Transrectal Ultrasound Research Articles

Implant geometry and detection rates of prostate fiducial markers after transrectal ultrasound-guided perineal implantation for image-guided 6D-tracking in robotic stereotactic body radiotherapy.

Fiducial markers (FM) are essential in prostate robotic stereotactic body radiotherapy (SBRT). Accuray® (Madison, WI, USA) provides an implantation guideline for reliable detection. We report on complication rates and analyze how the geometrical implantation quality correlated with subsequent detection rates. We also investigated whether factors such as single vs. double FM, body mass index (BMI), prostatic gland volume, and implantation-to-treatment interval were predictive for geometry and detection quality. Aretrospective analysis of 64patients receiving transrectal ultrasound (TRUS)-guided transperineal implantation of ≥ 3 prostate FM and robotic SBRT between January2011 and May2021 was performed. Adverse events (AE) were classified according to the Society of Interventional Radiology (SIR) classification system. Digitally reconstructed radiographs (DRR) and the planning CT constituted the basis for implant geometry calculations. Marker detection rates were obtained from the Synchrony® (Accuray®) log. Complication rates were low, with mostly mild AE. Double FM significantly improved the rate of obtaining an optimal implantation geometry. High FM detection rates during treatment could be achieved independent of implantation geometry and type of FM. BMI and prostatic gland volume did not correlate with geometry and detection quality. An implantation-to-treatment interval of > 42days was predictive for lower detection rates. Transperineal intraprostatic FM implantation is asafe procedure. We recommend the use of double markers for reduction of trauma (two punctures instead of four) and, hence, increased patient comfort. Double FM were significantly predictive for achieving an optimal implantation geometry, which was borderline significant for improved marker detection rates over the course of the five-fraction treatment.

P-1571. Risk Factors for Infections after Urological Procedures among Patients with Negative Urine Culture Screening

Abstract Background The increased demand for urological procedures had become significant complications and correlating with an elevated prevalence of multidrug-resistant organisms (MDROs) infections, prolonged hospital stay, and the cost of treatment. Table 1 Multivariate analysis of risk factors for infection after urological procedures among patients with negative urine culture screening Methods We conducted a retrospective cohort study to identify the risks for infections after urological procedures among patients with negative urine culture screening. The patients underwent transrectal ultrasound (TRUS) and biopsy of the prostate, transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and transurethral resection of bladder tumor (TURBT) between 2021 and 2023, at Thammasat University Hospital, Thailand. Results A total of 441 patients had the procedures. There were 55 patients (12.5%) developed infections including urinary tract infections (UTIs) (55/55; 100%) and sepsis (9/55; 16%). The significant risks of infections were chronic kidney disease (CKD) stage III-V (P=0.005), history of previous UTI within 3 months (P< 0.05), Revised Cardiac Risk Index (RCRI) for preoperative risk > 2 (P=0.002), and PCNL (P< 0.05). The patients received antibiotic prophylaxis with levofloxacin (26.5%) for TRUS and biopsy of the prostate and cefoxitin (73.5%) for other procedures. The most common causative pathogens of UTIs after the procedures were Escherichia coli (27/55; 49%), Pseudomonas aeruginosa (9/55; 16.4%) and Klebsiella pneumoniae (7/55; 12.7%). MDROs were identified including extended-spectrum cephalosporinase (24/55; 43.6%) and fluoroquinolone-resistant Gram-negative bacteria (12/55; 21.8%). The median hospital stay was 12 days (IQR 10-15) VS 3 days (IQR 3-4) for infection VS non-infection. Conclusion Our study emphasized the novel significance of CKD and RCRI scores as risk factors and severity indices for preoperative risk assessment, correlating with postoperative infections following urological proceOur study emphasized the novel significance of CKD and RCRI scores as risk factors and severity indices for preoperative risk assessment, correlating with postoperative infections following urological procedures. Disclosures All Authors: No reported disclosures

Evaluation of the Accuracy and Performance of Two Commercial Pregnancy-Associated Glycoprotein Tests for Early Pregnancy Detection in Cows.

The aim of this study was to determine and compare the diagnostic accuracies of two commercial pregnancy-associated glycoprotein tests, Alertys OnFarm Pregnancy Test (AOPT) and Alertys Milk Pregnancy Test (AMPT), for early pregnancy diagnosis in dairy cattle. Holstein cows (n=124) were used in the study. Whole blood samples were collected from the jugular vein 28 days after fixed-time artificial insemination (FTAI). In addition, teats of these cows were swabbed and milk samples were collected into sterile Falcon tubes. AOPT was performed on the farm within 2h after whole blood collection. Milk samples for AMPT analysis were taken to the laboratory and analysed within 2h. Transrectal ultrasonography was performed on the 32nd day after FTAI as a reference test. Comparative evaluation was made according to the AOPT and AMPT results, 28days after FTAI. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the AOPT were 92.4%, 80.0%, 87.9%, 89.0% and 85.7% and for AMPT were 97.5%, 82.2%, 91.9%, 90.6% and 94.9% respectively. Cohen's kappa statistic showed a 91.9% agreement (kappa=0.820, p<0.001) between the reference test and AMPT, and an 87.9% agreement (kappa=0.735, p<0.001) between the reference test and AOPT. AOPT and AMPT offers a reliable, non-invasive (in milk) and practical approach to pregnancy diagnosis in cows. These methods enable early pregnancy detection and can be easily integrated into farm routines, enhancing reproductive management and overall herd productivity.

P1186 Transperineal ultrasound is accurate in detecting perianal complications in Crohn’s disease: a systematic review and meta-analysis

Abstract Background Perianal complications such as fistulas and abscesses are common in Crohn’s disease (CD) and contribute to significant morbidity. Transperineal ultrasonography (TPUS) has emerged as a non-invasive and accurate method for perianal CD (PACD). This review evaluates the diagnostic accuracy of TPUS compared with MRI, transrectal ultrasonography (TRUS), and examination under anaesthesia (EUA) for detecting and classifying perianal fistulas and abscesses. Methods A comprehensive literature search was conducted across multiple databases from their inception to December 2023 to identify studies evaluating TPUS accuracy in detecting perianal fistula and abscesses using MRI, TRUS, or EUA as reference standards. Meta-analysis was performed to assess TPUS accuracy for fistula detection (FD), fistula classification (FC), internal opening (IO) detection and abscess detection (AD) with a subgroup analysis carried out in CD patients. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the risk of bias. Results Of the 994 studies identified, 25 (involving 1435 patients) met the inclusion criteria for the meta-analysis. These included 24 studies on FD, 11 on FC, 21 on AD and 10 on IO detection. Overall, these studies had a moderate risk of bias, with moderate applicability concerns due to high risk of bias in patient selection (non-consecutive enrollment) and reference standard chosen (non-blinding interpretation of scans). Significant heterogeneity was observed across study domains with I2 and X2 values of 98%, 88.0%, 93.0%, and 105.6, 16.0, 27.5 for FD, FC, and AD, respectively (p&amp;lt;0.001). Pooled sensitivities for FD, FC, IO detection and AD were 97.7%, 99.9%, 91.5% and 94.2% respectively while pooled specificities for FD, IO detection and AD were 77.8%, 73.1% and 78.6% respectively. Diagnostic Odd’s Ratio for FD, IO detection and AD were 148.13, 29.39 and 280.07 respectively. The overall accuracy of TPUS for FD, FC, IO detection and AD was 92.5%, 90.7%, 88.3% and 94.3% respectively (Table 1). A subgroup analysis focusing on CD patients (from 13 studies) showed pooled sensitivities of 96.6%, 99.9% and 85.5%, with overall accuracies of 85.2%, 86.5% and 83.4% for FD, FC and AD respectively. Stratification by publication date demonstrated improved accuracy in FD and AD in studies published after 2017 (91.6% vs 96.0% and 87.3% vs 96.8%). Conclusion TPUS demonstrates high accuracy in detecting perianal fistulas and abscesses in both CD and non-CD patients, supporting its use as a non-invasive, first-line diagnostic tool.

DOP047 Effectiveness of second-and-third line biologics in perianal Crohn’s disease (pCD) – a multicenter propensity score-matched study

Abstract Background Perianal involvement affects approximately 20-30% of Crohn’s Disease patients, significantly impairing their quality of life. Anti-tumor necrosis factor-α inhibitors (anti-TNFs) are still the established biological treatment for perianal Crohn's disease (pCD). However, relapse and non-response are frequent and evidence regarding the effectiveness of 2nd- and 3rd-line biologics is limited. This study aims to compare the efficacy of 2nd- and 3rd-line biologics in patients with pCD who have previously failed 1st-line anti-TNF therapy. Methods A retrospective multicenter study of adult pCD patients who failed 1st line anti-TNF therapy. The primary outcome was defined as clinical perianal response based on physician assessment. The main secondary outcome was radiological perianal response, based on magnetic resonance imaging (MRI) or transrectal ultrasound (TRUS). Additional secondary outcomes were clinical perianal remission and radiological perianal healing. Propensity-score matching (PSM) used to address baseline clinic-demographics differences between treatments. Results 486 patients with pCD were included. Of them, 333/486 patients (68.5%) in 2nd-line and 216/263 patients (82.1%) in 3rd-line treatment-groups were matched by PSM. Figure 1 illustrates patient inclusion in the study, stratified by active versus inactive disease status and 2nd-line versus 3rd-line treatment, along with the respective rates of primary outcome achievement. 62/78 (79.5%) patients with active pCD who were treated with ustekinumab (UST) as 2nd-line biologic met the primary outcome, compared to 46/78 patients (58.9%) with VDZ (OR 4.47, 95%CI 1.94-10.28, p&amp;lt;0.001) and 38/78 patients (48.7%) - anti-TNF (OR 5.29, 95%CI 2.39-11.71, p&amp;lt;0.001). 38/49 patients (77.6%) with active pCD who were treated with UST as 3rd line met the primary outcome, compared to 29/49 patients (59.2%) with VDZ (OR 9.96, 95%CI 2.6-38.4, p&amp;lt;0.001) and 27/49 (55.1%) with anti TNF (OR 12.03, 95%CI 2.99-48.47, p&amp;lt;0.001). Patients who were treated with UST as 3rd-line biologic had higher rates of radiological response and healing than patients who were treated with VDZ (OR of 3.28 95%CI 1.07-10.07, p=0.038) and anti-TNF (OR of 2.80 95%CI 0.95-8.21, p=0.061). Conclusion Clinical perianal outcomes in patients with active perianal Crohn’s disease were more frequently achieved with ustekinumab following the failure of 1st-line anti-TNFs.

Association of prostate-specific antigen density with prostate cancer mortality after a benign systematic prostate biopsy result.

To assess the association between prostate-specific antigen (PSA) density (PSAD) and prostate cancer mortality after a benign result on systematic transrectal ultrasonography (TRUS)-guided prostate biopsy. This retrospective study used data from the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) collected between 1996 and 2020. We identified men aged 55-71 years randomised to the screening arm with PSA ≥4.0 ng/mL and a benign systematic TRUS-guided biopsy result. The cumulative prostate cancer mortality of men stratified by a PSAD cutoff of 0.15 ng/mL/cm3 was modelled with competing risk functions. The ability of PSAD, PSA, and base variables (age at biopsy, DRE result, socioeconomic status, 5α-reductase inhibitor usage, family history, and Charlson Comorbidity Index (CCI)) to predict prostate cancer death was compared using c-statistics and a likelihood ratio test. After excluding 10 men without PSA data within 2 years of the biopsy and 65 without prostate volume data, 2276 men were eligible for inclusion in the study. A total of 50 men died from prostate cancer and 1028 from other causes during a median (interquartile range) follow-up of 17.4 (13.2-20.9) years. The cumulative prostate cancer mortality of men with PSAD <0.15 ng/mL/cm3 was significantly lower than that of men with PSAD ≥0.15 ng/mL/cm3: 0.5% (95% confidence interval [CI] 0.2%-1.1%) vs 2.0% (95% CI 1.2%-3.1%) at 15 years (Grey's test, P = 0.001). The model consisting of PSAD, PSA and the base variables predicted prostate cancer mortality (c-statistic 0.781) significantly better than either the base variables alone (c-statistic 0.737; likelihood-ratio test, P = 0.003) or the base variables and PSA (c-statistic 0.765; likelihood-ratio test, P = 0.039). Prostate cancer mortality after a benign systematic TRUS-guided biopsy is low. In these patients, PSAD predicts prostate cancer mortality and provides additional value to other clinical variables. PSAD-based stratification can be used to guide follow-up strategy.

Anti-Müllerian hormone levels in relation to ovarian structures, season and age in Lipizzaner broodmares.

The anti-Müllerian hormone (AMH) is a granulosa cell-derived hormone that has been associated with female fertility and reflects the population of growing follicles. This study aimed to evaluate the average concentration of AMH in Lipizzaner mares, as well as to determine the relationship between AMH concentration and follicle number and size. We also investigated the relationship between the age of mares and their AMH levels. The possible effect of seasonality of AMH levels was also assessed. Twenty-three mares between 6 and 24 years of age were included in the experiment. Mares were divided into two groups: Group 1 included mares aged 6 - 15 years (n = 11), while Group 2 included individuals older than 15 years of age (n = 12). Venous blood was collected and ovarian activity was monitored parallelly by transrectal ultrasonography. Serum AMH concentrations varied widely between the two different groups. AMH concentrations were significantly lower in old mares than in younger animals. Apositive relationship was detected between AMH concentration and the number of medium-sized follicles (P = 0.022), large follicles (P = 0.016) and the total follicle count (P = 0.026). No seasonal effect was detected.

Outlet type constipation in adult patients treated with type A botulinum toxin: a cohort study

PurposeChronic constipation is a common symptom. Constipation due to pelvic floor disorders remain a therapeutic challenge. Biofeedback therapy is considered as the first-choice treatment for pelvic floor disorders, whenever dedicated expertise is available. Type A botulinum toxin has been used to selectively weaken the external anal sphincter and puborectalis muscle in constipated patients.MethodEighty-two patients with chronic outlet obstruction constipation were treated with 100 units type A botulinum toxin, injected into the puborectalis muscle and the external anal sphincter.ResultsAt the 2-month evaluation, a symptomatic improvement was noted in 69 patients. Seven (8.5%) patients had mild flatus incontinence. Stool frequency per week increased from 2.4 ± 0.9 to 5.1 ± 1.0 (P = 0.0001). Anorectal manometry demonstrated decreased tone during straining from 91 ± 28 mmHg to 61 ± 27 mmHg (P = 0.0001). Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 96 ± 12° to 124 ± 14° (P = 0.0001).ConclusionType A botulinum toxin relaxes the puborectalis muscle. Pressure values decline after the treatment. Transrectal ultrasonography to guide injections is a safe procedure. Repeated injections were needed to maintain the clinical improvement.

Comparing the effectiveness of digital rectal examination, prostate specific antigen, and TRUS guided prostate biopsy, in the detection of prostate cancer

Prostate cancer has been the most common malignancy in men accounting for one fourth of cancers. Use of Trans rectal ultrasonography (TRUS) in men with an abnormal PSA and/or digital rectal examination acting as a guide to direct prostate biopsies will lead to decrease in number of early deaths It is a prospective observational study.All the patients attending the Urology Out patient Department with a suspicion of Ca prostate from clinical signs and symptoms were clinically evaluated using Digital Rectal Examination and screened for serum PSA levels. All the patients in whom abnormality was detected on DRE and/or an elevated serum PSA level were included in the study and TRUS biopsy was done. The statistical analysis was executed by SPSS version 20 continuous variables were analyzed with student t -test. The present study includes 95 men in whom abnormality detected in DRE or in the levels of serum PSA.10 core biopsy was done in 53 patients and 16 core biopsy was done in 42 patients. Among the total number of patients subjected to TRUS guided prostate biopsy either 10 core or 16 core, 31 patients detected with prostatic adenocarcinoma which accounts for 32.6%, 12 patients had High grade PIN accounting for 12.62%, 30 patients (31.57%) detected with fibroadenoleiomyomatous hyper plasia , 5 patients had fibroadenoleiomyomatous hyperplasia with chronic prostatitis which is 5.20% and chronic prostatitis is found in 15 patients attributing to 15.78%.Cancer detection rate with abnormalities in PSA alone was found to be 15% while it was 70% when both DRE and PSA showed abnormal results which is significantly higher. It shows that both DRE and PSA has to be considered while estimating the cancer rate. Detection rate with 16 core TRUS guided biopsy is 54.76% which is significantly (P value 0.0037) higher than that of 10 core biopsy (15.09 %).

Combined transrectal ultrasound and radiomics model for evaluating the therapeutic effects of neoadjuvant chemoradiotherapy in locally advanced rectal cancer

PurposeThis study aimed to explore a combined transrectal ultrasound (TRUS) and radiomics model for predicting tumor regression grade (TRG) after neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).MethodsAmong 190 patients with LARC, 53 belonged to GRG and 137 to PRG. Eight TRUS parameters were identified as statistically significant (P < 0.05) for distinguishing between the groups, including PSVpre, LDpost, TDpost, CEUS-IGpost, LD change rate, TD change rate, RI change rate, and CEUS-IG downgrade. The accuracies of these individual parameters in predicting TRG were 0.42, 0.62, 0.56, 0.68, 0.67, 0.70, 0.63, and 0.71, respectively. The AUC values were 0.596, 0.597, 0.630, 0.752, 0.686, 0.660, 0.650, and 0.666, respectively. The multi-parameter ultrasonic logistic regression (MPU-LR) model achieved an accuracy of 0.816 and an AUC of 0.851 (95% CI: [0.792–0.909]). The optimal pre- and post-treatment radiomics models were RF (Mean-PCA-RFE-6) and AE (Zscore-PCA-RFE-12), with accuracies of 0.563 and 0.596 and AUCs of 0.601 (95% CI: [0.561–0.641]) and 0.662 (95% CI: [0.630–0.694]), respectively. The combined model (US-RADpre-RADpost) showed the highest predictive power with accuracy and AUC of 0.863 and 0.913.ConclusionsThe combined model based on TRUS and radiomics demonstrated remarkable predictive capability for TRG after NCRT. It serves as a precision tool for assessing NCRT response in patients with LARC, impacting treatment strategies.

Ultrasound super-resolution imaging for non-invasive assessment of microvessel in prostate lesion

BackgroundProstate cancer (PCa) is the leading cause of cancer-related morbidity and mortality in men worldwide. An early and accurate diagnosis is crucial for effective treatment and prognosis. Traditional invasive procedures such as image-guided prostate biopsy often cause discomfort and complications, deterring some patients from undergoing these necessary tests. This study aimed to explore the feasibility and clinical value of using ultrasound super-resolution imaging (US SRI) for non-invasively assessing the microvessel characteristics of prostate lesion.MethodsThis study included 127 patients with prostate lesion who presented at Renmin Hospital of Wuhan University between November 2023 and June 2024 were included in this study. All the patients underwent transrectal US (TRUS), contrast-enhanced US (CEUS), and US SRI. CEUS parameters of time-intensity curve (TIC): arrival time (AT), rising time (RT), time to peak (TTP), peak intensity (PKI), falling time (FT), mean transit time (MTT), ascending slope (AS), descending slope (DS), D/A slope ratio (SR), and area under the TIC (AUC). US SRI parameters: microvessel density (MVD), microvessel diameter (D), microvessel velocity (V), microvessel tortuosity (T), and fractal number (FN), were analyzed and compared between prostate benign and malignant lesion.ResultsThe tumor markers of prostate in the malignant group were all higher than those in the benign group, and the differences were statistically significant (P < 0.001). The TIC parameters of CEUS revealed that the PKI, AS, DS, and AUC were significantly higher in the malignant group than in the benign group (P < 0.001), whereas the RT, TTP and FT in the malignant group were significantly lower (P < 0.001). Malignant lesion exhibited significantly higher MVD, larger D, faster V, greater T, and more complex FN than benign lesion (P < 0.001).ConclusionsUS SRI is a promising non-invasive imaging modality that can provide detailed microvessel characteristics of prostate lesion, offering an advancement in the differential diagnosis for prostate lesion. And, US SRI may be a valuable tool in clinical practice with its ability to display and quantify microvessel with high precision.

MULTI-PARAMETER DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING FOR PROSTATE CANCER STAGING TAKING HISTOPATHOLOGY AS THE GOLD STANDARD AT ISLAMABAD DIAGNOSTIC CENTER FAISALABAD

Background: Prostate cancer is one of the most prevalent malignancies in males and a leading cause of cancer-related mortality worldwide. Early detection and accurate staging are critical for improving outcomes and guiding treatment. Multiparametric MRI (mpMRI), particularly diffusion-weighted imaging (DWI), has emerged as a promising non-invasive diagnostic modality for detecting prostate cancer and assessing tumor aggressiveness. Compared to traditional diagnostic tools like transrectal ultrasound (TRUS), mpMRI offers superior sensitivity and diagnostic accuracy for identifying prostate malignancies. Objective: To evaluate the diagnostic performance of DWI MRI in detecting and characterizing prostate cancer in comparison with TRUS-guided histopathology. The study also assessed the effectiveness of different b-values and mpMRI sequences in staging and identifying prostate malignancies. Methods: A prospective cross-sectional study was conducted at Islamabad Diagnostic Center, Faisalabad, from July 2024 to December 2024. A total of 112 male patients, aged 30 years or older, presenting with elevated PSA levels, hematuria, urinary retention, weight loss, prostatitis, or pelvic pain, underwent mpMRI. Imaging sequences, including DWI, ADC mapping, T2-weighted (T2WI), and T1-weighted (T1WI) MRI, were analyzed by independent radiologists. TRUS-guided histopathology was used as the gold standard for correlation. Statistical analysis, including sensitivity, specificity, diagnostic accuracy, and correlation analysis, was performed using SPSS version 22.0. Results: The mean age of participants was 59.8 years (±1.116 SD), with the 70–80 age group comprising 42 (37.5%) patients. Clinical symptoms included elevated PSA levels in 65 (58%), urinary retention in 83 (74.1%), prostatitis in 70 (62.5%), pelvic pain in 35 (31.3%), hematuria in 30 (26.8%), and weight loss in 9 (8%). DWI and ADC mapping demonstrated the highest sensitivity (92%) compared to T2WI (88.5%) and T1WI (66.7%), while T1WI exhibited the highest specificity (72%). Diagnostic accuracy was highest for DWI (77.6%), followed by T2WI (75.8%), ADC (73.2%), and T1WI (67.8%). DWI demonstrated a significant correlation with TRUS findings (p=0.001) and PSA levels (p=0.038). Conclusion: DWI MRI proved to be a non-invasive, highly sensitive imaging modality for the early detection and characterization of prostate cancer, surpassing TRUS in diagnostic accuracy. Its ability to assess tumor aggressiveness and guide treatment decisions underscores its indispensable role in prostate cancer diagnosis. The incorporation of mpMRI, alongside PSA testing and TRUS, offers a more comprehensive diagnostic approach for improved outcomes in prostate cancer management.

Incidence and timing of pregnancy loss following timed artificial insemination or timed embryo transfer with a fresh or frozen in vitro-produced embryo

The aim of this study was to characterize the incidence and timing of pregnancy loss from service event (timed artificial insemination or timed embryo transfer) to parturition. Lactating Holstein-Friesian cows were randomly assigned to receive either artificial insemination (AI, n = 243) or embryo transfer (ET, n = 863) with a fresh or frozen in vitro-produced blastocyst derived from oocytes collected from the ovaries of elite dairy donors (n = 14 Holstein Friesian and n = 8 Jersey) and elite beef donors (n = 21 Angus) using transvaginal ovum pick-up. In addition, oocytes were collected from the ovaries of beef heifers of known pedigree following slaughter at a commercial abattoir (n = 119). Blood samples were collected on d 7 from all cows to determine progesterone concentration and from subsets of cows on d 18 (n = 524) and d 25 (n = 378) to determine mRNA abundance of interferon-stimulated gene-15 and pregnancy-specific protein B concentration, respectively, to provide an early pregnancy diagnosis. Transrectal ultrasonography was conducted to determine pregnancy status on d 32, d 62 and d 125 after synchronized ovulation. Parturition date was recorded for all cows that reached a term delivery. The predicted probability of pregnancy (%) varied at each time point (d7, 18, 25, 32, 62, 125, parturition) depending on treatment (AI: 77.0, 60.2, 52.3, 48.8, 47.0, 44.6, 44.0; fresh ET: 100.0, 69.5, 60.3, 56.1, 48.4, 46.8, 45.5; frozen ET: 100.0, 61.7, 52.2, 41.6, 32.9, 31.8, 30.2). Irrespective of treatment, the largest proportion of pregnancy loss occurred in the period from service event (AI on d 0 or ET on d 7) to d 18, with minimal loss occurring between d 62 and parturition (AI: 1.8%, fresh ET: 1.9%, frozen ET: 3.5%). Treatment differences in the predicted probability of pregnancy per service event were detected between fresh ET vs frozen ET on d 32 and both AI and fresh ET vs frozen ET on d 62, 125 and at parturition. There was greater probability of pregnancy loss between d 32 and 62 following ET (Fresh: 11.3%, Frozen: 18.0%) than AI (4.0%). The percentage of cows that calved following transfer of a fresh embryo (45.5%) was similar to AI (44.0%), but less when a frozen embryo was transferred (30.2%). In conclusion, AI and fresh ET led to a greater probability of a cow becoming pregnant and maintaining the pregnancy to term than frozen ET. Cows that were still pregnant on d 62 had a very strong likelihood of maintaining the pregnancy to full-term parturition, irrespective of treatment. Further work is required to improve the likelihood of pregnancy establishment and reduce embryonic and fetal mortality following transfer of a cryopreserved in vitro-produced embryo.

Feasibility of balloon rectal spacer implantation in HDR and LDR brachytherapy for prostate cancer treatment

This study evaluates the use of a biodegradable balloon rectal spacer in two prostate cancer patients undergoing low dose radiation (LDR) and salvage high dose radiation (HDR) brachytherapy. The spacer aims to reduce radiation dose to adjacent organs, particularly the rectum, in patients previously treated with radiation. The balloon spacer was implanted transperineally under transrectal ultrasonography (TRUS) guidance in two patients. For the LDR case (73-year-old, intermediate-risk), the balloon was placed postimplant with 55 iodine-125 seeds delivering 145 Gy. For the HDR case (66-year-old, high-risk), the balloon was placed one week before treatment, which delivered 23 Gy in two weekly fractions using 16 channels. The balloon provided a 14-15mm separation between rectum and prostate. In the LDR case, prostate D90 was 149.1Gy (102.83%), V100 was 91.95%, and rectum D30 was 23.93Gy (16.50%). For the HDR case, prostate D90 was 11.63Gy (105.79%), V100 was 93.63%, and rectum D0.5cc was 8.04Gy (73.15%). Both patients tolerated the treatment well, with no observed postoperative complications at 6-month follow-up. The use of a rectal balloon spacer in both salvage HDR and LDR brachytherapy is feasible and safe, allowing for controlled placement and providing rectal protection from high radiation doses.

Reconstruction errors in clinical intraoperative TRUS–based prostate HDR-BT detected using electromagnetic tracking

To investigate the occurrence of errors in transrectal ultrasound (TRUS)-based implant reconstructions for high-dose-rate brachytherapy (HDR-BT) in prostate cancer using an afterloader-integrated electromagnetic tracking (EMT) system. Fourteen patients were treated with one TRUS-based treatment fraction in an intraoperative setting while under general anesthesia, as part of their prostate HDR-BT (2×13.5 Gy) treatment. EMT measurements were performed before the start of the treatment in all implanted needles at dwell positions (DPs) with an interval of 5 mm. The Euclidean distances (EDs) between clinically reconstructed and EMT-measured DPs after registration were calculated. Errors were evaluated per needle (minimum ED of 2mm) and stratified into 4 severity levels (minor, moderate, major and severe). Error causes were investigated through retrospective inspection of TRUS imaging. The median (range) ED between EMT-measured and clinically reconstructed DPs was 1.0 (0.1-9.4) mm. Higher EDs were observed in the anterior and lateral regions of the prostate. From 265 evaluated needle reconstructions, 23% (61/265) had minor errors or higher, while 9% (24/265) had major or severe errors. Severe errors were mostly caused by incorrect needle or depth selection. Major, moderate and minor errors were mostly caused by artifact, shadowing, and user errors, respectively. This study found that a quarter of needle reconstructions contained errors >2mm, and that high and severe errors were not uncommon. EMT can play an important role in detecting and preventing these reconstruction errors without disrupting the clinical workflow.

ProCUSNet: Prostate Cancer Detection on B-mode Transrectal Ultrasound Using Artificial Intelligence for Targeting During Prostate Biopsies.

To assess whether conventional brightness-mode (B-mode) transrectal ultrasound images of the prostate reveal clinically significant cancers with the help of artificial intelligence methods. This study included 2986 men who underwent biopsies at two institutions. We trained the PROstate Cancer detection on B-mode transrectal UltraSound images NETwork (ProCUSNet) to determine whether ultrasound can reliably detect cancer. Specifically, ProCUSNet is based on the well-established nnUNet frameworks, and seeks to detect and outline clinically significant cancer on three-dimensional (3D) examinations reconstructed from 2D screen captures. We compared ProCUSNet against (1) reference labels (n=515 patients), (2) eight readers that interpreted B-mode ultrasound (n=20-80 patients), and (3) radiologists interpreting magnetic resonance imaging (MRI) for clinical care (n=110 radical prostatectomy patients). ProCUSNet found 82% clinically significant cancer cases with a lesion boundary error of up to 2.67mm and detected 42% more lesions than ultrasound readers (sensitivity: 0.86 vs 0.44, p<0.05, Wilcoxon test, Bonferroni correction). Furthermore, ProCUSNet has similar performance to radiologists interpreting MRI when accounting for registration errors (sensitivity: 0.79 vs 0.78, p>0.05, Wilcoxon test, Bonferroni correction), while having the same targeting utility as a supplement to systematic biopsies. ProCUSNet can localize clinically significant cancer on screen capture B-mode ultrasound, a task that is particularly challenging for clinicians reading these examinations. As a supplement to systematic biopsies, ProCUSNet appears comparable with MRI, suggesting its utility for targeting suspicious lesions during the biopsy and possibly for screening using ultrasound alone, in the absence of MRI.

SYNCHRONIZATION OF GnRH AND PGF2Α ON THE REPRODUCTIVE PERFORMANCE IN ACEH CATTLE

This study aims to determine the effect of administering gonadotropin-releasing hormone (GnRH) accompanied by prostaglandin F2 alpha (PGF2α) on the reproductive performance of female Aceh cattle. In this study, eight female Aceh cattle were used, divided into two groups, group I (K1, n= 3) which received estrus synchronization treatment with PGF2α and group II (K2, n= 5) which received estrus synchronization treatment with PGF2α (25 mg/cow) and gonadotropin-releasing hormone (GnRH, 100 µg/cow). GnRH injection in K2 was performed 48 hours after PGF2α injection. The estrus displays measured included onset, duration, and intensity of estrus. Blood collection for estrogen examination was taken from day 1 to day 5 after PGF2α injection, while progesterone examination was taken on days 7, 14, and 21 after artificial insemination. Ovarian response and pregnancy examinations were performed using transrectal ultrasonography (USG). Data on estrus appearance and steroid concentration were analyzed using the Mann-Whitney U test, and differences in pregnancy percentage were analyzed using the chi-square test. In contrast, the number of follicles, dominant follicle diameter, and corpus luteum were analyzed using a split-plot test. Oestrus intensity, oestrus onset, oestrus duration, pregnancy percentage, estrogen and progesterone concentrations, ovarian response in class II follicles, class III follicles, and CL size in K1 vs K2 showed no significant differences (P0.05). The effect of time on ovarian response in class III follicles and CL size showed a significant difference (P0.05). In contrast, the interaction between hormone administration and day of treatment on ovarian response in class II follicles, class III follicles, and CL size showed no significant difference (P0.05). Based on the research results, it was concluded that administration of GnRH accompanied by PGF2α tends to increase the reproductive performance of Aceh cattle.

Diagnostic approach and therapeutic intervention for pyometra in multiparous dairy cattle: a case study

Pyometra is a prevalent and clinically important reproductive disorder in multiparous cattle, and is characterised by the accumulation of purulent exudate within the uterine lumen. This article examines the diagnosis and management of pyometra in a six-year-old Friesian Holstein cow from a traditional dairy farm in Lembang. The cow, with a history of abortion at 35 days of gestation during the last calving, presented with continuous white mucous vaginal discharge. Clinical assessment via rectal palpation revealed an enlarged uterus, which was initially suggestive of pregnancy. Diagnostic evaluations included haematology and transrectal ultrasonography. Haematological results showed elevated white blood cell counts, indicating a bacterial infection. Ultrasonography confirmed pus within the uterus and thickened uterine wall. Treatment consisted of uterine flushing and hormonal injections to induce contractions, facilitate the expulsion of accumulated fluids, and restore regular estrous cycles. A significant reduction in the size of the cornu uteri was observed one-week post-treatment, demonstrating the effectiveness of the intervention.

Automatic MRI-TRUS Fusion Technique for Transperineal Biopsy Guidance: From Preoperative Planning to Intraoperative Navigation.

Targeted and systematic transperineal biopsy of lesions guided by magnetic resonance imaging (MRI) and transrectal ultrasonography (TRUS) fusion technique may optimize the biopsy procedure and enhance the detection of prostate cancer. We described the transperineal biopsy guided by an automatic MRI-TRUS fusion technique, and evaluated the accuracy and feasibility of this method in a prospective single-center study. The proposed method focuses on automating the delineation of prostate contours in both the MRI and TRUS images, the registration and fusion of MRI and TRUS images, the generation and visualiztion of the systematic biopsy cores in their corresponding locations within the 2D and the 3D views, as well as the computation and visualiztion of needle trajectories from preoperative planning to intraoperative navigation. A total of 76 patients with clinically suspected prostate cancer underwent systematic (SBx) and targeted (TBx) biopsies, all performed by a single urologist with more than 10 years of experience. The detection rates of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were recorded. We also measured preoperative registration time, duration of the overall surgical procedure, and postoperative complication rates within the first week following the surgery. Descriptive analyses were presented in this study. PCa was identified in 73.7% (56/76) of the subjects, while csPCa was identified in 61.8% (47/76). The preoperative registration time was 5.0 min (IQR: 4.4-6.0), while the overall surgery duration was 24.8 min (IQR: 23.2-27.2). Postoperatively, 12 patients experienced immediate hematuria, and one patient reported dysuria 1 day following surgery. The automatic MRI-TRUS fusion technique for transperineal biopsy is feasible and safe, with preoperative planning to intraoperative navigation it offering convenient and efficient preoperative preparation and surgical procedure.

The Correlation Between Body Mass Index and Prostate Volume: A Retrospective Analysis of Pre and Postoperative Measurements in Prostate Cancer Patients

ABSTRACTBackgroundThis study aims to assess the relationship between body mass index (BMI) and prostate volume, utilizing pre and postoperative measurements.MethodsA retrospective, observational study was conducted at a single site using data from an institutional database. Medical records of patients who underwent robot‐assisted radical prostatectomy were reviewed. Data included age, BMI, and prostate volumes measured through digital rectal exam (DRE), transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and surgical specimen weight (SPW).ResultsA total of 168 patients were identified and included in the analysis. Spearman's correlation test revealed a significant association between BMI and prostate volume for all measurement methods, reporting r = 0.146 (p = 0.047) for DRE, r = 0.268 (p &lt; 0.0001) for TRUS, r = 0.177 (p = 0.021) for MRI and r = 0.234 (p = 0.002) for SPW. Linear regression analysis confirmed the significant association between BMI and prostate volume, reporting, respectively, R2 = 0.026 (p = 0.036) for DRE, R2 = 0.076 (p &lt; 0.0001) for TRUS, R2 = 0.038 (p = 0.011) for MRI and R2 = 0.040 (p = 0.009) for SPW. Notably, considering the SPW the best way to estimate prostate volume, for every increase in BMI, the predicted increase of prostate volume is 0.865gr.ConclusionsThis study demonstrates a positive linear correlation between BMI and prostate volume, highlighting the importance of considering BMI in prostate volume assessments.