单中心维持性血液透析患者钙磷代谢及全段甲状旁腺激素水平横断面调查分析

目的:探讨分析单中心维持性血液透析患者钙磷代谢及全段iPTH水平横断面调查状况。方法:选取我院2014年2月至2015年3月期间接收治疗的87例维持性血液透析患者作为研究分析对象,回顾分析患者临床资料研究横断面状况,统计患者透析龄、原发疾病、年龄、磷结合剂、活性维生素D、钙剂等使用状况,并检测患者血红蛋白、血浆白蛋白、碱性磷酸酶等指数,并进行统计学分析。结果:矫正总钙低于目标标准共14例,占比为16.09%,达标者共62例,占比为71.26%,11例患者高于标准范围,占比为12.64%。9例血磷指数比目标标准低,占比为10.34%,共34例达标,占比为39.08%,共44例患者高于标准值,占比为50.57%。检测全段甲状旁腺激素10例患者低于标准范围,占比为11.49%,共52例患者达标,占比为59.77%,共25例患者高于标准范围,占比为28.73%。整体为所有研究对象,自变量为iPTH,以血红蛋白、血磷、白蛋白、碱性磷酸酶等为自变量,逐步回归分析,得知血磷、血钙及钙磷乘积、血红蛋白、白蛋白、碱性磷酸酶等指数之间存在统计学意义(P0.05),同时血红蛋白、白蛋白和iPTH之间存在负相关,碱性磷酸酶、磷和iPTH之间存在正相关。结论:经探讨分析后得知,大部分维持性透析患者的iPTH指数和钙磷代谢状况未能得到更好的控制,导致其指数不达指南推荐K/DIGO标准,主要以全段甲状腺激素和血磷指数上升较为明显,临床需给予足够的重视。     

低钙透析液治疗维持性血液透析患者动力缺失性骨病的临床观察

目的：观察低钙透析液治疗维持性血液透析患者动力缺失性骨病的有效性和安全性以及对钙磷代谢的影响。方法：选取合并动力缺失性骨病的维持性血液透析患者31例,应用1.25mmol/L钙浓度透析液治疗12个月,观察不同时期（第1、3、6、12个月）患者血iPTH、血钙、血磷、血钙磷乘积、血红蛋白、白蛋白等指标的变化及相关不良反应。结果：所有患者治疗前血清总钙、血磷、钙磷乘积均高于NKF-K/DOQI指南推荐的目标范围,iPTH均〈100pg/ml,低钙透析液治疗1个月后患者iPTH水平较治疗前即明显升高,并随着治疗时间的延长,iPTH水平逐渐升高,治疗12个月后达到高峰,iPTH水平达到NKF-K/DOQI指南推荐的目标范围（150～300pg/ml）患者的比例随着治疗时间的延长逐渐上升;同时血清总钙、血磷、钙磷乘积水平在治疗1个月后即较治疗前均明显下降（P〈0.05）,随着治疗时间的延长下降更明显,治疗6个月后血清总钙、血磷、钙磷乘积逐渐趋于稳定。治疗前后患者血清白蛋白、血红蛋白、促红细胞生成素用量无明显差异,无明显低血压发生,低钙抽搐发生比例与普通钙（1.5mmol/L）透析液患者无明显差异。结论：低钙透析液（1.25mmol/L）能有效地治疗维持性血液透析患者的动力缺失性骨病并且有较好的安全性,同时能较好地控制血钙、血磷、钙磷乘积水平。     

53例维持性血液透析患者肾性骨病分析

目的分析维持性血液透析患者的钙磷代谢及肾性骨病情况。方法53例维持性血液透析患者均记录其临床症状表现,检测他们的血液透析前血白蛋白、碱性磷酸酶、尿素氮、肌酐、尿酸、二氧化氮结合力、钙、磷及血清iPTH。结果维持性血液透析患者皮肤瘙痒56．6％,骨或关节疼痛（排除骨性关节炎）28．3％,软组织钙化28．3％,肌无力26．4％,骨折1．8％。无症状18．9％,存在一个症状24．5％,同时存在两个症状26．4％,同时存在三个症状20．8％,同时存在四个症状9．4％。每周两次血液透析患者血白蛋白（P〈0．05）、血钙（P〈0．01）低于每周2．5—3次血液透析患者。维持性血液透析患者钙磷乘积大于4．43mmol^2／L^2 67．9％,高磷血症73．6％,低钙血症30．2％,血清iPTH〉300pg／ml43．4％,血清iPTH〈150pg／ml28．3％,低蛋白血症9．4％。血清iPTH〉300pg／ml血液透析高磷血症患者多于血清iPTH≤〈300pg／ml血液透析高磷血症患者,差异有统计学意义（P〈0．05）;血清iPTH〉300pg／ml患者且钙磷乘积大于4．43mmol^2／L^2（55mg^2／dl^2）血液透析患者多于血清iPTH≤300pg／ml且钙磷乘积大于4．43mmol^2／L^2血液透析患者,差异有统计学意义（P〈0．01）。结论肾性骨病是血液透析患者常见并发症之一,继发性甲状旁腺功能亢进如何有效治疗有待进一步解决。iPTH不宜抑制过低,以免导致非动力性骨病。     

糖尿病维持性血液透析患者血糖控制情况与甲状旁腺素的相关研究

目的：探讨糖尿病维持性血液透析（ MHD ）患者的血糖控制状况与血清甲状旁腺素的相关性。方法对维持性血液透析患者糖尿病组和其他肾病组之间年龄、血iPTH、磷、钙、钙磷乘积、血糖、糖化血红蛋白（ HbA1c）、性别、血肌酐、尿素氮、碱性磷酸酶（ AKP）、白蛋白（ ALB）进行相关性比较。结果维持性血液透析患者糖尿病组较非糖尿病组iPTH低（P＝0．020）;糖尿病组中血糖控制较差者iPTH较血糖控制较好者低（P＝0．014）;多元回归分析显示HAbc1与iPTH明显相关（ P＝0．000）。结论透析糖尿病患者的血糖控制水平与其血清iPTH水平相关,良好的血糖控制可能在一定程度上预防血液透析糖尿病患者的肾性骨病的发生。     

不同血液透析方法对维持性血液透析患者钙磷代谢的影响

目的：分析慢性肾衰竭维持性血液透析患者钙磷代谢状况,研究不同血液透析方法对钙磷代谢的影响,为临床治疗提供依据。方法：收治维持性血液透析患者125例,将患者分为单纯血液透析组（单纯HD组）及混合透析组,对这两组的血钙、血磷、甲状旁腺激素（iPTH）、钙磷乘积等指标进行统计学分析。结果：125例患者血钙平均值2．14±0．29mmol／L．血钙〈2．1mmol／L41例（32．8％）。血磷平均值2．01±0．77mmol／L,血磷〉1．78mmol／L67例（53．6％）,iPTH平均值315．76±371．75pg／ml,iPTH〈150pg／ml55例（44％）,iPTH〉300pg／ml45例（36％）,其中iPTH〉1000pg／ml8例（6．4％）。与单纯HD组相比,混合透析组血钙、血磷、钙磷乘积及iPTH等指标明显低于单纯HD组,差异有统计学意义（P〈0．05）。结论：有相当比例的血液透析患者未能满意的控制钙磷代谢紊乱及其继发性甲状旁腺功能亢进,应进一步加强透析,可联合血液透析滤过及血液灌流等透析方式来加强对钙磷及iPTH的控制。     

口服活性炭片降低血液透析患者血磷的疗效观察

目的观察口服活性炭片对血液透析患者高磷血症的疗效。方法给予50例血液透析患者口服活性炭片,观察治疗前、治疗一个月及三个月时血磷、血钙、血红蛋白、血清铁、铁蛋白、血白蛋白、血清全段甲状腺旁素(iPTH)水平。结果 1.与治疗前相比,治疗一个月及三个月时血磷水平明显下降(2.87±0.61vs2.19±0.49vs1.56±0.28),差异有统计学意义(P0.05);2.治疗后钙磷乘积也有显著下降,(64.1±11.6vs56.7±9.8vs51.6±8.3),差异有统计学意义(P0.05);3.治疗3个月时92%的患者血磷水平达标;4.19例应用含钙磷结合剂仍然存在高磷血症的患者,口服活性炭3个月后血磷均降至正常水平;5.口服活性炭片对血钙、血红蛋白、血清铁、铁蛋白、血白蛋白、iPTH水平无影响。结论口服活性炭片可有效降低维持性血液透析患者血磷和钙磷乘积,其降磷效果优于含钙磷结合剂。     

糖尿病肾病维持性血液透析患者肾性骨病分析

目的:分析糖尿病肾病维持性血液透析患者钙磷代谢及肾性骨病情况。方法:对维持性血液透析患者糖尿病肾病组与其他肾病组间年龄、透析龄、透析频率、血白蛋白(ALB)、血碱性磷酸酶(AKP)、血钙(Ca)、血磷(P)、钙磷乘积(Ca.P)、血尿素氮(BUN)、血肌酐(Scr)、血尿酸(UA)、二氧化碳结合力(TCO2)、阴离子间隙(AG)及血iPTH进行比较,并探讨iPTH与其他各因素的相关性。结果:与其他肾病组比较,糖尿病肾病组年龄较大(P<0.01),ALB、AKP及iPTH较低(P<0.05)。iPTH与高AKP相关(P<0.05)。结论:糖尿病肾病维持性血液透析患者ALB、AKP及iPTH较低,易发生无力性骨病。     

温州地区维持性血液透析患者矿物质代谢紊乱情况调查

目的 了解温州地区维持性血液透析患者矿物质代谢紊乱情况及相关影响因素。方法 收集2013 年在温州地区长期维持性血液透析患者血钙、血磷、全段甲状旁腺激素（iPTH）的资料,并根据美国肾脏病协会指南（KDOQI）及中华医学会肾脏病学分会（CSN）制订的《慢性肾脏病矿物质和骨异常诊治指导》计算患者的血钙、血磷、iPTH 的达标率,并对相关影响因素进行分析。结果 共收集2 227 例2013 年在温州地区各家透析中心维持性血液透析患者的资料。按KDOQI 指南标准,患者血钙、血磷、iPTH 的达标率分别为44.90%、46.30%、27.64%,3 项均达标者占6.29%;按《慢性肾脏病矿物质和骨异常诊治指导》建议,患者血钙、血磷、iPTH 的达标率分别为57.66%、46.30%、61.14%,3 项均达标者占16.97%。此外,三级医院维持性血液透析患者的平均血磷水平为（1.67±0.51）mmol/L,血磷达标率49.10%,二级医院患者的平均血磷水平为（1.79±0.53）mmol/L,达标率为43.22%,三级医院维持性血液透析患者的血磷达标率情况优于二级医院。血白蛋白、含钙磷结合剂的使用及透析频率是影响血钙达标的独立相关因素。患者的性别、年龄、活性维生素D 的使用、透析龄及透析频率是影响血磷达标的独立相关因素。患者活性维生素D的使用是影响iPTH 达标的独立相关因素。结论 温州地区维持性血液透析患者矿物质代谢紊乱纠正情况与有关指南的要求仍然存在较大差距;患者性别、营养状态、透析频率、含钙磷结合剂的服用、活性维生素D 的使用等是影响维持性血液透析患者矿物质代谢紊乱纠正的主要相关因素。     

维持性血液透析患者全段甲状旁腺激素对临床相关指标的影响

目的探讨慢性肾脏病维持性血液透析(HD)患者全段甲状旁腺激素(iPTH)对临床相关指标的影响。方法选取慢性肾脏病HD患者中血iPTH>500ng/L的20例患者为高iPTH组,iPTH<150ng/L的23例患者为低iPTH组,对两组患者体重指数(MBI)、透析龄及血红蛋白(HB)、血肌酐(Scr)、尿素氮(BUN)、血清白蛋白(Alb)等对比分析。结果高iPTH组的年龄、肌酐、血磷、透析龄、血校正钙、ALP水平较低iPTH组显著升高,死亡率明显低于高iPTH组。结论iPTH水平可影响慢性肾脏病维持性血液透析患者的预后。     

维持性血液透析患者钙磷认知水平的横断面调查

目的:了解目前维持性血液透析(maintenance hemodialysis,MHD)患者钙磷认知水平对钙磷代谢和甲状旁腺激素的影响。方法:选取2014年1月-2017年12月期间在惠州市中大惠亚医院血透中心规律血液透析且透析龄3个月的患者53例作为研究对象,记录患者的性别、年龄、透析龄、原发病、文化程度、近期实验室及钙磷代谢健康认知水平的调查问卷结果。结果:53例MHD患者中,男性31例(58.5%);平均年龄(53.2±13.8)岁;高中文化程度以上有16例(30.2%);有残余尿量23例(43.4%);平均透析龄22.0(9.0,40.0)个月;平均URR为(65.3±6.1)%;平均血钙水平为(2.24±0.24)mmol/L;平均血磷水平为(2.08±0.61)mmol/L;平均钙磷乘积水平为(58.4±17.5)mg2/d L2;平均iPTH水平为242.0(125.5,783.5)ng/L。53例MHD患者中,血磷达标17例(32.1%),钙磷乘积达标29例(54.7%),iPTH控制达标14例(26.4%)。在53例患者的调查问卷中,得分≥40分(达标组)有43例(81.1%),得分40分(非达标组)有10例(18.9%),本研究的MHD患者钙磷代谢健康认知水平达标率为81.1%。两组患者的性别、年龄、文化程度、有无残余尿量、透析龄、URR、血钙和iPTH水平比较,差异均无统计学意义(P0.05);而达标组血磷及钙磷乘积水平均明显低于非达标组,差异均有统计学意义(P0.05)。逐步多元回归分析显示,iPTH水平是影响血磷水平升高的独立危险因素(P0.05)。结论:维持性血液透析患者钙磷认知水平显著影响血磷及钙磷乘积水平,提高维持性血液透析患者的钙磷认知水平有助于提高患者的生活质量及生存率。iPTH水平是影响血磷水平的独立危险因素。     

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.