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Theodore Ward
Theodore Ward

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Thereafter, he defaulted follow up and presented to us again at six years of age. This time, he complained of bilateral calf pain with antalgic gait associated with coryzal symptoms and fever. The episode was not preceded by any injuries nor excessive exercises. There was also no preceding administration of any intramuscular injection. Upon detailed history taking, the patient revealed that he frequently got muscle cramps after exercise. There was no family history of recurrent rhabdomyolysis, malignant hyperthermia or musculoskeletal diseases. The parents were both Chinese and non-consanguineous.

All patients with LPIN1 mutations present with recurrent rhabdomyolysis triggered by febrile illness, prolonged fasting or anesthesia 12, 13 . Michot et al. reviewed 29 cases with recurrent rhabdomyolysis, in which 17 patients were confirmed to harbor LPIN1 mutations. For the patients who harbor LPIN1 mutations, the first episodes of rhabdomyolysis occurred before the age of five years. The mean age of presentation was 21 months old and the earliest age of presentation was at five months of age. The number of recurrent episodes ranged from one to ten per patient 13 . Our patient presented at 15 months of age and has so far experienced two episodes of rhabdomyolysis. As more than 50% of patients with recurrent rhabdomyolysis were found to have LPIN1 mutations after exclusion of FAOD 13 , genetic testing for LPIN1 mutations should be performed prior to muscle biopsy if metabolic investigations are unremarkable. Muscle biopsy is an invasive procedure and require general anesthesia which may trigger rhabdomyolysis.

For LPIN1-related acute recurrent rhabdomyolysis, it was reported that mortality was as high as 30% during an acute episode of severe rhabdomyolysis 14 . Between episodes, these patients thrived well. Intellectual disability was reported in one case at the age of nine years 12 . Our patient has been normal between the episodes apart from frequent muscle cramps after exercise and there is no evidence of intellectual disability. However, further observation is needed in view of the young age of our patient. The long-term prognosis of this condition has been reported in a 25-year-old female with LPIN1-related recurrent rhabdomyolysis, who had bilateral common peroneal neuropathies in addition to a background residual distal myopathy detected one year following discharge from intensive care. It was uncertain whether the neuropathies were a result of critical illness, compression and/or severe weight loss during the admission or intrinsic to the underlying genetic lipin 1 deficiency 23 .

There is a growing body of evidence in the literature correlating erectile dysfunction to obesity. We investigated the correlation of different anthropometric indexes of central obesity to erectile dysfunction. A cross-sectional study was performed including 256 consecutive men 40 years old or older. All men completed the International Index of Erectile Function, and were evaluated routinely with a clinical history, physical examination and blood analysis for fasting serum glucose, lipid profile and serum testosterone. Anthropometric measures included body mass index, waist circumference, sagittal abdominal diameter, maximal abdominal circumference, and waist-hip, waist-thigh, waist-height, sagittal abdominal diameter-thigh and sagittal abdominal diameter-height indexes. In men 40 to 60 years old the different anthropometric indexes of central obesity were not correlated with the presence of erectile dysfunction (p > 0.05). Men older than 60 years (41%, range 61 to 81) demonstrated an association among erectile dysfunction and waist-hip index (p = 0.04), waist-thigh index (p = 0.02), sagittal abdominal diameter (p = 0.03), sagittal abdominal diameter-height index (p = 0.02) and maximal abdominal circumference (p = 0.04). After logistic regression analysis an independent effect on the presence of erectile dysfunction was observed for waist-hip index (OR 8.56, 95% CI 1.44-50.73), sagittal abdominal diameter (OR 7.87, 95% CI 1.24-49.75), sagittal abdominal diameter-height index (OR 14.21, 95% CI 1.11-182.32), maximum abdominal circumference (OR 11.72, 95% CI 1.73-79.18) and waist circumference (OR 19.37, 95% CI 1.15-326.55). This study suggests that central obesity, assessed by several anthropometric indicators, is associated to the presence of erectile dysfunction in men older than 60 years. Sagittal abdominal diameter, sagittal abdominal diameter-height index, maximum abdominal circumference, waist circumference and waist-hip index were useful indicators to predict

to know the changes in trunk fat and visceral fat level determined by abdominal bioelectrical impedance (BIA) as well as other anthropometric measures related to the central or abdominal fat after the ingestion of a lunch. the experimental study was conducted to assess a longitudinal intervention descriptive study. 21 subjects (10 male and 11 female), volunteers who have access to a medical assessment, with an age of 74 13.43 years. Maximal waist circumference in standing position, waist circumference at navel level in supine position and sagittal abdominal diameter (SAD). In the same position trunk fat and visceral fat level by abdominal bioelectrical impedance analysis with Tanita AB-140 (ViScan) were obtained before and after meal. anthropometric measures as waist circumference in supine position and SAD did not show significant differences (P > 0.05), after food ingestion, except for a significant increase of the maximal waist circumference in standing position (P 0.05). The percentage changes of the measures were less than 2% for waist circumference in standing position, waist circumference by Viscan, sagittal abdominal diameter and trunk fat and 5.9% for visceral fat ratio. the effects on trunk fat and visceral fat ratio by abdominal bioelectrical impedance are minimal after the ingestion of a portion of food and drink, although it is always recommended to do it in fasting conditions. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

It is recognised that abdominal adiposity is associated with cardiovascular risk factors, such as intolerance to glucose, hypertension and dyslipidaemia. The objective of the present study was to assess the relationship of trunk fat and visceral fat index, obtained by anthropometric and bioelectrical impedance, with metabolic syndrome (SM) in an elderly population. The study included 208 subjects (78 men and 130 women) with a mean age of 82.5 years. Abdominal obesity was assessed by anthropometry and bioelectrical impedance. ROC curves were calculated in order to assess the ability of these variables to diagnose metabolic syndrome. There are differences between men and women in body mass index, waist to height ratio, waist circumference, and bioelectrical impedance measurements as trunk fat and visceral fat (p

Abdominal aorta pulsatility and blood flow patterns are important diagnostic indicators in congenital heart disease. Reference values for these indexes are lacking. We prospectively studied abdominal aorta pulsed-wave Doppler systolic peak velocity, deceleration time, and wave duration, and two-dimensional vessel diameters in systole and diastole in healthy Caucasian children. Heteroscedasticity was accounted for by White or Breusch-Pagan test. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Structured Z-scores were then computed. In all, 853 subjects (age 0 days to 17 years; 45% females; BSA 0.12-2.12m 2 ) were studied. The predicted values and Z-score boundaries are presented. Data are also presented as mean2 SDs for a given BSA. We report paediatric echocardiographic nomograms for multiple proximal abdominal aorta parameters including pulsed-wave Doppler systolic velocities, deceleration time, wave duration, and two-dimensional vessel diameter variations. Significant variations in these functional indexes with age were found that should be taken into account in clinical practice. At lower ages, steeper and shorter pulsed-wave Doppler peak velocity and limited pulsatility should be expected as physiologic findings. Copyright 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. To restore proper sagittal balance, one must assess the position of the occiput relative to the sacrum. The assessment of spinal balance preoperatively can be challenging, whereas predicting postoperative balance is even more difficult. This study was designed to evaluate and quantify multiple factors that influence sagittal balance. Retrospective analysis of existing spinal radiographs. A retrospective review of 52 adult spine patient records was performed. All patients had full-column digital radiographs that showed all the important skeletal landmarks necessary for accurate measurement. The average age of the patient was 53 years. Both genders were equally represented. The radiographs were measured using standard techniques to obtain the following parameters: scoliosis in the coronal plane; lordosis or kyphosis of the cervical, thoracic, and lumbar spine; the T1 sagittal angle (angle between a horizontal line and the superior end plate of T1); the angle of the dens in the sagittal plane; the angle of the dens in relation to the occiput; the sacral slope; the pelvic incidence; the femoral-sacral angle; and finally, the sagittal vertical axis (SVA) measured from both the dens of C2 and from C7. It was found that the SVA when measured from the dens was on average 16 mm farther forward than the SVA measured from C7 (p




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