Chih-Yao Chen

Impact of pregnancy on primary dysmenorrhea

Objective: Because it has been observed that dysmenorrhea can improve after childbirth, this investigation was intended to quantify the impact of both gestational length and mode of delivery on primary dysmenorrhea. Methods: This is an 8‐year prospective observational study. Patients with a history of dysmenorrhea who later gave birth were evaluated for improvement on the severity of dysmenorrhea, with use of visual analogue scale (VAS), and Likert‐type scale. Result: Final analysis involved 3694 patients. Women who had spontaneous delivery would have significantly more improvement than women with cesarean delivery per VAS (term delivery, 51 vs. 33, P < 0.001; preterm delivery, 17 vs. 10, P < 0.001). For first delivery, patients in the spontaneous delivery subgroup were the most likely to have improvement in severity of dysmenorrhea. For second delivery, only patients in the spontaneous delivery subgroup had statistically significant improvement. Conclusion: Both length of gestation and mode of delivery have an impact on primary dysmenorrhea. The most significant improvement occurred after the first delivery.

Effects of post materials and length on the stress distribution of endodontically treated maxillary central incisors: a 3D finite element analysis.

Traditionally, using a long post can cause progressive removal of the root structure, complicate the ability to re-treat the tooth if necessary and make it difficult to apply an adhesive bonding agent into the root canal. It is unclear if a shorter post length can be applied when a light translucent glass fibre post and adhesive resin cement are used. The aim of this study was to evaluate the biomechanical performance of endodontically treated teeth restored with three post materials, glass-fibre, stainless steel and cast-nickel chromium posts and cores of different lengths of 7, 10 and 13 mm. A 3D finite element analysis model of the maxillary central incisor was constructed. An occlusal load of 300 N was applied to a node at the palatal surface of the crown at 45 degrees to the long axis of the tooth. von Mises stress analyses were carried out in three regions. Simulated data were collected for plotting various pattern graphics and conducting statistical tests. The pattern graphics showed that when the post length changed from 13 to 7 mm, the stress patterns were even and flat in all fibre-post groups, while the stress patterns of the metal-post groups showed an M-shaped peak and trough. Statistical tests showed that the shorter fibre post was superior to the longer metal post in some situations. Within the limitations of this study, it was concluded that when a metal post is used, the post should be as long as possible, while the biomechanical performance of a glass-fibre post combined with a composite resin core was less sensitive to post length.

Prenatal Diagnosis of Pulmonary Sequestration by Ultrasound and Magnetic Resonance Imaging

A 36-year-old multigravida, G2P1, underwent routine ultrasound scan at 22+1 weeks of gestation, which revealed a single normally growing fetus with left intrathoracic mass and left displacement of the cardiac apex. The left intrathoracic wedge-shaped hyperechogenic mass, measuring 32 x 25 mm in size, was situated at the lower portion of the left lung. A combination of color and power Doppler ultrasound allowed visualization of a vessel arising from the descending aorta, which supplied the mass. The diagnosis of extralobar pulmonary sequestration was made. Magnetic resonance imaging (MRI) was also performed and revealed a well-defined mass with homogeneous high-signal intensity when compared with normal lung tissue in the left upper lung field, which was compatible with pulmonary sequestration. The pulmonary mass was followed up by color and power Doppler every 2 weeks. The peak velocity of 11.85 cm/sec and the diameter of the feeding artery of 1.19 mm gradually decreased and disappeared 8 weeks later. The intrathoracic mass disappeared 10 weeks later at 32+1 gestational weeks. Repeat MRI also revealed spontaneous regression of the mass in favor of resorption of sequestration. The fetus was delivered at 38+1 gestational weeks. A male newborn weighing 2,520 g was spontaneously delivered with an Apgar score of 8 at 1 minute and 9 at 5 minutes. In our patient, it is suggested that progressive decreases in the peak velocity of the feeding vessel heralded the spontaneous regression of pulmonary sequestration not associated with hydrops/hydrothorax.

Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan.

Abstract Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long‐term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities.

Combined Diverticulectomy and Anti-Incontinence Surgery for Patients with Urethral Diverticulum and Stress Urinary Incontinence: Is Anti-Incontinence Surgery Really Necessary?

OBJECTIVEnUrethral diverticulum has been identified in 0.6-6% of women and is diagnosed most frequently in the third to fifth decades. Combined diverticulectomy and anti-incontinence surgery are usually undertaken for patients with urethral diverticulum who present with symptoms of stress urinary incontinence. However, this approach may not always be necessary.nnnCASE REPORTnWe report two cases with urethral diverticulum and stress urinary incontinence successfully treated with diverticulectomy only.nnnCONCLUSIONnThis clinical approach could avoid the potential complications of anti-incontinence surgery.

Endothelial cell dysfunction and preeclampsia

Preeclampsia is a pregnancy-specific syndrome of hypertension and proteinuria and one of the leading causes of perinatal morbidity and mortality. The pathogenesis of preeclampsia, although not entirely clear, is typically abnormal placental implantation, followed by endothelial dysfunction with subsequently resulting vasospasm, coagulopathy, or changes in capillary permeability; this underscores the importance of successfully established circulation networks between the fetus and mother. These established circulation networks require an ongoing sequential process, and one of the most noteworthy facilitators of this process is the success of angiogenesis. However, angiogenesis is a very complicated procedure because normal physiological function is needed, and many diverse pathologies and disease status indicators also involve an active angiogenesis process. Endothelial progenitor cells (EPCs) were characterized and isolated from peripheral blood by Asahara et al in 1997, and are recruited to vascular lesion sites. EPCs may play a critical role in the repair of blood vessel damage, restoration of endothelial function, or neoangiogenesis after the fetal period. Dysfunction of endothelial cells is a hallmark of many cardiovascular diseases, and there is evidence that reductions in the number and functionality of circulating EPCs might contribute to adult cardiovascular disease. However, the role of circulating EPCs on the development of preeclampsia is not conclusive. The study by Parsanezhad et al in this issue of the Journal of the Chinese Medical Association seems to be the first report to study the differences between three distinct subsets of EPCs of maternal peripheral blood, including circulating angiogenic cells (CAC), colony-forming unit endothelial cells (CFUECs), and endothelial colony-forming cells (ECFCs) in women with and without preeclampsia. They show higher numbers of CACs and ECFCs subsets in the peripheral blood but fewer colony formation capacities in the peripheral blood of pregnant women with preeclampsia compared with that of women with normal pregnancy, suggesting that the functionality of CACs and ECFCs in women with preeclampsia was decreased. By contrast, the number of CACs increases without alternations in colony formation ability was found in women with normal pregnancy. It is unclear why the high numbers of ECFCs in the peripheral blood of women with preeclampsia did not contribute to an elevated number of colony formations, suggesting that ECFCs of women with and without preeclampsia might

Quantitative analysis of normal fetal brain volume and flow by three-dimensional power Doppler ultrasound

Background: Assessment of the fetal brain volume and blood flow is important in the evaluation of fetal growth. We used three‐dimensional (3D) ultrasound and power Doppler to assess the fetal brain volume and the blood flow index during normal gestation. The relationships of these parameters were further analyzed. Methods: We assessed the total volume and the blood flow index of the fetal brain in normal pregnancies using 3D ultrasound (Voluson 730). The bilateral parietal diameter (BPD) plane was measured by a 3D transabdominal probe to scan the fetal brain under the power Doppler mode. Then, we quantitatively assessed the total volume of the fetal brain, mean grey area (MG), vascularization index (VI), flow index (FI), and vascularization‐flow index (VFI) by applying Kretz VOCAL software. Results: The study included 126 fetuses, ranging from 15 to 38 weeks of gestation. The total volume of the fetal brain was highly positively correlated with the gestational age (GA) (correlation coefficient [r] = 0.976, p < 0.0001). The MG, VI, and VFI were negatively correlated with the GA (correlation coefficient [r] = −0.520, p < 0.0001; [r] = −0.421, p < 0.001; [r] = −0.319, p < 0.0001). The FI was positively correlated with the GA (correlation coefficient [r] = 0.483, p < 0.0001). Conclusion: 3D ultrasound can be used to assess the fetal brain volume and blood flow development quantitatively. Our study indicates that the fetal brain vascularization and blood flow correlates significantly with the advancement of GA. This information may serve as a reference point for further studies of the fetal brain volume and blood flow in abnormal conditions.

Carbetocin in prevention of postpartum hemorrhage: Experience in a tertiary medical center of Taiwan

OBJECTIVEnThe aim of this retrospective observational study was to determine the efficacy of carbetocin in reducing blood loss and primary postpartum hemorrhage (PPH) in vaginal and cesarean deliveries in a tertiary hospital in Taiwan.nnnMATERIALS AND METHODSnEligible gravid women (27-41xa0weeks) with available data were categorized into those treated prophylactically with and without carbetocin. The primary outcome was blood loss and incidence of primary PPH as measured by intrapartum/intraoperative and postpartum (recovery room) blood loss.nnnRESULTSnA total of 1069 deliveries were evaluated. Maternal age (∼31xa0years of age), body mass index (∼27xa0kg/m2) and parity (∼1.4) were similar among those treated with and without carbetocin for both vaginal and cesarean deliveries. The majority [749/1069 (70.1%)] of deliveries were vaginal; a similar proportion of women undergoing vaginal [221/749 (29.5%)] and cesarean [110/320 (34.4%)] deliveries received prophylactic carbetocin for prevention of PPH. Among vaginal deliveries, there was no significant difference in intrapartum (pxa0=xa00.083) or postpartum (pxa0=xa00.925) blood loss, or incidence of PPH (pxa0=xa00.092) between women with versus without carbetocin prophylaxis. However, there was a significant reduction in the intraoperative and total blood loss among cesarean deliveries with versus without carbetocin prophylaxis (pxa0<xa00.001). The incidence of PPH was higher [84/320 (26.3%)] among cesarean than among vaginal deliveries [62/749 (8.3%)], but was significantly lower among cesarean deliveries with [18 (16.36%)] versus without [66 (30.45%); pxa0=xa00.003] carbetocin prophylaxis.nnnCONCLUSIONnIn Taiwan, prophylactic use of carbetocin resulted in significantly less blood loss and incidence of PPH in cesarean than in vaginal deliveries.

Uterine sarcoma part III—Targeted therapy: The Taiwan Association of Gynecology (TAG) systematic review

Uterine sarcoma is a very aggressive and highly lethal disease. Even after a comprehensive staging surgery or en block cytoreduction surgery followed by multimodality therapy (often chemotherapy and/or radiation therapy), many patients relapse or present with distant metastases, and finally die of diseases. The worst outcome of uterine sarcomas is partly because of their rarity, unknown etiology, and highly divergent genetic aberration. Uterine sarcomas are often classified into four distinct subtypes, including uterine leiomyosarcoma, low-grade uterine endometrial stromal sarcoma, high-grade uterine endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Currently, evidence from tumor biology found that these tumors showed alternation and/or mutation of genomes and the intracellular signal pathway. In addition, some preclinical studies showed promising results for targeting receptor tyrosine kinase signaling, phosphatidylinositol 3-kinase/AKT/mammalian target of rapamycin pathway, various kinds of growth factor pathways, Wnt/beta-catenin signaling pathway, transforming growth factor β/bone morphogenetic protein signal pathway, aurora kinase A, MDM2 proto-oncogene, histone deacetylases, sex hormone receptors, certain types of oncoproteins, and/or loss of tumor suppressor genes. The current review is attempted to summarize the recurrent advance of targeted therapy for uterine sarcomas.

Chinese zodiac results in distortion of sex ratio

The sex ratio [male/female (M/F)], which is defined as the ratio of males to females in a population, is assumed to be close to 1:1. However, at birth, the sex ratio of males to females is approximately 105:100. In some countries, and especially in ethnic Chinese societies, a significant change and distortion of the sex ratio at birth have been reported. Dr. Grech has published an article in this issue addressing this topic in Hong Kong, and showed that the birth rate and sex ratio were both influenced by the Chinese zodiac (Shengxiao: a 12-year Chinese cycle with each year given an animals name, from rat to pig). The main findings of Dr. Grechs study were: (1) the sex ratio at birth in Hong Kong showed peaks in Dragon years, including 1975e6, 1988, and 2000; (2) the sex ratio remained stable overall, within a relatively narrow range, except for a rise commencing in 2004; and (3) there was a slow decline in the total number of births that reversed in 2004. Dr. Grech suggested that the M/F ratio follows a Ushaped regression on cycle days of insemination; that is to say, female conceptions result from conceptions around ovulation, and male conceptions occur more frequently at the beginning and end of the menstrual cycle. In addition, families in Hong Kong attempting to have children during Dragon years may have increased coital rates, inadvertently skewing the sex ratio in favor of an excess of males. Although the explanation may be reasonable, some are not clear. The first question is with regard to the frequency of coitus rates being related to the high birth rate. In some countries, this may be true, because there is an absence of effective contraception methods. However, many contraception methods are relatively advanced and highly accessible in modern societies, including Hong Kong, so it is not credible that higher coitus rates will result in higher pregnancy rates. In addition, conception is influenced by many nonbiological factors, such as economic, social, cultural, and ethical factors. For example, in Taiwan, the number of newborns has dramatically and progressively declined in recent years. No one believes that the decline in the number of newborns is secondary to a decreased coitus rate. Therefore, the change in birth rates cannot be explained simply by coitus rates. Although it has been scientifically demonstrated that lunar cycles might have an important effect on several biological events, controversy exists regarding the lunar influence on