B-mode and Doppler ultrasonography of abdominal structures of the peccary (Tayassu tajacu, Linnaeus 1758) / [Ultrassonografias Doppler e modo-B das estruturas abdominais de catetos (Tayassu tajacu Linnaeus, 1758)]

This study used B-mode and Doppler ultrasonography to characterize the abdominal structures of healthy peccaries raised in captivity. Fifteen peccaries were used for this study. The urinary vesicle appeared as an ovoid structure, located in the abdominal and pelvic transition, with a hyperechogenic, thin, smooth, and regular wall. The kidneys presented retroperitoneal topography and had similar sizes. The kidney/aorta ratio had an average value of 10.53±15cm (right) and 10.23±0.12 (left). The right adrenal gland had a length of 1.93±0.34cm and diameter of 0.56±0.16cm. The left adrenal gland had a length of 1.85±0.42cm and diameter of 0.52±0.11cm. The spleen had a diameter of 1.13±0.18cm. The hepatic vein demonstrated polyphasic flow in pulsed Doppler, with two retrograde peaks and an anterograde peak with a flow velocity of 25.7±0.83cm/s. The abdominal aorta had a diameter of 0.58±0.05cm and a flow velocity of 115.17±5.32cm/s. The morphological and hemodynamic study of the abdominal structures of the peccary, observed through B-mode and Doppler ultrasonography, aided in identifying the size, shape, position, echogenicity, and echotexture of the abdominal organs and in making inferences about the normal parameters for these structures in this species.(AU)

Este estudo teve como objetivo utilizar as ultrassonografias de modo-B e Doppler para caracterizar as estruturas abdominais de um cateto sadio criado em cativeiro. Quinze catetos foram utilizados para este estudo. A vesícula urinária apareceu como uma estrutura ovoide, localizada na transição entre as partes abdominal e pélvica, com uma parede hiperecogênica, fina, lisa e regular. Os rins apresentaram topografia retroperitoneal e tamanhos semelhantes. A relação rim/aorta teve um valor médio de 10,53 ± 15cm (direita) e 10,23 ± 0,12cm (esquerda). A glândula adrenal direita tinha um comprimento de 1,93 ± 0,34cm e um diâmetro de 0,56 ± 0,16cm. A glândula suprarrenal esquerda tinha um comprimento de 1,85 ± 0,42cm e um diâmetro de 0,52 ± 0,11cm. O baço tinha um diâmetro de 1,13 ± 0,18cm. A veia hepática demonstrou fluxo polifásico no Doppler pulsátil, com dois picos retrógrados e um pico anterógrado com velocidade de fluxo de 25,7±0,83cm/s. A aorta abdominal tinha um diâmetro de 0,58 ± 0,05cm e uma velocidade de fluxo de 115,17±5,32cm/s. Os estudos morfológico e hemodinâmico das estruturas abdominais do queixada, observadas por meio das ultrassonografias modo-B e Doppler, auxiliaram na identificação do tamanho, da forma, da posição, da ecogenicidade e da ecotextura dos órgãos abdominais e na realização de inferências sobre os parâmetros de normalidade para as estruturas nas espécies.(AU)

Echocardiographic reference ranges for sedated healthy peccaries ( Tayassu tajacu, Linnaeus, 1758 ) / Valores de referência para catetos saudáveis sedados

Peccaries are wild mammals belonging to the Tayassu genus that are found almost everywhere in the Americas and have demonstrated great potential as an experimental model for scientific investigations. Twelve healthy adult animals were sedated to perform echocardiographic examinations in B, M and Doppler mode. The variables that exhibited statistically significant correlation coefficients with weight were LVFWd, LVIDd, LVIDs, E wave, A'RV, MAM, and TAPSE. The HR exhibited a negative relationship with the IVRT. The LA variable showed a positive correlation with the AO. The MAM exhibited correlations with the LVIDd and LVIDs. The TAPSE showed positive correlations with the E'RV and A'RV. The present study provides the first reference values for echocardiographic measurements in B, M and Doppler modes from peccaries anesthetized with ketamine and midazolam. Echocardiography was easy to perform in collared peccaries, and the collected data revealed values that can aid in their clinical management and conservation.(AU)

Catetos são mamíferos selvagens, pertencentes ao gênero Tayassu, encontrados em quase toda a América, os quais têm se destacado como modelos experimentais. Doze animais adultos saudáveis foram sedados para a realização de exames ecocardiográficos em modos B, M e Doppler. As variáveis que apresentaram coeficientes de correlação estatisticamente significativos em relação ao peso foram: LVFWd, LVIDd, LVIDs, onda E, A'RV, MAM, TAPSE. O HR mostrou correlação positiva com LA/AO, onda E, onda A, MAM, TAPSE e E/IVRT, e negativa com IVRT. Os valores de AVmax mostraram correlações positivas com onda E e onda A'. A variável LA mostrou correlação positiva com AO e correlação negativa com IVSd. A EF apresentou forte correlação com a relação de ondas FS, E/A, com A', E'RV. FS apresentou correlação positiva com a relação de onda E/A. O MAM mostrou correlação com LVIDd e LVIDs. TAPSE mostrou correlações positivas com E'RV e A'RV. O presente estudo forneceu os primeiros valores de referência para medições ecocardiográficas em modos B, M e Doppler de catetos anestesiados com ketamina e midazolam. O exame ecocardiográfico em catetos foi de fácil execução e os dados encontrados evidenciaram valores que podem auxiliar no seu manejo clínico e conservação.(AU)

Ovarian response is a better predictor of clinical pregnancy rate following embryo transfer than is thin endometrium or presence of an endometrioma.

OBJECTIVES: To examine whether endometrial thickness and the presence of endometrioma are independent predictors of clinical pregnancy rate or simply associated with poor ovarian response (POR). METHODS: This was a retrospective cohort study assessing the first cycle of all women undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in a university hospital in Brazil between January 2011 and December 2012. Only the first cycle of each woman within the study period was considered. Women over 40 years of age and those who used clomiphene citrate during controlled ovarian stimulation (COS) or did not undergo embryo transfer were excluded from analysis. POR was defined as ≤ three oocytes retrieved and a thin endometrium was defined as endometrial thickness ≤ 7.0 mm on the day of human chorionic gonadotropin (hCG) administration. We performed a multiple regression analysis to identify which of the following parameters were independent predictors of clinical pregnancy: age, number of oocytes retrieved, endometrial thickness or the presence of endometrioma. RESULTS: Within the study period, 787 women began COS, but 270 were excluded from analysis. Among the 517 women analyzed, those who achieved pregnancy were younger and yielded more oocytes. The proportion of POR was higher in women with a thin endometrium (17/57 (29.8%) vs 80/460 (17.4%); P = 0.03) and in women with endometrioma (15/39 (38.5%) vs 82/478 (17.2%); P = 0.002). The results of regression analysis showed that only age and the number of oocytes retrieved were independent predictors of pregnancy. Additionally, we observed higher clinical pregnancy rates in women with a thin endometrium from whom ≥ seven oocytes were retrieved (11/25 (44.0%)) compared to women with normal endometrial thickness (99/241 (41.1%)). Considering only women from whom ≥ four oocytes were retrieved, we observed reasonable pregnancy rates in those with a thin endometrium (14/40 (35.0%)) and in those with endometrioma (9/24 (37.5%)). CONCLUSION: Both a thin endometrium and the presence of endometrioma are associated with POR but are not important independent predictors of clinical pregnancy. Good pregnancy rates can be observed when these conditions are present in women with a good ovarian response.

Ultrasound guidance during embryo transfer: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To summarize the current evidence on the effect of using ultrasound (US) guidance during embryo transfer (ET). METHODS: In this systematic review, we included randomized controlled trials examining the effect of the use of US guidance during ET; data from studies using the same catheter type in study arms were not pooled with the results from studies that used different catheter types. RESULTS: Twenty-one studies were included in the quantitative analysis: 18 compared 'US guidance' with 'clinical touch', of which one was subsequently excluded from the quantitative meta-analysis owing to a lack of available data, three studies compared transvaginal US guidance with transabdominal US guidance, and one study compared 'hysterosonometry before ET' with US guidance. Comparison of the use of US guidance with clinical touch, in studies that used the same catheter type in the study arms, indicated a benefit of using US guidance during ET on the rates of live birth (relative risk (RR), 1.48 (95% CI, 1.16-1.87)), based on two studies involving 888 women with moderate-quality evidence, and on the rates of clinical pregnancy (RR, 1.32 (95% CI, 1.18-1.46)), based on 13 studies involving 3641 women with high-quality evidence. However, when comparing the use of US guidance with clinical touch in studies that used different catheter types, the results suggest that using US guidance during ET has no effect on the rates of reproductive outcome: live birth (RR, 0.99 (95% CI, 0.83-1.19)), based on one study involving 1649 women with moderate-quality evidence; clinical pregnancy (RR, 1.04 (95% CI, 0.89-1.21)), based on five studies involving 2949 women with moderate-quality evidence. The estimates for the rate of miscarriage and for the other identified comparisons were imprecise. CONCLUSIONS: The available evidence suggests that there is a benefit of using US guidance during ET. However, both US-guided transfer and clinical touch should be considered acceptable, as the benefit of US is not large and should be balanced against the increased cost and need to change the catheter type. More studies are required before conclusions can be drawn regarding the effect of other techniques on reproductive outcome.

Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis.

OBJECTIVE: To evaluate whether the presence or severity of endometriosis affects the outcome of assisted reproductive techniques (ART). METHODS: In this systematic review, all studies comparing the outcome of ART in women with and those without endometriosis, or at different stages of the disease, were considered eligible. We used either risk ratio (RR) or mean difference (MD) and their 95%CIs for comparisons. The primary outcome was live birth; the secondary outcome was clinical pregnancy. Miscarriage and the number of oocytes retrieved were examined as additional outcomes. RESULTS: We included 92 studies in the review and 78 in the meta-analysis: 20,167 women with endometriosis were compared with 121,931 women without endometriosis, and 1703 women with Stage-III/IV endometriosis were compared with 2227 women with Stage-I/II endometriosis. The following results were observed for the comparison of women with endometriosis vs women without endometriosis: live birth, RR = 0.99 (95%CI, 0.92-1.06); clinical pregnancy, RR = 0.95 (95%CI, 0.89-1.02); miscarriage, RR = 1.31 (95%CI, 1.07-1.59); number of oocytes retrieved, MD = -1.56 (95%CI, -2.05 to -1.08). The following results were observed for the comparison of women with Stage-III/IV vs Stage-I/II endometriosis: live birth, RR = 0.94 (95%CI, 0.80-1.11); clinical pregnancy, RR = 0.90 (95%CI, 0.82-1.00); miscarriage, RR = 0.99 (95%CI, 0.73-1.36); number of oocytes retrieved, MD = -1.03 (95%CI, -1.67 to -0.39). CONCLUSIONS: Women with endometriosis undergoing ART have practically the same chance of achieving clinical pregnancy and live birth as do women with other causes of infertility. No relevant difference was observed in the chance of achieving clinical pregnancy and live birth following ART when comparing Stage-III/IV with Stage-I/II endometriosis. The quality of the evidence for the additional examined outcomes was very low, not allowing meaningful conclusions to be drawn.

Interventions to improve reproductive outcomes in women with elevated natural killer cells undergoing assisted reproduction techniques: a systematic review of literature.

STUDY QUESTION: Is there any scientific evidence to support the routine use of adjuvant therapies for women with elevated natural killer (NK) cells undergoing assisted reproduction techniques (ARTs) in order to improve live birth rate? SUMMARY ANSWER: Due to the poor quality evidence, this review does not support the use of described adjuvant treatments in women found to have elevated absolute numbers or activity of NK cells undergoing ART. WHAT IS KNOWN ALREADY: Deregulation in the numbers of NK cells and/or their activity, in the blood as well as in the endometrium, has been associated with various manifestations of reproductive failure. NK cell analysis is becoming increasingly popular as a test offered to investigate the causes of reproductive failure. Adjuvant therapies influencing the NK cells have been postulated as therapeutic options for couples where deregulation of this component of the maternal immune system is suspected as the cause of infertility or implantation failure. STUDY DESIGN, SIZE, DURATION: Systematic review. Embase, LILACS, MEDLINE, PsycINFO, CENTRAL and CINAHL databases from 1946 to present were searched with no language restrictions. PARTICIPANTS/MATERIALS, SETTING, METHODS: Studies evaluating the use of adjuvant therapies in women undergoing ART where NK cell numbers and/or activity were assessed were considered eligible for inclusion. MAIN RESULTS AND THE ROLE OF CHANCE: Only three studies (one in abstract form only) meeting the inclusion criteria were identified: two reported the use of intravenous immunoglobulins (IVIg) and one the use of oral prednisolone. All studies demonstrated a beneficial effect of the interventions on clinical pregnancy rates with a risk ratio (RR) of 1.63 [95% confidence interval (CI) 1.00-2.66] for prednisolone and 3.41 (95%CI 1.90-6.11) for IVIg. Studies assessing the efficacy of IVIg have also reported live birth rate with an RR of 3.94 (95% CI 2.01-7.69) favoring the intervention. Data heterogeneity was substantial however (I(2) = 66%) suggesting a cautious interpretation of the results. LIMITATIONS, REASONS FOR CAUTION: Differing study populations, lack of statistical power, method of data presentation (per couple or per cycle), the use of additional medications and differing dosage regimes contribute to data heterogeneity and suggest a cautious approach to data interpretation. WIDER IMPLICATIONS OF THE FINDINGS: This review identified some data showing that adjuvant therapies (mainly IVIg) in this selected population seem to confer some benefit on ART outcome. However, overall, the review does not support the use of prednisolone, IVIg or any other adjuvant treatment in women undergoing ART who are found to have elevated absolute numbers or activity of NK cells, purely due to the paucity of, or poor quality of, the evidence. Agreement as to the most reliable NK cell testing method must be made by the scientific community as well as 'normal' NK cell levels unequivocally defined. Well designed, sufficiently powered RCTs with an appropriate population selection and using the same NK cell testing methodology are required to ascertain the actual benefit of using adjuvant therapy treatment for elevated NK cell levels or activity in the context of pregnancy outcome following IVF. STUDY FUNDING/COMPETING INTEREST(S): None.

Ultrasound for monitoring controlled ovarian stimulation: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the efficacy and safety of monitoring controlled ovarian stimulation (COS) using ultrasonography. METHODS: We performed a search in April 2013 for randomized controlled trials (RCTs). Studies that compared different methods for monitoring COS, including ultrasound assessment of follicles (alone or combined with hormonal assessment), in at least one group were considered eligible. RESULTS: The search retrieved 1515 records, six of which were eligible. Five studies were included that compared ultrasonography alone with ultrasonography and hormonal assessment (estradiol and/or progesterone) and one study compared 2D and 3D ultrasound monitoring. None of the included studies reported on live birth. Four of the five studies reported on clinical pregnancy (RR, 0.95; 95% CI, 0.78­1.16; n = 611); the confidence interval (CI) was somewhat wide, but allowed us to conclude that ultrasonography alone differs little from ultrasonography combined with hormonal assessment. Three studies reported on the number of oocytes retrieved (mean difference (MD), 0.8 oocytes; 95% CI, ­0.4 to 2.0; n = 474); the CI was somewhat wide and did not permit us to conclude whether ultrasonography alone is better than or similar to ultrasonography and hormonal assessment for this outcome. All five studies reported on ovarian hyperstimulation syndrome (OR, 1.02; 95% CI, 0.47­2.25; n = 725) and only one study reported on miscarriage (RR, 0.37; 95% CI, 0.07­1.79; n = 45); for these two outcomes, the CI was very wide and did not permit us to conclude whether ultrasonography alone is better, similar or less effective than ultrasonography combined with hormonal assessment. For the study comparing 2D and 3D ultrasound, the reported outcomes were clinical pregnancy (RR, 1.00; 95% CI, 0.58­1.73, n = 72) and the number of oocytes retrieved (MD, ­0.4 oocytes; 95% CI, ­3.6 to 2.9; n = 72); for both, the CI was very wide and did not permit us to conclude whether use of 3D ultrasound is better, similar or less effective than use of 2D ultrasound. CONCLUSIONS: Current evidence suggests that monitoring COS only with ultrasonography is unlikely to substantially alter the chances of achieving a clinical pregnancy and the number of oocytes retrieved is similar to that when monitoring with ultrasonography and hormonal assessment. For the other outcomes and comparisons, the available data are inconclusive. We believe that more studies evaluating the optimal procedure for monitoring COS are needed.