Objective To investigate the expression characteristics of the transcription factor E2F2 in clear cell renal cell carcinoma (ccRCC), its impact on patient prognosis, and its potential role in the tumor immune microenvironment, with validation using clinical samples and functional assays. Methods RNA sequencing data and clinical information of ccRCC patients were obtained from the TCGA database; GSE53757 and GSE66272 datasets were downloaded from the GEO database as external validation cohorts. The expression difference of E2F2 between ccRCC tissue and normal tissue was compared, and the relationship between E2F2 expression and clinical pathological characteristics was analyzed. Kaplan-Meier (KM) survival analysis with log-rank test was performed to evaluate the effects of E2F2 on overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS). The prognostic efficacy of E2F2 in predicting 1-, 3- and 5-year survival was evaluated using receiver operating characteristic (ROC) curve. GSEA was performed to identify E2F2-related signaling pathways, and the ESTIMATE and CIBERSORT algorithms were used to assess the relationship between E2F2 expression level and tumor immune cell infiltration and immune microenvironment. Twenty pairs of surgically resected and pathologically confirmed ccRCC tissues and matched adjacent non-tumor tissues were collected from our hospital, and immunohistochemistry (IHC) was performed to detect the protein expression of E2F2. Human ccRCC cell line 786-O was used for functional assays;shRNA was used to knock down E2F2 expression (constructing stable shE2F2#1 and shE2F2#2 cell lines), and qRT-PCR and Western blot were performed to verify knockdown efficiency, followed by MTT, colony formation, and Transwell migration assays to evaluate the effects of E2F2 on the biological behaviors of ccRCC cells. Results E2F2 was significantly upregulated in ccRCC tissues (the same results in the verification set). Higher E2F2 expression was associated with advanced histological grade, clinical stage and higher TNM classification (P＜0.05). KM analysis showed that patients in the E2F2 high-expression group had worse OS, PFS, and DSS (P=0.019, 0.036, ＜0.001); the ROC curves showed area under the curve (AUC) of E2F2 of predicting 1-, 3- and 5- year survival of ccRCC patients were 0.844, 0.851 and 0.815, respectively. GSEA revealed that the E2F2 low-expression group was enriched in multiple metabolism-related pathways, whereas the E2F2 high-expression group was associated with immune-related pathways. Immune analysis demonstrated that high E2F2 expression was associated with increased immune scores, increased proportion of immune cells, higher tumor mutation burden, and potentially stronger immunotherapy response. IHC results showed that the E2F2 immunoreactivity score in ccRCC tissues was significantly higher than that in adjacent non-tumor tissues (P＜0.05). Functional assays indicated that E2F2 knockdown significantly inhibited the proliferation, colony formation, and migration of ccRCC cells. Conclusion E2F2 is highly expressed in ccRCC and may be involved in tumorigenesis and progression through modulation of the immune microenvironment. Its expression level is closely associated with patient prognosis, and E2F2 has the potential to serve as a prognostic biomarker and immunotherapeutic target in ccRCC.

Objective:To compare the active respiratory circulation technique (ACBT) with the oscillatory positive pressure expiration technique (OPEP) in terms of their ability to improve pulmonary function and minimize complications after cardiac surgery, seeking to define an airway management strategy for such patients.Methods:A total of 101 patients who had undergone cardiac surgery were randomly divided into an ACBT group ( n=50) and an OPEP group ( n=51). On the 1st day after the operation, in addition to conventional medical treatment and early rehabilitation, the subjects were additionally provided with daily 20-minute sessions of ACBT or OPEP training for seven consecutive days. Before the operation, and on the 3rd and 7th day afterward, lung function was assessed using a pulmonary edema imaging assessment system (RALE), computed tomography and pulmonary function indexes. Any complications were also noted. Six-minute walking distance and the Barthel index quantified exercise endurance and ability in the activities of daily living, respectively. Turbidimetry was used to determine the levels of C-reactive protein in the blood. The duration of mechanical ventilation required, ICU stay time, length of postoperative and total hospital stays were also recorded. Results:On day seven after the operation, the average RALE scores of the ACBT and OPEP groups were (12.40±4.37) and (10.20±4.66), respectively—a significant difference. At the same time point, the incidence of atelectasis in the OPEP group was significantly lower than in the ACBT group. The OPEP group′s average maximum inspiratory pressure was a greater percentage of the predicted value, and its average 6-minute walk and BI score were also better. On the 3rd day after the operation, the incidence of lung consolidation in the ACBT group was significantly lower than that in the OPEP group, on average.Conclusions:The curative effect of ACBT is better than that of OPEP in the first few days after such an operation, but after a week OPEP more effectively restores respiratory muscle strength and relieves pulmonary complications. It is recommended to apply these two techniques in stages to optimize postoperative airway management. RALE scoring is an ideal tool for dynamic monitoring of pulmonary complications after cardiac surgery.

Objective:To compare the active respiratory circulation technique (ACBT) with the oscillatory positive pressure expiration technique (OPEP) in terms of their ability to improve pulmonary function and minimize complications after cardiac surgery, seeking to define an airway management strategy for such patients.Methods:A total of 101 patients who had undergone cardiac surgery were randomly divided into an ACBT group ( n=50) and an OPEP group ( n=51). On the 1st day after the operation, in addition to conventional medical treatment and early rehabilitation, the subjects were additionally provided with daily 20-minute sessions of ACBT or OPEP training for seven consecutive days. Before the operation, and on the 3rd and 7th day afterward, lung function was assessed using a pulmonary edema imaging assessment system (RALE), computed tomography and pulmonary function indexes. Any complications were also noted. Six-minute walking distance and the Barthel index quantified exercise endurance and ability in the activities of daily living, respectively. Turbidimetry was used to determine the levels of C-reactive protein in the blood. The duration of mechanical ventilation required, ICU stay time, length of postoperative and total hospital stays were also recorded. Results:On day seven after the operation, the average RALE scores of the ACBT and OPEP groups were (12.40±4.37) and (10.20±4.66), respectively—a significant difference. At the same time point, the incidence of atelectasis in the OPEP group was significantly lower than in the ACBT group. The OPEP group′s average maximum inspiratory pressure was a greater percentage of the predicted value, and its average 6-minute walk and BI score were also better. On the 3rd day after the operation, the incidence of lung consolidation in the ACBT group was significantly lower than that in the OPEP group, on average.Conclusions:The curative effect of ACBT is better than that of OPEP in the first few days after such an operation, but after a week OPEP more effectively restores respiratory muscle strength and relieves pulmonary complications. It is recommended to apply these two techniques in stages to optimize postoperative airway management. RALE scoring is an ideal tool for dynamic monitoring of pulmonary complications after cardiac surgery.

Objective:To investigate the risk factors and prognostic value of the textbook outcome (TO) in patients with advanced gastric cancer (AGC) who underwent neoadjuvant chemotherapy followed by surgical resection.Methods:This is a retrospective cohort study. A total of 253 patients with AGC who underwent neoadjuvant chemotherapy combined with gastrectomy and D2 lymphadenectomy in the Department of Gastric Surgery, Fujian Medical University Union Hospital from January 2010 to December 2019 were retrospectively included. There were 195 males and 58 females, aged (60.3±10.0) years (range: 27 to 75 years). The patients were then divided into the TO group ( n=168) and the non-TO group ( n=85). Multivariate Logistic regression was used to analyze the independent predictors of TO. Univariate and multivariate Cox analysis were used to analyze independent prognosis factors for overall survival (OS) and disease-free survival (DFS). Propensity score matching was performed to balance the TO and non-TO groups, and the Kaplan-Meier method was used to calculate survival rates and draw survival curves. Results:Among the 253 patients, 168 patients (66.4%) achieved TO. The Eastern Cooperative Oncology Group score ( OR=0.488, 95% CI: 0.278 to 0.856, P=0.012) and ypN stage ( OR=0.626, 95% CI:0.488 to 0.805, P<0.01) were independently predictive of TO. Multivariate analysis revealed that TO was an independent risk factor for both OS ( HR=0.662, 95% CI: 0.457 to 0.959, P=0.029) and DFS ( HR=0.687, 95% CI: 0.483 to 0.976, P=0.036). After matching, the 5-year OS rate (42.2% vs. 27.8%) and the 5-year DFS rate (37.5% vs. 27.8%) were significantly higher in the TO group than in the non-TO group (both P<0.05). Furthermore, patients in the non-TO group benefited significantly from postoperative chemotherapy (both P<0.05), but those in the TO group did not (both P>0.05). Conclusion:TO is an independent prognosis factor in patients undergoing neoadjuvant chemotherapy and surgery for AGC and is associated with postoperative chemotherapy benefits.

Objective:To investigate the risk factors and prognostic value of the textbook outcome (TO) in patients with advanced gastric cancer (AGC) who underwent neoadjuvant chemotherapy followed by surgical resection.Methods:This is a retrospective cohort study. A total of 253 patients with AGC who underwent neoadjuvant chemotherapy combined with gastrectomy and D2 lymphadenectomy in the Department of Gastric Surgery, Fujian Medical University Union Hospital from January 2010 to December 2019 were retrospectively included. There were 195 males and 58 females, aged (60.3±10.0) years (range: 27 to 75 years). The patients were then divided into the TO group ( n=168) and the non-TO group ( n=85). Multivariate Logistic regression was used to analyze the independent predictors of TO. Univariate and multivariate Cox analysis were used to analyze independent prognosis factors for overall survival (OS) and disease-free survival (DFS). Propensity score matching was performed to balance the TO and non-TO groups, and the Kaplan-Meier method was used to calculate survival rates and draw survival curves. Results:Among the 253 patients, 168 patients (66.4%) achieved TO. The Eastern Cooperative Oncology Group score ( OR=0.488, 95% CI: 0.278 to 0.856, P=0.012) and ypN stage ( OR=0.626, 95% CI:0.488 to 0.805, P<0.01) were independently predictive of TO. Multivariate analysis revealed that TO was an independent risk factor for both OS ( HR=0.662, 95% CI: 0.457 to 0.959, P=0.029) and DFS ( HR=0.687, 95% CI: 0.483 to 0.976, P=0.036). After matching, the 5-year OS rate (42.2% vs. 27.8%) and the 5-year DFS rate (37.5% vs. 27.8%) were significantly higher in the TO group than in the non-TO group (both P<0.05). Furthermore, patients in the non-TO group benefited significantly from postoperative chemotherapy (both P<0.05), but those in the TO group did not (both P>0.05). Conclusion:TO is an independent prognosis factor in patients undergoing neoadjuvant chemotherapy and surgery for AGC and is associated with postoperative chemotherapy benefits.

Aim To study the relationship between white blood cell count and clinical classification in patients with coronary heart disease and its clinical significance.Methods A total of 301 patients diagnosed with coronary heart disease in the Second Affiliated Hospital of Harbin Medical University from January 2022 to December 2023 were se-lected as the research subjects,and divided into stable angina pectoris(SAP)group and acute coronary syndrome(ACS)group based on their clinical manifestations and results of electrocardiogram,the differences of general data,biochemical indexes and cardiovascular indexes between the two groups were compared.Spearman correlation analysis was used to an-alyze the relationship between white blood cell count,neutrophil count and cardiovascular related indicators,including tro-ponin Ⅰ,N-terminal pro-brain natriuretic peptide(NT-proBNP),ejection fraction,left ventricular end-diastolic diameter(LVEDD),left atrial diameter,Gensini score,etc.ROC curve was employed to determine the cut-off point for diagno-sing ACS and SAP classification of coronary heart disease based on white blood cell count,and dividing patients into a group with normal white blood cell level and a group with above normal white blood cell level based on this cut-off point,the differences between the two groups were compared.Results The ratio of hyperlipidaemia history,white blood cell count,neutrophil count,C-reactive protein,platelet count,total cholesterol(TC),low density lipoprotein cholesterol(LDLC),troponin 1,NT-proBNP and Gensini score in the ACS group were significantly higher than those in the SAP group(all P＜0.05),while the ratio of aspirin use,the ratio of statin use,and ejection fraction in the ACS group were low-er than those in the SAP group(all P＜0.05).Spearman correlation analysis results showed that white blood cell count was positively correlated with C-reactive protein(r=0.443,P＜0.001),troponin Ⅰ(r=0.333,P＜0.001),NT-proBNP(r=0.245,P＜0.001)and Gensini score(r=0.341,P＜0.001),but negatively correlated with LVEDD(r=-0.212,P＜0.001).Similarly,neutrophil count was positively correlated with C-reactive protein(r=0.430,P＜0.001),troponin Ⅰ(r=0.325,P＜0.001),NT-proBNP(r=0.292,P＜0.001)and Gensini score(r=0.353,P＜0.001),but negatively correlated with LVEDD(r=-0.175,P=0.002).The cut-off point of white blood cell count in the diagnosis of ACS was 9.35×109 L-1(sensitivity was 56.7％,specificity was 93.1％).The patients were divided into normal white blood cell level group(n=202)and above normal white blood cell level group(n=99).Hyperlipidemia,smoking history,TC,LDLC,C-reactive protein,troponin Ⅰ,NT-proBNP and Gensini scores in above normal white blood cell level group were significantly higher than those in the normal white blood cell level group(all P＜0.05),while LVEDD was lower than that in the normal white blood cell level group(all P＜0.05).Conclusion White blood cell count can easily identify the high-risk type of coronary heart disease,and the cut-off point for the diagnosis of ACS is 9.35×109 L-1.

Aim To study the relationship between white blood cell count and clinical classification in patients with coronary heart disease and its clinical significance.Methods A total of 301 patients diagnosed with coronary heart disease in the Second Affiliated Hospital of Harbin Medical University from January 2022 to December 2023 were se-lected as the research subjects,and divided into stable angina pectoris(SAP)group and acute coronary syndrome(ACS)group based on their clinical manifestations and results of electrocardiogram,the differences of general data,biochemical indexes and cardiovascular indexes between the two groups were compared.Spearman correlation analysis was used to an-alyze the relationship between white blood cell count,neutrophil count and cardiovascular related indicators,including tro-ponin Ⅰ,N-terminal pro-brain natriuretic peptide(NT-proBNP),ejection fraction,left ventricular end-diastolic diameter(LVEDD),left atrial diameter,Gensini score,etc.ROC curve was employed to determine the cut-off point for diagno-sing ACS and SAP classification of coronary heart disease based on white blood cell count,and dividing patients into a group with normal white blood cell level and a group with above normal white blood cell level based on this cut-off point,the differences between the two groups were compared.Results The ratio of hyperlipidaemia history,white blood cell count,neutrophil count,C-reactive protein,platelet count,total cholesterol(TC),low density lipoprotein cholesterol(LDLC),troponin 1,NT-proBNP and Gensini score in the ACS group were significantly higher than those in the SAP group(all P＜0.05),while the ratio of aspirin use,the ratio of statin use,and ejection fraction in the ACS group were low-er than those in the SAP group(all P＜0.05).Spearman correlation analysis results showed that white blood cell count was positively correlated with C-reactive protein(r=0.443,P＜0.001),troponin Ⅰ(r=0.333,P＜0.001),NT-proBNP(r=0.245,P＜0.001)and Gensini score(r=0.341,P＜0.001),but negatively correlated with LVEDD(r=-0.212,P＜0.001).Similarly,neutrophil count was positively correlated with C-reactive protein(r=0.430,P＜0.001),troponin Ⅰ(r=0.325,P＜0.001),NT-proBNP(r=0.292,P＜0.001)and Gensini score(r=0.353,P＜0.001),but negatively correlated with LVEDD(r=-0.175,P=0.002).The cut-off point of white blood cell count in the diagnosis of ACS was 9.35×109 L-1(sensitivity was 56.7％,specificity was 93.1％).The patients were divided into normal white blood cell level group(n=202)and above normal white blood cell level group(n=99).Hyperlipidemia,smoking history,TC,LDLC,C-reactive protein,troponin Ⅰ,NT-proBNP and Gensini scores in above normal white blood cell level group were significantly higher than those in the normal white blood cell level group(all P＜0.05),while LVEDD was lower than that in the normal white blood cell level group(all P＜0.05).Conclusion White blood cell count can easily identify the high-risk type of coronary heart disease,and the cut-off point for the diagnosis of ACS is 9.35×109 L-1.

Objective:To compare the efficacy of femoral neck system (FNS) and cannulated compression screw (CCS) in the treatment of femoral neck fracture in the young and middle-aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 91 patients with femoral neck fracture admitted to Fuzhou Second Hospital from July 2020 to December 2021, including 52 males and 39 females; aged 23-65 years [(48.9±10.3)years]. Garden classification of the fracture found that 31 patients were with type I, 9 with type II, 12 with type III and 39 with type IV. Pauwels classification of the fracture found that 7 patients were with type I, 33 with type II and 51 with type III. A total of 53 patients were treated with FNS fixation (FNS group) and 38 patients with CCS fixation (CCS group). The operation time, intraoperative blood loss, Haidukewych fracture reduction quality, hospitalization time, Barthel index, fracture healing time, and weight-bearing time were compared between the two groups. The hip function was assessed by Harris hip score in both groups at postoperative 3 months, 6 months and 1 year and at the final follow-up. The incidences of postoperative complication and secondary surgery were also compared between the two groups.Results:All the patients were followed up for 15-31 months [(22.2±5.5)months]. There were no significant differences in the operation time, Haidukewych fracture reduction quality, hospitalization time, or Barthel index (all P>0.05). The intraoperative blood loss in the FNS group was 50.0(20.0,85.0)ml, which was more than that in the CCS group [20.0(10.0,50.0)ml] ( P<0.01). The fracture healing time, partial weight-bearing time, and full weight-bearing time in the FNS group [4.0(3.0,5.0)months, 3.0(2.0,3.0)months, 5.0(4.5,6.0)months] were shorter than those in the CCS group [6.0(5.0,7.0)months, 3.0(2.8,4.0)months, 6.0(6.0,7.0)months] (all P<0.01). The Harris hip score at postoperative 3 months, 6 months and 1 year and at the final follow-up were 74.0(71.0,77.0)points, 87.0(84.0,88.5)points, 91.0(88.0,95.0)points, and 94.0(91.0,96.0)points in the FNS group, significantly higher than those in the CCS group [73.0(70.0,74.0)points, 82.5(79.8,87.0)points, 88.0(83.5,91.0)points, 89.0(84.0,93.0)points] (all P<0.05 or 0.01). There were no statistically significant differences in the incidences of postoperative complication or secondary surgery between the two groups (all P>0.05). Conclusion:Compared with CCS, FNS can shorten fracture healing time, allow patients to carry full weight as soon as possible, and significantly improve hip function in the treatment of middle-aged and young adults with femoral neck fracture, although there is more intraoperative blood loss.

In order to solve the difficulties and challenges in the implementation of the original blood distribution and collection regulations caused by the expansion of hospital area, the extension of blood transfer time, the changeability of blood transfer environment, and the strain of personnel due to the increase of workload, as well as to ensure the accuracy of the information throughout blood remote verification and distribution and the safety of clinical blood transfusion, , Shanghai experts related to clinical transfusion and blood management had made a systematic study on the applicable scope and management rules of remote verification of blood distribution and collection, and formulated this Expert Consensus combined with the development status of digital, intelligent and remote communication technologies, so as to provide corresponding guidance for clinical medical institutions in line with the changes in reality.

Common bile duct stones are a common of digestive system disease, and as one of the long-term complications after Billroth II subtotal gastrectomy, it has attracted more and more attention from clinicians. Common bile duct stones after Billroth II subtotal gastrectomy have a complex pathogenesis, including neurological, humoral, and mechanical factors. Even though there are many methods to remove stones, there are still controversies over the selection of digestive endoscopy, surgical operation, or percutaneous transhepatic approach. Clinicians should fully evaluate the specific conditions of patients and formulate individualized treatment regimens to achieve the best treatment outcome.