ObjectiveObserving and analyzing the delivery behaviour of cynomolgus macaques, to establish the criteria for determining the occurrence of delivery in cynomolgus macaques, and then combining with veterinary assistance in order to improve the live birth rate of cynomolgus macaques. MethodsBy backtracking and analyzing the surveillance videos of 112 perinatal cynomolgus macaques with a gestation period of 140 d or more from 2017 to 2021, we observed and recorded the main behavioural manifestations of the cynomolgus macaques during labour, including Valsalva's maneuver, touching and licking the birth canal, lying on their backs or stomachs, and rolling and tumbling of the body. On this basis, we established the weights of delivery-related behavioural indicators and exhaustively analysed the perinatal behavioural performances of 30 cynomolgus macaques for delivery determination. ResultsThe perinatal behavioural validation results of the 30 cynomolgus macaques showed that the behavioural indicators of Valsalva's maneuver, touching and licking the birth canal, lying on the stomach or on the floor, body rolling and tumbling occurred with different frequencies, among which Valsalva's maneuver and lying on the stomach or on the back were the most important, with weight values of 35.5% and 27.2%, respectively. These two behaviours can be used to accurately determine the onset of parturition in cynomolgus macaques. The average live birth rate of the monkeys that were accurately determined to have given birth and were assisted by veterinarians reached 87.1%, which was significantly higher than that of the monkeys that had unassisted spontaneous deliveries, which was 63.5%, and there was a significant difference between these two rates (P<0.05). ConclusionThe combination of accurate birth determination and veterinary assisted delivery can significantly increase the live birth rate of experimental cynomolgus macaques.

Objective To investigate the value of bacterial artificial chromosome-on-beads(BoBs) technology in the genetic analysis of early missed abortion chorionic villi. Methods Early missed abortion chorionic villi were detected with both conventional karyotyping method and BoBs technology in Peking Union Medical Hospital from July 2014 to March 2015. Compared the results of BoBs with conventional karyotyping analysis to evaluate the sensitivity, specificity and accuracy of this new method. Results (1) A total of 161 samples were tested successfully in the technology of BoBs, 131 samples were tested successfully in the method of conventional karyotyping.(2)All of the cases obtained from BoBs results in(2.7 ± 0.6) days and obtained from conventional karyotyping results in (22.5 ± 1.9) days. There was significant statistical difference between the two groups(t=123.315, P<0.01).(3)Out of 161 cases tested in BoBs, 85(52.8%, 85/161)cases had the abnormal chromosomes, including 79 cases chromosome number abnormality, 4 cases were chromosome segment deletion, 2 cases mosaic. Out of 131 cases tested successfully in conventional karyotyping, 79(60.3%, 79/131)cases had the abnormal chromosomes including 62 cases chromosome number abnormality, 17 cases other chromosome number abnormality, and the rate of chromosome abnormality between two methods was no significant differences(P=0.198).(4)Conventional karyotyping results were served as the gold standard, the accuracy of BoBs for abnormal chromosomes was 82.4%(108/131), analysed the normal chromosomes (52 cases) and chromosome number abnormality (62 cases)tested in conventional karyotyping, the accuracy of BoBs for chromosome number abnormality was 94.7%(108/114). Conclusion BoBs is a rapid reliable and easily operated method to test early missed abortion chorionic villi chromosomal abnormalities.

Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.

Objective To explore the clinical characters, diagnosis and treatment methods of placenta accreta. Methods A retrospective analysis was made of 47 cases of placenta accreta admitted during May 1997 to May 2007 into Peking Union Medical College Hospital. They included 17 cases in the second trimester and 30 cases in the third. Results Among all the patients, the incidence of placenta accreta was 0. 262% ( 47/17 918 ). Most of these cases ( 81%, 38/47 ) experienced a uterine procedure.30% (14/47) of the cases were found with placenta previa and 11% ( 5/47 ) with myoma in the current pregnancy. 11% (5/47) of all the cases suffered postpartum hemorrhage. In the 17 cases in the second trimester, 12 were diagnosed by uhrasonography and 5 by clinical evidence . While in the 30 cases in the third trimester, 8 were diagnosed by biopsy, 2 by uhrasonography, and 20 by clinical evidence. 45 cases were cured by conservative treatment, which included dilatation and curettage, uterine artery embolization (UAE) with or without methotrexate (MTX), tamping B-lynch suture, singly with MTX, and mifepristone. Only 2 cases received cesarean hysterectomy. Conclusions The incidence of placenta accreta seems on the rise. The incidence in the second trimester is higher than that in the third. In the second trimester, most cases can be diagnosed by uhrasonography after labor, and presently UAE is the best conservative management. While in the third trimester clinical evidence is the most frequent diagnostic approach. A majority of the cases could be cured by conservative therapies, which help them avoid a hysterectomy.

Objective To evaluate the effect of traditional Chinese herbal medicine on the prevention of hemolytic disease caused by maternal-fetal blood group incompatibility.Methods A total of 126 Chinese patients with maternal-fetal blood group incompatibility were studied, including 105 cases of ABO type and 21 cases of Rh type incompatibility. The traditional Chinese herbal medicine was used for preventative treatment in 79 cases, and 47 cases served as controls. The prescription consisted of Herba leonuri 500 g, white peony root 180 g, Banksia rose 12 g, root of Chinese angelica 150 g and Rhizomal ligustica 150 g.Results Preventative treatment with traditional Chinese herbal medicine significantly reduced the perinatal mortality rate in cases of Rh type incompatibility, from 50.0% in the control group to 7.7% in the treatment group (P<0.05). There was no death in the cases of ABO incompatibility. The traditional Chinese herbal medicine also decreased the degree of hemolysis. The percentage of severe cases in the control group was 29.8%, while it was 15.2% in the treatment group (P=0.05). The duration of treatment was closely related to the outcomes. In patients who used traditional Chinese herbal medicine for more than 10 weeks, the incidence of severe hemolysis was 8.2%, compared with 38.9% in those treated for less than 10 weeks (P<0.05). The change of serum immune antibody (A and /or B) titers during the treatment was a very important predictive factor for the outcome of the pregnancy.Conclusion Traditional Chinese herbal medicine is effective not only for ABO type but also for Rh type maternal-fetal blood group incompatibility, with no side effects.