Chi-Hsin Chiang

Chang Gung Memorial Hospital, T’ai-pei, Taipei, Taiwan

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Publications (15)23.31 Total impact

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    ABSTRACT: Background: Despite widespread human exposure to biphenol A (BPA), limited studies exist on the association of BPA with adverse health outcomes in young children. This study aims to investigate the effect of prenatal exposure to BPA on toll-like receptor -induced cytokine responses in neonates and its association with infectious diseases later in life. Methods: Cord bloods were collected from 275 full-term neonates. Production of TNF-α, IL-6, and IL -10 were evaluated after stimulating mononuclear cells with toll-like receptor ligands (TLR1-4 and 7-8). Serum BPA concentrations were analyzed by ELISA. Bacteria from nasopharyngeal specimens were identified with multiplex PCR and culture method. Result: Result showed significant association between cord BPA concentration and TLR3 and TLR4 stimulated TNF-α response (p = 0.001) and that of TLR7-8 stimulated IL-6 response (p = 0.03). Clinical analysis did not show prenatal BPA exposure to be correlated with infection or bacterial colonization during the first year of life. Conclusion: This is the first cohort study that indicated prenatal BPA exposure to play a part in TLR- related innate immune response of neonatal infants. However, despite an altered immune homeostasis, result did not show such exposure to be associated with increased risk of infection during early infancy.Pediatric Research (2015); doi:10.1038/pr.2015.234.
    No preview · Article · Nov 2015 · Pediatric Research
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    ABSTRACT: Introduction and hypothesis We investigated physiological functions of the extraordinary muscular structure in the paraurethral area with pelvic floor muscle and the impact of these muscular structures on the resting maximal urethral closure pressure (MUCP) in rats. Methods Sixteen female Wister rats were divided into four groups: Groups I and II rats received 5 and 2.5 IU botulinum toxin A (BoNT-A), respectively, injected into the bilateral paraurethral striated muscles. Group III rats received 2.5 IU BoNT-A injected into the bilateral pelvic floor muscles, and group IV rats received 2.5 IU BoNT-A injected into the unilateral pelvic floor muscles. Measurements of MUCP were made at different time points after BoNT-A injection. Results All groups showed a rapid reduction in average MUCP by 70–80 % after BoNT-A injection, regardless of injection site or side. Conclusions Paraurethral striated muscular structures and the pelvic floor muscles possess the function of maintaining resting MUCP in rats.
    No preview · Article · May 2012 · International Urogynecology Journal

  • No preview · Article · Jun 2011 · Taiwanese journal of obstetrics & gynecology
  • Shih-Yin Huang · Chi-Hsin Chiang · Fang-Ping Chen · Chia-Li Yu
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    ABSTRACT: According to a novel mechanism for fetal evasion from maternal immune attack via the engagement and down-regulation of the maternal natural killer cell receptor NKG2D by soluble MHC class I chain-related proteins (sMIC) A and B derived from placenta, we aimed to measure whether the sMICA/B level altered during pregnancy. Healthy women undergoing routine antepartum examination at Kee-Lung Chang Gung Memorial Hospital from December 2006 to December 2007 were prospectively registered for this study. We collected 337 serum specimens and 10 amniotic fluid samples from 300 normal pregnant women for sMICA/B analysis. Capture ELISA procedures were used to determine sMICA/B concentration in serum and amniotic fluid specimens. We hypothesized that the sMICA/B level would increase in proportion to the gestational age to protect the fetus from maternal immune rejection in the normal pregnancy. Results. The serum sMICA/B level rose gradually with the progression of gestation and decreased after the second trimester, with the lowest level appearing before delivery. In addition, we found that levels of soluble MICA/B were extremely low in amniotic fluid. We suggest that, as delivery approaches, the reduced production of soluble MICA/B by the aged placenta may be playing a role in parturition. Furthermore, we suggest that the effect of soluble MICA/B on natural killer cells of pregnant women is limited to the maternal placental surface, but not transferred through the placenta into the amniotic cavity.
    No preview · Article · Mar 2011 · Acta Obstetricia Et Gynecologica Scandinavica
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    ABSTRACT: The aim of this study is to explore causality of birth trauma after vaginal delivery and anatomical findings. A total of 28 virgin mice were studied. Treatment groups received vaginal distention. Specimens were collected and subjected to the following fluorescence stains: progenitor cell (c-kit), smooth muscle (SMA), fibroblast (vimentin), and skeleton muscle (Masson's trichrome). Confocal microscopy was used to screen all of the urogenital tissue to localize the stained cells. Fibroblasts were spread all over perivaginal and urethral surroundings. Progenitor cells appeared at urethral-vagina intersection and urethral circle. They were noticeable only within smooth muscle layer. Two extraordinary skeleton muscle bands appeared on the urethra bilaterally. Our study demonstrates existence of muscle bands at the bilateral urethra. They can limit the mobility of urethra during vaginal delivery and thereby cause urethra injury. Progenitor cells are located only in the smooth muscle of the urethral circle.
    No preview · Article · Oct 2010 · International Urogynecology Journal
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    ABSTRACT: The use of indigo naturalis to treat psoriasis has proved effective in our previous clinical studies. The present study was designed to examine the anti-inflammatory effect of indigo naturalis in primary cultured human umbilical vein endothelial cells (HUVECs). Pretreatment of cells with indigo naturalis extract attenuated TNF-α-induced increase in Jurkat T cell adhesion to HUVECs as well as decreased the protein and messenger (m)RNA expression levels of vascular cell adhesion molecule-1 (VCAM-1) on HUVECs. Indigo naturalis extract also inhibited the protein expression of activator protein-1 (AP-1)/c-Jun, a critical transcription factor for the activation of VCAM-1 gene expression. Since the reduction of lymphocyte adhesion to vascular cells by indigo naturalis extract could subsequently reduce the inflammatory reactions caused by lymphocyte infiltration in the epidermal layer and help to improve psoriasis, this study provides a potential mechanism for the anti-inflammatory therapeutic effect of indigo naturalis extract in psoriasis.
    Preview · Article · Sep 2010 · Molecules
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    ABSTRACT: To evaluate the changes in symptoms of overactive bladder (OAB) on the advanced cystocele after restoration of prolapse using the Perigee system. This prospective clinical study recorded 16 women for the Perigee procedure due to advanced cystocele with OAB symptoms. Prolapse assessment was measured according to the pelvic organ prolapse quantization system. Complete urodynamic examination was performed before and six months after the operation. Subjects were also asked to fill in a questionnaire before and after the operation for a quantitative assay of OAB symptoms. Additional pelvic reconstructive surgeries including the Apogee procedure, retropubic tension-free vaginal tape and posterior colporrhaphy with tension-free vaginal tape were performed concurrently on 10 patients. Eleven cases were available for data analysis. Results showed significant improvement at points Aa and Ba after the operation. The Perigee procedure could restore the advanced cystocele adequately, with points Aa and Ba almost back to their normal physiological and anatomical positions. However, urodynamics showed two subjects with motor urgency and one with sensory urgency having objective improvement in urge sensation. Questionnaire results of postoperative subjective symptoms revealed a significant improvement with respect to coping, concern and sleep as compared to preoperative symptoms. This preliminary report reveals that the Perigee procedure is an efficient and effective surgical approach for the treatment of anterior vaginal wall prolapse. It can also improve the subjective symptoms of OAB.
    No preview · Article · Aug 2009 · Journal of Obstetrics and Gynaecology Research
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    ABSTRACT: We report on a 27-year-old woman who presented with an ovarian solid tumor (20 x 15 cm) and massive ascites. A physical examination and chest X-ray revealed a moderate amount of pleural effusion on the right side. Cytologic study of the pleural effusion showed reactive mesothelial cells without evidence of malignancy. Gram's stain was negative. The blood chemistry was within normal limits. The serum CA-125 level was 22 (normal, < 35) U/ml, the alpha-fetoprotein (AFP) level was 8 (normal, < 20) ng/ml, and the carcinoembryonic antigen (CEA) was 0.5 (normal, < 5) ng/ml. An explorative laparotomy revealed approximately 1500 ml of serous ascites and a very large multilobulated left adnexal mass (20 x 15 cm) with no malignant cytology in the ascitic fluid. Postoperatively, the pleural effusion spontaneously resolved, and the microscopic examination revealed a benign fibroma-thecoma, confirming the diagnosis of Meigs' syndrome. The symptoms resolved after removal of this pelvic tumor. This is an unusual case of a young female with Meigs' syndrome and a normal serum CA-125 level.
    Preview · Article · Aug 2005 · Chang Gung medical journal
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    ABSTRACT: Since Asherman first published his series of intrauterine synechiae in 1948, only a few physicians have described the obstetric complications of patients who conceived following surgical treatment of intrauterine synechiae. We present a woman with a history of resectoscopic resection of intrauterine adhesions with a term pregnancy and spontaneous uterine rupture that occurred during the intrapartum period. At emergent cesarean section, hemoperitoneum of approximately 1500 mL was noted and a 10-cm defect was present in the lateral uterine wall; the edges of the defect were bleeding actively. Because of the potential for a disastrous outcome in the rupture of the pregnant uterus, patients treated for Asherman's syndrome should be identified early and appropriate precautions should be taken in their obstetric management.
    Preview · Article · Mar 2005 · Chang Gung medical journal
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    ABSTRACT: Objective: A retrospective study to evaluate the ovarian reserve via antral follicle counts and basal hormone changes in infertile patients who had previously undergone laparoscopic surgery for ovarian endometriosis. Materials and Methods: Infertile women who had undergone laparoscopy for ovarian endometriosis were enrolled and divided into four groups according to the ovarian surgical procedure, determined by the degree of the invading lesion: bipolar cauterization of the superficial ovarian endometriosis (group A), cystectomy of the endometrioma with a diameter of less than 5 cm (group B) or a diameter of at least 5 cm (group C), or unilateral oophorectomy (group D). Follow-up statistics included basal serum hormone levels and ovarian antral follicle counts, which were determined about 12 months after surgery. Results: The study included 233 women. We found a significant difference in remaining antral follicle counts in groups A, B, C, and D: 11.1 ± 3.5, 9.4 ± 3.1, 7.5 ± 2.3, and 4.0 ± 2.0, respectively (p < 0.001). There was no difference in day 3 follicle-stimulating hormone (FSH) levels: 6.2 ± 2.0, 6.2 ± 2.8, 6.3 ± 2.2, and 7.8 ± 2.1 IU/L in groups A, B, C, and D, respectively. Significantly higher basal FSH levels were noted when comparing group D with groups A, B, and C (p < 0.05). Conclusion: Ovarian endometrioma cystectomy or oophorectomy damages the ovarian reserve. Damage to the vascular system and the cortex of the ovary during surgery might accelerate depletion of the follicular pool. The FSH level is compromised significantly until the follicular pool is depleted below a certain threshold. This might be because of various components controlling FSH modulation, mainly inhibin but possibly other steroids and peptides influenced by extraovarian mechanisms or the aging of neuroendocrine tissues.
    No preview · Article · Sep 2004 · Taiwanese Journal of Obstetrics and Gynecology
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    ABSTRACT: Management of severe ovarian hyperstimulation syndrome (OHSS) includes hospitalization for fluid and electrolyte management. Abdominal paracentesis is also used as minimally invasive form of management in selected cases of severe OHSS following ovulation induction. However, if pregnancy ensues, the syndrome persists for a longer period, and the clinical manifestations of severe OHSS could mask the picture of a bleeding gestational sac. It could be easily overlooked unless the possibility of an ectopic pregnancy is kept in mind in cases of severe OHSS exacerbated by early pregnancy with or without a previous ectopic pregnancy history. We report a case of severe OHSS with simultaneous bilateral tubal pregnancy following intrauterine insemination (IUI). A 31-year-old woman with polycystic ovarian disease developed severe OHSS during the therapeutic course of IUI. An emergent exploratory laparotomy was performed 14 days after admission, and the operative findings showed persistent profuse bleeding from the bilateral fimbrial ends with marked enlargement of the ampullary portions. A linear salpingotomy was performed by a longitudinal incision along the area of maximal distension of the dilated fallopian tubes to preserve her fertility. We recommend that in cases of severe OHSS exacerbated by early pregnancy, serial serum beta-hCG and transvaginal ultrasound follow-up may be necessary due to the potential association of severe OHSS in pregnancy with an ectopic pregnancy.
    Preview · Article · Mar 2004 · Chang Gung medical journal

  • No preview · Article · Nov 2003 · Fertility and Sterility
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    ABSTRACT: CA-125 is a 220-kD cell surface glycoprotein present in over 80% of non-mucinous epithelial ovarian carcinomas and it occurs in the serum of healthy males and females at low concentrations (< 35 U/mL). Serum CA-125 concentration may also be moderately elevated in several benign conditions, such as pelvic inflammatory disease, uterine fibroids, pregnancy, spontaneous abortion with chromosomal abnormality, and especially in endometriosis. However, serum CA-125 concentration is seldom > 100 IU/ml in endometriosis. In this paper, we present a patient with unilateral ovarian endometrioma associated with abnormally high serum CA-125 level (> 6000 U/mL) and after excision of the ovarian tumor, the CA-125 levels returned to normal. Our case further emphasizes the association of high levels of CA-125 with benign gynecologic conditions and we discussed the possible explanations for this abnormal elevation of CA-125 levels.
    Preview · Article · Sep 2003 · Chang Gung medical journal
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    ABSTRACT: To obtain quantitative data on endometrial volume and subendometrial blood flow by three-dimensional ultrasound clue to endometrial receptivity. A prospective, nonrandomized clinical study. One tertiary center for assisted reproduction. Fifty-four patients aged <38 years with normal basal serum FSH level experiencing their first IVF cycle, whose uteri were morphologically normal as confirmed by 3-dimensional (3-D) ultrasound, were studied. Ultrasound evaluation was performed for all patients with 3-D facility by a single operator on the day of hCG administration. Ultrasonographic parameters and conception rates. Subendometrial vascularization flow index (VFI) in predicting the pregnancy rate of IVF was superior to that using vascularization index, flow index, or endometrial volume in the receiver operating characteristics curve analysis. The best prediction rate was achieved by a VFI cutoff value of >0.24. The detection of subendometrial blood flow by 3-D power Doppler ultrasound may be a useful ultrasound parameter in the prediction of pregnancy rate of IVF, especially subendometrial VFI.
    No preview · Article · Mar 2003 · Fertility and Sterility
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    ABSTRACT: To investigate normal reference values of nuchal translucency (NT) thickness in normal Taiwanese fetuses between 11 and 14 weeks of gestation. A prospective study of ultrasound measurements of fetal NT and crown-rump length (CRL) at 11-14 weeks of gestation was conducted in 724 consecutive Taiwanese fetuses between 1998 and 2001. The relationship between NT and 5-mm intervals of the CRL of the fetus was analyzed. NT thickness was converted into multiple of median (MoM) values for the proper CRL. The estimated risk of trisomy 21 was calculated in combination with maternal age and NT MoM. NT thickness increased with increasing CRL and gestational week in the first trimester. The mean (median) of NT thickness at 11-14 weeks was 1.56 (1.50) mm. Values of NT logMoM showed a normal Gaussian distribution with a mean of -0.0062 and standard deviation of 0.1146. The overall frequency of NT thickness of > 2.5 mm and > 3.0 mm was 1.7% (12/724) and 0.7% (5/724), respectively. There were 18 (2.5%) of 724 normal fetuses with the eseimated risk of trisomy 21, based on maternal age and NT thickness higher than 1:300. Because of weekly variations and racial differences in NT measurements, normal reference values should be established to convert NT thickness into MoM values for calculating the estimated risk of trisomy 21 in first-trimester NT screening.
    No preview · Article · Jan 2003 · Chang Gung medical journal