造血干细胞移植后巨细胞病毒感染临床分析

目的观察各种类型的造血干细胞移植（HSCT）后巨细胞病毒（CMV）感染的发生情况及疗效。方法选择我院59例异基因造血干细胞移植（allo—HSCT）和自体造血干细胞移植（auto—HSCT）患者移植后不同时期血和尿标本，检测CMV—pp65抗原及（或）CMV—DNA（荧光定量PCR法）进行动态观察分析。CMV感染的预防采用更昔洛书（DHPC）5～10mg／kg，1次／12h，分别在移植前第8天至移植当天及当CMV血清学检测阳性或发生CMV病时应用2-4周，并可同时应用大剂量丙种球蛋白。结果CMV感染在allo—HSCT后好发，非亲缘性移植CMV感染率高，9例allo—HSCT出现CMV感染发生在移植后＋42-＋68天，其中5例均存在不同程度的移植物抗宿主病（GVHD），尤其是Ⅱ～Ⅳ度急性GVHD，2例进展为巨细胞间质性肺炎（CMV-1P）；多为既往CMV感染被激活，对CMV—DNA阳性而无症状者进行预防治疗可使CMV—DNA阴转，可降低CMV病的发生。结论CMV病是allo—HSCT的常见并发症及主要致死原因之一；因此积极防治GVHD的发生及发展、定期监测CMV血清学阳性患者、早期干预性治疗可以提高移植的成功率。     

造血干细胞移植后出血性膀胱炎

目的探讨造血干细胞移植（HSCT）后出血性膀胱炎（HC）的发病相关因素及治疗措施。方法观察135例HSCT患者HC的发生情况，就其发生因素进行分析，并对HC的预防和治疗进行临床评价。结果HC发病率为10．4％，中位发病时间36．5d（11-54d），平均病程20．1d（7-50d），经过积极治疗均可好转或治愈；无关供者与HC发病明显相关。结论异基因造血干细胞移植尤其是无关供者的移植是引起HC的危险因素。     

造血干细胞移植后早期出血并发症的危险因素与预后分析

目的了解造血干细胞移植（HSCT）患者早期出血并发症的状况,分析其危险因素及与生存的关系。方法观察318例HSCT患者的出血状况,按出血程度分为轻、中、重度出血,按出血部位分为皮肤黏膜、消化道、呼吸道、女性阴道、眼、颅内出血及出血性膀胱炎（HC）,选用Logistic回归模型分析各因素与出血的相关性,Cox比例风险模型进行预后分析。结果211例患者在移植后初期发生出血并发症,其中轻度143例（45．O％）,中度59例（18．6％）,重度9例（2．8％）。预处理方案含ATG（OR=3．460）、异基因来源干细胞（OR=1．918）、感染（OR=1．691）、急性移植物抗宿主病（aGVHD）（OR：2．252）、血小板最低值≤15×109／L（OR=2．499）是出血的危险因素,异基因移植（OR=5．431）、aGVHD（OR=5．059）、巨细胞病毒感染（OR：4．241）、多瘤病毒尿（OR=5．723）是HC的危险因素,重度出血（RR=6．106）、出血部位位于颅内（RR=12．131）及呼吸道（RR=9．202）可独立增加移植后死亡风险。结论移植期间血小板减少等多种因素可造成出血风险增加,重度出血、颅内出血及呼吸道出血增加移植后患者死亡风险。     

造血干细胞移植患者巨细胞病毒感染危险因素和疗效分析

目的 :了解造血干细胞移植 (hematopoieticstemcelltransplantation ,HSCT)后巨细胞病毒 (Cy tomegalovirus,CMV)感染的发生率、相关危险因素及抗病毒药物疗效。 方法 :选择 1 998年 1月至 2 0 0 0年 1 2月在我所行HSCT的 2 0 2例患者进行回顾性分析。移植前预处理采用化疗联合全身照射或马利兰联合环磷酰胺方案。多数异基因HSCT移植后移植物抗宿主病 (graft versushostdisease,GVHD)预防采用环孢菌素A联合短程甲氨喋呤。CMV感染预防采用更昔洛韦 (ganciclovir,DHPG) 1 0mg·kg-1 ·d-1 ,分两次静点 ,移植前第 9天至移植前第 2天连续 8d。移植后应用多聚酶链反应 (PCR)定期进行病毒DNA监测 ,CMV阳性或发生CMV病的患者应用DH PG或 /和膦甲酸钠或联合这两种制剂进行治疗。结果 :HSCT后CMV活动性感染率为 35 .6 % (72 /2 0 2 ) ;间质性肺炎最常见占感染人数的 4 4 .4 % (32 /72 ) ,单纯病毒血症占 33.3% (2 4 /72 ) ,CMV肠炎占 1 3.9% (1 0 /72 )。感染的高峰时间为移植后第 6 0～ 90天。DHPG或 /和膦甲酸钠治疗的总有效率约为 6 0 %。经单因素分析证明异基因HSCT ,急、慢GVHD是HSCT后CMV感染的重要危险因素 ,而年龄、性别、疾病种类、移植前CMV血清学状态、预处理方案与CMV感染无显著相关性。结论 :CMV感     

CD25抗体在单倍型干细胞移植后肠道急性GVHD治疗中的应用

目的 观察CD25抗体(巴利昔单抗)治疗单倍型造血干细胞移植(HSCT)后发生肠道Ⅲ～Ⅳ度急性移植物抗宿主病(aGVHD)的疗效.方法 2004年10月至2009年9月北京军区总医院20例单倍型HSCT后发生肠道Ⅲ～Ⅳ度aGVHD的患者,男13例,女7例,于确诊肠道aGVHD当日给予巴利昔单抗治疗,同时使用甲泼尼龙1 mg·kg-1·d-1静脉点滴,巴利昔单抗分别在第1、4天静脉点滴,每次的剂量是20 mg,如果肠道aGVHD无改善,第2周再重复使用,分析治疗疗效,观察输注相关的不良反应和巨细胞病毒(CMV)感染情况.结果 20例患者中完全缓解10例,部分缓解为5例,总有效率75.0%.使用巴利昔单抗后1～12 d,患者肠道aGVHD症状开始缓解,平均取得缓解时间为7 d.随访时间6～64个月,中位随访时间25个月.在完全缓解的10例中8例持续完全缓解无aGVHD复发;2例aGVHD复发患者,再次用巴利昔单抗取得缓解.9例生存,最长存活64个月,其中4例患者停用糖皮质激素,另外5例用低剂量糖皮质激素维持.Kaplan-Meier生存计算2年无病生存率为47.5%.结论 巴利昔单抗治疗单倍型HSCT后发生的肠道Ⅲ～Ⅳ度aGVHD疗效显著,未增加白血病复发和感染率.     

儿童异基因脐血造血干细胞移植期间的巨细胞病毒感染

目的：研究儿童异基因脐血造血干细胞移植期间巨细胞病毒（CMV）感染与移植疗效的关系及治疗效果。方法：12例儿童异基因脐血造血干细胞移植患者均在移植前检测CMV－IgM，阳性者检查CMV－Ag，均应用阿昔洛韦口服或联合更昔洛韦静滴进行预防及治疗，待CMV－Ag阴转后进行移植，移植后CMV活动性感染（CMV－IgM或CMV－Ag阳性），应用更昔洛韦或膦甲酸钠治疗，结果：10例患者移植前CMV－IgM阴性，2例患者移植前CMV－IgM及CMV－Ag阳性，移植后9例在＋4－＋380d初次发现活动性CMV感染，＋180d以内发生者共8例，7例伴急性移植物抗宿主病（aGVHD)，经更昔洛韦或膦甲酸钠治疗，7例CMV－Ag阴转，治疗期间未发现严重毒性，＋180d以后伴CMV活动性感染者5例，定期监测，未予治疗，暂未发现CMV相关疾病。结论：CMV感染与aGVHD发生可能有关。移植后应用更昔洛韦或膦甲酸钠治疗CMV感染是较安全的；对于经济困难的患者，若移植180d后CMV－Ag阳性，可选予密切监测。     

无关供者脐血移植治疗小儿急性白血病

目的　探讨无关供者脐血移植 (UNRUCBT)治疗小儿急性白血病的可行性。方法　用HLA不全相合UNRUCBT治疗小儿急性白血病患儿 6例。供给受者的有核细胞 (3 63～ 15 35 )× 10 7/kg ,CD34 +细胞 (0 2 8～ 1 0 3)×10 7/kg ,粒 -巨噬细胞集落形成单位 (2 12～ 8 32 )× 10 5/kg。移植的预处理方案采用马利兰 +环磷酰胺 +抗胸腺细胞球蛋白方案。结果　 6例患儿白细胞均达到了植入的标准 ,其平均中性粒细胞 >0 5× 10 9/L时间为 19 33d ;5例血小板达到植活标准 ,其平均血小板 >5 0× 10 9/L时间为 5 7 4d。 5例患儿发生急性移植物抗宿主病 (aGVHD) ,其中Ⅰ度aGVHD 1例 ,Ⅱ度aGVHD 3例 ,Ⅳ度aGVHD 1例 ,慢性移植物抗宿主病 (aGVHD) 1例。 1例死于Ⅳ度aGVHD ,1例死于Ⅲ度HC。 4例长期存活的患儿中 ,1例在移植后 12个月出现“供者型”复发 ,经再次化疗获得完全缓解 ;另 3例分别无病存活 2 9,2 2 ,16个月。结论　URUCBT能长期重建受体造血功能     

凝血相关因子与细胞因子在造血干细胞移植早期的临床意义

目的揭示造血干细胞移植（HSCT）早期凝血相关因子及特异性细胞因子的动态改变,探讨其在移植相关性血栓病变及其他并发症中的临床意义。方法采用ELISA法对95例接受HSCT的患者标本进行监测,观察预处理过程以及造血干细胞移植后4周内患者血浆中各种指标的动态改变。根据移植后首先出现的并发症分为4组：平稳组41例、急性移植物抗宿主病（aGVHD）组29例、血栓组6例和感染组19例进行统计分析。结果 HSCT在预处理过程中,纤溶酶原激活剂移植物（PAI-1）水平先升高,移植当周下降,随后又逐步上升;PAI-1和组织型纤溶酶原激活剂（t-PA）在血栓组有明显的升高（均P〈0.001）,且两者在血栓组和aGVHD组间差异亦有高度统计学意义（均P〈0.01）。蛋白C（PC）水平的降低在aGVHD组有高度统计学意义（P〈0.001）,且在aGVHD与感染组间差异有高度统计学意义（均P〈0.01）。预处理前肿瘤坏死因子（TNF-α）水平在aGVHD组已经较正常升高（P﹤0.01）,其他患者中未见明显改变。在预处理第4天后所有患者都较前明显升高（P﹤0.05）,预处理结束TNF-α较前降低。发生aGVHD、血栓或感染时,TNF-α均明显升高,以aGVHD组升高更为明显,血栓组TNF-α升高水平大于感染组（P﹤0.05）。血栓和aGVHD组的TNF-α在发病前2周即有升高,感染组患者在发病前未见改变。白介素（IL）1-β在移植患者预处理各阶段未见明显变化,发生aGVHD、血栓、感染时IL1-β均有升高,以血栓组升高更明显,aGVHD组较感染组也明显升高（P﹤0.01）。在血栓患者发病前2周明显升高,而aGVHD组于发病前1周升高。结论 （1）血浆PAI-1水平的增高可能是移植相关性血栓病变的特异性指标,提示肝静脉闭塞病（HVDD）、血栓性微血管病（TMA）等血栓并发症的发生。（2）t-PA抗原对aGVHD和血栓有鉴别诊断的意义,PC在aGVHD的早期预测方面有一定的作用。（3）预处理可造成细胞因子TNF-α释放增加。在aGVHD发生时,血清TNF-α水平明显升高且较血栓患者升高更突出;在血栓发生时,血清IL1-β含量明显升高,并高于aGVHD患者。     

45例造血干细胞移植相关并发症分析

目的探讨造血干细胞移植（HSCT）治疗恶性血液病并发症的发生情况及其防治。方法45例急慢性白血病、恶性淋巴瘤患者中,30例选择自体造血干细胞移植（auto-HSCT）,15例接受异基因造血干细胞移植（allo-HSCT）,包括HLA不全相合3例及非血缘关系移植4例,混合移植2例;预处理auto-HSCT主要选用BE-AC、CBV方案,allo-HSCT采用BU/CY2及改良的BU/CY方案;移植物抗宿主病（GVHD）的预防采用环孢菌素A（CsA）＋甲氨喋呤（MTX）或CsA＋MTX＋骁悉（MMF）方案。结果30例auto-HSCT患者中70%出现口腔黏膜炎;40%出现不同部位的感染。15例allo-HSCT患者中80%出现口腔黏膜炎;53%出现不同部位的感染;巨细胞病毒（CMV）感染发生率20%;出血性膀胱炎（HC）发生率13%;7%出现肝静脉闭塞病（HVOD）;33%出现急性移植物抗宿主病（aGVHD）;7%出现慢性移植物抗宿主病（cGVHD）;移植相关死亡率27%。结论移植相关并发症是影响造血干细胞移植成功的重要因素,移植期间需要进一步探索、加强移植相关并发症的防治,以提高移植成功率。     

HLA配型不合造血干细胞移植治疗血液病

目的 评价亲缘人类白细胞抗原(HLA)配型不合造血干细胞移植(HSCT)治疗血液病的疗效和并发症.方法 对12例血液病患者进行了亲缘HLA至少1个位点不合的HSCT.预处理分别采用改良Bu/Cy ATG、Flu Cy ATG、Flu Bu ATG、Ara-C Bu Flu ATG方案.采用环孢素A(CsA)、短疗程甲氨蝶呤(MTX)、霉酚酸酯(MMF)的三联方案预防急性移植物抗宿主病(aGVHD),对2例患者加用了CD25单抗.结果 患者移植后造血均顺利恢复,除1例骨髓增生异常综合征伴骨髓纤维化患者植入失败自身恢复外,均达完全供者型植入.10例发生aGVHD(10/12),其中Ⅰ度4例,Ⅱ度3例,Ⅲ度1例,Ⅳ度2例.在可供评价的9例患者中,5例发生慢性GVHD(cGVHD),其中局限型3例,广泛型2例.巨细胞病毒(CMV)感染5例,其中1例为CMV间质性肺炎.死亡4例,其中2例死于肺部感染,1例死于肠道Ⅳ度aGVHD,1例死于多器官功能衰竭.中位随访时间239(72～570) d,7例无病生存,1年预计总生存率(66.7±2.3)%,1年预计无病生存率(58.3±2.2)%,仍在继续随访中.结论 亲缘HLA配型不合HSCT是治疗血液病的有效方法之一,须警惕移植后GVHD及机会性感染的发生.     

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.