Sisomicin is a broad-spectrum aminoglycoside antibiotic produced by Micromonospora inyoensis (M. inyoensis), which has attracted considerable attention due to its effectiveness in treating bacterial infections. However, low production levels have significantly constrained its wider application in clinical settings. This study aimed to improving the sisomicin production capability of M. inyoensis through a multi-modal breeding and engineering approach. Initially, sisomicin production of the mutant strain R168 was enhanced by 28.7% through atmospheric and room temperature plasma (ARTP)-mediated mutagenesis of the parental strain OG-1. Next, the mutant strain R168's tolerance to sisomicin stress increased from 1.6 g/L to 5.7 g/L through adaptive laboratory evolution (ALE) strategy, two ALE evolved strains A20-10 and A50-12 with improved sisomicin production were successfully obtained. Then, genome shuffling combined with rifamycin resistance screening based on the two ALE evolved strains generated strain GS2-137 with a sisomicin production of 2036.5 U/mL, representing an increase of 97.5% compared to the parental strain OG-1. Comparative genomic and transcriptional analysis revealed key genes related to the synthesis of sisomicin and provided more insight into the mechanism of high production of sisomicin. Following fermentation process optimization, the production of sisomicin by the shake flask fermentation strain GS2-137 increased to 2182.3 U/mL (3835.3 mg/L) and reached 1306.4 U/mL (2296.0 mg/L) in a 5 L bioreactor. The study underscored the potential of systematic microbial breeding engineering to improve sisomicin production in M. inyoensis.

The core hydroxylation of steroids plays a pivotal role in steroid drug synthesis. However, direct hydroxylation of sp3 C-H bonds by chemical catalysis is challenging due to poor selectivity and substantial environmental pollution. Fungal biotransformation may be a solution to these issues. In this study, Mortierella sp. CICC 40250 was identified as being capable of hydroxylating progesterone through a two-step process, yielding 6 beta,11 alpha-dihydroxyprogesterone. The dihydroxy metabolite was evaluated using Swiss ADME, and the results suggested that it might exhibit bioavailability and bioactivity. To address the limitation associated with the low solubility of the substrate in the reaction system, 36 types of deep eutectic solvents (DESs) were constructed for the sequential two-step biohydroxylation of progesterone. The newly designed ternary DES (Pro/EG/Glc at a molar ratio of 2:1:1) exhibited excellent biocompatibility and enhanced the cell membrane permeability. Compared with the original system, the ternary DES system achieved a higher progesterone conversion rate of 80.5% and increased the time-space yield of 6 beta,11 alpha-diOH-PG by 3.3-fold in the 5-L fermenter. DESs were inherently natural and nontoxic. Consequently, they are environmentally friendly and well-suited for the green synthesis of steroid drugs. The results demonstrated the significant potential of solvent engineering in the development of efficient and sustainable biocatalytic solutions.

Squalene, a long-chain unsaturated triterpene compound, finds extensive applications in the food, pharmaceutical, and cosmetic industries owing to its distinctive molecular structure. Traditional methods of squalene production involve extraction from shark liver and plant oils, practices that are neither environmentally sustainable nor economically viable. In light of these challenges, microbial biosynthesis has emerged as a promising alternative, offering significant environmental and economic benefits. In this study, a combinatorial metabolic engineering approach was utilized to modify Saccharomyces cerevisiae for the efficient biosynthesis of squalene. Firstly, by introducing an exogenous NADH-dependent HMGR and enhancing the endogenous synthesis pathways, resulting in a squalene titer of 56.5 mg/L. Subsequently, by integrating the mevalonate synthesis pathway into the mitochondria and introducing the ethanol utilization pathway, the supply of precursors for squalene synthesis was enhanced, resulting in a significant increase in the squalene titer to 312.5 mg/L. Furthermore, the native promoter of ERG1 gene was engineered to reduce the flux through the ergosterol biosynthesis pathway. Following optimization of the culture medium, the squalene titer of the engineered strain was improved to 595 mg/L in shake flasks and 1929.7 mg/L in 5 L fermenters, respectively. This research provides valuable insights into the metabolic engineering of microorganisms for enhanced squalene production.

Hyaluronic acid (HA) is a well-known functional marine polysaccharide. The utilization and derivative development of HA are of great interest. Hyaluronan lyase has wide application prospects in the production of HA oligosaccharides and lower molecular weight HA. In this study, a strain of Enterobacter asburiae CGJ001 with high hyaluronan lyase activity was screened from industrial wastewater. This strain exhibited an impressive enzyme activity of 40,576 U/mL after being incubated for 14 h. Whole genome sequencing analysis revealed that E. asburiae CGJ001 contained a cluster of genes involved in HA degradation, transport, and metabolism. A newly identified enzyme responsible for glycosaminoglycan degradation was designated as HylEP0006. A strain of E. coli BL21(DE3)/pET-22b(+)-hylEP0006 was successfully constructed. HylEP0006 exhibited optimal degradation at 40 °C and pH 7.0, showing a high activity of 950,168.3 U/mg. HylEP0006 showed specific activity against HA. The minimum degradation fragment of HylEP0006 was hyaluronan tetrasaccharides, and HylEP0006 could efficiently degrade HA into unsaturated disaccharides (HA2), with HA2 as the final product. These characteristics indicate that HylEP0006 has a potential application prospect for the extraction and utilization of hyaluronic acid.

Conventional mini percutaneous nephrolithotomy (mPCNL) typically necessitates the pre-operative placement of ureteral catheters. With the development of enhanced recovery after surgery (ERAS), we introduce a novel approach: no ureteral catheter mini percutaneous nephrolithotomy (NUC-mPCNL). To evaluate the efficacy and safety of this innovative procedure compared to mPCNL, we compared the total operative time, stone clearance rate (SCR), stone-free rate (SFR), and complications among patients undergoing either modality from January to September 2021. Our findings revealed a statistically significant reduction in the mean total operative time for the NUC-mPCNL group (42.6 +/- 2.4 vs. 60.2 +/- 3.4 min, p < 0.001). The SCR, SFR and CSFR were comparable between two groups (98.5% vs. 97.8%, 84.3% vs. 76.0%, 64.7% vs. 60.0%, p = 0.337, 0.295, 0.625). WBC rise, hemoglobin drop and neutrophil percentage rise were similar in both groups. The overall complication rate in the NUC-mPCNL group was lower; however, the difference was not statistically significant (Clavien I, II and III; 11 vs. 13, 1 vs. 2 and 1 vs. 1). Consequently, we conclude that NUC-mPCNL effectively shortens the operative time and holds potential for expedited postoperative recovery.

Androstenedione (ADD), an important precursor for steroid hormone drug synthesis, can be obtained through the transformation of phytosterols by members of the Mycobacteria genus. In this study, multidirectional pathway engineering of Mycobacterium neoaurum LY-2 was applied to improve ADD production from phytosterols. Initially, the nonessential gene KasB which encoding a cell wall β-ketoacyl acyl carrier protein synthase in Mycobacterium neoaurum LY-2 was knocked out, and the production of ADD was increased by 21.0%. Then, the key enzymes involved in ADD synthetic metabolism were systematically explored. These assays revealed that propionyl coenzyme A carboxylase (PCC) and Hsd4A play important roles in the synthesis of ADD. In addition, the heterologous expression of Vitreoscilla hemoglobin (VHb), a protein with oxygen-binding capacity, was successfully realized in Mycobacterium neoaurum LY-2, and the ADD concentration reached 4.42g/L. Finally, the recombinant strain LY-2-ΔKasB-hsd4A-pcc-vgb with high ADD production was constructed by combining the above strategies. Through optimization of conversion conditions, the recombinant strain LY-2-ΔKasB-hsd4A-pcc-vgb produced an ADD concentration of 11.12g/L when adding 20g/L phytosterols.

Objectives: To introduce a novel hydrodynamic design for a flexible ureteroscope that can increase stone debris clearance. Methods: Based on hydrodynamics, the new design allowed the ureteroscope to have six water jets. Fluid gushed from the six jets and would ultimately converge into an eddy. The safety and stone debris clearance efficiency were tested in a 3D-printed kidney model. Stone fragments between 0.5 and 1 mm were used to mimic the debris. A ureteroscope already approved for marketing was used as a control. Results: The new design did not change the local renal pressure and did not raise the whole renal pressure under irrigation at 80 or 100 mL/min but slightly raised it under irrigation at 120 mL/min. The pressures in the 2 g stone clearance procedures were 26.0, 33.1, and 37.5 cmH(2)O for the new design and 25.1, 30.2, and 39.3 cmH(2)O for the current design; in the 4 g stone clearance procedures, the pressures were 30.1, 37.2, and 40.0 cmH(2)O for the new design and 26.9, 30.8, and 39.8 cmH(2)O for the current design, all under conditions of 80, 100, and 120 mL/min irrigation, respectively. The new design significantly improved the stone clearance rate by similar to 10-fold. It effectively cleared 2 and 4 g stones within 900 seconds under the three irrigation rates. In contrast, the current design cleared <10% of the stone debris in all tests. Conclusion: The new hydrodynamic design significantly improved the stone debris clearance rate without causing obviously increased renal pressure, and the improvement was maintained under different irrigation pressures and stone burdens.

Objectives To compare the efficiency and safety of a novel flexible ureteral access sheath (f-UAS) and traditional ureteral access sheath (UAS) during retrograde intrarenal surgery (RIRS). Patients and methods Between January 2022 and September 2022, a total of 152 consecutive cases with renal stones underwent RIRS with the f-UAS. Their outcomes were compared with those of another 152 consecutive cases undergoing RIRS with traditional UAS using a 1:1 scenario matched-pair analysis, with matching parameters including age and stone size. The f-UAS is a novel UAS with a 10-cm-long tube at the tip that can follow the bends of flexible ureteroscope (f-URS). Results Baseline characteristics were found to be similar between the two groups. The f-UAS group demonstrated significantly higher SFR (76.3% vs. 7.2%; P < 0.001) at 1 day postoperatively and a higher clearance rate of stone volume (98.11% vs. 91.78%; P < 0.001). The f-UAS group also had lower total complications rate (9.9% vs. 22.4%; P = 0.003), lower incidence of fever (5.9% vs 11.9%; P = 0.001), shorter operative times (56.5 min vs. 59.9 min; P = 0.047), and lower usage rate of baskets (17.1% vs. 100%; P < 0.001). There was no significant difference in SFR at 1 month postoperatively ( P = 0.627) and in the length of postoperative hospital stay between the two groups ( P = 0.225). Conclusion Compared to the traditional UAS during RIRS, the f-UAS showed several advantages, including higher SFR at 1 day postoperatively, shorter operative times, lower incidence of complications, and less use of basket.

BACKGROUNDDentin matrix protein 1 (DMP1) is central to matrix mineralization. Clarification of the function of DMP1 is crucial to understanding normal bone formation and pathological calcification. The tissue-nonspecific alkaline phosphatase (TNAP) -progressive ankylosing enzyme (ANK) -extracellular nucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) axis induces deposition of hydroxyapatite (HA) and pyrophosphate dehydrate (CPPD) by regulating pyrophosphate (PPi). Here, we investigated the mechanism by which DMP1 and the TNAP-ANK-ENPP1 axis participate in mineralization.METHODSExpression of DMP1, TNAP, NPP1, and ANK genes in MC3T3-E1 cells was detected by RT-qPCR before and after treatment with DMP1 siRNA. An enzyme-linked immunosorbent assay was used to determine expression of DMP1 protein, TNAP activity was detected by SIGMAFAST p-nitrophenyl phosphate tablets, and mineralization of osteoblasts was determined by alizarin red staining. PPi levels were determined radiometrically and equalized for cell DNA. Levels of calcium, inorganic phosphate, zinc, and magnesium were assessed by standard laboratory techniques.RESULTSAfter DMP1 gene silencing, expressions of TNAP, ENPP1, and ANK were correspondingly reduced. DMP1 altered extravesicular and intravesicular ion levels through the TNAP-ENPP1-ANK axis in MC3T3-E1 cells.CONCLUSIONSDMP1 regulated mineralization of MC3T3-E1 cells via the TNAP-ANK-ENPP1 axis and affected TNAP activity by two processes-rapid regulation of the Zn2+ transporter (ZnT) and transcriptional regulation of hysteresis. However, DMP1 may affect expression of ENPP1 and ANK only via hysteresis transcriptional regulation. DMP1, as a calcium trap or catalytic enzyme, appears to have a role in collagen mineralization.

NH2-SBA-15 was prepared as an enzyme loading microreactor by modifying SBA-15 with 3-aminopropyltriethoxysilane as the functionalizing reagent. After modification, alpha-glucosidase (alpha-Glu) can be easily and fast immobilized on the surface and inner wall of the two-dimensional pores of NH2-SBA-15 by electrostatic adsorption in phosphate buffered saline (PBS, pH 7.4). The quantity of immobilized alpha-Glu by NH2-SBA-15 under the optimum conditions was 39.93 mu g mg(-1) which was much higher than unmodified SBA-15 (15.92 mu g mg(-1)), and the enzyme activity still retained 76.1% after 7 cycles. In addition, due to the restricted conformational change of the immobilized enzyme in the 2D pore structure, which had some protective effect on the enzyme, the immobilized enzyme had good acid and alkali resistance, and high temperature resistance. The results showed that the relative activity of the immobilized enzyme fluctuated less in the same pH range, and still retained more than 90% of the activity after standing at 40 degrees C and 60 degrees C for 24 h. Finally, the NH2-SBA-15-alpha-Glu microreactors were co-incubated with the tea extract, and the alpha-Glu inhibitory active components were screened by HPLC. Several chemical components were successfully screened out, verifying the feasibility of the microreactor.

ObjectiveTo explore the advantages and disadvantages of robot-assisted laparoscopic adrenalectomy compared with retroperitoneal laparoscopic adrenalectomy.MethodsA total of 101 patients with adrenal tumors who received retroperitoneal laparoscopic adrenalectomy (RLA) (n=75) or robot-assisted laparoscopic adrenalectomy (RARLA) (n=26) in our hospital from January 2021 to December 2021 were retrospectively collected. Patients’ demographics, tumor characteristics, and perioperative indicators were compared. Statistical analysis was performed using t-test for continuous variables and Pearson chi-square test or Fisher’s exact test for categorical variables.ResultsWe found that blood loss in the RARLA group was significantly less than that in the RLA group (66.9 ± 35.5 ml vs 91.5 ± 66.1 ml, p = 0.020). Gastrointestinal function recovery time in RARLA group was significantly less than that in RLA group (19.9 ± 6.9 hours vs 32.0 ± 9.0 hours, p < 0.001). However, the operation time, drainage tube placement time, post-operative hospital stay in the RARLA group were significantly longer compared with the RLA group (149.6 ± 53.4 mins vs 118.7 ± 41.2 mins, p = 0.003; 4.9 ± 2.0 days vs 3.6 ± 1.1 days, p = 0.004; 6.4 ± 1.8 days vs 4.6 ± 1.6 days, p < 0.001). The hospitalization expense in the RARLA group is significantly higher than that in the RLA group (59284 ± 8724 RMB¥ vs 39785 ± 10126 RMB¥, p < 0.001). We found that there was no significant difference in the incidence of postoperative complications between the two groups. However, the pathological types of the two groups were significantly different. Patients in the RLA group had a higher proportion of adrenocortical adenoma, while patients in the RARLA group had a higher proportion of pheochromocytoma.ConclusionCompared with traditional laparoscopic adrenalectomy, robot-assisted laparoscopic adrenalectomy can significantly reduce intraoperative blood loss and accelerate postoperative gastrointestinal recovery. It is committed to studying how to reduce the hospitalization time and hospitalization cost of RARLA, which can make RARLA more widely used.

OBJECTIVES:To assess and compare the effectiveness and safety of flexible ureteroscopy (f-URS) with a novel flexible ureteral access sheath (f-UAS) versus mini-percutaneous nephrolithotripsy (mini-PCNL) in treating 2-3 cm renal stones. METHODS:Retrospectively analyzed consecutive cases that underwent f-URS with f-UAS (12/14 Fr) from January 29, 2022, to November 30, 2022. Consecutive cases that underwent mini-PCNL (18 Fr) from June 5, 2021, to January 26, 2022, were selected as controls. The f-UAS is a novel device with a 10 cm anterior tip that passively bends along with the f-URS to enter the renal calyx. We analyzed demographic characteristics, stone parameters, operative time, stone-free rates (SFR), hospitalization time, and complication. RESULTS:A total of 96 consecutive cases that underwent f-URS with f-UAS and 96 consecutive cases that underwent mini-PCNL were included in the study. There were no significant differences between the two groups in terms of operative time (p = 0.06), stone volume clearance (p = 0.533) and complete SFR (p = 0.266) on the first postoperative day or residual Stone after 1 month (p = 0.407). We observed a significantly shorter postoperative hospital stay (1.4 days vs. 2.1 days; p < 0.001) and a lower decrease in hemoglobin levels (0.39 g/dL vs. 0.68 g/dL; p < 0.001) in the f-UAS group. The mini-PCNL group had a significantly higher overall complication rate (13.5%) compared with the f-UAS group (5.2%; p = 0.048). CONCLUSIONS:In the treatment of 2-3 cm renal stones, f-URS with a novel f-UAS may provide a superior alternative to mini-PCNL, potentially challenging its established status.

CYP68JX, a P450 hydroxylase, derived from Colletotrichum lini ST-1 is capable of biotransforming dehydroepiandrosterone (DHEA) to 3β,7α,15α-trihydroxy-5-androstene-17-one (7α,15α-diOH-DHEA). Redox partners and cofactor supply are important factors affecting the catalytic activity of CYP68JX. In this study, the heterologous expression of CYP68JX in Saccharomyces cerevisiae BY4741 was realized resulting in a 17.1% target product yield. In order to increase the catalytic efficiency of CYP68JX in S. cerevisiae BY4741, a complete cytochrome P450 redox system was constructed. Through the combination of CYP68JX and heterologous CPRs, the yield of the target product 7α,15α-diOH-DHEA in CYP68JX recombinant system was increased to 37.8%. Furthermore, by adding NADPH coenzyme precursor tryptophan of 40 mmol/L and co-substrate fructose of 20 g/L during the conversion process, the catalytic efficiency of CYP68JX was further improved, the target product yield reached 57.9% which was 3.39-fold higher than initial yield. Overall, this study provides a reference for improving the catalytic activity of P450s.

Ultrasound-guided transrectal prostate biopsy was widely used to diagnose prostate cancer. The prediction of lymph node metastases was not yet explored in prostate cancer undergoing ultrasound-guided transrectal prostate biopsy. We analyzed the clinical data from 235 prostate cancer patients, and 134 patients met the criteria and were included for analysis. To identify independent risk factors for lymph node invasion, univariate and multivariate logistic regression analyses were performed. A nomogram predicting lymph node metastasis was developed and validated by R software. Patients received an average of 12.8 prostate biopsies. A mean of 8.25 positive biopsy indicated prostate cancer. The mean Gleason score was 7.25. We found that 37 of 134 patients had lymph node invasion; the mean number of positive lymph node was 2.63. Three models (named LN4, LN5, and LN7) were developed using different variables. Multivariate logistic analyses were performed and area under the curve values were calculated. LN5 built based on five predictive variables (positive biopsy in external and internal glands, percentage of positive biopsy, and primary and secondary Gleason grades) showed good calibration, with an area under the curve value of 88.2%. Our nomogram could predict lymph node invasion in prostate cancer patients diagnosed via ultrasound-guided transrectal prostate biopsy. It also contributed to selecting good candidates for surgery with lymph node dissection.

Introduction: Nowadays, emerging SARS-CoV-2 Omicron, the novel highly mutated VOC, has quickly spread as the dominant variant in over 190 countries worldwide through the first part of 2022, which is influencing the infectivity, transmissibility, pathogenicity, and severity of COVID-19 pandemic. Additionally, clinical cases and experimental studies have reported that Omicron variant likely leads to weakened immune protection elicited by infection, antibody therapies, and vaccines. The new wave, from late February, 2022, was escalated abruptly by higher levels of transmission of Omicron BA.2 sublineage in China. Methods and Results: Following a systematic database search, this review summarizes the salient features of Omicron sublineages, and their impact on transmissibility, disease severity as well as the efficacy of the available vaccines and treatment against the Omicron. Conclusion: We hope this study will provide a scientific reference for alleviating the burden of COVID-19.

ObjectiveThis pilot study aimed to assess the practicability and effectiveness of percutaneous nephrolithotomy (PCNL) with vacuum-assisted nephrostomy sheaths for patients under modified local anesthesia (m-LA).MethodsPCNL with a vacuum-assisted nephrostomy sheath under m-LA was performed in 83 patients between November 2020 and May 2021. An 18F or 20F ClearPetra Nephrostomy Sheath connected vacuum aspiration was used in surgery to keep low pressure in the renal pelvis. For LA, lidocaine and ropivacaine hydrochloride were 1:1 mixed and instilled under ultrasound guidance through the percutaneous nephrolithotomy channel directed toward the design calix. Demographic characteristics, stone characteristics, visual analogue scale (VAS) score, vital signs, operation time, complications, and stone clear rate were recorded and analyzed.ResultsAll operations were completed. The mean VAS score was 3.9 ± 1.0. The mean operation time was 55.1 ± 23.6 min. The changes for systolic blood pressure, diastolic blood pressure, and heart rate were 3 ± 21 mmHg, 1 ± 14 mmHg, and −6 ± 14 beats/min, respectively. The change for hemoglobin was −10.7 ± 10.9 g/L. The change for C-reactive protein was 5.39 ± 43.1 mg/L. The total stone-free rate was 69.9% (93.8% for simple stones and 54.9% for complex stones).ConclusionPerforming PCNL with vacuum-assisted nephrostomy sheaths under modified local anesthesia under ultrasound guidance was found to be strongly practical and effective.

Purpose. Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. Methods. We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. Results. Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p = 0.013 ), length of history 15–31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p = 0.045 ), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p = 0.023 ), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p = 0.035 ) were associated with UAS placement. Conclusion. Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.

Purpose. Ureteral access sheaths (UAS) are widely used in retrograde intrarenal surgery (RIRS), and this study aimed to develop a model for predicting the success of UAS placement based on computed tomography. Methods. We analyzed the clinical data of 847 patients who received ureteroscopy. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected. A nomogram predicting the success of UAS placement was developed and validated using R software. Results. Two hundred and forty-seven patients were identified. Twenty-five patients (10.1%) failed to pass through the UAS. A model with three factors including the short diameter of ureteral calculi, the short diameter of hydronephrosis, and the diameter of the narrowest part of the renal parenchyma was to be strongly practical and had a high area under the curve on internal validation (80.3%). Using a threshold cutoff of 92%, the sensitivity and specificity for predicting UAS placement were 0.35 and 0.92, respectively. Conclusion. Our study provides a nomogram for predicting the success of UAS placement, and this model could help discriminate patients who are likely to suffer from failed UAS insertion; preoperative ureteral stenting is recommended according to the prediction.

Background and objectives The extent and survival benefits of lymph node dissection (LND) in radical prostatectomy (RP) for pN1M0 prostate cancer (PCa) patients remained unclear and were controversial. This study aimed to determine the survival benefit of different lymph node yields in RP for pN1M0 PCa patients. Methods pN1M0 PCa patients who received RP and LND were identified in Surveillance Epidemiology and End Results (SEER) (2010–2015). Patients were divided into two groups in SEER based on the removal of one to three regional lymph nodes (LND1 group) or four or more regional lymph nodes (LND4 group). Kaplan–Meier methods were used to calculate cancer-specific survival (CSS) and overall survival (OS). Results In total, 2,200 patients were identified; 264 patients received LND1 and 1,936 patients received LND4. CSS had no significant difference between the LND4 and LND1 groups (101mon vs. 98mon, p = 0.064), and OS was higher in LND4 patients compared with LND1 patients (97mon vs. 93mon, p = 0.024); for patients with Gleason score = 9 or 10 and T3b or T4, 5-year OS was higher in patients undergoing LND4 (80.9%; 95% CI, 79.0–82.8) compared with those undergoing LND1 (67.5%; 95% CI, 60.8–74.2) ( p = 0.009). Conclusion More lymph node yield provided better survival for patients with Gleason score = 9 or 10 and T3b or T4, but not for other pN1M0 PCa patients. The extent of LND would be determined after a comprehensive evaluation including Gleason score, tumor stage, and the general condition of the patient.