原发性高血压患者自我护理与预后关系

目的 评估原发性高血压患者自我护理能力与预后的关系.方法 将158例原发性高血压患者随机分成干预组(78例)与对照组(80例),对照组采用一般性健康教育方式,干预组进行2年持续性个体化自我护理教育.将2组患者干预前后自我护理能力与预后指标进行统计学分析.结果 2年后干预组患者自我护理能力与对照组相比有显著性差异(x2=13.961,P＜0.01);血压[收缩压(138.32±11.03)mm Hg,舒张压(85.94±8.24)mm Hg]、血糖[(5.41±0.91)mmol/L]、血脂[总胆固醇(5.04±1.14)mmol/L]等与对照组相应指标[分别为(147.73±11.19)mm Hg、(91.74±7.65)mm Hg、(6.86±1.78)mmol/L、(5.31±0.74)mmol/L]相比差异具有显著性(P＜0.01或P＜0.05);心绞痛和暂时性脑缺血发作发生率与对照组相比差异有显著性(P＜0.01或P＜0.05),其他各项比较差异无显著性(P＞0.05).结论 护理干预可提高患者自我护理能力,有效改善原发性高血压患者预后.     

呼吸训练器对胸外科术后患者肺功能恢复的影响

目的 观察呼吸训练器训练对胸外科术后患者用力肺活量等肺功能指标的改善程度和生存质量的影响。 方法 选择2016年7月—2018年9月在杭州市第一人民医院胸外科就诊的84例接受开胸手术治疗的患者,并按照随机数字表法随机分为干预组和对照组,每组42例。对照组患者接受常规护理,干预组患者基于常规护理基础上接受呼吸训练器进行的呼吸训练干预,干预时间为2周。 结果 开胸术后肺功能指标1秒用力呼气容积(FEV1)干预组[(2.23±0.26)L]与对照组[(2.03±0.33)L]比较差异有统计学意义(P=0.003);用力肺活量(FVC)干预组[(3.25±0.37)L]与对照组[(3.01±0.39)L]比较差异有统计学意义(P=0.005);运动耐量指标血二氧化碳分压(PaCO₂)干预组[(65.34±3.75)mm Hg(1 mm Hg=0.133 kPa)]与对照组[(63.77±3.24)mm Hg]比较差异有统计学意义(P=0.043);血氧分压(PaO₂)干预组[(46.95±4.26)mm Hg]与对照组[(48.92±3.69) mm Hg]比较差异有统计学意义(P=0.026),生存质量干预组[(66.27±4.36)分]与对照组[(63.18±5.31)分]比较差异有统计学意义(P=0.005),但1秒用力呼气容积与用力肺活量的比值(FEV1/FCV)方面2组患者比较差异无统计学意义。 结论 胸外科术后应用呼吸训练器能有效改善患者的肺功能,改善其生存质量。      

基于“互联网+”院外管理对台州地区高血压脑病患者血压变异性的影响

目的 探究基于“互联网+”院外管理对急诊高血压脑病患者的干预效果，为改善高血压脑病的院外管理提供有效方法。 方法 选择2017年1月—2018年8月于台州市中心医院住院治疗并在远程医疗中心注册的急诊高血压脑病患者116例作为研究对象，按照随机数字表法分为观察组和对照组，各58例。对照组采用院内常规护理结合院外定期随访，观察组在对照组基础上应用基于“慢健康”互联网平台的院外管理，比较2组护理干预12个月后24小时平均收缩压(SBP)、舒张压(DBP)、血压变异性(BPV)，利用护理工作者自行设计的调查问卷评价患者治疗依从性和护理满意度。 结果 观察组无失访，对照组2例无应答，最终纳入114例，其中观察组58例，对照组56例。干预后，观察组24小时平均SBP、DBP均低于对照组(均P＜0.05)。观察组24小时SBP BPV为(10.20±2.13) mm Hg (1 mm Hg=0.133 kPa)，对照组为(16.64±4.36) mm Hg，差异有统计学意义(t=10.073，P＜0.05)；观察组24小时DBP BPV为(5.26±1.06) mm Hg，对照组为(7.44±1.35) mm Hg，差异有统计学意义(t=9.614，P＜0.05)。观察组依从优良率为81.04%，远高于对照组的44.64%(χ2=16.216，P＜0.05)。观察组护理满意度为96.55%，对照组满意度为66.08%，差异具有统计学意义(χ2=17.614，P＜0.05)。 结论 基于“慢健康”互联网平台的院外管理能够有效控制高血压脑病患者血压水平，稳定血压变异性，提高患者依从性和护理满意度。      

多种慢性病管理模式在社区老年高血压患者中的综合应用与评价

目的 分析多种慢性病管理模式在社区老年高血压患者中综合应用的效果,为改进慢性病社区防控效果提供依据。 方法 按照简单随机抽样法从社区卫生服务中心初建慢性病管理档案的老年高血压患者中抽取120例,使用随机数字表法分为干预组和对照组各60例。对照组依照《高血压患者健康管理服务规范》管理,干预组在此基础上融入自我管理、群组管理、家庭干预、同伴教育,6个月后使用《高血压患者自我管理行为测评量表》《高血压自我功效量表》《焦虑自评量表SAS》《高血压病相关知识调查表》对2组患者进行测评。 结果 干预组高血压病相关知识知晓率高于对照组,干预组自我管理行为测评总分(124.50±17.32)分、自我效能得分(63.33±7.02)分均高于对照组(113.77±20.65)分和(58.12±8.68)分,干预组的平均血压(132.63±7.14/74.40±7.46)mm Hg(1 mm Hg=0.133 kPa)低于对照组(140.48±10.69/78.53±7.58)mm Hg、干预组焦虑自评得分(54.15±8.40)分低于对照组(59.41±9.10)分,以上差异具有统计学意义(P<0.05)。干预组自我效能感与焦虑程度呈负相关(r=-0.288,P=0.026),与自我管理行为能力呈正相关(r=0.382,P=0.003)。对自我效能影响最大的因素是自我管理水平(P<0.01),其次是焦虑情绪(P<0.05)。 结论 多种慢性病管理模式综合应用于老年高血压患者的日常管理中有助于患者对疾病知识的掌握,促进其情绪改善,提高自我管理能力,通过自我效能感的提升,促进健康行为的长期改善。      

子宫肌瘤合并高血压患者围术期护理干预效果观察

目的 观察子宫肌瘤合并高血压患者围术期护理干预的效果.方法 选取2014年6月-2016年12月期间我院收治的58例子宫肌瘤合并高血压患者,随机分为观察组和对照组,对照组给予常规护理,观察组在此基础上行护理干预,对比2组护理前后血压指标变化及并发症发生情况.结果 护理后,观察组患者收缩压(SBP)、舒张压(DBP)分别为(128±4)mm Hg、(86±3)mm Hg,对照组SBP、DBP分别为(141±5)mm Hg、(92±3)mm Hg,观察组患者SBP、DBP均优于对照组,差异显著(P<0.05);观察组患者并发症发生率为3.45%,对照组并发症发生率为20.69%,差异显著(P<0.05).结论 将护理干预应用于子宫肌瘤合并高血压患者围术期效果显著,建议推广.     

畲医搓痧疗法联合护理干预在高血压性头痛患者中的应用

目的 探讨畲医搓痧疗法联合护理干预治疗高血压性头痛的临床疗效及对患者生活质量和护理满意度的影响。 方法 将丽水市中医院2017年3月—2019年3月间收治的86例高血压性头痛患者采用随机数字法分为对照组和观察组,各43例。对照组采用常规治疗,观察组在对照组基础上采用畲医搓痧疗法。2组患者均给予综合护理干预。比较2组临床疗效以及治疗前后血压、头痛发作频率、肱动脉血流介导的舒张功能。采用健康状况调查简表(SF-36)评价患者生活质量。 结果 观察组患者治疗总有效率显著高于对照组(95.35%vs.81.40%,χ2=4.074,P<0.05)。观察组治疗后头痛发作频率[(1.85±1.02)次/月vs.(2.96±1.36)次/月]、舒张压[(76.93±8.66) mm Hg vs.(84.36±7.15) mm Hg]和收缩压[(126.18±13.29) mm Hg vs.(132.45±14.45) mm Hg]显著低于对照组,肱动脉血流介导的舒张功能率[(6.48±1.25)%vs.(5.32±1.62)%]显著高于对照组(均P<0.05)。观察组治疗后SF-36量表各维度的评分显著高于对照组(均P<0.05)。 结论 畲医搓痧疗法联合护理干预治疗高血压性头痛疗效显著,能显著减少患者头痛频率,改善高血压和血管内皮功能障碍,提高生活质量。      

高血压患者胰岛素水平与血脂、血糖关系的临床研究

目的:探讨高血压患者胰岛素水平与血脂、血糖的关系.方法:对32例无糖尿病史的高血压患者及32例健康对照组进行血脂、血糖、糖化血红蛋白、胰岛素和C-肽测定并进行对比研究.结果:高血压组胰岛素及C-肽水平[(21.4±6.3)μg/L及(2.5 ±0.5)μg/L]显著高于对照组[(9.2±4.7)μg/L及(0.90±0.30)μg/L],均为P ＜ 0.001;血脂明显增高,甘油三脂分别为[(1.89±0.15)mmol/L及(1.61±0.06)mmol/ L],P＜0.01;葡萄糖耐量减低,P＜0.001.结论:高血压患者存在糖代谢及脂代谢异常,胰岛素抵抗导致的高胰岛素血症为基本的代谢异常.     

抑郁症和精神分裂症患者激惹症状的对照研究

目的探讨抑郁症与精神分裂症患者激惹症状的特点。方法使用激惹、抑郁和焦虑量表(IDA)对64例抑郁症患者,50例精神分裂症患者及67例健康人进行评定。结果与对照组比较,抑郁症组内向性激惹因子[(5．09±2．88)分]、外向性激惹因子[(4．23±2．80)分]、抑郁因子[(8．78±3．56)分]及焦虑因子[(8．45±2．96)分]分均显著升高,差异有显著性(P＜0．01)。精神分裂症组除抑郁因子分外,其余因子分与对照组差异无显著性(P＞0．05)。与抑郁症组比较,精神分裂症组的内向性激惹因子、抑郁因子及焦虑因子分均显著下降,差异有显著性(P＜0．05或P＜0．01)。结论对抑郁症患者激惹症状的防治是非常有必要的。     

延续护理对糖尿病患者血压、血糖以及血脂水平变化的影响

目的 探讨延续护理对糖尿病患者血压、血糖及血脂水平的影响.方法 选取2013年1～12月重庆三峡中心医院内分泌科收治的糖尿病患者136例,随机分为两组,其中,对照组68例,予常规护理;实验组68例,给予延续护理模式.干预6个月后检测患者血压、血糖及血脂水平.结果接受不同护理模式后,实验组[收缩压为(120.7±8.9)mm Hg,舒张压为(83.5±7.8)mmHg]血压控制明显优于对照组[收缩压为(126.8±14.3)mm Hg,舒张压为(89.3±8.8)mm Hg],差异有统计学意义(P＜0.05);实验组接受干预后空腹血糖及餐后2h血糖[(7.1±1.6),(9.1±2.6)mmol/L],明显低于对照组[(8.7±2.3),(10.7±3.3)mmol/L],差异有统计学意义(P＜0.05);治疗后实验组胆固醇、三酰甘油、低密度脂蛋白胆固醇水平[(2.5±0.2)、(1.3±0.5)、(1.8±0.2)mmol/L]较对照组[(3.6±0.2)、(1.5±0.3)、(2.1±0.2)mmol/L]下降明显,差异有统计学意义(P＜0.05);治疗后实验组高密度脂蛋白胆固醇水平[(1.7±0.3)mmol/L]较对照组[(1.4±0.3) mmol/L]升高更明显,差异有统计学意义(P＜ 0.05).结论 在糖尿病患者中应用延续护理模式能够明显改善患者血压、血糖及血脂水平,对临床具有指导意义,值得临床推广.     

辛伐他汀对高血压患者血压及左心室结构的影响

目的 观察辛伐他汀对社区原发性高血压患者血压及左心室结构的影响,提高社区原发性高血压治疗效果及改善预后.方法 将280例符合入组标准的原发性高血压患者按随机数字表分为观察组140例和对照组140例,对照组给予氨氯地平治疗,5 mg/次,1次/d,观察组在对照组基础上再口服辛伐他汀治疗,20mg/次,1次/d,2组均治疗8周,治疗前后观察血压变化情况,检查血脂水平变化情况,并采用超声心动图检查评价心肌肥厚程度,记录不良反应发生情况.结果 ①观察组和对照组总有效率分别为95.00％、83.57％,差异具有统计学意义,x2 =16.311,P＜0.01;②观察组与对照组治疗前SBP、DBP、TC、TG、IVST、LVPWT、LVDd差异没有统计学意义,具有可比性,观察组与对照组治疗后SBP、DBP、TC、TG、IVST、LVPWT、LVDd分别为（131 ＆#177;4） mm Hg vs.（139＆#177;5） mmHg,（78＆#177;6） mm Hg vs.（91 ＆#177;6） mm Hg,（4.02＆#177;0.95） mmol/L vs.（5.24＆#177;1.05） mmol/L,（1.05＆#177;0.86） mmol/L vs.（1.55＆#177;1.00） mmol/L,（9.3＆#177; 1.6） mm vs.（11.1＆#177;1.8）mm,（10.0＆#177;1.5） mm vs.（11.9＆#177;1.7） mm,（44.4＆#177;2.2） mmvs.（49.3＆#177;3.3） mm,各个指标差异具有统计学意义,均P＜0.05（1mm Hg =0.133 kPa）.结论 辛伐他汀联合氨氯地平能协同降低血压及逆转左室肥厚,降低靶器官损伤,改善预后,效果优于单纯氨氯地平治疗,值得临床推广使用.     

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.