CONFERÊNCIA DE 1997: UM PASSO PARA A PADRONIZAÇÃO

Ao longo dos séculos foram realizadas inúmeras tentativas de padronização, mas sempre existiu um fator que dificultava a conquista de uma uniformização, como questões culturais, regionais e o próprio nacionalismo. A Conferência de 1997 foi a que chegou mais próximo dessa realização, com a consolidação de algumas normas regentes até hoje. O objetivo com este estudo foi analisar a motivação para a realização de uma conferência para estabelecer uma unanimidade global sobre termos anatômicos empregados na prática médica e avaliar as mudanças. O trabalho constitui-se de uma revisão bibliográfica realizada a partir de diferentes fontes de pesquisa e artigos virtuais. Conhece-se por nomenclatura anatômica o apanhado de termos empregados para descrição de partes do organismo e é considerada a base da linguagem anatômica (BIOMANIA, [2010?]). A finalidade da Conferência de 1997 foi escolher os melhores nomes de todos os que existiam, decidir os que mais fossem informativos e descritivos de cada estrutura (DI DIO, [2001?]). Segundo Di Dio [2001?], dos dez mil nomes, apenas seis mil foram analisados, e destes, de 10% a 15% foram alterados. Além de abolir os epônimos (nome de pessoas para designar coisas), os termos foram selecionados de acordo com a forma (músculo trapézio), posição (nervo mediano), trajeto (artéria circunflexa da escápula), conexões ou inter-relações (ligamento sacroilíaco), relação com o esqueleto (artéria radial), função (músculo levantador da escápula) e critério misto (músculo flexor superficial dos dedos – função e situação) (EPÔNIMOS... [20--]). Utilizando esses critérios, sofreram alterações: canal de Havers para canal central, fossa nasal para cavidade nasal, ouvido para orelha, sarcômero para miômero, entre outros (OLIVEIRA, [201-?]). A abolição dos epônimos e a consolidação dos demais termos impostos pela Conferência de 97 têm difícil aceitação em razão de fatores como história, resistência por parte de médicos mais antigos e pela cultura popular (SILVA; SYLVESTRE; PIRES, 2014). Apesar de as alterações realizadas na Conferência de 97 terem sido um grande avanço para a padronização, encontraram-se dificuldades para a efetivação completa da Nomina em decorrência de fatores como o patriotismo, a falta de interesse dos profissionais pela atualização, a história e a cultura popular.Palavras-chave: Conferência. Nomina. Epônimos. Padronização

RECUSA DE TRATAMENTO: INTERVENÇÕES MÉDICAS ALTERNATIVAS NA HEMOTRANSFUSÃO

A recusa de tratamento constitui um dos dilemas éticos do recente exercício da Medicina. Em alguns estágios da intervenção médica são necessários procedimentos que contrariam dogmas, como a não aceitação da hemotransfusão por pacientes testemunhas de Jeová, desencadeando um conflito moral que exige soluções alternativas para não ferir sua autonomia. O objetivo com este estudo foi descrever o conflito ético das intervenções médicas em casos de recusa de hemotransfusão por pacientes testemunhas de Jeová e suas alternativas. Realizou-se uma revisão bibliográfica na base de dados da SciELO e legislação pertinente. A Associação Testemunhas de Jeová constitui um grupo religiosos em expansão em todo o mundo, que recusa transfusão sanguínea com fundamento na interpretação da Bíblia (BESIO; BESIO, 2006, p. 276). Em seu favor, a Constituição Brasileira de 1998, em seu artigo 5º, garante a liberdade religiosa e a inviolabilidade da liberdade de consciência (BRASIL, 1998). Ademais, a Carta de Direitos dos Usuários da Saúde garante ao paciente a recusa de tratamento (BRASIL, 2011). Por outro lado, o Conselho Federal de Medicina interpretou o Código de Ética Médica por meio da Resolução n. 1.021/1980, em que o médico se obriga à transfusão em caso de risco de vida do paciente, mesmo sem consentimento (CONSELHO FEDERAL DE MEDICINA, 1980). Essa resolução pode ferir a autonomia do paciente, já que pelo Princípio Fundamental XXI do Código de Ética Médica, o médico deve aceitar a escolha dos seus pacientes (CONSELHO FEDERAL DE MEDICINA, 2010). Nesse contexto, as alternativas de tratamento sem sangue devem ser sempre consideradas (BONAMIGO, 2015, p. 251). Conclui-se que, para não ferir a autonomia do paciente que se recusa a receber sangue, o médico precisa usar alternativas de tratamento sem sangue, apresentando ao paciente seus riscos e vantagens. Infere-se que seja imprescindível atualizar a Resolução CFM n. 1.021/80 e que ocorra aprimoramento da formação médica, em especial quanto aos substitutos do sangue, facilitando, dessa forma, o tratamento alternativo e respeitando a autonomia do paciente.Palavras-chave: Hemotransfusão. Tratamento. Testemunha de Jeová. Ética Médica

The influence of genetic stability on Aspergillus fumigatus virulence and azole resistance

Genetic stability is extremely important for the survival of every living organism, and a very complex set of genes has evolved to cope with DNA repair upon DNA damage. Here, we investigated the Aspergillus fumigatus AtmA (Ataxia-telangiectasia mutated, ATM) and AtrA kinases, and how they impact virulence and the evolution of azole resistance. We demonstrated that A. fumigatus atmA and atrA null mutants are haploid and have a discrete chromosomal polymorphism. The ?atmA and ?atrA strains are sensitive to several DNA-damaging agents, but surprisingly both strains were more resistant than the wild-type strain to paraquat, menadione, and hydrogen peroxide. The atmA and atrA genes showed synthetic lethality emphasizing the cooperation between both enzymes and their consequent redundancy. The lack of atmA and atrA does not cause any significant virulence reduction in A. fumigatus in a neutropenic murine model of invasive pulmonary aspergillosis and in the invertebrate alternative model Galleria mellonela. Wild-type, ?atmA, and ?atrA populations that were previously transferred 10 times in minimal medium (MM) in the absence of voriconazole have not shown any significant changes in drug resistance acquisition. In contrast, ?atmA and ?atrA populations that similarly evolved in the presence of a subinhibitory concentration of voriconazole showed an ~5-10-fold increase when compared to the original minimal inhibitory concentration (MIC) values. There are discrete alterations in the voriconazole target Cyp51A/Erg11A or cyp51/erg11 and/or Cdr1B efflux transporter overexpression that do not seem to be the main mechanisms to explain voriconazole resistance in these evolved populations. Taken together, these results suggest that genetic instability caused by ?atmA and ?atrA mutations can confer an adaptive advantage, mainly in the intensity of voriconazole resistance acquisition.We thank the Fundação de Amparo a Pesquisa do Estado de São Paulo and the Conselho Nacional de Desenvolvimento Cientí fi co e Tecnológico, Brazil, for fi nancial support. F.R. and B.H.F. were supported by the Northern Portugal Regional Operational Program (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (NORTE-01-0145-FEDER-000013)info:eu-repo/semantics/publishedVersio

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

Measurements of Higgs boson production cross sections and couplings in the diphoton decay channel at root s=13 TeV

Measurements of Higgs boson production cross sections and couplings in events where the Higgs boson decays into a pair of photons are reported. Events are selected from a sample of proton-proton collisions at root s = 13TeV collected by the CMS detector at the LHC from 2016 to 2018, corresponding to an integrated luminosity of 137 fb(-1). Analysis categories enriched in Higgs boson events produced via gluon fusion, vector boson fusion, vector boson associated production, and production associated with top quarks are constructed. The total Higgs boson signal strength, relative to the standard model (SM) prediction, is measured to be 1.12 +/- 0.09. Other properties of the Higgs boson are measured, including SM signal strength modifiers, production cross sections, and its couplings to other particles. These include the most precise measurements of gluon fusion and vector boson fusion Higgs boson production in several different kinematic regions, the first measurement of Higgs boson production in association with a top quark pair in five regions of the Higgs boson transverse momentum, and an upper limit on the rate of Higgs boson production in association with a single top quark. All results are found to be in agreement with the SM expectations.Peer reviewe

Probing effective field theory operators in the associated production of top quarks with a Z boson in multilepton final states at root s=13 TeV

Peer reviewe

Measurement of the top quark mass using events with a single reconstructed top quark in pp collisions at root s=13 TeV

Abstract:A measurement of the top quark mass is performed using a data sample en-riched with single top quark events produced in thetchannel. The study is based on proton-proton collision data, corresponding to an integrated luminosity of 35.9 fb−1, recorded at√s= 13TeV by the CMS experiment at the LHC in 2016. Candidate events are selectedby requiring an isolated high-momentum lepton (muon or electron) and exactly two jets,of which one is identified as originating from a bottom quark. Multivariate discriminantsare designed to separate the signal from the background. Optimized thresholds are placedon the discriminant outputs to obtain an event sample with high signal purity. The topquark mass is found to be172.13+0.76−0.77GeV, where the uncertainty includes both the sta-tistical and systematic components, reaching sub-GeV precision for the first time in thisevent topology. The masses of the top quark and antiquark are also determined separatelyusing the lepton charge in the final state, from which the mass ratio and difference aredetermined to be0.9952+0.0079−0.0104and0.83+1.79−1.35GeV, respectively. The results are consistentwithCPTinvariance

Measurements of the Electroweak Diboson Production Cross Sections in Proton-Proton Collisions at root s=5.02 TeV Using Leptonic Decays

The first measurements of diboson production cross sections in proton-proton interactions at a center-of-mass energy of 5.02 TeV are reported. They are based on data collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 302 pb(-1). Events with two, three, or four charged light leptons (electrons or muons) in the final state are analyzed. The WW, WZ, and ZZ total cross sections are measured as sigma(WW) = 37:0(-5.2)(+5.5) (stat)(-2.6)(+2.7) (syst) pb, sigma(WZ) = 6.4(-2.1)(+2.5) (stat)(-0.3)(+0.5)(syst) pb, and sigma(ZZ) = 5.3(-2.1)(+2.5)(stat)(-0.4)(+0.5) (syst) pb. All measurements are in good agreement with theoretical calculations at combined next-to-next-to-leading order quantum chromodynamics and next-to-leading order electroweak accuracy

Observation of tW production in the single-lepton channel in pp collisions at root s=13 TeV

A measurement of the cross section of the associated production of a single top quark and a W boson in final states with a muon or electron and jets in proton-proton collisions at root s = 13 TeV is presented. The data correspond to an integrated luminosity of 36 fb(-1) collected with the CMS detector at the CERN LHC in 2016. A boosted decision tree is used to separate the tW signal from the dominant t (t) over bar background, whilst the subleading W+jets and multijet backgrounds are constrained using data-based estimates. This result is the first observation of the tW process in final states containing a muon or electron and jets, with a significance exceeding 5 standard deviations. The cross section is determined to be 89 +/- 4 (stat) +/- 12 (syst) pb, consistent with the standard model.Peer reviewe