CD44v6、C-erbB-2在肺癌中的表达及预后意义

目的研究CD44v6、C-erbB-2基因在肺癌中的表达及临床意义.方法采用免疫组化S-P法,检测CD44v6、C-erbB-2基因蛋白在116例肺癌中的表达.结果在SCLC中,CD44v6、C-erbB-2均不表达.在NSCLC中,CD44v6在鳞癌中的阳性表达率为66.7%,腺癌为36.1%(P＜0.01).C-erbB-2在鳞癌中的阳性表达率为47.8%,腺癌为66.7%(P＞0.05).癌旁正常肺组织均未见CD44v6、C-erbB-2的表达.CD44v6表达与NSCLC的肿瘤T分期、淋巴结转移、临床分期及生存率有关(P＜0.05),而与病理分级无关(P＞0.05).C-erbB-2表达与NSCLC淋巴结转移、临床分期及生存率有关(P＜0.05),而与肿瘤病理分级及肿瘤T分期无关(P＞0.05).NSCLC中CD44v6与C-erbB-2表达无相关性(P＞0.05).结论CD44v6、C-erbB-2不仅可作为鉴别SCLC与NSCLC的参考指标,而且CD44v6、C-erbB-2阳性表达的患者易发生淋巴结转移、病期较晚、预后差,故二者还可作为判断NSCLC预后的较可靠的指标.     

局部晚期非小细胞肺癌同步放化疗前后血清VEGF/血小板数、OPN水平的测定及临床意义

目的探讨局部晚期NSCLC患者同步放化疗前后血清VEGF/血小板数和OPN的表达水平及变化的临床意义。方法 56例局部晚期NSCLC患者同步放化疗前采用ELISA法测定血清VEGF/血小板数和OPN的表达水平,然后行三维适形放疗,中后期重复CT定位缩野并对残存靶体积加量照射,至总DT60～64Gy,同步化疗采用顺铂25mg/m2,每周静脉滴注1次,连用5～6周。治疗结束后3周再次测定血清VEGF/血小板数和OPN的表达水平,并行胸部CT检查,根据CT结果分为疗效有效组(完全缓解+部分缓解)和疗效无效组(病情稳定+疾病进展)。结果同步放化疗前VEGF/血小板数、OPN在有效组(CR+PR)的表达水平分别为(0.83±0.14)10-6pg、(32.26±7.46)ng/ml,治疗后二者血清浓度明显下降,分别为(0.44±0.10)10-6pg、(25.46±2.21)ng/ml,差异均有统计学意义(t=23.10、4.89,P<0.05)。而无效组(SD+PD)VEGF/血小板数、OPN表达水平反而明显升高,VEGF/血小板数差异具有统计学意义(t=21.51,P<0.05)。结论局部晚期NSCLC患者同步放化疗前后血清VEGF/血小板数和OPN的表达水平可为疗效判断提供依据。     

局部晚期非小细胞肺癌同步放化疗前后血清VEGF、TGF-β_1水平的测定及临床意义

目的通过测定不可手术局部晚期非小细胞肺癌（NSCLC）患者同步放化疗前后血清中VEGF/血小板数和TGF-β1的表达水平及变化,探讨二者在病情监测中的临床意义。方法 58例局部晚期非小细胞肺癌（NSCLC）患者同步放化疗前采用酶联免疫法测定血清中VEGF/血小板数和TGF-β1的表达水平,然后三维适形放疗,后期缩野对残存靶体积加量照射,至总DT60-64Gy,同步化疗采用紫杉醇40mg/m^2,每周静脉滴注1次,连用6周。治疗结束后3周再次测定血清中VEGF/血小板数和TGF-β1的表达水平,并行胸部CT检查,根据CT结果分为化疗有效组（完全缓解＋部分缓解）和无效组（病情稳定＋疾病进展）。结果局部晚期NSCLC患者治疗前血清VEGF/血小板数、TGF-β1表达水平分别为（0.834±0.085）10-6pg、（46.00±5.61）ng/ml,均高于对照组的（0.517±0.044）10-6pg、（21.48±4.25）ng/ml,差异有统计学意义（t=21.51、23.35,P〈0.05）。同步放化疗前VEGF/血小板数、TGF-β1在有效组（CR＋PR）的表达水平分别为（0.824±0.136）10-6pg、（44.22±4.65）ng/ml,治疗后二者血清浓度明显下降,分别为（0.435±0.098）10-6pg、（19.77±2.21）ng/ml,差异均有统计学意义（t=23.10、31.82,P〈0.05）。而进展组（SD＋PD）VEGF/血小板数、TGF-β1表达水平不但没有下降,反而明显升高,差异具有统计学意义。结论局部晚期NSCLC患者同步放化疗前后血清VEGF/血小板数和TGF-β1的表达水平可为疗效判断提供依据。     

骨桥蛋白和CD44v6在子宫内膜癌中的表达及其意义

目的 探讨骨桥蛋白(OPN)和CD44拼接变异体6(CD44v6)在子宫内膜癌中的表达及其与子宫内膜癌临床分期、病理类型和组织学分级的关系.方法 采用免疫组化法检测48例子宫内膜癌标本中OPN和CD44v6的阳性表达情况,分析其与子宫内膜癌的临床分期、病理类型和组织学分级的关系.结果 不同临床分期的子宫内膜癌患者,其OPN和CD44v6阳性率间差异均无统计学意义(P＞0.05);不同病理类型的子宫内膜癌患者,其OPN和CD44v6阳性率间差异均有统计学意义(P＜0.05);不同组织学分级的子宫内膜癌患者,其OPN阳性率间差异有统计学意义(P＜0.05),CD44v6阳性率间差异无统计学意义(P＞0.05).OPN与CD44v6的表达无相关性.结论 OPN和CD44v6的表达可能与子宫内膜癌的病理类型和组织学分级有关.     

CD44v6和P53在肾细胞癌中的表达及意义

目的:通过检测CD44v6和P53在肾细胞癌(RCC)中的表达,探讨它们与肾癌的发生、病理分级、临床分期的关系.方法:免疫组织化学方法检测40例RCC石蜡标本中CD44v6和P53的蛋白表达,并分组进行统计学分析.结果:CD44v6与P53在RCC中表达率与对照组相比明显升高(P＜0.05),但不同病理分级、临床分期之间差异无显著性(P＞0.05).CD44v6和P53表达存在正性相关,但两者在RCC中表达率差异存在显著性,CD44v6表达率高于P53的表达率(P＜0.05).结论:CD44v6和P53高表达可能成为肾癌的恶性表型之一,但两者与病理分级、临床分期无明显相关性.     

护理干预在非小细胞肺癌患者同步放化疗中的应用

①目的 探讨护理干预对局部晚期非小细胞肺癌(NSCLC)同步放化疗患者焦虑及抑郁情绪的影响.②方法 将65例同步放化疗的局部晚期NSCLC患者随机分为护理干预组和对照组.对照组采用常规同步放化疗,干预组在常规同步放化疗的基础上加用护理干预技术,两组患者在治疗前、治疗结束时采用抑郁自评量表(SAS)、焦虑自评量表(SDS)进行问卷调查.③结果 治疗前干预组和对照组SAS及SDS得分差异均无统计学意义(P＞0.05).干预组在治疗后SAS及SDS得分明显降低,与治疗前比较差异有统计学意义(P＜0.05),而对照组在治疗前后SAS及SDS得分无明显变化,差异均无统计学意义(P＞0.05).④结论 NSCLC患者存在明显的心理障碍,护理干预可显著降低患者的焦虑、抑郁水平.     

Livin、CD44v6、E-钙黏蛋白在非小细胞肺癌组织中的表达及意义

目的 检测非小细胞肺癌（NSCLC）癌组织和癌旁组织中Livin、CD44v6、E-钙黏蛋白（E-cad）的表达,探讨NSCLC组织Livin、CD44v6、E-cad表达的临床意义.方法 运用免疫组织化学染色法检测71例NSCLC组织、癌旁组织及20例良性肺组织标本中Livin、CD44v6、E-cad的表达情况,分析其与肺癌分期、分化、病理类型及淋巴结转移之间的关系及相关性.结果 （1）肺癌组织中Livin阳性表达率明显增高,与癌旁组织及良性肺组织比较差异有统计学意义（P＜0.01）,癌旁组织中Livin阳性表达率较良性肺组织中增高,但差异无统计学意义（P ＞0.05）; Livin在Ⅲ期肺癌中表达较Ⅰ、Ⅱ期明显增高,其表达与肺癌TNM分期呈正相关;淋巴结转移组Livin阳性率86.2%（25/29）,高于无淋巴结转移组23.8%（10/42）,两组比较差异有统计学意义（P＜0.01）.（2）CD44v6在肺癌组织中表达增高,与癌旁组织及良性肺组织比较差异有统计学意义（P＜0.01）; CD44v6表达与临床病理分期（TNM）呈正相关（P＜0.01）.淋巴结转移组CD44v6阳性率96.6%（28/29）,高于无淋巴结转移组[33.3%（14/42）],两组比较差异有统计学意义（P＜0.01）;CD44v6的表达与肺癌的分化程度呈负相关（P＜0.05）.（3）E-cad在肺癌组织中表达降低,与癌旁组织及良性肺组织相比差异有统计学意义（P＜0.01）.E-cad的表达与临床病理分期、淋巴结转移、分化程度无关（均P ＞0.05）.（4）Livin与CD44v6在肺癌组织均有较高表达,Livin阳性表达组中CD44v6的表达强度较阴性组明显增高,Livin与CD44v6表达呈正相关（P＜0.01）.Livin与E-cad在肺癌组织中的表达无相关性.结论 Livin、CD44v6在NSCLC组织中高表达、E-cad在NSCLC组织中表达降低,Livin、CD44v6与NSCLC临床病理分期、淋巴结转移的相关,提示三者在NSCLC的发病过程中可能起重要作用.CD44v6 与Livin在肺癌组织中的表达呈正相关,推测两者可能共同参与了NSCLC的疾病过程,其确切机制有待于进一步研究.     

CD44v6在肾细胞癌中的表达及意义

目的:通过检测CD44v6在肾细胞癌(RCC)中的表达,探讨它们与肾癌的发生、病理分级、临床分期的关系.方法:免疫组织化学方法检测40例RCC石蜡标本中CD44v6蛋白表达,并分组进行统计学分析.结果:CD44v6在RCC中表达率与对照组相比明显升高(P＜0.05),但不同病理分级、临床分期之间差异无显著性(P＞0.05).结论:CD44v6高表达可能成为肾癌的恶性表型之一,但该指标与病理分级、临床分期无明显相关性.     

整合素α5 β1及CD44v6与卵巢癌生物学行为关系研究

目的:研究黏附分子整合素α5 β1及CD44v6在卵巢癌中的表达情况及与临床病理因素的关系.方法:用免疫组化检测65例卵巢癌及20例卵巢良性肿瘤的整合素α5 β1及CD44v6的表达情况,分析其与卵巢癌的组织类型、临床分期、细胞分化程度、手术减瘤情况、淋巴结转移情况、CA125、无瘤生存期、3年生存率之间的关系.结果:整合素α5 β1及CD44v6在恶性和良性上皮性肿瘤中的阳性表达率差异均有显著性(P＜0.01).整合素α5 β1及CD44v6的表达情况均与组织学类型无关(P＞0.05);整合素α5 β1的表达与临床分期无关(P＞0.05),而与细胞分化程度有关,细胞分化愈差,整合素α5 β1表达愈低(P＜0.005);CD44v6的表达情况与临床分期、细胞分化程度有关,分期愈晚,细胞分化愈差,CD44v6表达愈高(P＜0.05和P＜0.005).整合素α5β1表达与血CA125呈负相关,CD44v6表达与CA125呈正相关(P＜0.005).整合素α5 β1阴性表达者淋巴结转移率高,CD44v6阳性表达者淋巴结转移率高(P＜0.05).整合素α5 β1表达情况与减瘤满意程度及无瘤生存期均无明显关系(P＞0.05),但与3年生存率有关(P＜0.05).CD44v6表达情况与减瘤满意程度、无瘤生存期及3年生存率均有关(P＜0.05～P＜0.005).结论:整合素α5 β1及CD44v6在卵巢癌中的表达与肿瘤的生物学行为有关.整合素α5 β1表达下降或缺失,CD44v6表达升高,提示肿瘤进展,恶性度高,预后不良.监测整合素α5 β1及CD44v6的表达情况有助估价预后.     

胃癌患者血清中可溶性CD44v6含量和组织中CD44v6蛋白表达的研究

目的:研究胃癌患者外周血清中可溶性CD44v6(sCD44v6)含量/CD44v6蛋白表达,及其与临床病理参数之间的关系。方法:应用定量ELISA方法检测胃癌患者(术前和术后)及健康对照组血清中sCD44v6含量,并以(S-P)免疫组化法测定相应组织中CD44v6蛋白的表达。结果:70例胃癌患者血清中sCD44v6含量(2.15±0.78 ng/ml)明显高于16例正常对照组(1.18±0.43 ng/ml),14树根治性手术后血清中sCD44v6含量(1.21±0.39 ng/ml)比术前(2.67±0.83 ng/ml)明显下降(P<0.01),而6例非根治性手术后(3.29±0.41ng/ml)比术前(3.61+0.49 ng/ml)下降不明显(P>0.05)。而胃癌组织中CD44v6蛋白表达在肠型和弥漫型中有显著差异,不同的浸润深度、有无淋巴结及远处转移也有显著差异。结论:胃癌患者外周血清中sCD44v6含量及组织中CD44v6蛋白表达的变化与转移、临床分期、病理分期有关,sCD44v6含量升高可作为胃癌患者淋巴结转移(尤其是早期转移)的监测指标。     

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.