Objective:To summarize the clinicopathological features, evolving trends in treatment and surgical approaches, and survival outcomes of patients who underwent D2 radical gastrectomy for gastric cancer in Shanxi Provincial Cancer Hospital over the past 11 years with the goal of providing a reference for the clinical practice of gastric cancer in this region.Methods:A retrospective observational study was conducted to analyze the clinicopathological data of patients who underwent D2 radical gastrectomy for pathologically confirmed gastric malignancy at the Department of Gastrointestinal Surgery, Shanxi Provincial Cancer Hospital from January, 2013 to December, 2023. Exclusion criteria consisted of: (1) residual gastric cancer or recurrent gastric cancer after surgery; (2) emergency gastric cancer resection due to bleeding, perforation, obstruction, or other causes; (3) comorbidity with other primary malignant tumors; (4) severe preoperative cardiopulmonary insufficiency or hepatic and renal insufficiency who cannot tolerate radical surgery; and (5) inconsistent main diagnosis information across the medical record system, pathological system, and gastric cancer-specific database. Patients were divided into three groups based on treatment methods: the surgery-only group, the perioperative chemotherapy group, and the adjuvant chemotherapy group. Endpoints included: (1) baseline patient characteristics; (2) trends in tumor location and pathological features; (3) evolution of treatment modalities; and (4) survival outcomes.Results:A total of 15,644 patients were included in the analysis, with 12,591 males and 3,053 females, the male-to-female gender ration was approximately 4∶1; the mean age was (61.2±9.5) years. The tumor sites were mainly concentrated in the esophagogastric junction (EGJ) (57.4%), followed by the antrum (25.9%). The incidence of EGJ cancer initially rose and then declined. However, gastric antrum tumors remained stable, and gastric body tumors showed a slow upward trend after 2020, accounting for 16.7%. In terms of pathological types, poorly differentiated carcinoma was the most prevalent, accounting for 55.9%, followed by moderately differentiated carcinoma (24.2%), mucinous adenocarcinoma (or signet ring cell carcinoma,14.1%), neuroendocrine carcinoma (4.8%), and well-differentiated carcinoma (0.9%). The proportion of poorly differentiated adenocarcinoma showed a significant upward trend overall as well, peaking at 65.6% in 2022 and decreasing to 57.5% in 2023. Mucinous adenocarcinoma (or signet ring cell carcinoma) exhibited fluctuations with a first increase followed by a decrease: it peaked at 17.3% in 2018, dropped sharply to 8.4% in 2022, and rose back to 13.8% in 2023. The proportions of well-differentiated adenocarcinoma, moderately differentiated adenocarcinoma, and neuroendocrine tumors remained stable year by year. In terms of pathological staging, the overall proportions of gastric cancer at Stage 0, Stage I, Stage II, Stage III, and Stage IVa were 0.5%, 17.3%, 25.1%, 54.9%, and 2.3%, respectively. For Stage III, its proportion was 74.6% in 2013, which decreased to 46.4% by 2023. Stages I and II gastric cancer showed an upward trend, with their proportions rising from 10.2% and 12.1% in 2013 to nearly 21.0% and 29.6% in 2023, respectively. Between 2013 and 2023, the proportion of patients who received surgery alone continued to decrease, with this proportion dropping to 34.7% in 2023. In contrast, the number of patients who received adjuvant chemotherapy increased year by year, reaching 54.2% in 2023. Since 2017, the application of perioperative chemotherapy has gradually increased, rising to 11.1% in 2023. Immunotherapy showed an almost synchronous growth trend with perioperative chemotherapy. However, targeted therapy exhibited a downward trend after a period of growth. There were 10,704 cases of open surgery (68.4%), 4,744 cases of laparoscopic surgery (30.3%), and 193 cases of transthoracic surgery (1.2%). Pathological margin positivity was observed in 443 cases (2.8%), and the volume of gastric cancer surgeries gradually increased, peaked in 2021 before subsequently decreasing gradually. However, the volume of laparoscopic surgeries did not decrease; instead, it showed an upward trend. The main resection method for EGJ tumors was total gastrectomy, accounting for 78.5% of the total, followed by proximal gastrectomy, which accounted for 21.5%. After total gastrectomy, esophagojejunal Roux-en-Y anastomosis was the primary anastomotic method, and for proximal gastrectomy, the main anastomotic method was esophagogastric anastomosis, which accounted for 68.0% of the total. For distal gastrectomy, Billroth II anastomosis was the most common anastomotic technique, accounting for 92.7% of these procedures. The overall incidence of postoperative complications was 14.5% (2,264/15,644), among which the incidence of severe complications (grades III-IV) was 4.5% (706/15,644). The entire cohort was followed up with for (47.1±36.8) months, and the 1-year, 3-year, and 5-year overall survival rates were 86.4%, 65.9%, and 58.1%, respectively. For patients with stage 0, I, II, III, and IV gastric adenocarcinoma, the 1-year overall survival rates were 95.7%, 98.0%, 89.4%, 81.0%, and 49.1%, respectively; the 3-year overall survival rates were 92.1%, 94.6%, 81.9%, 51.4%, and 14.7%, respectively; and the 5-year overall survival rates were 89.4%, 91.7%, 75.1%, 41.5%, and 10.0%, respectively. For patients with stage I, II, III, and IV gastric neuroendocrine carcinoma, the 1-year overall survival rates were 96.7%, 91.1%, 73.8%, and 52.6%, respectively; the 3-year overall survival rates were 87.2%, 69.6%, 46.1%, and 32.1%, respectively; and the 5-year overall survival rates were 87.2%, 62.2%, 36.7%, and 32.1%, respectively.Conclusions:Gastric cancer in Shanxi Province is characterized by a male predominance, a high prevalence of tumors at the esophagogastric junction, a large proportion of poorly differentiated adenocarcinoma, and presentation at advanced stages (predominantly Stage III). The detection rate of early gastric cancer has been increasing year by year, the volume of laparoscopic surgeries has been on the rise annually, and the treatment model has shifted from single surgery to comprehensive treatment.

Objective:To summarize the clinicopathological features, evolving trends in treatment and surgical approaches, and survival outcomes of patients who underwent D2 radical gastrectomy for gastric cancer in Shanxi Provincial Cancer Hospital over the past 11 years with the goal of providing a reference for the clinical practice of gastric cancer in this region.Methods:A retrospective observational study was conducted to analyze the clinicopathological data of patients who underwent D2 radical gastrectomy for pathologically confirmed gastric malignancy at the Department of Gastrointestinal Surgery, Shanxi Provincial Cancer Hospital from January, 2013 to December, 2023. Exclusion criteria consisted of: (1) residual gastric cancer or recurrent gastric cancer after surgery; (2) emergency gastric cancer resection due to bleeding, perforation, obstruction, or other causes; (3) comorbidity with other primary malignant tumors; (4) severe preoperative cardiopulmonary insufficiency or hepatic and renal insufficiency who cannot tolerate radical surgery; and (5) inconsistent main diagnosis information across the medical record system, pathological system, and gastric cancer-specific database. Patients were divided into three groups based on treatment methods: the surgery-only group, the perioperative chemotherapy group, and the adjuvant chemotherapy group. Endpoints included: (1) baseline patient characteristics; (2) trends in tumor location and pathological features; (3) evolution of treatment modalities; and (4) survival outcomes.Results:A total of 15,644 patients were included in the analysis, with 12,591 males and 3,053 females, the male-to-female gender ration was approximately 4∶1; the mean age was (61.2±9.5) years. The tumor sites were mainly concentrated in the esophagogastric junction (EGJ) (57.4%), followed by the antrum (25.9%). The incidence of EGJ cancer initially rose and then declined. However, gastric antrum tumors remained stable, and gastric body tumors showed a slow upward trend after 2020, accounting for 16.7%. In terms of pathological types, poorly differentiated carcinoma was the most prevalent, accounting for 55.9%, followed by moderately differentiated carcinoma (24.2%), mucinous adenocarcinoma (or signet ring cell carcinoma,14.1%), neuroendocrine carcinoma (4.8%), and well-differentiated carcinoma (0.9%). The proportion of poorly differentiated adenocarcinoma showed a significant upward trend overall as well, peaking at 65.6% in 2022 and decreasing to 57.5% in 2023. Mucinous adenocarcinoma (or signet ring cell carcinoma) exhibited fluctuations with a first increase followed by a decrease: it peaked at 17.3% in 2018, dropped sharply to 8.4% in 2022, and rose back to 13.8% in 2023. The proportions of well-differentiated adenocarcinoma, moderately differentiated adenocarcinoma, and neuroendocrine tumors remained stable year by year. In terms of pathological staging, the overall proportions of gastric cancer at Stage 0, Stage I, Stage II, Stage III, and Stage IVa were 0.5%, 17.3%, 25.1%, 54.9%, and 2.3%, respectively. For Stage III, its proportion was 74.6% in 2013, which decreased to 46.4% by 2023. Stages I and II gastric cancer showed an upward trend, with their proportions rising from 10.2% and 12.1% in 2013 to nearly 21.0% and 29.6% in 2023, respectively. Between 2013 and 2023, the proportion of patients who received surgery alone continued to decrease, with this proportion dropping to 34.7% in 2023. In contrast, the number of patients who received adjuvant chemotherapy increased year by year, reaching 54.2% in 2023. Since 2017, the application of perioperative chemotherapy has gradually increased, rising to 11.1% in 2023. Immunotherapy showed an almost synchronous growth trend with perioperative chemotherapy. However, targeted therapy exhibited a downward trend after a period of growth. There were 10,704 cases of open surgery (68.4%), 4,744 cases of laparoscopic surgery (30.3%), and 193 cases of transthoracic surgery (1.2%). Pathological margin positivity was observed in 443 cases (2.8%), and the volume of gastric cancer surgeries gradually increased, peaked in 2021 before subsequently decreasing gradually. However, the volume of laparoscopic surgeries did not decrease; instead, it showed an upward trend. The main resection method for EGJ tumors was total gastrectomy, accounting for 78.5% of the total, followed by proximal gastrectomy, which accounted for 21.5%. After total gastrectomy, esophagojejunal Roux-en-Y anastomosis was the primary anastomotic method, and for proximal gastrectomy, the main anastomotic method was esophagogastric anastomosis, which accounted for 68.0% of the total. For distal gastrectomy, Billroth II anastomosis was the most common anastomotic technique, accounting for 92.7% of these procedures. The overall incidence of postoperative complications was 14.5% (2,264/15,644), among which the incidence of severe complications (grades III-IV) was 4.5% (706/15,644). The entire cohort was followed up with for (47.1±36.8) months, and the 1-year, 3-year, and 5-year overall survival rates were 86.4%, 65.9%, and 58.1%, respectively. For patients with stage 0, I, II, III, and IV gastric adenocarcinoma, the 1-year overall survival rates were 95.7%, 98.0%, 89.4%, 81.0%, and 49.1%, respectively; the 3-year overall survival rates were 92.1%, 94.6%, 81.9%, 51.4%, and 14.7%, respectively; and the 5-year overall survival rates were 89.4%, 91.7%, 75.1%, 41.5%, and 10.0%, respectively. For patients with stage I, II, III, and IV gastric neuroendocrine carcinoma, the 1-year overall survival rates were 96.7%, 91.1%, 73.8%, and 52.6%, respectively; the 3-year overall survival rates were 87.2%, 69.6%, 46.1%, and 32.1%, respectively; and the 5-year overall survival rates were 87.2%, 62.2%, 36.7%, and 32.1%, respectively.Conclusions:Gastric cancer in Shanxi Province is characterized by a male predominance, a high prevalence of tumors at the esophagogastric junction, a large proportion of poorly differentiated adenocarcinoma, and presentation at advanced stages (predominantly Stage III). The detection rate of early gastric cancer has been increasing year by year, the volume of laparoscopic surgeries has been on the rise annually, and the treatment model has shifted from single surgery to comprehensive treatment.

Objective:To explore the risk factors for different severities of epiphyseal injury caused by distal tibial fractures in adolescents.Methods:A retrospective analysis was conducted on 195 children with distal tibial fractures accompanied by epiphyseal injuries who were admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2023. Among them, there were 132 males and 63 females; the age was 11.7±2.1 years (range, 5-15 years). Among them, 91 cases were on the left side and 104 cases were on the right side. Salter-Harris classification of epiphyseal injuries: there were 42 cases of type I, 90 cases of type II, 34 cases of type III, 26 cases of type IV, and 3 cases of type V. Causes of injury: 37 cases were sports injuries, 29 cases were traffic accident injuries, 120 cases were fall injuries, and 9 cases were fall from height injuries. Dias-Tachdjian classification of injury mechanisms: there were 65 cases of supination-adduction type, 59 cases of supination-plantar flexion type, 35 cases of supination-external rotation type, and 36 cases of pronation-abduction-external rotation type. Among them, 72 cases were complicated with fibular fractures, and 56 cases were accompanied by periosteum incarceration. The age, gender, side of injury, body mass index, cause of injury, presence or absence of fibular fracture, and injury mechanism of children with each type of Salter-Harris injury were compared. The indicators with statistically significant differences were included in the multiple logistic regression analysis to determine the independent risk factors for each type of Salter-Harris injury.Results:The ages of patients with type I-IV were 10.70±2.77, 12.18±1.70, 11.32±2.08, 12.35±1.19, and 11.67±2.08 years old respectively, and the difference was statistically significant ( F=4.794, P=0.001). The body mass indexes were 11.90±3.84, 21.30±4.48, 21.41±4.08, 22.42±3.74, and 24.32±4.82 kg/m 2 respectively, and the difference was statistically significant ( F=1.914, P=0.009). The numbers of cases of sports injuries/traffic accident injuries/fall injuries/fall-from-height injuries were 6/7/23/6, 17/12/59/2, 6/5/22/1, 7/4/15/0, and 1/1/1/0 respectively, and the difference was statistically significant ( P=0.032). The numbers of cases of supination-adduction/pronation-abduction-external rotation/supination-plantar flexion/supination-external rotation were 21/6/9/6, 21/16/37/16, 19/6/8/1, 4/7/4/11, and 0/1/1/1 respectively, and the difference was statistically significant ( P=0.001). The numbers of cases of periosteum incarceration (none/yes) were 32/10, 54/36, 27/7, 25/1, and 1/2 respectively, and the difference was statistically significant (χ 2=17.156, P=0.002). There was no statistically significant difference in gender, side of injury, and presence or absence of fibular fracture among patients with each type of epiphyseal injury ( P>0.05). Age, body mass index, cause of injury, injury mechanism, and periosteum incarceration were included in the multiple logistic regression analysis. The results showed that age [ OR=1.337, 95% CI (1.097, 1.628), P=0.004], the supination varus type of the injury mechanism [ OR=0.257, 95% CI (0.075, 1.013), P=0.015] in the Salter-Harris type II, and the supination plantar flexion type of the injury mechanism [ OR=0.154, 95% CI (0.027, 0.872), P=0.034] in the Salter-Harris type IV were independent risk factors for the severity of epiphyseal injury caused by distal tibial fractures in adolescents. Conclusion:The severity of distal tibial fractures accompanied by epiphyseal injuries in adolescents is related to multiple factors such as age, body mass index, cause of injury, injury mechanism, and periosteum incarceration. For every one-year increase in age, the risk of epiphyseal injury in children with Salter-Harris type II is 1.337 times higher than that in those with type I. The type I epiphyseal injury caused by supination varus injury is 3.891 times that of type II injury, and the type I epiphyseal injury caused by supination plantar flexion injury is 6.493 times that of type IV injury.

Objective:To explore the risk factors for different severities of epiphyseal injury caused by distal tibial fractures in adolescents.Methods:A retrospective analysis was conducted on 195 children with distal tibial fractures accompanied by epiphyseal injuries who were admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2023. Among them, there were 132 males and 63 females; the age was 11.7±2.1 years (range, 5-15 years). Among them, 91 cases were on the left side and 104 cases were on the right side. Salter-Harris classification of epiphyseal injuries: there were 42 cases of type I, 90 cases of type II, 34 cases of type III, 26 cases of type IV, and 3 cases of type V. Causes of injury: 37 cases were sports injuries, 29 cases were traffic accident injuries, 120 cases were fall injuries, and 9 cases were fall from height injuries. Dias-Tachdjian classification of injury mechanisms: there were 65 cases of supination-adduction type, 59 cases of supination-plantar flexion type, 35 cases of supination-external rotation type, and 36 cases of pronation-abduction-external rotation type. Among them, 72 cases were complicated with fibular fractures, and 56 cases were accompanied by periosteum incarceration. The age, gender, side of injury, body mass index, cause of injury, presence or absence of fibular fracture, and injury mechanism of children with each type of Salter-Harris injury were compared. The indicators with statistically significant differences were included in the multiple logistic regression analysis to determine the independent risk factors for each type of Salter-Harris injury.Results:The ages of patients with type I-IV were 10.70±2.77, 12.18±1.70, 11.32±2.08, 12.35±1.19, and 11.67±2.08 years old respectively, and the difference was statistically significant ( F=4.794, P=0.001). The body mass indexes were 11.90±3.84, 21.30±4.48, 21.41±4.08, 22.42±3.74, and 24.32±4.82 kg/m 2 respectively, and the difference was statistically significant ( F=1.914, P=0.009). The numbers of cases of sports injuries/traffic accident injuries/fall injuries/fall-from-height injuries were 6/7/23/6, 17/12/59/2, 6/5/22/1, 7/4/15/0, and 1/1/1/0 respectively, and the difference was statistically significant ( P=0.032). The numbers of cases of supination-adduction/pronation-abduction-external rotation/supination-plantar flexion/supination-external rotation were 21/6/9/6, 21/16/37/16, 19/6/8/1, 4/7/4/11, and 0/1/1/1 respectively, and the difference was statistically significant ( P=0.001). The numbers of cases of periosteum incarceration (none/yes) were 32/10, 54/36, 27/7, 25/1, and 1/2 respectively, and the difference was statistically significant (χ 2=17.156, P=0.002). There was no statistically significant difference in gender, side of injury, and presence or absence of fibular fracture among patients with each type of epiphyseal injury ( P>0.05). Age, body mass index, cause of injury, injury mechanism, and periosteum incarceration were included in the multiple logistic regression analysis. The results showed that age [ OR=1.337, 95% CI (1.097, 1.628), P=0.004], the supination varus type of the injury mechanism [ OR=0.257, 95% CI (0.075, 1.013), P=0.015] in the Salter-Harris type II, and the supination plantar flexion type of the injury mechanism [ OR=0.154, 95% CI (0.027, 0.872), P=0.034] in the Salter-Harris type IV were independent risk factors for the severity of epiphyseal injury caused by distal tibial fractures in adolescents. Conclusion:The severity of distal tibial fractures accompanied by epiphyseal injuries in adolescents is related to multiple factors such as age, body mass index, cause of injury, injury mechanism, and periosteum incarceration. For every one-year increase in age, the risk of epiphyseal injury in children with Salter-Harris type II is 1.337 times higher than that in those with type I. The type I epiphyseal injury caused by supination varus injury is 3.891 times that of type II injury, and the type I epiphyseal injury caused by supination plantar flexion injury is 6.493 times that of type IV injury.

Objective:To investigate the efficacy of total laparoscopic radical gastrectomy for locally advanced esophagogastric junction carcinoma and its effect on patient's immune function and levels of tumor markers.Methods:A total of 106 patients who underwent total laparoscopic radical gastrectomy (total endoscopic group) in the Affiliated Cancer Hospital of Shanxi Medical University from January 2016 to April 2020 were collected, and 98 patients who underwent open radical gastrectomy (open group) in the same period were selected. The short-term efficacy, preoperative and postoperative immune function and tumor markers were compared between the two groups.Results:The operative time of the total endoscopic group was longer than that of the open group [(214±49) min vs. (165±32) min, t = 8.87, P < 0.01], the intraoperative blood loss was less than that of the open group [(86±50) ml vs. (113±53) ml, t = 3.59, P < 0.01], the postoperative first exhaust time was shorter than that of the open group [3.0 d (3.0 d, 4.0 d) vs. 3.5 d (3.0 d, 4.5 d), Z = 2.89, P < 0.01], and the incision length was shorter than that of the open group [(4.6±0.6) cm vs. (17.6±2.0) cm, t = 68.63, P < 0.01]. The postoperative proportion of CD4 + T cells, CD4 +/CD8 + and proportion of NK cells in the total endoscopic group were higher than those in the open group [(41±8)% vs.(36±8)%, t = 4.710, P < 0.01; 1.63 (1.19, 2.30) vs. 1.15 (0.87, 1.63), Z = 4.165, P < 0.01; 24.60 % (17.77 %, 32.50 %) vs. 19.25 % (13.35 %, 25.80 %), Z = 3.440, P < 0.01], while the postoperative proportions of CD8 + T cells and regulatory T cells in the total endoscopic group were lower than those in the open group [(26±11)% vs. (30±10)%, t = 2.375, P = 0.018; 3.37% (5.00%, 6.70%) vs. 4.48% (5.70%, 7.20%), Z = 3.057, P = 0.002]. Postoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) in the total endoscopy were lower than those in the open group group [0.96 μg/L (0.54 μg/L, 1.50 μg/L) vs. 1.27 μg/L (0.70 μg/L, 2.98 μg/L), Z = 2.745, P = 0.036; 8.07 U/ml (5.48 U/ml, 13.07 U/ml) vs. 10.80 U/ml (6.54 U/ml, 19.93 U/ml), Z = 2.690, P = 0.043]. Conclusion:Compared with open surgery, total laparoscopic radical gastrectomy has less trauma and stress response, and has less impact on the gastrointestinal and immune function of patients, and the levels of tumor markers CEA and CA199 are low.

Objective:To compare the therapeutic characteristics of anterior hybrid decompression and posterior cervical posterior laminectomy in the treatment of multilevel cervical spondylotic myelopathy.Methods:Thirty six cases of multilevel cervical spondylotic myelopathy patients treated by anterior hybrid decompression and thirty three cases of multilevel cervical spondylotic myelopathy patients treated by posterior cervical posterior laminectomy were involved.The general information,bleeding amount,operative time,cervical curvature D value,JOA score and incidence of postoperative complications of the two groups before and after surgery were compared.Results:There was no significant difference in the general information among the two groups(P＞0.05),including age (anterior group:56.23± 7.64 years old,posterior group:55.76± 8.18 years old),sex (anterior group:22 males/14 females,posterior group:20 males/13 females),cervical curvature D value (anterior group:7.41± 3.14,posterior group:8.19± 2.74),JOA score (anterior group:9.08± 1.09 scores,posterior group:8.82± 1.26 scores),disease course (anterior group:17.24± 7.36 months,posterior group:15.75± 5.78 months) and affected segment (anterior group:3.11 ± 0.26 segments,posterior group:3.24± 0.39 segments).The the amount of bleeding in the anterior group (anterior approach:221.79± 178.02 ml,posterior group:483.07± 434.25 ml) was lower than that of the posterior group(P＜0.05).The operative time (anterior group:196.54± 51.88 mins,posterior group:175.12± 54.93 mins) was longer,but there was no significant difference (P＞0.05).The cervical curvature D value and JOA score of posterior group were increased with the extension of surgery time.However,the cervical curvature D value of posterior group was decreased,but JOA score was increased.The incidence of bone unfinished,hoarseness and cerebrospinal fluid leakage were found in the anterior group,and axial pain and C5 nerve root paralysis were found in the posterior group.But there was no significant difference in the incidence of complications between the two groups (anterior group 14.89％,posterior group:12.12％)(P＞0.05).Conclusions:Anterior hybrid decompression and posterior cervical posterior laminectomy had their own advantages in the treatment of multilevel cervical spondylotic myelopathy.,The appropriate treatment should be taken according to the condition of patients.