Pemex), Yacimientos Petrolíferos Fiscales (YPF), and Empresa Colombiana de Petróleos S.A. (Ecopetrol), analyzed in this article – have pursued various paths in the transition to a low-carboneconomy. Each company’s strategy has been influenced by factors such as the existence of reserves, historical energy use, and differentiated government policies. In this scenario, it is concluded that oil companies are key players in the energy transition in Latin America because they can leverage their economic weight to drive the necessary economic transformations in this process and enhance the utilization of the region’s abundant renewable resources.

Abstract Introduction Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies. Methods We used the MESH terms “appendicitis” AND “situs inversus” AND/OR “gut malrotation” to search for titles and abstracts. Inclusion criteria were patients with clinical and/or radiological diagnosis of acute appendicitis, with conservative or surgical management and with preoperative/intraoperative findings of situs viscerum inversus or gut malrotation. Additionally, previous reviews were examined. Exclusion criteria of the studies were insufficient patient clinical and demographic data. Results We included in this review 70 articles concerning 73 cases of acute appendicitis with anatomical anomaly. Patients were aged from 8 to 86 years (median: 27.0 years). 50 were male and 23 were female. 46 patients (63%) had situs viscerum inversus, 24 (33%) had midgut malrotation, 2 (2.7%) had Kartagener’s syndrome, one of them (1.4%) had an undetermined anomaly In 61 patients the anatomical anomaly was unknown previously (83.6%), while 16,4% already were aware of their condition. Conclusion Acute appendicitis can occur in association of rare anatomical anomalies and in these cases diagnosis can be challenging. Situs viscerum inversus and midgut malrotation should always be considered in the differential diagnosis of a patient with left lower quadrant pain, especially in younger population. Besides clinical features, it is fundamental to implement the diagnostic progress with radiological examination. Laparoscopic approach is useful to identify and treat acute surgical emergency and it is also a diagnostic tool and can be tailored in order to offer the best exposition of the operatory field for each single case.

Abstract Laparoscopic TAPP/TEP approaches are well-established options for the cure of inguinal hernias. As in the open approach, mesh fixation and poor-quality biologic response represent controversial questions and are a source of concerns. Furthermore, hernia defect patency represents another problem which seems not well acknowledged among surgeons. These problems are considered the cause of frequent intra and postoperative complications. To overcome these concerns, recently a different concept of cure has emerged. Based on a newly developed dynamic responsive 3D scaffold named ProFlor, a permanent hernia defect obliteration has been finalized. Following its inherent centrifugal expansion due to its dynamic responsivity, this hernia device is positioned fixation free within the defect and induces a probiotic biological response allowing for the re-establishment of the degenerated inguinal barrier. A laparoscopic approach with the 3D scaffold has been tested on 71 patients to demonstrate its effectiveness in reducing intra and postoperative complications. The operated patients presented with bilateral and/or recurrent inguinal hernia. Overall, 122 hernia defects were obliterated with 119 dynamic responsive scaffolds. The procedures were carried out from January 2018 to January 2022 with a defined protocol and detailed procedural steps. The laparoscopic technique with the 3D hernia scaffold allowed for fixation free placement, permanent defect obliteration and dynamically induced regenerative effects. The technique proved effective in reducing intra and postoperative complications. In particular, early postoperative pain and discomfort significantly decreased. No chronic pain and no recurrences were reported during follow up. The results achieved with the described laparoscopic technique seem to embody an innovative concept for inguinal hernia repair. Fixation free, dynamic responsive, permanent defect obliteration, histologically proven regenerative effects are the distinctive features of this 3D scaffold. It seems to embody a more physiological and pathogenetically coherent concept of cure, thus improving treatment results of this widespread disease.

Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.

IntroductionBowel perforation is a relatively rare presentation of abdominal tuberculosis, whose diagnosis is challenging but fundamental to minimize morbidity and mortality. Laparoscopy is considered an effective modality for diagnosis, but its role in surgical treatment is still not established. We reported the first worldwide case of totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation.Case presentationA 30-year-old man with a history of weight loss, preceded by 2 years of nonproductive cough, was admitted to the Infectious Disease Department with a presumed diagnosis of tuberculosis. A microbiological culture test confirmed the diagnosis, and the patient undertook quadruple antituberculous therapy. During hospitalization, he presented sudden abdominal pain, fever, and vomit. An abdominal CT scan showed small bowel perforation with granulomatous reaction. Laparoscopy was performed and revealed a 2 cm perforation on the medium ileum. Small bowel resection and totally intracorporeal side-to-side anastomosis were performed. No complication occurred until a clinical follow-up of 2 months.ConclusionIn consideration of the increasing incidence of intestinal TB in both underdeveloped and Western countries, the diagnosis of this pathology should be taken into account in high-risk patients. Probably, the diagnostic challenges and emergency settings of intestinal TB with perforation and peritonitis, together with the lack of standardized guidelines regarding surgical management, make the use of laparoscopy apparently arduous, but the known advantages of laparoscopy and its technical feasibility should make it a conceivable option for the treatment of complicated cases.

Background: Compared to other types of abdominal protrusions, Spigelian hernias are not very common. In prosthetic repair of abdominal protrusions, mesh fixation and defect overlap are an open issue, as they are a source of complications. A newly developed tentacle-shaped mesh has been used to ensure a fixation-free repair with a broader defect overlap in the repair of abdominal hernias. This study describes the long-term results of a fixation-free repair of Spigelian hernias carried out with a tentacle mesh. Methods: A proprietary mesh composed of a central body with integrated radiating arms was used for repairing Spigelian hernias in 54 patients. The implant was positioned in preperitoneal sublay, and the straps were delivered across the abdominal musculature with a needle passer, and then, after fascia closure, cut short in the subcutaneous layer. Results: The friction of the straps passing through the abdominal wall served to hold the mesh in place, guaranteeing a wide overlap over the defect without fixation. In a long-term follow-up of 6 to 84 months (mean 64 months), a very low rate of complications occurred, but no recurrence was reported. Conclusions: The tentacle strap system of the prosthesis allowed for an easy, fast and safe fixation-free placement granting a wide overlap, avoiding intraoperative complications. Greatly reduced pain and a negligible amount of postoperative complications characterized the postoperative outcome.

IntroductionKlippel–Trenaunay syndrome (KTS) is a rare vascular congenital disorder characterized by the classical triad of port-wine stains, abnormal growth of soft tissues and bones, and vascular malformations. The involvement of the genitourinary tract and of the uterus in particular is extremely infrequent but relevant for possible consequences.MethodsWe performed an extensive review of the literature using the Pubmed, Scopus and ISI web of knowledge database to identify all cases of KTS with uterine involvement. The search was done using the MeSH term “Klippel–Trenaunay syndrome” AND “uterine” OR “uterus.” We considered publications only in the English language with no limits of time. We selected a total of 11 records of KTS with uterine involvement, including those affecting pregnant women.ResultsKlippel–Trenaunay syndrome was described for the first time in the year 1900 in two patients with hemangiomatous lesions of the skin associated with varicose veins and asymmetric soft tissue and bone hypertrophy. Uterine involvement is a rare condition and can cause severe menorrhagia. Diagnosis is based on physical signs and symptoms. CT scans and MRI are first-choice test procedures to evaluate both the extension of the lesion and the infiltration of deeper tissues before treatment. The management of Klippel–Trenaunay syndrome should be personalized using careful diagnosis, prevention and treatment of complications.ConclusionKlippel–Trenaunay syndrome is a rare vascular malformation with a wide variability of manifestations. There are no univocal and clear guidelines that suggest the most adequate monitoring of the possible complications of the disease. Treatment is generally conservative, but in case of recurrent bleeding, surgery may be needed.

Resumo O setor petrolífero tem uma vasta experiência com políticas de Conteúdo Local (CL), em particular na Noruega. No Brasil, essa política ganhou força nos governos Lula da Silva, mas começou a sofrer desgaste nos governos de Dilma Rousseff. A tentativa de repactuar aspectos dessa política em 2015 chegou tarde e, no governo Temer, sofreu um rebaixamento considerável. O objetivo deste artigo é entender a facilidade política e a rapidez com as quais o processo se deu, a partir de dois fatores. Primeiro, a tempestade perfeita que atingiu a Petrobras em meados de 2014 e em 2015, com uma forte queda de preço do petróleo e os impactos da Operação Lava Jato e outros fatores. Segundo, o desgaste ao qual a política de Conteúdo Local foi submetida, identificada como parte do problema, e não da solução, para o desenvolvimento brasileiro. A partir de uma análise das medidas governamentais e do posicionamento dos atores relevantes, percebe-se que a política de Conteúdo Local foi sacrificada no intuito atrair operadoras internacionais.

Abstract Laparoscopic cholecystectomy (LC) is the standard technique for treatment of gallbladder disease. In case of acute cholecystitis we can identify preoperative factors associated with an increased risk of conversion and intraoperative complications. The aim of our study was to detect preoperative laboratory and radiological findings predictive of difficult LC with potential advantages for both the surgeons and patients in terms of options for management. We designed a retrospective case–control study to compare preoperative predictive factors of difficult LC in patients treated in emergency setting between January 2015 and December 2019. We included in the difficult LC group the surgeries with operative time > 2 h, need for conversion to open, significant bleeding and/or use of synthetic hemostats, vascular and/or biliary injuries and additional operative procedures. We collected 86 patients with inclusion criteria and difficult LC. In the control group, we selected 86 patients with inclusion criteria, but with no operative signs of difficult LC. The analysis of the collected data showed that there was a statistically significant association between WBC count and fibrinogen level and difficult LC. No association were seen with ALP, ALT and bilirubin values. Regarding radiological findings significant differences were noted among the two groups for irregular or absent wall, pericholecystic fluid, fat hyperdensity, thickening of wall > 4 mm and hydrops. The preoperative identification of difficult laparoscopic cholecystectomy provides an important advantage not only for the surgeon who has to perform the surgery, but also for the organization of the operating block and technical resources. In patients with clinical and laboratory parameters of acute cholecystitis, therefore, it would be advisable to carry out a preoperative abdominal CT scan with evaluation of features that can be easily assessed also by the surgeon.

Surgical repair of groin protrusions is one of the most frequently performed procedures. Currently, open or laparoscopic repair of inguinal hernias with flat meshes deployed over the hernial defect is considered the gold standard. However, fixation of the implant, poor quality biologic response to meshes and defective management of the defect represent sources of continuous debates. To overcome these issues, a different treatment concept has recently been proposed. It is based on a 3D scaffold named ProFlor, a flower shaped multilamellar device compressible on all planes. This 3D device is introduced into the hernial opening and, thanks to its inherent centrifugal expansion, permanently obliterates the defect in fixation-free fashion. While being made of the same polypropylene material as conventional hernia implants, the 3D design of ProFlor confers a proprietary dynamic responsivity, which unlike the foreign body reaction of flat/static meshes, promotes a true regenerative response. A long series of scientific evidence confirms that, moving in compliance with the physiologic cyclical load of the groin, ProFlor attracts tissue growth factors inducing the development of newly formed muscular, vascular and nervous structures, thus re-establishing the inguinal barrier formerly wasted by hernia disease. The development up to complete maturation of these highly specialized tissue elements was followed thanks to biopsies excised from ProFlor from the short-term up to years post implantation. Immunohistochemistry made it possible to document the concurrence of specific growth factors in the regenerative phenomena. The results achieved with ProFlor likely demonstrate that modifying the two-dimensional design of hernia meshes into a 3D outline and arranging the device to respond to kinetic stresses turns a conventional regressive foreign body response into advanced probiotic tissue regeneration.

Abstract Background Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. Methods Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI

Purpose: Double ipsilateral inguinal (“pantaloon”) hernias and also the more advanced “combined” inguinal hernia involve disruption of the inguinal floor. In the case of pantaloon hernias, the medial boundary of the internal ring remains intact but in combined hernias this is fully disrupted, producing a single hernial protrusion. Deepening the pathophysiology of these hernias may be helpful in addressing hernia genesis, thus improving strategies for the treatment of this disease. Materials and Methods: A cohort of 22 patients who underwent inguinal hernia repair showed double ipsilateral (pantaloon) hernia, comprising distinct direct and indirect protrusions separated by a tissue septum. In 19 patients, the septal arrangement dividing the 2 hernias showed macroscopically evident structural damages, then excised and histologically studied. Different tissue markers were used for the identification of the structural damages. Results: Macroscopically, the divisor septum represents the boundary between internal ring and Hesselbach’s triangle. Anteriorly it is composed by fibers of the internal oblique and transverse muscles, which form a complex with the inferior epigastric vessels on the corresponding posterior side of the inguinal floor. In the patient cohort studied, this anatomical structure showed a progressive sufferance characterized by chronic compressive damage. Conclusion: The anatomical structure which separates the indirect and direct components of a pantaloon hernia, herein referred to as the “septum inguinalis”, has been shown progressively alter in both macro- and microscopically until it f undergoes disruption with development of a combined hernia. Understanding of this anatomical concept may help surgeons to perform sound repairs of these complex hernias.

Background: Postoperative chronic pain caused by fixation and/or fibrotic incorporation of hernia meshes are the main concerns in inguinal herniorrhaphy. As inguinal hernia is a degenerative disease, logically the treatment should aim at stopping degeneration and activating regeneration. Unfortunately, in conventional prosthetic herniorrhaphy no relationship exists between pathogenesis and treatment. To overcome these incongruences, a 3D dynamic responsive multilamellar scaffold has been developed for fixation-free inguinal hernia repair. Made of polypropylene like conventional flat meshes, the dynamic behavior of the scaffold allows for the regeneration of all typical inguinal components: connective tissue, vessels, nerves, and myocytes. This investigation aims to demonstrate that, moving in tune with the groin, the 3D scaffold attracts myogenic growth factors activating the development of mature myocytes and, thus, re-establishing the herniated inguinal barrier. Methods: Biopsy samples excised from the 3D scaffold at different postoperative stages were stained with H&E and Azan–Mallory; immunohistochemistry for NGF and NGFR p75 was performed to verify the degree of involvement of muscular growth factors in the neomyogenesis. Results: Histological evidence of progressive muscle development and immunohistochemical proof of NFG and NFGRp75 contribution in neomyogenesis within the 3D scaffold was documented and statistically validated. Conclusion: The investigation appears to confirm that a 3D polypropylene scaffold designed to confer dynamic responsivity, unlike the fibrotic scar plate of static meshes, attracts myogenic growth factors turning the biological response into tissue regeneration. Newly developed muscles allow the scaffold to restore the integrity of the inguinal barrier.

Abstract This article makes a comparison between the challenges faced by the US to maintain its hegemonic position at the end of the 1970s and in the 2010s. To do so we review Robert Gilpin’s writing during the first period. He suggested the US had three options: 1) a defensive protectionist reaction 2) fragmentation of the international system 3) a new wave of innovation, (“rejuvenation”). It is argued that the Reagan administration was able to establish support for the third option. We argue the US is now faced with the same dilemma again, but with a different kind of challenger: China.

Abstract Background laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses ( 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. Methods at the University Hospital Policlinico “P. Giaccone” of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications. Results Mean size of adrenal neoplasm was 7,5 cm (range 1.5 to 18 cm). The mean operative time was 145 min (range 75–240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p

Since the end of the 2000tees there has been a considerable amount of Chinese investments in Brazil´s energy sector, specifically in oil and electricity. These flows are part of a wider movement that transformed China from a net recipient to a net exporter of capital. This article analyses the dynamics of this new reality in the Brazil case, in the framework of Chinese strategy for a new stage in its internationalization and the strategies of the companies involved. Investments in the oil sector correspond basically to a resource-seeking strategy that has been a reality for a longer period of time and reflects China´s high dependence of fossil energy in general and import dependency of oil in specific. On the other hand, the investment flow in the electricity sector corresponds to a new strategy of capital export and market-seeking based on technological supremacy.

Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, without alfa-blockers. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Univariate and multivariate analysis was conducted. A p-value < 0.05 was considered statistically significant. Results: Major postoperative complications were similar (p = 0.49). Advanced hemostatic agents were 44.9% in Group 1 and 100% in Group 2 (p < 0.001). In Group 2, no patients were admitted to the ICU, while only 73.5% of Group 1 (p < 0.001) were admitted. The median length of stay was larger in Group 1 than in Group 2 (p = 0.026). At the induction, SBP was 130 mmHg in Group 1, and 115 mmHg (p < 0.001). The pre-surgery treatment was the only almost statistically significant variable at the multivariate analysis of DBP at the end of surgery. Conclusion: The preoperative use of alfa-blockers should be considered not a dogma in PCC.

Primary rhabdomyomas obstructing the right or left outflow tract are uncommon findings in the perinatal period. The presenting symptom may be arrhythmia, cardiac murmur, complete or variable atrioventricular block, pericardial effusion, cardiomegaly, cardiac failure, or sudden death. The variety of symptoms can be explained on the basis of obstruction of blood flow, myocardial involvement, and disturbance of the cardiac rhythm. Commonly, rhabdomyoma spontaneously regresses in the majority of cases, and neonatal surgery is advocated only in case of severe left ventricular outflow tract (LVOT) obstruction or the development of arrhythmias. Herein, we describe the pathologic and clinical characteristics of neonatal presentation of a cardiac rhabdomyoma with a nearly obstructive mass in the LVOT, discovered during pregnancy and operated 4 months after delivery.

Esta pesquisa analisou o Brexit em uma perspectiva histórica, focando a conturbada relação entre a Europa continental e o Reino Unido ao longo do século XX, com ênfase no período pós Segunda Guerra Mundial. Foi utilizado o conceito de path dependency para argumentar sobre o papel de fatores históricos e decisões do passado, embora tomados em outras circunstâncias, ainda com força para influenciar o presente, para entender o Brexit. A premissa básica que será apresentada no ensaio é que o Reino Unido nunca participou de fato da ideia da Europa e sempre se viu como um país diferente por sua história e seu papel no mundo. Quando entrou, foi com uma perna só, a outra sempre ficou atrás, inclusive devido às especificidades de sua estrutura econômica herdada do passado, em particular no que diz respeito à agricultura. Desta forma, defende-se que, embora longe de ter sido inevitável, se tratou de um fenômeno limitado ao Reino Unido que tinha pouquíssima probabilidade de se repetir em outros países da União Europeia.

O estudo da economia política da energia é cada vez mais relevante para as Relações Internacionais em função do aumento da interdependência energética e da sua interação com os demais aspectos da agenda internacional, em particular as mudanças climáticas. Este trabalho pretende analisar os avanços e as dificuldades da política energética da União Europeia (UE). O objetivo é identificar os fatores que levaram a Comissão Europeia a articular, sobretudo a partir de 2005, um ativismo inédito na área de energia, apesar da inexistência de uma competência formal para o estabelecimento de uma política energética comum. Isso resultou em uma legislação europeia inovadora e ambiciosa, analisada e avaliada neste trabalho a partir de documentos oficiais, da literatura recente e de entrevistas qualitativas com cerca de vinte formuladores e analistas de política, realizadas em Bruxelas, em setembro de 2012. Ficou evidente que a discussão em torno da mudança climática alterou o olhar sobre a questão energética. O fato de a UE como um todo ser crescentemente deficitária no campo energético aumentou a relevância da questão da segurança e acabou também estimulando a busca de fontes alternativas, ao mesmo tempo em que condicionou suas relações externas, em particular com a Rússia. Houve avanços importantes, sobretudo a partir do estabelecimento de normas rígidas e mandatórias para os países-membros com o Pacto Energia-Clima que justificavam o papel de liderança que a UE estava assumindo nas negociações internacionais sobre o clima. A busca de respostas comunitárias e de convergência entre os objetivos relacionados às mudanças climáticas,àsegurança energéticaeàcompetividade econômica sofreu uma forte pressão com o impacto da crise global, depois de setembro de 2008. A crise evidenciou o ainda frágil arcabouço institucional que, diante do contexto de recessão, acabou reforçando tendências centrífugas em torno de interesses e estratégias nacionais. Ao mesmo tempo, complicou a realização dos investimentos necessários para avançar na implementação das políticas delineadas na área de energia e clima. De outro lado, existe uma inegável e forte interdependência entre as economias do bloco, e a Comissão Europeia insistiu em defender os ganhos a serem alcançados com ações comunitárias.

Since the 1930s development strategies in Brazil have made reducing its dependence on imported energy one of their priorities. Efforts focused on hydro-electric power, ethanol and oil. Offshore oil exploration by the state oil company Petrobras began in the 1970s and resulted in energy independence by 2006. In the same year, however, unexpectedly large oil reserves were discovered in the so-called Pre-Salt levels, transforming the country into a potential major oil exporter. This new reality creates major challenges for Brazil. New legislation and new policies have been set up to use this opportunity to accelerate development. The discussion on how to make the best use of offshore oil resources is guided by a so-called neo-developmentalism approach, introduced during President Lula’s second term. In practice this means a modest increase in state control with new regulations focused on local content. Special attention should be given to expanding research and development activities. Foreign capital and technology are welcome as long as they are willing to operate in the framework of a national development strategy. This paper will examine the main features and challenges of these new policies within the broader framework of the present discussion on neo-developmentalism in Brazil.Resumen: Brasil: Nuevo desarrollismo y la gestión de la riqueza petrolífera offshoreDesde los años treinta del siglo pasado, las estrategias de desarrollo en Brasil se han propuesto como una de sus prioridades reducir su dependencia de la energía importada. Los esfuerzos se enfocaron en la energía hidroeléctrica, en el etanol y en el petróleo. Las prospecciones petrolíferas offshore llevadas a cabo por la petrolera estatal Petrobras empezaron en los años setenta y tuvieron como resultado la independencia energética en 2006. Sin embargo, ese mismo año, se descubrieron inesperadamente grandes reservas de petróleo en los niveles llamados pre-sal, que transformaron el país en un importante exportador potencial de petróleo. Esta nueva realidad supone retos importantes para Brasil. Se han puesto en marcha políticas nuevas y una legislación nueva para aprovechar esta oportunidad de acelerar el desarrollo. El debate sobre cómo hacer el mejor uso de los recursos petrolíferos offshore va guiado por un enfoque llamado neodesarrollismo, introducido durante la segunda legislatura del presidente Lula. En la práctica supone un aumento modesto del control estatal mediante nuevas regulaciones enfocadas en el contenido local. Se debe prestar especial atención a ampliar las investigaciones y las actividades de desarrollo. La tecnología y el capital extranjeros son bien recibidos mientras estén dispuestos a operar en el marco de una estrategia de desarrollo nacional. Este artículo examinará las principales características y retos de estas políticas nuevas dentro del marco más amplio del presente debate sobre el neodesarrollismo en Brasil.

Secondary achalasia due to submucosal invasion of cardia by gastric cancer is a rare condition. We report a case of pseudoachalasia, secondary to the involvement of gastroesophageal junction by poorly differentiated gastric cancer, initially mistaken as idiopathic form. We focus on the difficulty to establish differential diagnosis only on the basis of routine exams and we stress the necessity of “second level” instrumental exams; EUS in routine workup in selected patients should be considered. We support that routine workup based on history, clinical presentation, radiological and endoscopic findings, and certainly manometry could be insufficient for a correct differential diagnosis between primary and secondary forms in some patients.