Transrectal Ultrasound Research Articles

Ovarian function and endocrine phenotypes of lactating dairy cows during the estrous cycle are associated with genomic-enhanced predictions of fertility potential

The objectives of this prospective cohort study were to characterize associations among genomic merit for fertility with ovarian and endocrine function and the estrous behavior of dairy cows during an entire nonhormonally manipulated estrous cycle. Lactating Holstein cows entering their first (n = 82) or second (n = 37) lactation had ear-notch tissue samples collected for genotyping using a commercial genomic test. Based on genomic predicted transmitting ability values for daughter pregnancy rate (gDPR), cows were classified into high (Hi-Fert; gDPR > 0.6, n = 36), medium (Med-Fert; gDPR -1.3 to 0.6, n = 45), and low fertility (Lo-Fert; gDPR < -1.3, n = 38) groups. At 33 to 39 DIM, cohorts of cows were enrolled in the Presynch-Ovsynch protocol for synchronization of ovulation and initiation of a new estrous cycle. Thereafter, the ovarian function and endocrine dynamics were monitored daily until the next ovulation by transrectal ultrasonography and concentrations of progesterone (P4), estradiol, and FSH. Estrous behavior was monitored with an ear-attached automated estrus detection system that recorded physical activity and rumination time. Overall, we observed an association between fertility group and the ovarian and hormonal phenotype of dairy cows during the estrous cycle. Cows in the Hi-Fert group had greater circulating concentrations of P4 than cows in the Lo-Fert group from d 4 to 13 after induction of ovulation and from day -3 to -1 before the onset of luteolysis. The frequency of atypical estrous cycles was 3-fold greater for cows in the Lo-Fert than the Hi-Fert group. We also observed other modest associations between genomic merit for fertility with the follicular dynamics and estrous behavior. We found several associations between milk yield and parity with ovarian, endocrine, and estrous behavior phenotypes as cows with greater milk yield and in the second lactation were more likely to have unfavorable phenotypes. These results demonstrate that differences in reproductive performance between cows of different genomic merit for fertility classified based on gDPR may be partially associated with circulating concentrations of P4, the incidence of atypical phenotypes during the estrous cycles, and, to a lesser extent, the follicular wave dynamics. The observed physiological and endocrine phenotypes might help explain part of the differences in reproductive performance between cows of superior and inferior genomic merit for fertility.

The Diagnostic Value of Multiparametric-MRI in Locating Prostate Cancer in Comparison with Transrectal Ultrasound-Guided Biopsy

Purpose: The present study was designed to evaluate the potential efficacy of Multiparametric-Magnetic Resonance Imaging (MP-MRI) in the detection of prostate cancer locations compared to Transrectal Ultrasound (TRUS) guided biopsy, as the gold standard method.&#x0D; Materials and Methods: A total of 66 subjects participated in this cross-sectional study. All individuals underwent MP-MRI imaging before the prostate TRUS. The findings of either method have been investigated and the comparison had been made using the Chi-squared test.&#x0D; Results: The sensitivity and specificity of the MP-MRI in the diagnosis of prostate cancer were 81.8% and 93.9%, respectively. The positive and negative predictive values were 93.1% and 83.8%, respectively.&#x0D; Conclusion: The current study indicates that the MP-MRI imaging method has sufficient sensitivity and specificity for detecting the location of prostate cancer and can potentially be employed as a clue-providing method prior to the TRUS-guided biopsy.

LensePro: label noise-tolerant prototype-based network for improving cancer detection in prostate ultrasound with limited annotations.

The standard of care for prostate cancer (PCa) diagnosis is the histopathological analysis of tissue samples obtained via transrectal ultrasound (TRUS) guided biopsy. Models built with deep neural networks (DNNs) hold the potential for direct PCa detection from TRUS, which allows targeted biopsy and subsequently enhances outcomes. Yet, there are ongoing challenges with training robust models, stemming from issues such as noisy labels, out-of-distribution (OOD) data, and limited labeled data. This study presents LensePro, a unified method that not only excels in label efficiency but also demonstrates robustness against label noise and OOD data. LensePro comprises two key stages: first, self-supervised learning to extract high-quality feature representations from abundant unlabeled TRUS data and, second, label noise-tolerant prototype-based learning to classify the extracted features. Using data from 124 patients who underwent systematic prostate biopsy, LensePro achieves an AUROC, sensitivity, and specificity of 77.9%, 85.9%, and 57.5%, respectively, for detecting PCa in ultrasound. Our model shows it is effective for detecting OOD data in test time, critical for clinical deployment. Ablation studies demonstrate that each component of our method improves PCa detection by addressing one of the three challenges, reinforcing the benefits of a unified approach. Through comprehensive experiments, LensePro demonstrates its state-of-the-art performance for TRUS-based PCa detection. Although further research is necessary to confirm its clinical applicability, LensePro marks a notable advancement in enhancing automated computer-aided systems for detecting prostate cancer in ultrasound.

Discrepancies in Gleason score between needle core biopsy and radical prostatectomy specimens with correlation between clinical and pathological staging.

The studies have shown that GS given after assessment of the entire prostate gland on the radical prostatectomy specimen may differ from GS given after examination of a small sample from needle core biopsy. We conducted this study to assess discrepancies in the Gleason score between NCB and RP specimens and to find out the correlation between the clinical stage and pathological stage. The study included 174 patients with carcinoma prostate which underwent robotic-assisted radical prostatectomy (RARP). Pre-operative Gleason score was determined on 12-core biopsy samples under trans-rectal ultrasound (TRUS) guidance. The Gleason score obtained from the radical prostatectomy specimen was compared with that of the NCB Gleason score to find out differences. The preoperative Gleason score (GS) ranges from 6 to 9 with a mean GS of 6.97 ± 1.02. The post-operative GS ranges between 6 and 10 with mean and GS of 7.5 ± 1.10. On the pre-operative assessment of biopsy specimens, 70 (43.2%) patients had a GS of 6, while 44 patients had a GS of 7 (27.1%) and 48 (29.8%) patients had a GS of more than 7. On the postoperative assessment of specimens, 31 (19.1%) patients had post-operative GS of 6, while 66 (41%) patients had GS of 7 and 74 (41.1%) patients had GS of more than 7. When pre-operative GS and post-operative GS were compared, no changes were observed in the GS of 79 patients, whereas 83 patients showed the difference in GS, with 75 patients showing up-gradation and eight patients marked as down-graded. concordance between biopsy and the pathology results directly affects the prognosis of the patient. The results of our study demonstrated the rate of discordance between Gleason scores obtained from transrectal prostate biopsy and RP surgical specimens. This rate brings into question the accuracy of the chosen treatment.

Assessment of the accuracy of biparametric MRI/TRUS fusion-guided biopsy for index tumor evaluation using postoperative pathology specimens

BackgroundMultiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens.MethodsWe included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients.ResultsThe preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both).ConclusionThe diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.

Nutritional Supplement With Fermented Soy in Men With an Elevated Risk of Prostate Cancer and Negative Prostate Biopsies: General and Oncological Results From the Prospective PRAECAP Trial

Introduction & ObjectivesTo investigate the effect of a dietary supplement containing fermented soy on PSA, IPSS, changes in prostate volume and prostate cancer development after a 6-month challenge in men at increased risk of prostate cancer and negative previous biopsies. Materials & MethodsPatients with an elevated risk of PCa, defined by either 1 of the following criteria: PSA > 3 ng/ml, suspect lesion at digital rectal examination (DRE), suspect lesion at transrectal ultrasound (TRUS) / magnetic resonance imaging (MRI) and previous negative prostate biopsies (at least 8 cores) within 12 months before inclusion. Statistical analysis was carried out using a non-parametric one-sided paired Wilcoxon rank sum test, chi-square test and Fisher's exact test. ResultsIn this trial, 94 patients where eligible for analysis. A PSA response was detected in 81% of the cases. In 25.8% (24/93) of patients, a decrease of at least 3 points on the IPSS was observed. The median prostate volume did not statistically change after 6 months (p=0.908). Patients with PSA modulation required fewer investigations and had fewer positive biopsies (p<0.001) and significantly fewer ISUP≥3 lesions (p=0.02). ConclusionsWe observed a significantly lower PSA level after a 6-month challenge with a fermented soy-containing supplement, and an effect on IPSS in a subset of patients. Prescribing a fermented soy supplement in patients with an increased PCa risk could lead to a better selection of patients at real increased risk of having occult PCa.

Comparison of Ga-68 PSMA PET/CT and Multiparametric MRI for Initial Detection and Staging of Prostate Cancer

Abstract Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells. Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard. Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men (n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software. Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT. Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate. Summary Statement: Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.

Multispecies comparative prostate anatomy by imaging: Implications for experimental models of prostatic disease.

There is an increasing interest in using preclinical models for development and assessment of medical devices and imaging techniques for prostatic disease care. Still, a comprehensive assessment of the prostate's radiological anatomy in primary preclinical models such as dogs, rabbits, and mice utilizing human anatomy as a reference point remains necessary with no optimal model for each purpose being clearly defined in the literature. Therefore, this study compares the anatomical characteristics of different animal models to the human prostatic gland from the imaging perspective. We imaged five Beagle laboratory dogs, five New Zealand White rabbits, and five mice, all sexually mature males, under Institutional Animal Care and Use Committee (IACUC) approval. Ultrasonography (US) was performed using the Vevo® F2 for mice (57 MHz probe). Rabbits and dogs were imaged using the Siemens® Acuson S3000 (17 MHz probe) and endocavitary (8 MHz) probes, respectively. Magnetic resonance imaging (MRI) was also conducted with a 7T scanner in mice and 3T scanner in rabbits and dogs. Canine transrectal US emerged as the optimal method for US imaging, depicting a morphologically similar gland to humans but lacking echoic zonal differentiation. MRI findings in canines indicated a homogeneously structured gland similar to the human peripheral zone on T2-weighted images (T2W) and apparent diffusion coefficient (ADC). In rabbits, US imaging faced challenges due to the pubic symphysis, whereas MRI effectively visualized all structures with the prostate presenting a similar aspect to the human peripheral gland on T2W and ADC maps. Murine prostate assessment revealed poor visualization of the prostate glands in ultrasound due to its small size, while 7T MRI delineated the distinct prostates and its lobes, with the lateral and dorsal prostate resembling the peripheral zone and the anterior prostate the central zone of the human gland. Dogs stand out as superior models for advanced preclinical studies in prostatic disease research. However, mice present as a good model for early stage studies and rabbits are a cost-effective alternative and serve as valuable tools in specific research domains when canine research is not feasible.

Using mycobacterium cell wall fraction to decrease equine chorionic gonadotropin after abortion.

Equine embryonic loss following the development of endometrial cups delays return to cyclicity due to the production of equine chorionic gonadotropin (eCG). Natural degradation of endometrial cups coincides with an influx of immune cells at 100-120 days of gestation, but therapeutic stimulation of reduced eCG production has been relatively unsuccessful. Recently, we observed an increase in pro-inflammatory cytokine production following the use of the immunostimulant mycobacterium cell wall fraction (MCWF). To evaluate the efficacy of hysteroscopic-guided injection of MCWF on the accelerated decline of eCG secretion. In vivo experiment. Mares were pharmacologically aborted at 40-45 days of gestation, and then divided into groups: MCWF-treated (6 mg MCWF suspended in 20 mL LRS; n = 10) and Control (20 mL LRS; n = 6). Five days after abortion, hysteroscopic-guided injection of endometrial cups was performed, with 1 mL of volume placed into each visible endometrial cup. This was repeated 7 days later. Trans-rectal ultrasonography was performed to monitor ovarian activity, and serum was obtained to assess eCG and cytokine concentrations. Concentrations of eCG decreased in the MCWF-treated group (p < 0.01) with a significant suppression noted as early as 14 days after onset of treatment and remained suppressed for the duration of the study. This coincided with an increase in peripheral IFN-γ (p < 0.01) and IL-1β (p < 0.01) concentrations. Eight out of ten MCWF-treated mares (80%) developed pre-ovulatory follicles, in comparison to 2/6 controls (33%). A pre-ovulatory follicle was noted 23 ± 4 days after onset of treatment. No pregnancy data was obtained following treatment. This is the first report of a treatment for the accelerated reduction of eCG following abortion. Stimulation of this process allowed mares to develop a pre-ovulatory follicle within a month of MCWF treatment onset, granting repeat attempts at breeding within the confines of a single breeding season.

Risk-Adapted Strategy Combining Magnetic Resonance Imaging and Prostate-Specific Antigen Density to Individualize Biopsy Decision in Patients With PI-RADS 3 ``Gray Zone'' Lesions

IntroductionRecent guidelines suggest that biopsy may be omitted in some groups of patients with PI-RADS 3 lesions on mpMRI. In this study, we aimed to evaluate biopsy strategies involving prostate-specific antigen density (PSAd) to avoid unnecessary biopsy versus the risk of missing clinically significant prostate cancer (csPCa) in patients with PI-RADS 3 lesions. Material and MethodsData of 616 consecutive patients who underwent PSAd and mpMRI before prostate biopsy between January 2017 and January 2022 at a single center were retrospectively assessed. All of these patients underwent combined cognitive or fusion targeted biopsy of suspicious lesions and transrectal ultrasonography guided systematic biopsy. PI-RADS 3 based strategies with PSAd and mpMRI combination were created. For each strategy, avoided unnecessary biopsy, reduced ISUP Grade 1, and missed ISUP Grade ≥ 2 ratios were determined. Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. ResultsDCA revealed that patients who had PI-RADS 3 lesions with PSAd ≥ 0.2, and/or patients who had PI-RADS 4 and 5 lesions had the most benefit, under the threshold probability level between 10% and 50%, which avoided 48.2% unnecessary prostate biopsies and reduced 51% of ISUP grade 1 cases, while missed 17.5% of ISUP grade ≥ 2 cases. (22.1% for ISUP grade 2 and 8.8% for ISUP grade ≥ 3). Strategy 1 (PI-RADS 4-5 and/or PSAd ≥ 0.2), 3 (PI-RADS 4-5 and/or PI-RADS 3 if PSAd ≥ 0.15), and 7 (PI-RADS 4-5 and/or PI-RADS 3 if PSAd ≥ 0.15 and/or PI-RADS 2 if PSAd ≥ 0.2) were the next three best strategies. ConclusionmpMRI combined with PSAd strategies reduced biopsy attempts in PI-RADS 3 lesions. Using these strategies, the advantage of avoiding biopsy and the risk of missing the diagnosis of csPCa can be discussed with the patient, and the biopsy decision can be made afterwards.

99 Diversity of vaginal bacteria in lactating dairy cattle on pregnancy establishment

Abstract Establishment and maintenance of pregnancy has a substantial economic impact within the dairy industry each year. Recent research has indicated a potential role of the reproductive microbiome on impacting pregnancy status as a result of hormone concentrations and breeding strategies. However, the association between alpha (within sample metric) and beta (between samples metric) bacterial diversity with pregnancy establishment has not been extensively evaluated in dairy cattle. Thereby, the objective of this study was to analyze vaginal bacterial diversity in lactating dairy cows 1) between day of artificial insemination (AI; day 0) and maternal recognition of pregnancy (MRP; d 18), and 2) between resulting Open and Pregnant females. Lactating Holstein dairy cows (n = 53) were sampled of day of AI and day of MRP. Pregnancy determination occurred on day 32 via transrectal ultrasonography. Sterile swabs were inserted into the vagina, rotated eight times against the vaginal wall, and stored in sterile microcentrifuge tubes at -80°C. Swab samples were utilized for subsequent bacterial diversity analyses targeting the V4 hypervariable region of the 16S rRNA gene. Cows underwent transrectal ultrasonography on gestational day 32 for pregnancy determination. Sample quality was determined by FastQC before being processed with the qiime2 pipeline for taxonomic classification. Alpha diversity metrics were analyzed with Kruskal-Wallis and beta diversity was measured utilizing PERMANOVA in the qiime2 pipeline. At day 32 of gestation, the pregnancy rate was 47.2%. According to Faith’s Phylogenetic Diversity metric for alpha diversity, there was no significant difference in diversity richness (i.e., number of different bacterial species within a sample) between day of AI and MRP or between cows diagnosed as Open or Pregnant (P &amp;gt;0.05). Pielou’s Evenness metric (i.e., distribution or balance of bacterial species within a sample) for alpha diversity indicated greater diversity within samples at day of AI compared with day of MRP (P = 0.02). Shannon’s diversity index metric (i.e., richness and evenness within a sample) for alpha diversity also indicated greater diversity at day of AI compared with day of MRP (P = 0.04). However, there was no difference between resulting Open and Pregnant females for Pielou’s or Shannon’s metrics (P &amp;gt; 0.05). Distinctions between samples (beta diversity) were compared utilizing pairwise comparisons of the unweighted and weighted Unifrac distance metrics. Specifically, day of AI indicated lower diversity compared with day of MRP for both metrics (P &amp;lt; 0.01). However, upon comparisons of Open and Pregnant status, there was no difference between samples for unweighted or weighted Unifrac distances (P &amp;gt; 0.05). Based on these results, bacterial diversity within and between vaginal samples appear to shift between day of AI and day of MRP. Additional studies are needed to elucidate the mechanisms altering bacterial diversity during early gestation in lactating dairy cows.

Current Status and Future Directions of Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer.

The standard of care for patients with locally advanced cervical cancer is definitive chemoradiation followed by a brachytherapy boost. This review describes the current status and future directions of image-guided adaptive brachytherapy for locally advanced cervical cancer. A systematic search of the PubMed and Clinicaltrials.gov databases was performed, focusing on studies published within the last 10 years. The search queried "cervical cancer [AND] image-guided brachytherapy [OR] magnetic resonance imaging (MRI) [OR] adaptive brachytherapy". The retroEMBRACE and EMBRACE-I trials have established the use of MRI as the standard imaging modality for brachytherapy application and planning. Quantitative imaging and radiomics have the potential to improve outcomes, with three ongoing prospective studies examining the use of radiomics to further risk-stratify patients and personalize brachytherapy. Another active area of investigation includes utilizing the superior soft tissue contrast provided by MRI to increase the dose per fraction and decrease the number of fractions needed for brachytherapy, with several retrospective studies demonstrating the safety and feasibility of three-fraction courses. For developing countries with limited access to MRI, trans-rectal ultrasound (TRUS) appears to be an effective alternative, with several retrospective studies demonstrating improved target delineation with the use of TRUS in conjunction with CT guidance. Further investigation is needed to continue improving outcomes for patients with locally advanced cervical cancer treated with image-guided brachytherapy.

139 Impact of supplementing rumen-protected methionine during the periconceptional period in the post-weaning period in female calves

Abstract This study aimed to identify the impact of supplementing rumen-protected methionine (RPM) during the periconceptional period on beef cows in their progeny. Evidence suggests that changes in maternal nutrition in the periconceptional period have effects during the postnatal growth phase in cattle. We hypothesized that feeding RPM during the periconceptional period would program bovine gestation to enhance progeny growth. A total of 114 beef cows were fed a roughage-based diet and randomized to receive corn gluten supplemented with 15 g of RPM (Smartamine M, Adisseo) or not (CON) from d -7 to +7 relative to artificial insemination (AI) with female sex-sorted semen. Pregnancy diagnoses were conducted using transrectal ultrasonography 30 and 60 d after AI. Female calves (n = 34) remained with their dams until weaning. A month after weaning, calves were weighed every 14 d during an 8-mo period, and wither height (WH), body length (BL), and heart girth (HG) were measured. Dry matter intake (DMI), average daily gain (ADG), and residual feed intake (RFI) were measured during a 56-d performance test. At the end of the performance test, the 12th rib back fat (BF), ribeye area (REA), intramuscular fat (IMF), and rump fat (RF) were determined via ultrasound. A treatment-by-day interaction tendency (P = 0.10) was observed in HG, having larger HG in the RPM treatment from d 336-adj of age (CON = 154.52 ± 1.46 cm; RPM = 158.36 ± 1.34 cm). During the performance test, animals in the RPM treatment were heavier (CON = 437.25 ± 2.46 kg; RPM = 442.79 ± 2.34 kg; P = 0.01) at the end of the test. However, no treatment difference (P &amp;gt; 0.05) was observed in DMI (CON = 12.06 ± 0.19 kg/d; RPM = 12.14 ± 0.18 kg/d), ADG (CON = 1.50 ± 0.03 kg; RPM = 1.55 ± 0.03 kg) and RFI (CON = -0.12 ± 0.15; RPM = 0.11 ± 0.14). No treatment difference (P &amp;gt; 0.05) was observed in BF, REA, and IMF. However, RF was greater in the control treatment (CON = 1.16 ± 0.07 cm; RPM = 0.91 ± 0.06 cm), and a tendency of having a thicker BF in control was observed (Table 1). In conclusion, supplementing RPM enhanced final body weight during the performance test; furthermore, a treatment-by-day interaction tendency was observed in HG. On the contrary, CON progeny had more RF and a tendency to have a thicker BF.

Diagnostic advantages of transrectal ultrasound with gastrointestinal agent instillation for rectal adenoma and early-stage rectal cancer: comparison of conventional transrectal ultrasound techniques.

Despite being a major focus of medical research for decades, rectal cancer remains a major threat to human health. This study aimed to compare and analyze the diagnostic value of transrectal ultrasonography (TRUS) for rectal adenoma and early-stage rectal cancer before and after gastrointestinal agent instillation. In this prospective study, patients diagnosed with rectal adenomas and early-stage rectal cancer by ultrasound were randomly selected for inclusion. All patients underwent ultrasound examination at the Outpatient Department of the First Affiliated Hospital of China Medical University and underwent surgical treatment at the First Affiliated Hospital of China Medical University. Patients with a lesion located 13 cm or more from the edge of the anus, or history of surgery, and a history of radiation and chemotherapy were excluded. A gastrointestinal agent was directly instilled into the rectal cavity during conventional TRUS to compare and analyze the display of rectal lesions before and after such instillation and to evaluate the infiltration depth of rectal lesions. These findings were compared to the pathological findings to determine the diagnostic efficacy. Both the conventional TRUS and TRUS with gastrointestinal agent instillation were able to show the rectal wall structure and rectal lesions; the detection rate of rectal lesions of the former was 75.0%, and that of the latter was 97.1% (P<0.001). Of the 27 rectal adenomas, conventional TRUS detected 10, and TRUS with gastrointestinal agent instillation detected 25 lesions. The accuracy [90.54%; 95% confidence interval (CI): 81.48-96.11%; P=1.05E-08], specificity (87.88%; 95% CI: 71.80-96.60%; P=1.09E-05), and sensitivity (92.68%; 95% CI: 80.08-98.47%; P=1.05E-08) of TRUS in diagnosing early-stage rectal cancer were consistent with the pathological findings (P<0.001). The accuracy (95.95%, 95% CI: 88.61-99.16%; P=3.82E-11), specificity (93.94%, 95% CI: 79.77-99.26%; P=1.31E-07), and sensitivity (97.56%, 95% CI: 87.15-99.94%; P=3.82E-11) of TRUS after gastrointestinal agent infusion in diagnosing early-stage rectal cancer were consistent with the pathological findings (P<0.001). The specificity (87.88%; 95% CI: 71.80-96.60%; P=1.09E-05) of TRUS in diagnosing rectal adenomas was consistent with the pathological finding (P<0.001), but the accuracy (65%; 95% CI: 51.60-76.87%; P=0.25) and sensitivity (37.04%, 95% CI: 19.40-57.63%; P=0.25) were not (P>0.05). Meanwhile, the accuracy (93.33%; 95% CI: 83.80-98.15%; P=5.65E-06), specificity (93.94; 95% CI: 79.77-99.26%; P=1.31E-07), and sensitivity (92.59%; 95% CI: 75.71-99.09%; P=5.65E-06) of TRUS after gastrointestinal agent infusion in diagnosing rectal adenomas were consistent with the pathological findings (P<0.001). TRUS with gastrointestinal agent instillation had significantly improved accuracy in diagnosing early-stage rectal cancer and detecting intrarectal adenomatoid lesions.

The relationship between depression, anxiety and lower urinary tract symptoms in men

PurposePatients with lower urinary tract symptoms (LUTS) often experience comorbid depression and anxiety, yet the mechanisms underlying this association remain incompletely understood. This prospective study aimed to investigate the relationship between depression, anxiety, and LUTS in men. Materials and methodsA prospective study was conducted with 350 male patients who underwent urologic examinations at our institution from January 2021 to December 2021. Of these, 131 patients meeting the inclusion criteria were included. Various questionnaires, including the International Prostate Symptom Score (IPSS) and the Hospital Anxiety and Depression Scale (HADS), as well as LUTS examinations (prostate-specific antigen test, transrectal ultrasonography, and urine flowmetry), were administered. ResultsAmong the 350 patients, 131 were included in the analysis, with an average age of 58.0 ± 13.69 years. The total IPSS was 18.0 ± 8.69, with the average voiding symptom score at 8.7 ± 5.19 and the average storage symptom score at 6.0 ± 3.27. Both anxiety and depression were found to be correlated with LUTS (P < 0.05). After adjusting for age, hypertension, and diabetes, anxiety (but not depression) was significantly associated with LUTS based on regression analysis. ConclusionMen with LUTS are more likely to experience anxiety. Therefore, it is essential to assess and address anxiety when managing men with LUTS.

Transrectal ultrasound for intraoperative interstitial needle guidance in cervical cancer brachytherapy

ObjectiveThis study aimed to prospectively assess the visibility of interstitial needles on transrectal ultrasound (TRUS) in cervical cancer brachytherapy patients and evaluate its impact on implant and treatment plan quality.Material and methodsTRUS was utilized during and after applicator insertion, with each needle’s visibility documented through axial images at the high-risk clinical target volume’s largest diameter. Needle visibility on TRUS was scored from 0 (no visibility) to 3 (excellent discrimination, margins distinct). Quantitative assessment involved measuring the distance between tandem and each needle on TRUS and comparing it to respective magnetic resonance imaging (MRI) measurements. Expected treatment plan quality based on TRUS images was rated from 1 (meeting all planning objectives) to 4 (violation of High-risk clinical target volume (CTVHR) and/or organ at risk (OAR) hard constraints) and compared to the final MRI-based plan.ResultsAnalysis included 23 patients with local FIGO stage IB2-IVA, comprising 41 applications with a total of 230 needles. A high visibility rate of 99.1% (228/230 needles) was observed, with a mean visibility score of 2.5 ± 0.7 for visible needles. The maximum and mean difference between MRI and TRUS measurements were 8 mm and –0.1 ± 1.6 mm, respectively, with > 3 mm discrepancies in 3.5% of needles. Expected treatment plan quality after TRUS assessment exactly aligned with the final MRI plan in 28 out of 41 applications with only minor deviations in all other cases.ConclusionReal-time TRUS-guided interstitial needle placement yielded high-quality implants, thanks to excellent needle visibility during insertion. This supports the potential of TRUS-guided brachytherapy as a promising modality for gynecological indications.

Characterization of placentome vascular perfusion in relation to pregnancy associated glycoproteins throughout gestation in pregnant beef heifers

During pregnancy, blood flow to the uterus changes to support fetal demand. Placentomes serve as vascular attachment sites on the placenta for exchange of gases, nutrients, and metabolic products. Non-invasive methods of ultrasonography and biomarkers have been described to assess placental health and fetal viability. Pregnancy associated glycoproteins (PAGs) are produced by the ruminant placenta and are detected in maternal circulation. In cattle, changes in circulating PAG concentrations are associated with embryonic and fetal outcomes. The objective of this study was to determine the association between placentome blood perfusion and circulating PAG concentrations as they relate to the health of the developing fetus. We hypothesized that placentome perfusion and PAG concentration will be positively correlated and associated with neonatal outcome. A prospective, observational study was designed using 26 pregnant, nulliparous, Angus heifers in which PAG concentration and placentome blood perfusion were assessed throughout gestation, with assessment of calving characteristics following parturition. Placentome blood perfusion was visualized at 30-day intervals via transrectal Doppler ultrasonography with power flow function. Ultrasound images were analyzed using ImageJ software to determine the percent area of perfusion and integrated pixel densities. Venous blood was collected and PAG concentrations were determined via serum PAG enzyme-linked immunoassay. Mean placentome blood perfusion increased as gestation advanced. PAG concentrations demonstrated the expected temporal trend, increasing with gestation length, and were positively linearly correlated with placentome perfusion (P < 0.0001). The relationship identified between circulating PAG concentration and placentome blood perfusion suggests the use of transrectal power flow Doppler ultrasonography as a noninvasive technique to determine placental blood flow morphometrics to assess conceptus wellbeing throughout pregnancy.

Colic signs caused by an unilateral abdominal seminoma in a Friesian stallion

SummaryThis case report describes the diagnosis and surgical treatment of a 12‐year‐old Friesian stallion that presented with colic and was diagnosed with an unilateral abdominal seminoma. The diagnostic work‐up included haematology, blood chemistry, rectal examination and ultrasonography before the tentative diagnosis of a neoplastic intra‐abdominal testicle was made. The mass was removed surgically and diagnosed as a seminoma via histopathology. Regular follow‐up was performed since suspected metastasis was seen on transrectal ultrasonography and laparoscopy. Unfortunately, the patient was subjected to euthanasia 18 months post‐surgery due to clinical deterioration. Post‐mortem examination was performed and confirmed the cause of clinical deterioration was due to metastasis of the previously removed seminoma. Colic is, to the author's knowledge, rarely seen in stallions with an abdominal testicular neoplasm, in contrast to humans and dogs.

Effects of the lesion size on clinically significant prostate cancer detection rates in PI-RADS category 3-5 lesions

IntroductionProstate cancer (PCa) ranks second among prevalent cancers in men, necessitating effective screening tools such as multiparametric magnetic resonance imaging (mpMRI) with the prostate imaging reporting and data system (PI-RADS) classification. This study explores the impact of lesion volume on clinically significant prostate cancer (csPCa) detection rates in PI-RADS 3–5 lesions, aiming to contribute insights into the underexplored relationship between lesion size and csPCa detection. Materials and methodsA retrospective analysis was conducted on data from 754 patients undergoing mpMRI-guided transrectal ultrasound (TRUS) prostate biopsy between January 2016 and 2023. Patients with PI-RADS 3, 4, and 5 lesions were included. Lesion size and PI-RADS categories were assessed through mpMRI, followed by MR fusion biopsy. ResultsOf the patients, 33.7%, 52.3%, and 14.1% had PI-RADS 3, 4, and 5 lesions, respectively. Lesion sizes correlated significantly with csPCa detection in PI-RADS 4 and 5 categories. For PI-RADS 3 lesions, no significant differences in csPCa rates were observed based on lesion size. However, in PI-RADS 4 and 5 groups, larger lesions showed higher csPCa rates. ConclusionThis study suggests that subgroup categorizations based on lesion volume could predict clinically significant PCa with high accuracy, potentially reducing unnecessary biopsies and associated overtreatment. Future research should further explore the relationship between lesion size and csPCa, clarifying discussions regarding the inclusion of systematic biopsies in diagnostic protocols.

Comparison of serum uric acid levels between localised prostate cancer patients and a control group.

The aim of this study is to find out whether serum uric acid levels in patients with localised prostate cancer differ from patients with lower urinary tract symptoms without carcinoma prostate. We performed a prospective observational study of 60 patients having age ⩾ 50 years with c/o lower urinary tract symptoms( LUTS) evaluated by digital rectal examination (DRE), prostate-specific antigen (PSA) level and ultrasonography kidney, ureter, bladder (USG KUB) prostate and patients who were suspicious for carcinoma prostate underwent trans rectal ultrasonography (TRUS) biopsy of prostate. Patients with biopsy s/o prostate cancer were evaluated for metastasis and localised cancer patients were considered as CASE group. Patients with negative biopsy and other patients having LUTS were considered as CONTROL group. The age, serum uric acid level, PSA value, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count were measured. Serum uric acid level was compared in both the groups. The mean serum uric acid level was lower in prostate cancer group (4.77 mg/dl) than control group (6.22 mg/dl) that was statistically significant (p < 0.001). The mean PSA value was 7.43 ng/dl in cancer group and 2.72 ng/dl in control group. (p < 0.001). The mean C-reactive protein (CRP) values were 1.32 and 0.45 respectively (p < 0.001), erythrocyte sedimentation rate (ESR) were found 21 and 10.5 respectively (p < 0.001)and total leucocyte counts (TLC) were found 6.450 and 5.120 respectively (p < 0.001). All were statistically significant (p < 0.05). The serum uric acid levels measured in localised prostate cancer patients were found to be reduced compared to the control group and inflammatory markers were found to be increased. Decreased levels of serum uric acid and increased levels of inflammatory markers were determined as risk factors for prostate cancer.