bluuebunny/crossref_metadata_2025 huggingface dataset:
Trimeresurus venom inhibition of anti-HPA-1a and anti-HPA-1b antibody binding to human platelets
Authors: Wlodar S.J. , Stone D.L. , Sinor L.T.
Published: May 2021

A solid-phase red cell adherence assay was used to demonstrate the specific inhibitory effect of seven species of Trimeresurus snake venom on the binding of HPA-1a- and HPA-1b-specific platelet antibodies. Trimeresurus venom did not inhibit the binding of HLA-, HPA-3a-, HPA-3b-, HPA-4a-, HPA-5a-, and HPA-5b-specific platelet antibodies. Venom from other genera of snakes, including representatives from Agkistrodon, Ancistrodon, Bitis, Bothrops, Bungarus, Causus, Crotalus, Dendroaspis, Ecis, Micrurus, Naja, Notechis, Ophiophagus, Pseudechis, Sepedon (Hemachatus), and Vipera, all failed to specifically inhibit anti-HPA-1a and HPA-1b binding. These results may indicate that the component in Trimeresurus snake venom previously reported to bind to the platelet GPIIb-IIIa complex, inhibiting fibrinogen binding, binds close to the HPA-1a and HPA-1b epitopes.
Immunohematology
1995;11:129–132.
Detection of drug-dependent platelet antibodies by use of solid-phase red cell adherence techniques
Authors: Leach M.F. , Cooper L.K. , AuBuchon J.P.
Published: May 2021

Many drugs have been reported to cause drug-dependent thrombocytopenia, either by the immune complex or by hapten mechanisms. Testing for the presence of these platelet antibodies has not been considered feasible for transfusion services because their presence was thought to be rare, and their detection involved complex and costly methods. We have developed a new technique for detection of these antibodies that can be performed without the need for specialized and expensive instrumentation. A solid-phase red cell adherence assay was used to detect drug-dependent platelet antibodies active by either the immune complex or the hapten mechanism. Three cases were evaluated for the presence of drug-dependent platelet antibodies. Two patients presented with thrombocytopenia that could not be attributed to other causes. The third case was evaluated for the presence of drug-dependent antibodies after poor responses to platelet transfusions. In these three cases, discontinuation of the implicated drugs, i.e., porcine heparin, quinine sulfate, amoxicillin, BactrimTM, and albuterol, was followed by a correction of thrombocytopenia or improved platelet transfusion response within 72 hours. This test methodology and protocol has proven very useful in avoiding transfusions with little likelihood of benefit, and in identifying drugs interfering with platelet recovery or survival. Further investigations with this technique may expand our knowledge of the capability of this technique and of the observed frequency of drug-related immunologic platelet destruction.
Immunohematology
1995;11:143–149.
Case report: a pregnant woman with immune thrombocytopenic purpura and unusual red cell antibodies
Authors: Nanton C.R. , Martin S.M. , Cook L.O. , Larison P.J.
Published: May 2021

Maternal immune thrombocytopenic purpura (ITP) may lead to fetal platelet destruction. This process is mediated by IgG platelet autoantibodies that cross the placenta. In this case, not only were platelet autoantibodies present, but red cell alloantibodies anti-E, anti-M, and anti-He were also present. Anti-E, present as an IgG antibody, crossed the placenta, but did not cause clinical problems in the E+ newborn, other than possible hyperbilirubinemia that was treated by phototherapy.
Immunohematology
1995;11:153–155.
New human monoclonal antibody reagents for detecting C, c, E, e, K1, Jka, and Jkb red cell antigens
Authors: Kemper M. , Sazama K.
Published: May 2021

Using routine methods, human monoclonal Rh, Kell, and Kidd antibody reagents compared favorably with licensed humansource polyclonal antibody reagents when typing random donor blood specimens. In three different clinical trials, using standard methods and both types of reagents, we tested 2,866 samples by tube, 381 samples by slide, and, using only monoclonal antibodies (MAbs), 1,043 samples by microplate. No discrepant typings were found. More than 95 percent of all reactions using MAbs were the same as or stronger than those with polyclonal antibodies (PAbs). Use of MAbs instead of PAbs for routine typing will result in distinctly stronger reactions, shorter testing times, and decreased anti-human globulin reagent and equipment needs. Product quality will be more standardized, since uniform batches of antibody from immortalized hybrid cell lines can be made available in virtually unlimited supply. Cost-effective production should decrease or eliminate dependence on hyperimmunized human and animal donors from whom variably reactive reagents are currently obtained. This ease of use and more rapid results should improve patient care by facilitating availability of phenotype-appropriate red blood cells for special needs.
Immunohematology
1994;10:8.
A comparison of the reactivity of monoclonal and polyclonal Rh reagents with red cells after prolonged storage
Authors: Westhoff C.M. , Sipherd B.D. , Toalson L.D.
Published: May 2021

Previous studies with stored red cells collected into EDTA anticoagulant had shown that commercial polyclonal anti-C, -c, and -E reagents gave acceptable reactions for 60 days, but polyclonal antie reagents reliably detected the e antigen only through 14 days. At that time it was noted that a monoclonal anti-e reacted 3+ to 4+ with red cells that no longer reacted, or reacted very weakly, with the polyclonal anti-e reagents. This observation led to a comparison study of the reactivity of monoclonal versus polyclonal Rh reagents with stored red cells. Monoclonal and polyclonal anti-C, -c, and -E reagents showed comparable reaction strengths, and gave acceptable reactions over the entire testing period. Polyclonal anti-e reagents, which are known to be of lower titer, again did not give reliable reactions with stored cells after 14 days. However, three different monoclonal anti-e reagents were able to detect the presence of the e antigen on stored cells for many weeks. This study showed that the monoclonal anti-e reagents tested are superior to polyclonal anti-e reagents for typing specimens that have been stored for more than 14 days.
Immunohematology
1994;10:12.
Case reports: use of a polyethylene glycol additive to enhance eluate sensitivity
Authors: Lang N.A.
Published: May 2021

The use of polyethylene glycol additives to enhance the detection of clinically significant alloantibodies in serum has been widely described. This report outlines several cases in which polyethylene glycol additives were added to eluate test systems to enhance the detection of alloantibodies in recently transfused patients.
Immunohematology
1994;10:19.
Misidentification of anti-Vel due to inappropriate use of prewarming and adsorption techniques
Authors: Storry J.R. , Mallory D.
Published: May 2021

Two units of red blood cells (RBCs) were ordered for a 44-year-old Caucasian woman with renal failure and cancer. Pretransfusion testing performed at the regional reference laboratory had revealed the presence of an antibody reactive with all cells at the indirect antiglobulin test (LAT) but apparently nonreactive by a prewarmed IAT. The patient’s RBCs were direct antiglobulin test negative. Adsorption of the serum with rabbit erythrocyte stroma or with allogeneic RBCs at 4°C reduced the reactivity at the IAT. The patient was transfused with two units of washed RBCs and died 6 to 8 hours later. Retrospective testing in our laboratory detected anti-Vel in both pretransfusion and posttransfusion samples. The pretransfnsio serum was hemolytic when tested in LISS or with papain-treated RBCs. Weak reactivity (1+) was observed at the IAT. EDTA-treated serum (to prevent C’-mediated hemolysis) was strongly reactive (3+s) with Vel+ RBCs but compatible with 10 examples of Vel-RBCs. Adsorptions with rabbit RBCs did not affect reactivity. Pretransfusion RBCs were nonreactive with three examples of anti-Vel at the IAT. The posttransfusion serum was grossly hemolyzed and anti-Vel was demonstrable, although weaker than in the pretransfusion sample. The antibody was subclassed as IgG1 and IgG3. In this case, the use of a prewarming technique precluded detection of hemolysis caused by the antibody prior to the IAT. This case stresses the importance of antibody identification and the correct use of such techniques as prewarming and adsorptions.
Immunohematology
1994;10:83-86.
Successful transfusion in the presence of anti-K4 (anti-Kpb)
Authors: Watt J. , Moffatt P. , Chatfield S. , Grimm W. , Bryant J.
Published: May 2021

A 71-year-old group A, D+ female, with anti-K4(-Kpb),-E, and -S was admitted for her second coronary artery surgery. Four units of autologous red blood cells (RBCs) were transfused perioperatively, and four units of homologous K:-4, E-, S-RBCs were transfused over the next 24 hours. Ten units of fresh frozen plasma and 28 units of platelets were also transfused. Continued bleeding necessitated calling donors from other states in Australia and from the International Panel of Donors of Rare Type, Bristol, UK, maintained by the World Health Organization. Four units of group O, K:4, E-, S-RBCs were transfused in the next 24 hours while the K: 4 blood was in transit. No immediate signs of a transfusion reaction were noted. Blood pressure, temperature, bilirubin, and urinary output were normal, and an increase in hemoglobin was observed. A positive direct antiglobulin test was evident 3 days posttransfusion of the incompatible units and was still present 8 days later. Anti-A and anti-K4 were eluted from the patient’s RBCs. The titer of anti-K4 increased from 8 preoperatively to 2,048 19 days posttransfusion of K:4 RBCs. Subsequent transfusions were not required, and the patient was discharged 3 weeks after the operation without further incident.
Immunohematology
1994;10:87-89.
A comparison of the monocyte monolayer assay with 51chromium red cell recovery for determining the clinical significance of red cell alloantibodies
Authors: Davey R.J. , Esty S.S , Chin J.F. , Mallory D.
Published: May 2021

The 51chromium (51Cr) red cell recovery study is a reliable measure of transfusion compatibility. However, the monocyte monolayer assay (MMA) does not require the use of radioactive isotopes or the injection of incompatible RBCs. In this study, 51Cr recoveries were performed on 12 patients with well-defined antibodies, and the results compared to the MMA procedure. The MMA method was interpreted by counting the percentage of monocytes with associated RBCs (>3% = positive). The MMA correlated with the 51Cr recovery in 11 of 12 subjects. One anti-K1 that caused moderately accelerated red cell destruction (60% recovery at 24 hours) had a negative MMA. Four control subjects with no atypical antibodies had normal autologous RBC 51Cr recoveries and were negative by the MMA technique. The MMA test can be a reliable predictor of in vivo antibody behavior and an acceptable alternative to 51Cr recovery studies.
Immunohematology
1994;10:90–94.
Loss and reappearance of Rho(D) antigen on the red blood cells of an individual with acute myelogenous leukemia
Authors: Mohandas K. , Najfield V. , Gilbert H. , Azar P. , Skerrett D.
Published: May 2021

Complete loss of Rho(D) antigen from red blood cells (RBCs) of individuals with hematologic disorders, though not frequent, has been reported. This case reports the loss of D antigen on the RBCs of a patient with acute myelogenous leukemia and its reappearance when he was in remission. Loss of D antigen expression coincided with worsening clinical and cytogenetic disease. At the time of D antigen loss, the patient also had cytogenetic abnormalities in the bone marrow cells. When he was in remission, the chromosomal abnormalities were no longer detectable, and his RBCs regained D antigen expression.
Immunohematology
1994;10:134–135.
The incidence of V (Rh10) and Jsa (K6) in the contemporary African American blood donor
Authors: Byrne P.C. , Howard J.H.
Published: May 2021

Following an apparent increase in the number of patients with anti- V and/or anti-Jsa who required V– and/or Js(a–) red cell units, red cells from African American blood donors negative for C, E, S, K, Fya, Fyb, and Jkb were typed for V and Jsa over a 2-year period. Of the 438 donors typed for V and Jsa, 168 (38.36%) were V+ and 71 (16.44%) were Js(a+). The incidence of V (Rh10) was higher than that reported in previous studies, but no change was seen in the incidence of Jsa (K6).
Immunohematology
1994;10:136–138.
COVID-19 HASTALIĞININ SOSYAL SİGORTALAR HUKUKU VE BİREYSEL İŞ HUKUKU AÇISINDAN İŞ KAZASI VE/VEYA MESLEK HASTALIĞI NİTELİĞİ
Authors: BAYCIK Gaye , ERDOĞAN Çağla
Published: May 2021

Covid-19 hastalığının sosyal sigortalar hukuku açısından iş kazası, meslek hastalığı veya hastalık olarak nitelendirilmesi, sigortalıların haklarını etkiler. Salgın bir hastalık, sigortalının kişisel hayatında bulaşabileceği gibi çalışırken veya çalışma koşulları nedeniyle de bulaşabilir. Hastalık, iş kazasının yasal koşulları altında sigortalıya bulaştığında iş kazası olarak nitelendirilecektir. Sağlık çalışanları bakımından, Covid-19 meslek hastalığı olarak ele alınabilir. Her halde, belirlemenin yapılmasında sosyal devlet ilkesi ve sosyal sigortaların koruyucu şemsiyesinin genişletilmesi amacı dikkate alınmaldır. Yapılan iş ve çalışma koşullarından bağımsız olarak, özel hayatta hastalananlar sadece hastalık sigortasından yararlanırlar. Hastalığın bulaşma koşullarının ispatındaki güçlük, sigortalıların hak kaybına uğramasına neden olacak şekilde yorumlanmamalıdır. Bireysel iş hukuku açısından, işverenin işçiyi gözetme borcu gereği Covid-19’a karşı gelişen bilim ve teknolojinin gerektirdiği en üst düzey önlemleri alma yükümlülüğü vardır. Bu yükümlülüğün ihlali sonucunda işçinin Covid-19’a yakalanması halinde işverenin tazminat sorumluluğu doğar. Filyasyon raporlarından yararlanılarak veya çalışma koşullarının değerlendirilmesi yoluyla, işçinin hastalığa yakalanması ile işverenin gözetme borcu ihlali arasında uygun illiyet bağı kurulabilir. Hastalığın salgın niteliğinde olması mücbir sebep olarak nitelendirilemez ve illiyet bağını kesmez.
PESQUISA DOCUMENTAL SOBRE O PENSAMENTO COMPUTACIONAL NO ENSINO SUPERIOR: ANÁLISE DOS PROJETOS PEDAGÓGICOS DOS CURSOS DE LICENCIATURA EM COMPUTAÇÃO NO BRASIL
Authors: Sinésio Ferris da Silva Iago , Pontual Falcão Taciana
Published: May 2021

Com a crescente integração do pensamento computacional (PC) à educação básica, fazem-se necessárias políticas voltadas à formação de professores. Embora haja várias iniciativas nos âmbitos acadêmico, institucional e governamental para apoiar a formação continuada dos professores que já atuam nas escolas, pouco se tem feito em relação à formação inicial dos professores, ou seja, no sentido de integrar o PC aos projetos pedagógicos dos cursos de licenciatura. As primeiras iniciativas têm despontado nas licenciaturas em computação (LC), que de fato têm um papel chave para promover o PC na educação básica. Este artigo apresenta uma pesquisa documental feita a partir da plataforma e-MEC e com base nos projetos pedagógicos dos cursos (PPC) de LC disponíveis online, que analisa como tem sido feita a integração do PC. Os resultados indicam que o PC tem sido apresentado como habilidade essencial a todos, e fundamentalmente enquanto ferramenta para resolução de problemas em qualquer área do conhecimento, tendo o licenciado em computação a responsabilidade de promovê-lo na educação básica. Embora ainda sejam poucos os cursos de LC que contemplam o PC em seus projetos pedagógicos, entende-se que eles indicam uma transformação em andamento, que demanda tempo dada a complexidade de reformulação de projetos pedagógicos.
Prevalence of HIVInfection inPatients with TBSpine Admitted to the University Teaching Hospital, Lusaka, Zambia
Authors:   University of Zambia, D. Shumba Chabwela
Published: May 2021

Background: Extra pulmonary TB is an AIDS defining opportunistic infection in patients with HIV infection. TB spine is the commonest form of bone TB and whose clinical picture depends on the site and the presence of HIV infectionMethod: This was a retrospective review of patient records (n=101) over a two-year period (2008-2010) at the University Teaching Hospital, Lusaka, Zambia. Clinical and radiological features, laboratory data were analyzed Results: One hundred and one patients (57 male: 44 female) had TB spine in this period. The mean age was 37.22 ± 14.29 years. The main presenting complaint was backache in 71(70.3%) patients and the mean duration of symptoms was 2.68 ± 1.23 months. The Gibbus was present in 77 (76.24%) of the patients while neurological deficit was identified in 32 (31.6%) patients. The lumbar spine the most affected in 64(63.4%) patients. The mean ESR was determined to be 59.43 ± 32.23 mm/hour. The prevalence rate of HIV infection in the patients with TB spine was 24.8 %. The average CD4 count was found to be 262± 121.3 cells/μl.Conclusion: The prevalence rate of HIV infection (24.8%) is higher than that obtaining in the Zambian general population (13.7%) but lower than the general prevalence of HIV infection in patients with TB (68%).
Effects of Aerobic Exercise on Fasting Blood Glucose and Blood Pressure Levels of Diabetic-Hypertensive Clients at a Diabetes Clinicin Accra, Ghana
Authors:   Physiotherapy Department, Korle-Bu Teaching Hospital, Accra, Ghana., Lotsu Edmund , Kwakye Samuel ,   West Africa Football Academy, Sogakope, Ghana., Mohammed Tawagidu ,   Department of Physiotherapy, School of Biomedical and Allied HealthSciences,College of Health Sciences, University of Ghana,Accra,Ghana, Opoku Bridgette ,   chool of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands., Quartey Jonathan ,   Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Lawson Henry ,   Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana
Published: May 2021

Background: Hypertension and diabetes are associated with an increased risk of cardiovascular diseases. Effective interventions are therefore relevant in reducing the morbidity and mortality associated with hypertension and diabetes. We set out to determine the effect of aerobic exercise on type-2 diabetic-hypertensive clients at a diabetes clinic in Accra.Method: Twenty-one participants were recruited from the National Diabetes Management and Research Center in Korle-Bu in Accra.Participants undertook 30 minutes of aerobic exercise comprising, warm up, ergonomic cycling and cool down, three times a week for a period of eight weeks. Fasting blood glucose and blood pressure levels were measured and changes with respect to exercise were analysed. The mixed model ANOVA was used to test for the differences in the weekly blood pressure and blood glucose levels while the paired t-test was used to compare the baseline and final readings of blood pressure and blood glucose levels. Pearson’s correlation test was used to determine the relationship between age and change in blood pressure and blood glucose levels after eight weeks of exercise.Results: Mean systolic blood pressure reduced from 142mmHg to 135mmHg while the mean diastolic blood pressure also reduced from 89mmHg to 84mmHg post exercises. The baseline and eighth week post exercise average blood glucose level were 8.0 mmol/L and 5.2 mmol/L respectively. There were significant differences in baseline and week eight systolic (p = 0.0017), and diastolic (p = 0.006) blood pressure as well as blood glucose (p=0.0027) levels. There was also a significant positive correlation between age and change in blood glucose level (p = 0.036).Conclusion: Aerobic exercise reduces the fasting blood glucose level and blood pressure in type-2 diabetic-hypertensives. Diabetic-hypertensives should therefore be encouraged to participate in aerobic exercises.
Study on anti-scaling of landfill leachate treated by evaporation method
Authors: Bai Zhongteng , Wang Yanqiu , Shan Mingjun , Lv Yanli , Meng Guangcai , Zhu Siwei , Pan Dawei
Published: May 2021

In the mechanical vapor recompression (MVR) treatment of landfill leachate, scaling in the evaporator and heat exchanger poses a serious problem. This study explored the reasons for such scaling and proposed acid or ion-exchange pre-treatments to reduce the alkalinity of the landfill leachate nanofiltration concentrate (LLNC) to prevent scaling. The feasibility of these two methods was evaluated and the technical and economic parameters for application were obtained via experiments. A large amount of HCO3- in the LLNC was the main cause of scaling. The acid addition experiment and field application demonstrated that this method could prevent fouling problems. The cost of acid addition was USD 0.18/t. LLNC pre-treatment by ion-exchange showed that a weakly acidic cation-exchange resin performed better than a strongly acidic cation-exchange resin did. The amount of solid residue under an alkalinity of 0 mg/L could be decreased by 92.9% compared with that of raw LLNC during evaporation. Both methods could alleviate scaling and enable the wide application of the MVR evaporation process in landfill leachate treatment.
Building Competitive Advantages Within the Frames of Different Approaches to Competitiveness Management (illustrated by the company ‘Belgorod Plant RITM’)
Authors: Skrug V. S.
Published: May 2021

Serious changes that took place lately in business environment form new challenges to processes of enterprise management. The article studies specific features of current management aiming at shaping and retaining competitive advantages of the organization. The author reviewed different approaches to the interpretation of the notions ‘competitive enterprise’ and ‘competitive advantages’. Processes of shaping competitive advantages on the basis of identifying strong and weak sides of the organization were discussed. The empiric base of the research was made by data of Rosstat, the Federal Customs Service, the Institute of Statistic Research and Economy of Knowledge of the Higher School of Economics and the company ‘Belgorod Plant RITM’. The competitive environment on market of seeding-machines was investigated. Special attention was paid to measures of state support to market of agricultural equipment. At the result of the research a conclusion was drawn that market of seeding-machines is fast growing with high competition. External and internal factors affecting the competitive potential of the enterprise were studied and specific features of enterprise management in conditions of competitive environment were systematized. It was shown that the company ‘Belgorod Plant RITM’ has a number of competitive advantages, among which the availability of own technological developments and no dependence on imported components. Recommendations were prepared aimed at improving competitiveness of the company ‘Belgorod Plant RITM’.
Russia and the Development of Eurasian Communications and Transit: After-Effects of the Pandemic and National Transportation Interests
Authors: Turaeva M. O. , Gorokhova I. V.
Published: May 2021

The article analyzes the changes that the Eurasian transit is undergoing in connection with the consequences of the global COVID-19 pandemic. The authors consider the development of transport communications and the expansion of international transport corridors as a strategically important part of the national Russian economy, which has recently been rapidly gaining momentum, largely due to the pandemic. The demand for Eurasian land routes has increased even more due to the force majeure blocking of theSuez Canalin the spring of 2021. The content analysis of databases, regulatory documents, strategies, expert assessments and up-to-date statistics on the Eurasian cargo container transit was carried out. The latest trends related to the introduction of quarantine restrictions and the potential of countries to adapt to new realities are investigated. The connection between internal processes in the EAEU countries and the growth of container transit through the Russian territory is revealed. The authors identified the reasons for the significant loss in 2020.Kazakhstan's transit competitiveness and shows how the internal political crisis inBelaruscloses its routes for transshipment of goods toEurope. The main priorities in the development of the national transport interests of theRussian Federationhave been formed.
Digital Economy, Industry 4.0 and Artificial Intellect
Authors: Barinova N. V. , Barinov V. R.
Published: May 2021

Processes of information and communication technologies, which lately have been developing very fast resulted in creation of analytical systems of management and production based on technologies of artificial intellect and neuronet. The authors analyzed the latest trends in the field, provided examples of working-out technologies and products based on these achievements, which caused considerable improvement of people quality of life. Apart from that the article shows changes in economy connected with pandemic after-effects and key trends of developing digital economy in post-pandemic situation. The article studies interpretations of the term ‘digital economy’ that are used in academic literature and puts forward the definition, which explains the term in the most comprehensive way. Serious attention is paid to the latest trends in the development of machine learning, artificial intellect and neuronet. The applications of neuronet in different field of human activity have been investigated, including academic knowledge and economic analysis.
Effects of Macroporous Resin Extract of Dendrobium officinale Leaves in
Rats with Hyperuricemia Induced by Fructose and Potassium Oxonate
Authors: Yu Qiao-Xian , Lv Gui-Yuan , Chen Su-Hong , Wang Yu-Zhi , Zhou Cong , Zhu Li-Jie , He Xing-Li-Shang , Li Lin-Zi , Zheng Xiang , Xu Wan-Feng , Dong Ying-Jie , Li Bo
Published: May 2021

Aim and Objective:

Fructose, as a ubiquitous monosaccharide, can promote ATP
consumption and elevate circulating Uric acid (UA) levels. Our previous studies have confirmed that
the macroporous resin extract of Dendrobium officinale leaves (DoMRE) could reduce the UA level of
rats with hyperuricemia induced by a high-purine diet. This study aimed to investigate whether
DoMRE had a UA-lowering effect on rats with hyperuricemia caused by fructose combined with
potassium oxonate, so as to further clarify the UA-lowering effect of DoMRE, and to explore the UAlowering
effect of DoMRE on both UA production and excretion.

Materials and Methods:

Rats with hyperuricemia induced by fructose and potassium oxonate were
administered with DoMRE and vehicle control, respectively, to compare the effects of the drugs. At
the end of the experiment, the Serum Uric Acid (SUA) and Creatinine (Cr) levels were measured using
an automatic biochemical analyzer, the activities of xanthine oxidase (XOD) were measured using an
assay kit, and the protein expressions of Urate Transporter 1 (URAT1), glucose transporter 9
(GLUT9), and ATP-Binding Cassette Superfamily G member 2 (ABCG2) were assessed using
immune-histochemical and western blot analyses. Hematoxylin and eosin staining was used to assess
the histological changes in the kidney, liver, and intestine.

Results:

Fructose and potassium induced hyperuricemia in rats. Meanwhile, the activities of XOD
were markedly augmented, the expression of URAT1 and GLUT9 was promoted, and the expression
of ABCG2 was reduced, which were conducive to the elevation of UA. However, exposure to DoMRE
reversed these fructose- and potassium oxonate-induced negative alternations in rats. The activities of
XOD were recovered to the normal level, reducing UA formation; the expressions of URAT1,
ABCG2, and GLUT9 returned to the normal level, resulting in an increase in renal urate excretion.

Conclusion:

DoMRE reduces UA levels in rats with hyperuricemia induced by fructose combined with
potassium oxonate by inhibiting XOD activity and regulating the expression of ABCG2, URAT1, and
GLUT9. DoMRE is a potential therapeutic agent for treating hyperuricemia through inhibiting UA
formation and promoting UA excretion.
Celastrol Inhibits the Proliferation and Decreases Drug Resistance of Cisplatin-
Resistant Gastric Cancer SGC7901/DDP Cells
Authors: Zhan Dongmei , Ni Tengyang , Wang Haibo , Lv Mengying , Sunagawa Masataka , Liu Yanqing
Published: May 2021

Background:

This study aimed to determine the effect and mechanism of Celastrol inhibiting the
proliferation and decreasing the drug resistance of cisplatin-resistant gastric cancer cells.

Objective:

The objective of this study was to explore the effect and mechanism of Celastrol on proliferation and
drug resistance of human gastric cancer cisplatin-resistant cells SGC7901/DDP.

Methods:

The thiazole blue (MTT) method was used to detect the sensitivity of human gastric cancer cisplatinresistant
cells SGC7901/DPP to cisplatin and Celastrol to determine the Drug Resistance Index (DRI). According
to the half Inhibitory Concentration (IC50) value, the action of the concentration of the following experimental
drugs was set to reduce the cytotoxicity. Annexin V-FITC/PI double staining method was used to detect the
apoptosis of SGC7901/DDP cells induced by Celastrol. Western Blot was used to examine the expression levels
of P-glycoprotein (P-gp), Multidrug Resistance Associated Protein 1 (MRP1), Breast Cancer Resistance Associated
Protein (Breast Cancer Resistance)-relative protein (BCRP), and mechanistic Target of Rapamycin
(mTOR) pathway-related proteins. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR)
was used to detect the mRNA expression levels of P-gp, MRP1, and BCRP.

Results:

(1) Compared with the control group (we set the untreated group as the control group), the proliferation
of the SGC7901/DPP cells was significantly inhibited after treating with 0.1-6.4μmol/L Celastrol in a time- and
concentration-dependent manner (P<0.05). The Drug Resistance Index (DRI) of the SGC7901/DPP cells to
DDP was 5.64. (2) Compared with the control group, Celastrol could significantly inhibit the proliferation and
induce the apoptosis of the SGC7901/DPP cells (P<0.05). (3) The mRNA and protein expression levels of P-gp,
MRP1, and BCRP in the SGC7901/DPP cells were significantly higher than those in the SGC7901 cells. However,
after treating with Celastrol, the expression levels of P-gp, MRP1, and BCRP in the SGC7901/DPP cells
were significantly reduced (P<0.05). (4) Compared with the control group, the Celastrol treatment also reduced
the expression of the mTOR signaling pathway-related proteins, suggesting that the mTOR signaling pathway
may be involved in the process of Celastrol inhibiting the proliferation of the SGC7901/DDP cells and reducing
their drug resistance. (5) Significantly, the combination of Celastrol and DDP reduced the expression of P-gp,
MRP1, and BCRP in the SGC7901/DPP cells.

Conclusion:

Celastrol can inhibit the proliferation of the SGC7901/DDP cells, induce their apoptosis, and reduce
the expression of drug resistance genes, probably by inhibiting the expression of the proteins related to the
mTOR signaling pathway.
Stenting of the esophagus in the course of the malignant dysphagia in elderly patients
Authors:   Department of Thoracic and Surgical Oncology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow, Poland, Włodarczyk Janusz , Włodarczyk Alicja ,   Faculty of Medicine Jagiellonian University Collegium Medicum, Cracow, Poland
Published: May 2021

Esophageal cancer is a disease with difficult clinical management, and palliative therapy is the only predominant treatment. This retrospective study analyses the results of clinical management of elderly patients (>75 years of age) who were treated with esophageal stenting for malignant dysphagia due to primary esophageal cancer, including squamous cell carcinoma (SCC), esophageal adenocarcinoma (EAC), as well as secondary esophageal malignant strictures due to non-small cell lung cancer (NSCLC). Patients with esophago-respiratory fistula (ERF) were also included in the study. This study included 166 patients aged 75–88 (mean age, 78) years. Nine (5.4%) patients had upper malignant esophageal stenosis, 48 (28.1%) had the middle, 43 (25.9%) in the lower part of the esophagus, 49 (29.5%) patients had EAC-related stenosis, and 17 (10.2%) patients reported lung cancer-related esophageal stenosis. Dysphagia was rated at 2.8 (range, 2–3) before stenting and at 1.2 (range, 1–2) after the stenting procedure. Seven (4%) patients experienced stenting migration, 12 (7.2%) had granulation tissue overgrowth and prosthesis obstruction, two (1.2%) developed respiratory failure, and one (0.6%) patient died. Twelve (7.2%) patients were treated for ERF with double-stenting, and three (1.8%) patients developed a secondary fistula after the stent implantation. The mean survival of patients with esophageal cancer and ERF was 101.8 days and 62.5 days, respectively. Esophageal stenting has proven a safe procedure in patients over 75 years of age. It has a low rate of stenting obstruction and migration. Patients with ERF are a particularly difficult group to treat, show very poor outcomes and short survival rates.
Evaluation of the Privacy Risks of Personal Health Identifiers and Quasi-Identifiers in a Distributed Research Network: Development and Validation Study
Authors: Oh SeHee , Sung MinDong , Rhee Yumie , Hong Namki , Park Yu Rang
Published: May 2021

Background

Privacy should be protected in medical data that include patient information. A distributed research network (DRN) is one of the challenges in privacy protection and in the encouragement of multi-institutional clinical research. A DRN standardizes multi-institutional data into a common structure and terminology called a common data model (CDM), and it only shares analysis results. It is necessary to measure how a DRN protects patient information privacy even without sharing data in practice.

Objective

This study aimed to quantify the privacy risk of a DRN by comparing different deidentification levels focusing on personal health identifiers (PHIs) and quasi-identifiers (QIs).

Methods

We detected PHIs and QIs in an Observational Medical Outcomes Partnership (OMOP) CDM as threatening privacy, based on 18 Health Insurance Portability and Accountability Act of 1996 (HIPPA) identifiers and previous studies. To compare the privacy risk according to the different privacy policies, we generated limited and safe harbor data sets based on 16 PHIs and 12 QIs as threatening privacy from the Synthetic Public Use File 5 Percent (SynPUF5PCT) data set, which is a public data set of the OMOP CDM. With minimum cell size and equivalence class methods, we measured the privacy risk reduction with a trust differential gap obtained by comparing the two data sets. We also measured the gap in randomly sampled records from the two data sets to adjust the number of PHI or QI records.

Results

The gaps averaged 31.448% and 73.798% for PHIs and QIs, respectively, with a minimum cell size of one, which represents a unique record in a data set. Among PHIs, the national provider identifier had the highest gap of 71.236% (71.244% and 0.007% in the limited and safe harbor data sets, respectively). The maximum size of the equivalence class, which has the largest size of an indistinguishable set of records, averaged 771. In 1000 random samples of PHIs, Device_exposure_start_date had the highest gap of 33.730% (87.705% and 53.975% in the data sets). Among QIs, Death had the highest gap of 99.212% (99.997% and 0.784% in the data sets). In 1000, 10,000, and 100,000 random samples of QIs, Device_treatment had the highest gaps of 12.980% (99.980% and 87.000% in the data sets), 60.118% (99.831% and 39.713%), and 93.597% (98.805% and 5.207%), respectively, and in 1 million random samples, Death had the highest gap of 99.063% (99.998% and 0.934% in the data sets).

Conclusions

In this study, we verified and quantified the privacy risk of PHIs and QIs in the DRN. Although this study used limited PHIs and QIs for verification, the privacy limitations found in this study could be used as a quality measurement index for deidentification of multi-institutional collaboration research, thereby increasing DRN safety.
User Experience With Dynamic Difficulty Adjustment Methods for an Affective Exergame: Comparative Laboratory-Based Study
Authors: Darzi Ali , McCrea Sean M , Novak Domen
Published: May 2021

Background

In affective exergames, game difficulty is dynamically adjusted to match the user’s physical and psychological state. Such an adjustment is commonly made based on a combination of performance measures (eg, in-game scores) and physiological measurements, which provide insight into the player’s psychological state. However, although many prototypes of affective games have been presented and many studies have shown that physiological measurements allow more accurate classification of the player’s psychological state than performance measures, few studies have examined whether dynamic difficulty adjustment (DDA) based on physiological measurements (which requires additional sensors) results in a better user experience than performance-based DDA or manual difficulty adjustment.

Objective

This study aims to compare five DDA methods in an affective exergame: manual (player-controlled), random, performance-based, personality-performance–based, and physiology-personality-performance–based (all-data).

Methods

A total of 50 participants (N=50) were divided into five groups, corresponding to the five DDA methods. They played an exergame version of Pong for 18 minutes, starting at a medium difficulty; every 2 minutes, two game difficulty parameters (ball speed and paddle size) were adjusted using the participant’s assigned DDA method. The DDA rules for the performance-based, personality-performance–based, and all-data groups were developed based on data from a previous open-loop study. Seven physiological responses were recorded throughout the sessions, and participants self-reported their preferred changes to difficulty every 2 minutes. After playing the game, participants reported their in-game experience using two questionnaires: the Intrinsic Motivation Inventory and the Flow Experience Measure.

Results

Although the all-data method resulted in the most accurate changes to ball speed and paddle size (defined as the percentage match between DDA choice and participants’ preference), no significant differences between DDA methods were found on the Intrinsic Motivation Inventory and Flow Experience Measure. When the data from all four automated DDA methods were pooled together, the accuracy of changes in ball speed was significantly correlated with players’ enjoyment (r=0.38) and pressure (r=0.43).

Conclusions

Although our study is limited by the use of a between-subjects design and may not generalize to other exergame designs, the results do not currently support the inclusion of physiological measurements in affective exergames, as they did not result in an improved user experience. As the accuracy of difficulty changes is correlated with user experience, the results support the development of more effective DDA methods. However, they show that the inclusion of physiological measurements does not guarantee a better user experience even if it yields promising results in offline cross-validation.
Developing Adaptive Serious Games for Children With Specific Learning Difficulties: A Two-phase Usability and Technology Acceptance Study
Authors: Yildirim Oguzcan , Surer Elif
Published: May 2021

Background

Specific learning difficulties (SpLD) include several disorders such as dyslexia, dyscalculia, and dysgraphia, and the children with these SpLD receive special education. However, the studies and the educational material so far focus mainly on one specific disorder.

Objective

This study’s primary goal is to develop comprehensive training material for different types of SpLD, with five serious games addressing different aspects of the SpLD. The second focus is measuring the impact of adaptive difficulty level adjustment in the children’s and their educators’ usability and technology acceptance perception. Receiving feedback from the children and their educators, and refining the games according to their suggestions have also been essential in this two-phase study.

Methods

A total of 10 SpLD educators and 23 children with different types of SpLD tested the prototypes of the five serious games (ie, Word game, Memory game, Category game, Space game, and Math game), gave detailed feedback, answered the System Usability Scale and Technology Acceptance Model (TAM) questionnaires, and applied think-aloud protocols during game play.

Results

The games’ standard and adaptive versions were analyzed in terms of average playtime and the number of false answers. Detailed analyses of the interviews, with word clouds and player performances, were also provided. The TAM questionnaires’ average and mean values and box plots of each data acquisition session for the children and the educators were also reported via System Usability Scale and TAM questionnaires. The TAM results of the educators had an average of 8.41 (SD 0.87) out of 10 in the first interview and an average of 8.71 (SD 0.64) out of 10 in the second interview. The children had an average of 9.07 (SD 0.56) out of 10 in the first interview.

Conclusions

Both the educators and the children with SpLD enjoyed playing the games, gave positive feedback, and suggested new ways for improvement. The results showed that these games provide thorough training material for different types of SpLD with personalized and tailored difficulty systems. The final version of the proposed games will become a part of the special education centers’ supplementary curriculum and training materials, making new enhancements and improvements possible in the future.
Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study
Authors: Palos-Sanchez Pedro R , Saura Jose Ramon , Rios Martin Miguel Ángel , Aguayo-Camacho Mariano
Published: May 2021

Background

An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps.

Objective

The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications.

Methods

The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS–SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant.

Results

The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%).

Conclusions

mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users’ symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender.
Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study
Authors: Der-Martirosian Claudia , Wyte-Lake Tamar , Balut Michelle , Chu Karen , Heyworth Leonie , Leung Lucinda , Ziaeian Boback , Tubbesing Sarah , Mullur Rashmi , Dobalian Aram
Published: May 2021

Background

At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020.

Objective

We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020).

Methods

We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes.

Results

Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted.

Conclusions

Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.