短期胰岛素泵强化治疗对初诊2型糖尿病患者胰岛功能的影响及其氧化应激机制

目的 探讨短期胰岛素泵治疗对初诊2型糖尿病患者胰岛β细胞功能的影响及其氧化应激机制。方法 应用胰岛素泵治疗初诊2型糖尿病患者2周,分析比较治疗前后空腹血糖、餐后2h血糖、胰岛素分泌指数（Homaβ）、胰岛素抵抗指数（HomaIR）、血MDA和SOD的变化。结果短期胰岛素泵治疗后,空腹血糖、餐后2h血糖均较治疗前明显下降（P〈0．01）;Homaβ较治疗前明显升高（P〈0．01）,而HomaIR较治疗前显著下降（P〈0．05）;血MDA水平较治疗前显著下降（P〈0．01）,而血SOD水平较治疗前明显升高（P〈0．01）。结论短期胰岛素泵强化治疗可显著改善初诊2型糖尿病患者胰岛β细胞功能,可能是由于降低氧化应激对胰岛β细胞功能的损害。     

两种胰岛素强化治疗对初诊2型糖尿病患者胰岛β细胞功能的影响分析

目的 观察胰岛素泵连续皮下输注和多次皮下注射治疗方法对初诊2型糖尿病患者胰岛β细胞功能的影响.方法 新诊断的2型糖尿病患者（T2DM）46例,将患者随机分为胰岛素泵组和多次胰岛素注射组,分别予以2周的降血糖治疗,检测治疗前后患者的空腹和餐后2h血糖、胰岛素水平以及静脉葡萄糖耐量试验（IVGTT）、得出AIR、Homaβ和Homa IR值,评价两种治疗方法对T2DM患者胰岛β细胞功能的影响.结果 胰岛素泵组治疗后多数患者都恢复了不同程度的第一时相分泌,治疗后AIR 、Homaβ较治疗前显著性升高（P〈 0.01）,Homa IR无显著性差异（P〉0.0 5）.多次胰岛素注射组治疗前后,AIR 、Homaβ和Homa IR均无统计学差异（P〉0.05）.两组患者治疗后胰岛素泵组患者AIR、Homaβ较多次胰岛素注射组显著性升高（P〈0.01）,两组患者的Homa IR治疗后差异无统计学意义（P〉0.05）.结论 对于初诊2型糖尿病患者,短期胰岛素泵强化治疗和多次皮下注射胰岛素治疗均能很好控制患者血糖水平,但是胰岛素泵治疗可以显著改善T2DM患者的胰岛β细胞功能.     

胰岛素泵强化治疗对初诊2型糖尿病糖代谢及胰岛β细胞功能的影响

目的 观察短期胰岛素泵强化治疗对初诊2型糖尿病患者的胰岛β细胞功能及糖脂代谢的影响。方法 新诊断的2型糖尿病患者31例，给予为期2周的胰岛素泵强化治疗，比较治疗前后空腹血糖（fasting plasma glucose，FPG）、餐后2h血糖（2hours postprandial glucose，2hPG）、糖化血红蛋白（glycosylated hemoglobin A1c HbA1c）、血清总胆固醇（total cholesterol，Tch）、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol，LDL-c）、甘油三酯（triglyceride，TG）、胰岛素分泌指数（I30／G30）、胰岛素曲线下面积（area under the curve，AUC）、胰岛素抵抗指数（Homa IR）及胰岛素分泌指数（Homa B）的变化。结果 经2周胰岛素泵强化治疗，患者空腹及餐后2h血糖、糖化血红蛋白、血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯均较治疗前明显降低，高密度脂蛋白胆固醇有明显升高，I30／G30、胰岛素曲线下面积及HomaB明显升高，HomaIR明显下降。结论 初诊2型糖尿病短期应用胰岛素泵冶疗可显著改善胰岛β细胞功能，迅速纠正血糖、血脂异常。     

短期应用胰岛素泵输注人胰岛素类似物对初诊2型糖尿病患者胰岛β细胞功能影响的观察

目的观察短期应用胰岛素泵输注人胰岛素类似物对伴明显高血糖的初诊2型糖尿病患者的降糖效果和胰岛β细胞功能的影响。方法采用自身前、后对照,对19例空腹血糖>11.1mmol/L的初诊2型糖尿病患者进行2周的CSⅡ强化治疗,分析比较治疗前、后FBG、2hBG、HbA1c、胰岛β细胞功能Homaβ及胰岛素抵抗指数Homa IR的变化。结果治疗2周后,19例患者的空腹和餐后2h血糖分别于治疗后(4.3±2.6)d、(3.9±2.3)d达到良好控制;FBG和2hBG水平均较治疗前显著下降(P<0.001);HbA1c、Homa IR较治疗前下降(P<0.05),Homaβ较治疗前显著增高(P<0.005)。结论对伴明显高血糖的初诊2型糖尿病患者,短期应用胰岛素泵持续皮下输注人胰岛素类似物具有快速控制血糖、减轻胰岛素抵抗,从而明显改善胰岛细胞功能的作用。     

2型糖尿病40例胰岛素泵强化治疗观察

目的:观察短期胰岛素泵强化治疗对初诊2型糖尿病患者的胰岛β细胞功能影响。方法:初诊2型糖尿病患者40例,给予为期15d的胰岛素泵强化治疗,比较治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血清总胆固醇(Tch)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、胰岛素分泌指数(I30/G30)、胰岛素曲线下面积(AUC)、胰岛素抵抗指数(HomaIR)及胰岛素分泌指数(Homaβ)的变化。结果:经15d胰岛素泵强化治疗,患者空腹及餐后2h血糖、糖化血红蛋白、血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯均较治疗前明显降低,高密度脂蛋白胆固醇有明显升高,I30/G30、胰岛素曲线下面积及Homaβ明显升高,HomaIR明显下降。结论:初诊2型糖尿病短期应用胰岛素泵治疗可显著改善胰岛β细胞功能,有效改善糖脂代谢异常。     

撤泵后不同治疗对初诊2型糖尿病β细胞功能及缓解期的影响

目的 探讨撤除胰岛素泵后采用不同治疗方式对新诊断2型糖尿病(T2DM)患者的β细胞功能的影响及由此获得缓解期的长短.方法 选择空腹血糖(阳G)≥10.0 mmol/L,餐后2 h血糖(2hPG)≥15.0mmol/L,糖化血红蛋白(HbAlc)≥8.0%的新诊断T2DM患者200例,经胰岛素泵(CSII)强化治疗血糖达标后,分为预混胰岛素、甘精胰岛素+口服药物及口服药物3组,观察各组稳态模型评估胰岛素抵抗指数及胰岛β细胞功能指数的变化.随访3年,观察各组停药血糖达标持续时间(缓解期)及β细胞功能变化.结果 200例患者CSII治疗(6.42±3.15)d后血糖达到良好控制,未见严重低血糖反应.血糖达标时胰岛素剂量(32.03±8.67)u/d.各组胰岛素抵抗指数(Homa,IR)较治疗前下降(P＜0.01),胰岛β细胞功能指数(Homa β)较治疗前升高(P＜0.01).撤除CSII后不同治疗方式对Homa β的影响差异无显著性(P＞0.05),对由此诱导的缓解期差异无显著性(P＞0.05).结论 短期胰岛素强化治疗可使伴有高血糖的新诊断2型糖尿病血糖迅速达标,并可改善胰岛β细胞功能.新诊断2型糖尿病患者在解除"高糖毒性"血糖迅速达标后,部分患者获得的缓解期长短与选择不同的治疗方式无相关性.     

持续皮下胰岛素输注对2型糖尿病患者糖脂代谢的作用

目的观察持续皮下胰岛素输注(CSⅡ)对2型糖尿病并脂质代谢紊乱患者的作用。方法对28例2型糖尿病并脂质代谢紊乱患者使用胰岛素泵治疗,比较治疗前后血糖、血脂、C肽及各项生化指标的变化。结果治疗后血糖、血清总胆固醇、低密度脂蛋白胆固醇、三酰甘油均较治疗前明显降低,高密度脂蛋白胆固醇明显升高,胰岛β细胞功能在治疗后获得显著改善。结论对伴明显高血糖的2型糖尿病患者,短期胰岛素泵强化治疗具有快速稳定控制血糖、改善脂质代谢和显著改善胰岛β细胞功能的作用。     

初诊2型糖尿病胰岛素强化治疗后的胰岛功能变化分析

目的：探讨短期胰岛素泵强化治疗（CSII）和胰岛素多点皮下注射（MDI）强化治疗初诊2型糖尿病患者胰岛β细胞功能改变.方法： 38例空腹血糖≥7.0 mmol/L的初诊2型糖尿病患者随机分为CSII组和MDI组,CSII组共24人,MDI组共14人,进行一个月强化治疗,以末梢空腹血糖〈6.1 mmol/L和餐后2 h血糖〈7.8 mmol/L为血糖控制目标.根据血糖调整胰岛素用量,比较两组治疗前后的口服葡萄糖耐量试验胰岛素和C肽曲线下面积、Homa胰岛功能（Homa β）和抵抗指数（Homa RI）.结果： 治疗前后,两组间的胰岛素和C肽曲线下面积、HOMA胰岛功能和抵抗指数无明显的统计学意义.除Homa RI外,同组内其他上述指标在治疗前后有明显的统计学差别.结论： 胰岛素泵强化治疗和胰岛素多点注射强化治疗都可以使初诊2型糖尿病患者的胰岛细胞功能得到同样程度的改善.     

胰岛素泵强化治疗新诊断2型糖尿病对患者胰岛β细胞功能和血糖水平的影响

目的探讨短期应用胰岛素泵强化治疗对新诊断2型糖尿病患者胰岛β细胞功能以及血糖控制水平的影响。方法选取我院内科2010年7月至2013年7月就诊的80例新诊断2型糖尿病病患者,采用计算机随机分组的方式将患者分为观察组与对照组,每组40例,对照组采用胰岛素笔多次皮下注射胰岛素治疗（于患者三餐前皮下注射诺和灵R加睡前注射诺和灵N）,观察组则采用丹纳胰岛素泵连续皮下输注。观察并比较两组患者治疗前后的血浆胰岛素的峰值（AIR）、β细胞功能（Homaβ）、胰岛抵抗（Homa IR）、空腹血糖（GLU）和餐后2 h血糖水平（2 h PG）。结果治疗后,观察组患者AIR、Homaβ明显升高,分别为（22 859.62±12 186.79）μU/L和（57.13±5.79）μU/L,与治疗前比较差异均有统计学意义（P〈0.05）。治疗前,对照组患者GLU和2 h PG分别为（12.62±4.79）mmol/L和（20.47±4.63）mmol/L,治疗后则分别降为（5.74±0.58）mmol/L和（9.27±1.83）mmol/L,而观察组治疗前的GLU和2h PG分别为（12.57±4.87）mmol/L和（20.39±4.34）mmol/L,治疗后则分别降为（5.82±0.65）mmol/L和（9.23±1.79）mmol/L,对照组和观察组患者GLU和2 h PG均优于治疗前,差异均有统计学意义（P〈0.05）。结论胰岛素泵连续皮下输注能够明显改善新诊断2型糖尿病患者胰岛β细胞功能,并且很好地控制患者血糖控制水平。     

胰岛素泵治疗对初诊 2型糖尿病患者糖脂代谢的影响

[目的] 观察胰岛素泵治疗对初诊 2型糖尿病患者糖脂代谢的改善作用.[方法]对空腹血糖 >11.1 mmol/L的 85例初诊 2型糖尿病患者进行为期 2周的胰岛素泵强化治疗,分析比较其治疗前后血糖、糖化血红蛋白、血清胆固醇、甘油三酯及游离脂肪酸(FFA)水平.分析评价治疗前后胰岛β细胞功能和胰岛素抵抗改善情况,前者以静脉葡萄糖耐量试验(IVGTT)时胰岛素分泌第一时相、 Homa β和胰岛素原 /胰岛素比值反映,后者用 Homa IR表示. FFA用酶法,血浆胰岛素、胰岛素原浓度用 RIA法测定.[结果] 82/85患者胰岛素泵治疗次日即可见到明显的血糖下降,空腹、餐后 2 h血糖分别于治疗后 3.45 d、 6.15 d达到良好控制,且未见明显低血糖.治疗后血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯均较治疗前明显降低,高密度脂蛋白胆固醇有明显升高,FFA则由治疗前(0.67± 0.24) mmol/L下降至(0.60± 0.19) mmol/L,差异具显著性.胰岛β细胞功能在治疗后获得显著改善:胰岛素分泌第一时相明显增加,胰岛素曲线下面积(AUC)比治疗前有明显提高,由治疗前的每分钟 (892± 386) pmol/L增加至 (1318± 518) pmol/L(P=0.000). Homa β值明显提高,而胰岛素原、胰岛素原 /胰岛素比值则明显下降(由 30%± 16%下降至 17%± 9%,P=0.000).胰岛素抵抗指标 Homa IR也较治疗前明显降低.[结论] 对伴明显高血糖的初诊 2型糖尿病患者,短期胰岛素泵强化治疗具有快速稳定控制血糖、改善脂质代谢和显著改善胰岛β细胞功能、减轻胰岛素抵抗的作用.     

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.