人禽流感H5N1毒株PB1基因突变分析

目的 通过对人禽流感H5N1毒株PB1基因序列的变异分析,揭示毒株PB1基因的特征与进化.方法 检测广东地区人禽流感H5N1毒株PB1基因核苷酸序列,同时检索全球人禽流感H5N1毒株PB1基因序列,采用DNA Star Lasergene软件对检索的人禽流感H5N1毒株PB1基因核苷酸序列进行比对和分析,并结合流行病学资料对变异毒株进行进化速度分析.结果 将50株毒株PB1基因核苷酸序列按同源性分成两组:1997-1998年毒株为第1组(G1),2003-2006年毒株为第2组(G2).PB1基因74个氨基酸发生位点置换,占9.78%(74/757).PB1基因Ks值为26.1×10-6～39.8×10-6Nt/d,Ka值为3.91×10-6～5.59×10-6 Nt/d,检验结果显示,基因进化受到负选择性压力.2003-2006年毒株(G2)丢失G757,引起氨基酸结构改变;同时糖基化位点也较1997-1998年毒株减少了1个糖基化位点NES382-384.结论 目前PB1基因进化分成两组,自发突变作用影响PB1基因进化;PB1基因与PB2基因的进化途径在时间特征和区域特征方面类似.2003-2006年毒株PB1基因氨基酸结构和糖基化位点均有改变.     

新型甲型H_1N_1流感毒株NA基因特征和进化

目的 通过对新型甲型H1N1流感毒株神经氨酸酶(NA)基因序列的变异分析,揭示毒株NA基因变异与进化.方法 检测广东地区分离毒株NA基因核苷酸序列,同时对全球新型甲型H1N1流感毒株NA基因进行检索下载,采用Lasergene 7.1软件比对和分析NA基因核苷酸和氨基酸序列,结合临床资料分析变异基因进化,同时分析糖基化位点.结果 2009年4-12月69株毒株NA基因16个氨基酸位点置换,占3.41%(16/469);NA蛋白主要置换位点在V106I/H和N248D.毒株GD-801-2009(H1N1)和GD-1202-2009的NA基因明显受到的感染宿主选择性作用,而毒株GD-1-2009的NA基因明显受到的感染宿主负选择性作用.与毒株GD-1-2006(H5N1) NA基因比较,毒株GD-801-2009的NA基因插入Nt145-204,导致H1N1 NA蛋白增加第49~68位氨基酸(CNQSVITYENNTWVNQTYVN),其中包括4个糖基化位点.结论 广东新型甲型H1N1流感毒株NA基因正向不同方向进化;新型甲型H1N1流感NA蛋白新增4个糖基化位点.     

两株人H7N9禽流感病毒的全基因组测序及分子特征分析

【目的】对两株从轻症病例和重症死亡病例中分离的人H7N9禽流感病毒进行全基因组测序,研究其来源、基因组特征以及相互间的分子差异,旨在了解毒株的遗传进化特征与其致病性及其所致疾病临床类型的关系,为进一步阐明H7N9禽流感病毒的致病机制提供科学依据。【方法】选取两株从轻症病例和重症死亡病例中分离的H7N9禽流感病毒进行全基因组序列测定;运用生物信息学软件比较分析两株病毒的遗传进化关系、基因组特征、受体结合位点、宿主特异性位点及致病相关位点等重要分子特征;从禽流感共享数据(GISAID)下载2013年至2014年10月轻症和重症病例的病毒分离株序列,分析致病相关关键位点差异,并分析这些变异与其致病性及所致疾病临床类型的关系。【结果】这两株H7N9禽流感病毒的HA、NA和M基因来源于2013年华东地区流行的H7N9禽流感病毒,NP、NS、PA、PB1和PB2基因来源于2013年在广东地区禽类中流行的H9N2禽流感病毒;H7N9禽流感病毒PA蛋白L336M和PB1蛋白I368V的突变率随流行时间的延长而逐渐上升,并存在地区差异;两株病毒各基因核苷酸同源性达到99.2%以上,氨基酸同源性在99.5%以上,但各基因节段存在个别氨基酸的差异,其中HA受体结合位点存在一个关键氨基酸的差异(226L和226 Q),宿主特异性位点存在两个关键氨基酸的差异(PB2-591L和PB2-591Q,PB2-627E和PB2-627K),毒力位点存在两个关键氨基酸差异(PA-353R和PA-353K,PB2-627E和PB2-627K);M2均发生了S31N突变;潜在糖基化位点均相对保守;2013年至2014年10月报道的重症病例病毒分离株PB2蛋白E627K突变率高于轻症病例分离株。【结论】两株来自不同临床类型的H7N9禽流感病毒是一种新的重组病毒,是由华东地区流行的人H7N9禽流感病毒和在广东地区禽类中流行的H9N2禽流感病毒基因重组而来;H7N9禽流感病毒的某些致病相关的关键氨基酸位点在流行的过程中不断发生变异,必须密切监测毒株的变异动向;两株致病力不同的病毒各基因节段虽然同源性较高,但存在关键氨基酸位点的差异,其中PB2蛋白627位氨基酸位点的差异可能对病毒的致病性起重要作用,与所致疾病临床类型相关。     

新型甲型H7N9流感病毒PB1-F2蛋白基因进化和变异分析

目的：对新型甲型H7N9流感病毒PB1-F2蛋白基因的进化和变异进行分析,为进一步研究致病性禽流感的致病机制和毒力因子奠定基础。方法：从IRD数据库中下载2013年2月19日至2013年10月31日的H7N9流感病毒PBl基因序列63条,运用MEGA5．2．1软件进行序列分析,用邻接法构建基因进化树;通过氨基酸序列分析PB1基因95～367片段的PB1-F2蛋白氨基酸位点变化;应用Excel表格对氨基酸构成进行计算;运用Predictive Analytics Software（PASW）18．0软件对氨基酸构成改变进行统计分析。结果：63株甲型H7N9毒株中有17株毒株的PB1-F2蛋白在其氨基酸序列第25位后发生断裂。新型甲型H7N9的进化主要分为两个系别,系别I主要由完整型PB1-F2蛋白毒株构成,系别Ⅱ主要由52aa截短型PB1-F2蛋白毒株构成。完整型PB1-F2蛋白与截短型PB1-F2蛋白各类氨基酸构成存在差异。结论：H7N9流感毒株中存在着截短型PB1-F2蛋白毒株,并且H7N9流感病毒毒株PB1-F2蛋白断裂位点均在25位氨基酸后,这将成为H7N9流感毒株进化过程中重要的特征。完整型PB1-F2蛋白与截短型PB1-F2蛋白氨基酸构成的差异对于甲型H7N9流感病毒致病性的影响有待进一步研究。     

H7N9禽流感病毒对人类致病的分子基础分析

【目的】 了解H7N9禽流感病毒对人类致病的分子特征,为更好地预防与治疗H7N9人禽流感提供科学依据。【方法】 从GISAID数据库中下载中国2013年分离的所有H7N9禽流感病毒株的基因及蛋白序列,并从NCBI数据库中下载其他相关的流感病毒序列,运用生物信息学软件分析H7N9禽流感病毒基因的系统进化特征?受体结合位点?宿主特异位点?飞沫传播关键氨基酸位点?致病及毒力相关位点?耐药性位点及潜在糖基化位点等的变异情况。【结果】 2013年中国流行的H7N9禽流感病毒为四源重组病毒, 所有基因片段均来源于禽类,不含任何人流感病毒基因;病毒HA的受体结合位点发生了2个关键氨基酸的变异(G186V和Q226L);在与飞沫传播有关的关键氨基酸位点中,个别氨基酸已发生了变异(T160A? Q226L);该病毒具有8个毒力增强位点;所有分离株的M2均发生了 S31N变异;分离株A/Shanghai/1/2013的NA的耐药位点发生了R294K变异;所有毒株的潜在糖基化位点均相对保守。【结论】 H7N9禽流感病毒为四源重组的新型禽流感病毒。该病毒具有与人呼吸道上皮细胞SAa-2,6 Gal受体结合的分子基础,但目前尚未获得经飞沫传播的充分条件,人传人的可能性不大。该病毒具有低致病性禽流感病毒的分子特征,表明对禽类致病性不强,但其对人类呈高致病性,这可能与其毒力位点的特征有关。所有分离毒株均发生了对离子通道抑制剂金刚烷胺类药物的耐药性突变,个别毒株已发生了对神经氨酸酶抑制剂奥司他韦(达菲)的耐药性突变。     

2009年新型甲型H1N1流感病毒神经氨酸酶基因进化分析

目的:探讨2009年新型甲型H1N1流感病毒神经氨酸酶(NA)基因的进化及NA基因编码蛋白抗原性、酶活性位点、糖基化位点变异情况。方法:从NCBI基因库检索获得43株不同年代不同地域甲型流感病毒NA基因序列,用Molecular Evolutionary Genetics Analysis version 4.0（MEGA 4.0）软件进行基因进化分析和氨基酸序列分析。结果:2009年新型甲型H1N1流感病毒与禽H5N1流感病毒NA基因的同源性达到85％,潜在抗原位点氨基酸分布相同;所有毒株的酶活性中心位点高度保守,但糖基化位点有变异。结论:2009年新型甲型H1N1流感病毒的NA基因可能来源于禽H5N1流感病毒;神经氨酸酶抑制剂治疗有效。     

中国南方地区3株H5N1亚型人禽流感病毒血凝素基因特性

目的研究中国南方地区H5N1亚型人禽流感病毒血凝素基因分子特征。方法从Genebank中下载中国南方地区3株H5N1亚型人禽流感病毒和其他国家或地区的16株代表性H5N1亚型人禽流感病毒血凝素基因序列，利用生物信息学软件DNASTAR5．0进行核酸同源性分析，用MEGA3．1进行核酸和氨基酸序列比对和进化树分析。结果中国南方3株H5N1亚型人禽流感病毒HA蛋白的重链区和轻链区连接肽的序列为LRERRR—KR，与动物分离的高致病性H5N1亚型禽流感病毒和东南亚地区人禽流感病毒的连接肽相比，减少1个碱性氨基酸；共有8个潜在的糖基化位点，抗原决定簇位点有其独特的特征。基因进化树表明中国南方3株H5N1亚型人禽流感病毒HA基因位于单一的进化簇，与动物来源的高致病性禽流感病毒HA基因同源性高。结论中国南方3株H5N1亚型人禽流感病毒HA基因分子特征一致，有其显著的独有特点。提示候鸟或其他扩散因素在高致病性H5N1亚型流感病毒HA基因的重配方面扮演了重要的作用。     

2000-2009年H1N1甲型流感病毒神经氨酸酶的进化分析和序列解析

目的研究2000-2009年世界各地不同物种流感病毒神经氨酸酶的进化特征和关键位点的变异情况。结论从NCBI数据库下载所需序列,采用生物信息软件对其氨基酸序列进行种系发生树的构建,以及序列特性的分析。结果新型流感病毒和猪/禽流感病毒NA蛋白在进化关系上非常接近,并且抗原决定簇和糖基化位点的变异也大致相同。结论新型毒株NA蛋白可能由早期的H1N1猪/禽流感病毒进化而来,在进化过程中,一些重要位点的变异导致NA蛋白发生抗原性变异,从而导致流感的大爆发。     

新型甲型H7N9流感病毒血凝素基因进化分析

目的探讨2013年4月流行的新型甲型H7N9禽流感病毒的表面蛋白血凝素(HA)基因的进化,以及氨基酸的变异情况。方法从美国国家生物技术信息中心(NCBI)和全球禽流感基因共享数据库(GISAID)中下载H7N9流感病毒以及有代表性的H7N2、H7N3、H7N7亚型流感病毒的HA基因序列,运用Molecular Evolutionary Genetics Analysis(MEGA)version 5.05软件进行序列分析,用邻接法构建基因进化树;通过氨基酸序列分析HA蛋白受体结合位点、糖基化位点和裂解位点的变化。结果 2013年新型甲型H7N9流感病毒与2011年浙江禽类H7N3流感病毒株(JQ906573.1)的相似性达到95.3%～95.6%;受体结合位点氨基酸发生变异,为Q226L,5个糖基化位点高度保守;HA裂解位点位于aa339和aa340之间,仅有1个碱性氨基酸:R。结论 2013年新型甲型H7N9流感病毒HA基因是由中国禽类H7亚型进化而来,Q226L变异导致的受体结合位点的变化可能是新型流感病毒具有人感染性的原因。     

广州市一起水禽H5N1疫情禽流感病毒血凝素基因分析

目的了解广州市一起水禽H5N1疫情中高致病性禽流感H5N1亚型病毒血凝素(HA)基因的特点以及与其他毒株序列间的关系。方法自疫点采集97份咽拭子标本及84份环境拭子标本,实时荧光RT-PCR检测H5核酸,从阳性标本中扩增全长HA基因并作序列测定,同2006年广州市及国内其他地区报道的人禽流感病毒HA基因进行比较并作系统发生分析。结果从一份环境拭子中扩增获得一株H5N1禽流感病毒HA基因,系统发生树分析发现与广州市2006年人禽流感病毒HA序列一致性较高,且与国内其他地区报道的H5N1病毒HA基因属于同一组;从基因序列推导出HA的氨基酸序列,发现其受体特异性为禽源的,蛋白酶水解位点含有多个连续的碱性氨基酸,符合高致病性禽流感病毒的特征。结论引发此次禽间禽流感的为高致病性H5N1病毒,和广州市人禽流感的H5N1病毒在遗传上有紧密的亲缘关系。禽源性的H5N1病毒仍存在感染人类的可能性,禽类从业人员目前处于感染高致病性禽流感的高危状态,进一步加强对活禽市场和禽类从业人员的监测,对于预防禽流感的流行具有重要意义。     

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.