Ductus venosus as a marker of fetal growth in first trimester in a population of Colombian pregnant women / Ductus venoso como marcador de crecimiento fetal en primer trimestre en una población de gestantes colombianas

Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth.

Resumen Objetivos: evaluar la relación entre el ductus venoso (DV) y las variables del crecimiento fetal en primer trimestre en una población de gestantes colombianas. Métodos: se realizó un estudio transversal descriptivo con datos secundarios obtenidos de un estudio multicéntrico. Se incluyeron 526 pacientes entre las semanas 11 a 14 para seguimiento ecográfico gestacional atendidas en tres instituciones prestadoras de salud en Bogotá, Colombia, entre mayo del 2014 y octubre del 2018. Se realizó un análisis descriptivo bivariado donde se evaluó la relación entre las características del DV en primer trimestre y los hallazgos ecográficos. Resultados: la onda de flujo del DV en primer trimestre fue normal en la totalidad de la muestra, con un índice medio de pulsatilidad del ductus venoso (IPDV) de 0,96±0.18. Se encontró una correlación negativa entre la longitud cefalocaudal (LCC) y el IPDV (p<0.05). Conclusión: existe una relación entre el IPDV respecto a la LCC, señalando un interés de este marcador temprano en relación con las alteraciones del crecimiento fetal, sin embargo, se requieren más estudios para determinar la utilidad entre esta variable respecto al crecimiento fetal

Twin pregnancies, crown-rump length and birthweight discordancy: the influence of chorionicity / Gestações gemelares, comprimento craniocaudal e discordância de peso ao nascimento: a influência da corionicidade

Abstract Objective The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). Methods The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. Results No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. Conclusion No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.

Resumo Objetivo O objetivo do presente estudo foi analisar a influência da corionicidade nos parâmetros biométricos comprimento craniocaudal, peso ao nascimento, discordância de comprimento craniocaudal e discordância de peso ao nascimento, determinar a correlação entre estes dois últimos caso haja discordância intergemelar e analisar a influência da corionicidade na presença destas discordâncias com relevância clínica (> 10% e > 15%, respectivamente). Métodos O presente estudo foi um estudo retrospectivo baseado na base de dados de gestações gemelares do Centro Hospitalar S. João (2010-2015), incluindo 486 fetos de 66 gestações monocoriônicas e 177 dicoriônicas. Os critérios de inclusão foram gestações múltiplas de 2 fetos e gestações gemelares saudáveis. Os critérios de exclusão foram gestações tricoriônicas ou de corionicidade inconclusiva, gestações múltiplas com ≥ 3 fetos e gestações gemelares patológicas. Resultados Não se encontrou diferença estatisticamente significativa no peso ao nascimento (p =0,09) e sua discordância (p = 0,06) nem no comprimento craniocaudal (p = 0,48) e sua discordância (p = 0,74) entre gestações monocoriônicas e dicoriônicas. Considerando todas as gestações, as discordâncias de comprimento craniocaudal e peso ao nascimento foram correlacionadas pela reta de regressão "discordância de peso ao nascimento = 0.8864 x discordância de comprimento craniocaudal + 0.0743," com r2 = 0,1599. A discordância de comprimento craniocaudal > 10% descobriu-se em 7.58% das gestações monocoriônicas e em 13.56% das dicoriônicas. A discordância de peso ao nascimento > 15% detectou-se em 16.67% das gestações monocoriônicas e em 31.64% das dicoriônicas. Conclusão Não se identificou influência estatisticamente significativa no peso ao nascimento e sua discordância, bem como no comprimento craniocaudal e sua discordância. A discordância de peso ao nascimento correlacionou-se com a discordância de comprimento craniocaudal em 20% dos casos.

Histogenesis of human fetal liver from 12 weeks to 36 weeks of gestation

Background: Fetal human liver developmental morphology is very important for diagnosis of congenital anomalies. The development of human liver is an ongoing process which begins after fertilization and continues into post-natal life. Liver is one of the organs of gastrointestinal tract having both exocrine and endocrine functions and capable of regeneration. Not only adult liver, the fetal liver is also an important organ with Haemopoietic functions. Pediatric liver transplants accounting for 10-15% of all liver transplants worldwide occur due to congenital defects.Methods: The study is conducted on 50 livers procured from 50 aborted fetuses (34 males and 16 females) ranging from 12 to 36 weeks of gestation .After confirming their age through CRL they were grouped. Then processed to form sections and stained with hematoxylin and eosin and seen under light microscope.Results: Histogenesis and development of human liver in prenatal period was observed under the microscope at various gestational age groups which was confirmed with lobular pattern, portal triad structures ,central vein and sinusoids showing fetal haemopoietic function which regress towards the term.Conclusions: The present study gave emphasis on all physical parameters and a detail histogenesis and development of human liver in prenatal period from 12 to 36 weeks of gestation. This work agreed with previous studies.

Study on reliability of children anthropometric indicators measured by medical students during clinical practice / 重庆医学

Objective To evaluate the reliability of children anthropometric indicators measured by medical students in clini-cal practice .Methods The convenient sampling was adopted to collect the data of the head circumference (HC) ,recumbent length (RL) and crown-rump length (CRL) of infants and young children measured by the students in clinical practice from entering-de-partment training to exiting-department .The re-measured data by clinical teachers were simultaneously collected .The measurement difference were compared between the students and clinical teachers .The measurements reliability was described by using the indi-cators such as the mean absolute differences (MAD) ,percentages of difference within a critical value (PDCV) and so on .Results MAD of HC ,RL and CRL at entering-department were 0 .46 ,0 .55 ,0 .81 cm respectively ,which at exiting-department were 0 .30 , 0 .43 ,0 .51 cm respectively ,the difference were statistically significant (P<0 .05) .PDCV of HC ,RL and CRL belonging to good quality standard at entering-department were 41 .5% ,58 .0% and 36 .0% respectively ,which at exiting-department were increased to 53 .5% ,70 .0% and 59 .0% respectively .PDCV of HC ,RL and CRL belonging to error data were 19 .0% ,10 .0% and 13 .0% re-spectively .Conclusion RL measured by medical students in clinical practice has good quality ,while the bigger errors exist in the measurement values of HC and CRL .

Crown-Rump Length estimation of Human Fetuses by external surface area of Right Parietal bone.

Background: Despite enormous volume of research devoted to the skeletogenous and to the quantitative studies of the developing and mature skeleton, the growth of skull in respect to its surface area is still never been comprehensively studied. Since classical study of Streeter reported gestational age estimation from crown-rump length (CRL), numerous investigators have studied and reported various measures of fetal growth during pregnancy such as biparietal diameter, diaphyseal length of long bones and even cephalometric growth analysis. Present study was done in dried fetal skull bones by calculation of their external surface area and estimation of linear correlation with crown-rump length and hence determination of gestational age. Aim: To establish the correlation between the external surface area of right parietal bone and crown-rump length, to predict fetal age from crown-rump length and circulation of growth rate of right parietal bone. Material and methods: Fifty apparently normal fetuses ranging from 12 cm -42 cm CR length of both sexes were obtained from the Departmen of Obstetrics and Gynecology, of our native hospital. After measuring crown-rump length of each fetal skull after removing brain tissue via foramen magnum was then kept for maceration in running tap water. After complete maceration and separation of right parietal skull bone, measurement of external surface area of right parietal skull bone was obtained using wet cotton cloth, marker pen and graph paper. Results: The regression values were plotted in the graph and these values were found to cluster around the standard straight line and are in hand with the straight line indicating highly significant results. Conclusion: In the present study, CR length was estimated from external surface area of right parietal bone. A definite correlation was observed between external surface area of right parietal bone and CR length.

Comparative study on values of blood physiological and biochemical for middle and old-aged cynomolgus monkey / 中国比较医学杂志

Objective To provide reference of the general physiological index, blood physiology and biochemistry for middle and old-aged cynomolgus monkey.Methods 119 cynomolgus monkey aged from 11~16 (80 were males and 39 were females) were involved in the study.We detected the general physiological index( body weight, the crown-rump length and waist circumference ) , hematology and blood biochemistry parameters respectively and compared these parameters between males and females.Results Between males and females, there were significant differences in Body weight, the crown-rump length and Waist circumference of the general physiological index(P 0.05).Conclusion It provides reference of general physiological index, blood physiology and biochemistry parameters of cynomolgus monkey and basis for their application in biomedical domain.

Estimation of nomograms according to Crown-Rump Length in Mongolian population / Монголын Анагаах Ухаан

GoalThis study was performed to construct Mongolian ethnic specific crown-rump length (CRL)nomogram and to compare its ability to predict gestational age with previously published widelyused nomograms in the world.Materials and MethodsA regression model was developed for estimation of gestational age using CRL measurements of1170 singleton fetuses in the Mongolian population. Measurements were obtained by placing thecalipers of the ultrasound machine from the crown to the rump. The appropriateness of previouslyestablished widespread CRL nomograms for predicting the gestational age was assessed in theMongolian population to determine comparability between nomograms.ResultsCRL corresponds to other nomograms up to 9 weeks of gestational age. There is a 4-5mm differenceof Robinson Hadlock; 7mm of Osaka at 10-12 weeks but the same with Campbell, 4 mm long ofCampbell at 13 weeks.Conclusions:CRL measurements are used as a reliable method for estimation of the gestational age as well asa baseline for comparing gestational ages later. CRL corresponds to other widely used nomogramup to 9 weeks gestational age. There is a 3mm differences of M.A.Esetov, 4-5mm Robinson, andHadlock; 7mm of Osaka at 10-12 weeks but the same with Campbell, 4 mm long of Campbell at13 weeks. Difference with the established nomograms may be due to ethnic differences of theMongolian fetal development. After 13 weeks, CRL measurement is unreliable due to flexion of thefetus.

Avaliação do coração fetal no primeiro trimestre de gestação: influência do comprimento cabeça-nádega e índice de massa corporal materna / Fetal heart assessment in the first trimester of pregnancy: influence of crown-rump length and maternal body mass index

OBJETIVO: Avaliar a influência do comprimento cabeça-nádega e do índice de massa corporal na avaliação ultrassonográfica do coração fetal, pelas vias abdominal e vaginal, no primeiro trimestre de gestação. MÉTODOS: Realizou-se um estudo de corte transversal com 57 gestantes normais entre 12 a 14 semanas (CCN < 84 mm). Foram avaliados os seguintes planos cardíacos, pelas vias abdominal e vaginal: quatro câmaras, via de saída do ventrículo direito, via de saída do ventrículo esquerdo e arco aórtico. Utilizou-se o modo B, Doppler colorido e ultrassonografia de quarta dimensão (spatio-temporal image correlation). Para avaliar a influência do comprimento cabeça-nádega e índice de massa corporal na avaliação dos planos cardíacos fetal, utilizou-se o teste t não-pareado. RESULTADOS: Não se observou diferenças estaticamente significativas nas taxas de sucesso e insucesso entre as vias abdominal e vaginal em relação ao índice de massa corporal, contudo, observou-se maior taxa de insucesso na avaliação vaginal utilizando o modo B associado ao Doppler colorido (P<0,01). CONCLUSÃO: O índice de massa corporal e o comprimento cabeça-nádega não tiveram interferência na avaliação cardíaca fetal no primeiro trimestre de gestação.

OBJECTIVE: To evaluate the influence of the crown-rump length and body mass index on sonographic evaluation of the fetal heart using abdominal and vaginal routes in the first trimester of pregnancy. METHODS: We conducted a cross-sectional study with 57 pregnant women between 12-14 weeks (CRL< 84 mm). We evaluated the following fetal cardiac plans using the abdominal and vaginal routes: four-chamber view, right ventricle outflow tract, left ventricle outflow tract and aortic arch. We used the B-mode, color Doppler and four-dimensional ultrasonography (spatio-temporal image correlation). To evaluate the influence of crown-rump length and body mass index in the assessment of fetal cardiac planes, we used the t test unpaired. RESULTS: There were no statistically significant differences in the rates of success and failure between abdominal and vaginal routes in relation to body mass index, however, there was a higher failure rate in vaginal assessment using B mode associated with color Doppler (P<0.01). CONCLUSION: The crown-rump length and body mass index had no interference in fetal cardiac assessment in the first trimester of pregnancy.

Crown-Rump Length Measured in the Early First Trimester as a Predictor of Low Birth Weight

The aim of this study is to assess the association between crown-rump length (CRL) measured before the 10th gestational week and birth weight. Results from 316 transvaginal ultrasonography scans at the 46th, 53rd, 60th, 67th, and 74th days of pregnancy were compared in low birth weight (LBW) versus normal birth weight groups. A positive correlation between CRL and birth weight was observed when CRL was measured at days 60, 67, and 74. CRL measured on the 67th day of pregnancy was significantly smaller in the LBW group than in the normal birth weight group. A cut-off value of CRL=26.5 mm measured at day 67 has the highest power to predict LBW.

Relationship between fetal nuchal thickening and crown-rump length in Thai fetuses during 10-14 weeks of gestation.

Objective: To investigate the relationship between the Nuchal thickening (NT) and crown–rump length (CRL) in normal Thai fetuses during 10-14 weeks of gestation. Methods: A prospective observational study was conducted. Ultrasound measurement of NT and CRL was offered for 1,000 consecutive Thai fetuses between 10-14 weeks of gestation. Regression analysis was used to analyze the relationship between the NT and CRL. Results: The mean maternal age was 28.03 ± 5.8 yr (range 14-47 yr). The mean CRL was 54.7 ± 12.7 mm (range 10.0-82.0 mm), and the mean NT was 1.6 ± 0.60 mm (range 0.3-6.9 mm), respectively. The median gestational age was 12.0 weeks. The regression equation relating median NT to CRL was described as follows: expected Nuchal thickening (mm) = 0.437 + (0.01764 × CRL) (mm) (R2 = 0.134, p <0.001). Conclusion: The present study offers normative data of the fetal NT in Thai fetuses, which may improve the performance of NT measurement during the first-trimester as a screening tool for chromosomal abnormalities or other congenital abnormalities in the first trimester. The present study shows that NT measurements increase with increasing CRL.

Volume do embrião estimado pela ultra-sonografia tridimensional entre a sétima e a décima semana de gestação / Embryo volume estimated by three-dimensional ultrasonography at seven to ten weeks of pregnancy

OBJETIVO: avaliar a evolução do volume do embrião (VE) entre a sétima e a décima semana de gestação por meio da ultra-sonografia tridimensional. MÉTODOS: realizou-se um estudo de corte transversal com 63 gestantes normais entre a sétima e a décima semana. Os exames ultra-sonográficos foram realizados por meio de um transdutor endocavitário volumétrico. Para o cálculo do VE, utilizou-se o método VOCAL (Virtual Organ Computer-aided Analysis) com ângulo de rotação de 12º, com delimitação de 15 planos seqüenciais. Para o VE foram calculadas médias, medianas, desvios padrão e valores máximo e mínimo em todas as idades gestacionais. Para se avaliar a correlação entre o VE e o comprimento cabeça-nádega (CCN) foi criado gráfico de dispersão, sendo o ajuste realizado pelo coeficiente de determinação (R²). Para se determinarem intervalos de referência do VE em função do CCN, utilizou-se a seguinte fórmula: percentil =VE+K versus dp, com K=1,96. RESULTADOS: o CCN variou de 9,0 a 39,7 mm, com média de 23,9 mm (±7,9 mm), enquanto o VE variou de 0,1 a 7,6 cm³, com média de 2,7 cm³ (±3,2 cm³). O VE foi altamente correlacionado com o CCN, sendo que o melhor ajuste foi obtido com regressão quadrática (VE=0,165 - 0,055 x CCN + 0,005 x CCN²; R²=0,853). O VE médio variou de 0,1 (-0,3 a 0,5 cm³) a 6,7 cm³ (3,8 a 9,7 cm³) no intervalo de 9 a 40 mm do CCN. Neste intervalo o VE aumentou 67 vezes, enquanto o CCN aumentou apenas 4,4 vezes. CONCLUSÕES: o VE é um parâmetro mais sensível que o CCN para avaliar o crescimento embrionário entre a sétima e a décima semana de gestação.

PURPOSE: to evaluate the embryo's volume (EV) between the seventh and the tenth gestational week, through tridimensional ultrasonography. METHODS: a transversal study with 63 normal pregnant women between the seventh and the tenth gestational week. The ultrasonographical exams have been performed with a volumetric abdominal transducer. Virtual Organ Computer-aided Analysis (VOCAL) has been used to calculate EV, with a rotation angle of 12º and a delimitation of 15 sequential slides. The average, median, standard deviation and maximum and minimum values have been calculated for the EV in all the gestational ages. A dispersion graphic has been drawn to assess the correlation between EV and the craniogluteal length (CGL), the adjustment being done by the determination coefficient (R²). To determine EV's reference intervals as a function of the CGL, the following formula was used: percentile=EV+K versus SD, with K=1.96. RESULTS: CGL has varied from 9.0 to 39.7 mm, with an average of 23.9 mm (±7.9 mm), while EV has varied from 0.1 to 7.6 cm³, with an average of 2.7 cm³ (±3.2 cm³). EV was highly correlated to CGL, the best adjustment being obtained with quadratic regression (EV=0.2-0.055 versus CGL+0.005 versus CGL²; R²=0.8). The average EV has varied from 0.1 (-0.3 to 0.5 cm³) to 6.7 cm³ (3.8 to 9.7 cm³) within the interval of 9 to 40 mm of CGL. EV has increased 67 times in this interval, while CGL, only 4.4 times. CONCLUSIONS: EV is a more sensitive parameter than CGL to evaluate embryo growth between the seventh and the tenth week of gestation.

The Distribution of Fetal Nuchal Translucency Thickness in Normal Korean Fetuses

The aim of present study was to establish normative data for the distribution of nuchal translucency (NT) thickness in normal Korean fetuses. The data were collected from pregnant women with singleton pregnancies in whom fetal ultrasound was performed and the fetal NT thickness was measured between 11 and 14 weeks of gestation. Among them, a total of 2,577 fetuses with a known normal outcome were included in this study. The distribution of multiple of median (MoM) values of the NT thickness with crown-rump length (CRL) in 10-mm intervals and the 95th percentile of MoM were calculated with the linear regression method. The present study showed that NT measurements increase with increasing CRL and a false positive rate increases with increasing gestational age. Therefore, a fixed cut-off point through the first trimester was not appropriate and each NT measurement should be examined according to the gestational age. The present study offers normative data of the fetal NT thickness in a Korean population, which can be used as reference for screening chromosomal aberrations or other congenital abnormalities in the first trimester.

Nuchal Translucency Measurement in Normal Korean Fetuses at 10-14 Weeks of Gestation(II) / 대한산부인과학회잡지

The aim of the present cross-sectional study is to define the reference range for the nuchal translucency (NT) measurements in normal Korean fetuses between 10 and 14 weeks' gestation. The nuchal translucency was measured prospectively in 202 chromosomally normal singletons of women attending our antenatal clinic or prenatal diagnostic center by 177 transabdominal sonography (88%) and by 25 transvaginal sonography (12%) if difficulty was encountered with transabdominal sonography. The NT measurement was expressed as the median and 5th, 95th centiles according to crown-rump length (CRL) measurements by ultrasound. Mean multiple of median (MoM) and the 95th centile of MoM values of the NT measurements with CRL in 10 mm intervals were also calculated. NT measurements increased significantly with CRL[NT (mm)=0.481647+0.020142xCRL (mm)]. A NT measurement greater than 2.5 mm was found in 4% of normal fetuses, but this proportion increased form 0% at 10-11 weeks, to 3.8, 8.8, 11.5% at 12, 13, 14 weeks, respectively. The present study provides normative data on the fetal NT thickness in a Korean population, which may improve the performance of NT screening for chromosomal abnormalities in the first trimester.

Transvaginal Measurements of Fetal Crown-Rump Length during the First Trimester after In Vitro Fertilization and Embryo Transfer in Korean Women / 대한산부인과학회잡지

The crown-rump length(CRL) remains the most accurate parameter used for gestational dating. We aimed to establish the early fetal growth with CRL range in Korean women. The CRL of 48 singleton pregnancies which resulted from in vitro fertilization and e mbryo transfer(IVF-ET) at SNUH were assessed two to six times in the first trimester by trans-vaginal ultrasonography. All women included in this study went on to deliver norma l infa-nts at 37 completed weeks or after weighing over 2.5 kg. And we also studied the r elationship between CRL(in millimeters) and gestational age(in days), and found that the fo llowing second-order polynomial might be applied either to expect CRL using the menstr ual gestational age, or to estimate gestational age using measured CRL(r2=0.980, p=0.000 1). CRL=0.0175(GA)2-1.049(GA)+19.17 GA=7.5593(CRL-3.45)1/2+29.97 Finally we compared our data with some of published articles which assessed CRL in spontaneous and induced pregnancies. In conclusion, this study establish the early fetal growth with CRL range in Korean women on the basis of exact ovulation timing using high resolution transvaginal ultrasonography. And these data will be of great use in the evaluation of fetal growth in the first trimester.

THE GROWTH OF THE FEMUR OF CHINESE FETUS AND IT'S CORRELATION-RATIO WITH THE C-R LENGTH / 解剖学报

The femurs of 98 Chinese fetuses were observed and measured with radiographic method. A series data of femur-length and -width of different fetal-age groups was obtained. Calculated femur index (width/length?100)showed that the proportion between the femural length and the femural width remained considerably constant dur- ing the development of the fetus. The positive correlation between the length of the femur and the C-R length was revealed by statistical analysis; a regression equation was obtained. The authors suggest that it is possible to take the femural length as a criterion parameter to estimate the fetal age.

THE DYNAMIC ANATOMY OF TESTICULAR DESCENT OF CHINESE FETUS / 解剖学报

The testis and its relative structures of 101 normal male fetuses (fetal-age 12-33 weeks) have been studied in this paper. The results were as follows: 1. The data of fetal growth of testis, epididymis and gubernaculum were given. 2. It has been found that there is no scrotum ligament existed. The gubernaculum is a mesenchyme tissue and is cylindrical pyramid in shape. Objectively, we cannot find any anatomical structure acted as a tractor in testis descending. 3. It has been found that the testis descends in chinese fetus between the 21th and the 25th week of fetal-age. It was completed in all of them after the 26th week. The time is more advanced than that of the traditional conception which referred to be between 7 th and 8 th month. 4. It has been confirmed that once the descent started, the testis run through inguinal canal rapidly. Generally, it seems that the testicular descent in left side is earlier than that in the right. From the above findings, the author suggests that it be necessary to correct the traditional conception in the Chinese anatomy book.