有效再灌注的急性脑梗死患者卒中后抑郁相关因素分析

[摘要]　目的　探讨有效再灌注的急性缺血性脑卒中（AIS）患者机械取栓术后90 d发生卒中后抑郁（PSD）的影响因素。方法　回顾性分析2019.01-2020.12海军军医大学（第二军医大学）第一附属医院脑血管病中心有效再灌注[机械取栓治疗血管成功再通（改良脑梗死溶栓分级≥2b）且90 d功能预后良好（改良Rankin评分≤3分）]的AIS患者的临床资料。收集患者入院时基线资料，包括入院时白细胞计数、淋巴细胞/单核细胞比值（LMR）等炎症指标和机械取栓治疗相关资料，并采用9条目患者健康问卷（PHQ-9）评估患者的抑郁情绪。将患者分为PSD组（PHQ-9评分≥10分）和无PSD组（PHQ-9评分＜10分），分析两组患者临床特征的差异。采用二元多因素logistic回归模型分析PSD的独立影响因素，采用ROC曲线分析LMR及多因素联合预测PSD的价值。结果　共纳入206例有效再灌注的AIS患者，其中PSD组68例（33.01%）、无PSD组138例（66.99%）。二元多因素logistic回归分析显示年龄（OR=0.946，P=0.011）、入院时Alberta脑卒中计划早期CT评分（OR=0.707，P=0.008）、入院时白细胞计数（OR=0.729，P=0.006）和LMR（OR=0.596，P=0.003）是AIS患者机械取栓术后90 d发生PSD的独立影响因素。ROC曲线分析显示，上述4项因素联合预测PSD的AUC值为0.795；LMR单独预测PSD的AUC值为0.711，临界值是2.96，灵敏度为71.0%，特异度为64.7%。LMR≤2.96(86例)和LMR＞2.96（120例）的患者取栓术后90 d的PSD发生率分别为51.20%（44/86）和20%（24/120），差异有统计学意义（χ2=22.00，P＜0.001）。结论　机械取栓术后获得有效再灌注的AIS患者约1/3会发生PSD。年轻、发病初缺血范围大和入院时LMR与白细胞计数低是PSD的独立危险因素。     

急性缺血性脑卒中机械取栓术后出血转化及其对预后的影响

目的 探讨急性缺血性脑卒中(AIS)患者机械取栓(MT)治疗后出血转化(HT)及其对预后的影响。方法 选取接受MT治疗的AIS患者114例,应用改良Rankin量表随访评价发病90 d时的临床转归(0～2分为预后良好,3～6分为预后不良)。根据术后复查头颅CT有无HT分为HT组(n=25)和非HT组(n=89),采用二项式Logistic回归分析确定术后HT和预后的影响因素。结果 114例患者中HT 25例,非HT 89例。HT组患者合并糖尿病比例显著高于非HT组,出院时NIHSS评分高于非HT组,90 d预后较好比例显著低于非HT组,差异均有统计学意义(均P<0.05);二项式Logistic回归分析显示,糖尿病、高总胆固醇血症、吸烟史是取栓术后发生HT的主要血管危险因素(均P<0.05)。术后HT是动脉取栓术后不良预后的重要影响因素(P=0.026)。结论 糖尿病、高总胆固醇血症、吸烟史是AIS患者MT术后HT的血管主要危险因素,而术后HT为MT术后预后不良的独立危险因素。     

溶栓治疗急性缺血性脑卒中患者的早期神经功能恶化情况及危险因素分析

目的:探讨溶栓治疗急性缺血性脑卒中(AIS)患者的早期神经功能恶化(END)情况及危险因素。方法:回顾性分析2017年7月-2019年10月在本院神经内科住院的150例AIS患者的临床资料。统计AIS患者溶栓治疗后的END发生率、END病因及END在不同TOAST分型AIS中的分布情况。根据是否发生END将AIS患者分为END组和对照组。采用单因素和多因素Logistic回归分析END的危险因素。结果:END的发生率为23.3%(35/150)。原因未明的END占45.7%(16/35)。来源于大动脉粥样硬化型AIS的END占48.6%(17/35)。多因素Logistic回归分析显示踝肱指数≤0.9、糖尿病、大动脉粥样硬化型卒中、入院NIHSS评分7分、无抗血小板治疗是END的独立危险因素。结论:原因未明和来源于大动脉粥样硬化型AIS的END最为常见。踝肱指数≤0.9、糖尿病、大动脉粥样硬化型卒中、入院NIHSS评分7分、无抗血小板治疗是END的独立危险因素。     

血清胆红素水平对急性缺血性脑卒中患者静脉溶栓后出血转化的诊断价值

目的 观察血清胆红素水平与急性缺血性脑卒中（acute ischemic stroke,AIS）静脉溶栓后出血转化（hemorrhagic transformation,HT）的关系,并探讨其诊断价值。方法 回顾性分析2020年1月至2021年12月宁波市第二医院接受静脉溶栓治疗的AIS患者107例,根据溶栓后24h内随访的头颅计算机断层扫描（computed tomography,CT）或磁共振成像（magnetic resonance imaging,MRI）检查结果是否发生HT,将入选患者分为HT组（n=32）和非HT组（n=75）,对可能的HT危险因素行单因素和多因素Logistic回归分析,采用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）评估其对AIS患者静脉溶栓后HT预测的效能。结果 单因素分析显示,HT组与非HT组AIS患者的血清总胆红素、直接胆红素、间接胆红素、吸烟史、入院时美国国家卫生研究院卒中量表（National Institutes of Health stroke scale,NIHSS）评分比较,差异均有统计学意义（P<0.05）。多因素分析显示,血清总胆红素、吸烟史、入院时NIHSS评分均为AIS患者静脉溶栓后HT的独立危险因素[OR=1.097（1.028～1.171）、4.238（1.002～17.928）、1.061（1.009～1.114）,P<0.05]。ROC曲线显示,总胆红素、入院时NIHSS评分及联合预测模型预测HT的曲线下面积分别为0.643、0.698、0.769。结论 血清胆红素水平与AIS患者静脉溶栓后HT发生风险相关,可作为HT的风险预测因子,联合吸烟、入院时NIHSS评分可提高预测效能。     

急性脑梗死后出血转化临床特征及影响预后的危险因素分析

目的探讨急性脑梗死后出血转化（hemorrhagic transformation,HT）临床特征,并分析影响预后的危险因素。 方法回顾性分析40例HT患者的临床特征。根据预后情况将其分为良好组22例和不良组18例,比较两组临床病例资料,分析影响预后的危险因素。 结果HT临床特征：HT患者中,脑叶梗死占52.50%,大面积梗死占65.00%,心源性脑栓塞型（cardioembolism,CE）占62.50%;HT发生在发病后8~14 d占57.50%;出血性梗死（hemorrhagic infarction,HI）占90.00%,脑实质内血肿（parenchyma haematoma,PH）占10.00%;HT发生后症状加重占42.50%。良好组和不良组性别、吸烟史、卒中史、美国国立卫生研究院卒中量表（National Institute of Health stroke scale,NIHSS）评分、服用抗凝药物差异有统计学意义（P＜0.05）。多因素分析结果表明,NIHSS评分>12分、服用抗凝药物是影响预后的危险因素,差异有统计学意义（P＜0.05）。 结论脑叶梗死、大面积梗死和CE型的急性脑梗死患者更容易发生HT,HT多发于急性脑梗死后8~14 d内,多数为HI型,大部分患者不会发生症状加重。NIHSS评分>12分、服用抗凝药物是影响HT患者预后的危险因素。     

SWI对急性缺血性脑卒中出血性转化的检测及其对预后的影响

目的:探讨磁共振磁敏感加权成像(SWI)技术用于急性缺血性脑卒中(AIS)出血性转化(HT)检测的敏感性及不同HT面积对临床预后的影响.方法:选取90例接受静脉溶栓救治的AIS患者作为研究对象,均给予SWI检查和颅脑CT检查;观察两种检查技术的HT检出情况及不同HT面积对患者神经缺损的影响.结果:SWI检查溶栓后发生HT的总检出率为42.22％ (38/90),其中HI-1型比例最高(26.67％,24/90);头颅CT检查发生HT总检出为27.78％(25/90),其中HI-1型所占比例为(14.44％,13/90),与SWI总检出率和HI-1型检出率之间的差异均存在统计学意义(P＜0.05);SWI检查出血面积大于CT检查(P＜0.05);大出血组患者出院时NIHSS评分为(50.15 ±5.24)分,高于入院时的(34.52 ±3.26)(P＜0.05);微小出血组患者出院时NIHSS评分为(30.25±2.60)分,低于入院时(35.83 ±3.65) (P ＜0.05);出院时微小出血组患者NIH-SS评分相比大出血组显著更低(P＜0.05).结论:SWI技术用于AIS患者静脉溶栓后HT诊断,可较好地识别微小出血,检出效果较理想,对HT出现面积的判断也较准确;另外,出血面积越大,AIS患者的预后也越差.     

急性缺血性脑卒中患者血运重建前后NLR值与预后相关性分析

  目的   通过研究急性缺血性脑卒中血运重建前后与预后不良有关的影响因素,以期为临床医师预测患者预后提供更多的生物学标志物。   方法   收集2020年12月至2021年10月昆明医科大学附属曲靖医院神经内科及神经介入科收治的急性缺血性脑卒中并接受血运重建治疗（包括静脉溶栓、机械取栓切除术或者2者均行）的患者179例,根据3个月后mRS评分分为预后良好组（mRS < 3分）和预后不良组（mRS≥3分）。比较2组患者的一般资料、临床检验指标、血运重建前后NLR值、NIHSS评分等,并进一步分析预后不良组患者的独立危险因素。  结果   （1）预后良好与预后不良2组患者的甘油三酯、总胆固醇、C反应蛋白、入院的NIHSS评分、中性粒细胞数及百分比、淋巴细胞数及百分比、NLR值及血运重建后8h的白细胞、中性粒细胞数及百分比、淋巴细胞数与百分比、NLR值,差异具有统计学意义（P < 0.05）;（2）多因素Logistic回归分析,入院NIHSS评分（OR = 1.123,95% CI 1.065～1.184,P < 0.05）是AIS患者血运重建后3个月预后不良的独立危险因素,临床诊断分界值为11;（3）NLR值比较:预后不良组血运重建前后的NLR值均高于预后良好组,差异有统计学意义（P < 0.05）,AIS患者血运重建后NLR值较血运重建前升高,差异有统计学意义（P < 0.05）。  结论  入院时的NIHSS评分是AIS血运重建患者发病3个月不良预后的独立危险因素。AIS患者血运重建前后NLR变化具有上升趋势,预后不良组血运重建前后的NLR高于预后良好组,但并非AIS患者血运重建3个月后不良预后的独立危险因素。     

肾功能损害对急性缺血性脑卒中机械取栓临床预后的影响

目的 ：评估肾功能损害对急性缺血性脑卒中（acute ischemic stroke,AIS）患者行机械取栓（mechanical thrombectomy,MT）术后临床结局的影响。方法：选择行MT治疗的AIS患者270例,根据估算肾小球滤过率（estimated glomerular filtration rate,eGFR）分为对照组（eGFR≥60 min/1.73 m2）165例和肾功能损害组（eGFR<60 mL/min/1.73 m2）105例,比较两组临床特征、症状性颅内出血（symptomatic intracerebral hemorrhage,sICH）发生率、血管再通程度和术后3个月改良RANKIN量表（mRS）评分,分析不良预后的危险因素。结果：肾功能损害组平均年龄78.6±8.6岁、冠心病占比28.6%、房颤病史占比53.3%、入院时NIHSS评分16(12～20)分,分别高于对照组的67.2±11.4岁、13.3%、30.3%和13(10～18)分,差异均有统计学意义（P<0.05）。肾功能损害组吸烟比例27.6%低于对照组的44.2%(P=0...     

超时间窗急性缺血性脑卒中患者动脉取栓后颅内出血预警模型构建

目的：分析超时间窗急性缺血性脑卒中（acute ischemic stroke,AIS）患者动脉取栓后颅内出血的危险因素,建立预警模型以指导临床。方法：回顾性分析2018年1月—2020年6月接受动脉取栓治疗的146例超时间窗AIS患者的临床资料,依据是否发生颅内出血转化分为出血组和非出血组,比较两组患者的人口学、临床和影像资料。采用Logistic回归分析动脉取栓后颅内出血的危险因素并建立预警模型。采用受试者工作特性（receiver operator characteristic,ROC）曲线评估预警模型对动脉取栓后颅内出血的预测效能。结果：48例（32.9%）出现颅内出血。与非出血组比较,出血组基线美国国立卫生研究院脑卒中量表（NIHSS）评分更高（P < 0.001）、支架取栓次数更多（P=0.049）、基线Alberta卒中项目早期CT（ASPECT）评分更低（P < 0.001）。Logistic回归显示,高NIHSS评分（P=0.001）和低ASPECT评分（P < 0.001）是出血转化的危险因素。预警模型为：颅内出血风险值=-0.535+0.130×NIHSS评分-0.597×ASPECT评分。模型预测取栓后颅内出血的ROC曲线下面积灵敏度和特异度分别为0.875、0.854和0.837。结论：高基线NIHSS评分和低基线ASPECT评分是超时间窗AIS患者动脉取栓后发生颅内出血的危险因素。预警模型可为超时间窗AIS患者动脉取栓后的临床观察和出血转化防治提供依据。     

急性脑梗死患者r-tPA静脉溶栓后出血转化的风险预测研究

目的 研究急性脑梗死患者重组组织型纤溶酶原激活剂（r-tPA）静脉溶栓治疗后出血转化（HT）的预测方法.方法 回顾性分析80例急性脑梗死患者溶栓治疗前后的临床和影像学资料.结果 单因素回归分析表明溶栓前有阿司匹林服药史、房颤史、溶栓前美国国立卫生院神经功能缺损评分（NIHSS）高及心源性卒中是HT的危险因素,而Alberta卒中项目早期CT评分（CT-ASPECTS）高则是保护因素.多因素回归得出NIHSS评分和CT-ASPECTS评分为溶栓后发生HT的独立预测因素.NIHSS评分预测r-tPA静脉溶栓后HT发生的最佳分割点为11分,CT-ASPECTS评分预测r-tPA静脉溶栓后HT发生的最佳分割点为7分.NIHSS评分≥11分组较＜1 1分组、CT-ASPECTS评分≤7分组较＞7分组患者的HT风险高.结论 NIHSS评分和CT-ASPECTS评分是急性脑梗死患者r-tPA静脉溶栓治疗后发生HT的独立预测因素,有助于临床判断r-tPA静脉溶栓治疗后HT的发生.     

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.