Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck preservation was completed;deep dorsal vein complex was bunched;jumper intussusception technology was applied for bladder and urethral anastomosis.Functional outcomes of continence and sexual function (IIEF-score) were followed-up.Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml.Median operating time was 150 minutes (75-240 minutes), blood loss was 350 ml (100-1 600 ml), preoperative IIEF-score was 21 scores (15-25 scores).Pathologic stage included pT1 (8 cases), pT2a (15 cases), pT2b (4 cases) and pT3a (3 cases).By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores.4 cases had positive margins including 2 cases (10.5 ％) of pT2 and 2 cases (67 ％) of pT3.There were no postoperative complications.Mean follow-up was 19 months (6-48 months).At the 1st month, 27 patients (90 ％) got full continence, and at the 3rd month, all of the patients had full continence.At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 ％ (at the 3rd month) and 70 ％ (at the 6th month) of preoperative level.Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients.Preserving all periprostatic fasciae/nerves can recover early continence and maintains potency without affecting outcomes.

Objective : To understand the epidemiological characteristics of injury deaths among residents in Taizhou,and to provide evidence for prevention and control of injury death. Methods : The monitoring data of injury deaths in Taizhou residents from 2010 to 2016 were derived from the Chronic Disease Surveillance Information Management System of Zhejiang Province. Descriptive epidemiological methods were used to analyze injury mortality,cause of death,population characteristics and life lost due to injury. Results : From 2010 to 2016,a total of 26 313 injury death cases were reported in Taizhou,with an average annual injury mortality rate of 63.61/100 000 and a standardized rate of 56.64/100 000; the mortality rate of injury from 2010 to 2016 showed a downward trend year by year（P<0.05）,and the annual change percentage（APC）was -7.1%. The mortality rates of 0-14 years old,15-44 years old,45-64 years old,65 years old and above group were 15.37/100 000,22.45/100 000, 69.64/100 000 and 315.69/100 000. There were statistically significant differences in the mortality rates of residents between different age groups （P<0.05）. Except for there were no statistically significance differences between the mortality rates of 15-44 years old and 0-14 years old in 2013 and 2014（both P>0.008 3）. The mortality rate in each year from 2010 to 2016 were decreased by 0-14 years old,15-44 years old,45-64 years old,65 years old and above group （all P<0.008 3）. The mortality rate of all age groups showed a downward trend year by year（P<0.05）. The top five injury death causes were accidental falls（17.97/100 000）,motor vehicle traffic accidents（13.97/100 000）,drowning（5.59/100 000）,suicide （5.25/100 000）,other accidents and harmful effects（4.50/100 000）,accounting for 84.35% of the total number of deaths. The injury death causes of the 0-14 years old group were mainly drowning,which was 407 cases,accounting for 1.55% of the total number of deaths; for 15-44 years old group and the 45-64 years old group,the main causes were motor vehicle traffic accidents,which were 1 373 and 2 354 cases,accounting for 5.22% and 8.95%,respectively; for 65 years old and above group,the main cause was mainly accidental falls,which was 6 777 cases,accounting for 25.76%. The years of potential life lost （PYLL） due to injury was 328 678 person-years and the years of potential life lost rate （PYLLR） was 7.95‰. Conclusion The injury mortality rates of Taizhou residents were declined from 2010 to 2016. The mortality rate of elderly residents due to injury were high and accidental falls was the main cause of injury deaths.

Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.

Objective To analyze oncological outcomes of 125I permanent implant brachytherapy (125I-PIB) in clinically localized prostate cancer. Methods Between June 2008 and June 2015, 121 patients with clinically localized prostate cancer were treated with 125I-PIB, and their average age was 72.37 years old. Before treatment, the average prostate-specific antigen (PSA) level was 17.7 ng/ml, prostate volume was (51.4 ±15.0) cm3, the International Prognostic Scoring System (IPSS) score was (21.6 ±2.4) scores. The intermediate-risk and high-risk patients were treated with adjuvant endocrine or supplemental external beam radiotherapy. All patients were followed-up. Biochemical recurrence was defined as the PSA nadir plus 2.0 ng/ml. Results Average follow-up time of the 121 patients was 41.81 months. The prostate volume was (23.1 ± 10.2) cm3, and the IPSS score was (9.7±3.3) scores. Rates of 5-year overall survival, biochemical recurrence-free survival and cancer-specific survival were 86.7 %, 76.7 % and 96.5 %, respectively. 5-year biochemical recurrence-free survival rates were 88.5 %, 67.5 % and 65.2 % in the low-, intermediate-, and high-risk groups, respectively. Biochemical recurrence-free survival did not differ significantly by three risk groups (P=0.103), but the difference between high-risk and low-risk groups was statistically significant (P=0.028). According to multivariate analysis, higher prostate-specific antigen (P=0.021), higher Gleason score (P=0.023) and higher clinical T stage (P=0.037) were the significant covariates associated with biochemical recurrence-free survival. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than brachytherapy monotherapy (P=0.036, P=0.027). As for complications, there were 4 cases of surgery (trans-urethral resection of the prostate) and 4 cases of cardiovascular complications. Conclusions The 125I-PIB can bring excellent oncological outcomes and acceptable complications in patients. Adjuvant endocrine or external beam radiotherapy for the intermediate-risk and high-risk patients may improve the outcome. Factors influencing efficacy include the high PSA, Gleason score and clinical T stage.

Objective:To evaluate the efficacy and side effects of PD-1 monoclonal antibody in the treatment of advanced metastatic renal cell carcinoma in China.Methods:The clinical data of 117 patients with advanced metastatic renal cell carcinoma (mRCC) treated with PD-1 monoclonal antibody from October 2016 to February 2022 were retrospectively analyzed. There were 87 males (74.4%) and 30 females (25.6%), with an average age of (57.9±10.9) years old, BMI of (23.6±3.4) kg/m 2and smoking history of 79 (67.5%). There were 44 cases (37.6%) with hypertension, 19 (16.2%) cases of diabetes. The ECOG score of 59.8% (70/117) patients was 0, 33.3% (39/117) was 1, 4.3% (5/117) was 2, and 2.5% (3/117) was 3. The pathological type of 104 cases were renal clear cell carcinoma (ccRCC), 8 cases of papillary renal cell carcinoma, 2 cases of chromophobe cell carcinoma, 2 cases of collecting duct carcinoma and 1 case of eosinophilic cell carcinoma. The general condition of the overall population and the overall survival (OS) of relevant subgroups were analyzed. Secondary goals included progression free survival (PFS), objective response rate (ORR), adverse reactions, overall survival (OS), and progression free survival (PFS). Results:65.8% (77 / 117) of the patients chose targeted combined with PD-1 monoclonal antibody in the first-line treatment. The main targeted drugs were acitinib (81.8%, 63 / 77), tirelizumab (37.6%, 29 / 77) and cindilimab (25.9%, 20 / 77). After first-line treatment, 19.6.1% (23 / 117) patients needed to be converted to second-line treatment, and 15 patients changed the type of PD-1 antibody during treatment. In addition, the targeted drug of combined therapy was replaced by acitinib in 8 patients. The main causes of drug withdrawal were disease progression (70.7%, 29 / 41) and death (29.2%, 12 / 41). The median OS of the overall population was 35.6 (19-60) months and PFS was 12.1 (1-60) months. The ORR of the overall population was 47.8% (56 / 117). 4.2% (5/117) patients had complete remission, another 17.0% (20/117) patients were in stable condition, and 43.5% (51 / 117) patients were in partial remission. In the first-line treatment, the median PFS time of targeted combined with PD-1 monoclonal antibody was 12.6 (1-30) months, the median PFS time of PD-1 single drug immunotherapy was 10.5 (1-60) months. In the second-line treatment, the PFS of patients treated with PD-1 monoclonal antibody was 10.1 (4-19) months, and that of patients treated with PD-1 monoclonal antibody combined with targeted therapy was 11.7 (1-25) months. The most common adverse reactions were elevated blood pressure (18.5%, 23 / 124), followed by hypothyroidism (15.3%%, 19/124), rash (14.5%, 18 / 124), elevated transaminase (10.5%, 13 / 124) and bone marrow suppression (9.7%, 12/124). 9.4% (11 / 117) patients needed to reduce the related adverse reactions by interrupting the treatment control of PD-1 monoclonal antibody.Conclusions:The safety and efficacy of PD-1 monoclonal antibody in domestic patients are better, and the side effects are less. The efficacy and safety of PD-1 monoclonal antibody combined with targeted therapy in the real world population are consistent with many key clinical trials abroad. PD-1 monoclonal antibody combined with targeted drugs can be popularized in the domestic MRCC population.

ObjectiveTo analyze the characteristics of death and premature death of 4 major chronic diseases （cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes） in Taizhou City from 2011 to 2018，and provide data basis for the government to formulate chronic disease prevention planning. MethodsThe death data of household registration residents in Taizhou City from 2011 to 2018 were derived from the Chronic Disease Surveillance Information Management System in Zhejiang Province. The death toll ratio of chronic diseases， the mortality rate of chronic diseases， the probability of premature death of chronic diseases were analyzed. The standardization rate was calculated six times in 2010. Population composition of the census. The Joinpoint Regression Program 4.2 software was used for calculating annual percent change （APC） and its statistical test results. ResultsFrom 2011 to 2018， there were 231 724 chronic disease deaths in Taizhou City， with a mortality rate of 486.52/10⁵ and a standardized mortality rate of 381.55/10⁵. The proportion of chronic disease deaths to total deaths was 79.89%， of which males were higher than females and rural areas were higher than urban areas.From 2011 to 2018， the standardized mortality and early death probability of cardiovascular and cerebrovascular diseases， malignant tumors and chronic respiratory diseases in Taizhou showed a downward trend （P<0.05）， the standardized mortality of diabetes （P=0.46） and the early death probability （P=0.22） did not decline， and the mortality of all age groups of the above four types of chronic diseases in rural areas was higher than that in urban areas. The mortality of the four types of chronic diseases from high to low are cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes， and the mortality tends to increase with age. From 2011 to 2018， the probability of premature death from four types of chronic diseases in Taizhou City showed a downward trend， from 13.49% in 2011 to 10.49% in 2018， with an average annual decrease of 2.97%. The difference was statistically significant （t=‒5.83，P<0.05）. ConclusionChronic disease death is the main cause of death in Taizhou City. In order to reduce the mortality rate of chronic diseases， effective prevention and control measures for chronic diseases should be carried out， especially the prevention and control of diabetes and male chronic diseases.