TK1、Ki-67在非小细胞肺癌组织中的表达及预后意义

目的:探讨细胞质胸苷激酶1(thymidine kinase 1,TK1)和Ki-67在非小细胞肺癌(non-small cell lung cancer,NSCLC)中的表达水平及其对NSCLC患者预后的意义?方法:将202例NSCLC及63例癌旁肺组织标本制作成组织芯片,采用免疫组织化学EnVision法检测TK1和Ki-67的表达,探讨其表达水平与临床病理特征及预后的关系?结果:NSCLC组织中TK1(60.89%)和Ki-67(55.45%)的阳性表达率均显著高于癌旁肺组织(P < 0.01);Spearman等级相关分析显示二者的表达呈正相关(r = 0.518, P < 0.001);NSCLC中,TK1和Ki-67的表达均与肿瘤分化程度和TNM分期显著相关(P < 0.05);Kaplan-Meier生存分析显示随TK1表达的增强和Ki-67指数的增高,NSCLC患者的总体生存期逐渐降低(P < 0.01);Cox 回归分析提示肿瘤TK1表达和TNM分期是影响NSCLC患者预后的独立危险因素(P < 0.05)?结论:TK1在NSCLC的表达与肿瘤的分化?进展有关,TK1表达有助于对患者预后的评价?     

胰腺癌组织FOXC2的表达及其与预后的关系

目的: 探讨叉头框C2(forkhead box C2,FOXC2)在胰腺癌中的表达及其与胰腺癌患者预后的相关性。方法: 利用Oncomine数据库分析FOXC2 mRNA在胰腺癌及癌旁组织中的表达;收集112例胰腺患者癌组织及相应癌旁组织,采用qRT-PCR和免疫组织化学染色检测FOXC2的表达,并分析其与临床病理参数的关系。应用Kaplan-meier法分析FOXC2表达对患者生存时间的影响。结果： Oncomine数据库中FOXC2 mRNA在胰腺癌癌组织中表达明显高于癌旁组织(t_Badea=4.074,t_Pei= 3.741,P均<0.05);FOXC2蛋白主要表达于胰腺癌细胞胞核,且癌组织免疫组化评分明显高于癌旁组织( t=7.571,P<0.05);FOXC2 mRNA在胰腺癌组织中表达明显高于癌旁组织( t=13.79,P<0.05);有淋巴结转移的癌组织中FOXC2阳性表达率高于无淋巴结转移的癌组织(χ ² =16.998,P<0.01),胰腺癌Ⅲ期FOXC2阳性表达率高于Ⅰ期( χ 2=15.688,P<0.001)和Ⅱ期( χ ²=10.678,P=0.001)。FOXC2阳性组胰腺癌患者的中位生存时间显著短于阴性组( χ ²=10.32,P=0.001 3),FOXC2阳性表达(HR=2.569,P=0.003)可作为预测胰腺癌预后的独立因素。 结论： FOXC2在胰腺癌组织中呈高表达,且与胰腺癌患者的预后高度相关。     

FOXC2在非小细胞肺癌细胞株及组织中的表达及意义

目的:研究叉头框C2(Forkhead box c2,FOXC2)在人非小细胞肺癌(non small cell lung cancer,NSCLC)细胞株和组织中的表达水平,并探讨FOXC2与临床病理因素的相关性。方法:应用RT-PCR方法检测FOXC2在人肺癌细胞株A549和H460中mRNA水平的表达情况,并与永生化人支气管上皮细胞株16HBE进行比较;应用免疫组化(IHC)方法检测FOXC2蛋白在66例NSCLC组织和8例癌旁肺组织中的表达情况,并分析FOXC2表达与NSCLC患者临床病理因素的关系。结果:肺癌细胞株A549和H460中FOXC2的mRNA表达水平高于永生化人肺上皮细胞株,差异有统计学意义(P<0.05);FOXC2蛋白在NSCLC组织中表达高于癌旁组织,与肺癌组织淋巴结转移密切相关(P<0.05),而与患者年龄、性别、吸烟、组织学类型、分化程度和TNM分期无明显相关(P>0.05)。结论:FOXC2可能在促进NSCLC的发生和发展过程中发挥了重要的作用,有望作为评估临床肺癌患者预后的指标。     

MCT1、CD147、CD44在非小细胞肺癌中表达的相关性及意义

目的:探讨单羧酸转运蛋白1(monocarboxylate transporters 1,MCT1)?CD147?CD44 mRNA和蛋白在非小细胞肺癌(non-small cell lung cancer,NSCLC)中表达的相关性及其在NSCLC发生?发展及预后中的意义?方法:取经病理确诊的56例NSCLC患者癌组织?癌旁组织(距肿瘤边缘> 5 cm)和21例肺良性病变组织采用免疫组化和实时荧光定量PCR检测MCT1?CD147?CD44蛋白及mRNA的表达?结果:①在NSCLC组织中MCT1?CD147?CD44表达均明显高于对照组(P < 0.05);②MCT1在肺癌细胞膜上的表达水平与CD147?CD44的表达均存在相关性(P < 0.05);③MCT1?CD147?CD44的表达与NSCLC患者的性别?年龄?肿瘤大小?TNM分期均无关,但与肿瘤的组织类型(P < 0.05)?淋巴转移(P < 0.05)显著相关,且MCT1?CD44蛋白和mRNA的表达与肿瘤的分化程度显著相关(P < 0.05)?结论:MCT1?CD147?CD44可能参与肿瘤的发生?发展及远处淋巴结转移,可作为检测NSCLC和预后评价的指标?     

非小细胞肺癌组织中HIF-1α和BNIP3的表达及相关性研究

目的:研究缺氧诱导因子-1α(hypoxia inducible factor-1α,HIF-1α)和Bcl-2/腺病毒E1B19kDa结合蛋白3(Bcl-2 and adenovirus E1B 19kDa interacting protein 3,BNIP3) 在非小细胞肺癌(non-small cell lung carcinoma,NSCLC)组织中的表达及其相关性?方法:收集45例新鲜NSCLC标本(含癌旁组织)和14例正常对照肺组织,采用半定量RT-PCR和SP免疫组织化学方法,测定HIF-1α和BNIP3的表达水平及分析二者相关性,并与组织类型?分化程度?淋巴结转移?TNM分期?年龄?吸烟等进行多因素分析?结果:肺癌肿瘤组织中HIF-1α?BNIP3的mRNA表达水平显著高于癌旁组织及正常对照肺组织(P < 0.01),并且两者表达呈正相关(r=0.68,P < 0.01);HIF-1α?BNIP3在肿瘤组织中的蛋白阳性表达率分别为53.3%?66.7%,显著高于癌旁组织及正常对照肺组织(P < 0.01),且二者阳性率呈正相关(rs=0.38,P < 0.01)?单因素分析发现HIF-1α与组织类型?TNM分期相关(P < 0.05),而BNIP3在相关临床病理参数分组中无显著差异?结论:HIF-1α与BNIP3在NSCLC中高表达且呈正相关,推测二者的高表达在肺癌的发生发展中可能具有重要作用?     

FLIP､Smac和survivin蛋白在肺小细胞癌及低分化鳞癌中表达规律及预后相关性研究

目的:通过检测小细胞肺癌(small cell lung carcinoma,SCLC)和低分化鳞状细胞癌(poorly differentiated squamous－cell carcinoma,PDSCC)中 FLICE抑制蛋白(FLICE inhibitory protein,FLIP)?促凋亡蛋白Smac(second mitochondrial activator of caspase,Smac)?抗凋亡因子survivin的表达,探讨小细胞肺癌及低分化鳞癌中FLIP?Smac和survivin蛋白的表达规律及其与临床病理指标及预后的关系,为临床诊断?治疗及预后判断提供新的理论依据?方法:应用免疫组化S－P法检测肺小细胞肺癌及低分化鳞状细胞癌中FLIP?Smac和survivin阳性表达;应用蛋白印记(Western blot)和逆转录-聚合酶链反应(RT－PCR)检测正常肺组织及两种癌组织中FLIP?Smac?survivin蛋白和mRNA表达水平?结果:73例肺癌患者1年生存率为64.5%?其中小细胞肺癌60.5%,低分化鳞状细胞癌68.6%?FLIP?Smac及survivin在小细胞肺癌及低分化鳞癌中的表达均与年龄?性别?是否吸烟及淋巴结转移无关(P > 0.05),但Smac的表达与临床分期及生存率有关 (P < 0.05);Smac在正常组织表达显著高于癌组织(P < 0.05);FLIP及survivin在正常组织中的表达显著低于癌组织 (P < 0.05)?结论:癌组织中Smac低表达提示低生存率,Smac可作为独立预后指标;FLIP?Smac和survivin联合检测有助于预后判断?     

膜转运蛋白基因在非小细胞肺癌中的表达及预后意义

目的:探讨膜转运蛋白MRP1、LRP和BCRPmRNA在非小细胞肺癌(NSCLC)中的表达及临床预后意义。方法:用RT-PCR法检测60例NSCLC患者癌组织及癌旁组织中MRP1、LRP和BCRPmRNA的表达。用t检验、方差分析、秩相关分析、Kaplan-Meier生存曲线和COX多因素回归分析进行统计分析。结果:MRP1和LRPmRNA在NSCLC中的表达量高于癌旁组织(P=0.02和P=0.000),癌组织中两者表达呈正相关(rs=0.530,P=0.000),BCRPmRNA在癌组织中表达量低于癌旁组织(P=0.042)。不同组织类型中,肺腺癌LRPmRNA表达量高于鳞癌(P=0.02);不同临床分期癌组织中MRP1、LRP和BCRPmRNA表达均无差异。预后分析显示MRP1mRNA低表达组患者生存期明显长于高表达组(P=0.023),MRP1mRNA高表达是影响NSCLC患者预后的独立因素。结论:MRP1、LRP和BCRPmRNA在NSCLC组织中有不同程度的表达。MRP1mRNA表达水平与患者生存期相关,可作为判断NSCLC患者预后的一项指标。     

PD-L1在NSCLC组织中的表达及对患者预后影响的多因素分析

目的探讨程序性死亡配体-1(PD-L1)在非小细胞肺癌(NSCLC)组织中表达及对患者预后的影响。方法选取江苏省中医院病理科收集的90例NSCLC组织(NSCLC组)、40例癌旁正常肺组织作为癌旁正常组进行免疫组化检测,对比两组标本中的PD-L1蛋白阳性表达率。根据PD-L1蛋白表达是否为阳性,将90例NSCLC分为PD-L1阳性组和PD-L1阴性组。 结果NSCLC组的PD-L1蛋白阳性表达(80.00%)高于癌旁正常组(5.00%,P＜0.05)。90例NSCLC中PD-L1阳性组72例和PD-L1阴性组18例。 PD-L1蛋白阳性表达的NSCLC患者3年生存率(19.70%)显著低于阴性患者(52.94%,P＜0.05);PD-L1蛋白阳性表达的NSCLC患者的生存时间21.0月显著低于PD-L1蛋白阴性表达患者的28.0月(P＜0.05)。肿瘤淋巴结转移(TNM)分期增高、发生淋巴结转移、PD-L1蛋白阳性表达是NSCLC患者不良预后的独立危险因素(P＜0.05)。结论PD-L1在NSCLC组织中表达程度上调,并且与患者肿瘤发生、发展及不良预后具有显著的关系。     

非小细胞肺癌中半乳凝素1的表达及其临床意义

目的探讨非小细胞肺癌(NSCLC)组织中半乳凝素1(Gal-1)mRNA及蛋白的表达及临床意义。方法采用RT-PCR、蛋白质印迹技术分别检测35例NSCLC患者的癌组织、癌旁组织及远处正常肺组织(距癌组织边缘大于5cm)中Gal-1mR-NA及蛋白表达情况。结果 NSCLC患者癌组织、癌旁组织以及有淋巴结转移的NSCLC患者正常肺组织中,Gal-1mRNA的表达水平均明显高于无淋巴结转移的NSCLC患者正常肺组织(P<0.05);NSCLC患者癌组织、癌旁组织以及有淋巴结转移的NSCLC患者正常肺组织中,Gal-1蛋白表达水平明显高于无淋巴结转移的NSCLC患者正常肺组织(P<0.05);NSCLC患者癌组织中Gal-1mRNA的表达与患者TNM分期及分化程度密切相关(P<0.05),而与患者的性别、年龄、病理组织类型无明显相关性(P>0.05)。结论 Gal-1表达与NSCLC的发生、发展、侵袭转移密切相关,可作为一个潜在的NSCLC发病与转移的观察指标。     

非小细胞肺癌组织中lncRNA FOXD2-AS1、miR-1913表达与患者生存期的关系

目的 探究非小细胞肺癌(NSCLC)组织中长链非编码RNA(lncRNA)FOXD2-AS1、miR-1913的表达与患者生存期的关系。方法 选取2017年11月—2019年11月滨州医学院烟台附属医院肿瘤中心收治的NSCLC患者100例癌组织和癌旁组织作为研究对象。根据术后3年预后情况分为生存组58例和死亡组42例,采用实时荧光定量—聚合酶链式反应(qRT-PCR)测定组织中lncRNA FOXD2-AS1、miR-1913表达水平;Pearson法分析NSCLC组织中lncRNA FOXD2-AS1与miR-1913表达水平的相关性;用Kaplan-Meier法分析NSCLC组织中lncRNA FOXD2-AS1、miR-1913表达与预后的关系;Cox分析NSCLC患者预后的影响因素。结果 与癌旁组织比较,NSCLC组织中lncRNA FOXD2-AS1表达水平升高,miR-1913表达水平降低(t/P=11.439/<0.001、17.709/<0.001);Target Scan Human网址预测lncRNA FOXD2-AS1与miR-1913间存在结合位点;...     

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.