Diagnostic accuracy of Wisconsin and California scoring systems to detect bovine respiratory disease in preweaning dairy calves under subtropical environmental conditions

Bovine respiratory disease (BRD) is a multifactorial disease which causes short- and long-term negative effects. Early detection is crucial for a prompt response to therapy, as well as to decrease mortality risk. Clinical scoring systems have been developed mostly in North America for screening calves at risk or suspected of having BRD, and these tools have also been applied in subtropical and tropical countries. However, it has been unknown whether these scoring systems had the same accuracy in tropical environmental conditions. Therefore, this study evaluated the accuracy of 4 different field techniques, as well as serum haptoglobin (HAP), to diagnose BRD in Holstein dairy calves in subtropical conditions. The tests used to diagnose BRD were thoracic ultrasound (TUS; positive if consolidation depth ≥1 cm), thoracic auscultation (AUSC; positive if crackles, wheezes, or silent areas were present), Wisconsin score (WISC; ≥2 categories with scores of ≥2), and California score (CALIF; positive if total score ≥5). Also, HAP was measured and classified as positive if ≥15 mg/dL. Heifers between 30 d of age and weaning (n = 482), residing on 17 commercial dairies in São Paulo state, were enrolled in this study. Bayesian latent class models were used with informative priors to evaluate the accuracy of TUS, AUSC, and HAP, and noninformative priors for the accuracy of WISC and CALIF. The percentage of calves positive for each test on each farm ranged from 0 to 56% for WISC, 11–51% for CALIF, 0–72% for TUS, 0–32% for AUSC, and 0–100% for HAP. The sensitivity (Se; 95% credible interval) and specificity (Sp) for WISC were 77.9% (64.8–90.2) and 81.9% (76.3–88.2). For CALIF, the Se was 67.1% (53.6–80.1) and Sp 79.1% (73.9–84.6). For TUS Se was 59.8% (46.5–73.1) and Sp was 84.8% (80.0–89.5), and for AUSC, Se was 58.8% (41.3–79.8) and Sp was 98.6% (95.7–99.9). The Se and Sp of HAP was 67.6% (55.3–78.8) and 46.7% (41.4–52.2), respectively. The performance of the scoring systems was similar to, or better than, the performance found in North American studies, despite the fact that calves were in a tropical environment.     

Diagnosis of respiratory disease in preweaned dairy calves using sequential thoracic ultrasonography and clinical respiratory scoring: Temporal transitions and association with growth rates

Bovine respiratory disease (BRD) in dairy calves is a multifactorial condition, involving environmental, host, and pathogen factors. Thoracic ultrasound scoring (TUS) has recently been validated as an accurate method of detecting BRD-related lung pathology in dairy calves. Previous studies investigating the use of TUS in preweaned dairy calves have largely been based on cross-sectional data from all-year production systems. The objectives of this longitudinal observational study were to characterize the temporal transitions in TUS scores in dairy calves from pasture-based, seasonal-calving herds using sequential examinations during the preweaning period, and to investigate the relationship between the presence and temporal pattern of BRD, diagnosed by TUS or clinical respiratory scoring (CRS), and average daily gain (ADG). In spring of 2019, 317 preweaned calves from 7 commercial dairy farms were recruited at less than 4 wk old (ranging from 1–27 d of age). Each farm was examined on at least 3 occasions at 20- to 28-d intervals and housed indoors in group or individual pens. At each visit TUS scores, CRS scores based on the University of Wisconsin Calf Respiratory Score Chart (https://www.vetmed.wisc.edu/fapm/wp-content/uploads/2020/01/calf_respiratory_scoring_chart.pdf), and live weight using a dairy breed–specific weigh band were recorded. All data were recorded by the same 2 veterinarians over the course of the study. The final data set consisted of 966 TUS and CRS scores collected from 317 calves over a period of approximately 6 wk from 7 farms. The data were analyzed in multivariable, mixed effects, linear regression models, with separate models constructed for TUS and CRS scores. Random effects (intercepts) were included for calf, farm, and visit week. Additionally, a random slope was included for age at sampling by farm. Median farm TUS score ranged from 0 to 2.5 over the 3 visits (possible range: 0–5). The percentage of calves with a TUS score ≥3 (consolidation of the full thickness of 1 lung lobe), on each farm ranged from 0 to 50%. The median CRS in calves on individual farms ranged from 1 to 3 over the 3 visits (possible range: 0–12). The percentage of calves on each farm with a CRS score ≥5 (possible range: 0–12) ranged from 0 to 26%. The TUS and CRS scores were weakly correlated. The TUS was associated with reduced ADG. Calves with TUS scores ≥3 grew at 126 g/d less than unaffected calves over the 3-wk period before examination. The predicted effect on ADG was dependent on the age and duration over which the animal was affected. Calves affected later (i.e., between visits 2 and 3) had lower predicted weights at 63 d compared with calves with increased TUS scores earlier in the study period. Calves with a TUS score ≥3 at each of the 3 sampling points had the lowest weight at 63 d of age. There was no association of CRS with ADG. This study showed that in contrast to CRS, higher TUS scores are associated with lower ADG, with weight loss being more pronounced in chronic cases.     

Short communication: Diagnostic accuracy of focused lung ultrasonography as a rapid method for the diagnosis of respiratory disease in dairy calves

This study estimates the accuracy of the focused lung ultrasound (FLUS) compared with systematic thoracic ultrasonography (TUS) as the reference test for diagnosing pneumonia in pre- and postweaned dairy calves. One hundred thirty-five Holstein Friesian calves, aged between 1 to 6 mo were enrolled and were kept in the same pen with one or more animals showing signs of bovine respiratory disease complex (BRDC). One operator performed FLUS on each calf, and then a second, blinded operator performed TUS on the same calf. For the FLUS, we only scanned the lung lobes that are most frequently affected during BRDC and are thus easier to detect, such as the caudal aspect of the cranial lobe of the left lung (fifth and fourth left intercostal spaces; ICS), the middle lobe of the right lung (fifth right ICS), and the caudal aspect of the cranial lobe of the right lung (fourth right ICS). Pneumonia was diagnosed when a calf had a minimum of one small lobular lung lesion that was at least 1 cm deep within a normally aerated lobe (TUS score of ≥2). Diagnostic accuracy indexes of the FLUS were calculated using TUS as the gold standard. The McNemar test was performed to evaluate the differences between the 2 techniques. In addition, an intertest agreement was assessed using the weighted kappa test. A total of 76 out of 135 calves had a TUS score of ≥2 and were therefore considered to be affected by BRDC. The FLUS had a sensitivity of 81.6% (95% CI = 71.0–89.5%), specificity = 100% (95% CI = 93.9–100%), positive predictive value was 100%, negative predictive value was 96.6% (95% CI = 94.7­­–97.9%), and accuracy was 97% (95% CI = 92.6–99.2%). The McNemar test highlighted a difference of 10.3% between the FLUS and TUS. The agreement between the TUS and FLUS was substantial (weighted kappa test 0.78). Although FLUS shows some limitations in diagnosing lung lesions associated with BRDC compared with the systematic approach, this study shows that the focused method could be used as an additional tool for evaluating consolidation, especially when examining a large number of postweaned dairy calves.     

超声胃肠充盈造影检查对胃癌TNM分期的预测评估价值

目的:探究超声胃肠充盈造影检查对胃癌TNM分期的预测评估价值。方法:选取我院在2019年4月-2020年4月期间收治的100例胃癌患者作为研究对象,所有患者术前都进行超声胃肠充盈检查,术后进行病理证实与分期,进一步观察超声胃肠充盈造影检测对胃癌TNM分期的情况。结果:癌症TNM分期检测中的T分期准确率为76.72%, T1为68.97%,T2为76.20%,T3为73.47%,T4为88.24%,N分期的准确率为83.79%,N0为81.36%,N1为85.37%,N2为77.78%,N3为90.63%,M分期的准确率为90.97%,M0为96.74%,M1为85.19%。结论:超声胃肠充盈造影检查对于胃癌TNM分期预测评估的准确率较高,且成本较低、无痛无创,具有一定的安全性、实用性和临床使用价值,不会对患者造成不利影响,值得在临床疾病检测过程中推广使用。     

Effect of interval to resynchronization of ovulation on fertility of lactating Holstein cows when using transrectal ultrasonography or a pregnancy-associated glycoprotein enzyme-linked immunosorbent assay to diagnose pregnancy status

The objective of this study was to compare 2 strategies for resynchronization of ovulation based on nonpregnant diagnoses using transrectal ultrasonography or a pregnancy-associated glycoprotein (PAG) ELISA. Lactating Holstein cows (n = 1,038) were submitted for first postpartum timed artificial insemination (TAI) using a Presynch + Ovsynch protocol. After the initial breeding, cows were randomly assigned to initiate resynchronization 25 d (D25) or 32 d (D32) later. Pregnancy status of cows initiating Resynch 25 d after TAI was determined 27 d after TAI by using a PAG ELISA, whereas pregnancy status of cows initiating Resynch 32 d after TAI was determined 39 d after TAI using transrectal ultrasonography. Cows diagnosed as not pregnant continued the Resynch protocol by receiving an injection of PGF_2α 7 d after the initial GnRH injection and a second GnRH injection 54 h after the PGF_2α injection. Cows in both treatments were inseminated approximately 16 h after the second GnRH injection. Blood samples for analysis of progesterone (P₄) were collected at the first GnRH injection of each Resynch protocol. Pregnancies per AI (P/AI) of nonpregnant cows initiating Resynch 25 vs. 32 d after first postpartum TAI did not differ 39 d after TAI and were 28.3 vs. 30.9% for D25 vs. D32 cows, respectively. Mean P₄ at the first GnRH injection of Resynch was greater for D32 than for D25 cows (3.67 ± 0.22 vs. 2.83 ± 0.22 ng/mL), indicating that the Resynch treatments were initiated at different stages of the estrous cycle. After blocking P₄ concentration into low (<1.0 ng/mL) or high (≥1.0 ng/mL) classes, P₄ class was not found to affect P/AI 39 d after TAI. Early resynchronization was not found to affect P/AI 39 d after TAI; however, early resynchronization did decrease days between inseminations and the interval from the initial nonpregnant diagnosis to conception. Earlier detection of nonpregnant cows using the PAG ELISA in conjunction with a TAI resynchronization program may improve the rate at which cows become pregnant in a dairy herd compared with transrectal ultrasonography conducted at a later stage after TAI.     

超声造影评价肝硬化血流灌注特征的初步研究

目的 探讨超声造影评价肝硬化血流灌注特征的临床应用价值.方法选择慢性乙肝患者60例,其中无肝硬化（无肝硬化组）30例,肝硬化（肝硬化组）30 例;正常对照组20例.无肝硬化组、肝硬化组和正常对照组应用六氟化硫微泡混悬液在低机械指数条件下进行超声造影检查,观察肝动脉、门静脉、肝静脉和肝实质的显影动态过程,记录门静脉开始显影时间（PVAT）、肝静脉开始显影时间（HVAT）、门静脉达峰值时间（PVPT）和肝静脉达峰值时间（HVPT）和门静脉-肝静脉渡越时间（PV-HVTT）.分析无肝硬化组、肝硬化组和正常对照组上述各参数差异有无统计学意义.结果 3组PVAT、PVPT和HVPT比较差异无统计学意义（P＞0.05）,肝硬化组HVAT、PV-HVTT均较正常对照组、无肝硬化组显著缩短（均P＜0.05）.结论 超声造影定量参数HVAT和PV-HVTT可反映肝硬化微循环及血流动力学改变,为临床早期诊断肝硬化提供依据.同时,可以更好地指导临床治疗.     

Bismuth Ferrite‐Based Nanoplatform Design: An Ablation Mechanism Study of Solid Tumor and NIR‐Triggered Photothermal/Photodynamic Combination Cancer Therapy

Although nanomaterial‐mediated phototherapy, in particular photothermal therapy (PTT) and photodynamic therapy (PDT), is extensively investigated in recent years, the ablation mechanism, evolution, and rehabilitation process of in vivo solid tumor after phototherapy are rarely explored yet and remain a terra incognita. Herein, a kind of bismuth ferrite nanoparticles (abbreviated as BFO NPs) are strategically designed and synthesized with a desirable size and bioactivity as a brand‐new phototherapeutic agent for the phototherapy, which are of strong near infrared (NIR) absorbance, excellent biocompatibility, and outstanding photophysical activity for the hyperthemia and reactive oxygen species generation. Resultantly, BFO NPs can realize simultaneous PTT/PDT synergistic therapy outcome against cancer cells and solid tumor under NIR laser irradiation. Meanwhile, for the first time, more attentions are paid to demonstrate ablation mechanism and evolution process of in vivo solid tumor after phototherapy by B‐mode ultrasonography/magnetic resonance imaging as well as histopathological analysis, all of which verify a series of physiological processes, being in order of necrosis of parenchymal cells, in situ tissue disintegration, liquefaction, and finally encapsulation process.     

Vascular Access in the Hemodialysis Patient – Personal Experience and Review of the Literature

There is consensus that arteriovenous (AV) fistulae represent the best choice for initial vascular access in patients suffering from chronic renal insufficiency (CRI) or end‐stage renal disease (ESRD) approaching the need of initiating hemodialysis therapy.
However, this is a challenging task in the rapidly growing population of diabetic, aged, and hypertensive patients. The preexisting damage of the vascular anatomy and the high cardiovascular comorbidity hinder construction of a well functioning arteriovenous fistula. Late referrals to the nephrologist delay access surgery and increase the use of temporary and cuffed tunneled catheters with all their potential risks.
Nevertheless, various strategies and tools exist to overcome these problems. Early referral results in venous preservation and early selection of side, site, and type of initial vascular access. Ultrasound findings are essential components of preoperative investigations. Special attention should be paid to the quality of the arteries at each section along the forearm, the elbow region, and the upper arm. Dedicated, meticulous surgery is mandatory. Fistula monitoring and elective revision of the failing AV fistula will result in increasing longevity of the blood access, and will reduce morbidity and costs.     

灰阶超声造影对肝肿瘤21例诊断的临床应用

目的：探讨灰阶超声造影在肝肿瘤诊断上的临床应用价值。方法：选取我院2013年1月至2015年1月收治的21例肝肿瘤患者,采用SonoVue造影剂进行灰阶超声造影检查,并且和二维超声、彩色多普勒超声造影检查比较分析。结果：灰阶超声造影准确定性了19例患者,彩色多普勒超声为12例,常规超声为10例,准确定性率依次为90.5%、57.1%、47.6%。结论：二代造影剂SonoVu e能够持续观察病灶内部的血流灌注状况,与增强MRI和增强CT的检查原理以及判断标准相一致,在超声诊断肝肿瘤患者上具有新型性和实用性。     

时间-强度曲线在淋巴瘤脾脏浸润灶的应用价值

目的：探讨时间-强度曲线在淋巴瘤脾脏浸润灶临床研究和应用中的价值。方法：对16例淋巴瘤脾脏浸润灶进行超声造影检查,绘制超声造影时间-强度曲线,测量并分析病灶与周围正常脾组织的定量参数,并对两者进行对比分析。结果：脾脏浸润灶的上升支斜率、下降支斜率、始增时间和峰值强度均高于周围正常脾脏组织,差异均有统计学意义（P〈0.05）。结论：时间-强度曲线可量化分析淋巴瘤脾脏浸润灶的血管生成情况;有助于淋巴瘤脾脏浸润灶的临床研究和诊疗。