Performance of local reference curve on the diagnosis of large for gestational age fetuses in diabetic pregnant women.

OBJECTIVE: To evaluate the performance of a local fetal weight curve based on the prediction for large gestational age (LGA) newborns in diabetic pregnant women and to compare it to reference curves established for other populations. METHOD: A reference model for estimated fetal weight was created from a local sample of 2211 singleton low-risk pregnancies. The estimated fetal weight from 194 women with gestational diabetes mellitus was then plotted on this curve, and the results were compared to those obtained by Intergrowth 21st and Hadlock curves. RESULTS: The sensitivity of the proposed model to predict LGA fetuses was 55.6%, the specificity was 82.1%, and the accuracy was 74.7%. The sensitivity, specificity, and accuracy for the Intergrowth 21st curve were 46.3%, 87.9%, and 76.3%, respectively, and no statistically significant difference was observed compared to the proposed model. Conversely, significant differences were observed for the Hadlock curve, which presented a lower sensitivity (24.1%), higher specificity (97.1%), and similar accuracy (76.8%). CONCLUSION: The sensitivity of the proposed model was higher compared to the Hadlock curve for the screening of LGA newborns in diabetic pregnant women. However, no significant differences were observed in comparison to the Intergrowth 21st curve.

Performance of a local reference curve for predicting small for gestational age fetuses in pregnant women with HIV/AIDS.

PURPOSE: To compare the performance of a local estimated fetal weight curve with curves established for other populations to predict small for gestational age (SGA) fetuses. METHODS: A retrospective and cross-sectional study involving 231 fetuses in which the performance of a local curve (proposed model) was compared with the Hadlock and Intergrowth-21st curves in the prediction of SGA fetuses, by applying them to a population of high-risk pregnant woman with HIV/AIDS. For each model, a receiver operating characteristic curve was adjusted, considering the SGA classification by the neonatal Intergrowth method as the gold standard, and the area under the curve (AUC) was calculated. RESULTS: The models presented linear correlations with each other. The agreement of the proposed model with Hadlock was very good (kappa = 0.83), whereas the proposed model and Intergrowth-21st had moderate agreement (kappa = 0.44). The SGA fetus detection sensitivities of the proposed model and Hadlock were 61.9% and 57.1%, with specificity of 84.1% and 86.2% and accuracy of 80.1% and 81%, respectively, without statistical difference. The sensitivity of the Intergrowth-21st model was 33.3%, while the accuracy was 85.7% and the specificity was 97.4%. The AUC estimated values for the Hadlock, proposed, and Intergrowth-21st models were 0.834, 0.832, and 0.835, respectively. CONCLUSION: The proposed model and Hadlock were interchangeable in the prediction of SGA fetuses and superior to the Intergrowth-21st model.

Local References for Ultrasound-Estimated Fetal Weight Based on 2,211 Singleton Pregnancies in the City of Curitiba, South of Brazil.

OBJECTIVE: To develop reference curves of estimated fetal weight for a local population in Curitiba, South of Brazil, and compare them with the curves established for other populations. METHODS: An observational, cross-sectional, retrospective study was conducted. A reference model for estimated fetal weight was developed using a local sample of 2,211 singleton pregnancies with low risk of growth disorders and well-defined gestational age. This model was compared graphically with the Hadlock and Intergrowth 21st curves. RESULTS: Reference curves for estimated fetal weight were developed for a local population. The coefficient of determination was R2 = 99.11%, indicating that 99.11% of the fetal weight variations were explained by the model. Compared with Hadlock curves, the 50th, 90th, and 97th percentiles in this model were lower, whereas the 10th percentile nearly overlapped, and the 3rd percentile was slightly higher in the proposed model. The percentiles were higher in the proposed model compared with the Intergrowth 21st curves, particularly for the 3rd, 10th, and 50th percentiles. CONCLUSION: We provide a local reference curve for estimated fetal weight. The proposed model was different from other models, and these differences might be due to the use of different populations for model construction.

OBJETIVO: Desenvolver curvas de referência para o peso fetal estimado em uma população de Curitiba, Sul do Brasil, e compará-las com curvas estabelecidas para outras populações. MéTODOS: Foi realizado um estudo observacional, transversal e retrospectivo. Um modelo de referência para o peso fetal estimado foi desenvolvido usando uma amostra local de 2.211 gestações únicas de baixo risco de distúrbios do crescimento e idade gestacional bem definida. Este modelo foi comparado graficamente com as curvas de Hadlock e Intergrowth 21 st. RESULTADOS: As curvas de referência para o peso fetal estimado foram desenvolvidas para uma população local. O coeficiente de determinação foi de R2 = 99,11%, indicando que 99,11% das variações do peso fetal foram explicadas pelo modelo. Em comparação com as curvas de Hadlock, os percentis 50, 90, e 97 neste modelo foram inferiores, enquanto o percentil 10 quase se sobrepôs, e o percentil 3 foi ligeiramente superior no modelo proposto. Os percentis foram maiores no modelo proposto em comparação com as curvas do Intergrowth 21st, particularmente para os percentis 3, 10, e 50. CONCLUSãO: Fornecemos uma curva de referência local para o peso fetal estimado. O modelo proposto foi diferente de outros modelos, e essas diferenças podem ser devido ao uso de diferentes populações para a construção do modelo.

Local references for ultrasound-estimated fetal weight based on 2, 211 singleton pregnancies in the City of Curitiba, south of Brazil / Referências locais para o peso fetal estimado por ultrassom baseado em 2. 211 gestações únicas na cidade de Curitiba, Sul do Brasil

Abstract Objective To develop reference curves of estimated fetal weight for a local population in Curitiba, South of Brazil, and compare them with the curves established for other populations. Methods An observational, cross-sectional, retrospective study was conducted. A reference model for estimated fetal weight was developed using a local sample of 2,211 singleton pregnancies with low risk of growth disorders and well-defined gestational age. This model was compared graphically with the Hadlock and Intergrowth 21st curves. Results Reference curves for estimated fetal weight were developed for a local population. The coefficient of determination was R2 = 99.11%, indicating that 99.11% of the fetal weight variations were explained by the model. Compared with Hadlock curves, the 50th, 90th, and 97th percentiles in this model were lower, whereas the 10th percentile nearly overlapped, and the 3rd percentile was slightly higher in the proposed model. The percentiles were higher in the proposed model compared with the Intergrowth 21st curves, particularly for the 3rd, 10th, and 50th percentiles. Conclusion We provide a local reference curve for estimated fetal weight. The proposed model was different from other models, and these differences might be due to the use of different populations for model construction.

Resumo Objetivo Desenvolver curvas de referência para o peso fetal estimado em uma população de Curitiba, Sul do Brasil, e compará-las com curvas estabelecidas para outras populações. Métodos Foi realizado um estudo observacional, transversal e retrospectivo. Um modelo de referência para o peso fetal estimado foi desenvolvido usando uma amostra local de 2.211 gestações únicas de baixo risco de distúrbios do crescimento e idade gestacional bem definida. Este modelo foi comparado graficamente com as curvas de Hadlock e Intergrowth 21st. Resultados As curvas de referência para o peso fetal estimado foram desenvolvidas para uma população local. O coeficiente de determinação foi de R2 = 99,11%, indicando que 99,11% das variações do peso fetal foram explicadas pelo modelo. Em comparação com as curvas de Hadlock, os percentis 50, 90, e 97 neste modelo foram inferiores, enquanto o percentil 10 quase se sobrepôs, e o percentil 3 foi ligeiramente superior no modelo proposto. Os percentis foram maiores no modelo proposto em comparação com as curvas do Intergrowth 21st, particularmente para os percentis 3, 10, e 50. Conclusão Fornecemos uma curva de referência local para o peso fetal estimado. O modelo proposto foi diferente de outros modelos, e essas diferenças podem ser devido ao uso de diferentes populações para a construção do modelo.

[Prevention of normothermic hepatic ischemia during in situ liver perfusion with three different preservation solutions: experimental analysis by realtime infrared radiation thermography]. / Prevenção de isquemia hepática normotérmica durante perfusão hepática in situ com três diferentes soluções de preservação: análise experimental através de termografia por radiação infravermelha em tempo real.

OBJECTIVE: To establish the usefulness of infrared radiation thermography on monitoring in situ liver perfusion with different preservation solutions during liver harvesting. METHODS: Twenty-four adult male Wistar rats, weighing 385.31 g were randomly divided into four groups of six animals each according to the solution used to perfuse the liver (Euro-Collins® solution--EC group; Custodiol® solution--CUST group; Celsior® solution--CEL group and Ringer-Lactate solution--RL group). Under inhalatory ether anesthesia, animals were submitted to upper transversal laparotomy, exposure of median and left-lateral hepatic lobes, heparin injection (500 UI/Kg) through infrahepatic vena cava, portal vein infusion through 18G catheter of cold (4°C) solution according to the group of study. Infrared images, with respective temperature evaluations from hepatic surface, were picked up in real time by Therma CAM SC500® infrared camera positioned at constant distance from three fixed points of the diaphragmatic surface of median and left lateral lobes at the following moments regarding liver perfusion: immediately after laparotomy; after portal vein cannulation and immediately before solution infusion; at each minute from the beginning of liver perfusion during five minutes. Mean temperatures of each moment were compared intra and intergroups with the difference between means test with normal distribution, with significance level of 5% (p=0.05). RESULTS: There was statistically significant difference of means temperatures between the moment of laparotomy and immediately after cannulation; between this later and after the first minute of perfusion; and between the first and fifth minutes of infusion in all groups of study in a similar way. CEL group showed additional difference between the first and second minutes means temperatures. Intergroup comparison showed Euro-Collins solution with significant less cooling power when compared to all others solutions. CONCLUSION: It was possible to follow the liver cooling process during preservation solutions perfusion using infrared radiation images. Preservation solutions had similar behaviors, with Celsior® solution showing additional cooling power until the second minute of perfusion. Euro-Collins solution had less cooling power than other solutions studied.

Prevenção de isquemia hepática normotérmica durante perfusão hepática in situ com três diferentes soluções de preservação: análise experimental através de termografia por radiação infravermelha em tempo real / Prevention of normothermic hepatic ischemia during in situ liver perfusion with three different preservation solutions: experimental analysis by realtime infrared radiation thermography

OBJETIVO: Determinar a aplicabilidade da termografia por radiação infravermelha no monitoramento da perfusão hepática in situ com diferentes soluções de preservação. MÉTODOS: 24 ratos Wistar machos adultos, foram distribuidos aleatoriamente em quatro grupos de seis animais: grupo EC; ®grupo CUST; ®grupo CEL e grupo RL. Todas as soluções estavam resfriadas à exatamente 4ºC e posicionadas 20 cm acima do nível do fígado. As imagens infravermelhas, com as respectivas avaliações de temperatura da superfície hepática, foram captadas em tempo real : imediatamente após a laparotomia; após a canulação dos vasos e imediatamente antes da infusão; a cada minuto cronometrado após início da infusão até o quinto minuto de infusão. As médias de temperaturas de cada momento foram comparadas intra e intergrupos através do teste da Diferença entre médias de distribuição normal, com nível de significância p 0,05. RESULTADOS: Houve diferença entre as temperaturas do momento da laparotomia e imediatamente após a canulação; entre este último e após o primeiro minuto de perfusão; e entre as medidas ao final do primeiro e do quinto minutos de perfusão em todos os grupos. O grupo CEL mostrou diferença significativa adicional entre as temperaturas medidas ao final do primeiro e do segundo minutos. CONCLUSÃO: Foi possível avaliar o resfriamento hepático durante a perfusão das soluções de preservação utilizando-se a radiação infravermelha. As soluções tiveram comportamento semelhante entre si, com a solução Celsior® mostrando potencial adicional de resfriamento significativo até ao final do segundo minuto.

OBJECTIVE: To establish the usefulness of infrared radiation thermography on monitoring in situ liver perfusion with different preservation solutions during liver harvesting. METHODS: Twenty-four adult male Wistar rats, weighing 385.31g were randomly divided into four groups of six animals each according to the solution used to perfuse the liver (Euro-Collins® solution - EC group; Custodiol® solution - CUST group; Celsior® solution - CEL group and Ringer-Lactate solution - RL group). Under inhalatory ether anesthesia, animals were submitted to upper transversal laparotomy, exposure of median and left-lateral hepatic lobes, heparin injection (500 UI/Kg) through infrahepatic vena cava, portal vein infusion through 18G catheter of cold (4°C) solution according to the group of study. Infrared images, with respective temperature avaliations from hepatic surface, were picked up in real time by Therma CAM SC500® infrared camera positioned at constant distance from three fixed points of the diaphragmatic surface of median and left lateral lobes at the following moments regarding liver perfusion: immediately after laparotomy; after portal vein cannulation and immediately before solution infusion; at each minute from the beginning of liver perfusion during five minutes. Mean temperatures of each moment were compared intra and intergroups with the difference between means test with normal distribution, with significance level of 5 percent (p=0.05). RESULTS: There was statistically significant difference of means temperatures between the moment of laparotomy and immediately after cannulation; between this later and after the first minute of perfusion; and between the first and fifth minutes of infusion in all groups of study in a similar way. CEL group showed additional difference between the first and second minutes means temperatures. Intergroup comparison showed Euro-Collins solution with significant less cooling power when compared to all others...