Recent Advances of Microfluidic Platform for Cell Based Non-Invasive Prenatal Diagnosis

The purpose of the present review is to try to highlight recent advances in the application of microfluidic technology on non-invasive prenatal diagnosis (NIPD). The immunoaffinity based microfluidic technology is the most common approach for NIPD, followed by size-based microfluidic methods. Immunoaffinity microfluidic methods can enrich and isolate circulating fetal extravillous trophoblasts (fEVTs) or fetal nucleated red blood cells (fnRBCs) for NIPD by using specific antibodies, but size-based microfluidic systems are only applied to isolate fEVTs. Most studies based on the immunoaffinity microfluidic system gave good results. Enough fetal cells were obtained for chromosomal and/or genetic analysis in all blood samples. However, the results from studies using size-based microfluidic systems for NIPD are less than ideal. In conclusion, recent advances in microfluidic devices make the immunoaffinity based microfluidic system potentially a powerful tool for cell-based NIPD. However, more clinical validation is needed

Post-discharge re-hospitalization and in-hospital mortality in Taiwanese women with hip fracture

[[abstract]]Objectives To explore the factors concerning postdischarge rehospitalization and in-hospital mortality among Taiwanese women older than 50 years with hip fracture. Materials and methods The National Health Insurance database from 2000 to 2006 was used to identity relevant cases. Women inpatients aged over 50 years with new-onset hip fracture in 2003 were identified. We analyzed the factors affecting postdischarge rehospitalization and in-hospital mortality. Results In 2003, there were 9467 new-onset hip fracture inpatients claimed among Taiwanese women aged over 50 years. The 3-year cumulative rates of rehospitalization after discharge and in-hospital mortality rate were 11.01% (1043) and 7.10% (672), respectively. The factors determined to be related to rehospitalization were patient age, hospital level, length of stay of the initial hospitalization due to hip fracture, and Charlson comorbidity index (CCI) score. The factors determined to be related to in-hospital mortality were age, urbanization level of region where patients were insured, hospital level, length of stay of the initial hospitalization due to hip fracture, and CCI score. Conclusion Characteristics of women aged over 50 years with hip fracture remain an important issue based on high rehospitalization and in-hospital mortality rates. We have identified related risk factors that may be helpful in treating hip fracture among this population segment

Perinatal Outcome of One Fetal Death in Twin-Twin Transfusion Syndrome

　　This study was conducted to evaluate the perinatal outcome of the surviving fetus after one fetal death in twin -twin transfusion syndrome( TTTS) and the possible mechanism determining the outcome. A cooperative study was conducted at three hospitals in Taiwan from October 1, 1991 to January 30, 1993. The clinical course, and perinatal and placental findings in five sets of twin pregnancies complicated by TTTS with one fetal death were studied. Subsequent intrauterine death of immediate neonatal death of the surviving fetus due to severe anemia was noted in the three severe or moderate cases. In the two mild cases, both infants were born alive with a macerated co-twin, but with organ damage and disseminated intravascular coagulation. Sefere anemia was also noted in one of the mild cases. The outcome of the surviving frtus complicated by TTTS with one fetal demise is quite poor. Both acute blood shunting and disseminated intravascular coagulation contribute to the poor prognosis. In moderate or severe twin-twin transfusion syndrome, the death of one fetus results in a large amount of blood shunting from the survivor to the dead fetus, the surviving fetus dying subsequently due to rapid blood loss. In mild cases, the acute blood shunting is less and the fetuses may survive with anemia of varying degrees of severity. However, anemia as well as subsequent disseminated intravascular coagulation may cause severe handicap and even neonatal death of the surviving infant.#0252

The Evolving National Birth Prevalence of down Syndrome in Taiwan. A Study on the Impact of Second-Trimester Maternal Serum Screening

Objectives The aim of the present study was to determine whether the liberal use of second-trimester maternal serum screening in Taiwan started in 1994 had a measurable impact on birth prevalence of infants with Down syndrome (DS) in the past decade. Methods We based our study on the databases of National Birth Defect Registration and Notification System, Amniocentesis in Pregnant Women, and Demographic Fact Book in Taiwan. Collected data included total registered birth number, the registered number of stillbirths, the registered numbers of live births and of DS stillbirths affected with DS, amniocentesis rates each year in pregnant women aged 35 or more, and the age distribution of pregnant women in Taiwan. The live birth rate of and total birth rate of fetuses affected with DS, and the rates of live birth and stillbirth to total birth with DS , were analyzed year by year, in order to understand the change of birth rate of infants affected with DS between 1993 and 2001 . Those with isolated cleft palate (ICP) were also analyzed as internal control variable. Confidence interval of live birth rate of infants with DS under Poisson distribution was calculated. Chi-square test for trend in binomial proportions was performed to see if there is an increasing ( or decreasing) trend in the proportion of incidence of fetuses affected with DS. The difference was statistically significant if a p value was <0.05. Results A total of 1 331 616 deliveries were collected during the study period, including 840 cases of DS confirmed by karyotyping study. A marked decrease in the live birth rates of case with DS occurred in 1994-95, from 0.63 per 1000 births to 0.23 per 1000 births. There was a crossover from more live births with DS to more stillbirths with DS during 1994 to 1996 after the implementation of second-trimester maternal serum screening for DS in 1994. In 1993, 76.9% of births diagnosed with DS were born alive, compared to 32.5% in 2001 (p < 0. 001). Conclusions The policy of prenatal diagnosis program including amniocentesis for pregnant women aged 35 or more and the liberal application of maternal serum screening for DS in younger women was responsible for the marked decrease in the live births affected with DS in Taiwan from 1993 to 2001. Copyright © 2005 John Wiley & Sons, Ltd

First-Trimester Down's Syndrome Screening by Fetal Nuchal Translucency Measurement in Taiwan

Background: Fetal nuchal translucency (NT) measurement is now widely used in many Western countries as a screening tool for Down's syndrome during the first trimester. However , at present there is no data on its use in Taiwan. The purpose of the present study was to evaluate the efficacy of NT measurement in first-trimester Down's syndrome screening in Taiwan. Methods: We conducted a prospective study from October 1997 to May 1999. Sonographic measurement of fetal NT was performed in 1,249 fetuses at 9-14 weeks of gestation . Transabdominal ultrasound scanning was performed to obtain a sagittal section of the fetus for measuring the crown- rump length (CRL) and the maximum thickness of the subcutaneous translucency between the skin and the soft tissue overlying the cervical spine. Two different cut-off points were used for screening: a fixed cut-off point of at least 2.5 mm and a CRL-related cut-off point. In the latter method, fetuses with an NT measurement in the 95th percentile were considered at high risk for Down's syndrome. Results: Three fetuses had Down's syndrome, with NT measurements of 2.1 mm, 2.7 mm, and 4.0 mm. The false positive rates for the fixed cut-off point and CRL-related cut-off point were 6.3% and 4.6%, respectively. Both methods had a sensitivity of 66.7%. However, the screening program using the CRL-related cut-off point had two advantages: a higher specificity (95.5% vs 93.8%) and a more reasonable distribution pattern for screening. Conclusion: This study showed that NT measurement is a potential screening tool for Down's syndrome during the first trimester in Taiwan. Using CRL-related cutoff points for screening is more resonable than using a fixed cut-off point