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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.

^{180m}Ta is a rare nuclear isomer whose decay has never been observed. Its remarkably long lifetime surpasses the half-lives of all other known β and electron capture decays due to the large K-spin differences and small energy differences between the isomeric and lower-energy states. Detecting its decay presents a significant experimental challenge but could shed light on neutrino-induced nucleosynthesis mechanisms, the nature of dark matter, and K-spin violation. For this study, we repurposed the Majorana Demonstrator, an experimental search for the neutrinoless double-beta decay of ^{76}Ge using an array of high-purity germanium detectors, to search for the decay of ^{180m}Ta. More than 17 kg, the largest amount of tantalum metal ever used for such a search, was installed within the ultralow-background detector array. In this Letter, we present results from the first year of Ta data taking and provide an updated limit for the ^{180m}Ta half-life on the different decay channels. With new limits up to 1.5×10^{19}  yr, we improved existing limits by 1-2 orders of magnitude which are the most sensitive searches for a single β and electron capture decay ever achieved. Over all channels, the decay can be excluded for T_{1/2}

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.

BackgroundThe association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes.MethodsThis study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014-2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied.ResultsThe median age was 55 years (range, 18-83 years). The median PCS was -0.21 (range, -1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was -0.13 (range, -1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00-1.08; P = .0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00-1.08; P = .0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02-1.15; P = .0004). CCS was not significantly associated with survival, relapse, or NRM.ConclusionsPatients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.

Despite increased attention on how to conduct pragmatic trials and their importance, there remains an under-appreciation for the reality of what they take to design, compete and secure funding and execute. Many barriers are surmountable through increased exposure to experiences from completed trials. This report summarizes our experience in designing, securing funding and implementing the Home-Based Options to Make screening Easier (HOME) pragmatic trial, which was designed to evaluate home human papillomavirus testing for cervical cancer screening in underscreened women (women who had not received a cervical cancer screening test in ≥3.5 years). This report highlights factors at the level of research teams, organizations seeking to conduct embedded research, reviewers and funding agencies that challenge pragmatic trial design and execution. There is an urgent need to train on peer-reviewers how to evaluate embedded trial grant proposals, for agencies to pursue more rapid and innovative funding strategies, and to consider strategies for reviewers and funders to evaluate stakeholder buy-in (beyond letters of support). These factors together are needed to realize the promise of pragmatic trials to more efficiently and effectively generate critical data that inform changes in health care delivery and benefit patients.

This report summarises the physics opportunities in the search and study ofphysics beyond the Standard Model at a 100 TeV pp collider.