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Biomedical subjects

Chin-Yuan Hsu

Publications and source records attributed to Chin-Yuan Hsu.

At least 19 recordsLinked to original sources
PubMed2006

Cesarean births in Taiwan.

OBJECTIVE: To evaluate the use of cesarean delivery in Taiwan by comparing local clinical indications with those in international cohorts. METHODS: In-patient claims from the National Health Insurance (NHI) in Taiwan were analyzed. Indications for cesarean delivery were evaluated with primary diagnosis codes and procedure codes from the NHI dataset. To produce a stable numerator for cesarean section, 3 years (1998-2000) of claims for cesarean delivery were abstracted and annualized. RESULTS: Rates ranged between 27.3% and 28.7% for primary cesarean delivery and were below 5% for vaginal birth after a cesarean section (VBAC). Compared with rates in other countries, rates for overall and primary cesarean section as well as for VBAC were significantly higher in medical centers in Taiwan (P<0.001). However, the clinics contributed the most to the difference in both overall and primary cesarean rates. The most common indication for cesarean section was prior cesarean section (43.3%-45.5%), followed by malpresentation (19.6%-23.4%). The proportion of fetuses with malpresentation delivered by cesarean section in Taiwan was 7.9%, almost twice the upper limit expected for all pregnancies as indicated in international studies. CONCLUSION: It is important to use appropriately documented data and to compare them with international data when monitoring local obstetric practices. The disproportionately high cesarean delivery rates in Taiwan may hold major lessons for the many countries contemplating or having universal health insurance coverage with a similar mix of providers.

Birthing Centers↗
PubMed2006

Antioxidant activity of extract from Polygonum aviculare L.

Free radicals induce numerous diseases by lipid peroxidation, protein peroxidation, and DNA damage. It has been reported that numerous plant extracts have antioxidant activities to scavenge free radicals. Whether Polygonum aviculare L. (Polygonaceae) has antioxidant activity is unknown. In this study, dried Polygonum aviculare L. was extracted by ethanol, and the extract was lyophilized. The antioxidant activities of extract powder were examined by free radical scavenging assays, superoxide radical scavenging assays, lipid peroxidation assays and hydroxyl radical-induced DNA strand scission assays. The results show that the IC50 value of Polygonum aviculare L. extract is 50 microg/ml in free radical scavenging assays, 0.8 microg/ml in superoxide radical scavenging assays, and 15 microg/ml in lipid peroxidation assays, respectively. Furthermore, Polygonum aviculare L. extract has DNA protective effect in hydroxyl radical-induced DNA strand scission assays. The total phenolics and flavonoid content of extract is 677.4 +/- 62.7 microg/g and 112.7 +/- 13 microg/g. The results indicate that Polygonum aviculare L. extract clearly has antioxidant effects.

Animals↗
PubMed2006

Postcesarean splenic torsion.

OBJECTIVE: Splenic torsion is an exceedingly rare complication in pregnancy. We present a case of acute splenic torsion that manifested after cesarean section and which was successfully treated with laparotomy with splenectomy and partial pancreatectomy. CASE REPORT: A 35-year-old, gravida 7, para 1, aborta 5, woman presented at our hospital for planned cesarean section at 38 weeks of gestation. Thrombocytopenia was noted antenatally and enlarged spleen with smooth surface and contour was observed at the conclusion of cesarean section. One day after delivery, dyspnea and left upper abdominal pain developed. Abdominal computed tomography showed a huge abscess in the left anterolateral abdomen and bilateral pleural effusion. Acute splenic torsion was highly suspected, but the patient refused surgical intervention until the condition exacerbated 21 days after delivery. Splenic pedicle strangulation with thrombosis, a severely ischemic spleen with rupture and distal pancreatic necrosis were noted during emergent laparotomy. She had an uneventful recovery and was discharged 5 days after left splenectomy and partial pancreatectomy. CONCLUSION: Splenic torsion is a rare cause of acute abdominal pain during pregnancy or postpartum, and the symptoms vary depending on the degree of torsion. Early involvement of many complementary specialty services enabled early recognition of this rare entity and timely definitive treatment.

Abdominal Pain↗
PubMed2006

Prenatal diagnosis and antenatal history of total anomalous pulmonary venous return.

OBJECTIVE: Total anomalous pulmonary venous return (TAPVR) is traditionally diagnosed by echocardiography or cardiac catheterization postnatally after the appearance of clinical signs. We report a case of TAPVR diagnosed prenatally by targeted echocardiography. CASE REPORT: A 17-year-old woman was referred at 34 weeks of gestation because of persistent bradycardia. Echocardiography showed atrial disproportion and no direct pulmonary venous return to the left atrium. A female infant was delivered by cesarean section at 38 weeks of gestation. Echocardiography and cardiac catheterization were arranged soon after delivery and TAPVR was confirmed. The infant underwent surgical repair of TAPVR by anastomosis between the left atrium and pulmonary venous confluence as well as surgical ligation of the patent ductus arteriosus at the age of 2 days. The infant died on the 28th postoperative day due to obstruction of pulmonary venous return and respiratory failure. CONCLUSION: With advances in sonographic equipment and careful evaluation of cardiac structures, it is possible to diagnose TAPVR prenatally. Pulmonary venous anatomy should be checked during prenatal examination.

Adolescent↗
PubMed2006

Ectopic molar pregnancy in a cesarean scar.

OBJECTIVE: To report a case of cesarean scar molar pregnancy. CASE REPORT: A 31-year-old, gravida 8, para 1, female patient underwent suction curettage for a diagnosis of molar pregnancy. However, she had persistent vaginal spotting and residual decidual tissue in a cesarean scar. She was successfully treated with repeat suction curettage. CONCLUSION: Cesarean scar pregnancy is difficult to diagnose and must be considered in the patient with a history of cesarean section who has persistent vaginal bleeding after suction curettage. To our knowledge, this is the first report of molar pregnancy in a cesarean scar.

Adult↗
PubMed2006

Angiomyxoma of the umbilical cord.

OBJECTIVE: Angiomyxoma is a rare tumor of the umbilical cord and is associated with increased perinatal morbidity and mortality. However, the management of these pregnancies in the third trimester is not clearly defined. We present a case of an angiomyxoma of the umbilical cord diagnosed in the second trimester, and highlight the contribution of color Doppler imaging to the early diagnosis of cord anomalies. CASE REPORT: A 29-year-old, gravida 3, para 1, woman had elevated maternal serum alpha-fetoprotein at 17 weeks of gestation. Ultrasonography at 19 weeks showed a placental mass measuring 2 x 1.5 cm over the insertion site of the umbilical cord. The mass slowly enlarged in size, from 2.72 x 1.09 cm at 21 weeks to 3.9 x 3.9 cm at 33 weeks. Beyond the cord lesion, the development of the fetus was unremarkable. At 38 weeks, a normal female infant was delivered by cesarean section due to previous history of cesarean section. A mass measuring 3.2 cm was found near the insertion site of the umbilical cord to the placenta. Pathologic examination showed proliferation of thin-walled vessels embedded in a myxoid stroma, and the endothelial cells were positive for factor VIII-related antigen. CONCLUSION: Angiomyxoma is a rare tumor of the umbilical cord and should be considered when using prenatal ultrasound for detection of cystic lesion. Color Doppler imaging can easily and instantly detect perfusion through the umbilical vessels and assess cardiac function. In our case, application of color Doppler imaging for monitoring the relationship between the tumor and the adjacent vessels allowed the fetus to be delivered at term with a favorable outcome.

Adult↗
PubMed2006

Comparative analysis of neonatal morbidity for vaginal and caesarean section deliveries using hospital charge.

AIM: To assess the neonatal morbidity of alternative modes of delivery using economic data. METHODS: Two groups of neonatal morbidity data were extracted according to mode of delivery from inpatient claims on National Health Insurance in Taiwan: uncomplicated vaginal and caesarean section deliveries. Outcome variables included number of infants treated as inpatients, duration of hospital stay, and hospital charge during both the first month and the first year of age. RESULTS: Uncomplicated caesarean section delivery of term infants carried a significant increase either in the first month of life or during the first year after birth in both duration of hospital stay and hospital discharge when compared with uncomplicated vaginal delivery. Neonatal jaundice accounted for the greatest morbidity among term newborns, irrespective of delivery mode, followed by infectious, gastrointestinal and respiratory morbidity. Logistic regression analysis demonstrated that uncomplicated vaginal delivery was associated with skin diseases. Uncomplicated caesarean section delivery was associated with infectious disease and disease of the respiratory, digestive and circulatory systems. CONCLUSION: The findings of this study may provide further information for clinicians and would be an important consideration when advising pregnant women on the preferred route of delivery.

Birth Certificates↗
PubMed2006

Prenatal two- and three-dimensional ultrasound diagnosis of limb reduction defects associated with homozygous alpha-thalassemia.

OBJECTIVES: We present the prenatal two-dimensional (2D-) and three-dimensional ultrasound (3D-US) diagnosis of limb reduction defects associated with homozygous alpha-thalassemia and a review of the literature. METHODS: At 17 weeks' gestation, amniocentesis was performed for cytogenetic and molecular studies, and 2D- and 3D-US examinations were made for evaluation of the fetal malformations. RESULTS: Amniocentesis revealed a 46,XY karyotype and molecular analysis of the amniocytes showed that the fetus was homozygous for the Southeast Asian deletion (--SEA/--SEA). 2D-US examination revealed bilateral ventriculomegaly, brachycephaly, pleural effusion, digital deficiency and hypoplasia of the right foot, and digital deficiency of the left foot. 3D-US confirmed the distal limb reduction defects. CONCLUSIONS: When the fetus is at risk for homozygous alpha-thalassemia, 2D- and 3D-US examinations are useful for prenatal detection of the associated limb reduction defects. Prenatal identification of the possible association with limb reduction defects is important for parental counseling and decision-making when intrauterine fetal therapy is an option.

Adult↗
PubMed2005

Prenatal diagnosis, sonographic findings and molecular genetic analysis of a 46,XX/46,XY true hermaphrodite chimera.

OBJECTIVES: To present the prenatal diagnosis, sonographic findings and, molecular genetic analysis of a 46,XX/46,XY true hermaphrodite chimera and to review the literature. CLINICAL SUBJECT AND METHODS: Amniocentesis was performed at 22 weeks' gestation because of sonographic diagnosis of ambiguous genitalia. Initial amniocentesis, repeat amniocentesis, and cordocentesis revealed a mixture of 46,XX cells and 46,XY cells. Polymorphic DNA marker analysis using the fetal and parental blood was applied to investigate the genetic origin of the chimera. A 3,625-g baby was delivered at 37 weeks' gestation with clitoromegaly, prominent labia majora, fusion of the labia, and an orifice of the urogenital sinus. A lymphangioma was noted over the right arm and was excised at age 3 days. Extraembryonic tissues and the infant's skin were cytogenetically and molecularly studied. RESULTS: Initial amniocentesis, repeat amniocentesis, and cordocentesis revealed the karyotype of 46,XX[12]/46,XY[9], 46,XX[15]/46,XY[12], and 46,XX[27]/46,XY[15], respectively. The cytogenetic results of the extraembryonic tissues and skin were consistent with prenatal diagnosis. Informative sex chromosome and pericentromeric autosome markers demonstrated double paternal and single maternal genetic contributions. CONCLUSIONS: Prenatal sonographic diagnosis of ambiguous genitalia should alert true hermaphroditism and prompt thorough genetic investigations. DNA marker analysis is helpful in delineation of true fetal chimerism as well as determination of its genetic origin in prenatally detected 46,XX/46,XY chromosome complement.

Adult↗
PubMed2005

Genetic-based fuzzy image filter and its application to image processing.

In this paper, we propose a Genetic-based Fuzzy Image Filter (GFIF) to remove additive identical independent distribution (i.i.d.) impulse noise from highly corrupted images. The proposed filter consists of a fuzzy number construction process, a fuzz filtering process, a genetic learning process, and an image knowledge base. First, the fuzzy number construction process receives sample images or the noise-free image and then constructs an image knowledge base for the fuzzy filtering process. Second, the fuzzy filtering process contains a parallel fuzzy inference mechanism, a fuzzy mean process, and a fuzzy decision process to perform the task of noise removal. Finally, based on the genetic algorithm, the genetic learning process adjusts the parameters of the image knowledge base. By the experimental results, GFIF achieves a better performance than the state-of-the-art filters based on the criteria of Peak-Signal-to-Noise-Ratio (PSNR), Mean-Square-Error (MSE), and Mean-Absolute-Error (MAE). On the subjective evaluation of those filtered images, GFIF also results in a higher quality of global restoration.

Algorithms↗