Evaluation of vaginoscopy for the diagnosis of clinical endometritis in dairy cows

Development of feeding and reproduction technology in dairy cattle breeding based on the use of digital technologies

A study on the study of the qualitative assessment of the behavior of dairy cattle according to the VAS system (visual analog scale) was conducted in the LLP "Agrofirme "AKAS", located in the West Kazakhstan region of the Republic of Kazakhstan. According to research, it follows that different seasons of time affect the conditions of detention in different ways. So, for the maintenance of cows in the summer, the distance of avoidance at the feeding site according to test 1 and 2 is within 3 meters, whereas in spring and autumn it was 2 meters. The difference between the reference norm and the household ration has been determined, from which it follows that the feeding ration of the farm corresponds to the norm of 12 kg of milk yield per head per day. The vitamin and mineral premix developed by us includes vitamins, minerals, including macro-microelements. The premix also includes components in the following ratio: phosphorus (P) - 5% of monocalcium phosphate, vitamin A - 1.2% of rovimix A 1000, vitamin D3 - 0.64% of rovimix D3, vitamin E - 16% of rovimix E-50, manganese (Mn) - 22.2%, copper (Cu) - 9%, zinc (Zn) - 19%, iodine (I) - 0.28%, selenium (Se) - 7.65 and cobalt (Co) - 0.14%, and feed chalk - 5% and chickpea flour - 13.89% are used as fillers as a source of calcium (Ca).. The average daily milk yield at the beginning of the experiment in both study groups was in the range of 10.6-10.8 kg. At the end of the experiment, the average daily milk yield in animals receiving premix exceeded their peers from the control group by 1.4 kg or 1.6%. According to the chemical composition of milk, the indicators of fat, protein and lactose were higher in the cows of the experimental group compared with the peers of the control group (for fat - 3.92>3.37, for protein - 3.32>3.23, for lactose - 4.16>4.01).

Correlation Analysis of Serum Pepsinogen, Interleukin, and TNF-α with Hp Infection in Patients with Gastric Cancer: A Randomized Parallel Controlled Clinical Study

Background

Gastric cancer pathological biopsy and visual examination have been the gold standard for gastric cancer diagnosis, but their operation is costly, demanding, and risky, so it is especially important to find an effective examination method in clinical practice.

Aims

To investigate the correlation between serum pepsinogen I (PGI), pepsinogen II (PGII), pepsinogen I and II ratio (PGR), IL-6, and TNF-α and Helicobacter pylori (Hp) infection in patients with gastric cancer.

Materials and Methods

Fifty patients with Hp-infected gastric cancer admitted to the Department of Gastroenterology of our hospital from January 2019 to December 2021 were selected for the study as the observation group, and another 50 patients without Hp-infected gastric cancer were selected as the comparison group to compare the correlation analysis of PGI, PGII, PGR, IL-6, and TNF-α with Hp infection between the two groups after admission and treatment.

Results

After measurement, PGI and PGII in the observation group were significantly lower than those in the comparison group, and TNF-α, IL-18, and IL-6 in the observation group were significantly higher than those in the comparison group, and the comparative differences were all statistically significant (P < 0.05). The results of multivariate logistic regression model analysis of independent risk factors for gastric cancer showed that IL-18, hs-CRP, and tumor necrosis factor- (TNF-) α were risk factors for Hp infection in gastric cancer.

Conclusion

The expression of IL-18, hs-CRP, and TNF-α factors in Hp-infected gastric cancer patients is correlated. IL-6, IL-18, and TNF-α are involved in the entire process from the onset to the development of Hp-positive gastric mucosal inflammation in patients, which is of great value in the diagnosis of gastric cancer and helps to assess the degree of progression and prognosis of gastric cancer.

Effect of Vaginoscopy versus Conventional Hysteroscopy on Pain, Complications, and Patient Satisfaction in Patients with Endometrial Polyps

Background

Hysteroscopy is considered the gold standard for diagnosing intrauterine pathology. Traditional hysteroscopy requires the placement of a vaginal speculum and cervical forceps, which are large in diameter, causing discomfort and pain to the patient and even causing vagal reflexes.

Aims

To investigate the impact and clinical value of vaginoscopy versus conventional hysteroscopy on pain, complications, and patient satisfaction in patients with endometrial polyps and to analyse the advantages of clinical application of vaginoscopy examination.

Materials and Methods

One hundred and twenty-five patients with endometrial polyps treated in our hospital from May 2021 to December 2021 were selected for this study and divided into 52 cases in the hysteroscopy group and 73 cases in the vaginoscopy group according to the random remainder grouping method. Conventional hysteroscopy was used, and in the vaginoscopy group, vaginoscopy was performed. The impact of pain, complications, patient satisfaction, and clinical value of the two groups was observed and compared.

Results

The time taken for the examination varied between the different hysteroscopic methods, with the hysteroscopy group taking the longest time compared to the vaginoscopy group (P < 0.01). The VAS scores immediately after the examination and 30 minutes after the examination were both significantly higher in the hysteroscopy group than in the vaginoscopy group (P < 0.01). The difference in NPY, PGE2, and 5-HT after the pain-causing mediator intervention was significantly better in the vaginoscopy group than in the hysteroscopy group. The difference in the incidence of complications such as abortion syndrome, cervical laceration, uterine perforation, and haemorrhage after treatment was significantly lower in the vaginoscopy group than in the hysteroscopy group. In the vaginoscopy group, the satisfaction rate was 91% significantly higher than that of the hysteroscopy group (P < 0.05).

Conclusion

The vaginoscopy technique shortens the examination and treatment time, reduces patient pain, improves patient compliance, reduces the use of preintervention drugs and anaesthetics, and reduces complications.

Reproductive tract disease in Irish grazing dairy cows: Retrospective observational study examining its association with reproductive performance and accuracy of 2 diagnostic tests

The detection of reproductive tract disease (RTD) 3 wk postpartum is important because of its effect on subsequent reproductive outcomes. Numerous methods for the diagnosis of RTD are described, some of which are more practical and instantaneous in terms of diagnosis. Two of these methods involve identification of purulent vaginal discharge (PVD) and evidence of ultrasonographic uterine changes indicative of endometritis (UE). The objectives of our retrospective observational study were (1) to assess the association of PVD or UE score at the prebreeding examination (PBE) with the hazard of pregnancy within the subsequent breeding season; (2) to determine the test sensitivity (Se) and specificity (Sp) at the point of sampling of both tests using a Bayesian latent class model; and (3) to determine the effect of varying positivity thresholds on test accuracy. To achieve these objectives, we analyzed an initial data set of 5,049 PBE from 2,460 spring-calved cows in 8 herds between 2014 and 2018. Each PBE was conducted once between 25 and 86 d in milk. At each PBE, vaginal discharge was obtained with a Metricheck device (Simcro) whereas uterine contents were assessed using transrectal ultrasonography. Purulent vaginal discharge was scored on a scale of 0 to 3 depending on discharge character, and UE was scored on a scale of 0 to 4 depending on the presence and consistency of intraluminal fluid. Cows with scores of ≥2 in either test had received treatment. Fertility data were available from 4,756 PBE after data exclusion. The association between PVD or UE score at the PBE and subsequent hazard of pregnancy was analyzed using a Cox proportional hazards model. Cows with a PVD score of 2 or 3 were less likely to conceive than cows with a PVD score 0 [score 2 hazard ratio (HR) = 0.74; 95% confidence interval (CI): 0.59-0.94; score 3 HR = 0.65; 95% CI: 0.51-0.84]. Cows with a UE score of 1, 2, 3, or 4 were less likely to conceive than cows with a UE score of 0 (score 1 HR = 0.82; 95% CI: 0.73-0.93; score 2 HR = 0.79; 95% CI: 0.62-1.00; score 3 HR = 0.43; 95% CI: 0.43-0.90; score 4 HR = 0.39; 95% CI: 0.26-0.58). To determine the Se and Sp of PVD or UE score for diagnosis of RTD at the time of PBE, a Bayesian latent class model was fitted on 2,460 individual cow PBE. Flat priors were used for the Se and Sp of UE, whereas informative priors were used for PVD Se (mode = 65%, 5th percentile = 45%) and Sp (mode = 90%, 5th percentile = 80%) and RTD prevalence (mode = 20%, 5th percentile = 10%). Posterior estimates (median and 95% Bayesian probability intervals; BPI) were obtained using 'rjags' (R Studio). The optimal test thresholds (PVD and UE score ≥1) were selected by assessing the effect of different thresholds on test estimates and using a misclassification cost analysis. Based on these, median (95% BPI) Se for PVD and UE score ≥1 were 44% (29-60%) and 67% (33-100%), respectively. Median Sp for PVD and UE score ≥1 were 90% (86-93%) and 91% (86-93%), respectively. Higher scores in both tests were associated with impaired fertility, and UE scoring with a threshold of ≥1 had the highest test Se and Sp estimates although test Se was conditional on days in milk when the PBE occurred.

Using vaginal discharge score (VDS) grading system to evaluate the effect of clinical endometritis on reproductive performance of dairy cows in China

Clinical endometritis (CE) is a major cause in affecting the reproductive performance of dairy cows. The objectives of this study were to ascertain the prevalence of CE and to evaluate the effect of CE on reproductive performance in dairy cows using vaginal discharge score (VDS) grading system. 803 dairy cows were examined by vaginoscope with 4-point VDS at 26 ± 3 days in milk (DIM) and classified into six groups: non-endometritis with VDS 0 (control; CON), endometritis with VDS 1 (MEM), non-treated endometritis with VDS 2 (NTME), treated endometritis with VDS 2 (TME), non-treated endometritis with VDS 3 (NTPE), and treated endometritis with VDS 3 (TPE). Cows in TME and TPE groups were treated with 200 mL of 50% dextrose solution by intrauterine infusion. The prevalence of CE was 33% at 26 ± 3 DIM. Binary logistic regression analysis revealed cows in MEM, NTME and NTPE groups had a less likelihood of first artificial insemination (AI) pregnancy than those in CON group (P < 0.05). Kaplan-Meier survival curves for days open were statistically different (P = 0.004). In Cox regression model, cows in NTME and NTPE groups had a reduced pregnancy rate than those in CON group (P < 0.05). The hazard of pregnancy in NTME group was lower than that in TME group (P = 0.044). Similarly, it was lower for the hazard of pregnancy in NTPE group than in TPE group (P = 0.048). Cows in MEM, NTME, and NTPE groups required more services per pregnancy than those in CON group (P < 0.05). In conclusion, CE examined by the VDS grading system impaired reproductive performance, and mild endometritis with VDS 1 should be treated in the early postpartum period to ameliorate fertility in dairy herds.

Estimating prevalence of endometritis in smallholder zero-grazed dairy cows in Rwanda

Endometritis is a postpartum uterine disease of cows that interrupts reproductive cycles resulting in suboptimal fertility, reduced performance and profitability of the dairy herd. The objective of the study was to estimate the perceived and observed prevalence of endometritis among zero-grazed dairy cows in smallholder farms in Rwanda. A snowball sampling method was applied in cross-sectional survey to obtain data from 370 farms on 466 cows within their 21-60 days postpartum (dpp). The survey, conducted from September 2018 to March 2019, simultaneously examined cows using the Metricheck Device (MED) to determine the presence and type of vaginal mucus (VMC) based on a score scale of 0 to 3. Cows scoring VMC ≥ 1 were recorded as clinical endometritis (CLE)-positive. Cytotape (CYT) was used to determine the percentages of polymorphonuclear cells (PMN) in endometrial cytology sample. Cows with ≥ 5% PMN were recorded subclinical endometritis (SCLE)-positive, whereas cows with VMC-0 and < 5% PMN were considered healthy cows. At cow-level, endometritis prevalence was 70.2% with 67.2% CLE and 31.8% SCLE while at the herd-level, prevalence was 71.1% with 68.1% CLE and 34.4% SCLE. The differences between the diagnostic performance of the MED and CYT were significant (p < 0.001). Perceived prevalence by farmers was much lower (3.2%) and without agreement with the observed prevalence (kappa = - 0.02, p > 0.05). The highly observed prevalence and farmer underestimation of endometritis prevalence indicate knowledge gaps about endometritis. The extension service therefore needs to increase awareness and education among smallholder farmers about detection and management of endometritis.

The Effect of Abnormal Reproductive Tract Discharge on the Calving to Conception Interval of Dairy Cows

Prolonged calving-to-conception interval (CCI) can increase economic loss in cattle. We investigated the effect of post-calving abnormal reproductive tract discharge (ARTD) on CCI in dairy cows and quantified the relationship of ARTD and associated risk factors with CCI. The source population was dairy cows that calved in the study period on three pasture-based, year-round calving farms in the Riverina, NSW, Australia. Farm records and records from veterinarians' visits were analyzed. ARTD was defined as the presence of reproductive tract discharge according to the following classification: per vaginum purulent discharge ≥21 days post-calving or mucopurulent discharge >26 days post-calving. The incidence of ARTD was calculated. A Kaplan-Meier survivor function was used to estimate median time to conception post-calving dependent on the presence or absence of ARTD. Mixed effects Cox-proportional hazard models were used to estimate the direct and indirect effects of ARTD, and other potential risk factors on CCI such as body condition score (BCS), ambient temperature, and milk yield. Model structures were guided by a directed acyclic graph of potential risk factors for ARTD. The incidence of ARTD in lactations was 16% (95% CI 13.8–18.5%) and did not differ significantly between the three farms (P > 0.05). The median CCI was 176 and 118 days for lactations with and without ARTD, respectively (P < 0.01). The rate of pregnancy following calving in cows with ARTD was significantly decreased relative to the rate of pregnancy in cows without (total effect hazard ratio = 0.62, se = 0.18, P = 0.01). High peak milk yield (>32 L) and parity >2 also significantly extended CCI. We did not observe an effect of BCS or ambient temperature on CCI. The incidence of ARTD in the current study was consistent with clinical endometritis (considered a major source of ARTD) reported in other studies. In contrast—and despite regular veterinary assessment and treatment of on the farms in this study—ARTD extended CCI. Evaluation of the economic impact of ARTD on dairy farms in this region is warranted, and methods to identify high risk cows and develop effective interventions are required.

Risk factors associated with reproductive performance in Japanese dairy cows: Vaginal discharge with flecks of pus or calving abnormality extend time to pregnancy

The present study aimed to determine possible risk factors affecting reproductive performance, especially time taken to establish pregnancy in dairy cows, using Cox’s proportional hazard model. The data were collected from 154 Holstein Friesian cows (199 lactations). Cows diagnosed with a vaginal discharge score (VDS) of one or calving abnormality showed significantly delayed pregnancy: hazard ratio (HR)=0.654 (95% confidence interval [CI]: 0.436–0.983; P=0.041) and HR=0.457 (95% CI: 0.270–0.774; P=0.004), respectively. Our study suggested that the occurrence of VDS of one or calving abnormality might be possible risk factors increasing the number of days open and affecting reproductive performance in dairy cows.

Optimization of diagnostic methods and criteria of endometritis for various postpartum days to evaluate infertility in dairy cows

Postpartum endometritis is the main cause of infertility in dairy cows, but there is a lack of critical diagnostic criteria. We aimed to 1) determine the optimal diagnostic method and criteria of endometritis for various postpartum days to evaluate infertility, and 2) assess the diagnostic accuracy of a combination of diagnostic methods. Holstein dairy cows (n = 441) from nine commercial dairy herds were examined at 42 ± 7 days postpartum by using 5 methods: 1) transrectal palpation measurement of the cervical diameter, 2) ultrasonographic measurement of the fluid in uterus (FIU) score, 3) vaginoscopic detection of external uterine orifice hyperemia, 4) vaginal discharge score (VDS), and 5) endometrial cytological percentage of polymorphonuclear leukocytes (PMN%). The clinical findings that were significant in the Pearson chisquare test and had the highest sum of sensitivity and specificity for infertility at 100, 125, 150, 175, and 200 days after parturition were determined the optimal criteria of endometritis. Logistic regression and the Cox proportional hazards model were used to compare the accuracies of the different diagnostic methods for infertility at various postpartum days. The combinations of methods which were significant in Pearson chisquare test and had the highest sum of sensitivity and specificity for infertility were proposed as the optimal combination for determination of endometritis status for various postpartum day. The optimal diagnostic criteria were PMN% ≥ 6.0, FIU ≥ 2 (continuous hyperechogenic or large amount of storage material), or VDS ≥ 2 (mucopurulent or worse vaginal discharge) for postpartum days 100 and 125; PMN% ≥ 8.0, FIU = 3 (large amount of storage material), VDS ≥ 2, or external uterine orifice hyperemia for day 150; PMN% ≥ 6.0, FIU = 3, VDS ≥ 2, or external uterine orifice hyperemia for day 175; and PMN% ≥ 5.0, FIU = 3, VDS ≥ 2, or external uterine orifice hyperemia for day 200. Only the results of endometrial cytology were related to infertility regardless of the postpartum days to evaluate infertility or statistical models. Compared with the sensitivity and specificity of a single diagnostic method, the sensitivity of a combination of methods improved but specificity decreased. We concluded that different diagnostic methods and criteria were required for postpartum days to evaluate infertility and diagnostic accuracy was improved by a combination of diagnostic methods rather than by a single method.

Effect of diagnosis and treatment of clinical endometritis based on vaginal discharge score grading system in postpartum Holstein cows

In this study, the prevalence, effectiveness of diagnosis, and treatment based on vaginal discharge score (VDS) of clinical endometritis in cattle were evaluated. To detect clinical endometritis and classify its severity, vaginoscopy was performed during 21 to 60 days postpartum in 164 Holstein cows consisting of 229 lactations. Groups were defined using the 4-point VDS scale. Study groups included the following: non-endometritis (VDS=0; no/clear mucus; NEM group; n=168); mild endometritis, no treatment (VDS=1; mucus containing flecks of white/off-white pus; NTR group; n=30); and severe endometritis, treated with PGF2α (VDS≥2; discharge containing <50% pus; and VDS=3; discharge containing >50% pus, and fluid or uterine horn asymmetry; TEM group; n=31). Cows treated with PGF2α that did not recover (VDS≥1, n=5) received intrauterine procaine penicillin and streptomycin. Prevalence of clinical endometritis (VDS≥1) was 26.6%. The NTR group required significantly more artificial inseminations per pregnancy than NEM and TEM groups (2.8 ± 1.8 vs 2.0 ± 1.3, 1.9 ± 0.8, P<0.05). In survival analysis, the proportion of non-pregnant cows was higher in the NTR group compared to the NEM (P=0.012) and TEM (P=0.076) groups. In the TEM group, calving to first artificial insemination interval tended to be higher in cows treated 41 to 60 days postpartum than cows treated 29 to 40 days postpartum (97.2 ± 27.1 vs 74.4 ± 19.7, P=0.084). Our study suggests that cows with VDS=1 may require treatment to recover fertility. Diagnosis and treatment of clinical endometritis based on a VDS grading system may improve dairy herd reproductive performance.

Early postpartum administration of equine chorionic gonadotropin to dairy cows calved during the hot season: Effects on fertility after first artificial insemination

Heat stress reduces fertility of high-producing dairy cows, and early administration of equine chorionic gonadotropin (eCG) may improve it. Here, 401 heat-stressed, high-producing dairy cows on a single commercial farm were given eCG (500 UI, n = 214) or saline (n = 187) on days 11-17 after calving, and the effects on fertility after the first artificial insemination (AI) were assessed. On post-partum day 96.34 ± 9.88, all cows were inseminated after a "double short Cosynch" synchronization protocol. Ovarian activity and uterine status were checked by ultrasound on the day of eCG administration and every 7 days thereafter for a total of 3 weeks; checks were also performed during synchronization, and 7 days after AI. On post-partum day 30, cytobrush uterine cytology was performed to check for subclinical endometritis. Pregnancy status was checked on days 30 and 60 after AI. The eCG and control groups did not differ significantly in terms of average lactations per cow (2.33 ± 1.34), days in milk at first AI (96.33 ± 9.88), average milk yield at AI (41.38 ± 7.74 L), or the particular inseminator or bull used for AI. The eCG and control groups showed increasing ovarian activity with time, with approximately 75% of cows in both groups showing a corpus luteum at the beginning of the synchronization protocol. On post-partum day 30, 17.4% of eCG cows and 22.9% of control cows showed subclinical endometritis. Cows treated with eCG showed a tendency toward lower hyperecogenic intraluminal content (16.8 vs. 21.4%, P = 0.15), but ovarian activity during the synchronization protocol was similar between eCG and control groups, with 91% of animals in both groups showing luteolysis after prostaglandin application and 88% showing ovulation after the last administration of gonadotropin-releasing hormone. Fertility was similar between the two groups at both time points after AI (30 days, 34.9 vs. 31.8%; 60 days, 30.6 vs. 28.5%; P > 0.2). These results suggest that early postpartum eCG administration does not improve fertility of heat-stressed dairy cows as long as 60 days after AI. Other strategies may be more effective at mitigating the ability of post-partum heat stress to reduce fertility of high-producing dairy cows.

A weekly postpartum PGF2α protocol enhances uterine health in dairy cows

Postpartum uterine health in dairy cows is crucial for the maintenance of good reproductive performance. In order to improve uterine health and reduce puerperal intrauterine infection, 608 Holstein cows received a weekly PGF_2α protocol (3 i.m. injections of PGF_2α at 7, 14 and 21 d postpartum). For comparison, 593 cows in the control group received injections of sterile saline at the same time. Uterine score at 14 d postpartum, the prevalence of endometritis at 21-27 d postpartum, and subsequent reproduction performance was evaluated. Cows in the treated group exhibited higher tonicity (P<0.05) of the uterus, with less prevalence of endometritis (10.4%, 63/608 vs. 34.6%, 205/593; P<0.001), and required shorter time to the first AI postpartum (67.5±3.4 d vs. 84.4±3.7 d, P<0.05) and to pregnancy (114.5±5.4 d vs. 131.4±5.8 d, P<0.05). In conclusion, the present study demonstrated that uterine health in Holstein cows can be promoted while puerperal infection can be suppressed by this weekly postpartum PGF_2α protocol.

Associations between intrauterine bacterial infection, reproductive tract inflammation, and reproductive performance in pasture-based dairy cows

Reproductive tract bacterial infections, particularly those caused by Escherichia coli and Trueperella pyogenes, can have a negative impact on reproductive performance. It has been hypothesized that the presence of E coli early postpartum may increase the risk of isolation of T pyogenes later postpartum. The objective of the present study was to examine associations between intrauterine bacterial infections with E coli and T pyogenes and any bacterial growth (irrespective of bacterial species), purulent vaginal discharge (PVD), cytologic evidence of endometritis (an increased proportion of polymorphonuclear cells [PMNs]), and reproductive performance. Dairy cows (n = 272) from six herds were examined at Days 0 (median, 2 days in milk), 21 and 42 postpartum. From each cow two intrauterine samples were collected via triple-guarded cytobrush at Days 0 and 21. The first cytobrush was used for bacteriologic culture. Escherichia coli and T pyogenes were isolated by culture, and E coli isolates were assigned to one of four phylogenetic groups using a two-step triplex polymerase chain reaction. In addition, T pyogenes was confirmed by polymerase chain reaction. The second cytobrush was used to prepare a cytology slide. Nucleated cells (n = 200) were categorized as epithelial cells, PMNs, or macrophages. Cows were also assessed for body condition score, PVD score, the presence of a CL, and pregnancy. Statistical analysis was performed using multivariable models. There was no association between the presence of E coli at Day 0 and probability of isolation of T pyogenes 3 weeks later; however, E coli positive cows at Day 0 were more likely to be diagnosed with E coli at Day 21 (relative risk [RR] = 2.0, P < 0.01). Escherichia coli at Day 0 or T pyogenes at Day 21 increased the risk of PVD diagnosis 3 weeks later (RR = 1.9; P = 0.04 and RR = 3.0; P = 0.05, respectively). Cows with any bacterial growth at Day 21, irrespective of species, were less likely to conceive within 3 weeks after the start of the seasonal breeding program (RR = 0.8; P = 0.05). Interestingly, cows with 25% PMNs or greater at Day 0 had shorter time to pregnancy (hazard ratio = 1.32; P = 0.05). Intrauterine bacterial infection may impair reproductive performance but the presence of E coli was not associated with isolation of T pyogenes 3 weeks later. Increased endometrial flux of PMNs in cows early postpartum may be a physiological process and improve reproductive performance.

Invited review: Systematic review of diagnostic tests for reproductive-tract infection and inflammation in dairy cows

The objective of this study was to conduct a systematic and critical appraisal of the quality of previous publications and describe diagnostic methods, diagnostic criteria and definitions, repeatability, and agreement among methods for diagnosis of vaginitis, cervicitis, endometritis, salpingitis, and oophoritis in dairy cows. Publications (n=1,600) that included the words "dairy," "cows," and at least one disease of interest were located with online search engines. In total, 51 papers were selected for comprehensive review by pairs of the authors. Only 61% (n=31) of the 51 reviewed papers provided a definition or citation for the disease or diagnostic methods studied, and only 49% (n=25) of the papers provided the data or a citation to support the test cut point used for diagnosing disease. Furthermore, a large proportion of the papers did not provide sufficient detail to allow critical assessment of the quality of design or reporting. Of 11 described diagnostic methods, only one complete methodology, i.e., vaginoscopy, was assessed for both within- and between-operator repeatability (κ=0.55-0.60 and 0.44, respectively). In the absence of a gold standard, comparisons between different tests have been undertaken. Agreement between the various diagnostic methods is at a low level. These discrepancies may indicate that these diagnostic methods assess different aspects of reproductive health and underline the importance of tying diagnostic criteria to objective measures of reproductive performance. Those studies that used a reproductive outcome to select cut points and tests have the greatest clinical utility. This approach has demonstrated, for example, that presence of (muco)purulent discharge in the vagina and an increased proportion of leukocytes in cytological preparations following uterine lavage or cytobrush sampling are associated with poorer reproductive outcomes. The lack of validated, consistent definitions and outcome variables makes comparisons of the different tests difficult. The quality of design and reporting in future publications could be improved by using checklists as a guideline. Further high-quality research based on published standards to improve study design and reporting should improve cow-side diagnostic tests. Specifically, more data on intra- and interobserver agreement are needed to evaluate test variability. Also, more studies are necessary to determine optimal cut points and time postpartum of examination.

Diagnosis of acute puerperal metritis by electronic nose device analysis of vaginal discharge in dairy cows

The objective of this study was to estimate the diagnostic accuracy of an electronic nose device using vaginal discharge samples to diagnose acute puerperal metritis (APM) in dairy cows. Uterine fluid was sampled manually with a gloved hand and under sterile conditions for electronic nose device analysis (day in milk (DIM) 2, 5, and 10) and bacteriologic examination (DIM 5), respectively, and on additional days, if APM was diagnosed during the daily clinical examinations. A dataset containing samples from 70 cows was used to create a model and to validate the APM status predicted by this model, respectively. Half of the dataset (n = 35; 14 healthy and 21 metritic cows) was provided with information regarding the APM diagnosis and contained all three measurements (DIM 2, 5, and 10) for each cow and was used as a training set whereas the second half was blinded (n = 35; 14 healthy and 21 metritic cows) and contained only the samples collected on DIM 5 of each cow and was used to validate the created prediction model. A receiver operating characteristic curve was calculated using the prediction results of the validation test. The best observed sensitivity was 100% with specificity of 91.6% when using a threshold value of 0.3. The calculated P-value for the receiver operating characteristic curve was less than 0.01. Overall, Escherichia coli was isolated in eight of 28 (28.6%) and 22 of 42 (52.4%) samples collected from healthy and metritic cows, respectively. Trueperella pyogenes and Fusobacterium necrophorum were isolated in 14 and six of 28 (50.0% and 21.4%) and 17 and 16 of 42 (40.5% and 38.1%) samples collected from healthy and metritic cows, respectively. The prevalence of Escherichia coli and Trueperella pyogenes was similar in the samples obtained from metritic cows used for the training set and the validation test. The results are promising especially because of the objective nature of the measurements obtained by the electronic nose device.

Technical note: Evaluation of odor from vaginal discharge of cows in the first 10 days after calving by olfactory cognition and an electronic device

The objective of this study was to determine test characteristics (i.e., intra- and interobserver variability, intraassay variability, sensitivity, and specificity) of an evaluation of odor from vaginal discharge (VD) of cows in the first 10 d postpartum conducted by olfactory cognition and an electronic device, respectively. In experiment 1, 16 investigators (9 veterinary students and 7 licensed veterinarians) evaluated 5 VD samples each on 10 different days. The kappa test revealed an agreement between investigators (interobserver) of κ=0.43 with a Fleiss adjusted standard error of 0.0061. The overall agreement was the same for students (κ=0.28) and veterinarians (κ=0.28). Mean agreement within observers (intraobserver) was κ=0.52 for all observers, and 0.49 and 0.62 for students and veterinarians, respectively. In experiment 2, the repeatability of an electronic device (DiagNose; C-it, Zutphen, the Netherlands) was tested. Therefore, 5 samples of VD from 5 cows were evaluated 10 times each. The repeatability was 0.97, determined by Cronbach's α. In experiment 3, 20 samples collected from healthy cows and 20 of cows with acute puerperal metritis were evaluated by the 16 investigators and the DiagNose using a dichotomous scale (1=cow with acute puerperal metritis; 0=healthy cow). Sensitivity and specificity of olfactory evaluation was 75.0 and 60.1% compared with 92.0 and 100%, respectively, for the electronic nose device. The study revealed a considerable subjectivity of the human nose concerning the classification into healthy and sick animals based on the assessment of vaginal discharge. The repeatability of the electronic nose was higher. In conclusion, the DiagNose system, although imperfect, is a reasonable tool to improve odor assessment of VD. The current system, however, is not suitable as a screening tool in the field. Further research is warranted to adapt such electronic devices to practical on-farm screening tools.

Uterine bacterial flora in postpartum Danish Holstein dairy cows determined using DNA-based fingerprinting: correlation to uterine condition and calving management

The overall aim of this study was to describe uterine bacterial flora during the postpartum period in Danish Holstein cows using the Terminal Restriction Fragment Length Polymorphism (T-RFLP) method. This method produces a pattern of nucleic acid fragments from the microorganisms present, reflecting the "fingerprint" of the actual microbial flora. As well as characterizing changes in flora with time from calving and between herds, data were examined for strong relations between uterine bacterial flora, calving management and uterine condition. In total 125 Holstein cows from five herds were included, and for each cow calving management was recorded. Cows were clinically examined on average 8 (range 0-19) and 28 (range 22-38) days after calving, and a uterine sample was taken for bacterial identification using T-RFLP. Milk samples were taken weekly for progesterone analysis. Bacteria were found in all cows at both examinations, and the flora was composed of many species, including species not traditionally reported to be present in the bovine uterus. The bacterial composition differed according to days from calving and herd. In all five herds Fusobacterium necrophorum, Pseudomonas/Acinetobacter and Bacteroides/Sphingobacterium/Prevotellaceae were among the most common at both examinations. In four herds there was a percentage decrease of F. necrophorum from first to second examination, and in all herds there was a percentage increase of Pseudomonas/Acinetobacter from first to second examination. No differences in bacterial flora were found between cows with different uterine scores, which were influenced by herd, calving difficulty and retained placenta.

A critical evaluation of diagnostic methods used to identify dairy cows with acute post-partum metritis in the current literature

The overall objective of this study was to investigate how relevant research publications address the validity of diagnostic methods for acute puerperal metritis (APM) in dairy cows, a disease commonly treated with antibiotic drugs. Therefore, a literature search was conducted in Journal of Dairy Science, Theriogenology, Animal Reproduction Science and The Veterinary Journal utilizing the ScienceDirect database. The search revealed 259 articles addressing APM. After applying exclusion criteria, a total of 48 trials remained. It was determined whether the author gave a clear definition of APM, the time of diagnosis relative to calving, and the person who performed the diagnosis. Studies were checked for the presence of definitions of possible findings, thresholds, and test characteristics of the methods used. Overall 9 different diagnostic methods were employed. On average 2·5 ± 1·75 diagnostic methods were used in a study. References to support the use of the diagnostic methods were provided in 10 of 48 articles (20·8%). Vaginal discharge, transrectal palpation and rectal temperature were examined in 39, 22, and 21 of the studies, respectively. Thresholds for diagnostic tests and test characteristics were mentioned in 6 and 3 of the 48 articles, respectively. Based on this systematic review of 48 research papers the evidence supporting the use of the diagnostic methods to identify cows with APM has either been not reported or is weak. In conclusion, the reporting of the diagnostic methods to identify cows with APM needs to be improved and further high-quality research is necessary to improve diagnostic performance of the methods employed.