The aim of this study was to evaluate the efficacy and safety of extracorporeal shockwave therapy (ESWT) and acupuncture therapy for patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We searched electronic databases including PubMed, Cochrane Library, Embase and web of science from its inception to June 1, 2021. The randomized controlled trials (RCTs) that compared ESWT and acupuncture in the management of CP/CPPS were identified. A network meta-analysis was conducted with the software of STATA 14.0. Nine RCTs with 525 patients were enrolled in our analysis. The results revealed that both ESWT and acupuncture were significantly better than the sham procedure in the outcomes of total score of NIH-CPSI, pain subscore, urinary symptoms subscore, QoL subscore, IPSS score, the IIEF score and response rates ( p < .05). Both ESWT and acupuncture were well-tolerated and had no obviously increased adverse events. Compared with acupuncture, ESWT was associated with better short term (<4w) and mid-term (8-12 w) efficacy of total score, pain subscore, urinary symptoms subscore, and QoL subscore of NIH-CPSI, IPSS score, IIEF score, and response rate. However, ESWT did not present better long-term (<24 w) outcomes than acupuncture in total score, pain subscore, urinary symptoms subscore, and QoL subscore of NIH-CPSI. Both ESWT and acupuncture were effective and well-tolerated in the management of CP/CPPS. ESWT seemed to have better short (<4 w) and mid-term (8-12 w) efficacy but similar long-term (>24 w) efficacy than acupuncture.

Objective: The aim of this study was to evaluate the prognosis of patients with metastatic prostate cancer (mPCa) in different age groups. Methods: Patients with mPCa from 2004 to 2016 in the Surveillance, Epidemiology and End Results (SEER) database were identified. Seven groups were divided according to the age at diagnosis, including ≤55 years, 56-60 years, 61-65 years, 66-70 years, 71-75 years, 76-80 years and >80 years. Fine and Gray's competing risks model and Kaplan-Meier analysis were conducted to evaluate the cancer-specific survival (CSS). Results: A total of 36231 patients with mPCa were included. The CSS curves of the overall cohort showed that patients aged ≤55 years had significantly worse CSS than patients in age groups of 56-60 [HR:0.93 (0.87~1.00), p=0.039], 61-65 [HR:0.91 (0.85~0.97), p=0.003] and 66-70 [HR:0.90 (0.84~0.96), p=0.001]. After removing patients dead for other reasons, the differences of CSS curves between ≤55 years group and 56-70 years groups were not significant. However, the mean survival time of ≤55 years group (55.78±2.48 months) was still shorter than 56-60 years (57.28±2.35 months), 61-65 years (57.64±2.07 months), and 66-70 years (57.11±2.11 months). When stratified by M stages, similar results were found in M1a, M1b and M1c stage groups. According to Fine-Gray competing risks models, patient ≤55 years featured significantly higher sub-distribution hazard ratio (sdHR) than 61-65 years group [sdHR: 0.94(0.88~1.00); p=0.046]. Conclusions:The mPCa patients ≤55 years seemed to be associated with worse prognosis in comparison with patients aging 56-70 years.

<b><i>Objective:</i></b> The aim of this study was to evaluate the survival outcomes of radical prostatectomy (RP), external beam radiotherapy plus brachytherapy (EBRT + BT), and EBRT alone among elderly men (aged 70 years and above) with very high-risk (VHR) prostate cancer (PCa). <b><i>Methods:</i></b> We identified elderly men diagnosed with VHR PCa between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database. The propensity score-matching method was adopted to balance the covariates and generate new cohorts. ­Kaplan-Meier and Cox analyses were conducted to build up survival curves and evaluate the overall survival (OS) and PCa-specific survival (PCSS) outcomes. <b><i>Results:</i></b> A total of 9,818 patients were identified. Of them, 5,839 were in the EBRT group, 725 in the EBRT + BT group, and 3,254 in the RP group. The survival curves of the overall cohort showed that RP was associated with the best OS, followed by EBRT + BT and EBRT (<i>p</i> &#x3c; 0.001). As for the PCSS, RP shared similar outcomes with EBRT + BT (hazard ratio [HR]: 1.25 [0.93–1.69], <i>p</i> = 0.175). EBRT was associated with significantly worse PCSS than both RP (HR: 1.88, 95% confidence interval [95% CI] [1.64–2.15], <i>p</i> &#x3c; 0.001) and EBRT + BT (HR: 1.48, 95% CI [1.19–1.85], <i>p</i> = 0.002). In the matched cohorts, RP presented better OS (HR: 1.41, 95% CI [1.07–1.86], <i>p</i> = 0.041) and similar PCSS with EBRT + BT (HR: 1.50, 95% CI [0.91–2.47], <i>p</i> = 0.12). RP was associated with significantly better OS and PCSS outcomes than EBRT alone (OS HR: 1.58, 95% CI [1.59–2.12], <i>p</i> &#x3c; 0.001; PCSS HR: 2.08 [1.60–2.72], <i>p</i> &#x3c; 0.001). EBRT + BT also had significantly better OS and PCSS outcomes than EBRT alone (OS HR: 1.33, 95% CI [1.11–1.60], <i>p</i> &#x3c; 0.001; PCSS HR: 1.57 [1.13–2.19], <i>p</i> = 0.003). <b><i>Conclusions:</i></b> For patients above 70 years with VHR PCa, RP was associated with better OS and similar PCSS than EBRT + BT. Both RP and EBRT + BT have better OS and PCSS than EBRT alone.

Background: The aim was to evaluate the prognosis of men with all possible high-risk prostate cancers (PCa) stratified by risk factors.Methods: Within the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2015, men with non-metastasis high-risk PCa were identified. Kaplan-Meier analysis and Cox regressions were adopted to evaluate the overall survival (OS) and prostate cancer-specific survival (PCSS). Nomograms were conducted to build a predictive model. Concordance index (C-index) and calibration curves were used to validate the model.Results: A total of 151,799 patients were included. Seven risk groups were divided including one highrisk factor of T3-4 (A1), prostate-specific antigen (PSA) >20 ng/mL (A2), and Gleason score (GS) 8-10, two high-risk factors of T3-4 PSA >20 ng/mL (B1), T3-4 GS 8-10 (B2), PSA >20 ng/mL GS 8-10 (B3), and three high-risk factors of T3-4 PSA >20 ng/mL GS 8-10 (C). The survival curves of PCSS showed that A1 was the best among all groups. A2, A3 and B1 had similar results and were all better than B2 [with A2 as

Background Echinococcosis is a global enzootic disease influenced by different biological and environmental factors and causes a heavy financial burden on sick families and governments. Currently, government subsidies for the treatment of patients with echinococcosis are only a fixed number despite patients’ finical income or cost of treatment, and health authorities are demanded to supply an annual summary of only endemic data. The risk to people in urban areas or non-endemic is increasing with climate, landscape, and lifestyle changes. Methods We conducted retrospective descriptive research on inpatients with human echinococcosis (HE) in Lanzhou hospitals and analyzed the healthcare expenditure on inpatient treatment and examined the financial inequalities relating to different levels of gross domestic product. The livestock losses were also estimated by infection ratio. The occurrence records of Echinococcus spp. composed of hospitalized patients and dogs infected in the Gansu province were collected for Ecological niche modeling (ENM) to estimate the current suitable spatial distribution for the parasite in Gansu province. Then, we imported the resulting current niche model into future global Shared Socioeconomic Pathways scenarios for estimation of future suitable habitat areas. Results Between 2000 to 2020, 625 hospitalized HE patients (51% men and 49% women) were identified, and 48.32 ± 15.62 years old. The average cost of hospitalization expenses per case of HE in Gansu Province was ￥24,370.2 with an increasing trend during the study period and was negative with different counties’ corresponding gross domestic product (GDP). The trend of livestock losses was similar to the average cost of hospitalization expenses from 2015 to 2017. The three factors with the strongest correlation to echinococcosis infection probability were (1) global land cover (GLC, 56.6%), (2) annual precipitation (Bio12, 21.2%), and (3) mean temperature of the Wettest Quarter (Bio12, 8.5% of variations). We obtained a robust model that provides detail on the distribution of suitable areas for Echinococcus spp. including areas that have not been reported for the parasite. An increasing tendency was observed in the highly suitable areas of Echinococcus spp. indicating that environmental changes would affect the distributions. Conclusion This study may help in the development of policies for at-risk populations in geographically defined areas and monitor improvements in HE control strategies by allowing targeted allocation of resources, including spatial analyses of expenditure and the identification of non-endemic areas or risk for these parasites, and a better comprehension of the role of the environment in clarifying the transmission dynamics of Echinococcus spp. Raising healthcare workers’ and travelers’ disease awareness and preventive health habits is an urgent agenda. Due to unpredictable future land cover types, prediction of the future with only climatic variables involved needs to be treated cautiously.

Background: Echinococcosis is a global enzootic disease influenced by different biological and environmental factors. We investigated do and patient populations, and climatic and environmental factors affecting the distribution of Echinococcosis in Gansu Province, China. The risk to people in urban areas is increasing with climate, landscape, and lifestyle changes.Methods: We conducted a retrospective descriptive study using hospitalization case data (2000 to 2020) in Lanzhou. All hospital discharges with echinococcosis diagnosis placed in the first diagnostic position were analyzed, and clinical characteristics were described. We mapped the addresses of 626 hospitalized echinococcosis patients and distribution dogs and studied the effects of different temperature models, mean annual rainfall and slope, latitude, land covers, closeproximity to travel routes, livestock, and dog densities on the occurrence of echinococcosis using a geographical information systems approach. The spatial and temporal distribution of patient epidemiological data combined with infected dog fecal incidence from the scientific literature was also evaluated. We assessed model performance and variable importance to discover the relation of these variables to the exposure of the Echinococcus spp. niche. Then, we imported the resulting niche model into future global Shared Socioeconomic Pathways scenarios.Results: The average cost of treating a case of echinococcosis in Gansu Province was $24,370.2 and showed an increasing trend during the study period. The cost of treating a case of echinococcosis in different counties was significantly negative with their corresponding gross domestic product (GDP). The three factors with the strongest correlation to echinococcosis infection probability were (1) GLC (56.6%), (2) annual precipitation (Bio12, 21.2%), and (3) mean temperature of the Wettest Quarter (Bio12, 8.5% of variations). The risk map showed that areas characterized by Echinococcus spp were mainly located east southern Gansu Province with the highest probability, followed by areas in the center of Gansu Province. When comparing the possible future distribution with the present distribution of Echinococcus spp., an increasing tendency was observed in the highly suitable areas of Echinococcus spp., indicating that environmental changes would affect the distribution of Echinococcus spp.Conclusion: This study provides valuable information for cost-effective public health programs to control echinococcosis in Gansu Province and elsewhere. Raising travelers’ disease awareness and preventive health habits is an urgent agenda and most efficient-reaching action with a small investment.