肺表面活性物质对兔胸部撞击肺损伤中促炎性细胞因子的影响

目的 观察肺表面活性物质(PS)对兔胸部撞击肺损伤中促炎性细胞因子的影响。方法 选取新西兰大白兔113只,垂直撞击右侧胸部,复制急性肺损伤模型,随机分为对照组(n=38)、羊PS组(n=38)和牛PS组(n=37),分别以生理盐水、自制的羊PS和牛PS行支气管肺泡灌洗。采用酶联免疫吸附(ELISA)法测定肺泡灌洗液和肺组织匀浆的白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)的含量。结果 按照IL-1、IL-6、TNF-α的顺序,肺泡灌洗液中的含量依次为对照组[(155.10±20.31)、(175.10±22.34)、(89.57±80.55)pg/m L]、羊PS组[(90.62±4.15)、(80.51±4.72)、(46.79±20.61)pg/m L]、牛PS组[(81.49±3.56)、(77.94±3.05)、(52.04±15.97)pg/m L],肺组织匀浆中的含量依次为对照组[(305.70±133.65)、(324.70±23.65)、(283.21±50.49)pg/m L]、羊PS组[(182.00±27.69)、(178.00±21.96)、(150.34±4.88)pg/m L]、牛PS组[(179.20±34.37)、(173.20±24.07)、(145.52±10.95)pg/m L]。与对照组相比,羊PS组和牛PS组的含量均明显降低,差异有统计学意义(P<0.05)。结论 针对交通事故致胸部撞击肺损伤,采用胸部垂直撞击建立的兔急性肺损伤动物模型,分别以羊或牛PS行支气管肺泡灌洗,皆减少了肺泡灌洗液和肺组织匀浆中的促炎性细胞因子的含量,对促炎症细胞因子有一定的抑制作用。     

疏水性肺表面活性蛋白质预防大鼠肺出血的作用

观察人工合成磷脂加牛肺疏水性肺表面活性蛋白质(SP)模拟天然牛肺表面活性物质(PS)预防大鼠肺出血效果，结果在肺组织学变化，降低肺指数，肺泡灌洗液蛋白质量，血清脂质过氧化物均优于不加SP组，疗效可与应用天然牛PS组相比拟。     

TNF-α、IL-8与急性重症胰腺炎肺损伤中PMNs凋亡延迟的相关性研究

目的探讨肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)在急性重症胰腺炎(acute severe pancreatitis,ASP)合并急性肺损伤中中性粒细胞(polymorphonuclear leukocyte,PMNs)凋亡延迟的相关性及其机制。方法选取雄性SD大鼠48只,穿刺胆胰管并注入3.5%牛磺胆酸钠制作ASP合并急性肺损伤大鼠模型,分为牛磺胆酸钠注射后3、6、12 h及对照组。病理检测胰腺及肺组织;于预定时相取支气管灌洗液,密度梯度离心分离PMNs,流式细胞仪测定PMNs凋亡、坏死比例;ELISA检测灌洗液中TNF-α及IL-8的含量;检测NF-κB在肺组织中的表达。结果 ALI大鼠肺灌洗液中PMNs凋亡、坏死比例增加,凋亡延迟。支气管-肺泡灌洗液中的TNF-α及IL-8的含量较对照组显著增加,灌洗液中细胞TNF-α及IL-8 mRNA表达增加,不同干预时间组间具有显著差异,具有时间依赖效应;肺组织中NF-κB的表达显著增加。结论TNF-α、IL-8在ASP合并急性肺损伤中可能发挥一定的作用。     

抑制炎症反应治疗急性肺损伤的实验研究

目的通过观察急性肺损伤（ALI）大鼠血液和肺组织中IL-6、IL-10、TNF-α、NF-κΒ等炎性细胞因子的变化,探讨抑制炎症反应在治疗急性肺损伤中的作用。方法应用气管内滴入内毒素（LPS）复制大鼠急性肺损伤模型。将48只大鼠随机分成4组：对照组（N组）、LPS组、N-乙酰半胱氨酸（NAC）治疗组（NAC组）、NAC联合地塞米松（Dex）治疗组（NAC＋Dex组）,采用免疫印迹法（Western Blotting）检测NF-κΒ的含量,采用RT-PCR检测肺组织中IL-6、IL-10、TNF-α、NF-κΒmRNA的表达,并采用放免检测血清及支气管肺泡灌洗液（BALF）中的IL-6、TNF-α的含量。结果LPS组大鼠肺病理可见明显的肺损伤表现,NAC组及NAC＋Dex组肺组织病理改变明显减轻;NAC组及NAC＋Dex组肺NF-κB,肺IL-6、IL-10、TNF-α、NF-κΒmRNA表达水平及血清和BALF中的IL-6、TNF-α含量明显高于N组（P〈0.01）,而明显低于LPS组（P〈0.05）。结论NAC、Dex等可以抑制炎症反应,减少炎性介质的释放从而减轻肺损伤的程度,达到防治急性肺损伤的目的。     

己酮可可碱对重症急性胰腺炎大鼠肺损伤的保护作用

目的 观察己酮可可碱对重症急性胰腺炎(SAP)大鼠相关肺损伤的保护作用,并探讨其可能的发病机制.方法 36只雌性SD大鼠随机分为假手术组、模型组、治疗组.采用5%牛磺胆酸钠逆行胰胆管注射的方法,复制大鼠SAP相关肺损伤模型.治疗组在模型制作前30min给予己酮可可碱.12h后分别对胰腺损伤、肺损伤程度进行病理评分,测定肺系数、胰腺湿重、血清淀粉酶,用ELISA法检测血清和支气管肺泡灌洗液中TNF-α、IL-6、IL-1β含量,用半定量RT-PCR法检测肺组织中NF-κB p65 mRNA的表达.结果与模型组比较,治疗组胰腺及肺损伤程度明显减轻;其血清和支气管肺泡灌洗液中TNF-α、IL-6、IL-1β含量明显下降,肺组织中NF-κB p65 mRNA的表达亦明显减少.结论己酮可可碱对SAP相关急性肺损伤具有保护作用,其机制可能与抑制肺组织中NF-κB p65 mRNA的表达,从而抑制促炎细胞因子TNF-α、IL-6、IL-1β的产生相关.     

烫伤致兔急性肺损伤早期肺泡灌洗液中促炎性细胞因子的变化

目的:探讨烫伤致兔急性肺损伤早期肺泡灌洗液中促炎性细胞因子的变化。方法:健康新西兰大白兔36只,随机分为6组,每组6只。其中1组为对照组(A组),背部脱毛37℃水浸浴;另5组均为烫伤组(B组),均建立30%总体表面积Ⅲ度烧伤模型,分别于烫伤后2、4、8、12、24 h时间点处死动物,作为B1、B2、B3、B4、B5组。观察各组肺组织病理,进行肺损伤评分,计算肺湿干质量比(W/D),并应用双抗夹心的酶联免疫吸附法测定肺泡灌洗液中促炎性细胞因子TNF-α、IL-1β、IL-8的变化。结果:B组中所有兔子处死后经病理证实均达到30%总体表面积Ⅲ度烫伤。B1~B5组均可见到肺泡腔及间质内白细胞渗出、浸润,肺泡腔内见渗出液,肺泡隔增厚,肺泡及间质充血,部分肺泡塌陷、不张,透明膜形成,且随时程延长病变加重,肺损伤评分增加,B1~B5组与A组比较差异均有统计学意义(P<0.05～P<0.01);B3~B5组肺W/D均较A组明显升高(P<0.01);B1~B4组肺泡灌洗液中TNF-α、IL-1β、IL-8水平较A组均升高(P<0.05～P<0.01),其中TNF-α、IL-8均在12 h达到高峰(P<0.01),IL-1β在8 h达到高峰(P<0.01),而24 h时IL-8、IL-1β水平与A组比较差异均无统计学意义(P>0.05)。结论:兔烫伤后早期,肺泡灌洗液中的促炎性细胞因子TNF-α、IL-1β、IL-8水平明显升高,与急性肺损伤的发生有关。     

骨髓间充质干细胞对小鼠急性肺损伤治疗作用的研究

目的探讨输入外源性骨髓间充质干细胞(MSCs)对脂多糖(LPS)诱导的小鼠急性肺损伤(AL)I的治疗作用.方法实验随机分为3组(n=10):对照组、ALI组和MSCs治疗组.健康小鼠LPS气管滴入方法建立ALI模型,尾静脉输入全骨髓培养法分离纯化的MSCs.流式细胞分析鉴定MSCs.HE染色组织切片观察输入MSCs前后肺组织病理形态学改变,W/D比值和髓过氧化物酶(MPO)活性评价肺水肿和炎症反应程度.ELISA检测肺组织匀浆中肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的含量.结果流式细胞分析鉴定:培养MSCs表面标记CD105为阳性,CD34为阴性.肺组织病理学显示:ALI组小鼠肺组织呈现典型的炎症病理变化,包括肺泡充血、出血、水肿,肺泡腔和血管壁中性粒细胞浸润,肺泡壁增厚等肺损伤性病变;MSCs治疗组小鼠肺组织损伤程度明显减轻.肺W/D比值、肺组织MPO活性及TNF-α和IL-6含量:ALI组小鼠肺W/D比值、肺组织MPO活性及TNF-α和IL-6含量高于对照组(P<0.05);MSCs治疗组肺W/D比值、肺组织MPO活性及TNF-α和IL-6含量低于ALI组(P<0.05).结论输入MSCs能够减轻脂多糖致急性肺损伤程度,其作用可能与降低肺W/D比值和肺组织MPO活性、IL-6及TNF-a含量有关.     

红霉素对内毒素诱导急性肺损伤大鼠炎症因子的影响

目的:观察红霉素对内毒素诱导急性肺损伤(ALI)大鼠模型干预阻断作用。方法:通过鼠尾静脉注射内毒素(LPS)4 mg/kg建立大鼠ALI(acute lung injury)模型。将54只月龄和体重相近的雄性SD大鼠随机分为3组:对照组(NC组)、实验组(LPS组)、治疗组(EY组),每组18只。对照组注射生理盐水,实验组注射内毒素,治疗组注射内毒素的同时,注射红霉素粉针剂50 mg/kg。采用双抗体夹心酶标免疫(enzyme linked immunosorbent as-say,ELISA)分析法测定54只大鼠血清和肺泡灌洗液中中IL-1β、IL-6、TNF-α以及IL-8和IL-10的水平。结果:治疗组与内毒素组相比,PaO2和pH值升高,PaCO2降低,肺系数(0.62±0.07vs0.96±0.13,P<0.05)、肺含水量(85.76±0.56vs82.88±0.47,P<0.05)、肺通透性指数(7.41±0.61vs12.26±0.58,P<0.05)均有明显下降,血清和肺泡灌洗液中的IL-1β、IL-6和IL-8以及TNF-α下降,而IL-10明显升高。病理学观察治疗组肺组织病变较内毒素组为轻。结论:红霉素能够抑制内毒素诱导急性肺损伤(ALI)大鼠体内白介素1β、白介素6和白介素8以及肿瘤坏死因子α的表达,起到干预阻断急性肺损伤向恶性循环发展的作用。     

雷帕霉素对脂多糖诱导的C57BL/6小鼠急性肺损伤模型白介素-33表达及失控性炎症影响实验研究

目的:探讨雷帕霉素(rapamycin,RAPA)对脂多糖(lipopolysaccharides,LPS)诱导的小鼠急性肺损伤(acute lung injury,ALI)模型白介素-33(interleukin-33,IL-33)表达以及对失控性炎症的影响。方法:将25只雄性C57BL/6小鼠按照随机数字表法分为正常对照组(N组)、急性肺损伤组(LPS组)、雷帕霉素预处理组(RAPA组),其中正常对照组5只,LPS组和RAPA组各10只。采用气道滴注LPS方法来构建急性肺损伤模型,其中RAPA组在气道滴注LPS前半小时采用4 mg/kg的雷帕霉素预处理。于给药后6、24 h用水合氯醛麻醉小鼠,取得小鼠血液、肺泡灌洗液(bronchoalveolar lavage fluid,BALF)以及肺组织,检测小鼠血清及肺泡灌洗液当中IL-33表达量的变化,小鼠肺组织中IL-33的表达量的变化,以及小鼠血清及肺泡灌洗液当中炎性因子肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、IL-6、IL-1β和IL-10的变化。结果:相比于LPS组,经过雷帕霉素预处理之后,小...     

肺表面活性物质对大鼠高氧性肺损伤的影响

目的探讨肺表面活性物质(PS)在大鼠高氧性肺损伤中的作用。方法将大鼠随机分为3组:高氧组、高氧+PS组、空气氧组。HE染色观察肺组织形态结构;检测支气管肺泡灌洗液(BALF)中肿瘤坏死因子(TNF-α)浓度;肺组织匀浆液中丙二醛(MDA)浓度。结果PS组BALF中TNF-α浓度及肺组织匀浆液中MDA浓度均较高氧组低,两组比较具有显著性差异;高氧组肺组织有严重的毛细血管阻塞和血管周围水肿及白细胞浸润,肺泡间隔明显增厚;PS组有轻微的毛细血管阻塞和血管周围轻度水肿及少量的白细胞浸润,肺泡间隔轻度增厚。结论PS对大鼠高氧性肺损伤有减轻和保护作用,其机理可能与PS具有抗氧化损伤作用有关。     

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.