CyClinD1及MDR1在NSCLC中的表达研究

目的 :探讨非小细胞肺癌 (NSCLC)中细胞周期蛋白D1 (CyclinD1 )及多药耐药基因 (MDR1 )的表达及临床意义。方法 :用鼠抗人CyclinD1 及鼠抗人MDR1 单克隆抗体对 4 0例石蜡包埋的原发性NSCLC组织进行免疫组化染色 ,并与 10例肺良性病变比较。结果 :CyclinD1 及MDR1 在NSCLC中均有较高的表达 ,其阳性率分别为 6 7.5 %和4 7.5 % ;而在肺良性病变中 ,CyclinD1 无 1例表达 ,而MDR1 有 1例表达 ,阳性率为 10 % ;在NSCLC中 ,CyclinD1 表达与肿块大小 ,有无淋巴结转移 ,分化程度及临床分期无关 (P >0 .0 5 ) ;而MDR1 表达则在肿块≥ 3cm高于肿块 <3cm(P<0 .0 5 ) ;有淋巴结转移高于无淋巴结转移 (P <0 .0 5 ) ,低～中度分化高于中～高度分化 (P <0 .0 5 ) ;Ⅲ～Ⅳ期高于Ⅰ～Ⅱ期 (P <0 .0 5 )。结论 :CyclinD1 的过表达与肺癌的发生有关 ,是NSCLC的早期分子蛋白之一 ,而与NSCLC的发展和预后无关 ,可作为NSCLC早期诊断的指标之一。MDR1 的过表达与NSCLC的发展与预后有关 ,可作为NSCLC预后的指标之一 ,同时 ,有利于进行NSCLC耐药的监测与评价。     

CyclinD1 MDR1在非小细胞肺癌中的表达及临床意义

目的　探讨非小细胞肺癌 (NSCLC)中细胞周期蛋白D1(CyclinD1)及多药耐药基因 (MDR1)的表达及临床意义。方法　用鼠抗人CyclinD1及鼠抗人MDR1单克隆抗体对 40例石蜡包埋的原发性NSCLC组织进行免疫组化染色 ,并与 10例肺良性病变比较。结果　CyclinD1及MDR1在NSCLC中均有较高的表达 ,其阳性率分别为 67 5 %和 47 5 % ;而在肺良性病变中 ,CyclinD1无 1例表达 ,而MDR1有 1例表达 ,阳性率为 10 % ;在NSCLC中 ,CyclinD1表达与肿块大小、有无淋巴结转移、分化程度及临床分期无关 (P >0 0 5 ) ;而MDR1表达则在肿块≥ 3cm高于肿块 <3cm(P <0 0 5 ) ;有淋巴结转移高于无淋巴结转移 (P <0 0 5 )。结论　CyclinD1的过表达与肺癌的发生有关 ,是NSCLC的早期分子事件之一 ,而与NSCLC的发展和预后无关 ,可作为NSCLC早期诊断的指标之一。MDR1的过表达与NSCLC的发展与预后有关 ,可作为NSCLC预后的指标之一 ,同时 ,有利于进行NSCLC耐药的监测与评价。     

细胞周期蛋白D1,P63蛋白在非小细胞肺癌中的表达及临床意义

目的:探讨细胞周期蛋白D1(CyclinDl),P63蛋白在非小细胞肺癌(NSCLC)中的表达及临床意义.方法:应用免疫组化EnVision二步法检测71例NSCLC和15例肺良性病变组织中两种基因蛋白的表达.结果:在肺鳞癌、肺腺癌、肺良性病变中CyclinDl的阳性表达率分别为64.3%(18/28),67.5%(27/40)和13.3%(2/15);P63蛋白阳性表达率分别为78.6%(22/28),27.5%(11/40)和26.7%(4/15).有淋巴结转移组CyclinD1和P63阳性率明显高于无淋巴结转移组,P＜0.01;Ⅲ-Ⅳ期CyclinD1表达的阳性率高于Ⅰ-Ⅱ期,P＜0.01.结论:CyclinD1和P63的过表达与肺癌的发生、发展有关.     

p-mTOR在Ⅰ～Ⅲ期非小细胞肺癌组织中的表达及其与预后的关系

目的探讨磷酸化的哺乳动物雷帕霉素靶蛋白（p-mTOR）在非小细胞肺癌（NSCLC）中的表达及其对预后的预测价值。方法运用免疫组织化学EnVision法检测59例NSCLC肺癌组织和10例非肺癌组织（3例肺结核和7例炎性假瘤）中p-mTOR蛋白的表达。结果p-mTOR在肺良性疾病组均为阴性，在NSCLC组织中表达的阳性率为40．7％，显著高于肺良性疾病组（X^2=6．237，P=0．013）；p-mTOR在NSCLC组织中的表达与性别、年龄和pTNM分期有关，而与其他临床病理参数（肿瘤大小、病理类型和淋巴结转移情况）无明显相关性。Kaplan—Meire生存分析显示，p-mTOR与生存期无明显相关（Logrank检验P=0．055）。结论检测p-mTOR有助于肺部良恶性疾病的鉴别，单独p-mTOR不能作为判断NSCLC预后的参考指标。     

NSCLC组织中VEGF和Ki67的表达及其与生存时间的相关性

目的　探讨血管内皮生长因子 (VEGF)、细胞核增殖相关抗原 (Ki6 7)在非小细胞肺癌 (NSCLC)中的表达及其与患者生存时间的相关性。方法　用SP免疫组织化学方法观察VEGF、Ki6 7在 6 2例NSCLC组织中的表达。用Kaplan Meier法计算生存率。结果　 (1 )VEGF、Ki6 7在NSCLC组织中表达阳性率均明显高于癌旁正常组织 (P <0 0 1 )。 (2 )VEGF、Ki6 7在NSCLC组织的表达与临床分期及有无淋巴结转移明显相关 (P <0 0 5 ) ,有淋巴结转移组VEGF、Ki6 7阳性率明显高于无淋巴结转移组 ,Ⅲ～Ⅳ期的阳性率明显高于Ⅰ～Ⅱ期的阳性率 (P <0 0 5 )。 (3)VEGF、Ki6 7阳性患者的 3年生存率均明显低于阴性者 (P <0 0 5 )。结论　VEGF、Ki6 7在NSCLC组织的阳性表达与NSCLC的临床分期、淋巴结转移有关。VEGF、Ki6 7阳性患者的预后差     

血管内皮生长因子在非小细胞肺癌组织中的表达及其临床意义

目的探讨血管内皮生长因子（vascular endothelial growth factor，VEGF）在NSCLC中表达及其临床病理特征之间的关系。方法应用免疫组织化学技术检测100例NSCLC和60例肺良性病变组织中VEGF的表达。结果VEGF在NSCLC中的表达率高于肺良性病变组（P〈0．01），并且与患者的年龄、性别、肿瘤的大小、分化程度以及组织类型之间比较差异无显著性（P〉0.05）。而在有淋巴结转移组和Ⅲ期＋Ⅳ期组的表达分别显著高于无淋巴结转移组和Ⅰ期＋Ⅱ期组（P〈0．05）。结论VEGF表达与NSCLC的病程分期和淋巴结转移密切相关，可作为评估NSCLC病程、转移潜力和判断预后的一个重要标志物。     

Bmi-1蛋白在肺癌组织中的表达及临床意义

目的研究原癌基因鼠类淋巴瘤滤过性病毒致癌基因（Bmi-1）在人非小细胞肺癌（NSCLC）组织中的表达,探讨Bmi-1作为新的肿瘤标志物在NSCLC临床诊断、分期及预后评估中的意义。方法应用免疫组化方法检测48例肺癌组织、29例癌旁肺组织及13例肺良性病变组织中Bmi-1蛋白的表达情况,并分析与NSCLC临床病理特征之间的关系。结果Bmi-1水平的表达在NSCLC组织中明显高于肺良性病变（P〈0．05）,而在肺良性病变组织及癌旁组织之间无明显差异（P〉0．05）。Bmi-1在鳞癌和腺癌组织中的表达并无明显差异（P〉0．05）;在低分化肺癌中的表达明显高于中分化和高分化肺癌（均P〈0．05）,但中分化和高分化肺癌间无明显差异（P〉0.05）;Ⅲ、Ⅳ期肺癌标本中Bmi-1阳性表达率明显高于Ⅰ、Ⅱ期肺癌,差异有统计学意义（均P〈0．05）,但Ⅰ、Ⅱ期肺癌间无明显差异（P〉0.05）;Bmi-1在有淋巴结转移的肺癌患者中阳性表达率明显高于无淋巴结转移患者（P〈0．05）。结论Bmi-1在肺癌组织中表达增高,并与肺癌的分期、淋巴结转移相关;Bmi-1可作为评估肺癌患者病变范围和预后的标志物。     

VEGF及Ki67与NSCLC生物学行为的相关性研究

目的　探讨血管内皮生长因子 (VEGF)、细胞核增殖相关抗原 (Ki67)在非小细胞肺癌 (NSCLC)的表达及与其生物学行为的关系。方法　用SP免疫组织化学方法观察VEGF、Ki67在 62例NSCLC组织的表达。结果　VEGF、Ki67在NSCLC组织中表达阳性率均明显高于癌旁正常组织 (P <0 .0 1)。它们的表达与临床分期及有无淋巴结转移有明显相关 (P <0 0 5 ) ,有淋巴结转移组VEGF、Ki67阳性率明显高于无淋巴结转移组 ,Ⅲ～Ⅳ期NSCLC组织中明显高于Ⅰ～Ⅱ期(P <0 0 5 )。VEGF、Ki67阳性的患者 3年生存率均明显低于阴性者 (P <0 0 5 )。通过Cox回归分析发现临床分期、VEGF、Ki67及淋巴结转移可以作为独立的指标影响NSCLC患者的生存时间。结论　VEGF、Ki67与NSCLC的形成、转移有重要关系 ;VEGF、Ki67阳性的患者 3年生存率明显降低 ;通过检测VEGF、Ki67可以估计NSCLC患者的预后和指导临床治疗     

抑癌基因PTEN在非小细胞肺癌发生发展中的作用

目的　研究抑癌基因 10q丢失的与张力蛋白同源的磷酸酶基因 (PTEN)在非小细胞肺癌 (NSCLC)组织中的表达水平与NSCLC的发生和发展的关系 ,以及PTEN和抑癌基因p2 7Kip1、细胞周期蛋白D1(CyclinD1)表达的相关性。方法　以免疫组化方法分别检测 6 2例石蜡包埋的NSCLC组织中PTEN、p2 7Kip1和CyclinD1蛋白表达水平 ;用原位杂交方法检测 2 1例新鲜NSCLC组织中PTENmRNA的表达情况。结果　PTEN的表达在肺鳞癌中阳性率为4 0 0 % ( 12 / 30 ) ,肺腺癌中为 4 3 75 % ( 14 / 32 ) ;中高分化组肺癌中阳性率为 5 4 2 9% ( 19/ 35 ) ,低分化组中为2 5 93% ( 7/ 2 7) ;淋巴结转移组阳性率为 4 0 91% ( 9/ 2 2 ) ,无转移组阳性率为 5 4 84 % ( 17/ 31)。 2 1例新鲜肺癌标本原位杂交结果显示 ,鳞癌阳性率为 4 1 6 7% ( 5 / 12 ) ,腺癌阳性率为 33 33% ( 3/ 9)。同时检测了 p2 7Kip1和CyclinD1在肺癌中的表达状况。PTEN与p2 7Kip1表达呈正相关 ( χ2 =4 2 6 6 6 7,P <0 0 5 ) ,与CyclinD1的表达呈负相关 ( χ2 =4 5 5 814 ,P <0 0 5 )。结论　PTEN的失表达在NSCLC的发生、发展和转移过程中扮演着重要的角色。其失表达与NSCLC的分化程度 (P <0 0 5 )、淋巴结转移 (P <0 0 5 )有关 ,而与其组织学类型无关 (P >0 0     

ERa、cyclinD1在人甲状腺乳头状癌组织中的表达及意义

目的探讨雌激素受体a亚型(ERa)、细胞周期蛋白D1(cyclinD1)在人甲状腺乳头状癌(PTC)组织中的表达及意义。方法 PTC 48例,甲状腺良性病变69例(甲状腺滤泡性腺瘤28例,结节性甲状腺肿34例,慢性淋巴细胞性甲状腺炎6例,甲状腺嗜酸细胞瘤1例),甲状腺良性病变旁正常甲状腺组织30例,用Envision免疫组化方法检测ERa、cyclinD1的表达。结果 (1)ERa在PTC中的阳性率(25%)高于在正常甲状腺组织(6.7%)和良性甲状腺病变(10.1%)中的阳性率(P<0.05),ERa表达在PTC患者的年龄、性别、淋巴结转移情况、肿瘤有无包膜侵犯间差异无统计学意义(P>0.05)。(2)cyclinD1在正常甲状腺组织中无表达,在PTC中(79.2%)的阳性率明显高于在良性甲状腺病变中的阳性率(27.5%)(P<0.05),cyclinD1的高表达与PTC患者的淋巴结转移和肿瘤包膜侵犯有关(P<0.05)。结论 (1)ERa在PTC中的表达率高于正常甲状腺组织和甲状腺良性病变组织,PTC可能为一种雌激素依赖性肿瘤。(2)cyclinD1在正常甲状腺组织中无表达,在PTC中高表达,cyclinD1的高表达与患者淋巴结转移和肿瘤包膜侵犯有关,提示患者预后不良。(3)对ERa和cyclinD1的检测,有助于预测PTC肿瘤的复发、转移风险,抗雌激素治疗和针对cyclinD1的治疗有可能成为PTC新的治疗途径之一。     

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.