ObjectiveTo explore the improving effect of Huangqi Chifengtang（HCT） on atherosclerosis（AS）， and elucidate its mechanism in relation to adenosine monophosphate-activated protein kinase（AMPK）/peroxisome proliferator-activated receptor α（PPARα） signaling pathway and nucleotide-binding oligomerization domain（NOD）-like receptor thermal protein domain associated protein 3（NLRP3） inflammasome. MethodsEight C57BL/6J mice were set as the normal group， and 32 ApoE^-/- mice were randomly divided into the model group， the positive drug group（atorvastatin， 5 mg·kg^-1·d^-1）， HCT low- and high-dose groups（1.95， 3.90 g·kg^-1·d^-1）. ApoE^-/- mice were fed with high-fat and high-cholesterol feed to establish an AS mouse model. After modeling， they were orally administered corresponding dose of drugs for 28 days， while the normal and model groups received an equal volume of physiological saline via oral gavage. Hematoxylin-eosin（HE） staining was used to observe the pathological status of the aorta and liver in mice， Biochemical testing and enzyme-linked immunosorbent assay（ELISA） were used to detect the levels of total cholesterol（TC）， triglycerides（TG）， low-density lipoprotein cholesterol（LDL-C）， alanine aminotransferase（ALT）， aspartate aminotransferase（AST）， C-reactive protein（CRP）， interleukin（IL）-1β， IL-18 in the serum， as well as superoxide dismutase（SOD）， malondialdehyde（MDA）， and reduced glutathione（GSH） in the liver. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was used to measure the mRNA expression levels of NLRP3， apoptosis-associated speck-like protein（ASC）， cysteinyl aspartate specific proteinase-1（Caspase-1）， Toll-like receptor 4（TLR4） in the aorta， and fatty acid synthase（FAS）， stearoyl-CoA desaturase 1（SCD1）， PPARα， and carnitine palmitoyltransferase 1A（CPT1A） in the liver. Immunohistochemistry was used to determine the protein expressions of NLRP3， Caspase-1， and ASC in the aorta， and Western blot was used to measure the protein expressions of AMPK， p-AMPK， sterol regulatory element binding protein-1c（SREBP-1c）， CPT1A， and FAS in the liver. ResultsCompared with the normal group， the model group showed a significant increase in lipid plaque deposition in the aorta and lipid accumulation in the liver， the levels of TC， TG， LDL-C， AST， ALT， IL-1β， IL-18 and CRP in the serum were significantly increased（P<0.01）， and the mRNA and protein expressions of aortic TLR4， NLRP3， Caspase-1 and ASC were significantly upregulated（P<0.01）. The levels of SOD and GSH in the liver were significantly reduced， while the level of MDA was significantly increased（P<0.01）. The mRNA expressions of FAS and SCD1 in the liver were significantly downregulated， while the mRNA expressions of PPARα and CPT1A were significantly upregulated. The protein expressions of p-AMPK/AMPK and CPT1A in the liver were significantly reduced， while the expressions of SREBP-1c and FAS proteins were significantly increased（P<0.01）. Compared with the model group， the low- and high-dose HCT groups showed significant improvements in aortic plaques and hepatic lipid deposition. The levels of TC， LDL-C， AST， IL-1β and IL-18 in the serum of the low-dose HCT group， as well as TC， TG， LDL-C， AST， ALT， IL-1β， IL-18 and CRP in the serum of the high-dose HCT group， were significantly reduced（P<0.01）. The mRNA expressions of TLR4， NLRP3 and Caspase-1 in the aorta of the low-dose HCT group， as well as TLR4， NLRP3， Caspase-1 and ASC in the aorta of the high-dose HCT group， were significantly downregulated（P<0.01）. The protein expressions of Caspase-1 and ASC in the aorta of the low-dose HCT group， as well as NLRP3， Caspase-1 and ASC in the high-dose HCT group， were significantly downregulated（P<0.01）. The levels of SOD and GSH in the liver of the low- and high-dose HCT groups were significantly increased， while the level of MDA in the high-dose HCT group was significantly decreased（P<0.05， P<0.01）. In the HCT-treated group， the mRNA expressions of FAS and SCD1 in the liver were significantly upregulated， while the mRNA expressions of PPARα and CPT1A were significantly downregulated， the protein expressions of p-AMPK/AMPK and CPT1A in the liver were significantly increased， while the protein expressions of SREBP-1c and FAS were significantly decreased（P<0.05， P<0.01）. ConclusionHCT can improve lipid metabolism by activating the AMPK/PPARα pathway and inhibit NLRP3 inflammasome-mediated inflammatory responses， thereby reducing hepatic lipid deposition and AS plaque formation.

Objective The aim of this study is to analyze the expression level of cell-free DNA(cf-DNA),a biomarker of neutrophil extracellular traps(NETs),in children with Mycoplasma pneumoniae pneumonia(MPP),and to explore the predictive efficacy of cf-DNA(as a marker of NETs)for the severity of MPP in these children.Methods A total of 115 children with MPP were prospectively selected as the MPP group.Based on the disease severity,the MPP group was categorized into the mild group(n=75)and the severe group(n=40).During the same period,50 healthy children undergoing physical examinations were selected as the control group.The levels of serum cf-DNA in the MPP group and the control group,as well as the levels of C-reactive protein(CRP),D-dimer,lactate dehydrogenase(LDH),interleukin-6(IL-6),interferon-γ(IFN-γ),and tumor necrosis factor-α(TNF-α)in the MPP group were detected.The differences in the levels of serum cf-DNA and related inflammatory factors among the groups were compared,and the role of serum cf-DNA in evaluating the severity of MPP was analyzed.Results The level of serum cf-DNA in children of the MPP group was notably higher than that in the control group,with a more significant elevation observed in the severe group(P<0.05).The levels of CRP,D-dimer,LDH,IL-6,IFN-γ,and TNF-α were all higher in the severe group than in the mild group(P<0.05).Multivariate logistic regression analysis showed that the increased levels of serum cf-DNA,CRP,and IL-6 were closely related to the severity of MPP(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the combination of serum cf-DNA,CRP,and IL-6 for predicting severe MPP was 0.981,which was higher than that of each index alone(P<0.05).Conclusions Serum cf-DNA(as a marker of NETs)is closely related to the severity of MPP in children.The combined detection of cf-DNA,CRP,and IL-6 is more beneficial for assessing the severity of MPP in children.

Objective The aim of this study was to analyze the incidence trend and age-specific characteristics of esophage-al cancer in cancer registration areas of Gansu Province from 2010 to 2021,and predict the incidence of esophageal cancer from 2022 to 2030.Methods Based on the incidence data of esophageal cancer in 15 cancer registries in Gansu Province from 2010 to 2021,the incidence was calculated by age,sex,urban and rural areas.The age-standardized incidence by Chinese standard population(ASIRC)was standardized using the 2000 Chinese standard population.Joinpoint regression model was used to analyze the change trend of esophageal cancer incidence,and the average annual percentage change(AAPC)was calculated to quantify the overall rate of change.A birth cohort model was constructed to analyze incidence trend of different birth groups from 1930 to 2021,and the Bayesian age-period-cohort(BAPC)model was used to predict incidence.Results From 2010 to 2021,the ASIRC of esophageal cancer in Gansu Province showed a significant downward trend(AAPC=-14.47％,95％CI:-18.72％--9.99％,P＜0.001).The ASIRC in men decreased at an annual rate of 13.02％(AAPC=-13.02％,95％CI:-17.28％--8.54％,P＜0.001),the incidence of esophage-al cancer in women at a rate of 15.80％per year(AAPC=-15.80％,95％CI:-20.69％--10.61％,P＜0.001).The ASIRC of e-sophageal cancer in urban areas decreased at an annual rate of 15.32％(AAPC=-15.32％,95％CI:-21.04％--9.18％,P＜0.001);ASIRC of esophageal cancer in rural areas decreased at a rate of 5.33％per year(AAPC=-5.33％,95％CI:-8.94％--1.58％,P＜0.001).From 2010 to 2021,the incidence of esophageal cancer in all age groups showed a significant downward trend(AAPC:-19.59％to-9.18％).The birth cohort analysis revealed that the incidence of esophageal cancer in people over 40 years old in the province,men,women,urban and rural areas showed a downward trend with increase of birth years.BAPC model predicted that that the ASIRC of esophageal cancer for the total province population,men and women would decrease from 6.47/100,000,10.02/100,000,and 2.95/100,000 in 2021 to 1.31/100,000,1.72/100,000,and 0.91/100,000 in 2030,respectively.Conclu-sions The incidence of esophageal cancer in Gansu Province showed a downward trend from 2010 to 2021,but men and rural areas were still the focus of high incidence.The prediction indicates that the incidence of esophageal cancer in Gansu Province will further decline by 2030,suggesting that the prevention and control measures have achieved results;however,it is still necessary to strengthen the intervention and long-term monitoring of high-risk groups.

Objective The aim of this study was to analyze the incidence trend and age-specific characteristics of esophage-al cancer in cancer registration areas of Gansu Province from 2010 to 2021,and predict the incidence of esophageal cancer from 2022 to 2030.Methods Based on the incidence data of esophageal cancer in 15 cancer registries in Gansu Province from 2010 to 2021,the incidence was calculated by age,sex,urban and rural areas.The age-standardized incidence by Chinese standard population(ASIRC)was standardized using the 2000 Chinese standard population.Joinpoint regression model was used to analyze the change trend of esophageal cancer incidence,and the average annual percentage change(AAPC)was calculated to quantify the overall rate of change.A birth cohort model was constructed to analyze incidence trend of different birth groups from 1930 to 2021,and the Bayesian age-period-cohort(BAPC)model was used to predict incidence.Results From 2010 to 2021,the ASIRC of esophageal cancer in Gansu Province showed a significant downward trend(AAPC=-14.47％,95％CI:-18.72％--9.99％,P＜0.001).The ASIRC in men decreased at an annual rate of 13.02％(AAPC=-13.02％,95％CI:-17.28％--8.54％,P＜0.001),the incidence of esophage-al cancer in women at a rate of 15.80％per year(AAPC=-15.80％,95％CI:-20.69％--10.61％,P＜0.001).The ASIRC of e-sophageal cancer in urban areas decreased at an annual rate of 15.32％(AAPC=-15.32％,95％CI:-21.04％--9.18％,P＜0.001);ASIRC of esophageal cancer in rural areas decreased at a rate of 5.33％per year(AAPC=-5.33％,95％CI:-8.94％--1.58％,P＜0.001).From 2010 to 2021,the incidence of esophageal cancer in all age groups showed a significant downward trend(AAPC:-19.59％to-9.18％).The birth cohort analysis revealed that the incidence of esophageal cancer in people over 40 years old in the province,men,women,urban and rural areas showed a downward trend with increase of birth years.BAPC model predicted that that the ASIRC of esophageal cancer for the total province population,men and women would decrease from 6.47/100,000,10.02/100,000,and 2.95/100,000 in 2021 to 1.31/100,000,1.72/100,000,and 0.91/100,000 in 2030,respectively.Conclu-sions The incidence of esophageal cancer in Gansu Province showed a downward trend from 2010 to 2021,but men and rural areas were still the focus of high incidence.The prediction indicates that the incidence of esophageal cancer in Gansu Province will further decline by 2030,suggesting that the prevention and control measures have achieved results;however,it is still necessary to strengthen the intervention and long-term monitoring of high-risk groups.

Background and Aims:The completeness of lymph node dissection in laparoscopic radical gastrectomy for gastric cancer directly affects postoperative patient prognosis.Indocyanine green(ICG)fluorescence-guided navigation,as an emerging auxiliary technique,enables real-time visualization of lymphatic drainage pathways and enhances surgical precision.This study was performed to evaluate the impact of ICG fluorescence navigation on lymph node dissection,positive lymph node detection,and patient prognosis during laparoscopic D2 radical gastrectomy for gastric cancer.Methods:The clinical data of 168 patients who underwent laparoscopic radical gastrectomy at Zhangzhou Affiliated Hospital of Fujian Medical University from January 2021 to December 2022 were retrospectively analyzed.Among them,51 patients received ICG-guided surgery(ICG group),and 117 underwent conventional surgery(non-ICG group).Perioperative variables,extent of lymph node dissection,positive lymph node detection efficiency,and postoperative survival outcomes were compared between the two groups.Results:There were no statistically significant differences between the two groups in baseline clinicopathologic characteristics,as well as operative time,intraoperative blood loss,postoperative recovery,and incidence of surgical complications(all P>0.05).The ICG group had a significantly higher mean number of lymph nodes dissected than the non-ICG group(48.62 vs.37.20,P<0.001),with a greater proportion of patients achieving≥30 nodes dissected(92.16％vs.69.23％,P=0.001).Stratified analysis showed a significantly higher number of dissected lymph nodes in the ICG group at D2 stations,the supra-pancreatic region(stations 7,8,9,11),in total gastrectomy,T3-4 stage,and stage Ⅲ patients(all P<0.01).In the ICG group,the number and positivity rate of fluorescent lymph nodes were significantly higher than those of non-fluorescent nodes(30.31 vs.17.36;2.03 vs.0.94,both P<0.05).The diagnostic sensitivity of ICG fluorescence imaging for positive lymph nodes was 68.4％,with a negative predictive value of 94.6％for non-fluorescent nodes.No significant differences were observed between the two groups in terms of adjuvant therapy,overall survival(HR=0.737,P=0.471),or disease-free survival(HR=0.502,P=0.089).Conclusion:ICG-guided navigation in laparoscopic radical gastrectomy for gastric cancer is safe and significantly improves lymph node yield,particularly in the supra-pancreatic region,total gastrectomy,and advanced-stage patients.It also enhances positive node detection.However,no survival benefit has been observed in the short term.Further multicenter studies with long-term follow-up are warranted to confirm its clinical value and optimize intraoperative navigation strategies.

Objective To investigate the status and influencing factors of type 2 diabetes mellitus(T2DM)patients' fear of complications,and to provide a reference for formulating targeted intervention measures.Methods From April to November 2024,370 patients with T2DM in 2 tertiary general hospitals in Daqing City were selected by convenience sampling method.General data questionnaire,Fear of Complications Questionnaire,Self-Perceived Burden Scale,Psychological Capital Questionnaire,Mishel Uncertainty in Illness Scale and Family Apgar Index Questionnaire were used for investigation.Univariate analysis and binary Logistic regression were performed to analyze the influencing factors.Results A total of 364 valid questionnaires were collected,with an effective recovery rate of 98.38％.The score of Fear of Complications Questionnaire was(23.47±7.47),and the incidence of fear of complications was 22.25％.Logistic regression analysis showed that medical payment methods,the number of complications,positive psychological capital and family care were the influencing factors of FoC in T2DM patients.Conclusion The fear of complications in T2DM patients is at a moderate level.Nursing staff should pay attention to the early assessment of patients' fear of complications,promptly identify and take effective measures to reduce the level of patients' fear of complications,improve their quality of life.

Objective The aim of this study is to analyze the expression level of cell-free DNA(cf-DNA),a biomarker of neutrophil extracellular traps(NETs),in children with Mycoplasma pneumoniae pneumonia(MPP),and to explore the predictive efficacy of cf-DNA(as a marker of NETs)for the severity of MPP in these children.Methods A total of 115 children with MPP were prospectively selected as the MPP group.Based on the disease severity,the MPP group was categorized into the mild group(n=75)and the severe group(n=40).During the same period,50 healthy children undergoing physical examinations were selected as the control group.The levels of serum cf-DNA in the MPP group and the control group,as well as the levels of C-reactive protein(CRP),D-dimer,lactate dehydrogenase(LDH),interleukin-6(IL-6),interferon-γ(IFN-γ),and tumor necrosis factor-α(TNF-α)in the MPP group were detected.The differences in the levels of serum cf-DNA and related inflammatory factors among the groups were compared,and the role of serum cf-DNA in evaluating the severity of MPP was analyzed.Results The level of serum cf-DNA in children of the MPP group was notably higher than that in the control group,with a more significant elevation observed in the severe group(P<0.05).The levels of CRP,D-dimer,LDH,IL-6,IFN-γ,and TNF-α were all higher in the severe group than in the mild group(P<0.05).Multivariate logistic regression analysis showed that the increased levels of serum cf-DNA,CRP,and IL-6 were closely related to the severity of MPP(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the combination of serum cf-DNA,CRP,and IL-6 for predicting severe MPP was 0.981,which was higher than that of each index alone(P<0.05).Conclusions Serum cf-DNA(as a marker of NETs)is closely related to the severity of MPP in children.The combined detection of cf-DNA,CRP,and IL-6 is more beneficial for assessing the severity of MPP in children.

BackgroundPrevious studies have identified a close relationship among psychological neglect and abuse， negative affect， different stages of adolescence， and suicidal ideation. However， the mechanisms underlying the impact of psychological abuse and neglect on suicidal ideation among left-behind adolescents remain unclear， and this field of research is still in its relative infancy. ObjectiveTo explore the relationship between psychological neglect/abuse and suicidal ideation among left-behind adolescents， as well as the mediating role of negative affect and the moderating effect of different stages of adolescence， so as to provide insights for preventing and intervening suicidal ideation in this population. MethodsFrom November 2021 to May 2022， a cluster random sampling technique was utilized to select 2 309 left-behind adolescents in western China. Assessments were conducted using the Child Psychological Abuse and Neglect Scale （CPANS）， the Positive and Negative Suicide Ideation （PANSI） and the Positive and Negative Affect Schedule for Children （PANAS-C）. Spearman correlation coefficients were calculated across all samples， and Process 4.1 was employed to test the mediating role of negative affect and the moderating role of different stages of adolescence in the pathway linking psychological abuse/neglect to suicidal ideation. ResultsA total of 2 119 left-behind adolescents （mean age： 14.94±1.20 years） completed the study， with males comprising 51.34% （1 088/2 119） and females 48.66% （1 031/2 119）.Among left-behind adolescents， scores on CPANS psychological neglect subscale showed positive correlations with both psychological abuse subscale scores and PANAS-C negative affect subscale scores （r=0.446， 0.496， P<0.01）. Additionally， CPANS psychological neglect and psychological abuse subscale scores were also positively correlated with PANSI scores （r=0.487， 0.508， P<0.01）. Furthermore， PANAS-C negative affect subscale scores demonstrated a positive correlation with PANSI scores （r=0.499， P<0.01）. Negative affect partially mediated the relationship between psychological abuse/psychological neglect and suicidal ideation， with effect sizes of 0.166 （95% CI： 0.141~0.191） and 0.131 （95% CI： 0.112~0.152）. Different stages of adolescence moderated the latter part （negative emotion → suicidal ideation） of the indirect mediation path from psychological neglect to suicidal ideation through negative affect （β=-0.066， P<0.01）. ConclusionBoth psychological neglect and psychological abuse may influence suicidal ideation among left-behind adolescents via negative affect. Moreover， different stages of adolescence may moderate the indirect path from psychological neglect to suicide ideation through negative affect.

Background and Aims:The completeness of lymph node dissection in laparoscopic radical gastrectomy for gastric cancer directly affects postoperative patient prognosis.Indocyanine green(ICG)fluorescence-guided navigation,as an emerging auxiliary technique,enables real-time visualization of lymphatic drainage pathways and enhances surgical precision.This study was performed to evaluate the impact of ICG fluorescence navigation on lymph node dissection,positive lymph node detection,and patient prognosis during laparoscopic D2 radical gastrectomy for gastric cancer.Methods:The clinical data of 168 patients who underwent laparoscopic radical gastrectomy at Zhangzhou Affiliated Hospital of Fujian Medical University from January 2021 to December 2022 were retrospectively analyzed.Among them,51 patients received ICG-guided surgery(ICG group),and 117 underwent conventional surgery(non-ICG group).Perioperative variables,extent of lymph node dissection,positive lymph node detection efficiency,and postoperative survival outcomes were compared between the two groups.Results:There were no statistically significant differences between the two groups in baseline clinicopathologic characteristics,as well as operative time,intraoperative blood loss,postoperative recovery,and incidence of surgical complications(all P>0.05).The ICG group had a significantly higher mean number of lymph nodes dissected than the non-ICG group(48.62 vs.37.20,P<0.001),with a greater proportion of patients achieving≥30 nodes dissected(92.16％vs.69.23％,P=0.001).Stratified analysis showed a significantly higher number of dissected lymph nodes in the ICG group at D2 stations,the supra-pancreatic region(stations 7,8,9,11),in total gastrectomy,T3-4 stage,and stage Ⅲ patients(all P<0.01).In the ICG group,the number and positivity rate of fluorescent lymph nodes were significantly higher than those of non-fluorescent nodes(30.31 vs.17.36;2.03 vs.0.94,both P<0.05).The diagnostic sensitivity of ICG fluorescence imaging for positive lymph nodes was 68.4％,with a negative predictive value of 94.6％for non-fluorescent nodes.No significant differences were observed between the two groups in terms of adjuvant therapy,overall survival(HR=0.737,P=0.471),or disease-free survival(HR=0.502,P=0.089).Conclusion:ICG-guided navigation in laparoscopic radical gastrectomy for gastric cancer is safe and significantly improves lymph node yield,particularly in the supra-pancreatic region,total gastrectomy,and advanced-stage patients.It also enhances positive node detection.However,no survival benefit has been observed in the short term.Further multicenter studies with long-term follow-up are warranted to confirm its clinical value and optimize intraoperative navigation strategies.

Objective:To investigate the impact of neoadjuvant immunotherapy combined with chemotherapy on the safety and efficacy of radical resection in patients with cT3-4NxM0 gastric cancer.Methods:A retrospective cohort study method was used. The clinicopathological data of 515 patients who underwent radical gastrectomy after neoadjuvant treatment at Second Department of Gastric Surgery,Fudan University Shanghai Cancer Center and Department of Gastric Surgery,Zhangzhou Hospital Affiliated to Fujian Medical University from January 2020 to June 2023 were collected. Among them,379 patients received neoadjuvant chemotherapy alone(chemotherapy group),and 136 patients received neoadjuvant immunotherapy combined with chemotherapy(immunotherapy group). There were 382 males and 133 females,with an age of (58.4±10.9)years(range:26 to 85 years). To reduce the influence of potential confounding factors,a 1∶1 propensity score matching method was adopted,and the clamp value was 0.02. The peri-operative safety,imaging and postoperative pathological tumor regression,and prognosis were compared by independent sample t-test, Mann-Whitney U test, χ 2 test or Fisher exact probability method between the two groups. The Kaplan-Meier method was used to draw survival curves, and the differences between groups were compared by Log-rank test. Results:After matching, there were 101 patients in each of the chemotherapy group and the immunotherapy group. The baseline data of the patients in the two groups were evenly distributed (all P>0.05). According to the RECIST 1.1 criteria, the complete response rate (11.9% (12/101) vs. 4.0% (4/101)), partial response rate(68.3%(69/101) vs. 53.4%(54/101)), stable disease rate (17.8%(18/101) vs. 39.6%(40/101)) and disease progression rate (2.0%(2/101) vs. 3.0%(3/101)) between the immunotherapy group and the chemotherapy group were no statistical defferences ( χ2=14.374, P=0.002), and objective response rate (80.2%(81/101) vs. 57.4%(58/101), χ2=12.203, P<0.01) in the immunotherapy group was higher than that in the chemotherapy group. The results of postoperative pathological examination showed that the immunotherapy group had a higher complete response rate (16.8%(17/101) vs. 6.9% (7/101), χ2=4.728, P=0.030) and major pathological response rate (42.6%(43/101) vs. 23.8% (24/101), χ2=8.062, P=0.005). For the two groups, the operation time (175.0(76.0)minutes vs. 160.0 (30.0)minutes, Z=-0.059, P=0.953), intraoperative blood loss (110.0 (150.0)ml vs. 100.0 (120.0)ml, Z=-0.370, P=0.712), overall incidence of postoperative complications (20.8%(21/101) vs. 18.8%(19/101), χ2=0.125, P=0.724) and incidence of severe complications (5.0%(5/101) vs. 3.0%(3/101), χ2=0.130, P=0.718) were comparable. The median follow-up time of all patients was 46 months(range: 19 to 61 months). The 3-year overall survival rate (63.2% vs. 54.4%, P=0.035) and progression-free survival rate (59.1% vs. 45.6%, P=0.022) of the immunotherapy group were higher than those of the chemotherapy group. Meanwhile, there were no statistically significant differences in the incidence of neoadjuvant-treatment-related adverse events (48.5%(49/101) vs. 40.6% (41/101), χ2=1.283, P=0.411) and the incidence of severe adverse reactions of grade 3 or above (13.9% (14/101) vs. 10.9% (11/101), χ2=0.257, P=0.522) between the two groups. Conclusion:Neoadjuvant immunotherapy combined with chemotherapy can significantly improve the imaging and postoperative pathological tumor response rates and 3-year survival rate of patients with locally advanced gastric cancer,without increasing the incidence of postoperative complications and neoadjuvant treatment-related adverse event.