Objective To explore the effect of the ratio of high-density lipoprotein cholesterol(HDL-C)/total cholesterol(TC)on no-reflow after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome(ACS)complicated with diabetes mellitus(DM).Methods A retrospective analysis was conducted on 206 elderly ACS patients complicated with DM undergoing PCI in our hospital from January 2018 to August 2024.The HDL-C and TC levels were detected by cholesterol oxidase test,and the HDL-C/TC ratio was calculated.Coronary angi-ography(CAG)was applied to evaluate no-reflow phenomenon after PCI,and according to the re-sults,the patients were divided into a non-reflow group(41 cases)and a normal reflow group(165 cases).ROC curve was plotted to evaluate the predictive performance of HDL-C/TC ratio for no-reflow after PCI in patients with ACS complicated DM.Results The no-reflow group had signifi-cantly higher TC and glycated hemoglobin A1c(HbA1c)levels and more balloon dilatations,but lower HDL-C level and HDL-C/TC ratio than the normal flow group(P＜0.01).Multivariate lo-gistic regression analysis showed that HbA1c(OR=3.196,95％CI:1.619-6.310,P=0.001),number of balloon dilatations(OR=3.504,95％CI:1.807-6.797,P=0.000),and HDL-C/TC ra-tio(OR=3.927,95％CI:2.0 73-7.441,P=0.000)were influencing factors of no-reflow after PCI in patients with ACS and DM.The AUC value of HDLC,TC,and HDL-C/TC ratio in predicting no-reflow after PCI was 0.842,0.726,and 0.922,respectively.Conclusion HDL-C/TC ratio is an influencing factor for no-reflow in patients with ACS and DM after PCI.The ratio at a cut-off val-ue of ≤0.21 has a certain predictive value for no-reflow after PCI in these elderly patients.

BackgroundPostpartum depression （PPD） is a prevalent postpartum complications that significantly compromises women's psychological and physical well-being. Repetitive transcranial magnetic stimulation （rTMS）， a conventional neuromodulation technique， has been increasingly used in the treatment of PPD. However， high-quality evidence regarding its efficacy and safety remains limited. ObjectiveTo evaluate the efficacy and safety of rTMS in the treatment of PPD， thereby providing references for clinical treatment. MethodsDatabases including Cochrane Library， PubMed， Embase， CNKI， Wanfang， VIP and China Biology Medicine disc （CBM） were electronically searched for randomized controlled trials （RCTs） on rTMS for PPD， with the search spanning from database inception to February 8， 2025. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1， and the certainty of evidence was graded according to the Grading of Recommendations Assessment， Development and Evaluation （GRADE） approach. Meta-analysis was conducted using RevMan 5.3 and Stata 12.0. The outcomes of the Meta-analysis included the total effective rate， Edinburgh Postnatal Depression Scale （EPDS） score， Hamilton Depression Rating Scale （HAMD） score， and adverse reactions （dizziness， headache， nausea， diarrhea， and the overall incidence of adverse reactions）. ResultsA total of 11 studies involving 729 patients with PPD were included. Meta-analysis results showed that the total effective rate in the study group was significantly higher than that in the control group （OR=5.54， 95% CI： 3.07–10.01， P<0.01）. Both EPDS score （SMD=-2.38， 95% CI： -3.39–-1.37， P<0.01） and HAMD score （SMD=2.53， 95% CI： 1.21–3.85， P<0.01） in the study group were significantly lower than those in the control group， with statistically significant differences. Comparisons between the study group and control group reveal no significant differences in the incidence of dizziness and headache （RR=1.47， 95% CI： 0.63–3.43， P>0.05）， nausea （RR=1.46， 95% CI： 0.55–3.86， P>0.05）， diarrhea （RR=0.71， 95% CI： 0.23–2.20， P>0.05）， and overall adverse reactions （RR=1.30， 95% CI： 0.79–2.15， P>0.05）. GRADE assessment rated the four indicators of dizziness and headache， diarrhea， overall incidence of adverse reactions， and EPDS score as "moderate-certainty evidence"， and rated the total effective rate， nausea， and the HAMD score as "low-certainty evidence". ConclusionrTMS demonstrates certain therapeutic efficacy for PPD， with a safety profile comparable to conventional treatment. ［Funded by Sichuan Psychological Society Research Planning Project （number， SCSXLXH202403099）； Guiding Science and Technology Plan Project of Guangyuan （number， 23ZDYF0095）］

To summarize the diagnosis and management of a highly sensitized renal transplant recipient who developed Legionella pneumophila infection during the perioperative period. A 48-year-old male recipient presented early after transplantation with both acute allograft rejection and pulmonary infection. The acute rejection episode was successfully reversed with appropriate treatment, whereas the pulmonary infection continued to progress. Initial microbiological tests were negative, and empirical antimicrobial therapy was ineffective. Legionella pneumophila was subsequently detected by metagenomic next-generation sequencing of bronchoalveolar lavage fluid obtained via bronchoscopy. Following combined therapy with moxifloxacin and tigecycline, along with withdrawal of immunosuppressive agents, the pulmonary lesions completely resolved.

Objective To explore the effect of the ratio of high-density lipoprotein cholesterol(HDL-C)/total cholesterol(TC)on no-reflow after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome(ACS)complicated with diabetes mellitus(DM).Methods A retrospective analysis was conducted on 206 elderly ACS patients complicated with DM undergoing PCI in our hospital from January 2018 to August 2024.The HDL-C and TC levels were detected by cholesterol oxidase test,and the HDL-C/TC ratio was calculated.Coronary angi-ography(CAG)was applied to evaluate no-reflow phenomenon after PCI,and according to the re-sults,the patients were divided into a non-reflow group(41 cases)and a normal reflow group(165 cases).ROC curve was plotted to evaluate the predictive performance of HDL-C/TC ratio for no-reflow after PCI in patients with ACS complicated DM.Results The no-reflow group had signifi-cantly higher TC and glycated hemoglobin A1c(HbA1c)levels and more balloon dilatations,but lower HDL-C level and HDL-C/TC ratio than the normal flow group(P＜0.01).Multivariate lo-gistic regression analysis showed that HbA1c(OR=3.196,95％CI:1.619-6.310,P=0.001),number of balloon dilatations(OR=3.504,95％CI:1.807-6.797,P=0.000),and HDL-C/TC ra-tio(OR=3.927,95％CI:2.0 73-7.441,P=0.000)were influencing factors of no-reflow after PCI in patients with ACS and DM.The AUC value of HDLC,TC,and HDL-C/TC ratio in predicting no-reflow after PCI was 0.842,0.726,and 0.922,respectively.Conclusion HDL-C/TC ratio is an influencing factor for no-reflow in patients with ACS and DM after PCI.The ratio at a cut-off val-ue of ≤0.21 has a certain predictive value for no-reflow after PCI in these elderly patients.

To summarize the diagnosis and management of a highly sensitized renal transplant recipient who developed Legionella pneumophila infection during the perioperative period. A 48-year-old male recipient presented early after transplantation with both acute allograft rejection and pulmonary infection. The acute rejection episode was successfully reversed with appropriate treatment, whereas the pulmonary infection continued to progress. Initial microbiological tests were negative, and empirical antimicrobial therapy was ineffective. Legionella pneumophila was subsequently detected by metagenomic next-generation sequencing of bronchoalveolar lavage fluid obtained via bronchoscopy. Following combined therapy with moxifloxacin and tigecycline, along with withdrawal of immunosuppressive agents, the pulmonary lesions completely resolved.

Tumor-associated macrophages(TAMs)are the predominant cell group in the tumor microenvironment(TME)and are the most important regulatory cells of immune system suppression and tumor cell proliferation in TIME.Src homology-2 domain-containing protein tyrosine phosphatase 2(SHP-2)is a non-receptor protein tyrosine phosphatase that plays an important role in the transmission of signals from the cell surface to the nucleus.SHP-2 is a key intracellular regulatory factor mediating cell proliferation and differentiation and is involved in a variety of growth factor and cytokine signaling pathways linking the cell surface to the nucleus.Recent studies have shown that SHP-2 is a key enzyme in determining the function of TAMs,but because of its variable function,it plays different or even opposite roles in different solid TMEs.This paper reviews the function of SHP-2 in TAMs and related solid tumors to provide a comprehensive reference for tumor immunity and targeted therapy research.

Objective To investigate the therapeutic effectiveness of ozone combined with low-temperature plasma coagulation therapy on patients with cervical spondylotic radiculopathy and its influence on inflammatory responses.Methods Ozone in combination with low-temperature plasma radio-frequency coagulation was applied to 75 patients with cervical spondylotic radiculopathy in Pain Medicine Department of Capital Medical University Affiliated Beijing Anzhen Hospital from May 2022 to May 2023.Pain scores were assessed using Visual Analog Scale(VAS)and Neck Disability Index(NDI)before and two weeks after treatment.Enzyme-linked immunosor-bent assay(ELISA)was used to analyze the level of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6)and interferon-gamma(IFN-γ)before and two weeks after treatment.Results After treatment with ozone plus low-temperature plasma radiofrequency,VAS and NDI scores showed a significant decrease[VAS:5.36(4,7)vs.1.32(1,2),P＜0.000 1;NDI:32.72(24,70)vs.7.62(3.55,8.9),P＜0.000 1].Two weeks after surgical intervention,there was an effective reduction in the level of IL-6,TNF-αand IFN-γ alleviating the inflammatory re-sponse[IL-6:4.33(2.51,5.04)vs.3.49(2.08,4.43),P＜0.05;TNF-α:1.95(1.41,2.21)vs.1.61(1.02,2.03),P＜0.05;IFN-γ:1.84(1.18,2.47)vs.1.55(0.76,2.09),P＜0.05].Conclusions This Ozone combined with low-temperature plasma radiofrequency ablation is an effective technology for treatment of cer-vical spondylotic radiculopathy.

Objective To explore the preoperative predictive factors influencing microscopic positive proximal margin in upper gastric cancer,and to establish a nomogram prediction model and to validate it internally.Methods Retrospective analysis of 187 patients with upper gastric cancer operated in the Department of Gastrointestinal Surgery of Hengshui People's Hospital from January 2018 to October 2022 were included in this study.Patients were divided into the microscopic positive proximal margin(the R0 group,n=15)and the negative microscopic proximal margin group(the R1 group,n=172)according to histopathological diagnosis.Preoperative factors that may influence positive upper margin of proximal gastric cancer were collected,including patient age,gender,tumor size,tumor location,Borrmann staging,tumor differentiation,Lauren staging,cT stage and cN stage.Receiver operating characteristic(ROC)curve was used to figure out the optimal cut-off value for predicting positive margin of proximal gastric cancer by tumor length.Multivariate Logistic regression was used to analyze the variables with statistical difference between the two groups,and independent risk factors were screened out,and prediction mode was constructed.The prediction accuracy of the model was verified internally using Bootstrap method.Results The best threshold for predicting positive margin of proximal gastric cancer by tumor length was 4.85 cm.Univariate analysis showed that there were significant differences in tumor length,tumor location,Borrmann staging,Lauren staging,cT staging and cN staging between the two groups(all P＜0.05).Multivariate Logistic regression analysis showed that tumor length>4.85 cm(OR=4.000,95%CI:1.039-15.399),tumor located in esophagogastric junction(OR=7.108,95%CI:1.604-31.494),Borrmann staging Ⅲ—Ⅳ(OR=6.991,95%CI:1.538-31.782),Lauren staging as diffuse or mixed(OR=7.583,95%CI:1.814-31.701)and cT staging as cT4(OR=8.249,95%CI:1.890-36.007)were independent predictors of microscopic positive proximal margin of advanced upper gastric cancer before surgery,and a prediction model was established based on results of multivariate analysis.The area under ROC curve(AUC)value for subjects with the model was 0.862 after internal validation.The calibration curve showed that the model predicted the probability of microscopic positive proximal margin occurrence in good agreement with the probability of actual microscopic positive proximal margin occurrence(Hosmer-Lemeshow χ2=6.145,P=0.523).Conclusion The established nomogram prediction model can predict the probability of positive upper incisal margin of proximal gastric cancer before operation,and provide clinical guidance for formulating surgical strategy.

This report described one human leukocyte antigen pre-sensitized recipient undergoing preoperative plasmapheresis (PP), intravenous immunoglobulins (IVIG) desensitization and immune induction therapy before kidney transplantation with a donor kidney. Early postoperative clinical diagnosis was acute antibody-mediated rejection (AMR). A marked elevation of donor-specific antibodies (DSA) was accompanied by a decline of renal function. PP/IVIG dosing failed to lower the level of DSA. After low-dose splenic irradiation, DSA level dropped steadily and transplanted kidney function normalized. Thus adjuvant low-dose splenic irradiation may eliminate DSA immediately without a rebound.