Objective: To investigate the level of chronic disease prevention and control literacy and its influencing factors among residents in Taizhou City, Zhejiang Province, so as to provide insights into formulating health education strategies on chronic diseases. Methods: A total of 32 313 permanent residents at ages of 15 to 69 years were sampled in Taizhou City using the multi-stage stratified random sampling method and probability proportionate to size sampling method (PPS). Subjects' demographic characteristics and chronic disease prevention and control literacy were collected using the national health literacy surveillance questionnaire. The levels of chronic disease prevention and control literacy from 2017 to 2022 were evaluated and standardized by the population data provided by Taizhou Municipal Bureau of Statistics. Factors affecting the chronic disease prevention and control literacy were identified using a multivariable logistic regression model. Results: Totally 32 313 questionnaires were distributed, and 32 258 valid questionnaires were recovered, with an effective recovery rate of 99.83%. The median age of participants was 51.00 (interquartile range, 19.00) years. There were 15 754 men (48.84%) and 16 504 women (51.16%), and 11 060 urban residents (34.29%) and 21 198 rural residents (65.71%). Farmer was the predominant occupation (16 003 residents, 49.61%). The level of chronic disease prevention and control literacy among residents in Taizhou City was 32.97%, which was 22.58%, 26.41%, 33.48%, 34.44%, 38.53% and 39.68% from 2017 to 2022, respectively, showing an upward trend (P<0.05) with a cumulative growth rate of 17.10%. Multivariable logistic regression analysis showed that age (15 to 24 years, OR=1.566, 95%CI: 1.309-1.874; 25 to 34 years, OR=1.345, 95%CI: 1.173-1.542; 35 to 44 years, OR=1.482, 95%CI: 1.311-1.675; 45 to 54 years, OR=1.203, 95%CI: 1.078-1.343), educational level (primary school, OR=1.728, 95%CI: 1.546-1.932; junior high school, OR=2.211, 95%CI: 1.977-2.472; high school/vocational high school/technical secondary school, OR=3.368, 95%CI: 2.972-3.817; college or above, OR=7.271, 95%CI: 6.313-8.373), occupation (farmer, OR=0.739, 95%CI: 0.663-0.825; others, OR=0.778, 95%CI: 0.694-0.872), place of residence (urban areas, OR=0.903, 95%CI: 0.852-0.956) and annual household income (30 000 to 49 999 Yuan, OR=1.138, 95%CI: 1.030-1.259; 50 000 to 99 999 Yuan, OR=1.239, 95%CI: 1.143-1.342; 100 000 to 199 999 Yuan, OR=1.445, 95%CI: 1.334-1.566; 200 000 Yuan and above, OR=1.803, 95%CI: 1.629-1.997) were influencing factors for chronic disease prevention and control literacy. Conclusions The level of chronic disease prevention and control literacy among residents in Taizhou City shows an upward trend from 2017 to 2022, with age, educational level, occupation, place of residence and annual household income as the influencing factors.

Objective: To understand the mortality and probability of premature death due to malignant tumors, cardio-cerebrovascular diseases, diabetes and chronic respiratory diseases in Taizhou City, Zhejiang Province, so as to provide the basis for the improvement of chronic diseases prevention and control strategies. Methods: The death data of the four chronic diseases among local residents in Taizhou City from 2019 to 2022 were collected through Taizhou Chronic Disease Information Management System, and the crude mortality, standardized mortality (standardized by the data of the seventh national population census in 2020) and probability of premature death were calculated. The trends in mortality and probability of premature death were analyzed using annual percent change (APC). The attainment of probability of premature death due to the four chronic diseases were evaluated using the target values and predicted values in 2025 and 2030. Results: There were 119 899 deaths from the four chronic diseases in Taizhou City from 2019 to 2022, with the crude mortality of 494.48/105 and the standardized mortality of 410.68/105, which was no significant changing trend (APC=4.680% and -2.795%, both P>0.05). The probability of premature death decreased from 10.39% to 8.69% (APC=-6.027%, P<0.05). The crude mortality and standardized mortality in males were higher than those in females (562.13/105 vs. 424.08/105; 461.67/105 vs. 353.81/105; both P<0.05). The crude mortality and standardized mortality in rural areas were higher than those in urban areas (499.65/105 vs. 480.52/105; 429.20/105 vs. 365.68/105; both P<0.05). The probability of premature death in women and rural residents showed downward trends (APC=-8.210% and -7.558%, both P<0.05) from 2019 to 2022. The standardized mortality and probability of premature death due to malignant tumors showed downward trends (APC=-6.090% and -8.019%, both P<0.05). The crude mortality of diabetes showed an upward trend (APC=18.654%, P<0.05). The predicted values for probability of premature death due to due to the four chronic diseases in 2025 and 2030 were 7.27% and 5.40%, respectively, and were lower than the target values of 10.02% and 8.77%. Conclusions From 2019 to 2022, there was no significant trends in the mortality of four chronic diseases in Taizhou City, with rural men being the key population for prevention and control. The probability of premature death showed a downward trend, and it was expected to achieve the target in 2025 and 2030.

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 learn the epidemiological characteristics of fall mortality among the elderly people in Taizhou，and to provide basis for intervention strategies of fall in the elderly. Methods: Data of fall mortality among residents aged 60 years or over in Taizhou from 2016 to 2018，collected from Zhejiang Chronic Disease Surveillance Information Management System，was used for analysis of time，population and geographical characteristics of fall deaths. The epidemic trend of fall mortality in the elderly was described by annual percentage change（APC）. Results: From 2016 to 2018，3 699 cases of fall death in Taizhou were reported，the crude and standardized mortality were 116.90/100 000 and 97.88/100 000. The standardized mortality of fall in women was 106.11/100 000，which was higher than 90.13/100 000 in men（P<0.05）. The standardized mortality of fall in rural residents was 131.20/100 000，which was higher than 28.15/100 000 in urban residents（P<0.05）. The mortality of fall in residents aged 65-69 years from 2016 to 2018 showed an upward trend（APC=4.20%，P<0.05），while the mortality trend of fall in other age groups was not statistically significant（P>0.05）. Conclusion Fall was the first cause of injury death in the elderly aged 60 years or over in Taizhou. Females and rural residents have relatively higher fall mortality.

Objective: To explore the effectiveness of healthy school canteen intervention on nutritional literacy, food consumption, as well as attitude towards school canteen. Methods: A primary school in Taizhou City was selected as the intervention school, and another comparable primary school was selected as the control one. A total of 320 students (163 in the intervention group and 157 in the control group) received a comprehensive intervention based on the construction of a healthy school canteen in the school,incluling healthy dining environment,food impravement,chef training,nutrition and health education, while the control group did not receive any intervention. Questionnaires survey was administered to both groups before and after the intervention. Results: Before the intervention, no significant differences were found in the total scores of skills and nutrition literacy, frequency of food intake, behaviors and attitudes related to canteen construction between the two groups( P >0.05). Daily intake of vegetables, dairy products, fish/poultry/eggs/lean meat increased by 19.63, 15.95 and 19.63 percentage point respectively ( χ 2=15.25，9.14，13.93， P <0.01). The proportion of students reporting have read related intervention materials in the intervention group(95.71%) was higher than the control group(84.71%) ( χ 2= 11.04, P < 0.01 ). The students in favor of low salt, low oil and low sugar dishes in the intervention group (74.85%) was higher than in the control group(48.41%) ( χ 2=23.73, P <0.01). Conclusion Based on the comprehensive intervention of nutrition and health canteens can improve students nutrition literacy and dietary structure. It is recommended to adopt the form of "home school linkage" to carry out the construction of large sample, multi regional and long term nutrition and health canteens.

Objective To investigate the therapeutic effects of presurgical TMT on the heights and levels of inferior vena cava(IVC)thrombi,and to assess its impact on surgical strategy.Methods We retrospectively reviewed data of 18 patients with renal cell carcinoma(RCC)involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy.Data from 18 patients(16 men and 2 women)were included in the analysis.The median age was 53.5 years(range:33-75 years),and the mean BMI was 24.7kg/m2(rrange:18.1 -30.4 kg/m2).4 cases of tumors located in the left kidney,14 cases were right.The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging.The IVC tumor thrombus level was evaluated according to the Mayo classification.Results The tumor thrombus levels before TMT were stage Ⅰ in 1 patient,Ⅱ in 1 2 patients,Ⅲ in 4 patients,and Ⅳ in 1 patient.The presurgical TMT was sorafenib in 6 patients(33.3%),sunitinib in 9(50.0%),and axitinib in 3(16.7%).After a median of 2 treatment cycles(range:1-6 cycles),three patients experienced grade 3 adverse events.One patient stopped treatment after 6 weeks owing to intolerable skin reactions and difficulty walking.The tumor thrombus height decreased measurably in 11 patients(61.1%).The thrombus height remained stable in 5 patients(27.8%)and was enlarged in 2(11.1%).The median reduction of tumor thrombus height was -0.53 cm (range:-4.23 to 1.21 cm).The median change in the maximum diameter of the thrombus was -0.30 cm (range:-1.23 to 0.29 cm).Down-staging of the thrombus level occurred in 4 patients(22.2%);the surgical strategy was modified in 3 patients(level≥Ⅲ)to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy.Conclusions Our data suggest a limited influence of presurgical TMT,with a positive benefit in RCC patients with level Ⅲ and Ⅳ thrombus.Thrombus-level regression may potentially alter the surgical strategy,especially robotic surgery.Additionally,preoperative targeted therapy did not significantly increase perioperative mortality and risk of serious complications.

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.