Comparison of transcutaneous ultrasound over the right flank with transrectal ultrasonography in the diagnosis of pregnancy in New Zealand dairy herds : a thesis presented in partial fulfillment of the requirements for the degree of Master of Veterinary Science at Massey University

Application of a 3.5 MHz sector transducer over the right flank allows the rapid and clear visualization of bovine pregnancy (ie: fetus, fetal membranes, fetal fluid and/or placentomes). A total of 1736 cows in ten commercial, pasture-based New Zealand dairy herds were examined for pregnancy by transcutaneous ultrasound across the right flank and transrectal ultrasound between 37 and 198 days of gestation. The gold standard was derived from calving records or examination at slaughter. The overall sensitivity of transrectal ultrasound (96.24%) was markedly higher than flank ultrasound (58.55%) and the overall probability of a correct diagnosis of pregnancy status was also significantly higher (p<0.0001). From 155 days of gestation, however, flank ultrasound represented a more accurate method of pregnancy diagnosis and the probability of a correct diagnosis was significantly higher (p<0.0001) after this gestational age. The gestational age of 225 cows from four Spring-calving dairy herds was determined and ultrasound pregnancy test recorded, to determine possible fetal characteristics able to be visualized via transcutaneous ultrasound over the right flank in order to age pregnancy during mid to late gestation. Linear or quadratic equations and curves were formulated from 60 to 198 days of gestation. The fetal characteristics of thoracic diameter, abdominal diameter or umbilical diameter can be used to age pregnancy from 60 days of gestation. Placentome height and length were not significant in the determination of gestational age

Transrectal ultrasonography of the adrenal glands in donkeys (Equus asinus)

Little information is available for medical imaging in donkeys and no report about adrenal glands ultrasonography can be found in scientific literature. The feasibility of transrectal ultrasonography of the adrenal glands was tested on 30 healthy donkeys using a 10 MHz linear transducer. Mean age of animals was 10.7 ±4.8 years, mean weight 275.0 ±62.9 Kg and mean height 126.7 ±7.1 cm. The left adrenal gland was visualized in all donkeys. The right gland ultrasonography was not feasible in seven animals with a height less than 116 cm. The left gland was visualized as a linear or slightly curved structure, the right gland was most often S-shaped. In both glands, an hypechoic peripheral zone was identified as the cortex with an inner, hyperechoic medulla. The length was 5.49 ±1.90 cm and 5.15 ±1.10 cm for right and left gland, respectively. Right gland whole and medullary thickness were 0.71 ±0.11 cm and 0.24 ±0.09 cm, 0.65 ±0.13 cm and 0.21 ±0.07 cm, 0.56 ±0.17 cm and 0.25 ±0.07 cm for cranial pole, middle point and caudal pole respectively. Left gland whole and medullary thickness were 0.69 ±0.13 cm and 0.25 ±0.09 cm, 0.66 ±0.13 cm and 0.23 ±0.09 cm, 0.57 ±0.15 cm and 0.26 ±0.09 cm for cranial pole, middle point and caudal pole respectively. There was a significant correlation between height and the entire length of the left gland. Ultrasonography of the adrenal glands is a suitable tool for evaluation of both adrenal glands in most of the donkey. The size is a limiting factor for proper visualization of the right gland

MRI-targeted or standard biopsy for prostate-cancer diagnosis

Background Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. Methods In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to undergo MRI, with or without targeted biopsy, or standard transrectal ultrasonography-guided biopsy. Men in the MRI-targeted biopsy group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; men whose MRI results were not suggestive of prostate cancer were not offered biopsy. Standard biopsy was a 10-to-12-core, transrectal ultrasonography-guided biopsy. The primary outcome was the proportion of men who received a diagnosis of clinically significant cancer. Secondary outcomes included the proportion of men who received a diagnosis of clinically insignificant cancer. Results A total of 500 men underwent randomization. In the MRI-targeted biopsy group, 71 of 252 men (28%) had MRI results that were not suggestive of prostate cancer, so they did not undergo biopsy. Clinically significant cancer was detected in 95 men (38%) in the MRI-targeted biopsy group, as compared with 64 of 248 (26%) in the standard-biopsy group (adjusted difference, 12 percentage points; 95% confidence interval [CI], 4 to 20; P=0.005). MRI, with or without targeted biopsy, was noninferior to standard biopsy, and the 95% confidence interval indicated the superiority of this strategy over standard biopsy. Fewer men in the MRI-targeted biopsy group than in the standard-biopsy group received a diagnosis of clinically insignificant cancer (adjusted difference, -13 percentage points; 95% CI, -19 to -7; P&lt;0.001). Conclusions The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously. (Funded by the National Institute for Health Research and the European Association of Urology Research Foundation; PRECISION ClinicalTrials.gov number, NCT02380027 .)

Presynchronizing PGF2α and GnRH injections before timed artificial insemination CO-Synch + CIDR program

Fixed-time artificial insemination is an effective management tool that reduces the labor associated with more conventional artificial insemination programs requiring detection of estrus. The 7-day CO-Synch + controlled internal drug release (CIDR) insert protocol has been shown to effectively initiate estrus and ovulation in cycling and non-cycling suckled beef cows, producing pregnancy rates at or greater than 50% in beef cows. The gonadotropin-releasing hormone (GnRH) injection that begins the CO-Synch + CIDR program initiates ovulation in a large proportion of cows, particularly anestrous cows. The CIDR, which releases progesterone intravaginally, prevents short estrous cycles that usually follow the first postpartum ovulation in beef cows. Our hypothesis was that inducing estrus with a prostaglandin injection followed 3 days later with a GnRH injection, 7 days before applying the 7-day CO-Synch + CIDR protocol, might increase the percentage of cycling cows that would exhibit synchronous follicular waves after the onset of the CO-Synch + CIDR protocol. We also hypothesized that the additional GnRH injection would increase the percentage of anestrous cows that would ovulate, thereby increasing pregnancy outcomes

Comparison of Lateral Flow to Other Pregnancy Determination Methods in Order to Determine Accuracy of Pregnancy Status in Beef Cattle Pre and Postpartum

Study Description: Blood samples were collected from six different Bos taurus herds between day 27 and 285 of gestation (heifers n = 1,205 and cows n = 1,539). Blood samples to determine PAG clearance interval were collected weekly postpartum for up to 12 weeks (heifers n = 418 and cows n = 657). Serum was tested using the lateral flow test and were read by two technicians who were blind to pregnancy status. Level of agreement between the tests were determined by Pearson’s correlation coefficients and Kappa scores. The MIXED procedure of SAS was used to evaluate the effect of dpp and age (heifers or cows) on postpartum test results. There was a positive correlation between transrectal ultrasonography and the lateral flow test (r2 = 0.71; P \u3c 0.01), and agreement between the two tests was very good (Kappa = 0.84). Of the animals that were diagnosed nonpregnant by transrectal ultrasonography, 5.61% were called pregnant by the lateral flow test. Of the animals diagnosed pregnant by transrectal ultrasonography, 2.00% were called not pregnant by the lateral flow test. Thus, a 92.38% agreement occurred between the two methods. For postpartum samples, there was no effect (P = 0.21) of age, but there was an effect of dpp (P \u3c 0.01) and a tendency for a dpp by age interaction (P = 0.06). All animals were still considered pregnant from the previous pregnancy through 35 dpp (100 ± 2.58%). The percentage of females receiving a false positive test result further decreased with time postpartum, by 77 dpp there were 13.72 ± 3.16% of the females positive for pregnancy and at 84 dpp there were 4.11 ± 4.39% positive for pregnancy detection

ULTRASONOGRAFIA TRANSRETAL PARA DETERMINAÇÃO DE GESTAÇÃO PRECOCE EM BORREGAS DA RAÇA SARDA

Serial transrectal ultrasound examinations were performed to determine the earliest day at which pregnancy could be detected after mating, as well as to determine the practicability of the method at normal flock management conditions without previous fasting and water restriction. Transrectal ultrasound was carried out daily from day 12th to 25th and once on day 35th after breeding in Sarda breed yearling ewe lambs. The feasibility of the method was evaluated in terms of necessity or not to remove rectal feces during examinations, adequacy to perform examination due to rectal conditions (gases, edema, etc.), adequacy to visualize uterine and ovarian structures and to make accurate pregnancy diagnosis based on uterine findings. The experiment showed that transrectal ultrasound examinations can be suitably used for early pregnancy diagnosis in yearling ewe lambs, without the necessity of previous fasting, lifting the abdomen up and restraining the animals in recumbent position. The transrectal ultrasound method showed to be practicable during daily management of the flock, in terms of animal feeding, watering and staff availability.Exames ultrasonográficos transretais em série foram realizados para determinar o primeiro dia no qual a gestação poderia ser diagnosticada após acasalamento e para determinar a praticidade do uso do método, em condições normais de manejo dos animais sem prévio jejum e restrição de água. A ultrasonografia transretal foi feita diariamente desde o 12º até o 25º dias e uma vez no 35º dia após acasalamento, em borregas de um ano de idade da raça sarda. Os parâmetros utilizados para verificar a praticidade do método foram a necessidade ou não de remover as fezes do reto durante os exames, a possibilidade de fazer o exame devido às condições retais (gases, edema, etc.), a possibilidade de visualizar estruturas uterinas e ovarianas, e a possibilidade de fazer acurado diagnóstico de gestação com base em achados uterinos. O experimento mostrou que  o exame ultrasonográfico transretal  pode ser usado com sucesso no diagnóstico precoce da gestação em borregas de 1 ano de idade, sem a necessidade de prévio jejum alimentar, sem  elevação do abdômen durante o exame e sem a necessidade de manter as borregas em decúbito dorsal. Verificou-se que o método é prático e pode ser utilizado  durante o manejo diário do rebanho, em termos de alimentação e de disponibilidade de pessoal auxiliar

Early pregnancy diagnosis and embryo/fetus mortality in cattle

Pregnancy diagnosis by transrectal ultrasonography (using a 5 MHZ linear probe) presented the maximum sensitivity and negative predictive values at day 26 and day 29 after estrus in heifers and cows, respectively. Palpation per rectum using the fetal membrane slip for pregnancy diagnosis did not increase embryo/fetus mortality when compared with a positive control group of non-palpated females. The use of a controlled randomized block design was a useful approach to study this problem. Blocking for category and number of embryos allowed us to remove these confounding factors. Factors that affected pregnancy loss during the first four months of pregnancy were: period of pregnancy, age of the animal, number of previous lactations and number of embryos. Pregnancy loss was higher during the embryonic than fetal periods. Spontaneous embryo/fetal mortality increased with the age of the animal and lactation number. The risk of spontaneous embryo/fetus mortality was higher in twin than in single pregnancies. Two types of embryo/fetus mortality were noted: Type I and Type II. Type I was characterized by presence of positive fetal membrane slip by palpation per rectum, signs of degeneration by transrectal ultrasonography and persistence of a functional corpus luteum. The uterus took approximately 3 weeks to be noted clean by transrectal ultrasonography and the animals showed estrus one month after the conceptus was diagnosed dead. Type II was characterized by absence of positive signs of pregnancy by palpation per rectum, absence of signs of degeneration by transrectal ultrasonography and absence of a functional corpus luteum. Pregnancy loss in nuclear transfer derived embryos was higher compared to in vivo derived embryos produced by artificial insemination. Pregnancy loss occurred mainly during the transition from the embryonic to the fetal period. Embryo/fetus mortality detected was Type I. Progesterone produced by the corpus luteum was noted at pregnancy levels for approximately two weeks after embryo/fetus death. Protein B, a hormonal placental marker, was maintained at pregnancy levels for approximately 3 weeks after embryo/fetus death. No differences in the levels of the two hormones were noted when comparing females with dead or live conceptuses

Review of diagnostic methods for prostate cancer with consideration of MRI-TRUS fusion biopsy

Introduction and purpose of the study: Prostate cancer is one of the most common malignancies in the human population worldwide. The continuous development of imaging methods allows for its increased recognition. Conclusions have been drawn that MRI-TRUS (magnetic resonance imaging - transrectal ultrasonography) fusion biopsy is superior to other diagnostic methods. The aim of this study is to review the available studies and publications and determine which method of diagnosing prostate cancer is most effective. Materials and Evidence: We reviewed the literature available on PubMed and Google Scholar using the words "fusion biopsy"; "prostate diagnosis"; "prostate cancer"; "transrectal ultrasonography". Results: The diagnosis of prostate cancer is made possible by a range of tests such as transrectal palpation, measurement of prostate specific antigen, transrectal ultrasonography, needle biopsy and MRI. The combination of biopsy, MRI and transrectal ultrasonography has led to the development of fusion biopsy. It combines the high-resolution features of MRI and the real-time images provided by ultrasound. Conclusions: The higher cost of the test and the need for specialised equipment together with the advanced software required for fusion biopsy ultimately provides a statistically significant higher success rate for the diagnosis of prostate cancer. Mentioned the effects of this method, further development and dissemination is expected

Prostate-Specific Antigen, Digital Rectal Examination and Transrectal Ultrasonography: A Meta-Analysis for This Diagnostic Triad of Prostate Cancer in Symptomatic Korean Men

We conducted a meta-analysis using results from the Korean literature to determine whether prostate-specific antigen (PSA) or digital rectal examination (DRE) or transrectal ultrasonography (TRUS) provides a better diagnostic outcome for possible prostate cancer patients. An extensive literature search of MedRIC database et al. (1980 to 2003) was performed using the medical subject headings "PSA", "DRE", "TRUS" and "prostate cancer". Of the 108 articles that we retrieved, 13 studies (2,029 subjects) were selected for this meta-analysis. The criteria for quality evaluation were as follows: the study subjects must have been compared clinically for suspected prostate cancer, and the articles must have included individual data about sensitivity and specificity for this diagnostic triad based on the biopsy results as a reference standard. For the quantitative meta-analysis process the Hasselblad method was utilized. The pooled sensitivity and specificity for a PSA level greater than 4 ng/mL were 91.3% and 35.9%, respectively; and those for a PSA level greater than 10 ng/mL were 77.3% and 67.5%, respectively; and those for DRE were 68.4% and 71.5%, respectively; and those for TRUS were 73.6% and 61.3%, respectively. According to the results in a fixed effect model for PSA criteria, the estimates of d for PSA4 and PSA10 were 0.8517 [95% confidence interval (CI): 0.6694, 1.0340] and 1.0996 (95% CI: 0.9459, 1.2534), respectively. Also, according to the results using a random effect model for both DRE and TRUS criteria, the estimates of d for DRE and TRUS were 0.8398 (95% CI: 0.7169, 0.9627) and 0.8002 (95% CI: 0.6714, 0.9289), respectively. The detection rate for combination testing of PSA, DRE and TRUS for the diagnosis of prostate cancer jumped further to 68.3% or to 76.8%. In conclusion, this study suggests that this diagnostic triad for prostate cancer was noneffective when they were used separately. Therefore, we recommend that the urologists should use PSA together with DRE and TRUS for the primary diagnosis of prostate cancer in men with lower urological symptoms

Postpartalni supklinički endometritis – dijagnostika i utjecaj na rane reproduktivne pokazatelje u mliječnih krava

The present study was aimed at the diagnosis of subclinical endometritis and its impact on early reproductive parameters in postpartum dairy cows (N=45). The proportion of polymorphonuclear cells (PMNCs-%) and intraluminal uterine fluid (ILUF-mm) was assessed by cytotape and transrectal ultrasonography, respectively, for the diagnosis of subclinical endometritis at 8 weeks post-partum. A receiver operator characteristics curve was used to determine the diagnostic threshold of PMNCs and ILUF. The optimal threshold value for PMNCs was ≥6% (area under the curve (AUC)-0.89; sensitivity-85.71%; specificity-83.33%; P<0.05) whereas it was ≥3.40 mm for ILUF (AUC-0.92; sensitivity-100%; specificity-83.33%; P<0.05). The diagnostic odds ratio (DOR) for the development of subclinical endometritis in cows having a PMNCs percentage and ILUF above the threshold level was 7.70 and 6.00, respectively. Early reproductive parameters, such as days needed for completion of uterine involution (UINV) and first postpartum ovulation (FPO) were studied and were reported to be significantly higher in cows diagnosed with subclinical endometritis based on the percentage of PMNCs (P<0.01; P<0.05 for UINV & FPO, respectively) and ILUF (P<0.05; P<0.01 for UINV & FPO, respectively). Linear correlation analysis showed a significant relationship (p≤0.01-0.05) between the proportion of PMNCs and early reproductive parameters. Similarly, a significant correlation (P<0.01) between ILUF and PMNCs was reported, irrespective of the threshold level. In conclusion, endometrial cytology and transrectal ultrasonography with a threshold level ≥6% for PMNCs and ≥3.40 mm for ILUF, respectively, defined the presence of subclinical endometritis, and this led to a delay in the establishment of subsequent early post-partum reproductive performance.Cilj ovog rada bio je istražiti dijagnostiku supkliničkog endometritisa i njegov utjecaj na rane reproduktivne pokazatelje mliječnih krava (n = 45) u postpartalnom razdoblju. Količina polimorfonuklearnih stanica (PMNC u postotku) i intraluminalne maternične tekućine (ILUF u milimetrima) procijenjena je s pomoću test traka i transrektalne ultrasonografije kako bi se dijagnosticirao supklinički endometritis osam tjedana poslije porođaja. ROC krivulja upotrijebljena je kako bi se odredio dijagnostički prag PMNC-a i ILUF-a. Optimalna vrijednost praga za PMNC bila je ≥ 6 % (područje ispod krivulje (AUC) 0,89; osjetljivost 85,71 %; specifičnost 83,33 %; P < 0,05), a za ILUF ≥ 3,40 mm for (AUC – 0,92; osjetljivost 100 %; specifičnost 83,33 %; P < 0,05). Omjer dijagnostičkih izgleda (DOR) za razvoj supkliničkog endometritisa u krava koje su imale postotak PMNC-a i ILUF iznad praga bio je 7,70 za PMNC i 6,00 za ILUF. Analizirani su rani reproduktivni pokazatelji, kao što je broj dana potreban za završetak involucije maternice (UINV) i prva postpartalna ovulacija (FPO), te se pokazalo da su bili znakovito veći u krava sa supkliničkim endometritisom uzme li se u obzir postotak PMNC-a (P < 0,01 za UINV i P < 0,05 za FPO) i ILUF (P < 0,05 za UINV i P < 0,01 za FPO). Analiza linearne korelacije pokazala je znakovit odnos (P ≤ 0,01 – 0,05) između vrijednosti PMNC-a i ranih reproduktivnih pokazatelja. Slično, uočena je znakovita korelacija (P < 0,01) između ILUF-a i PMNC-a, bez obzira na dijagnostički prag. Endometralnom je citologijom i transrektalnom ultrasonografijom s dijagnostičkim pragom ≥ 6 % za PMNC i ≥ 3,40 mm za ILUF dijagnosticiran supklinički endometritis, zbog čega je odgođeno uspostavljanje uvjeta za ranu reprodukciju nakon porođaja