1.Comparison of Wild and Cultivated Bupleurum scorzonerifolium Based on Traditional Quality Evaluation
Changsheng YUAN ; Feng ZHOU ; Xingyu LIU ; Yu SHI ; Yihan WANG ; Huaizhu LI ; Yongliang LI ; Shan GUAN ; Huaizhong GAO ; Yanmeng LIU ; Zhilai ZHAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):203-214
ObjectiveTo characterize the quality differences among different germplasm and introduced varieties of Bupleurum scorzonerifolium roots(BSR), and explore the underlying molecular mechanisms, providing a basis for high-quality production and quality control. MethodsWild BSR from Yulin(YLW) served as the quality reference, we conducted comparative analysis among YLW, locally domesticated wild germplasm in Yulin(YLC3), Daqing germplasm introduced and cultivated in Yulin(YLDQC3), and locally cultivated germplasm in Daqing(DQC3). A combination of traditional pharmacognostic methods and modern multi-omics analyses was employed, including macroscopic traits(appearance, odor), microscopic features(proportions of cork, phloem, xylem), cell wall component contents(hemicellulose, cellulose, lignin), carbohydrate contents(starch, water-soluble polysaccharides), marker compound contents(ethanol-soluble extracts, total saponins, liposoluble extracts, and saikosaponins A, B2, C, D), metabolomics, and transcriptomics, in order to systematically characterize quality differences and investigate molecular mechanisms among these samples. ResultsMacroscopically, Yulin-produced BSR(YLW, YLC3, YLDQC3) exhibited significantly greater weight, length, and upper and middle diameters than Daqing-produced BSR(DQC3). Odor-wise, YLW and YLC3 had a a fragrance taste, YLDQC3 had a rancid oil odor, and DQC3 had a sweet and fragrant taste. Microscopically, Yulin germplasm(YLW, YLC3) and Daqing germplasm(YLDQC3, DQC3) shared similar structural features, respectively. However, Yulin germplasm showed significantly higher proportions of cork and phloem, as well as stronger xylem vessel staining intensity compared to Daqing germplasm. Regarding various component contents, Yulin germplasm contained significantly higher levels of ethanol-soluble extracts, total saponins, and saikosaponins A, B2, C, D, while Daqing germplasm had significantly higher levels of hemicellulose, starch, and liposoluble extracts. After introduction to Yulin, the Daqing germplasm(YLDQC3) showed increased starch, water-soluble polysaccharides and liposoluble extracts contents, decreased cell wall component content, but no significant difference in other component contents. Metabolomics revealed that saponins and terpenes accumulated significantly in Yulin germplasm, while alcohols and aldehydes accumulated predominantly in Daqing germplasm. Transcriptomics indicated similar gene expression patterns within the same germplasm but specificity between different germplasms. Integrative metabolomic-transcriptomic analysis identified 145 potential key genes associated with the saikosaponin biosynthesis pathway, including one acetyl-coenzyme A(CoA) acetyltransferase gene(ACAT), one 3-hydroxy-3-methylglutaryl-coenzyme A synthase gene(HMGS), two hydroxymethylglutaryl-CoA(HMG-CoA) reductase genes(HMG), one phosphomevalonate kinase gene(PMK), one 1-deoxy-D-xylose-5-phosphate synthase gene(CLA), one hydroxymethylbuten-1-aldol synthase gene(HDR), two farnesyl pyrophosphate synthase genes(FPPS), one squalene synthase gene(SQS), one β-amyrin synthase gene(BAS), 102 cytochrome P450(CYP450) gene family members, and 32 uridine diphosphate-glucuronosyltransferase(UGT) gene family members. ConclusionAmong the three cultivated types, YLC3 most closely resembles YLW in appearance, microscopic features, contents of major bioactive constituents, metabolomic and transcriptomic profiles. Yulin germplasm exhibits superior saponin synthesis capability compared to Daqing germplasm, and Yulin region is more suitable for the growth of B. scorzonerifolium. Based on these findings, it is recommended that artificial cultivation in northern Shaanxi and similar regions utilize the local Yulin germplasm source cultivated for at least three years.
2.Long-term outcomes of laparoscopic gastrectomy for locally advanced gastric cancer with serosa-invasion
Ping′ang LI ; Fan ZHANG ; Zhengyan LI ; Yan SHI ; Feng QIAN ; Yongliang ZHAO ; Jun CHEN ; Chenjun TAN ; Zongwen WANG ; Yan WEN ; Peiwu YU
Chinese Journal of Surgery 2024;62(8):744-750
Objective:To evaluate the long-term outcomes and prognostic factors of locally advanced gastric cancer with serosa-invasion.Methods:This study is a retrospective cohort study. The clinical and pathological data of 495 patients with locally advanced gastric cancer with serosa-invasion who underwent laparoscopic radical gastrectomy in Department of General Surgery, the First Hospital Affiliated to Army Medical University from October 2012 to October 2018 was analyzed retrospectively. There were 356 males and 139 females with an age ( M(IQR)) of 59 (16) years (range: 18 to 75 years). Observation indicators included postoperative results and long-term prognosis. The survival curve was drawn by the Kaplan-Meier method. Univariate and multivariate prognostic analysis was performed using the Cox proportional hazards model. Results:Among the 495 patients, a total of 57 patients (11.5%) were lost to follow-up, with a follow-up time of 89 (40) months (range: 23 to 134 months). The 5-year disease-free survival rate (DFS) and the 5-year overall survival rate (OS) were 56.0% and 58.2%, respectively. The 5-year DFS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 60.5%, 51.6%, 33.3%, respectively. The 5-year OS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 62.2%, 54.1%, 39.3%, respectively. Multivariate analysis showed that age >65 years (DFS: HR=1.402, 95% CI: 1.022 to 1.922, P=0.036; OS: HR=1.461, 95% CI: 1.057 to 2.019, P=0.022), lymph node dissection number less than 25 (DFS: HR=1.348, 95% CI: 1.019 to 1.779, P=0.036; OS: HR=1.376, 95% CI: 1.035 to 1.825, P=0.028), pathological stage Ⅲ (DFS: HR=2.131, 95% CI: 1.444 to 3.144, P<0.01; OS: HR=2.079, 95% CI: 1.406 to 3.074, P<0.01), and no postoperative chemotherapy (DFS: HR=3.127, 95% CI: 2.377 to 4.113, P<0.01; OS: HR=3.768, 95% CI: 2.828 to 5.020, P<0.01) were independent prognostic factors for the decrease in DFS and OS rates. Conclusions:Laparoscopic radical gastrectomy for locally advanced gastric cancer with serosa-invasion could achieve satisfactory long-term oncological outcomes. More lymph node dissection and standardized postoperative adjuvant chemotherapy are expected to further improve the prognosis of patients with locally advanced gastric cancer with serous invasion after laparoscopic radical surgery.
3.Long-term outcomes of laparoscopic gastrectomy for locally advanced gastric cancer with serosa-invasion
Ping′ang LI ; Fan ZHANG ; Zhengyan LI ; Yan SHI ; Feng QIAN ; Yongliang ZHAO ; Jun CHEN ; Chenjun TAN ; Zongwen WANG ; Yan WEN ; Peiwu YU
Chinese Journal of Surgery 2024;62(8):744-750
Objective:To evaluate the long-term outcomes and prognostic factors of locally advanced gastric cancer with serosa-invasion.Methods:This study is a retrospective cohort study. The clinical and pathological data of 495 patients with locally advanced gastric cancer with serosa-invasion who underwent laparoscopic radical gastrectomy in Department of General Surgery, the First Hospital Affiliated to Army Medical University from October 2012 to October 2018 was analyzed retrospectively. There were 356 males and 139 females with an age ( M(IQR)) of 59 (16) years (range: 18 to 75 years). Observation indicators included postoperative results and long-term prognosis. The survival curve was drawn by the Kaplan-Meier method. Univariate and multivariate prognostic analysis was performed using the Cox proportional hazards model. Results:Among the 495 patients, a total of 57 patients (11.5%) were lost to follow-up, with a follow-up time of 89 (40) months (range: 23 to 134 months). The 5-year disease-free survival rate (DFS) and the 5-year overall survival rate (OS) were 56.0% and 58.2%, respectively. The 5-year DFS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 60.5%, 51.6%, 33.3%, respectively. The 5-year OS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 62.2%, 54.1%, 39.3%, respectively. Multivariate analysis showed that age >65 years (DFS: HR=1.402, 95% CI: 1.022 to 1.922, P=0.036; OS: HR=1.461, 95% CI: 1.057 to 2.019, P=0.022), lymph node dissection number less than 25 (DFS: HR=1.348, 95% CI: 1.019 to 1.779, P=0.036; OS: HR=1.376, 95% CI: 1.035 to 1.825, P=0.028), pathological stage Ⅲ (DFS: HR=2.131, 95% CI: 1.444 to 3.144, P<0.01; OS: HR=2.079, 95% CI: 1.406 to 3.074, P<0.01), and no postoperative chemotherapy (DFS: HR=3.127, 95% CI: 2.377 to 4.113, P<0.01; OS: HR=3.768, 95% CI: 2.828 to 5.020, P<0.01) were independent prognostic factors for the decrease in DFS and OS rates. Conclusions:Laparoscopic radical gastrectomy for locally advanced gastric cancer with serosa-invasion could achieve satisfactory long-term oncological outcomes. More lymph node dissection and standardized postoperative adjuvant chemotherapy are expected to further improve the prognosis of patients with locally advanced gastric cancer with serous invasion after laparoscopic radical surgery.
4.Effect of porcine GHRH(1-44)expression plasmid on mouse growth and per-formance of pregnant sows
Yukai WEI ; Yun WANG ; Yuxuan WANG ; Qianyun XI ; Jiajie SUN ; Ting CHEN ; Junyi LUO ; Hequn SHI ; Yongliang ZHANG
Chinese Journal of Veterinary Science 2024;44(9):2063-2071
The study adopted muscle injection of pVAX1-SP-GHRH(1-44)expression plasmid and electrostimulation to determine its effects on mouse growth and sow production performance.One hundred and fifty four-week-old C57 BL/6 female mice were randomly divided into 6 groups of 5 replicates each.Muscle single-injection followed by electrostimulation was performed.The con-trol group received an empty plasmid injection(80 μg/kg),while the treatment groups received pVAX1-SP-GHRH(1-44)plasmid injections(20,40,80,120,160 μg/kg).Twenty healthy preg-nant sows were randomly divided into 2 groups,each with 10 sows.Electrostimulation treatment was applied to the semimembranosus muscle of the pregnant sows after a single injection.The con-trol group received physiological saline injection,while the plasmid group received a 2 mg pVAX1-SP-GHRH(1-44)expression plasmid injection.Mouse weight,feed intake,and serum GHRH and IGF-1 levels were measured at days 0,7,14,21,and 28 after injection.Pregnant sows were bled via the tail vein at days 0,14,28,and 42 after injection,and their serum was separated to measure serum GHRH and IGF-1 levels.The birth weight,placental weight,number of piglets born,number of healthy piglets,number of weak piglets,number of deformed piglets,number of stillborn piglets,and number of mummified piglets were recorded at day 14.The mouse study re-sults showed that muscle injection of pVAX1-SP-GHRH(1-44)plasmid followed by electrostim-ulation could promote mouse feeding and increase weight gain(P<0.05),significantly increase mouse serum GHRH and IGF-1 levels(P<0.05),and maintain its effects until day 21.The results of the pregnant sow study showed that the average birth weight of the piglets in the plasmid group was significantly increased(P<0.01),and the placenta weight was significantly increased(P<0.05).The serum GHRH and IGF-1 concentrations in the plasmid group sows were significantly increased(P<0.01).The study results showed that muscle injection of pVAX1-SP-GHRH(1-44)expression plasmid followed by electrostimulation could promote mouse feeding and increase weight gain,and also significantly improve the average birth weight and placental weight of the piglets in pregnant sows.
5.The short-term outcomes of totally robotic surgical system and robotic surgical system assisted radical gastrectomy for gastric cancer
Zhenshun LI ; Feng QIAN ; Yan SHI ; Yongliang ZHAO ; Jun CHEN ; Fan ZHANG ; Ping′ang LI ; Chenjun TAN ; Peiwu YU
Chinese Journal of Digestive Surgery 2023;22(4):512-518
Objective:To investigate the short-term outcomes of totally robotic surgical system and robotic surgical system assisted radical gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 290 patients who under-went robotic surgical system radical gastrectomy for gastric cancer in the First Affiliated Hospital of Army Medical University from January 2018 to November 2021 were collected. There were 208 males and 82 females, aged 58 (range, 24?84)years. Of the 290 patients, 125 patients undergoing totally robotic surgical system radical gastrectomy combined with reconstruction of digestive tract were divided into the totally robot group, and 165 patients undergoing robotic surgical system radical gastrectomy combined with a small midline incision-assisted reconstruction of digestive tract were divided into the robotic-assisted group. Observation indicators: (1) surgical and postoperative situations; (2) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was conducted using the non-parameter rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical and postoperative situations. The operation time, volume of intraoperative blood loss, length of incision, duration of postoperative analgesic using, time to postoperative gastric tube removal, time to postoperative initial water intake, time to postoperative first anal flatus, duration of post-operative hospital stay were (246±43)minutes, (104±51)mL, 4(range, 3?6)cm, (2.2±0.5)days, 36(range, 10?112)hours, 62(range, 32?205)hours, 63(range, 18?138)hours, 8(range, 6?50)days in patients of the totally robot group, versus (296±59)minutes, (143±87)mL, 6(range, 3?13)cm, (3.6±0.7)days, 42(range, 12?262)hours, 90(range, 18?262)hours, 80(range, 16?295)hours, 9(range, 6?63)days in patients of the robotic-assisted group, showing significant differences in the above indicators between the two groups ( t=8.04, 4.42, Z=?13.98, t=18.46, Z=?5.47, ?5.87, ?6.14, ?4.04, P<0.05). (2) Post-operative complications. Cases with systemic related complications and cases with pulmonary infection were 7 and 4 in patients of the totally robot group, versus 31 and 16 in patients of the robotic-assisted group, showing significant differences in the above indicators between the two groups ( χ2=10.86, 4.68, P<0.05). Further analysis showed that there were significant differences in age ≥60 years, body mass index ≥25 kg/m 2, tumor diameter ≥3 cm, TNM staging as stage Ⅲ of cases with postoperative complications between the totally robot group and the robotic-assisted group ( odds ratio=0.44, 0.17, 0.40, 0.31, 95 confidence interval as 0.20?1.00, 0.03?0.88, 0.18?0.89, 0.11?0.84, P<0.05). Conclusion:Totally robotic surgical system radical gastrectomy for gastric cancer is safe and feasible with advantages of minimal trauma and quick recovery, especially for patients as age ≥60 years, body mass index ≥25 kg/cm 2, tumor diameter ≥3 cm and TNM stage Ⅲ in complication controlling.
6.Immunization effect and persistence of hepatitis B vaccine in HIV-infected patients with different CD4 +T cell levels
Yongliang FENG ; Yue CHANG ; Jing SHI ; Guanghua LAN ; Hongyan LU ; Shaomi XIANG ; Fuzhen WANG ; Suping WANG
Chinese Journal of Epidemiology 2021;42(9):1559-1565
Objective:To explore the immunogenicity and persistence of hepatitis B vaccine in HIV-infected patients with different CD4 +T cell (CD4) levels, and analyze the influence effect of CD4 levels on immunization response. Methods:A total of 182 HIV-infected patients who participated in a randomized controlled trial of 20 μg and 60 μg hepatitis B vaccination at month 0, 1, and 6 in 2014 by Guangxi Zhuang Atonomous Region CDC and Ningming county CDC were surveyed. Six months later after the first dose and 1 month, 6 months, 1 year, and 3 years later after the full course of the vaccination, 5 ml of the venous blood of the patients was collected, and the anti-HBs was detected by Chemiluminescent Microparticle Immunoassay (CMIA). On the basis of previous studies, this study focused on analyzing the immunogenicity and persistence of hepatitis B vaccine under different CD4 levels.Results:One month later after the whole course of hepatitis B vaccination, the anti-HBs geometric mean concentration (GMC), anti-HBs positive rate (≥10 mIU/ml) and strong positive rate (≥100 mIU/ml) in HIV patients with CD4 <350 cells/μl were 442.50 mIU/ml, 71.05% (27/38) and 44.74% (17/38), respectively, which were significantly lower than those HIV-infected patients with CD4 ≥350 cells/μl [583.90 mIU/ml, 92.13% (117/127) and 77.95% (99/127)] ( P<0.05). After controlling the confounding factors, the probability of being anti-HBs positive induced by hepatitis B vaccine in patients with CD4 <350 cells/μl was 0.14 times higher than in those with CD4≥350 cells/μl (95% CI: 0.03-0.62), and patients with CD4 <350 cells/μl had higher risk of no response. From 6 months to 3 years after the whole course of the vaccination, the anti-HBs GMC (195.00-27.55 mIU/ml vs. 300.10-45.81 mIU/ml), the positive rate (56.67%-36.67% vs. 78.57%- 51.58%) and the strong positive rate (33.33%-6.67% vs.44.64%-15.79%) in patients with CD4 <350 cells/μl gradually declined, lower than the levels in those with CD4 ≥350 cells/μl. Conclusions:HIV-infected patients with CD4 <350 cells/μl have high risk of no response to hepatitis B vaccination and poor immune persistence. It is necessary to strengthen the anti-HBs monitoring in HIV-infected patients, with special attention to those with CD4 <350 cells/μl. When anti-HBs is negative, hepatitis B vaccine should be injected as early as possible.
7.Immunity persistence of 60 μg high dose hepatitis B vaccine and influencing factors in maintained hemodialysis patients
Yuanting WU ; Tian YAO ; Jing SHI ; Jianmin WANG ; Guangming LIU ; Fuzhen WANG ; Yongliang FENG ; Suping WANG
Chinese Journal of Epidemiology 2021;42(9):1566-1572
Objective:To compare the anti-HBs level in maintained hemodialysis patients one year after receiving 20 μg and 60 μg hepatitis B vaccination at 0, 1 and 6 months, and explore the influence factors for the immunity persistence and their interactions.Methods:Based on a randomized controlled trial of 20 μg and 60 μg hepatitis B vaccine immunization in maintained hemodialysis patients at 0, 1, and 6 months, follow up was conducted for the patients for one year after the completion of the vaccination for the quantitative detection of anti-HBs, and χ 2 test, t test, unconditional logistic regression and interaction analyses were used for statistical analysis. Results:One year after the vaccination, 125 and 124 patients in the 20 μg and 60 μg groups were tested for anti-HBs, respectively. The positive rate of anti-HBs in the 60 μg group (77.42%, 96/124) was significantly higher than that in the 20 μg group (65.60%, 82/125) ( P<0.05). After adjusting for the confounding factors, the positive probability of anti-HBs in the 60 μg group was 1.925 times higher than that in the 20 μg group (95% CI: 1.068-3.468). Patients with hemodialysis duration ≥5 years ( OR=0.523, 95% CI: 0.293-0.935) and diabetes mellitus ( OR=0.376, 95% CI: 0.173-0.818) had lower positive probability of anti-HBs. Moreover, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus. Conclusions:The immunity persistence after one year in 60 μg hepatitis B vaccination group was longer than that in 20 μg hepatitis B vaccination group in maintained hemodialysis patients, vaccine dose, hemodialysis duration and diabetes mellitus were the influencing factors for the immunity persistence, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus.
8.Long-term efficacy of robotic radical total gastrectomy for gastric cancer and analysis of prognostic factors
Shaohui XIE ; Yan SHI ; Du LONG ; Jun CHEN ; Yongliang ZHAO ; Feng QIAN ; Yingxue HAO ; Bo TANG ; Ping′ang LI ; Peiwu YU
Chinese Journal of Gastrointestinal Surgery 2020;23(4):357-363
Objective:To analyze long-term outcomes and prognostic factors of gastric cancer patients after robotic radical total gastrectomy.Methods:A retrospective case-control study was conducted. Inclusion criteria: (1) receiving robotic radical total gastrectomy; (2) gastric adenocarcinoma was confirmed by postoperative pathology; (3) no previous history of other malignant tumors; (4) no preoperative chemotherapy or radiation therapy performed. Exclusion criteria: (1) age <18 years old or age >80 years old;(2)distant metastasis before surgery, or palliative surgery; (3) conversion to laparotomy;(4) R1 or R2 resection; (5)emergency surgery; (6) remnant gastric cancer or recurrence; (7)died of severe complications during hospitalization or within 1 month after surgery. Overall survival rates (OS) and disease-free survival rates (DFS) were evaluated using the Kaplan-Meier method. Cox regression analysis was used to identify prognosis factors for overall survival.Results:According to the above criteria, 166 gastric cancer patients who underwent robotic radical total gastrectomy between March 2010 and November 2018 were included in this study. Roux-en-Y reconstruction was performed in all patients. Reconstruction were achieved using extracorporeal method through a minilaparotomy in 149 case and intracorporeal anastomosis in 17 cases. The number of harvested lymph nodes was (34.8±17.5), and the number of harvested lymph nodes at group 2 was (10.1±6.7). The number of patients with lymph node metastasis of group 2 was 73 (44.0%). The median follow-up time was 25 months (range 2-109). There were 55 (33.1%) cases of recurrence during follow-up. The 3- and 5-year overall survival rates were 55.8% and 46.2% respectively. The 3- and 5-year disease-free survival rates were 53.4% and 45.4% respectively. The 5-year overall survival rates grouped based on TNM stage were 78.9% for stage I, 58.5% for stage II, and 37.1% for stage III. The 5-year disease-free survival rates grouped based on TNM stage were 78.9% for stage I, 59.2% for stage II, and 34.6% for stage III. Univariate analysis suggested that TNM stage, the number of harvested lymph nodes and number of harvested lymph nodes at group 2 were associated with overall survival rates (all P<0.05). Multivariate analyses revealed that TNM stage ( P<0.001; stage IIIB: HR=5.357, 95%CI:1.182 to 24.275; stage IIIC: HR=11.937, 95%CI: 2.677 to 53.226) and number of harvested lymph nodes at group 2 ( P=0.034; 6-10: HR=0.562,95%CI:0.326 to 0.969; >10: HR=0.388, 95%CI: 0.176 to 0.857) were independent prognostic factors for overall survival. Conclusion:The long-term outcomes of robotic radical total gastrectomy were satisfactory. TNM stage and number of harvested lymph nodes at group 2 were independent prognostic factors for overall survival.
9.Long-term efficacy of robotic radical total gastrectomy for gastric cancer and analysis of prognostic factors
Shaohui XIE ; Yan SHI ; Du LONG ; Jun CHEN ; Yongliang ZHAO ; Feng QIAN ; Yingxue HAO ; Bo TANG ; Ping′ang LI ; Peiwu YU
Chinese Journal of Gastrointestinal Surgery 2020;23(4):357-363
Objective:To analyze long-term outcomes and prognostic factors of gastric cancer patients after robotic radical total gastrectomy.Methods:A retrospective case-control study was conducted. Inclusion criteria: (1) receiving robotic radical total gastrectomy; (2) gastric adenocarcinoma was confirmed by postoperative pathology; (3) no previous history of other malignant tumors; (4) no preoperative chemotherapy or radiation therapy performed. Exclusion criteria: (1) age <18 years old or age >80 years old;(2)distant metastasis before surgery, or palliative surgery; (3) conversion to laparotomy;(4) R1 or R2 resection; (5)emergency surgery; (6) remnant gastric cancer or recurrence; (7)died of severe complications during hospitalization or within 1 month after surgery. Overall survival rates (OS) and disease-free survival rates (DFS) were evaluated using the Kaplan-Meier method. Cox regression analysis was used to identify prognosis factors for overall survival.Results:According to the above criteria, 166 gastric cancer patients who underwent robotic radical total gastrectomy between March 2010 and November 2018 were included in this study. Roux-en-Y reconstruction was performed in all patients. Reconstruction were achieved using extracorporeal method through a minilaparotomy in 149 case and intracorporeal anastomosis in 17 cases. The number of harvested lymph nodes was (34.8±17.5), and the number of harvested lymph nodes at group 2 was (10.1±6.7). The number of patients with lymph node metastasis of group 2 was 73 (44.0%). The median follow-up time was 25 months (range 2-109). There were 55 (33.1%) cases of recurrence during follow-up. The 3- and 5-year overall survival rates were 55.8% and 46.2% respectively. The 3- and 5-year disease-free survival rates were 53.4% and 45.4% respectively. The 5-year overall survival rates grouped based on TNM stage were 78.9% for stage I, 58.5% for stage II, and 37.1% for stage III. The 5-year disease-free survival rates grouped based on TNM stage were 78.9% for stage I, 59.2% for stage II, and 34.6% for stage III. Univariate analysis suggested that TNM stage, the number of harvested lymph nodes and number of harvested lymph nodes at group 2 were associated with overall survival rates (all P<0.05). Multivariate analyses revealed that TNM stage ( P<0.001; stage IIIB: HR=5.357, 95%CI:1.182 to 24.275; stage IIIC: HR=11.937, 95%CI: 2.677 to 53.226) and number of harvested lymph nodes at group 2 ( P=0.034; 6-10: HR=0.562,95%CI:0.326 to 0.969; >10: HR=0.388, 95%CI: 0.176 to 0.857) were independent prognostic factors for overall survival. Conclusion:The long-term outcomes of robotic radical total gastrectomy were satisfactory. TNM stage and number of harvested lymph nodes at group 2 were independent prognostic factors for overall survival.
10.The distribution characteristics of urine flora in patients with ureteral stent tube crusting
Yongliang NI ; Wei WEI ; Xiangtao WANG ; Xiaolu SUN ; Zhongxian HUANG ; Bo WANG ; Mingjie LI ; Deqi JIANG ; Yunwei LI ; Qiang WEI ; Xia LIU ; Benkang SHI
Chinese Journal of Urology 2020;41(4):262-266
Objective:To investigate the distribution characteristics of bacteria in urine of patients with ureteral stent crusting.Methods:Thirty-five patients who underwent ureteral stent placement at the Shandong Provincial Third Hospital, Shandong University Qilu Hospital, Jinan Central Hospital, and Jinan Jigang Hospital were selected from October, 2018 to March, 2019(the clinical study registration number is ChiCTR1800020025). The inclusion criteria were patients who had the stent intubated for 4 weeks after ureteroscopic lithotripsy, aged between 18 and 65 years. Exclusion criteria were patients with positive urine bacterial culture, severe gross hematuria, recent oral antibiotics, and patients with significant residual stones. This clinical study uses a cross-sectional study method, and those patients were divided into crusting group (n=23) and non-crusting group (n=12) according to the presence or absence of stent crusting. On the day of extubation, urine of the patients was collected for bacterial 16s DNA detection. The distribution characteristics of bacteria in urine of the two groups were analyzed using UPARSE, UCHIME and RDP calssifier. The total number of bacteria species, bacterial abundance and bacterial species with large-scale abundance in urine of the two groups were determined. The quantity of bacteria species and bacterial abundance in the urine between the two groups were compared, and the bacterial species with large-scale abundance in urine of the patients with stent crusting were identified.Results:There were no significant differences in general information such as age, body mass index, gender, affected side, type of stent tube, and stone composition between the two groups. Using 16s DNA sequencing to detect the bacteria in the urine of the two groups revealed that the number of bacterial species with abundance >1% was 11, and the number of bacterial species with abundance >0.01% was 74 in the crusting group. In the non-crusting group, the number of bacterial species with abundance >1% and >0.01% was 7 and 11, respectively. Compared with the non-crusting group, the number of bacterial species with abundance >1% in the crusting group was significantly larger ( t=5.12, P=0.000). In the crusting group, bacterial species with the top three abundance were g_Lactobacillus (23.1%), g_Bacteroides (18.8%) and g_norank_Bacteroides (17.1%). In the non-crusting group, bacterial species with the top three abundance were g_Escherichia-Shigella (32.2%), g_Enterococcus (24.9%) and g_Pseudomonas (18.2%). The three bacteria with the greatest difference between the two groups were g_ Lactobacillus ( P=0.010), g_Bacteroides ( P=0.004) and g_norank_Bacteroides ( P=0.004), respectively. Conclusion:The species and quantity of bacteria in the urine of patients with stent crusting are both significantly larger than those of patients without stent crusting. Bacteroides with larger-scale abundance in the urine of patients with stent crusting may promote the deposition of crystals on the stent wall through its structure, function and urease positive characteristics.

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