Objectives To find problems in the systematic management of maternal health and to provide evidence for developing effective interventions to reduce maternal mortality in Shanghai. Methods Every maternal death from 2000 to 2009 was audited by experts and relevant informations were collected and analyzed retrospectively. Results ( 1 ) Number of live births. The number of live births in Shanghai rised from 84 898 in 2000 to 187 335 in 2009, which increased by 120. 7%. Notably, the number of live births of migrating people increased 4. 6 times. In 2000, it took up 25.5% and in 2009, it rose to 54. 8%. ( 2 )Maternal mortality ratio (MMR) and its composition. The total live births from 2000 to 2009 was 1 279 010,among which there were 262 maternal deaths, with average maternal mortality of 20. 48 per 100 000 live birth (262/1 279 010). For Shanghai residents, the MMR was 8.09 per 100 000 live births (55/680 005 ),while the MMR of migrating people was 34. 56 per 100 000 live births ( 207/599 005 ). ( 3 ) Trends of MMR. The MMR declined from 21.2 per 100 000 live births in 2000 to 9.61 per 100 000 live births in 2009. The MMR of Shanghai residents maintained below 10 per 100 000 live births with exception of year 2003 and 2004. The MMR of migrating people declined sharply. In 2002 it was 77.42 per 100 000 live births, and in 2009 it decreased to 11. 69 per 100 000 live births. (4)The composition of causes of maternal deaths and rank order. The top 5 causes of deaths were obstetric hemorrhage (69 cases, 26. 3% of the total deaths), pregnancy induced hypertension (27 cases, 10. 3% of the total deaths), heart diseases (24 cases,9. 2% of the total deaths), liver diseases ( 17 cases, 6. 5% of the total deaths), amniotic fluid embolism and ectopic pregnancy ( 15 cases respectively, 5.7% of the total deaths). ( 5 ) The changes of causes between the first 5 years and the latter 5 years. The MMR of ectopic pregnancy, heart diseases and pregnancy induced hypertension changed significantly in Shanghai residents. The MMR of ectopic pregnancy decreased from 1.36 per 100 000 live births in the first 5 years to 0. 26 per 100 000 live births in the latter 5 years. The MMR of heart diseases decreased from 1.36 per 100 000 live births to 0. 52 per 100 000 live births. While the MMR of pregnancy induced hypertension increased from 0 to 0. 78 per 100 000 live births. For migrating population, the MMR of obstetric hemorrhage, ectopic pregnancy and pregnancy induced pregnancy deceased significantly. As the primary cause, the MMR of obstetric hemorrhage deceased from 21.85 per 100 000 live births in the first 5 years to 5.47 per 100 000 live births in the second 5 years. The MMR of ectopic pregnancy decreased from 4. 37 per 100 000 live births to 0. 68 per 100 000 live births. And the MMR of pregnancy induced hypertension decreased from 6. 87 per 100 000 live births to 2. 96 per 100 000 live births.(6) Direct obstetric causes and indirect obstetric causes of maternal deaths. Among the 262 deaths,141 cases (53. 8% ) were due to Direct obstetric causes and 121 (46. 2% ) were due to indirect obstetric causes. (7)The trend of MMR of obstetric hemorrhage. The MMR of obstetric hemorrhage declined from 10. 6 per 100 000 live births in 2000 to 1.7 per 100 000 live births in 2009. ( 8 ) The results of maternal death audit. The results of maternal death audit were classified into 3 categories: 41 cases ( 15.6% )belonged to the first category, i. e, avoidable deaths; 66 cases (25.2%) belonged to the second category,i. e, avoidable when creating some conditions; and 155 cases (59. 2% ) belonged to the third category,which means not avoidable. Among 55 deaths of Shanghai residents, 17 cases (30. 9% ) belonged to the first category, 14 cases (25.5%) belonged to the second, and 24 cases (43.6%) belonged to the third category. Among 207 deaths of migrating population, 24 cases (11.6%) belonged to the first category,52 cases (25. 1% ) belonged to the second, and 131 cases (63.3%) belonged to the third category. (9)WHO twelve-grid classification of maternal deaths. The factors, including attitude, knowledge and skills, resources and management of the dead people and their families, the medical institutes and social supportive departments were integrated and analyzed. It showed that the main reason of maternal deaths of Shanghai residents was poor knowledge and skills of medical staffs, accounting for 80. 0% of the deaths. While the main reasons of maternal deaths of migrating people were poor knowledge and skills, inappropriate attitude of the dead people and their families, which took up 54. 1% and 40. 1% respectively. Conclusions The MMR in Shanghai declined continuously from 2000 to 2009, especially for migrating population which reflected the interventions of maternal management in Shanghai were effective. Though obstetric hemorrhage was the first top cause of maternal death during past 10 years, it declined Sharply. 30% to 40% maternal deaths were avoidable if some conditions were created. However, in order to adapt the changes of main causes of maternal deaths and accomplish increasing service requirements, it is necessary to develop new service and management mode.

Objective To analyze the trend of maternal mortality ratio (MMR) and cause of death in Shanghai from 1996 to 2015.Methods To collect the material about the maternal death and the maternal death audit from 1996 to 2015,and to analyze the MMR,the cause of death and the result of the maternal death audit of Shanghai from 1996 to 2015 retrospectively.Results (1) The change of MMR:the MMR in Shanghai decreased from 28.84 per 100000 live births in 1996 to 6.66 per 100000 live births in 2015.(2) The characteristic of maternal death:the proportion of Shanghai citizens was 27.4％(121/441) and the proportion of migrant women was 72.6％(320/441).The women with advanced maternal age was 8.2％(20/243) since 1996 to 2005,and increased to 16.7％ (33/198) since 2006 to 2015.Maternal deaths during pregnancy increased from 27.6％(67/243) in the first 10 years (1996-2005) to 35.4％(70/198) in the recent 10 years(2006-2015).The intrapartum maternal deaths was 6.2％(15/243) in the first 10 years and in the recent 10 years it was zero.The proportion of postpartum deaths in the first 10 years and in the recent 10 years were 66.3％ (161/243) and 64.6％(128/198) respectively.(3) The cause of maternal death:During the recent 10 years,indirect obstetric causes [63.1％(125/198)] was more than direct obstetric causes [36.9％(73/198)] for the first time.The death causes changed significantly.Postpartum hemorrhage remained the leading cause of maternal deaths,but the specific mortality rate (SMR) of postpartum hemorrhage decreased significantly from 7.42 per 100000 live births in the first 10 years to 1.51 per 100000 live births in the recent 10 years.The maternal deaths because of heart disease and cerebrovascular disease rose to the second and the forth reasons.(4) Maternal death audit:the avoidable maternal death ratio decreased from 3.66 per 100000 live births in the first 10 years to 1.86 per 100 000 live births in the recent 10 years.Conclusions During the past 20 years,the MMR of Shanghai decreased significantly and was close to the level of developed countries.In recent years,the causes of maternal death become more complicated.With the implementation of the second child policy,women with high risk factors increase,so government investment,policy support should be strengthened to optimize the management.

Objective To summarize the experience of one case of anastomotic leakage after simultaneous pancreas-kidney transplantation (SPK ) with enteric drainage .Methods One case of type 2 diabetes mellitus complicated with end-stage nephropathy undergoing SPK was retrospectively analyzed .Iliac venous systemic circulation was employed for pancreatic venous reflux ,transplanted pancreas exocrine via enteric drainage and side-to-side anastomosis between donor pancreaticoduodenum and recipient jejunum . Pancreatoduodenal anastomotic leakage occurred at 12 days post-operation .During re-operation ,Roux-en-Y anastomosis was established between donor pancreaticoduodenum and recipient jejunum .And the relevant domestic and foreign literatures were searched .Results The follow-up time was 3 month after a second operation .Recipient pancreas and kidney transplantation survived well . There was no onset of enteric leakage .The incidence of anastomotic leakage varies greatly between different transplantation centers both at home and abroad .The incidence ranged from 3 .6％ to 11 .3％ .And the risk of pancreatic loss was as high as 54 .6％ .Conclusions As a severe postoperative complication ,anastomotic fistula after SPK may cuase abdominal infection . Even after reparing enteric fistula , the risk of leakage remains high . Roux-en-Y anastomosis is other therapeutic option .

OBJECTIVETo investigate RANK-RANKL expression in the kidneys of a rat model of puromycin aminonucleoside nephropathy (PAN).

METHODSThirty-six SD rats were randomly divided into PAN model group and normal control group. PAN was induced by a single intravenous injection of 100 mg/kg puromycin aminonucleoside. Serum creatinine and 24-hour urinary protein were measured on days 3, 7, and 14 after the injection, and renal pathologies were assessed with optical and immune transmission electron microscopy. The expression of RANK and RANKL in the kidneys was examined using reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.

RESULTSThe PAN model rats showed massive proteinuria and elevated serum creatinine on day 3, which peaked on day 7. RANK-RANKL protein and mRNA expressions in PAN model group was higher than those in the control group. In the PAN rats, RANK was expressed mainly on the top cell membrane and in the cytoplasm of renal podocytes with a significantly increased expression level compared with that in the control group.

CONCLUSIONThe PAN rat model shows aberrant RANK and RANKL expressions in the podocytes, indicating their contribution to podocyte injury in PAN.

Animals ; Creatinine ; blood ; Female ; Kidney ; drug effects ; metabolism ; Kidney Diseases ; chemically induced ; metabolism ; pathology ; Male ; Podocytes ; drug effects ; metabolism ; Proteinuria ; pathology ; Puromycin Aminonucleoside ; adverse effects ; RANK Ligand ; metabolism ; Rats ; Rats, Sprague-Dawley ; Receptor Activator of Nuclear Factor-kappa B ; metabolism

Objective To investigate RANK-RANKL expression in the kidneys of a rat model of puromycin aminonucleoside nephropathy (PAN). Methods Thirty-six SD rats were randomly divided into PAN model group and normal control group. PAN was induced by a single intravenous injection of 100 mg/kg puromycin aminonucleoside. Serum creatinine and 24-hour urinary protein were measured on days 3, 7, and 14 after the injection, and renal pathologies were assessed with optical and immune transmission electron microscopy. The expression of RANK and RANKL in the kidneys was examined using reverse transcription-ploymerase chain reaction (RT-PCR) and Western blotting. Results The PAN model rats showed massive proteinuria and elevated serum creatinine on day 3, which peaked on day 7. RANK-RANKL protein and mRNA expressions in PAN model group was higher than those in the control group. In the PAN rats, RANK was expressed mainly on the top cell membrane and in the cytoplasm of renal podocytes with a significantly increased expression level compared with that in the control group. Conclusion The PAN rat model shows aberrant RANK and RANKL expressions in the podocytes, indicating their contribution to podocyte injury in PAN.

Objective To investigate RANK-RANKL expression in the kidneys of a rat model of puromycin aminonucleoside nephropathy (PAN). Methods Thirty-six SD rats were randomly divided into PAN model group and normal control group. PAN was induced by a single intravenous injection of 100 mg/kg puromycin aminonucleoside. Serum creatinine and 24-hour urinary protein were measured on days 3, 7, and 14 after the injection, and renal pathologies were assessed with optical and immune transmission electron microscopy. The expression of RANK and RANKL in the kidneys was examined using reverse transcription-ploymerase chain reaction (RT-PCR) and Western blotting. Results The PAN model rats showed massive proteinuria and elevated serum creatinine on day 3, which peaked on day 7. RANK-RANKL protein and mRNA expressions in PAN model group was higher than those in the control group. In the PAN rats, RANK was expressed mainly on the top cell membrane and in the cytoplasm of renal podocytes with a significantly increased expression level compared with that in the control group. Conclusion The PAN rat model shows aberrant RANK and RANKL expressions in the podocytes, indicating their contribution to podocyte injury in PAN.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.