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Objetivos: O relato tem como objetivo mostrar a sintomatologia clínica da leucemia/linfoma de células t do adulto por HTLV-1, a epidemiologia, os métodos diagnósticos, fatores que indicam gravidade, o tratamento, e também a sobrevida da doença, a partir de revisão de prontuário da paciente, desde a admissão até alta hospitalar e continuidade do tratamento. Materiais e métodos: Trata-se de relato de caso realizado por pesquisa bibliográfica, revisão de prontuário com história clínica, exames laboratoriais, de imagem e imunofenotipagem, significativos para o diagnóstico e tratamento adequado. Relato de caso: AMFA, feminino, 62 anos, há 2 meses com quadro de linfonodomegalia inguinal à direita dolorosa e perda ponderal de 10 kg no último mês, sudorese noturna, hiporexia e paresia de membros inferiores. à admissão, apresentava-se sem linfonodos palpáveis, afebril, murmúrios reduzidos em bases pulmonares, hepatoesplenomegalia dolorosa, edema e paresia em membros inferiores. Hemoglobina 12, leucocitose de 144 mil, sendo 116.640 linfócitos, plaquetopenia (94 mil), ácido úrico 22,3, cálcio sérico 13, DHL 1990, reticulócitos 4,3%. Ao exame tomográfico, presença de derrame pleural de grande volume a esquerda, hepatoesplenomegalia vultuosa; linfonodomegalias de 1,2 cm em cadeias ilíaca externa, inguinal direita e retroperitoneais. Imunofenotipagem de sangue periférico, com 74,4% linfócitos (CD45 HIGH), sendo 97,7% linfócitos T, com fenótipo: CD4+, CD7-, CD 25+, com flower-cells, configurando infiltração de sangue periférico por neoplasia de células T maduras. Anticorpos HTLV-1 reagente. confirmado diagnóstico de Leucemia/Linfoma de Células T do Adulto (ATLL) e iniciado tratamento quimioterápico com esquema CHOEP. Atualmente, em tratamento apresentando boa resposta clínica, com melhora acentuada do estado hematológico e parcial do quadro neurológico. Discussão: A Leucemia/Linfoma de Células T do Adulto (ATLL) por HTLV-1 é uma doença rara. Epidemiologicamente, as características da paciente condizem com a literatura, pelo predomínio no sexo feminino e na sexta década de vida. A paciente teve seu diagnóstico confirmado e foi classificada na forma aguda, segundo os critérios de Shimoyama. A manifestação neurológica de paresia de membros inferiores se deve ao quadro da infecção viral por HTLV-1, porém, essas costumam ser assimétricas e com liberação piramidal. O diagnóstico realizou-se com teste positivo para HTLV-1, imunofenotipagem de sangue periférico e presença de linfócitos T anormais em sangue periférico (flower cells). A paciente apresentava indicadores de pior prognóstico, como aumento da desidrogenase lática e do cálcio sérico. Diagnósticos diferenciais são outras doenças linfoproliferativas crônicas. Conclusão: O caso relatado mostra a semelhança da doença com outras neoplasias linfoproliferativas, dado isso, ressalta-se a importância do diagnóstico e tratamento precoce, mesmo com baixas taxas de sobrevida. A relação com HTLV-1 evidencia a importância da prevenção na transmissão do vírus, e também da investigação sorológica, uma vez que no Brasil, é subdiagnosticado, piorando os desfechos dos casos.

The purpose of this article is to describe Paul�s self-control in 1 Corinthians 9 as an example to contemporary church leaders. After ascertaining the framework of 1 Corinthians 8:1 to 11:1 as following Christ in loving servitude, Paul�s introducing of his apostleship is described as a� combination of an example and a defense. He utilizes the agon motif to make his point regarding his own sacrifices. To him self-control enkrateia) has a finite meaning: to relinquish certain liberties and rights for the sake of his mission in Christ, the identity of the church and the perseverance of his fellow believers. Church leaders can take heed of this necessity for restriction of personal liberty in response to the views of others.

Bassam Felipe Mogharbel,1 Julio Cesar Francisco,1 Ana Carolina Irioda,1 Dilcele Silva Moreira Dziedzic,1 Priscila Elias Ferreira,1 Daiany de Souza,1 Carolina Maria Costa de Oliveira Souza,1 Nelson Bergonse Neto,2 Luiz Cesar Guarita-Souza,2 Celia Regina Cavichiolo Franco,3 Celso Vataru Nakamura,4 Vanessa Kaplum,4 Letícia Mazzarino,5 Elenara Lemos-Senna,6 Redouane Borsali,7 Paula A Soto,8 Patricia Setton-Avruj,8 Eltyeb Abdelwahid,9 Katherine Athayde Teixeira de Carvalho1 1Cell Therapy and Biotechnology in Regenerative Medicine Department, Pelé Pequeno Príncipe Institute, Child and Adolescent Health Research and Pequeno Príncipe Faculty, Curitiba, Paraná, Brazil; 2Institute of Biological and Health Sciences, Pontifical Catholic University of Paraná (PUCPR), Centro de Ciências Biológicas e da Saúde (CCBS), Curitiba, Brazil; 3Cell Biology Department, Federal University of Paraná, Curitiba, Paraná, Brazil; 4Department of Pharmaceutical Sciences, Universidade Estadual de Maringá, Maringá, Paraná, Brazil; 5Department of Pharmaceutical Sciences, NanoBioMat Laboratory, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; 6Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; 7Centre de Recherches sur les Macromolécules Végétales (CERMAV), Centre National de la Recherche Scientifique (CNRS), University Grenoble Alpes, F-38000, Grenoble, France; 8Instituto de Química y Físicoquímica Biológica (IQUIFIB), Departament of Química Biológica, Facultad de Farmacia y Bíoquímica, Universidad de Buenos Aires (UBA) Consejo nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentine; 9Feinberg School of Medicine, Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Il, USA Background: Posttransplant cell tracking, via stem cell labeling, is a crucial strategy for monitoring and maximizing benefits of cell-based therapies. The structures and functionalities of polysaccharides, proteins, and lipids allow their utilization in nanotechnology systems. Materials and methods: In the present study, we analyzed the potential benefit of curcumin-loaded nanoparticles (NPC) using Vero cells (in vitro) and NPC-labeled adipose-derived mesenchymal stem cells (NPC-ADMSCs) (in vivo) in myocardial infarction and sciatic nerve crush preclinical models. Thereafter, transplantation, histological examination, real time imaging, and assessment of tissue regeneration were done. Results: Transplanted NPC-ADMSCs were clearly identified and revealed potential benefit when used in cell tracking. Conclusion: This approach may have broad applications in modeling labeled transplanted cells and in developing improved stem cell therapeutic strategies. Keywords: mesenchymal stem cells, transplantation, cell marking, myocardium infarction, sciatic nerve crush

This paper aims to explore the concepts of self-efficacy and attitude towards consumption, approached by the theory of motivation and human behavior. This is a theoretical study based on literature. High levels of self-efficacy have beneficial consequences for the functioning of the individual. Concerning attitudes towards drugs, the presence or absence of preconceptions and positive values of drugs increases risk or consumer protection. Nurses should apply the concepts of self-efficacy and attitudes towards consumption to guide actions of health promotion and prevention of drug consumption in children and adolescents. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk patients (i.e., age greater than or equal to 80 years, serum creatinine level greater than or equal to 3mg/dL, severe pulmonary dysfunction, severe cardiac dysfunction). Methods: From April 2002 to June 2009, 50 consecutive high-surgical-risk patients (42 men; mean age 74.0±8.7, range 54-91) with an abdominal aortic aneurysm (AAA; mean diameter 64.8mm) who were treated electively using a bifurcated aortic endograft (32 Excluder, 18 Zenith) were entered in a prospective registry. Thirty-five (70%) patients were classified ASA III and 15 (30%) were ASA IV. High-risk status was corroborated using the Customized Probability Index (CPI). Primary endpoints were operative mortality and long-term survival; secondary endpoints were the frequency of reintervention, evolution of the aneurysm sac, and rates of primary and secondary patency and rupture. Results: The mean CPI score was 11.04±6.3. Operative mortality was 2% (1/50). There were 4 endoleaks, 1 case of endotension, and 1 endograft limb occlusion. Two patients required reintervention during the mean follow-up of 35.6 months. Survival at 3 years was 94%. Primary and secondary patency rates at 3 years were 98% and 100%, respectively. There were no ruptures. [ABSTRACT FROM AUTHOR]

A green procedure for the kinetic resolution of chiral amines via enzymatic acylation and deacylation has been demonstrated. The fully enzymatic approach obviates the common, waste-generating deacylation under strongly alkaline conditions. The acylating agent was (R)-phenylglycine propyl ester in combination with Candida antarctica lipase B as acylation catalyst. The enantiomerically enriched amides were subsequently deacylated in the presence of the penicillin G acylase from Alcaligenes faecalis. The degree of enantiomer recognition by CaLB in the acylation of aliphatic amines was unexpectedly modest, but a considerable further enantiomeric enrichment could be accomplished in the course of the subsequent enzymatic hydrolysis step. [ABSTRACT FROM AUTHOR]

Objective: We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs.Design: We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system.Measures: FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy.Results: There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health.Conclusion: The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures. [ABSTRACT FROM AUTHOR]

Lone mothers are a disadvantaged population, with research in several countries indicating that they experience low levels of physical and mental health. While research has demonstrated a socioeconomic gradient for cardiovascular disease (CVD), little research has explored lifestyle and clinical risk for CVD and prevalence of CVD events in lone mothers. The purpose of this study is (1) to compare select CVD lifestyle risks (smoking, obesity, physical activity), health, and relevant sociodemographic variables in partnered versus lone mothers; (2) to examine the relationship between partner status and having experienced a CVD event (myocardial infarction [MI], congestive heart failure [CHF], stroke). Data from the U.S. National Health and Nutrition Examination Survey III (NHANES III) included 1,446 women over 60 years with one or more children less than 17 years old. Lone mothers included women who were widowed, divorced, separated, never married, or married without the spouse living in the household (n = 623; weighted sample represents n = 3,904,450). Partnered mothers included women who reported living as married or married with the spouse in the household (n = 832; weighted sample represents n = 8,614,362). Weighted logistic regression was used to compare the prevalence of CVD risk factors in lone (43%) ver sus partnered (57%) mothers. Multivariate modeling was used to examine the relationship between partner status, CVD risks, and Coronary Heart Disease (CHD) events. Compared with partnered mothers, lone mothers were less educated and reported lower levels of income, health, and social support; and they were more likely to report non-White ethnicity. Lone mothers were more likely to be current smokers, overweight or obese, and physically active than partnered mothers. Those with clinical risks for CVD, including diabetes, elevated C-reactive protein, hypercholesterolemia, or hypertension, or all of these were more likely to be lone mothers. After adjusting for age, we found that mothers who had experienced a CVD event (MI, CHF, or stroke) were 3.3 times more likely to be a lone mother than a partnered mother (95% confidence interval (CI) 3.24, 3.31).Lone mothers are at increased risk for CVD. Health professionals and lone mothers should collaborate in the development of programs and policies not only to reduce lone mothers' risk for CVD, but also improve their conditions of living. [ABSTRACT FROM AUTHOR]

Background: The integration of bone density testing into well-designed fracture prevention programs that can be applied in populations has not been studied.Objectives: We sought to compare the outcomes of 3 strategies for allocating bone density testing within an HMO-based fracture prevention program.Research Design: Women were randomly sampled and allocated to one of 3 groups: (1) a universal group, in which all were offered bone mineral density (BMD) testing (1986 contacted; 415 participated); 2) the SCORE group, in which women scoring > or = 7 on the SCORE questionnaire were invited for BMD testing (1940 contacted; 576 participated); and (3) the Study of Osteoporotic Fracture (SOF)-based group, in which women with > or = 5 hip fracture risk factors were invited for BMD testing (5342 contacted; 2176 participated).Subjects: Women aged 60-80 not taking hormone therapy or osteoporosis medication were included.Measures: Outcomes ascertained during 33 months of follow-up in all women contacted included initiation of osteoporosis treatment and hip and total fracture rates. Outcomes evaluated among all participants included changes in fracture risk factors, osteoporosis knowledge, and satisfaction with the program.Results: Osteoporosis treatment rates did not differ among all women contacted but were slightly higher among trial participants in the universal and SCORE groups (21.1% and 20.2%, respectively; versus 16.7% in the SOF-based group (P value versus universal = 0.04). Among all women contacted, fracture rates were lowest in the universal group (74.11/1000) and differed significantly compared with the SCORE (99.44/1000; P = 0.009) and SOF-based groups (91.77/1000;P = 0.02). Knowledge about osteoporosis risk factors was highest in the universal group and lowest in the SOF-based group (P < 0.01).Conclusions: The degree to which BMD testing was offered to women in a fracture prevention program significantly affected total fracture rates, change in some fracture risk factors, and knowledge about risk factors. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to examine prescribing patterns (prevalence and rates of initiation and discontinuation) for estrogen plus progestin (hormone therapy [HT] and estrogen alone [ET]) in the United States in the 2 years before the published results of Women's Health Initiative's (WHI) HT trial's early termination and for 5 months after their release. METHODS: We conducted an observational cohort study of 169,586 women aged 40-80 years who were enrolled in 5 health maintenance organizations in the United States to estimate the prevalence of HT and ET and discontinuation and initiation rates between September 1, 1999, to June 31, 2002 (baseline), and December 31, 2002 (follow-up). We used automated pharmacy data to identify all oral and transdermal estrogen and progestin dispensed during the study period. RESULTS: The prevalence of HT declined 46% from baseline to follow-up (14.6% to 7.9%); ET use declined 28% during the same period (12.6% to 9.1%). The discontinuation of HT increased almost immediately, from 2.5% at baseline to 13.8% in October 2002. We saw an immediate decrease in HT and ET initiation rates, from 0.4% and 0.3% at baseline, respectively, to 0.2% for HT and ET at follow-up. CONCLUSION: The diffusion of the WHI HT trial results had an immediate impact on the discontinuation of HT and ET and is likely responsible for the 46% and 28% decline in the initiation of these respective therapies. Further exploration of why women continue to use HT and identification of methods for addressing reasons for continued use are indicated. LEVEL OF EVIDENCE: II-2. [ABSTRACT FROM AUTHOR]

Background: Younger women (40-49 years) have lower mammographic sensitivity (i.e., greater proportion of cancers detected after a negative mammogram) than older women (> or =50 years). We explored the effect of tumor growth rate, breast density, mammographic image quality, and breast cancer risk factors on mammographic sensitivity in younger and older women. Methods: We studied 576 women (n = 73 aged 40-49 years and n = 503 aged 50 years or older) who were diagnosed with invasive breast cancer between 1988 and 1993. Interval cancers were defined as those diagnosed within 12 or 24 months after a negative screening mammogram and before a subsequent mammogram. Tumor growth rate was assessed by mitotic figure count and Ki-67 positivity. The main outcome measures were percentage of women with interval cancer (1 -mammographic sensitivity) by age, odds ratio (OR) of interval cancer by age, and excess odds (i.e., the percentage of the odds ratio for age that was explained by individual covariates). Results: Interval cancers occurred in 27.7% of younger women and 13.9% of older women within 12 months (OR = 2.36, 95% confidence interval [CI] = 1.14 to 4.77) and in 52.1% of younger women and 24.7% of older women within 24 months (OR = 3.58, 95% CI = 2.15 to 5.97). Greater breast density explained 67.6% of the decreased mammographic sensitivity in younger women at 12 months, whereas rapid tumor growth explained 30.6% and breast density explained 37.6% of the decreased sensitivity in younger women at 24 months. Conclusions: Breast density largely explained decreased mammographic sensitivity at 12 months, whereas rapid tumor growth contributed to decreased mammographic sensitivity at 24 months. A 12-month versus a 24-month mammography screening interval may therefore reduce the adverse impact of faster growing tumors on mammographic sensitivity in younger women. [ABSTRACT FROM AUTHOR]

Se Young Jung,1,2 Hui-Woun Moon,2 Da Som Me Park,2 Sumi Sung,3 Hyesil Jung4 1Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 2Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 3Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; 4Department of Nursing, College of Medicine, Inha University, Incheon, Republic of KoreaCorrespondence: Hyesil Jung, Department of Nursing, College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 2221, Republic of Korea, Tel +82-32-860-8206, Fax +82-32-874-5880, Email hsjung@inha.ac.krBackground: Inpatients commonly experience problems with elimination due to incontinence, urinary retentions, and complications with indwelling catheters. Although elimination care (EC) is an important nursing area, few studies explore the burden of EC on nurses.Aim: To identify the burden on EC by analyzing nurses’ opinions using sequential explanatory mixed method.Methods: This research was conducted using a sequential explanatory mixed-methods design. A total of 59 nurses at a tertiary hospital in South Korea participated in the study from January 1 to March 31, 2022. For quantitative analysis, information about number of delays of work due to EC, required time for serving bedpan or diaper changes, percentage of EC per shift, and percentage of patients who need EC was collected through a survey. For qualitative analysis, focus group interviews were conducted to identify factors that put a burden on EC. Important themes were derived by analyzing nurses’ opinions on EC.Results: For nurses in intensive care units, general wards, and integrated nursing care wards, the number of work delays due to EC was 3.6 ± 1.5, 2.3 ± 1.2, and 4.8 ± 2.4 (p< 0.01), respectively. The mean percentage of EC work out of total nursing tasks per shift was 36.2 ± 19.0, 29.3 ± 14.4, and 43.8 ± 14.1 (p=0.02), respectively. The mean percentage of patients requiring EC out of patients a nurse cares was 85.4 ± 16.6, 41.3 ± 26.1, and 58.8 ± 21.9 (p< 0.01), respectively. Following qualitative analysis, four themes related to nurses’ EC burden were derived: physical burden, frequent care needs, delay of other jobs due to EC, and complications. Among them, frequent care needs were found to be the primary factor requiring consideration to reduce nurses’ burden.Conclusion: This research found that EC is one of the most burdensome tasks that nurses want to avoid. To alleviate their burden, effective EC protocol or smart medical devices assisting with EC should be developed.Keywords: nursing, elimination care, mixed-methods approach