Patients with body mass index ≥25 kg/m2 as a target population for improvement of rate of follow-up duplex venous ultrasound examinations following initial incomplete examinations.

OBJECTIVE: Obesity is highly prevalent and a major risk factor for deep vein thrombosis (DVT) and chronic venous disease. It can also technically limit duplex ultrasound evaluations for lower extremity DVT. We compared the rates and results of repeat lower extremity venous duplex ultrasound (LEVDUS) after an initial incomplete and negative (IIN) LEVDUS in overweight (body mass index [BMI] ≤25-30 kg/m2) and obese (BMI ≥30 kg/m2) patients with those of patients with a BMI <25 kg/m2 to evaluate whether increasing the rate of follow-up examinations in overweight and obese patients might facilitate improved patient care. METHODS: We performed a retrospective review of 617 patients with an IIN LEVDUS study from December 31, 2017 to December 31, 2020. Demographic and imaging data of the patients with an IIN LEVDUS and the frequency of repeat studies performed within 2 weeks were abstracted from the electronic medical records. The patients were divided into three BMI-based groups: normal (BMI <25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI ≥30 kg/m2). RESULTS: Of the 617 patients with an IIN LEVDUS, 213 (34.5%) were normal weight, 177 (29%) were overweight, and 227 (37%) were obese. The repeat LEVDUS rates were significantly different across the three weight groups (P < .001). After an IIN LEVDUS, the rate of repeat LEVDUS for the normal weight, overweight, and obese groups was 46% (98 of 213), 28% (50 of 227), and 32% (73 of 227), respectively. The overall rates of thrombosis (both DVT and superficial vein thrombosis) in the repeat LEVDUS examinations were not significantly different among the normal weight (14%), overweight (11%), and obese (18%) patients (P = .431). CONCLUSIONS: Overweight and obese patients (BMI ≥25 kg/m2) received fewer follow-up examinations after an IIN LEVDUS. Follow-up LEVDUS examinations of overweight and obese patients after an IIN LEVDUS study have similar rates of venous thrombosis compared with normal weight patients. Targeting improving usage of follow-up LEVDUS studies for all patients, but especially for those who are overweight and obese, with an IIN LEVDUS through quality improvement efforts could help minimize missed diagnoses of venous thrombosis and improve the quality of patient care.

Silencing of a putative alanine aminotransferase (ALT) gene influences free amino acid composition in hemolymph and fecundity of the predatory bug, Cyrtorhinus lividipennis Reuter.

In Asian rice systems, Cyrtorhinus lividipennis Reuter is an important predator that preys on rice planthopper eggs and young nymphs, as a primary food source. Alanine aminotransferase (ALT) acts in many physiological and biochemical processes in insects. We cloned the full-length complementary DNA of C. lividipennis ClALT. Expression analysis showed higher expression in the fat body and midgut compared to other tissues. It is expressed in all C. lividipennis developmental stages and at least four organs. Silencing of ClALT by RNA interference significantly decreased the ClALT enzyme activity and ClALT expression compared to dsGFP-treated controls at 2 days after emergence (DAE). Silencing of ClALT influenced free hemolymph amino acid compositions, resulting in a reduction of Aspartic acid (Asp) and Alanine (Ala) proportions, and increased Cysteine (Cys) and Valine (Val) proportions in females at 2 DAE. dsClALT treatments led to decreased soluble total protein concentrations in ovary and fat body, and to lower reduced vitellogenin (Vg) expression, body weight, and the numbers of laid eggs. The double-stranded RNA viruse treatments also led to prolonged preoviposition periods and hindered ovarian development. Western blot analysis indicated that silencing ClALT also led to reduced fat body Vg protein abundance at 2 DAE. These data support our hypothesis that ClALT influences amino acid metabolism and fecundity in C. lividipennis.