Improving follow-up of incomplete lower extremity venous duplex ultrasound examinations performed for deep and superficial vein thromboses.

OBJECTIVE: A lower extremity venous duplex ultrasound (LEVDUS) examination is the standard diagnostic test to evaluate patients for lower extremity deep vein thrombosis (DVT). However, some studies will be incomplete for a variety of reasons, including patient-related factors such as pain, edema, a large leg circumference, or the presence of overlying bandages or orthopedic devices. We previously reported that the frequency of obtaining a follow-up examination after an incomplete and negative (I/N) LEVDUS examination was low but that the rates of DVT found on the follow-up studies of initially I/N LEVDUS studies were similar to the rates of DVT found with initially complete LEVDUS examinations. Therefore, we recommended process improvements to increase follow-up LEVDUS studies after an I/N LEVDUS examination. In the present study, we have described the results of appending a recommendation to obtain a follow-up LEVDUS study to preliminary and final reports of I/N LEVDUS. METHODS: Starting in January 2019 through December 2019, a recommendation to obtain a repeat LEVDUS examination after an I/N study was appended to the preliminary and final reports of all I/N LEVDUS examination of patients who did not, otherwise, have an indication for anticoagulation (group 2). The patients were identified on an ongoing basis through the study period and entered into an Excel database (Microsoft Corp, Redmond, Wash). Group 2 was compared with a previously reported historic control cohort of patients identified from January 2017 to December 2017 (group 1). We compared groups 1 and 2 with respect to the frequency of the repeat studies performed within 4 weeks after an I/N LEVDUS examination and the DVT rates found from the follow-up LEVDUS examinations after an I/N LEVDUS study. RESULTS: Of the patients in groups 1 and 2, 187 and 229 had had I/N LEVDUS examinations, with 28% and 40.2% of group 1 and 2 studies having follow-up LEVDUS examinations (P < .01). Previously unidentified lower extremity thrombi were discovered in 21% of the group 2 follow-up examinations. Also, the rate of new thrombi detected was not different between groups 2 and 1 (historic controls; DVT, 14.3% vs 18.5% [P = .25]; SVT, 6.3% vs 3.3% [P = .15]). A definitive finding of either positive or negative for DVT and SVT with a complete examination in 50% of the group 2 patients with follow-up examinations. CONCLUSIONS: A recommendation to obtain a follow-up examination appended to the preliminary and final I/N LEVDUS reports was associated with an increased rate of follow-up examinations, which revealed many previously undetected DVTs and SVTs or had allowed for definitive exclusion of DVT.

Red raspberry (Rubus ideaus) supplementation mitigates the effects of a high-fat diet on brain and behavior in mice.

OBJECTIVES: Research has shown that berries may have the ability to reverse, reduce, or slow the progression of behavioral dysfunction associated with aging and neurodegenerative disease. In contrast, high-energy and high-fat diets (HFD) may result in behavioral deficits like those seen in aging animals. This research examined whether red raspberry (Rubus ideaus) mitigates the effects of HFD on mouse brain and behavior. METHODS: Eight-week-old mice consumed a HFD (60% calories from fat) or a control diet (CD) with and without 4% freeze-dried red raspberry (RB). Behavioral tests and biochemical assays of brain tissue and serum were conducted. RESULTS: After 12 weeks on the diets, mice fed CD and HFD had impaired novel object recognition, but mice on the RB-supplemented diets did not. After approximately 20 weeks on the diets, mice fed HFD + RB had shorter latencies to find the escape hole in the Barnes maze than the HFD-fed mice. Interleukin (IL)-6 was significantly elevated in the cortex of mice fed HFD; while mice fed the CD, CD + RB, and HFD + RB did not show a similar elevation. There was also evidence of increased brain-derived neurotrophic factor (BDNF) in the brains of mice fed RB diets. This reduction in IL-6 and increase in BDNF may contribute to the preservation of learning and memory in HFD + RB mice. CONCLUSION: This study demonstrates that RB may protect against the effects HFD has on brain and behavior; however, further research with human subjects is needed to confirm these benefits.

Myelin repair stimulated by CNS-selective thyroid hormone action.

Oligodendrocyte processes wrap axons to form neuroprotective myelin sheaths, and damage to myelin in disorders, such as multiple sclerosis (MS), leads to neurodegeneration and disability. There are currently no approved treatments for MS that stimulate myelin repair. During development, thyroid hormone (TH) promotes myelination through enhancing oligodendrocyte differentiation; however, TH itself is unsuitable as a remyelination therapy due to adverse systemic effects. This problem is overcome with selective TH agonists, sobetirome and a CNS-selective prodrug of sobetirome called Sob-AM2. We show here that TH and sobetirome stimulated remyelination in standard gliotoxin models of demyelination. We then utilized a genetic mouse model of demyelination and remyelination, in which we employed motor function tests, histology, and MRI to demonstrate that chronic treatment with sobetirome or Sob-AM2 leads to significant improvement in both clinical signs and remyelination. In contrast, chronic treatment with TH in this model inhibited the endogenous myelin repair and exacerbated disease. These results support the clinical investigation of selective CNS-penetrating TH agonists, but not TH, for myelin repair.