Patient and Provider Preferences for Monitoring Surgical Wounds Using an mHealth App: A Formative Qualitative Analysis.

Background: Surgical site infections complicate approximately 10% of all inpatient operations and account for nearly 20% of surgical re-admissions. Post-operative hospitalizations have become shorter over time, yet limited resources exist for patients to use at their home to communicate surgical wound problems with their medical providers. This study evaluated the attitudes of patients and providers towards using a remote wound monitoring application. Methods: This formative descriptive qualitative study reports the result of analysis of the interview content of five patients and five providers from a colorectal surgery clinic at the Medical University of South Carolina in Charleston, South Carolina. Semi-structured, face-to-face interviews were conducted in the clinic setting, were recorded, and professionally transcribed. Two of the authors independently reviewed and coded the transcribed interviews to identify themes across all 10 interviews. After independent coding, authors reviewed findings to reconcile and streamline the primary themes representing attitudes of patients and providers toward remote wound monitoring. Results: Five primary codes were found across our interviews: current barriers, infection types, workflow, interest in surgical site infection (SSI) monitoring, application considerations, and requested application features. We subcoded "symptom clarification" and "positive anticipation" under "interest in SSI monitoring," as well as "anticipated issues" and "application features" under "application considerations." From these codes, we synthesized findings into three overarching themes: smartphone app for remote wound monitoring has potential to improve patient-provider communication, specific wound evaluation processes are acceptable to patients and providers, and new collaboration with telehealth service is a welcome addition for interdisciplinary team management. Conclusions: A prospective approach to the development of a remote wound monitoring application enables a user-centric development process. Our analysis shows a readiness from both patients and providers to implement remote wound monitoring for identifying potential SSIs and coordinating surgical wound care within the community.

Analysing the Covid-19 Cases in Kerala: a Visual Exploratory Data Analysis Approach.

To analyse the Covid-19 cases and effective measures taken by the Kerala government in India to fight against the pandemic. To conduct an exploratory analysis of the model put forward by Kerala. Data were collected from various sources. Three phases were identified for analysis: first phase starting from January 30 to March 9, 2020; second phase starting from March 10 to May 8 and the last phase from May 9 to May 31, 2020. Data analysis was carried out in MATLAB software. The steps taken by the Kerala government ensured the virus to be contained in the affected persons itself. Community spread was reduced by the implementation of contact tracing and home quarantine. Welfare measures taken during the lockdown helped the people to adjust to the changes. The abstinence of community spread still stands strong. Apart from tackling the Covid-19 virus, Kerala with a series of welfare measures made the life of Kerala citizens comfortable. The model raised by Kerala for fighting against Covid-19 can be considered as a benchmark for how the public health department can be utilised properly.

Developmental Programming: Does Prenatal Steroid Excess Disrupt the Ovarian VEGF System in Sheep?

Prenatal testosterone (T), but not dihydrotestosterone (DHT), excess disrupts ovarian cyclicity and increases follicular recruitment and persistence. We hypothesized that the disruption in the vascular endothelial growth factor (VEGF) system contributes to the enhancement of follicular recruitment and persistence in prenatal T-treated sheep. The impact of T/DHT treatments from Days 30 to 90 of gestation on VEGFA, VEGFB, and their receptor (VEGFR-1 [FLT1], VEGFR-2 [KDR], and VEGFR-3 [FLT4]) protein expression was examined by immunohistochemistry on Fetal Days 90 and 140, 22 wk, 10 mo (postpubertal), and 21 mo (adult) of age. Arterial morphometry was performed in Fetal Day 140 and postpubertal ovaries. VEGFA and VEGFB expression were found in granulosa cells at all stages of follicular development with increased expression in antral follicles. VEGFA was present in theca interna, while VEGFB was present in theca interna/externa and stromal cells. All three receptors were expressed in the granulosa, theca, and stromal cells during all stages of follicular development. VEGFR-3 increased with follicular differentiation with the highest level seen in the granulosa cells of antral follicles. None of the members of the VEGF family or their receptor expression were altered by age or prenatal T/DHT treatments. At Fetal Day 140, area, wall thickness, and wall area of arteries from the ovarian hilum were larger in prenatal T- and DHT-treated females, suggestive of early androgenic programming of arterial differentiation. This may facilitate increased delivery of endocrine factors and thus indirectly contribute to the development of the multifollicular phenotype.

Aquaporin-1 protein levels elevated in fresh urine of renal cell carcinoma patients: potential use for screening and classification of incidental renal lesions.

INTRODUCTION AND OBJECTIVES: There are over 65,000 new cases of renal cell carcinoma (RCC) each year, yet there is no effective clinical screening test for RCC. A single report claimed no overlap between urine levels of aquaporin-1 (AQP1) in patients with and without RCC (Mayo Clin Proc. 85:413, 2010). Here, we used archived and fresh RCC patient urine to validate this report. METHODS: Archived RCC, fresh prenephrectomy RCC, and non-RCC negative control urines were processed for Western blot analysis. Urinary creatinine concentrations were quantified by the Jaffe reaction (Nephron 16:31, 1976). Precipitated protein was dissolved in 1x SDS for a final concentration of 2 µg/µL creatinine. RESULTS: Negative control and archived RCC patient urine failed to show any AQP1 protein by Western blot analysis. Fresh RCC patient urine is robustly positive for AQP1. There was no signal overlap between fresh RCC and negative control, making differentiation straightforward. CONCLUSIONS: Our data confirms that fresh urine of patients with RCC contains easily detectable AQP1 protein. However, archival specimens showed an absence of detectable AQP1 indistinguishable from negative control. These findings suggest that a clinically applicable diagnostic test for AQP1 in fresh urine may be useful for detecting RCC.

von Hippel-Lindau exonic methylation analysis using MALDI-TOF mass spectrometry.

PURPOSE: Aberrant promoter methylation turns off gene expression and is involved in human malignancy. Studies show that first exon methylation has a tighter association with gene silencing compared to promoter methylation or gene mutation. However, to our knowledge the clinical importance of exonic methylation in renal cell carcinoma is unknown. We analyzed renal cell carcinoma for VHL gene exonic methylation using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. MATERIALS AND METHODS: In 48 institutionally banked renal cell carcinoma patient tissue samples VHL exon sequencing was done as well as methylation analysis of promoter and exon 1 by mass spectrometry or conventional bisulfite analysis. Methylated human lymphocytic DNA (0% and 100%), nontemplate distilled H2O, and the UOK121 and UOK171 human renal cell carcinoma cell lines served as assay controls. Samples were considered hypermethylated if a CpG site showed greater than 50% methylation. RESULTS: Nine of the 43 patient samples read by our exon 1 assay had methylated VHL exon 1 sites, including 3 showing hypermethylation. The exon 1 methylation assay was robust and reproducible. Samples with exon 1 hypermethylation showed no exonic mutations. All samples assayed at VHL exon 2 were hypermethylated. CONCLUSIONS: To assay renal cell carcinoma tumors for VHL methylation matrix-assisted laser desorption/ionization time-of-flight mass spectrometry is robust and reproducible, and capable of quantifying the methylation status of individual DNA bases. Exon 1 methylation may be an alternate mechanism of VHL gene silencing in renal cell carcinoma in addition to mutation and promoter methylation. Applying this assay in patient populations may allow enhanced diagnosis or tumor typing in the future.

Retinoids regulate TGFbeta signaling at the level of Smad2 phosphorylation and nuclear accumulation.

Indirect regulation of transforming growth factor (TGF)-beta signaling by retinoids occurs on a long-term timescale, secondary to transcriptional events. Studies by our group show loss of retinoid X receptor (RXR) alpha results in increased TGFbeta2 in the midgestational heart, which may play a role in the cardiac defects seen in this model [S.W. Kubalak, D.R. Hutson, K.K. Scott and R.A. Shannon, Elevated transforming growth factor beta2 enhances apoptosis and contributes to abnormal outflow tract and aortic sac development in retinoic X receptor alpha knockout embryos, Development 129 (2002) 733-746.]. Acute and direct interactions between retinoid and TGFbeta signaling, however, are not clearly understood. Treatment of dispersed hearts and NIH3T3 cells for 1 h with TGFbeta and retinoids (dual treatment) resulted in increased phosphorylated Smad2 and Smad3 when compared to treatment with TGFbeta alone. Of all dual treatments, those with the RXR agonist Bexarotene, resulted in the highest level of phosphorylated Smad2, a 7-fold increase over TGFbeta2 alone. Additionally, during dual treatment phosphorylation of Smad2 occurs via the TGFbeta type I receptor but not by increased activation of the receptor. As loss of RXRalpha results in increased levels of Smad2 phosphorylation in response to TGFbeta treatment and since nuclear accumulation of phosphorylated Smad2 is decreased during dual treatment, we propose that RXRalpha directly regulates the activities of Smad2. These data show retinoid signaling influences the TGFbeta pathway in an acute and direct manner that has been unappreciated until now.