唑来膦酸注射液联合治疗老年女性骨质疏松症的疗效观察

目的观察老年女性骨质疏松患者应用唑来膦酸（Zoledronic Acid,ZOL）注射液联合钙剂和活性VitD治疗的临床疗效。方法采用双能X线骨密度仪诊断的老年女性骨质疏松症患者60例,随机分成ZOL组和对照组,各30例。ZOL组给予唑来膦酸注射液5 mg/100 mL静滴1次,同时口服钙尔奇D 600 mg/d和骨化三醇0.25μg,bid。对照组给予口服钙尔奇D 600 mg/d和骨化三醇0.25μg,bid。两组受试者均连续服药9个月。观察骨痛缓解率及腰椎、髋部骨密度（BMD）变化。结果①与对照组比较,治疗后ZOL组骨痛症状明显缓解,两组总有效率比较差异有统计学意义（P〈0.05）;②ZOL组与对照组比较、与自身前后比较L1～4全部、股骨颈和大粗隆BMD增加差异均有统计学意义（P〈0.01或P〈0.05）;③治疗期间ZOL组无新发骨折,对照组新发2例髋部骨折。结论 ZOL注射液对老年女性骨质疏松症患者具有缓解骨痛、增加骨密度、提高生活质量、减少骨折发生的作用,是一种有效、安全的抗骨质疏松药物。     

阿仑膦酸盐、唑来膦酸治疗原发性骨质疏松症的临床对比研究

目的:探讨阿仑膦酸盐、唑来膦酸治疗原发性骨质疏松症的临床效果。方法:选取2018年1-12月在本院接受治疗的原发性骨质疏松症患者100例,采用随机数字表法将患者分为阿仑膦酸盐组和唑来膦酸组,每组50例。阿仑膦酸盐组予以口服阿仑膦酸钠片治疗,唑来膦酸组予以静脉滴注唑来膦酸注射液治疗。比较两组患者治疗前后腰椎和股骨颈骨密度(BMD)、疼痛程度以及生化指标,并比较两组患者治疗期间的不良反应和新发骨折发生情况。结果:治疗6个月后,唑来膦酸组患者腰椎BMD、股骨颈BMD均高于阿仑膦酸盐组,差异均有统计学意义(P0.05),且唑来膦酸组患者VAS评分低于阿仑膦酸盐组,差异有统计学意义(P0.05)。治疗12个月后,唑来膦酸组患者腰椎BMD、股骨颈BMD均高于阿仑膦酸盐组,差异均有统计学意义(P0.05)。治疗6个月后,唑来膦酸组的碱性磷酸酶(ALP)为(59.14±4.53)U/L,低于阿仑膦酸盐组的(64.61±4.82)U/L,差异有统计学意义(P0.05)。阿仑膦酸盐组患者新发骨折发生率为18.0%,高于唑来膦酸组的4.0%,差异有统计学意义(P0.05)。结论:唑来膦酸治疗原发性骨质疏松症效果较阿仑膦酸盐显著,可有效提高患者骨密度,减轻患者疼痛程度。     

碳酸钙D_3片联合骨疏康胶囊治疗骨质疏松症的效果分析

目的探讨碳酸钙D_3片联合骨疏康胶囊治疗骨质疏松症的临床效果。方法选取南阳市骨科医院2013年5月至2015年8月诊治的80例骨质疏松患者,随机分为观察组与对照组,每组40例。对照组采用钙剂治疗,观察组在对照组基础上联合使用骨疏康胶囊治疗,比较两组治疗前后骨代谢指标、骨密度(BMD)、骨钙素(BGP)变化情况。结果治疗前,两组S-Ca、股骨颈BMD、BGP比较,差异均无统计学意义(P>0.05);治疗6个月后,两组S-Ca、股骨颈BMD、BGP均显著高于治疗前(P<0.05),但观察组S-Ca、股骨颈BMD、BGP显著高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论骨疏康胶囊联合钙剂治疗骨质疏松可提高治疗效果,明显改善患者骨代谢指标,且不良反应发生率低,值得临床应用。     

唑来膦酸联合透明质酸钠治疗绝经后骨质疏松合并膝骨关节炎的临床效果分析

目的 探究唑来膦酸联合透明质酸钠治疗绝经后骨质疏松(PMOP)合并膝骨关节炎(OA)的临床效果。 方法 收集2009年5月—2014年4月在金华市中心医院治疗并自愿参加本研究的105例PMOP合并膝OA的临床资料,随机分为唑来膦酸组和对照组,2组患者均采用膝关节腔内注射透明质酸钠,对照组在此基础上采用鲑鱼降钙素、钙剂、阿仑膦酸钠及骨化三醇等传统抗骨质疏松治疗,唑来膦酸组在对照组基础上采用唑来膦酸注射液5 mg配合0.9%生理盐水或5%葡萄糖溶液稀释后静脉滴注,每年1次。记录2组患者治疗前和治疗后3、6、12个月WOMAC评分、Lysholm膝关节评分、疼痛VAS评分、BMD以及血清β-CTX、BGP、B-ALP水平。 结果 唑来膦酸组患者治疗后WOMAC评分、Lysholm膝关节评分、疼痛VAS评分及BMD明显优于对照组(P＜0.05),2组患者治疗后WOMAC评分、Lysholm膝关节评分、疼痛VAS评分及BMD均较治疗前有很大改善(P＜0.05),治疗后12个月唑来膦酸组血清β-CTX、B-ALP、BGP水平低于治疗前(P＜0.05),对照组患者治疗12个月后血清β-CTX、BGP、B-ALP与治疗前差异无统计学意义(P＞0.05),唑来膦酸组与对照组血清β-CTX、B-ALP、BGP水平差异有统计学意义(P＜0.05)。 结论 唑来膦酸联合透明质酸钠治疗PMOP合并膝OA能明显改善患者骨代谢状态,抑制骨吸收,提高患者骨密度及膝关节功能,减轻膝关节疼痛,提高患者生活质量,值得临床推广。      

唑来膦酸注射液对动力髋螺钉螺旋刀片治疗后老年骨质疏松性移位型股骨颈骨折患者的疗效

目的 探讨唑来膦酸注射液对动力髋螺钉(DHS)螺旋刀片治疗后的老年骨质疏松性移位型股骨颈骨折患者的临床疗效. 方法 回顾性分析遂宁市中心医院骨科2015年1~12月采用唑来膦酸注射液治疗行DHS螺旋刀片治疗后的老年骨质疏松性移位型股骨颈骨折的60例患者的临床资料,根据术后抗骨质疏松方式的不同将患者分为治疗组和对照组,治疗组30例患者给予唑来膦酸注射液联合基础钙剂治疗,而对照组30例患者仅给予基础钙剂治疗.通过随访观察两组患者术后1年的Harris评分、疼痛缓解情况、OQOLS评分、骨密度、骨形成及骨代谢标志物、骨折愈合时间及新发骨折情况.分析唑来膦酸注射液的疗效.结果 两组患者的Harris评分(89.36±6.91 vs 88.66±6.43)及优良率(86.67% vs 80.00%)差异无统计学意义(P>0.05).治疗组的疼痛缓解情况、生活质量评分、骨密度增加、骨形成标志物上升、骨代谢标志物下降、骨折愈合时间均优于对照组,差异有统计学意义(P<0.05).结论 唑来膦酸注射液可以缓解DHS螺旋刀片治疗后的老年骨质疏松性移位型股骨颈骨折患者的疼痛,提高患者的生活质量,改善患者骨质疏松状况,减少新发骨折,促进骨折愈合.     

唑来膦酸注射液治疗糖尿病性骨质疏松疗效以及安全性Meta分析

目的:评价唑来膦酸注射液治疗糖尿病性骨质疏松(Diabetic Osteoporosis,DO)的临床疗效及安全性。方法:依据Meta分析要求,对CBM、CNKI、PubMed、Springer、Embase Databases、Cochrane Library、中国科技论文统计与分析网、专利数据库等进行检索,纳入以唑来膦酸注射液作为主要干预措施治疗原发性骨质疏松症临床试验的研究文献,检索年限从建库至2018年8月,检索资料由两名研究人员独立进行提取,若有分歧,则由第三方协助并解决;采用Review Manager 5.3对有效性、骨密度进行系统评价。结果:最终纳入12篇文献,受试者共1034例。Meta分析结果显示,治疗组各项血液指标[包括血钙、血磷、血清I型胶原C末端肽(s-CTX)、抗酒石酸酸性磷酸酶(TRACP-5b)、血清骨钙素蛋白(BGP)]显著优于对照组,差异具有统计学意义。治疗组不同部位的视觉模拟评分(VAS)、骨密度值(腰椎、股骨颈、股骨大转子、华氏三角区)的改善情况显著优于对照组,差异有统计学意义。6篇文献发现明确的唑来膦酸注射液引起的药品不良反应,且对症治疗后症状均可消失。结论:唑来膦酸注射液对治疗DO有一定疗效,且具有一定安全性,但还需更多高质量的RCT进行分析才能对其疗效及安全性得出肯定性结论。     

唑来膦酸联合仙灵骨葆胶囊治疗骨质疏松临床观察

目的 评估唑来膦酸联合仙灵骨葆胶囊治疗骨质疏松的疗效。方法 选取骨质疏松患者98例,按照随机数字表法分为观察组和对照组,各49例。对照组单独使用唑来膦酸治疗,观察组采用唑来膦酸联合仙灵骨葆胶囊治疗。治疗6个月。比较2组患者的治疗效果、骨代谢、骨密度指标、骨转换标志物及不良反应情况。结果 观察组治疗有效率为89.90%,高于对照组的75.51%,差异有统计学意义(P<0.05);治疗后,观察组骨代谢及骨密度指标骨钙素(OC)、L_1-4骨密度、左骨颈密度增加明显,而血清I型胶原交联C端肽(CTX)低于对照组,差异有统计学意义(P<0.05);治疗后,与对照组比较,观察组患者的血清碱性磷酸酶(ALP)及尿Ⅰ型胶原氨基末端肽(NTX)水平降低,差异均有统计学意义(P<0.05);观察组不良反应发生率为4.08%,对照组为2.04%,差异无统计学意义(P>0.05)。结论 唑来膦酸联合仙灵骨葆胶囊治疗骨质疏松效果较好。     

饮食干预对阿仑膦酸钠治疗2型糖尿病合并骨质疏松患者骨钙素及骨密度的影响

目的探讨饮食干预对阿仑膦酸钠治疗2型糖尿病合并骨质疏松患者骨钙素(BGP)和骨密度(BMD)的影响。方法选取2型糖尿病骨质疏松症患者80例,随机分为干预组和对照组。两组均予降血糖或胰岛素注射液以维持血糖浓度,治疗前检测血钙浓度,对于低钙血症患者予以钙剂治疗及阿仑膦酸钠70 mg口服,1片/次,每周1次,空腹用温开水送服。对照组患者予常规饮食,干预组患者予系统饮食干预。观察并比较两组患者治疗前及治疗3个月后的BGP和BMD水平的变化及疼痛评分(VAS)的变化。结果两组患者治疗前BGP和BMD比较差异无统计学意义(P>0.05)。治疗3个月后,两组患者BGP和BMD水平较治疗前明显升高,且观察组较对照组改变更明显(P<0.05);同时两组患者的VAS评分较治疗前明显降低,且观察组较对照组改善更明显(P<0.05)。结论2型糖尿病合并骨质疏松患者在应用阿仑膦酸钠的同时配合合理的饮食干预,有利于提高骨密度及骨钙素水平,减轻患者的疼痛症状。     

辛伐他汀治疗女性糖尿病伴高脂血症及骨质疏松症42临床观察

目的 探讨辛伐他汀在治疗女性糖尿病伴高脂血症及骨质疏松症中的临床应用价值.方法 按随机数字表法将84例患者随机分为研究组和对照组各42例,其中研究组患者在常规治疗的基础上给予辛伐他汀治疗,对照组患者在常规治疗的基础上给予非诺贝特治疗,比较2组患者治疗前后的血清骨钙素(BGP)、钙(Ca)、磷(P)、碱性磷酸酶(ALP)水平及骨密度(BMD).结果 2组患者在治疗前血清Ca、P、ALP、BGP及L2-4BMD、股骨颈BMD比较均无统计学差异(P均＞0.05);治疗后,对照组上述各指标与治疗前比较均无统计学差异(P均＞0.05),研究组患者ALP、BGP、L2～4BMD及股骨颈BMD等指标与治疗前比较差异均有统计学意义(P均＜0.05),且与对照组治疗后相应指标比较差异亦有统计学意义(P均＜0.05).结论 辛伐他汀治疗女性糖尿病伴高脂血症及骨质疏松症,既可有效降脂;又能促进骨细胞增殖,抗骨吸收,促进成骨细胞产生BGP,从而预防和治疗骨质疏松,具有重要的临床应用价值.     

密固达治疗老年骨质疏松的临床疗效分析

目的观察观察密固达(唑来膦酸)治疗老年性骨质疏松的临床疗效和安全性。方法选取46例老年骨质疏松症患者,随机分为两组,治疗组22例给予唑来膦酸5mg静脉滴注1次,同时每日口服钙尔奇D,而对照组24例仅每日给予口服钙尔奇D,1年后观察两组骨密度与骨代谢指标的变化。结果治疗组及对照组经治疗1年后,治疗组腰椎和股骨颈BMD均明显明显增加(P0.05),治疗组和对照组治疗前后血清BGP水平无明显改变,但治疗组TRACP-5b水平显著下降(P0.05)。结论静脉注射唑来膦酸可用于老年性骨质疏松的治疗,能有效地降低骨吸收,提高骨密度。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.