Objective To screen the genes related to novel gene AngReml04. Methods Gene chip was employed to detect the genes related to AngRem104 by its over-expressed constructs, which was produced by transfection of the sense- and antisense-AngReml04 into human mesangial cells, and then RT-PCR was used to confirm the up-regulated expression of related genes. Results There were 94 genes up-regulated and 2 genes down-regulated when AngRem104 was over-expression. The different expression genes were cataloged as extracellular matrix and receptor protein, DNA-binding and transcription-related protein, immune-related protein, cytoskeletal and dynamic protein, synthesis and metabolism related protein. Fibronectin (FN) and integrin beta 1 (fibronectin receptor) were dramatically over-expressed in the top of all up-regulated genes. Furthermore, the correlative expression between AngReml04 and FN was detected by RT-PCR. Conclusion Gene chip not only demonstrates the clues for further investigation of novel gene AngRem 104, but also reveals the co-expression of AngRem104 and fibronectin.

AIM: To study the expression and function of novel gene AngRem104. METHODS: Northern blot was performed to detect the distribution of AngRem104 in human multiple normal tissues as well as the effect of AngⅡ and AT1R antagonist (losartan) on AngRem104 expression. The sense and antisense eukaryotic expression vectors of AngRem104 were constructed and transfected into human mesangial cells. RT-PCR was used to detect the expression of FN when AngRem104 was over-expressed. Primary sequence and motif analysis of AngRem104 protein were performed by on-line ExPasy predictive tools. RESULTS: AngRem104 was predicted to localize at the cellular nucleus. It was widely expressed in human heart, placenta, liver, muscle, kidney and pancreas. Moreover, the up-regulated expression of AngRem104 induced by AngⅡ was inhibited by losartan in a dose-dependent manner. CONCLUSION: AngRem104 is a novel nuclear protein related to the expression of fibronectin and could be up-regulated by AngⅡ in human MC.

AIM: To investigate the mechanism of AngRem104-mediated regulation of fibronectin gene in human mesangial cells. METHODS: A series of deleted FN promoter sequences was constructed, which fuse to a luciferase reporter gene, and then the potential active regions that respond to AngRem104 in the upstream regulatory sequence of human FN gene was screened by detecting the luciferase activity of promoter-reporter gene. RESULTS: The detection of relative luciferase activity revealed that there was no significant differences when the HMC were transfected with FN122-reporter gene together with sense AngRem104 construct, but the luciferase activity significantly increased when transfection of FN507-reporter gene construct together with sense AngRem104 construct. However, no increase in luciferase activity was observed when transfection of FN1280-reporter gene construct together with sense AngRem104 construct. The potential regulatory region responds to AngRem104 is in the upstream sequence (-122 to -507) of human FN gene. CONCLUSION: Our preliminary study provided the evidence that AngRem104 may mediate the transcription of the FN gene via the activation of its promoter.

Objective To screen for proteins interacting with novel gene AngRem104 and to identify the putative interaction of novel gene AngRem104 and Bardet-Bied1 syndrome 2 (BBS2) protein in mammalian cells. Methods The yeast strain AH109 was transformed with AngRem104pGBKT7/c-myc and yeast-mating was utilized to screen for interacting proteins with AngRem104 in pretransformed human kidney cDNA library. The human embryonic kidney (HEK 293T) cells were transformed with two recombined plasmids,AngRem104-pcDNA3.1/V5-His and BBS2-pCMV/c-myc. Mouse anti-human V5 monoclonal antibody and mouse anti-human c-myc monoclonal antibody were used in immunoprecipitation and immunoblot analysis, respectively. Results Seven proteins that interact with AngRem104, including BBS2 were identified. The AngRem104-V5 and the BBS2-c-myc fusion protein were detected respectively in the immunoprecipitation by anti-c-myc and anti-V5 antibody. Conclusion The novel gene AngRem104 may interact with BBS2 protein in mammalian cells,which provides insights as to the function exploration of novel gene AngRem104 and the pathogenesis investigation of Bardet-Biedl syndrome.

Objective:To construct preliminarily the malignant risk classification system for the cervical lymph node.Methods:A total of 301 patients with cervical lymphadenopathy were collected in this prospective study from Union Hospital, Fujian Medical University from July 2018 to December 2019. The ultrasonographic features(including the short diameter, ratio of long to short diameters(L/S), margin, border, matting, echogenic hilum, echogenicity, gross necrosis, microcalcification, hyperechoic area, flow type, vascular distribution), history of malignancy, inflammation performance of the neck and history of tuberculosis were analyzed. A score was assigned for each significant index related to benign/malignant lymph nodes by a Logistic regression analysis. The classification of the malignant risk was determined on the basis of the scores.Results:The factors significantly associated with the malignant lymph nodes were enlargement of the short diameter, L/S<2, microcalcification, hyperechoic area, irregular margin, matting, abnormal flow pattern, malignancy history. While the factors related to the benign were the inflammation performance and the fuzzy boundary. The risk of malignancy increased as the score of lymph node increased. The malignant risk of lymph node according to the classification system was as follows: category 1, 7.30%; category 2a, 35.00%; category 2b, 69.30%; category 2c, 91.50%; and category 3, 99.05%. The area under the ROC curve of the system was 0.913.Conclusions:The system has great potential of clinical application to assess the risk of malignancy in cervical lymph nodes.

The treatment of heart failure is a common clinical problem faced by the medical community all over the world. It is also the only cardiovascular disease in the world that is on the rise. Although drug therapy for heart failure has made great progress in recent years, there are still many problems. Therefore, reversing ventricular remodeling, assisting or even replacing the function of the damaged heart and improving the prognosis and quality of life of patients with heart failure through surgical treatment will become the main battlefield for the future treatment of heart failure. As a transitional support therapy or permanent replacement therapy before heart transplantation, ventricular assist device can significantly improve the survival and quality of life of patients with heart failure, and is becoming an important treatment method for patients with end-stage heart failure. This paper aim to review the history and prospect of ventricular assist devices after heart failure.

Objective:To summarize our clinical experience of robot-assisted laparoscopic partial nephrectomy (RALPN), and to discuss its efficacy and safety. Methods:Between December 2007 and October 2008, 6 patients with small exophytie renal masses underwent intraperitoneal robotic partial nephrectomy utilizing the Da Vinci sur-gical system. The perioperative data were collected, and were compared with those performed the same operation in abroad and those performed laparoseopic partial nephrectomy(LPN) with the same team in internal. Results: All the operations were accomplished successfully except the one which required conversion to open nephron-sparing surgery (NSS) due to bleeding occured after the renal artery had been clamped. The mean lesion diameter was 3.2 (2.2-3.6)cm; the mean operative time (not including preoperative set-up time of the Da Vinci surgical system) was 130 (110-160) minutes; the mean warm ischemia time were 40(33-50)minutes; the mean estimated blood loss was 188 (100-380) ml. The patients were ambulant in the 7th postoperative days, and tubes were removaled in 3 days, and mean hospital stay was 9 (8-12)days. Renal function of all patients was in the normal range. Pathology revealed renal cell carcinoma in five, papillary renal cell carcinoma in one. All resection margins were negative. Follow-up ranged from 4 to t5 months, no local residual lesions, local recurrence, incision implantation and dis-tant metastasis were found in all patients. Conclusions.. Robot-assisted laparoscopic partial nephrectomy can be safe-ly performed in selected patients, and it is a feasible approach and a minimally invasive operation for small renal tumors.

Objective:To investigate short-term and long-term outcomes of off-pump coronary artery bypass grafting(OPCABG)in patients aged 80 years and over.Methods:In this retrospective study, clinical data were collected, from June 2005 to July 2014, of 31 patients aged 80 and over years with left ventricular dysfunction who had received OPCABG in Beijing Anzhen Hospital and a follow-up of 3-12 years after discharge.Results:Ages of the patients ranged from 80 to 88 years with a mean age of(82.0±2.1)years.There were 25 males(80.6%). The mean left ventricular ejection fraction(LVEF)of patients was(42.0±6.5)% before operation, and 15 patients had LVEF less than 35%(48.4%). The average operation time was 4 hours.Three patients died in hospital(9.7%), of whom, one died from acute respiratory failure and the two others from low cardiac output syndrome.Perioperative complications included myocardial infarction(1 case, 3.2%), acute cerebral infarction(2 cases, 6.5%), tracheal intubation(3 cases, 9.7%), secondary thoracotomy and hemostasis(1 case, 3.2%), continuous renal replacement therapy(3 cases, 9.7%)and perioperative intra-aortic balloon pump(IABP)(8 cases, 25.8%). Twenty-eight patients were followed up for 3-12 years(median, 8.0 years), and no one had withdrawn.There were 10 all-cause deaths(35.7%), including 5 cardiogenic deaths(17.9%), 2 lung cancer deaths(7.1%), 2 deaths due to sepsis from systemic infection(7.1%), and 1 death from unknown causes.Besides, 2 patients had re-admission(7.1%), 2 patients suffered angina(7.1%)and 1 patient(3.6%)had recurrent myocardial infarction(3.6%). No patient received re-revascularization.Coronary computed tomography angiography(CTA)was performed on all surviving patients 1 year after surgery, and the patency rate of vascular bridges was 100%.Conclusions:Both short-term and long-term clinical outcomes of OPCABG are fair in patients aged over 80 years with left ventricular dysfunction, but the mortality and risk of complications are still high, and comprehensive preoperative evaluation is needed for these patients.

Objective: To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD). Methods: From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG. Results: The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality. Conclusions Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments.

Objective:To summarize the experience of reoperation for 23 cases of cardiac myxoma recurrence.Methods:From January 2002 to December 2018, 1106 patients with cardiac myxoma underwent surgical treatment. Among them, 23 patients underwent reoperation after recurrence. 10 males and 13 females with an average age of (50.5±10.8) years old. There were 22 patients with secondary operation and 1 patient with four operations. 3 cases with mitral insufficiency and 1 case with tricuspid insufficiency. There were 20 patients with NYHA Ⅰ-Ⅱ and 3 patients with Ⅲ-Ⅳ. A total of 1 083 patients with cardiac myxoma undergoing primary operation were selected as the control group. The operation time, cardiopulmonary bypass time, aortic clamping time, ICU monitoring time, ventilator assisted breathing time, postoperative hospital stay, in-hospital mortality and cardiac ejection fraction at discharge were compared between the two groups.Results:8 cases (34.8%) had the first onset in the left atrial septum, and 15 cases (65.2%) in other parts. Recurrence site: left atrium in 17 cases(73.9%), left ventricle in 2 cases (8.7%), right atrium in 3 cases (13.0%), right ventricle in 1 case (4.3%). Reoperation accounted for 2.1% of cardiac myxoma surgery in the same period. The median recurrence time of 13 patients was 24 months. During the same period, mitral valve replacement was performed in 2 cases, mitral valvuloplasty in 1 case and tricuspid valve plasty in 1 case. The average operation time was (3.9±2.8) h, cardiopulmonary bypass time was (107.6±33.8) min, aortic clamping time was (64.9±23.8) min, ICU monitoring time was (20.1±16.0) h, ventilator assisted breathing time was (16.9±8.5) h, cardiac ejection fraction at discharge was 0.51±0.10, postoperative hospital stay was (8.3±1.5) days. The median follow-up time was 5 (1-18) years. One case (4.3%) died of all causes. There was no significant difference in ICU monitoring time, ventilator assisted breathing time, discharge cardiac ejection fraction, postoperative hospital stay and hospital mortality between reoperation patients and one operation ( P>0.05). Conclusion:Atypical cardiac myxoma has a high recurrence tendency after operation. Regular follow-up after the first operation of cardiac myxoma is a necessary means to early detect recurrence and avoid complications. Reoperation after recurrence can still achieve satisfactory results.