Miracle-dz/UniFAR-FTUs huggingface dataset:
Palliative Performance Scale’s Utility in the Non-Cancer Group, a Role as Yet Undefined

To the Editor We congratulate Aranha et al for their important work on the association of hospital readmission (HR) and survivability with the Clinical Frailty Scale (CFS) and Palliative Performance Scale (PPSv2). We agree with the authors that both CFS and PPS consider physical function as part of a composite measure and are useful tools to predict mortality. However, we wish to highlight several interesting observations in the paper that limit its conclusion. We will also discuss PPS’ inherent limitation for usage in a group of heterogeneous long-term care residents. Firstly, the paper concluded that CFS and PPS strongly predict HR and mortality. However, several important predictive factors for these adverse outcomes such as morbidity burden and advance care plans (ACP) were not presented. Higher morbidity burden is known to result in more HR and mortality. This can be represented in a weighted manner, an example being the Charlson Comorbidity Index which can be used to compare between groups with different outcomes. Although the authors provided a list of the residents’ chronic terminal illnesses, its impact on the assessed outcomes was not reported. On the other hand, the impact of ACP is more nuanced. In a systematic review of ACP, the presence of Do-not-hospitalize order is related to reduction in hospitalization. Ultimately, such interventions result in increased compliance with patient’s wishes. Furthermore, Do-not-hospitalize order is known to be more prevalent in older adults. Hence it is possible that in the study, HR rates were affected by Do-not-hospitalize orders. To summarize, further examination of the resident’s morbidity burden and ACP wishes will enhance our understanding of the outcomes and ultimately help to determine CFS and PPS’ impact in them. Secondly, while PPS is a valid and reliable tool for prediction of mortality, we have reservations in its use for patients with life-limiting non-cancer illnesses. Fundamentally, PPS was modified from the Karnofsky Performance Scale which was originally intended for cancer patients. In a recent systematic review of PPS, the majority of the patients involved were diagnosed with cancer. Furthermore, the PPS framework includes a component for “evidence of disease” which is defined in varying degrees of burden as “no evidence,” “some evidence,” “significant disease” or “extensive disease” which we found difficult to apply for patients with non-cancer diagnosis, particularly in this study population with heterogeneous chronic terminal illnesses. Downing et al provided some guidance in classifying patients with cancer and retroviral disease into these categories but the struggle remains for other diseases such as end stage renal failure or congestive heart failure. Therefore, further studies are needed to clarify and validate the usage of the PPS on the non-cancer group. In conclusion, whilst we applaud Aranha et al’s study intent, we have reservations about the outcome conclusion and we urge further clarification on the PPS’ applicability in patients with advanced non-cancer illnesses.
Neoadjuvant Intraperitoneal Chemotherapy in Patients with Pseudomyxoma Peritonei—A Novel Treatment Approach

Neoadjuvant intravenous chemotherapy in patients with pseudomyxoma peritonei (PMP) has not shown convincing results. The effectiveness of neoadjuvant intraperitoneal (IP) chemotherapy has never been reported. This prospective, non-randomized phase II study included patients with PMP treated between May 2017 and December 2018, who were not considered suitable for primary cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The majority of patients were treated with laparoscopic HIPEC (oxaliplatin 200 mg/m2, 60 min, 43 °C). IP chemotherapy was started 2 weeks after docetaxel 40 mg/m2 + cisplatin 40 mg/m2, accompanied by oral S1 (tegafur, gimeracil, and oteracil) (50 mg/m2) for 14 days, followed by one week rest. Clinical parameters and complications were recorded. In total, 22/27 patients qualified for CRS and HIPEC after neoadjuvant treatment. A complete cytoreduction (Completeness of cytoreduction Score 0/1) could be achieved in 54.5%. The postoperative morbidity rate was 13.6% and mortality was rate 4.5%. In total, 20/22 patients had major pathological tumor responses. The mean drop in CEA was 28.2% and in the peritoneal carcinomatosis index (PCI) was 2.6. Positive or suspicious cytology turned negative in 69.2% of patients. Thus, for PMP patients who were not amenable for primary surgery, the majority received complete cytoreduction after treatment with neoadjuvant IP chemotherapy, with satisfying tumor regression and with low complication rates. The oncological benefit in terms of survival with this new treatment regimen needs to be proven.
Research advance in maternal level of eCG in pregnant mare

Equine chorionic gonadotropin(eCG)is secreted by trophoblastic cells during gestation in the mare and known as glycoprotein of heterodimers. In this study, the structure of endometrial cup, the biological char acteristics and clinical application of eCG, and how the genetical and physical factors such as different equines, horse breed, age and fetal gender affected the maternel level of eCG were briefly reviened. Relative researches indicated that female donkey with hinny foal, young mares carrying first foal and mares with female foal kept a higher level of eCG in the early gestation. As an embryo derived glycoprotein, eCG plays a role in the progress of immunological tolerance in the pregnant mare.
Induction of Glucoraphasatin Biosynthesis Genes by MYB29 in Radish (Raphanus sativus L.) Roots

Glucoraphasatin (GRH) is a specific aliphatic glucosinolate (GSL) that is only abundant in radish (Raphanus sativus L.). The gene expression regulating GRH biosynthesis in radish is still poorly understood. We employed a total of 59 radish accessions to analyze GSL profiles and showed that GRH was specific and predominant among the aliphatic GSLs in radish roots. We selected five accessions roots with high, moderate and low GSL biosynthesis, respectively, to conduct a comparative transcriptome analysis and the qRT-PCR of the biosynthesis genes for aliphatic GSLs. In this study, among all the accessions tested, roots with the accession RA157-74 had a high GRH content and showed a significant expression of the aliphatic GSL biosynthesis genes. We defined the genes involved in the GRH biosynthesis process and found that they were regulated by a transcription factor (RSG00789) at the MYB29 locus in radish roots. We found 13 aliphatic GSL biosynthesis genes regulated by the RSG00789 gene in the GRH biosynthesis pathway.
Lymph nodes—The neglected battlefield in tuberculosis

Lymph nodes, particularly thoracic lymph nodes, are among the most common sites of extrapulmonary tuberculosis (TB). However, Mycobacterium tuberculosis (Mtb) infection in these organs is understudied. Aside from being sites of initiation of the adaptive immune system, lymph nodes also serve as niches of Mtb growth and persistence. Mtb infection results in granuloma formation that disrupts and—if it becomes large enough—replaces the normal architecture of the lymph node that is vital to its function. In preclinical models, successful TB vaccines appear to prevent spread of Mtb from the lungs to the lymph nodes. Reactivation of latent TB can start in the lymph nodes resulting in dissemination of the bacteria to the lungs and other organs. Involvement of the lymph nodes may improve Bacille Calmette-Guerin (BCG) vaccine efficacy. Lastly, drug penetration to the lymph nodes is poor compared to blood, lung tissue, and lung granulomas. Future studies on evaluating the efficacy of vaccines and anti-TB drug treatments should include consideration of the effects on thoracic lymph nodes and not just the lungs.
Maximal strength training in patients with Parkinson's disease: Impact on efferent neural drive, force generating capacity, and functional performance.

Parkinson's disease (PD) is characterized by progressive neurological deterioration, typically accompanied by reductions in skeletal muscle force-generating capacity (FGC) and functional performance. Physical activity has the potential to counteract this debilitating outcome, however, it is elusive if high intensity strength training included in conventional treatment may improve results. Therefore, we randomly assigned 22 PD patients (74±9 years) to conventional rehabilitation with or without maximal strength training (MST) performed as leg press and chest press at ~90% of one repetition maximum (1RM), five times per week for four weeks. FGC, physical performance, and efferent neural drive assessed as evoked potentials (V-wave normalized to M-wave in m.soleus) were measured following training. Results revealed that only MST improved 1RM leg press (101±23 to 118±18kg) and chest press (36±15 to 41±15kg), plantar flexion maximal voluntary contraction (235±125 to 293±158N·m-1) and rate of force development (373±345 to 495±446N⋅m-1⋅s-1; all p<0.05; different from controls p<0.05). FGC-improvements were accompanied by an increased efferent neural drive to maximally contracting musculature (V/M-ratio: 0.17±0.12 to 0.24±0.15; p<0.05; different from controls p<0.05), improved physical performance (stair climbing: 21.0±9.2 to 14.4±5.2seconds; timed up and go: 7.8±3.3 to 6.2±2.5seconds; both p<0.05), and self-perceived improvement in health (3.1±0.5 to 2.6±0.9) and social activities functioning (2.2±1.0 to 1.5±1.1; both p<0.05). No changes were observed in the control group. In conclusion, this study shows that MST improves FGC, neuromuscular function, and functional performance, and advocate that high intensity strength training should be implemented as an adjunct therapy in the treatment of PD patients.
Competing With Charter Schools: Selection, Retention, and Achievement in Los Angeles Pilot Schools

Charter schools place competitive pressure on school districts to retain students and public funding. Many districts also have moved to decentralize control of budgets and teacher hiring down to school principals, independent of competitive pressures. But almost no evaluation evidence gauges the effectiveness of charter-like schools, relative to traditional public schools. We find that autonomous pilot schools in Los Angeles enroll more low-income and Spanish-speaking students, compared with traditional schools. Pilot pupils are significantly less likely to exit the school district. But pilot pupils displayed lower test scores in mathematics and fell slightly below traditional students in English-language arts, taking into account prior performance and their propensity to enter pilot schools. We tracked 6,732 students entering pilot high schools between 2008 and 2012, statistically matched in multiple ways with traditional peers from identical sending middle schools. We discuss the advantages of our evaluation strategy and the implications of our findings for education leaders and policy makers.
Effect of High-velocity Resistance Exercise on 24-h Blood Pressure in Hypertensive Older Women

Abstract This study investigated the acute post-exercise effect of high-velocity resistance exercise on ambulatory blood pressure in hypertensive older women. Fourteen volunteers (67.9±5.1 years) performed a high-velocity resistance exercise session (8 exercises using Thera-Band, 3 sets of 6 repetitions as fast as possible in the concentric phase with moderate intensity) and a control session, separated by a 7–10-day period. Ambulatory blood pressure was monitored following 12-h post-sessions and compared between conditions at 1 to 4-h, 5 to 8-h, and 9 to 12-h. Average 24-h ambulatory blood pressure, awake, asleep periods, and blood pressure load were also analyzed. There was a condition by time interaction for systolic ambulatory blood pressure over 12-h post-sessions (P=0.043). It was observed a lower systolic ambulatory blood pressure in the first 4-h period following the high-velocity resistance exercise session compared to the control session (−6.7 mmHg, 95% CI − 11.6 to −1.8 mmHg; P=0.011). No changes were observed for diastolic ambulatory blood pressure over 12-h post-sessions as well as for the other variables analyzed (P>0.05). In summary, a single high-velocity resistance exercise session elicits a post-exercise antihypertensive effect and may be considered as a strategy to acutely improve blood pressure control in hypertensive older women.
Characterising the application of the “progressive overload” principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme

Background Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. Design Observational study. Methods We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. Results Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). Conclusion The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.
Effects of Enzymolytic Soybean Meal on Growth Performance,Mineral Availability and Intestine Health of Piglets

This experiment was conducted to study the effects of enzymolytic soybean meal(ESM) on growth performance,mineral availability and intestine health of piglets.A total of 120 crossed-bred(Duroc×Landrace ×Yorkshine) piglets with the initial body weight of(10.79 ± 1.59) kg were randomly divided into six groups with 4 replicates per group and 5 piglets per replicate.Six group were fed diets with 19 % crude protein(CP),18 % CP,and 18 % CP diets adding with 1.0 %,1.5 %,2.0 %,2.5 % ESMto replace the same amount of cron,respectively.The experiment lasted for 36 days.The results showed as follows: 1) compared with the 18 % CP group,average daily gain(ADG) and average daily feed intake(ADFI) of 18 % CP + 1.0 % and 1.5 % ESMgroups were increased but with no significant differences(P0.05). Compared with the18 % CP group,apparent digestibility of organic matter,CP,ash,calcium and phosphorus of 18 % CP+1.5 %ESMgroup were significantly increased(P0.05). Compared with the 18 % CP group,the contents of calcium,phosphorus in serum and bone of 18 % CP+1.0 % and 2.0 % ESMgroups were significantly increased(P0.05). Compared with the 18 % CP group,villus height in jejunum of 18 % CP+2.0 % ESMgroup and in ileum of 18 % CP+2.5 % ESMgroup was significantly increased(P0.05),the ratio of villus height to crypt depth(V / C) in duodenum and ileum of 18 % CP+2.0 % ESMgroup was significantly increased(P0.05). Compared with the 18 % CP group,the activity of diamine oxidase(DAO) in serum was significantly decreased of 18 % CP+1.5 % ESMgroup(P0.01),and secretary immunoglobulin A(s Ig A) content in ileum mucosa was significantly increased of 18 % CP+1.5 % ESMgroup(P 0.05). Compared with the 18 % CP group,Lactobacillus count and the ratio of Lactobacillus to Escherichia coli of caecum and colon were significantly increased(P0.05). 2) Compared with 19 % CP group,the ADG,ADFI and the ratio of feed to gain(F /G) of 18% CP+1.5% ESMgroup were no significant differences(P0.05),but apparent digestibility of dry matter,organic matter,CP,ash,phosphorus of 18 % CP + 1.5 % ESMgroup were significantly increased(P0.05). Compared with the 19 % CP group,the content of calcium in serum and bone of 18 % CP+1.5 % ESMgroup was significantly increased(P0.05),and the activity of DAO in serum was significantly decreased(P0.05). Compared with the 19 % CP group,Lactobacillus count and the ratio of Lactobacillus to Escherichia coli in caecum and colon of 18 % CP + 1.5 % ESMgroup were significantly increased(P 0.01). In conclusion,diet containing 1.0 % to 1.5 % ESMcan promote the growth of intestinal villi,maintain the integrity of intestinal structure,optimize the microbial community structure to keep the healthy of digestive tract,and improve the absorption and sedimentation of calcium and phosphorus to promote bone growth of piglet.
COVID 19 Vaccines: Should we fear ADE?

Abstract Might COVID 19 vaccines sensitize humans to antibody dependent enhanced (ADE) breakthrough infections? This outcome is unlikely because coronavirus diseases in humans lack the clinical, epidemiological, biological or pathological attributes of ADE disease exemplified by the dengue viruses (DENV). In contrast to DENV, SARS and MERS CoVs predominantly infect respiratory epithelium, not macrophages. Severe disease centers on older persons with pre-existing conditions and not young infants or individuals with previous coronavirus infections. Live virus challenge of animals given SARS or MERS vaccines has resulted in vaccine hypersensitivity reactions (VAH), similar to those in humans given inactivated measles or respiratory syncytial virus vaccines. Safe and effective COVID 19 vaccines must avoid VAH.
Increasing adverse drug reaction reporting—How can we do better?

Adverse drug reactions (ADRs) are associated with morbidity and mortality worldwide. Although national systems for reporting ADRs exist there is a low reporting rate. The aim of the current study was to evaluate an intervention plan for improving ADRs reporting among medical professionals (physicians and nurses). A multicentre intervention study was conducted, in which one medical centre was randomly assigned to the intervention group and two medical centres to the control group. The study consisted of 3 phases: baseline data collection, intervention and follow-up of the reporting rate. The questionnaire that was filled in at base line and at the end of study, contained questions about personal/professional demographic variables, and statements regarding knowledge of and behaviour toward ADRs reporting. The intervention program consisted of posters, lectures, distant electronic learning and reminders. An increase in the number of ADRs reports was noted in the intervention group (74 times higher than in the control group) during the intervention period, which was gradually decreased with as the study progressed (adjusted O.R = 74.1, 95% CI = 21.11–260.1, p<0.001). The changes in the "knowledge related to behaviour” (p = 0.01) and in the "behaviour related to reporting" (p<0.001) score was significantly higher in the intervention group. Specialist physicians and nurses (p<0.001), fulfilling additional positions (p<0.001) and those working in other places (p = 0.05) demonstrated a high rate of report. Lectures were preferable as a method to encourage ADRs reporting. The most convenient reporting tools were telephone and online reporting. Thus, implementation and maintenance of a continuous intervention program, by a pharmacovigilance specialist staff member, will improve ADRs reporting rates.
Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization

Emerging reports suggest that obese patients who are hospitalized with COVID-19 may have worse outcomes; whether this association extends to those who are not hospitalized is unclear. This study examines the association between obesity and death 21 days after diagnosis of COVID-19 among patients who receive care in an integrated health care system, accounting for obesity-related comorbidities and sociodemographic factors.
Children's behavioural problems and its associations with socioeconomic position and early parenting environment: findings from the UK Millennium Cohort Study

Abstract Aims To investigate behavioural problems throughout childhood and adolescent, and its relationship with socioeconomic position (SEP) and early parenting environment. Methods Using data from the Millennium Cohort Study conducted in the UK, behavioural problems of 14 452 children were analysed using a growth curve model. The children were followed from birth to adolescence, and their behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ). The SDQ was sub-scaled into externalising and internalising problems. After assessing the general trajectory of children's behavioural problems, variables representing SEP and parenting environments were introduced to the model to analyse the association with children's outcomes. Results Overall, children's trajectories in externalising problems showed a decreasing trend while internalising problems increased as they aged. Household income and maternal education in early childhood were independently associated with children's behavioural problems, while the association for maternal occupation was significantly weaker. Positive early parenting environments attenuated the association between SEP and children's behavioural problems. Also, with regards to children's behavioural problems, positive parenting explained more variance between children compared to SEP. Favourable parent–child relationship buffered the income gradient in children's behavioural problems during early childhood, and although this buffering effect did not last until adolescence, those who had good parent–child relationships developed better outcomes regardless of their SEP. Conclusions The results of the study emphasise the importance of a positive early parenting environment for improving and reducing the socioeconomic gap in children's behavioural problems and encourages policies to promote better parenting circumstances.