Larger Circumference Research Articles

Choice of standards for sonographic fetal abdominal circumference percentile

The diagnosis of abnormal fetal abdominal circumference is based on values >90th or <10th percentile. There are dozens of established norms that can be used to determine the percentile of a given abdominal circumference measurement, but there is no established method to determine which norms should be used. This study aimed to evaluate the applicability of 5 established abdominal circumference norms to our measurements and to determine which, if any, should be used for the diagnosis of abnormal fetal abdominal circumference. Data were pooled from 6 maternal-fetal medicine practices to conduct a cross-sectional study. The inclusion criteria were a singleton fetus at 22.0 to 39.9 weeks of gestation with cardiac activity present, complete fetal biometry measured, and examination from 2019 or 2020. For patients with >1 eligible examination during the study period, a single examination was chosen at random for inclusion. Five norms of abdominal circumference were studied: the Hadlock formula, the World Health Organization Fetal Growth Curves, the International Fetal and Newborn Growth Consortium for the 21st-Century Project; and the National Institutes of Child Health and Human Development Fetal Growth Studies (fetuses of White patients and unified standard). Using formulas relating abdominal circumference to gestational age, we calculated the z scores of abdominal circumference (standard deviations from the mean), standard deviation of the z score, Kolmogorov-Smirnov D statistic, and relative mean squared error. The 5 norms were assessed for fit to our data based on 6 criteria: mean z score close to 0, standard deviation of the z score close to 1, low D statistic, low mean squared error, fraction of values >90th percentile close to 10%, and fraction of values <10th percentile close to 10%. The inclusion criteria were met in 40,684 ultrasound examinations in 15,042 patients. Considering the 6 evaluation criteria, observed abdominal circumferences had the best fit to the World Health Organization standard (mean z score of 0.11±1.05, D statistic of 0.041, mean squared error of 0.84±1.46, 13% of examinations >90th percentile, and 7% of examinations <10th percentile). The Hadlock reference had an anomaly in its assumption of a constant standard deviation, resulting in the underdiagnosis of abnormal values at early gestational ages and overdiagnosis at late gestational ages. The International Fetal and Newborn Growth Consortium for the 21st-Century Project standard had a mean circumference smaller than all the other norms, resulting in the underdiagnosis of small circumferences and the overdiagnosis of large circumferences. Similar results were observed when restricting the analyses to a low-risk subgroup of 5487 examinations without identified risk factors for large for gestational age or small for gestational age. The diagnosis of abnormal abdominal circumference depends on the norms used to define abdominal circumference percentiles. The World Health Organization standard had the best fit for our data.

High Body Mass Index and Change in Cervical Carotid Artery Position on Serial Scans: A Retrospective Study of an Unexplained Phenomenon.

The purpose of this study was to investigate the relationship between increased body mass index (BMI) and abdominal circumference and prevalence of the change of position of common and internal carotid arteries on serial imaging, termed wandering carotid artery. We retrospectively reviewed computed tomography/magnetic resonance imaging neck scans and determined whether the common and internal carotid arteries moved in position on serial scans. We correlated patients' demographic and medical information along with abdominal circumference, BMI, location of the aortic arch, and area of soft tissue surrounding the carotid arteries with the prevalence of a wandering carotid artery. Computed tomography/magnetic resonance imaging neck performed on 56 randomly selected patients between 2017 and 2020 were reviewed. A total of 42.9% of the patients had a wandering common or internal carotid artery. The abdominal circumference and BMI were significantly higher in the patients with wandering carotid arteries compared with the patients without (abdominal circumference = 102.9 ± 14.13 vs 91.61 ± 13.9 cm [ P = 0.01] and BMI = 34.27 ± 8.58 [obese] vs 26.21 ± 4.89 [overweight, P = 0.0001]). After adjusting for age, sex, hypertension, diabetes, atherosclerosis grade, and aortic arch location, the odds of wandering carotid artery was 1.23 (95% confidence interval, 1.1-1.44) times higher for every one-unit increase in BMI. There is a higher prevalence of wandering common and internal carotid arteries in obese patients with large abdominal circumference irrespective of age, sex, diabetes, hypertension, or carotid atherosclerosis.

Investigating the Source of Fatal Pulmonary Thromboembolism in a Coronial Postmortem Population.

The incidence of how often a deep vein thrombosis is found in the calves of the legs at coronial postmortem examination is unclear. This study retrospectively examined postmortem examination reports from Australian Coronial investigations of sudden death resulting from pulmonary thromboembolism to determine the likelihood of dissection of the deep veins of calves of the legs revealing the source of a pulmonary thromboembolism. From 450 cases taken from the National Coronial Information System (NCIS) for 2016, the postmortem reports of 327 cases were reviewed to provide demographic details of victims of sudden death from pulmonary thromboembolism. In 235 cases, it was possible to determine in 76.6% a thrombus had been found in the deep veins of the calves of the legs after dissection. In 141 cases, it was documented that both sides had been examined. From these, it was determined there was no statistically significant difference in the prevalence of thrombus in either side. However, it was shown that the presence of an abnormality of a lower limb (such as leg or hip infection, burns, surgery and nonoperated fractures, or a larger circumference) increased the likelihood that a deep vein thrombus would be found on that side.

Formation of productivity of apple varieties in Kyiv

Growing high harvest of fruit in apple orchards is one of the priority tasks of gardeners in Ukraine. It is important to place the plantations in the most favorable zones for climatic conditions and in areas with appropriate soil conditions for certain apple varieties. This is achieved by introducing high-yielding, earlyfruiting, immune varieties with high fruit qualities, introducing appropriate rootstocks, especially weak and medium-sized, using optimal planting schemes, the correct methods of pruning trees. The aim is to study the productivity of new apple varieties in the Kyiv region. The research was performed during 2020-2021 at the Department of Horticulture prof. V.L. Symyrenko NULES of Ukraine. The experimental base for the research was apple orchards, which are located on the territory of the Training Laboratory "Fruit and Vegetable Garden" of NULES of Ukraine (Kyiv). The research site is located in the northern part of the Forest-Steppe of Ukraine. In the course of research conducted phenological observations, also, studied the morphological features of young plants, determined the assimilation surface area, counted the number of fruit formations, established the resistance of the studied varieties to the complex of pests and diseases, and determined the economic efficiency of growing new apple varieties in Kyiv region. The most intensive flowering took place in ‘Dmiana’ (9 points), while the other varieties - about (2-6 points). Flowering time was 7 (‘Palanka’, ‘Bahachka’) - 11 days (‘Dzhonahold’). Shoot duration - 67 (‘Palanka’) - 74 days (‘Hold Rash’, ‘Dzhuliia’, ‘Siabrina’, ‘Bahachka’, ‘Dmiana’). The number of fruits tied for the second year in the garden was the highest in the ‘Dmiana’ variety (average 20 pieces / tree). The results of research showed that most of the studied varieties were precocious. Most fruit formations were formed in the varieties ‘Siabrina’ (52 pieces), ‘Hold Rash’ (45 pieces), ‘Harant’ (43 pieces). According to the data obtained, it can be stated that in these varieties for the third year after planting there is an increase in productivity. The studied varieties for the 2nd year after planting have a height of 204 cm (‘Harant’) - 156 cm (‘Rozela’). There is a pattern: the small diameter of the trunk correlates with the small size of the tree itself in the varieties ‘Rubinola’, ‘Hold Rash’, ‘Dzhonahold’, and ‘Rozela’. Varieties with a large trunk circumference are characterized by significant tree growth (‘Berehynia’, ‘Palanka’, ‘Siabrina’, ‘Bahachka’). The exceptions are ‘Harant’ (tall trees with a fairly small trunk circumference) and ‘Dzhuliia’ and ‘Dmiana’ (large trunk circumference at low tree height). The largest leaf surface area was found in the varieties ‘Berehynia’ (1284.32 m2/ ha) and ‘Bahachka’ (1221.08 m2/ ha). ‘Hold Rash’ (218.88 m2/ ha), ‘Rubinola’ (412.0 m2/ ha) and ‘Dzhonahold’ (348.3 m2/ ha) were characterized by weak foliage. From the point of view of profitability it is expedient to grow all varieties. Varieties such as ‘Dmiana’, ‘Dzhuliia’, ‘Dzhonahold’ and ‘Palanka’ have the highest profitability rates (128 %), while ‘Rozela’ and ‘Rubinola’ have the lowest rates (63.6 %). Based on research, all varieties are recommended for cultivation in the Kiev region. Of particular note are the varieties ‘Dmiana’, ‘Dzhuliia’ and ‘Palanka’, which showed the best results in terms of productivity and resistance to a complex of diseases.

Differences in Calves’ Shape and Circumference Profiles between Chinese Males and Females

Functional garments are required to be closely and properly fitted on diverse human limbs. However, most manufacturers classify their products based on a number of anthropometric statistical parameters of Caucasian body sizes. This work focuses on the diversities in the real curved shapes, and their detailed anatomy characteristics, for Chinese people. Differences in the 3D-scanned human calves’ shapes and circumference profiles between Chinese male and female subjects were identified through primary component analysis, extracted, and compared. Results show that calves of males were longer in length, straighter, and had a larger circumference within the belly of gastrocnemius, while females were found to have shorter overall length, more bent, and had a smaller gastrocnemius. Females had a larger averaged circumference. The focus of this study was on the size design of compression stockings.

Prevalence and risk factors of striae gravidarumin a cohort of multiracial postpartum Nepalese population.

Striae gravidarum (SG), popularly called as stretch marks, is a common pregnancy-related asymptomatic skin condition, but is a cosmetic concern for females. A few epidemiological studies have been reported from Asian countries. However, no such study has been done in Nepal. This study was aimed to know the prevalence and risk factors associated with SG in a cohort of multi-ethnic postpartum Nepalese women who had delivered after completion of 36weeks. A cross-sectional comparative study was conducted among 420 postpartum females who had delivered after completion of 36weeks of gestation. Data were collected in the form of a questionnaire and relevant physical examination was done. The severity of SG was assessed by using Davey's scoring. Out of 420 females, 260 (62%) had SG while 160 (38%) did not. According to the results of logistic regression analysis, young age (<25years), large abdominal circumference (>100cm), increased weight gain during pregnancy (>15kg), presence of family history of SG, gestational diabetes mellitus, altered bowel movement, and presence of striae on the breasts, thighs, and buttocks were found to be independent risk factors for SG. Future expectant mothers must be informed about the risk factors of SG development. They need to be made aware that SG can be prevented by considering the modifiable risk factors, such as excessive weight gain. They should also be informed that SG is permanent and currently there is no definite treatment.

The Role of Diagnostic Biomarkers, Omics Strategies, and Single-Cell Sequencing for Nonalcoholic Fatty Liver Disease in Severely Obese Patients.

Liver disease due to metabolic dysfunction constitute a worldwide growing health issue. Severe obesity is a particularly strong risk factor for non-alcoholic fatty liver disease, which affects up to 93% of these patients. Current diagnostic markers focus on the detection of advanced fibrosis as the major predictor of liver-related morbidity and mortality. The most accurate diagnostic tools use elastography to measure liver stiffness, with diagnostic accuracies similar in normal-weight and severely obese patients. The effectiveness of elastography tools are however hampered by limitations to equipment and measurement quality in patients with very large abdominal circumference and subcutaneous fat. Blood-based biomarkers are therefore attractive, but those available to date have only moderate diagnostic accuracy. Ongoing technological advances in omics technologies such as genomics, transcriptomics, and proteomics hold great promise for discovery of biomarkers and increased pathophysiological understanding of non-alcoholic liver disease and steatohepatitis. Very recent developments have allowed for single-cell sequencing and cell-type resolution of gene expression and function. In the near future, we will therefore likely see a multitude of breakthrough biomarkers, developed from a deepened understanding of the biological function of individual cell types in the healthy and injured liver.

Improving follow-up of incomplete lower extremity venous duplex ultrasound examinations performed for deep and superficial vein thromboses

ObjectiveA lower extremity venous duplex ultrasound (LEVDUS) examination is the standard diagnostic test to evaluate patients for lower extremity deep vein thrombosis (DVT). However, some studies will be incomplete for a variety of reasons, including patient-related factors such as pain, edema, a large leg circumference, or the presence of overlying bandages or orthopedic devices. We previously reported that the frequency of obtaining a follow-up examination after an incomplete and negative (I/N) LEVDUS examination was low but that the rates of DVT found on the follow-up studies of initially I/N LEVDUS studies were similar to the rates of DVT found with initially complete LEVDUS examinations. Therefore, we recommended process improvements to increase follow-up LEVDUS studies after an I/N LEVDUS examination. In the present study, we have described the results of appending a recommendation to obtain a follow-up LEVDUS study to preliminary and final reports of I/N LEVDUS. MethodsStarting in January 2019 through December 2019, a recommendation to obtain a repeat LEVDUS examination after an I/N study was appended to the preliminary and final reports of all I/N LEVDUS examination of patients who did not, otherwise, have an indication for anticoagulation (group 2). The patients were identified on an ongoing basis through the study period and entered into an Excel database (Microsoft Corp, Redmond, Wash). Group 2 was compared with a previously reported historic control cohort of patients identified from January 2017 to December 2017 (group 1). We compared groups 1 and 2 with respect to the frequency of the repeat studies performed within 4 weeks after an I/N LEVDUS examination and the DVT rates found from the follow-up LEVDUS examinations after an I/N LEVDUS study. ResultsOf the patients in groups 1 and 2, 187 and 229 had had I/N LEVDUS examinations, with 28% and 40.2% of group 1 and 2 studies having follow-up LEVDUS examinations (P < .01). Previously unidentified lower extremity thrombi were discovered in 21% of the group 2 follow-up examinations. Also, the rate of new thrombi detected was not different between groups 2 and 1 (historic controls; DVT, 14.3% vs 18.5% [P = .25]; SVT, 6.3% vs 3.3% [P = .15]). A definitive finding of either positive or negative for DVT and SVT with a complete examination in 50% of the group 2 patients with follow-up examinations. ConclusionsA recommendation to obtain a follow-up examination appended to the preliminary and final I/N LEVDUS reports was associated with an increased rate of follow-up examinations, which revealed many previously undetected DVTs and SVTs or had allowed for definitive exclusion of DVT.

Are adults just big kids? Can the newer paediatric weight estimation systems be used in adults?

The weight of a patient is an important variable that impacts on their medical care. Although some drugs are prescribed on a so-called 'adult dose' basis, we know that adults come in all shapes and sizes - a 'one-dose-fits-all' approach is not necessarily appropriate. As a measured weight may not always be available, an alternative method of accurately estimating weight is required. To assess and compare the accuracy of weight estimations in adults by patient self-estimation, the Mercy method, Buckley method, Broca index and PAWPER XL-MAC (paediatric advanced weight prediction in the emergency room eXtra length/eXtra large mid-arm circumference) method. This was a prospective, cross-sectional study conducted at a tertiary academic hospital in a metropolitan area of Johannesburg, South Africa. Anthropometric variables of height, abdominal circumference, thigh circumference, mid-arm circumference and humeral length were measured. These variables were then applied to the various weight estimation methods and compared with the patient's actual weight. There were 188 adult patients included in the study. None of the methodologies evaluated in this study achieved the recommended &gt;70% of weight estimations within 10% of the patient's actual weight (PW10). The Mercy method was the closest to achieving greater than the recommended 95% for weight estimation falling within 20% of the patient's actual weight (PW20). The PW20 for the Mercy method was 91.5%. The PAWPER XL-MAC and patient self-estimate methods achieved a PW20 of 85.1% and 86.1%, respectively. The Broca and Buckley methods performed poorly overall. None of the evaluated weight estimation methodologies was accurate enough for use in adult weight estimation. The Mercy and PAWPER XL-MAC methodologies both showed significant promise for use in adult weight estimation, but need further refinement. Although patient self-estimates were similarly accurate to those found in previous studies, they were not an accurate option; self-estimations would remain the first choice if the patient was able to provide such an estimation. The Broca index and Buckley method cannot be recommended owing to their poor performance.

Purpose, conditions and indications for the operation of the so-called "high forceps"

Origo artis obstetriciae ab experientia, experientiae occasio a necessitate ... What are high forceps (forceps obstetricia superior s. Alta)? According to Max Runge, the ischial spines are the true guiding thread for determining the height of the head: if it is no longer possible to reach them with a finger, then this means that the head probably already stands with its largest circumference in the pelvis).

Retrospective risk analysis for acute urinary dysfunction after laparoscopic rectal cancer surgery in patients receiving epidural analgesia.

Urinary dysfunction (UD) is a frequent complication following rectal surgery. The aim of the present study was to investigate the risk factors for acute UD after laparoscopic low anterior resection (LALAR) for rectal cancer in patients receiving epidural analgesia. A retrospective study was conducted on 131 patients who underwent LALAR among those receiving epidural analgesia in a single institution between October 2008 and December 2019. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with acute UD. The overall incidence of acute UD was 16.0% (21/131). Univariate analysis showed that older age (P = 0.016) and earlier urinary catheter removal (P = 0.036) were associated with acute UD. Multivariate logistic regression analysis revealed that older age (10-year increments; odds ratio (OR) 2.046, 95% confidence interval (CI) 1.171-3.543, P = 0.011), urinary catheter removal before epidural analgesia discontinuation (OR 6.393, 95% CI 1.540-26.534, P = 0.011), and a large tumor circumference rate (10% increments; OR 1.263, 95% CI 1.043-1.530, P = 0.017) were independent risk factors for acute UD. Our findings suggest that older age, early removal of urinal catheter before epidural analgesia discontinuation, and large tumor circumference rate are risk factors of acute UD after LALAR for rectal cancer in patients receiving epidural analgesia.

Relationship between Abdominal Circumference and Incidence of Hypotension during Cesarean Section under Spinal Anesthesia.

Background Enlarged uterus can compress the inferior vena cava and cause hypotension when lying supine. Previous studies have shown a positive association between the abdominal circumference and size of the uterus. Therefore, the aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia. Methods The study cohort comprised women undergoing cesarean section under spinal anesthesia. Patients were divided into two groups according to the median abdominal circumference (<101 cm and ≥101 cm). Hypotension was defined as a systolic blood pressure of <90 mmHg or mean arterial pressure of <65 mmHg. The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women. Results The study cohort comprised 100 women. The incidence of hypotension did not differ between the groups (71.42% in the smaller vs. 78.43% in the larger abdominal circumference group, p=0.419). However, the decrease in mean arterial pressure and its percentage decrease from baseline were greater in the larger than in the smaller abdominal circumference group (change in mean arterial pressure: 28.33 mmHg (18.66–33.67) in the smaller vs. 36.67 mmHg (23.34–43.34) in the larger abdominal circumference group, p=0.004; percentage decrease: 31.41% (22.74–39.22) in the smaller vs. 38.47% (28.00–44.81) in the larger abdominal circumference group, p=0.022). Conclusions Large abdominal circumference in pregnancy is associated with greater decreases in mean arterial pressure from baseline. However, the incidence of hypotension defined by standard criteria did not differ between larger and smaller abdominal circumference groups.

Large mid-upper arm circumference is associated with metabolic syndrome in middle-aged and elderly individuals: a community-based study

BackgroundThe mid-upper arm circumference (MUAC) is a proxy for subcutaneous fat in the upper body and is a reliable screening measure for identifying individuals with abnormal regional fat distribution. The purpose of this study was to evaluate the association between MUAC and metabolic syndrome (MetS) in middle-aged and elderly individuals.MethodsWe measured the MUAC in a cross-sectional sample with a total of 9787 subjects aged 40 years and older. The measurement of MUAC is performed on the right arm using a non-elastic tape held midway between the acromion and the olecranon processes in duplicate, with the arm hanging loosely at the side of the body. The MetS was defined according to the Joint Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention.ResultsMUAC was positively correlated with waist circumference (r = 0.437, P < 0.001), BMI (r = 0.334, P < 0.001), fasting insulin (r = 0.348, P < 0.001), HOMA-IR (r = 0.134, P < 0.001), triglycerides (r = 0.138, P < 0.001), SBP (r = 0.124, P < 0.001), and DBP (r = 0.123, P < 0.001), and inversely correlated with adiponectin (r = − 0.147, P < 0.001) and HDL-cholesterol (r = − 0.176, P < 0.001) after adjusting for age and gender. Compared with the lowest quartile group, the odds ratios were substantially higher for MetS (OR 1.77; 95% CI 1.51–2.09, P for trend< 0.001) in the highest MUAC quartile group after adjustment for potential cofounder.ConclusionLarge mid-upper arm circumference is significantly associated with metabolic syndrome in middle-aged and elderly individuals.

Características clínicas y epidemiológicas del estado nutricional en ingresantes a la facultad de medicina humana de una universidad privada

Objetivos: determinar la frecuencia de malnutrición en los estudiantes ingresantes a la facultad de medicina humana de una universidad privada en el año 2018. Materiales y métodos: estudio transversal y retrospectivo, que consistió en la revisión de las historias clínicas de los estudiantes ingresantes en 2018 que pasaron evaluación médica en una facultad de Medicina de Lima, Perú. Se obtuvo frecuencias absolutas y relativas, se calculó Chi-cuadrado o Test exacto de Fisher para las variables cualitativas y Prueba de U de Mann – Whitney o T student para las cuantitativas. Se consideró como nivel de significancia al 95%. Resultados: La población de estudio fueron 263 personas; se obtuvo que el 53,99% tuvo malnutrición, conformado por un 36,5% con sobrepeso, el 11,03% obesidad y el 6.46% desnutrición. Se encontró asociación con malnutrición a: consumo de alcohol (p &lt;0,001), tabaco (p &lt;0,001), antecedentes familiares de diabetes tipo 2 (p &lt; 0,001), distrito de procedencia (p= 0,014) y perímetro abdominal (p &lt; 0,001). Conclusiones: más de la mitad de los estudiantes ingresantes a una facultad de medicina humana presentaron problemas de malnutrición, en mayor proporción por exceso de peso y estuvo asociada al riesgo cardiovascular por su aumentado perímetro abdominal y valores alterados en sus exámenes de laboratorio. Las variables asociadas a malnutrición fueron: consumo de alcohol, tabaco, antecedente familiar de diabetes tipo 2, distrito de procedencia y perímetro abdominal.

Large thigh circumference is associated with lower blood pressure in overweight and obese individuals: a community-based study.

ObjectiveA small thigh circumference is associated with an increased risk of diabetes, cardiovascular diseases, and total mortality. The purpose of this study was to evaluate the association between thigh circumference and hypertension in the middle-aged and elderly population.MethodsA total of 9520 individuals aged 40 years and older with measurement of thigh circumference were available for analysis. The measurement of thigh circumference was performed directly below the gluteal fold of the thigh. The association of thigh circumference with hypertension was tested in logistic regression analyses and reported as odds ratio (OR) with 95% CI.ResultsThigh circumference was negatively correlated with systolic blood pressure, diastolic blood pressure, fasting glucose, and total cholesterol. Compared with the lowest thigh circumference tertile group, the risk of hypertension was significantly lower in the highest tertile group, both in overweight individuals (OR 0.68; 95% CI 0.59–0.79, P < 0.001) and obese individuals (OR 0.51; 95% CI 0.38–0.70, P < 0.001).ConclusionIn the present study, large thigh circumference is associated with lower risk of hypertension in overweight and obese Chinese individuals.

Evaluation of Scrotal Temperature in Different Testicular Shapes by Infrared Thermography in Braford Bulls

Background: The mechanisms of testicular thermoregulation may influence the blood flow provided by the testicular artery, where the proper blood supply to the testicle is crucial for promotingspermatogenesis and reproductive function in bulls. The size and shape of the testicles are determined by genetic mechanisms and environmental effects. A better understanding of the relationships between the anatomical characteristics of the testicles and scrotum can support a better reproductive assessment. The purpose of the current study was to evaluate the testicular temperature of different scrotal shapes using infrared thermography in bulls.Materials, Methods &amp; Results: We evaluated 132 Braford bulls with an average age of 24 months. The evaluation of breeding bull semen was performed prior to the beginning of the experiment. Then, animals were selected on the basis of the size of their testes, which was determined by dividing the average width by the average length. The scrotal circumference was measured with a millimeter tape positioned around the largest circumference. Testicular and ocular temperature measurements and analysis were conducted using an infrared thermal camera, Flir T440 with emissivity of 0.98 and thermal sensitivity of 0.05°C. Testicular scrotum temperature and testicular shape were analyzed with one-way ANOVA using Minitab 16, and values of P &lt; 0.05 were considered statistically significant. We observed that 67.42% of testicle shapes were long-oval, and 32.58% were long-moderate. The testicular temperature was higher in bulls with the long-moderate shape compared to those with the long-oval shape (P &lt; 0.05). The mean length was higher in long-moderate shaped testicles compared to those of the long-oval shape (P &lt; 0.01). There was no significant differences in rectal and ocular temperatures or in scrotal circumference between bulls with long-moderate and long-oval shapes (P &gt; 0.05). In addition, the mean width was lower in testicles of long-moderate shape compared to those of the long-oval scrotal format (P &lt; 0.01).Discussion: The results obtained showed that Braford bulls with the long-moderate testicular shape have a higher testicular temperature to maintain proper thermoregulation. The present study demonstrated that IRT can be used to evaluate the testicular temperature in animals with different scrotal conformations. In this study, Braford bulls showed lower length and width values for animals having long-moderate (9.21 and 5.22, respectively) and long-oval formats (8.56 and 5.56, respectively). In contrast, previous reports examining Nellore bulls between the ages of 17-20 months found a predominance of the long oval shape followed by the long-moderate shape, which indicates a change in testicular shape as age progresses, resulting in a rounder testicular shape. Perhaps other factors, such as the external cremaster muscle and tunica dartos, cause the testicles to be retracted towards the body at lower temperatures while at high temperatures, relaxation occurs. The prevailing testicular shape in Braford animals with a mean age of 24 months was the long-moderate shape. Thus, testicles with a larger surface area will have lower temperatures because they can dissipate heat more easily than testicles with lower surface area. The results suggest that the long-moderate scrotum format may influence the testicular temperature in mature Braford bulls.

Reproducibility of the European Society of Hypertension - International Protocol for validation of blood pressure measuring devices in obese patients.

Electronic devices for blood pressure (BP) measurements need to go through independent clinical validation as recommended by different authorities, both in general and special populations. Reproducibility of such validation protocols is unknown. The aim of this study was to assess the inter-centre reproducibility of the European Society of Hypertension-International protocol (ESH-IP) in patients with large arm circumference at least 32 cm or obesity. Two independent validation studies were performed in parallel according to the ESH-IP protocol in two centres (Serbia and Armenia). The two studies were performed blindly and independently. The ESH-IP criteria were applied for the analysis. The OMRON RS7 wrist oscillometric devices were used in both studies. The distribution of the mean differences values of 5 or less, 10 or less and 15 mmHg or less between the observers and the device were for the Serbia team: 74, 95 and 98 for SBP and 78, 95 and 99 for DBP; and for the Armenia team: 86, 95 and 99 for SBP and 90, 99 and 99 for DBP. The mean differences (SD) of BP values between the observers and the device were for the Serbia team of 1.7 ± 4.8 mmHg for SBP and 1.2 ± 4.6 mmHg for DBP and for the Armenia team of -1.1 ± 4.2 mmHg for SBP and -0.3 ± 3.5 mmHg for DBP. This study showed that the ESH-IP validation protocol presents a good inter-centre reproducibility. The OMRON RS7 device showed similar results, fulfilling the validation criteria in two independent studies in patients with arm circumference at least 32 cm.

Reconstruction of the pulmonary artery by a novel biodegradable conduit engineered with perinatal stem cell-derived vascular smooth muscle cells enables physiological vascular growth in a large animal model of congenital heart disease

Lack of growth potential of available grafts represents a bottleneck in the correction of congenital heart defects. Here we used a swine small intestinal submucosa (SIS) graft functionalized with mesenchymal stem cell (MSC)-derived vascular smooth muscle cells (VSMCs), for replacement of the pulmonary artery in piglets.MSCs were expanded from human umbilical cord blood or new-born swine peripheral blood, seeded onto decellularized SIS grafts and conditioned in a bioreactor to differentiate into VSMCs. Results indicate the equivalence of generating grafts engineered with human or swine MSC-derived VSMCs. Next, we conducted a randomized, controlled study in piglets (12–15 kg), which had the left pulmonary artery reconstructed with swine VSMC-engineered or acellular conduit grafts. Piglets recovered well from surgery, with no casualty and similar growth rate in either group. After 6 months, grafted arteries had larger circumference in the cellular group (28.3 ± 2.3 vs 18.3 ± 2.1 mm, P < 0.001), but without evidence of aneurism formation. Immunohistochemistry showed engineered grafts were composed of homogeneous endothelium covered by multi-layered muscular media, whereas the acellular grafts exhibited a patchy endothelial cell layer and a thinner muscular layer. Resultsshow the feasibility and efficacy of pulmonary artery reconstruction using clinically available grafts engineered with allogeneic VSMCs in growing swine.

Risk factors analysis of gestational diabetes mellitus based on International Association of Diabetes Pregnancy Study Groups criteria

To study the risk factors for gestational diabetes mellitus (GDM). This retrospective case-control study was conducted among women registered at the Department of Obstetrics of West China Second University Hospital between March, 2016 and May, 2018. The women were divided into case group (GDM) and control group (Non- GDM) according to the diagnosis of GDM based on the International Association of Diabetes Pregnancy Study Groups (IADPSG) criteria. The data including age, education level, ethnicity and other socio-demographic data, as well as the gestational week, parity, polycystic ovary syndrome, family history of diabetes, fat mass, total body water, minerals and other clinical characteristics were collected. Univariate Logistic regression analysis was performed and the variables with statistical difference and clinical significance were included in multivariate Logistic regression analysis to identify the risk factors of GDM. A total of 3608 pregnant women were included in the study. Univariate logistic analysis revealed that age, previous GDM, intracellular/extracellular water, fat mass, arm circumference, skeletal muscle mass were risk factors for GDM. Multivariate logistic analysis showed that age, previous GDM, family history of DM, and an arm circumference ≥28.5 cm were independent risk factors for GDM after controlling pre-pregnancy BMI. The risk of GDM in pregnant women aged 30-35 years and 36 years or older was 1.883 (P &lt; 0.001) and 2.883 (P &lt; 0.001) times of that in women aged 20-29 years, respectively. Women with a history of GDM had a 6.604 (P &lt; 0.001) greater risk of developing GDM than women without a history of GDM. Compared with those without a family history of diabetes, those with a family history of diabetes were 2.518 times more likely to develop GDM (P &lt; 0.001). Compared with those with an arm circumference no greater than 25.5 cm, pregnant women with an arm circumference over 28.5 cm had an increased risk of GDM by 2.815 times (P &lt; 0.001). High fat free mass was a protective factor for GDM, and compared with a fat free mass below 35.1 kg, a fat free mass over 40.1 kg was associated with a lowered risk of GDM by 0.515 times (P &lt; 0.001). The onset of GDM was affected by multiple factors. Age, history of GDM, family history of diabetes, and a large arm circumference are all independent risk factors of GDM and should be controlled to reduce the incidence of GDM.

Does the thigh circumference affect the positioning of the acetabular component when using the direct anterior approach in total hip arthroplasty?

The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the acetabular component, radiological leg-length discrepancy, and femoral offset. The radiological outcomes were considered as continuous and binary outcome variables based on Lewinnek's 'safe zone'. Similar trends were seen in all three thigh circumference groups. In multivariable analyses, patients in the largest 20 cm thigh circumference quartile (59 cm to 78 cm) had inclination angles that were a mean of 5.96° larger (95% confidence interval (CI) 2.99° to 8.93°; p < 0.001) and anteversion angles that were a mean of 2.92° larger (95% CI 0.47° to 5.37°; p = 0.020) than the smallest quartile. No significant differences were noted in leg-length discrepancy or offset. There was an associated increase in inclination and anteversion as thigh circumference increased, with no change in the risk of malpositioning the components. THA can be performed using the DAA in patients with large thigh circumference without the risk of malpositioning the acetabular component. Cite this article: Bone Joint J 2019;101-B:529-535.