Chi-Mou Juang

Taipei Veterans General Hospital, T’ai-pei, Taipei, Taiwan

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Publications (30)51.07 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To study the surgical morbidity and outcomes of patients with markedly bulky cervical squamous cell carcinoma (≥ 6 cm Cx-SCC) who underwent radical hysterectomy (RH) with and without neoadjuvant chemotherapy (NACT). Materials and methods This retrospective study enrolled patients with International Federation of Gynecology and Obstetrics (FIGO) IB markedly bulky Cx-SCC who were treated with either three courses of weekly single agent cisplatin NACT (50 mg/m2) and subsequent radical hysterectomy (NACT-RH) or direct radical hysterectomy (RH) between 1996 and 2001. A total of 60 patients fulfilled the criteria, including 35 and 25 patients with NsACT-RH and RH, respectively. Results There was no statistically significant difference in basic characteristics between the two groups, except the smaller pathological tumor size, less blood loss, and lower immediate complication rate in the NACT-RH group. Median survival was 143.8 months in the NACT-RH group and 129.8 months in the RH group, respectively, without a statistically significant difference. Multivariate analysis showed that large pathological tumor size [hazard ratio (HR) 10.66, 95% confidence interval (CI) 2.93–38.80], the presence of para-aortic lymph node metastases and an immediate complication (HR 8.33 and 4.55, 95% CI 1.66–41.75 and 1.35–15.27, respectively) contributed to a worse outcome. Conclusion Weekly single agent cisplatin NACT indeed reduced the pathological tumor size and immediate complication rate during the RH, supporting the feasibility of subsequent RH in the management of patients with bulky Cx-SCC.
    Taiwanese Journal of Obstetrics and Gynecology. 09/2014; 53(3):330–336.
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    ABSTRACT: This study aims to establish the normal range of maxillary and mandibular lengths within the Taiwanese population at 11(+0) weeks to 13(+6) weeks of gestation in normal singleton pregnancy as a reference value for prenatal ultrasonographic examinations. We examined nuchal translucency in 269 normal singleton pregnancies, with the gestational age ranging from 11 weeks to 13(+6) weeks in this study. Fetal biometric measurements, with an emphasis on maxillary and mandibular lengths, were obtained from the patients during consecutive routine prenatal ultrasonographic examinations. Maxillary and mandibular lengths were recorded successfully in 191 patients and 179 patients, respectively. The mean maternal age was 31 years (range 19-45 years), with a corresponding gestational age of 12 + 4 weeks (range, 11(+0)-13(+6) weeks). A first-degree correlation was found to exist between the gestational age and maxillary length (r = 0.596; p < 0.0001; y = 1.491 × GA - 10.523) as well as mandibular length (r = 0.465; p < 0.0001; y = 1.050 × GA - 6.50). Normative data for ultrasonographic measurements of maxillary and mandibular lengths within the Taiwanese population were presented. Our data can serve as a reference value in congenital anomaly screening during prenatal examination.
    Taiwanese journal of obstetrics & gynecology 03/2014; 53(1):53-6.
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    ABSTRACT: Objective The aim of this study is to investigate the relationship between umbilical artery flow and gestational age (GA) at 11–13+6 weeks in normal pregnancy in the Taiwanese population. Materials and methods Two hundred and fifty-three normal singleton pregnancies with GA ranging from 11 to 13+6 weeks were included in this study. The velocity of systolic, diastolic, and pulsatility index (PI) of the umbilical artery, and the mean velocity of the umbilical vein were recorded. Results One hundred and eighty-seven participants fulfilling the inclusion and exclusion criteria were analyzed. The mean maternal age was 31 (range 19–45) years, with a corresponding GA of 12+4 (range 11–13+6) weeks. The absence of end-diastolic velocity of the umbilical artery was observed in most of our cases (90.1%). No significant change was found in the vascular indices with GA for the mean velocity of the umbilical vein (mean velocity = 0.923 × GA − 1.594, r = 0.1497, p = 0.115). The systolic velocity of the umbilical artery and PI, however, behaved differently from the other variables. There was a significant increase in systolic velocity with GA [systolic wave (S wave) velocity = 0.237 × GA + 2.267; r = 0.149, p = 0.041]. By contrast, the PI showed a significant decrease in relation to the GA (PI = −0.016 × GA + 4.068; r = 0.196, p = 0.007). Conclusion The S-wave velocity of the umbilical artery increased with GA. By contrast, the PI of the umbilical artery showed a decreasing trend with GA. This may ensure optimal placental perfusion, which is necessary to accommodate the increased blood flow to the developing fetus. Furthermore, an absence of end-diastolic velocity in the first trimester and early second trimester was usually seen.
    Taiwanese Journal of Obstetrics and Gynecology. 01/2014; 53(2):193–196.
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    ABSTRACT: Background Early fetal structure evaluation is crucial. Fetal abnormalities might indicate chromosomal anomalies or abnormal fetal growth. The aim of this study was to establish the appropriate reference range of maxillary and mandibular angles among the Taiwanese population at 11+0–13+6 weeks of gestation in normal singleton pregnancy as reference values for prenatal ultrasonographic examinations. Methods Fetal ultrasonographic data on maxillary angles and mandibular angles at a gestational age ranging from 11+0 weeks to 13+6 weeks were recorded in this study. Maternal background and pregnancy outcome were obtained from hospital records. Results A total of 87 patients were included in this study. Maxillary and mandibular angles were successfully recorded in 87 (100%) and 84 (96.6%) patients, respectively. The mean maternal age was 31 (range, 19–41) years, with a corresponding gestational age of 12+4 (range, 11+0–13+6) weeks. The maxillary and mandibular angles were 79.9° ± 15.6° and 71.0° ± 12.8°, respectively. First-degree correlation was not found to exist between gestational age and maxillary and mandibular angles. Conclusion Normative data for ultrasonographic measurements of maxillary and mandibular angles among the Taiwanese population are presented. Our results may serve as reference values in congenital anomaly screening during prenatal examination.
    Journal of the Chinese Medical Association 01/2014; · 0.75 Impact Factor
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    ABSTRACT: 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. 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. 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). 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.
    Journal of the Chinese Medical Association 06/2013; · 0.75 Impact Factor
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    ABSTRACT: To compare the prognosis of patients with advanced-stage primary peritoneal serous papillary carcinoma (PSPC) or papillary serous ovarian cancer (PSOC). This was a retrospective case-control study and included two study groups: one with stage III/IV PSPC (n = 38) patients and the other with PSOC (n = 53) patients. Patients were matched for histologic subtype (serous tumor), tumor stage, tumor grade, residual disease at the end of debulking surgery (primary or interval), and age (±5 years). Mean age was significantly greater for patients with PSPC (63.03 ± 11.88 years) than for patients with PSOC (55.92 ± 12.56 years, p = 0.008). Optimal debulking surgery was performed initially in 71.9% of PSPC patients and 66.0% of PSOC patients. In addition, 93.9% of PSPC patients and 92.3% of PSOC patients were treated with platinum-paclitaxel chemotherapy. The frequency of high-grade tumors was significantly higher in the PSPC (100%) than in the PSOC group (68.3%; p < 0.001). Progression-free survival (PFS) was similar in the PSPC [median 12 months, 95% confidence interval (CI) 7.3-16.7] and PSOC groups (median 16.7 months, 95% CI 12.9-20.4; p = 0.470). Overall survival was shorter in the PSPC (median 62 months, 95% CI 19.6-104.4) than in the PSOC group (median 77.5 months, 95% CI 69.7-85.2; p = 0.006, log-rank statistic). PFS was similar for advanced-stage PSPC and PSOC patients. Since the PSPC patients tended to be older and have more high-grade tumors, OS was shorter for PSPC than for POSC patients. Thus, management of the two types of cancer should not differ.
    Taiwanese journal of obstetrics & gynecology 03/2013; 52(1):81-4.
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    ABSTRACT: To investigate flow in the ductus venosus at 11-13 + 6 weeks of gestation in women with normal pregnancies in the Taiwanese population. Two hundred and fifty-two normal singleton pregnancies with gestational ages ranging from 11 to 13 + 6 weeks were examined in this study. The pulsatility index for veins (PIV), resistance index (RI), peak velocity during ventricular systole (S-wave), and peak velocity during ventricular diastole (D-wave) were recorded from the ductus venosus. We analyzed 252 participants who all fulfilled the inclusion and exclusion criteria of our study. The mean maternal age was 31 (range 19-45 years), with a corresponding gestational age of 12 + 4 weeks (range 11-13 + 6). No significant change was found in the vascular indices as gestational age increased for the S-wave (S-wave = 1.4214 (GA) + 17.448, r = 0.09, P = 0.154), PIV (PIV = -0.0358 (GA) + 1.4143, r = -0.05, P = 0.378) and RI (RI = -0.035 (GA) + 1.1478, r = -0.064, P = 0.468). In contrast, the D-wave behaved differently from the other variables. There was a significant increase (r = 0.155, P = 0.013) in the D-wave with gestational age (D-wave = 1.4896 (GA) - 7.1547). D-wave velocity in the ductus venosus increased with gestational age. S-wave peak velocity showed an increasing trend and PIV showed a decreasing trend with gestational age, but they did not reach statistical significance.
    Journal of the Chinese Medical Association 04/2012; 75(4):171-5. · 0.75 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of transobturator tension-free vaginal mesh (Perigee) and concomitant transobturator tension-free vaginal tape (TVT-O) for treating cystocele with urodynamic stress incontinence (UDSI). A retrospective study of 115 patients with symptomatic stages 2-3 cystocele and UDSI who were treated with a Perigee system (Group I, n=68) plus TVT-O procedure or traditional anterior colporrhaphy (Group II, n=47) plus TVT-O procedure. All patients were followed up for more than one year. Objective and subjective symptoms were evaluated at one year postoperatively. Statistical analysis was performed using SPSS software. The objective cure rates for cystocele at one year were significantly higher in Group I than in Group II (98.5% and 86.9%, P=0.018), respectively. The cure rates for UDSI in the two groups were 91.0% vs. 91.3% (P=1.000). Symptomatic improvement of frequency was better in Group I than Group II (87.7% vs. 70.0%, P=0.030). There were no significant differences with regard to intraoperative and postoperative complications between the two groups. The combination of the Perigee system and TVT-O offers a safe and effective treatment for cystocele with UDSI and may be performed as first-line treatment.
    European journal of obstetrics, gynecology, and reproductive biology 06/2011; 156(2):228-32. · 1.97 Impact Factor
  • Gynecologic Oncology 03/2010; · 3.93 Impact Factor
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    ABSTRACT: To examine the relationship between human papillomavirus (HPV) and Epstein-Barr virus (EBV) infections in relation to age of patients with cervical adenocarcinoma. Thirty samples of human cervical adenocarcinoma tissue were collected from the surgical pathology archive at Taipei Veterans General Hospital from 1996 to 2008. All samples were examined for EBV, HPV-16 and HPV-18 E6 DNA by conventional and real-time quantitative polymerase chain reaction assays. HPV-16 DNA was detected in 10 cases (33.3%), HPV-18 DNA in 12 cases (40%), and EBV DNA in three cases (10%); there were negative findings in seven cases (23.3%). EBV combined with HPV-16 or HPV-18 was also detected in one case each. No link could be demonstrated between HPV and EBV in endocervical lesions. When 20 patients 45 years old were compared with 10 patients > 45 years old, HPV-18 E6 DNA was detected in 45% vs. 30% (9/20 vs. 3/10), HPV-16 E6 DNA in 40% vs. 20% (8/20 vs. 2/10), EBV DNA in 10% vs. 10% (2/20 vs. 1/10), and no virus DNA was detected in 10% vs. 50% (2/20 vs. 5/10). HPV and EBV were significantly more common in younger women (p < 0.001). HPV-18 plays a major role in adenocarcinomas at any age. A high prevalence of HPV DNA is significantly associated with cervical adenocarcinoma, especially in younger women. The results do not support a role for EBV in cervical adenocarcinogenesis or any relationship between EBV and HPV infection in adenocarcinoma.
    Taiwanese journal of obstetrics & gynecology 12/2009; 48(4):370-4.
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    ABSTRACT: On the basis of outcome data from concurrent chemoradiotherapy (CCRT) for locally advanced cervical squamous cell carcinoma, the authors developed a nomogram for predicting survival outcome. Two hundred fifty-one eligible patients with International Federation of Gynecology and Obstetrics stage IIB-IVA squamous cell carcinoma of the uterine cervix who underwent CCRT were included for the construction of the nomogram. Predictor variables included age, serum squamous cell carcinoma antigen, tumor size, parametrium invasion, hydronephrosis, bladder/rectum invasion, and lymph node metastases. Internal validation of the nomogram was performed. A nomogram for predicting the 5 year overall survival for these patients was constructed on the basis of a Cox regression model from 7 parameters. The concordance index was 0.69. This nomogram is a predictive tool, upon external validation, that can be used to counsel patients in predicting outcomes. The discriminatory ability of the nomogram indicates that this population should not be considered homogeneous with respect to risk of death.
    American journal of obstetrics and gynecology 11/2009; 202(2):174.e1-7. · 3.28 Impact Factor
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    ABSTRACT: CD1d-restricted T (NKT) cells are potent regulators of autoimmunity, tumor immunity, and transplantation-related immunity. NKT cells are a subset of innate lymphocytes that recognize endogenous or exogenous glycolipids in the context of CD1d molecules. Recent progress in the research of NKT cells has proved that NKT cells function as a bridge between innate and adaptive immunity in anticancer immunity. Furthermore, NKT cells also function as a bridge to tolerance or rejection of grafts in organ transplantation. Harnessing the function of NKT cells, and trying to put it into clinical application in the treatment of autoimmune disease, anticancer cell immunotherapy, and organ transplantation are the dreams of immunologists. This minireview will focus on the physiology of NKT cells and potential clinical application.
    The Chinese journal of physiology 10/2009; 52(5):275-9. · 0.75 Impact Factor
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    ABSTRACT: Intraperitoneal (IP) chemotherapy has gained enthusiasm in the treatment of ovarian cancer. Despite having a better survival advantage than intravenous (IV) chemotherapy, IP chemotherapy still poses significant morbidity and complications. Identifying the subset of patients who could best benefit from IP chemotherapy, and those who would least benefit from this treatment, thus avoiding potential complications, is critical. Between January 2001 and December 2007, 367 patients with stage III epithelial ovarian cancer underwent randomized trial for IP/IV chemotherapy were recruited to construct a nomogram, which is a graphical representation of Cox proportional hazards model adopting six weighted risk factors including age, CA125, IP/IV delivery, stage, histology, and upper abdominal metastases. The nomogram was internally validated for discrimination and calibration. The concordance index was used for quantifying the predictive ability of overall survival with bootstrapping to correct for bias. The cycles of completed IP chemotherapy had an impact on overall survival (> or =5 vs. < or =4 cycles, P=0.02). A nomogram for predicting median survival and 5-year survival probability was constructed with a concordance index of 0.72. Upper abdominal tumor metastases (P<0.001) and colon resection (P=0.02) predicted increased chances for early discontinuation of IP chemotherapy. At least five IP cycles are needed to achieve better survival. Nomogram can help to identify the subset of patients who can least benefit from IP chemotherapy, thus avoiding potential IP complications and help to facilitate discussion between patient and physician, risk stratification, and help to guide clinical care.
    Gynecologic Oncology 10/2009; 114(3):415-9. · 3.93 Impact Factor
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    ABSTRACT: To compare the characteristics and prognosis of cervical cancer in young women (under 30 years) with those of older women (over 30 years). A retrospective study of 2443 patients diagnosed with FIGO stage IA-IIA cervical cancer who underwent surgical procedures between January 1983 and December 2007. Thirty patients (1.2%) were 30 years or younger. The proportion of non-squamous cell carcinoma was higher in patients 30 years or younger compared with in patients over 30 years (14/30, 46.7% vs 10/30, 33.3%; P=0.001). A higher rate of parametrial involvement was found in the younger group of patients compared with those over 30 years (10/30, 33.3% vs 289/2413, 12.0%; P=0.001). Patients under 30 years had a higher rate of distant metastases compared with older patients (60% vs 49.7%; P=0.036). Non-squamous histology, parametrial involvement, a higher rate of distant metastases, and poorer prognosis are more common in women aged 30 or younger with cervical cancer than in older women with the disease.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 09/2009; 107(3):220-3. · 1.41 Impact Factor
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    ABSTRACT: DNA vaccines are an attractive approach to eliciting antigen-specific immunity. Intracellular targeting of tumor antigens through its linkage to immunostimulatory molecules such as calreticulin (CRT) can improve antigen processing and presentation through the MHC class I pathway and increase cytotoxic CD8+ T cell production. However, even with these enhancements, the efficacy of such immunotherapeutic strategies is dependent on the identification of an effective route and method of DNA administration. Electroporation and gene gun-mediated particle delivery are leading methods of DNA vaccine delivery that can generate protective and therapeutic levels of immune responses in experimental models. In this study, we perform a head-to-head comparison of three methods of vaccination – conventional intramuscular injection, electroporation-mediated intramuscular delivery, and epidermal gene gun-mediated particle delivery – in the ability to generate antigen-specific cytotoxic CD8+ T cell responses as well as anti-tumor immune responses against an HPV-16 E7 expressing tumor cell line using the pNGVL4a-CRT/E7(detox) DNA vaccine. Vaccination via electroporation generated the highest number of E7-specific cytotoxic CD8+ T cells, which correlated to improved outcomes in the treatment of growing tumors. In addition, we demonstrate that electroporation results in significantly higher levels of circulating protein compared to gene gun or intramuscular vaccination, which likely enhances calreticulin's role as a local tumor anti-angiogenesis agent. We conclude that electroporation is a promising method for delivery of HPV DNA vaccines and should be considered for DNA vaccine delivery in human clinical trials.
    Vaccine 01/2009; · 3.77 Impact Factor
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    ABSTRACT: The concept of regulatory T cells was first described in the early 1970s, and regulatory T cells were called suppressive T cells at that time. Studies that followed have demonstrated that these suppressive T cells negatively regulated tumor immunity and contributed to tumor growth in mice. Despite the importance of these studies, there was extensive skepticism about the existence of these cells, and the concept of suppressive T cells left the center stage of immunologic research for decades. Interleukin-2 receptor alpha-chain, CD25, was first demonstrated in 1995 to serve as a phenotypic marker for CD4+ regulatory cells. Henceforth, research of regulatory T cells boomed. Regulatory T cells are involved in the pathogenesis of cancer, autoimmune disease, transplantation immunology, and immune tolerance in pregnancy. Recent evidence has demonstrated that regulatory T cell-mediated immunosuppression is one of the crucial tumor immune evasion mechanisms and the main obstacle of successful cancer immunotherapy. The mechanism and the potential clinical application of regulatory T cells in cancer immunotherapy are discussed.
    Taiwanese journal of obstetrics & gynecology 10/2007; 46(3):215-21.
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    ABSTRACT: To evaluate the efficacy of laparoscopic uterosacral nerve (LUNA) alone vs. LUNA plus presacral neurectomy (PN) in the treatment of primary dysmenorrhea. Seventy-four patients were randomly allocated to LUNA alone or LUNA plus PN. Evaluation of severity of menstrual pain was based on multidimensional scoring. Sixty-seven patients were eligible for analysis (35 LUNA alone, 32 LUNA plus PN). Baseline demographic features were comparable between the 2 groups. There was no difference between them in the proportion of improvement in dysmenorrhea at 3 months of follow-up (69% for LUNA vs. 73% for LUNA plus PN, p = 0.923), and the results were maintained at 6 and 12 months of follow-up. More surgical complications were found in the LUNA plus PN group. For patients with primary dysmenorrhea, LUNA plus PN has no additive therapeutic advantage over LUNA alone, and more surgical complications may be encountered.
    The Journal of reproductive medicine 08/2007; 52(7):591-6. · 0.75 Impact Factor
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    ABSTRACT: The treatment of women with mixed urinary incontinence still poses a great challenge. This study evaluated surgical outcomes of combined trans-obturator tension-free vaginal tape (TVT-O) and modified Ingelman-Sundberg (IS) procedure for the treatment of mixed urinary incontinence. A randomized controlled trial was conducted. Ninety-six women diagnosed with mixed incontinence were randomized, with 49 allocated to TVT-O plus IS and 47 to TVT-O alone. A baseline urodynamic study and evaluation of quality of life (QOL) was conducted. The primary outcome measure was objective assessment of surgical outcomes, and the secondary outcome measure was warning time. Objective surgical response rate was significantly higher in the TVT-O plus IS group than in the TVT-O alone group (84.8% vs. 62.8%; p=0.019). Furthermore, a significant increase in warning time was observed in the TVT-O plus IS group (from 3.9 to 9.4 min; p=0.006), but the increase in warning time within the TVT-O alone group was not statistically significant (from 4.3 to 4.5 min; p=0.695). Postoperative complications were similar in the two study groups with respect to pelvic hematoma, nerve injury, sepsis, mesh erosion, and fistula formation. However, fever occurred more frequently in the TVT-O plus IS group (30.4% vs. 20.9%; p=0.026). Mixed urinary incontinence can potentially be treated with a one-step combined surgery using trans-obturator sling plus modified IS procedure. Although surgical time and blood loss were significantly increased in the TVT-O plus IS group, overall morbidity was not significantly increased.
    European Urology 07/2007; 51(6):1671-8; discussion 1679. · 10.48 Impact Factor
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    ABSTRACT: Little is known about the mechanism and biochemical pathway of preterm delivery. Some drugs used to treat preterm labor are also useful for the treatment of primary dysmenorrhea. This study attempted to evaluate the association between primary dysmenorrhea and preterm delivery from an epidemiological perspective. A nested case-control study was conducted; 329 singleton preterm delivery cases were investigated, in aggregate and in subgroups (spontaneous preterm labor and preterm premature rupture of membranes). Concurrently, 329 singleton gravid women with term delivery served as controls. Medical charts and records provided information about the maternal history of dysmenorrhea, index pregnancy outcome, and demographic characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the multiple logistic regression method. Gravid women with a history of primary dysmenorrhea had no more risk of preterm delivery than those without a history of primary dysmenorrhea (adjusted OR, 1.16; 95% CI, 0.95 to 2.19; p=0.37). However, for subgroup analysis, gravid women with severe primary dysmenorrhea were associated with an adjusted 2.73-fold risk of spontaneous preterm delivery (95% CI, 1.49 to 4.95; p=0.02), and with an adjusted 1.51-fold risk of preterm premature rupture of membranes (95% CI, 0.68 to 3.22; p=0.31). Severe primary dysmenorrhea is associated with an increased risk of spontaneous preterm delivery. A common pathophysiologic pathway may exist between these two disorders. Further in-depth biochemical and molecular studies are necessary to explore this phenomenon.
    American Journal of Perinatology 02/2007; 24(1):11-6. · 1.57 Impact Factor
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    ABSTRACT: Menstrual pain can be alleviated after childbirth. The purpose of this observational study was to evaluate the natural progression of menstrual pain among nulliparous women at their reproductive age. A questionnaire-based study of perimenopausal women with a history of primary dysmenorrhea was performed. The study subjects were recruited between July 1, 2001 and June 30, 2005. Severity of menstrual pain was graded using a multidimensional scoring system. A total of 247 nulliparous women with primary dysmenorrhea were enrolled, and of these, 218 patients were eligible for analysis. Patients who had more frequent intercourse (p = 0.016), fewer associated systemic symptoms (p = 0.028), and use of oral contraceptive pills (p = 0.039) tended to have a higher chance of an improvement in dysmenorrhea after age 40. Multidimensional scoring distribution over chronologic age revealed that patients had significantly improved menstrual pain after 40 years of age. For nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40. More studies are needed to explore this phenomenon from a biochemical or molecular basis.
    Journal of the Chinese Medical Association 11/2006; 69(10):484-8. · 0.75 Impact Factor