[Post-transplant kidney from C-III donation after cardiac death of children: a clinicopathologic study of 20 cases].

OBJECTIVE: To study the clinical and histopathologic features of post-transplant kidney biopsy tissues from pediatric C-III donors. METHODS: The clinical and pathologic features of 20 cases (22 case-times) of renal transplant biopsies from pediatric cadaveric donors were analyzed by light microscopy and immunohistochemistry according to the Banff system of working classification of renal allograft pathology. Biopsies were compared to those from adult C-III donors and adult cadaveric donors. RESULTS: Sixteen cases (72.7%) showed renal allograft drug toxicity damage by Tacrolimus, seven cases (31.8%) showed degeneration and necrosis of renal tubular epithelial cells, four cases (18.2%) showed T cell-mediated acute rejection and six cases (27.3%) showed renal interstitial inflammation. There were two cases (9.1%) of renal dysplasia and one case (4.5%) of renal infarction. There was insufficient evidence for diagnosis of renal allograft nephropathy. Compared to post-transplant kidney from adult C-III donors, the proportion of drug toxicity damage was higher (P<0.05). Compared to post-transplant kidney from adult cadavers, the proportions of drug toxicity damage, degeneration and necrosis of renal tubular epithelial cells were higher (P<0.05) while the proportion of acute rejection was lower (P<0.05). CONCLUSIONS: The pathologic changes in the post-transplant kidneys from pediatric donors are different from those from adult donors. Optimal long-term outcome can be accomplished by effective treatment based on timely or procedural biopsy.

[Epidemiological analysis of selected congenital limb malformations in Hengyang].

OBJECTIVE: To describe the epidemiological characteristics of selected congenital limb malformations (CLM) in newborns of Hengyang. METHODS: During the period of 2008-2010, cluster sampling survey was adopted to investigate the congenital limb malformations of neonates born to women resident in Hengyang, including Nanyue District, Zhuhui District, Changning City and Hengshan County. Each newborn was examined for the screening of CLM after birth. Limb malformations were grouped into the isolated (ILM) and the syndromic (SLM) form, depending on associated malformations of the affected. Prevalence rates, CLM spectrum and clinical manifestations were analyzed. RESULTS: A total of 170 CLM cases were identified among 52,307 newborns during the study period, resulting overall rate of 32.50/10(4). The rates for isolated and syndromic CLM were 28.29 and 4.21 per 10 000 births respectively. The rates for polydactyly, congenital talipes equinovarus, syndactyly and limb reduction defects were 13.00/10(4), 9.56/10(4), 5.16/10(4) and 3.63/10(4), respectively. No significant difference in rates of overall CLM or specified CLM was observed across urban-rural, gender and maternal age groups. Of the cases affected by polydactyly, syndactyly and limb reduction defects, malformation involved upper limbs, lower limbs and the both accounted for 68.14%, 14.16% and 17.70%. Preterm birth, low birth-weight, still birth and neonatal death were observed more frequently in syndromic cases than in isolated patients. CONCLUSION: The high CLM prevalence rate and fatality rate in Hengyang suggest that effective measures should be taken to prevent malformations and to improve survival of the affected.

Prospective cohort study of the association between use of low-dose oral contraceptives and stroke in Chinese women.

PURPOSE: To clarify the association between use of widely distributed low-dose combined oral contraceptives (COCs) in China and the risk of stroke in order to decrease adverse reactions to COCs. METHODS: A prospective surveillance cohort study was undertaken in 25 towns in two counties in Jiangsu Province, China. Women (44,408 ) on hormonal contraceptives (HC) and 75,230 women with an intrauterine device (IUD) were followed up from July 1997 to June 2000 to study the difference in the incidence of stroke. RESULTS: The incidence of haemorrhagic stroke (age- and county-standardised rate) was far higher than that of ischaemic stroke (34.74 vs. 11.25 per 100,000 person years) among HC cohort. The relative risk (RR) of incidence of haemorrhagic stroke in the HC cohort (52 cases) was 2.72 times compared with that in the IUD cohort (23 cases). Compared with IUD users, the current users of HC had a higher RR of 4.20 (95%CI, 2.11-8.36) of haemorrhagic stroke, and still reached 2.17 (95%CI, 1.16-4.06) among past users after they stopped taking COCs for more than 10 years. The RR of haemorrhagic stroke was 3.09 (95%CI, 1.26-7.57) among women who had last used low-dose COCs during the previous 5 years. In women aged less than 45 years, compared to IUD users, the haemorrhagic stroke was strongly associated with current use of low-dose combined norethisterone pills, with RR being 19.06 (95%CI, 3.08-118.03). CONCLUSIONS: There is an increased risk of haemorrhagic stroke among Chinese users of long-term low-dose oral contraceptives, which appears to persist long after discontinuation.

The acceptability of an injectable, once-a-month male contraceptive in China.

PURPOSE: An acceptability study of an injectable preparation of the synthetic steroid testosterone undecanoate as a once-a-month male contraceptive method was carried out concurrently with, but independently from, a clinical safety and efficacy trial of this preparation in China, from 1997 to 1999. METHOD: Three hundred eight men, the entire group of volunteers enrolled in the clinical trial, were interviewed using a structured questionnaire. In addition, 24 sessions of focus group discussions and 54 in-depth interviews were conducted with a broad range of stakeholders, including men enrolled in the trial and their wives, potential users, service providers, principal investigators of the six participating clinical trial centers, provincial and national policy makers, and experts engaged in research and development of male methods of contraception. RESULTS: Overall, men found the regimen to be acceptable, and most reported no change or an improvement in their well-being as a result of participating in the clinical study. The frequency of the injections, monthly semen analyses and the need to use another contraceptive method during the period of sperm suppression were reported inconveniences of the trial. CONCLUSION: Further research is needed to assess the long-term safety, continuation rates, satisfaction among users and issues related to service delivery.

[Association between low-dose oral contraceptive use and stroke in Chinese women].

OBJECTIVE: To investigate the association between low-dose combined oral contraceptive (COC) widely distributed in China and the risk of hemorrhagic stroke so as to decrease the adverse reaction of COC. METHODS: A prospective cohort study was made among 44 408 women who took hormonal contraceptives (HCs) and 75 230 women who used in trauterine device (IUD) in 25 townships and toens in Rudong County and Taicang City, Jiangsu Province, to compare the incidence of stroke among them from 1 July 1997 to 30 June 2000. RESULTS: (1) The incidence of hemorrhagic stroke (age-and-county standardized rates) was 34.74 per 100 000 py in the HC cohort, 2.72 times higher than that in the IUD cohort (P < 0.01). The incidence of hemorrhagic stroke among women less than 45 years of age was remarkably higher in HC cohort than in the IUD cohort. The relative risk of incidence of hemorrhagic stroke was 2.17 (1.16, 4.06) among the HC users who had stopped HC use for more than 10 years, still significantly higher than among the IUD users. (2) The relative risk of incidence of hemorrhagic stroke among the women who used low-dose COCs during the survey was 3.60 (1.73, 7.53) times higher than that among the IUD users. The relative risk of incidence of hemorrhagic stroke was 3.09 (1.26, 7.57) among the women who had stopped low-dose COC use for less than five years, however, the risk of hemorrhagic stroke remarkably decreased after they stopped taking COC for more than 5 years. (3) No obvious increase in incidence of infarctional stroke was found among the women who took low-dose COC during the survey. (4) Hypertension might be the most important risk factor of hemorrhagic stroke among the low-dose COC users. CONCLUSION: There is an obvious increase in risk of hemorrhagic stroke among the Chines women who take low-dose of China-made COCs for a long time. The efffect of China-made COCs on pathogenesis of hemorrhagic stroke lasts sometime after the discontinuation of COC use.