氯胺酮对大鼠海马神经元瞬间外向钾电流的抑制作用

目的：观察氯胺酮对大鼠海马锥体神经元瞬间外向钾电流（I_A）的影响。方法：酶消化法急性分离Wistar大鼠海马锥体神经元,采用全细胞膜片钳技术测定I_A。加用不同浓度（10、30、100、300和1 000 μmol/L）氯胺酮后,计算I_A抑制率,建立氯胺酮的浓度-效应曲线,选择30 μmol/L氯胺酮作I_A稳态激活（及失活）曲线。结果：10 μmol/L的氯胺酮对I_A的电流幅度无影响;30、100、300和1 000 μmol/L的氯胺酮对I_A的电流幅度抑制率分别为（11±2）%、（22±3）%、（45±5）%和(53±5)%。IC₅₀为（130±24）μmol/L, Hill系数为1.19±0.56。30 μmol/L氯胺酮使激活曲线的半数最大激活膜电位（V _{1/ 2}）从（-8.70±0.13） mV 移动到 （-11.2±2.10） mV (n=8, P<0.05), K从（15.0±4.6） mV移动到（17.6±5.7）mV (n=8, P>0.05);失活曲线的V _1/2从（-75.53±7.98） mV移动到（-91.94±11.85） mV（n=8, P < 0.05）,K从（10.5±2.2） mV移动到（8.0±1.2） mV（n=8, P>0.05）。30 μmol/L氯胺酮使I_A的激活和失活曲线均向超极化方向明显移动。 结论： 临床浓度的氯胺酮能够同时加速I_A的激活和失活过程,但加速I_A失活的能力大于其加速I_A激活的能力。氯胺酮对中枢神经系统的作用可能与I_A抑制有关。     

氯胺酮对大鼠海马神经元高电压激活钙电流的作用

目的 观察氯胺酮对大鼠海马神经元高电压激活钙电流(ICa(HVA))的影响.方法 培养Wistar大鼠海马神经元,采用全细胞膜片钳技术测定ICa(HVA).加用不同浓度(10、30、100、300、1000μmol/L)氯胺酮后,计算ICa(HVA)抑制率,建立氯胺酮的浓度-效应曲线,选择100μmol/L氯胺酮作ICa(HVA)稳态激活(及失活)曲线.结果 10 μmol/L 的氯胺酮对ICa(HVA)的电流幅度无影响;30、100、300和1000μmol/L的氯胺酮对ICa(HVA)的电流幅度抑制率分别为(17.5±4.5)%、(25.5±6.9)%、(38.5±4.1)%和(42.3±4.6)%.拟合后的浓度-效应曲线的半数最大抑制浓度为68.2μmol/L,希尔系数为0.47.激活曲线的最大激活膜电位由(5.4±0.9)mV 变为(5.3±0.8)mV;失活曲线的半数最大激活膜电位从(-26.7±3.9) mV移动到(-32.8±4.2)mV,斜率从-0.0067±0.0002变为-0.0076±0.0002.结论 氯胺酮对ICa(HVA)通道有抑制作用,氯胺酮对中枢神经系统的作用可能与ICa(HVA)抑制有关.     

尼可刹米对新生大鼠海马神经元钠通道的影响

目的:观察尼可刹米对新生大鼠海马神经元电压依赖性钠通道的影响.方法:制备大鼠海马脑组织切片,灌流含5 mg/L尼可刹米的人工脑脊液,应用全细胞膜片钳技术记录给药前、给药后10 min脑组织切片海马神经元电压依赖性钠电流,绘制给药前后钠通道的钠电流一测试电压(I-V)曲线、稳态激活曲线和稳态失活曲线.结果:尼可刹米在脑电位-50-+20 mV范围内增大钠电流.尼可刹米使钠通道稳态激活曲线中钠通道半数激活电压由(-34.6±3.07)mV变为(-37.63±3.37)mV(t=3.38,P=0.02),曲线向超极化方向变化;尼可刹米使钠通道的稳态失活曲线中钠通道半数失活电压由(-43.36±3.06)mV变为(-33.24±2.05)mV(t=6.13,P=0.002),曲线向去极化方向变化.结论:增加电压依赖性钠电流可能是尼可刹米兴奋中枢神经元的作用机制之一.     

缺血再灌注处理对乳鼠心肌细胞钠电流的影响

目的研究缺血再灌注(I/R)处理对乳鼠心肌细胞钠电流的影响。方法实验分为两组:对照组为体外培养乳鼠心室肌细胞;I/R组为相同的细胞,缺血3 h,再灌注1 h,采用膜片钳全细胞模式记录仪分别记录并比较对照组和I/R组的钠电流。结果和对照组相比,I/R组在每一指令电压上都增大钠电流;在测试电压为-20 mV的条件下,钠电流峰值电流密度从(-159.74±63.80)pA/pF增至(-397.25±82.99)pA/pF(n=7,P(0.05);通道稳态激活V1/2分别为(-58.77±3.83)mV和(-51.51±5.34)mV(n=5,P(0.05);稳态失活V1/2分别为(-58.77±3.83)mV和(-51.51±5.34)mV(n=5,P(0.05);通道失活后恢复τ分别为(8.57±1.50)ms和(6.30±0.57)ms(n=5,P(0.05)。结论 I/R处理可以增大钠电流的峰值电流,并使电压电流曲线下移;减慢通道的时间依赖性激活,促进通道的电压依赖性失活,失活后恢复变快。钠通道的这些改变可能是引起心肌细胞缺血再灌注损伤的重要原因。     

加巴喷丁对急性分离大鼠三叉神经节神经元高电压激活钙电流的影响

目的:评价加巴喷丁对急性分离大鼠三叉神经节神经元高电压激活钙电流的影响.方法:清洁级SD雄性大鼠,150～200 g,酶消化急性分离双侧三叉神经节神经元,采用全细胞膜片钳技术记录三叉神经节神经元高电压激活钙电流.记录加巴喷丁10、30、100 μmol/L (G1-3组,n=10)作用下的钙电流,计算电流抑制率;并绘制浓度依赖曲线和100 μmol/L加巴喷丁作用下钙电流-电压曲线、钙通道激活曲线和稳态失活曲线.计算半数激活电压和半数失活电压.结果:加巴喷丁(10、30、100 μmol/L)均能抑制三叉神经节神经元钙电流(P<0.05),且抑制率随浓度增加而增大(P<0.05).加入100 μmol/L加巴喷丁后,钙电流峰值降低,激活曲线和稳态失活曲线分别向超极化方向移动,半数激活电压和半数失活电压均降低(P<0.05),且稳态失活曲线移动程度大于激活曲线.结论:加巴喷丁能够抑制三叉神经节神经元高电压激活钙电流,可能与其主要改变钙通道失活动力学特征有关.该作用可能为加巴喷丁治疗三叉神经痛作用机制之一.     

表达心脏SCN5A基因的人胚肾细胞钠电流特性及其对钠通道阻滞剂的反应性

目的 利用人胚肾293细胞表达心脏钠通道SCN5A基因并研究其钠电流特性和对钠通道阻滞剂的反应性.方法 野生型SCN5A基因和SCN1B基因共表达于人胚肾293细胞,应用全细胞膜片钳技术记录给药(氟卡尼与利多卡因)前后的钠电流.结果 SCN5A基因转染效率约为60%;测试电压为-40 mV时记录到钠电流峰值大小约为-8 nA;100 μmol/L的氟卡尼轻度抑制钠电流,使钠电流峰值减少(21.1±4.6)%[(-435.8±30.5) pA/pF vs.(-343.9±27.1) pA/pF,P＜0.01];氟卡尼使钠通道激活曲线和失活曲线均呈负向移动,改变的幅值分别是-6.08 mV[(-51.88±1.20) mV vs.(-57.96±0.79) mV,P＜0.05]和-9.08 mV[(-94.12±0.13) mV vs.(-103.20±0.11) mV,P＜0.05];1 Hz和10 Hz频率刺激时,氟卡尼使钠电流分别减少(64.5±10.7)%和(83.5±12.2)%(P＜0.01);30 μmol/L利多卡因使钠通道失活后快恢复时间常数和慢恢复时间常数分别延长2倍和3倍.结论 表达心脏钠通道SCN5A基因的人胚肾293细胞模型可用于基因特异性的钠通道阻滞剂安全性与药效学筛查.     

Effect of CPUHY002 on transient outward potassium current in rat ventricular myocytes

目的 观察一种新合成的磷酸二酯酶Ⅲ(PDEⅢ)抑制剂CPUHY002对大鼠心肌细胞瞬时外向钾电流(Ito)的影响.方法 采用全细胞膜片钳技术考察CPUHY002对急性分离大鼠心肌细胞和H9c2细胞系Ito的作用.结果 在+50 mV下,CPUHY002对急性分离细胞和H9c2细胞系的Ito呈浓度依赖性抑制,其半数有效抑制浓度(IC50)分别为0.98 μmol/L和0.91 μmol/L;1 μmol/L CPUHY002可使I-V曲线明显下移,Ito 峰值分别下降(39.10±2.30)% 和(47.32±2.06)%,激活曲线右移,失活曲线左移(未见于H9c2),恢复曲线无显著变化.结论 CPUHY002可浓度依赖性地抑制大鼠心肌细胞Ito.     

褪黑激素对新生大鼠海马神经元延迟整流钾电流的影响

目的 用膜片钳技术观察褪黑激素对电压门控性延迟整流钾电流(Ik)的影响,探讨褪黑激素在中枢神经系统的作用机制及其生物学意义.方法 选择7～12 d原代培养的新生Wistar大鼠海马锥体神经元,用膜片钳电压钳全细胞记录模式观察Ik的基本电生理特点,并观察不同浓度褪黑激素,包括1、10、100 nmol/L、1、10、100 μmol/L和1 mmol/L对Ik的幅度及动力学特性的影响.结果 利用海马锥体神经元的钾电流对4-AP、TEA的敏感性及电生理特性的不同可分离出激活、失活缓慢,具有强烈外向整流特性的延迟整流钾电流.褪黑激素对海马锥体神经元Ik的影响是快速、可逆、呈电压依赖性的,但对其激活曲线没有影响.褪黑激素对Ik的作用具有浓度依赖性.1～100nmoI/L的褪黑激素可逐渐递增地增加Ik幅度;1～100 μmol/L褪黑激素对Ik的增加程度随浓度增加而增大,而1 mmol/L褪黑激素的增加程度却减小.结论 褪黑激素可逆地增强体外培养新生大鼠海马神经元的Ik电流,这或许参与了神经元损伤和记忆损害的某些环节.     

厄贝沙坦电生理作用的实验研究

目的:研究厄贝沙坦(Irbesartan)对正常豚鼠心室肌细胞L-型钙电流(ICa-L)、内向整流性钾电流(IK1)、快钠流(INa)以及跨膜动作电位的影响.方法:应用膜片钳全细胞记录方法记录各项离子流和跨膜动作电位.结果:①厄贝沙坦呈浓度依赖性阻断ICa-L,10,100和1000 nmol/L的厄贝沙坦分别使ICa-L密度 (pA/pF)从 (-9.8±1.1)减少到(-6.7±0.9),(-4.2±0.8)和(-2.1±0.4)(n=5,P<0.05或P<0.01).②厄贝沙坦可使ICa-L I-V曲线上移,但不改变其激活的电压依赖性和反转电位.③厄贝沙坦呈使用依赖性阻滞ICa-L.④厄贝沙坦对ICa-L激活曲线无明显影响,但可使钙电流稳态失活曲线左移,加速钙通道电压依赖性失活,对照组V1/2和κ值分别为(-30±5)mV,(8.2±0.7),厄贝沙坦组为(-39±7) mV,(11.6±1.3)(n=5,P均<0.05).⑤厄贝沙坦100 nmol/L使ICa-L失活后再激活的恢复时间常数(τ)从对照组(62.5±2.3) ms延长至(126.4±2.6) ms(P<0.01).⑥厄贝沙坦对IK1和INa无明显影响.⑦厄贝沙坦(100 nmol/L)可使单个心室肌细胞动作电位时程(APD30,APD50,APD90)从(106±10),(125±16),(178±23)ms缩短至(82±16),(99±6),(122±18) ms(n=5,P<0.05),对静息电位、动作电位幅度无影响. 结论:厄贝沙坦作用于L-型钙通道的失活态从而阻断ICa-L.     

四氢小檗碱衍生物86035对豚鼠心室肌L型钙通道的抑制作用

目的　研究氯苄基四氢小檗碱 (CPU) 86 0 35对豚鼠单个心室肌细胞L型钙通道的抑制作用 ,分析对L型钙通道相互作用的状态依赖性。方法　采用膜片钳全细胞技术 ,记录不同浓度(5 0～ 2 5 0 μmol/L)CPU86 0 35作用前后的L型钙电流 (ICa L)。结果　 (1)CPU86 0 35呈剂量依赖性地抑制L型钙电流 ,半数抑制浓度 (IC50 )为 75 μmol/L。(2 )CPU86 0 35对L型钙电流的抑制依赖于保持电位(HP)。HP =- 4 0mV时 ,75 μmol/LCPU86 0 35的抑制率为 4 9%± 2 % ,HP =- 80mv时 ,抑制率为6 4 %± 4 %。 (3)CPU86 0 35作用后 ,稳态激活曲线右移 ,V1/ 2 由对照的 6 7mV± 1 6mV变为 15 4mV±0 8mV。 (4)CPU 86 0 35作用后 ,稳态失活曲线右移 ,V1/ 2 由对照的 - 19 1mV± 2 5mV变为 - 12 6mV± 2 7mV。 (5 )用药后L型钙通道从失活状态恢复的时间变长。结论　CPU86 0 35对L型钙通道有较强的抑制作用 ,药物可能主要与通道的静息状态结合     

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.