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1.
Neural Regen Res ; 16(2): 319-324, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32859791

RESUMO

Constraint-induced movement therapy (CIMT) can promote the recovery of motor function in injured upper limbs following stroke, which may be associated with upregulation of α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) at synapses in the ipsilateral sensorimotor cortex in our previous study. However, AMPAR distribution is tightly regulated, and only AMPARs on the postsynaptic membrane can mediate synaptic transmission. We speculated that synaptic remodeling induced by movement-associated synaptic activity can promote functional recovery from stroke. To test this hypothesis, we compared AMPAR expression on the postsynaptic membrane surface in a rat model of ischemic stroke induced by middle cerebral artery occlusion (MCAO) with versus without CIMT, which consisted of daily running wheel training for 2 weeks starting on day 7 after MCAO. The results showed that CIMT increased the number of glutamate receptor (GluR)2-containing functional synapses in the ipsilateral sensorimotor cortex, and reduced non-GluR2 AMPARs in the ipsilateral sensorimotor cortex and hippocampal CA3 region. In addition, CIMT enhanced AMPAR expression on the surface of post-synaptic membrane in the ipsilateral sensorimotor cortex and hippocampus. Thus, CIMT promotes the recovery of motor function of injured upper limbs following stroke by enhancing AMPAR-mediated synaptic transmission in the ischemic hemisphere. These findings provide supporting evidence for the clinical value of CIMT for restoring limb movement in stroke patients. All experimental procedures and protocols were approved by the Department of Laboratory Animal Science of Fudan University, China (approval No. 201802173S) on March 3, 2018.

2.
J Exp Med ; 218(1)2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33045062

RESUMO

The mechanism underpinning the regulation of microglial phagocytosis in demyelinating diseases is unclear. Here, we showed that the Quaking protein (Qki) in microglia was greatly induced by demyelination in the brains of both mice and humans. Deletion of the Quaking gene (Qk) in microglia severely impaired the clearance of myelin debris. Transcriptomic profiling indicated that depletion of Qki impaired total RNA levels and splicing of the genes involved in phagosome formation and maturation. RNA immunoprecipitation (RIP) confirmed the physical interactions between the Qki protein and the mRNAs of Qki targets that are involved in phagocytosis, indicating that Qki regulates their RNA stability. Both Qki depletion and inhibition of Qki target Cd36 greatly reduced the phagocytic activity of microglia and macrophages. The defective uptake and degradation of myelin debris caused by Qki depletion in microglia resulted in unresolved myelin debris that impaired axon integrity, oligodendrocyte maturation, and subsequent remyelination. Thus, our results demonstrate that Qki is an essential regulator of microglia's phagocytic activity under demyelinating conditions.

3.
Sci Total Environ ; 752: 141887, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32890836

RESUMO

Coke powders in the coking wastewater generated by petroleum refining industry needs to be removed to achieve water reuse for lack of water resources. This study developed a decoking hydrocyclone in the closed coking wastewater circulation treatment system to remove coke powders, which was highly efficient and environmentally friendly. Computational Fluid Dynamics (CFD) method was carried out to study the tangential velocity distribution index n-value to guide design of decoking hydrocyclone and experiment was conducted to verify the coke powders removal effect. It was found that the increase of n-value is conducive to the improvement of coke powders separation efficiency. A decoking hydrocyclone with a cone angle of 15° and an inlet size of 4 × 6 mm is the optimum hydrocyclone and the recovery efficiency of coke powders is stable at more than 90%. It is the first time for hydrocyclone successfully applied to the removal of coke powders in coking wastewater in the decoking process of petroleum refining industry, in which the separation efficiency of coke powders is considerably improved.

4.
Clin Lung Cancer ; 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33160898

RESUMO

BACKGROUND: To compare the surgical outcomes of patients with clinical stage I ground-glass opacity (GGO) lung adenocarcinomas with maximum diameters of ≤ 2 cm who underwent lobectomy versus limited resection. PATIENTS AND METHODS: We retrospectively reviewed cases of clinical stage I GGO lung adenocarcinoma with a diameter ≤ 2 cm that were treated via lobectomy or limited resection in our department between January 2011 and September 2018. The clinical characteristics and surgical outcomes were analyzed using a propensity score-matched comparison and a Cox regression model. RESULTS: A total of 552 patients were identified; 128 patients with pure GGO were excluded. Four hundred twenty-four patients met our criteria, including 242 (57.1%) who underwent lobectomy and 182 (42.9%) who underwent limited resection. No perioperative mortality occurred in either group. The overall 5-year survival rate of the entire cohort was 88%. Patients who underwent limited resection tended to have a shorter operation time, smaller blood loss volume, fewer removed nodes, and a shorter postoperative stay. However, the groups did not differ in terms of postoperative complications. Lobectomy and limited resection could lead to equivalent overall survival in patients with GGO-dominant tumor, while lobectomy showed better overall survival than limited resection in patients with solid-dominant tumor. CONCLUSION: Patients with small GGO lung adenocarcinoma had a favorable prognosis after surgery. The oncologic surgical procedures of lobectomy and limited resection yielded comparable outcomes in patients with clinical stage I GGO-dominant lung adenocarcinomas ≤ 2 cm, while lobectomy showed better survival than limited resection in patients with solid-dominant tumor.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33151418

RESUMO

PURPOSE: Petersen's hernia (PH) is a serious complication after gastrectomy for gastric cancer. The aim of this study was to investigate whether closure of Petersen's defect (PD) can decrease the rates of PH and suspected Petersen's hernia (SPH). METHODS: Patients who underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without PD closure (non-closure group). From February 2017 to June 2018, we closed PDs during gastrectomy (closure group). The rates of PH and SPH were compared between the two groups. The last follow-up was updated in August 2020. RESULTS: Among a total of 1213 patients, 12 patients (1.0%) developed PH, and 23 patients (1.9%) developed SPH. The rate of PH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 11/828, 1.3%, p = 0.042, log-rank test). The rate of SPH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 22/828, 2.7%, p = 0.008, log-rank test). Non-closure of PD was a risk factor for PH and SPH (odds ratio (OR) 7.72, 95% CI 1.84-32.35, p = 0.006). CONCLUSIONS: PD closure is recommended after gastrectomy for gastric cancer, as the rates of PH and SPH were significantly decreased.

7.
Opt Lett ; 45(22): 6286-6289, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33186971

RESUMO

We demonstrated a method of fabricating three-dimensional (3D) metal structures in hydrogels with good conductivity by using femtosecond laser ablation and electroplating. The hydrogel containing Ag+ was first ablated by a femtosecond laser to form microchannels with an entrance achieving surface and then sandwiched between the anode and cathode to operate electroplating. Silver structures were formed along the microchannel from the microchannel entrance close to the cathode due to reduction of Ag+. The average resistivity of metal structures is measured to be about 4×10-7Ωm. A tetrahedron metallic microstructure embedded in hydrogel by this method was demonstrated to show its ability of 3D micromachining.

8.
Environ Pollut ; : 116024, 2020 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-33187840

RESUMO

We collected 170 samples of airborne fine particulate matter from five coal-producing cities and one oil-producing city in northern China during both heating and non-heating periods to quantify the concentrations of 12 polycyclic aromatic hydrocarbons, estimate their bioaccessible fraction, and calculate the incremental lifetime cancer risk (ILCR) of this fraction. The major sources of the particulate matter were analyzed using the chemical mass balance model. We found that the main emission sources were coal combustion during the heating period and open sources during the non-heating period. The ILCR was initially calculated as 2.65 × 10-9 for coal-producing cities and 4.60 × 10-9 for the oil-producing city during the heating period and 1.17 × 10-8 and 3.34 × 10-8, respectively, during the non-heating period. When only the bioaccessible fraction was used, the ILCR in coal-producing cities and the oil-producing city decreased by 87.2% and 82.1%, respectively, for the heating period and by 89.0% and 80.1%, respectively, for the non-heating period. The findings suggest that bioaccessibility should be considered when assessing the carcinogenic risk of polycyclic aromatic hydrocarbons. This study provides insights into the contribution of major emission sources to air pollution related to the long-term exploitation, transportation, and use of coal and oil.

9.
Acta Neuropathol Commun ; 8(1): 193, 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183353

RESUMO

Frequently reported neurotoxic sequelae of cancer treatment include cognitive deficits and sensorimotor abnormalities that have long-lasting negative effects on the quality of life of an increasing number of cancer survivors. The underlying mechanisms are not fully understood and there is no effective treatment. We show here that cisplatin treatment of mice not only caused cognitive dysfunction but also impaired sensorimotor function. These functional deficits are associated with reduced myelin density and complexity in the cingulate and sensorimotor cortex. At the ultrastructural level, myelin abnormalities were characterized by decompaction. We used this model to examine the effect of bexarotene, an agonist of the RXR-family of nuclear receptors. Administration of only five daily doses of bexarotene after completion of cisplatin treatment was sufficient to normalize myelin density and fiber coherency and to restore myelin compaction in cingulate and sensorimotor cortex. Functionally, bexarotene normalized performance of cisplatin-treated mice in tests for cognitive and sensorimotor function. RNAseq analysis identified the TR/RXR pathway as one of the top canonical pathways activated by administration of bexarotene to cisplatin-treated mice. Bexarotene also activated neuregulin and netrin pathways that are implicated in myelin formation/maintenance, synaptic function and axonal guidance. In conclusion, short term treatment with bexarotene is sufficient to reverse the adverse effects of cisplatin on white matter structure, cognitive function, and sensorimotor performance. These encouraging findings warrant further studies into potential clinical translation and the underlying mechanisms of bexarotene for chemobrain.

10.
Thorac Cancer ; 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33205914

RESUMO

BACKGROUND: The majority of previous studies of the clinical outcome of video-assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non-small cell lung cancer (pN2 NSCLC) have been single-center experiences with small patient numbers. The aim of this study was therefore to investigate these procedures but in a large cohort of Chinese patients with pathological N2 NSCLC in real-world conditions. METHODS: Patients who underwent lobectomy for pN2 NSCLC by either VATS or thoracotomy were retrospectively reviewed from 10 tertiary hospitals between January 2014 and September 2017. Perioperative outcomes and overall survival of the patients were analyzed. Cox regression analysis was performed to identify potential prognostic factors. Propensity-score analysis was performed to reduce cofounding biases and compare the clinical outcomes between both groups. RESULTS: Among 2144 pN2 NSCLC, 1244 patients were managed by VATS and 900 by open procedure. A total of 305 (24.5%) and 344 patients died during VATS and the thoracotomy group during a median follow-up of 16.7 and 15.6 months, respectively. VATS lobectomy patients had better overall survival when compared with those undergoing the open procedure (P < 0.0001). Multivariate COX regression analysis showed VATS lobectomy independently favored overall survival (HR = 0.75, 95% CI: 0.621-0.896, P = 0.0017). Better perioperative outcomes, including less blood loss, shorter drainage time and hospital stay, were also observed in patients undergoing VATS lobectomy (P < 0.05). After propensity-score matching, 169 patients in each group were analyzed, and no survival difference were found between the two groups. Less blood loss was observed in the VATS group, but there was a longer operation time. CONCLUSIONS: VATS lobectomy might be a feasible alternative to conventional open surgery for resectable pN2 NSCLC. KEY POINTS: Significant findings of the study: VATS lobectomy has comparative OS in pN2 NSCLC versus open procedure in resectable patients. WHAT THIS STUDY ADDS: VATS lobectomy might be feasible for pN2 NSCLC.

11.
Artigo em Inglês | MEDLINE | ID: mdl-33206102

RESUMO

A novel fluorescent chemosensor based on trimesoyl chloride-rhodamine (TR) was successfully synthesized. Rising chromogenic and fluorogenic spectral enhancements could be observed in trimesoyl chloride-rhodamine (TR) probes when Hg2+ and Fe3+ were added, respectively. TR has shown selectivity for Hg2+ and Fe3+ with high sensitivity due to metal ion complexation induced photophysical "turn-on" signaling responses. The detection limit towards Hg2+ was 2.46 × 10-8 M as determined by the 3σ method. At the same time, fluorogenic spectral enhancements were observed in TR, which exhibits a superior sensitive and selective recognition towards Fe3+ with 4.11 × 10-8 M of the detection limit. The test strips were used for colorimetric and simple detection towards Hg2+, which might finally enable the advancement of the Hg2+ sensor in the field of on-site detection.

12.
Sci Rep ; 10(1): 18123, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33093595

RESUMO

Isomerization reactions are fundamental in biology. Lactate racemase, which isomerizes L- and D-lactate, is composed of the LarA protein and a nickel-containing cofactor, the nickel-pincer nucleotide (NPN). In this study, we show that LarA is part of a superfamily containing many different enzymes. We overexpressed and purified 13 lactate racemase homologs, incorporated the NPN cofactor, and assayed the isomerization of different substrates guided by gene context analysis. We discovered two malate racemases, one phenyllactate racemase, one α-hydroxyglutarate racemase, two D-gluconate 2-epimerases, and one short-chain aliphatic α-hydroxyacid racemase among the tested enzymes. We solved the structure of a malate racemase apoprotein and used it, along with the previously described structures of lactate racemase holoprotein and D-gluconate epimerase apoprotein, to identify key residues involved in substrate binding. This study demonstrates that the NPN cofactor is used by a diverse superfamily of α-hydroxyacid racemases and epimerases, widely expanding the scope of NPN-dependent enzymes.

13.
Sci Rep ; 10(1): 17860, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082496

RESUMO

Although intravenous immunoglobulin (IVIG) can effectively treat Kawasaki disease (KD), 10-20% of KD patients show no beneficial clinical response. Developing reliable criteria to discriminate non-responders is important for early planning of appropriate regimens. To predict the non-responders before IVIG treatment, gene expression dataset of 110 responders and 61 non-responders was obtained from Gene Expression Omnibus. After weighted gene co-expression network analysis, we found that modules positively correlated with the non-responders were mainly associated with myeloid cell activation. Transcripts up-regulated in the non-responders, IL1R2, GK, HK3, C5orf32, CXCL16, NAMPT and EMILIN2, were proven to play key roles via interaction with other transcripts in co-expression network. The crucial transcripts may affect the clinical response to IVIG treatment in acute KD. And these transcripts may serve as biomarkers and therapeutic targets for precise diagnosis and treatment of the non-responders.

14.
Chin J Nat Med ; 18(10): 729-737, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33039052

RESUMO

A series of novel pyrano[2, 3-d]trizaole compounds were synthesized and their α-glucosidase inhibitory activities were evaluated by in vitro enzyme assay. The experimental data demonstrated that compound 10f showed up to 10-fold higher inhibition (IC5074.0 ± 1.3 µmol·L-1) than acarbose. The molecular docking revealed that compound 10f could bind to α-glucosidase via the hydrophobic, π-π stacking, and hydrogen bonding interactions. The results may benefit further structural modifications to find new and potent α-glucosidase inhibitors.

15.
Mediators Inflamm ; 2020: 8191079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061831

RESUMO

Disrupted immune response is an important feature of many neurodegenerative conditions, including sepsis-associated cognitive impairment. Accumulating evidence has demonstrated that immune memory occurs in microglia, which has a significant impact on pathological hallmarks of neurological diseases. However, it remains unclear whether immune memory can cause subsequent alterations in the brain immune response and affect neurobehavioral outcomes in sepsis survivors. In the present study, mice received daily intraperitoneal injection of low-dose lipopolysaccharide (LPS, 0.1 mg/kg) for three consecutive days to induce immune memory (immune tolerance) and then were subjected to sham operation or cecal ligation and puncture (CLP) 9 months later, followed by a battery of neurobehavioral and biochemical studies. Here, we showed that repeated low-dose LPS injection-induced immune memory protected mice from sepsis-induced cognitive and affective impairments, which were accompanied by significantly decreased brain proinflammatory cytokines and immune response. In conclusion, our study suggests that modulation of brain immune responses by repeated LPS injections confers neuroprotective effects by preventing overactivated immune response in response to subsequent septic insult.

16.
Chin Med J (Engl) ; 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33086333

RESUMO

BACKGROUND: The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy. METHODS: A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed. RESULTS: There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ±â€Š1.6 vs. 12.1 ±â€Š1.5), immediately postoperatively (14.4 ±â€Š1.1 vs. 13.8 ±â€Š1.3), or at the last follow-up (14.6 ±â€Š1.0 vs. 14.2 ±â€Š1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0°â€Š±â€Š7.3° vs. -1.4°â€Š±â€Š7.5°). The Cobb angle significantly improved immediately postoperatively (12.3°â€Š±â€Š4.2° vs. 9.2°â€Š±â€Š3.6°) and at the last follow-up (12.4°â€Š±â€Š3.5° vs. 9.0°â€Š±â€Š2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group. CONCLUSIONS: Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

17.
Asia Pac Psychiatry ; : e12422, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33053613

RESUMO

INTRODUCTION: A family history of psychiatric disorders is one of the strongest risk factors for schizophrenia. The characteristics of patients with a family history of psychiatric disorders have not been systematically evaluated. METHODS: This multicenter study (26 centers, 2425 cases) was performed in a Chinese population to examine the sociodemographic and clinical characteristics of schizophrenia patients with a family history of psychotic disorders in comparison with those of patients with sporadic schizophrenia. RESULTS: Nineteen percent of patients had a family history of mental disease. Multiple logistic regression analysis revealed that ≥4 hospitalizations (OR = 1.78, P = .004), tobacco dependence (OR = 1.48, P = .006), alcohol dependence (OR = 1.74, P = .013), and physical illness (OR = 1.89, P = .001) were independently and significantly associated with a family history of mental disease. CONCLUSION: Patients with a family history of mental disorders present different demographics and clinical features than patients without a family history of psychiatric disorders.

18.
Sci Total Environ ; : 143141, 2020 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-33121766

RESUMO

In response to the potential water conflict caused by climate change and increased population, an integrated water yield analysis from the perspective of the coupled human-natural system is clearly required. This paper conducted an integrated water yield analysis in the Yellow River basin (YRB), China, with applications for irrigated cropland water modeling and many field, statistical and satellite images. We found the following during 2000-2017: (1) The irrigation water consumption, rain-fed water consumption of cropland and rain-fed water consumption of natural ecosystems all increased significantly. (2) Ecological restoration caused a consequence of the 81.7 108 m3 water consumption transfer from cropland to natural ecosystems. (3) Water consumption variability was strongly related to irrigation expansion and ecological restoration, and this variability dominated the high water yield variability in the midstream YRB (95.73% ± 0.5%). (4) The increased downstream human water use stress was mainly affected by increased downstream water use and upstream water yield change, with contribution ratios of 1.67 and -0.72, respectively. The study declares the intense relationship between ecological restoration, crop production and socioeconomic activities within the water-limited river basin. This research also highlights that synthetic river basin management is essential to balance the water demand between different sectors and between the upper stream and downstream sections of a basin.

19.
Artigo em Inglês | MEDLINE | ID: mdl-33063882

RESUMO

The aim of this study was to compare the effects of nalbuphine and sufentanil on the gastrointestinal (GI) tract after laparoscopic surgery for gynaecological malignancies. A total of 100 patients with American Society of Anesthesiologists (ASA) physical status I-II undergoing laparoscopic radical hysterectomy under general anaesthesia were enrolled. The patients were randomized to receive sufentanil (Group S) or nalbuphine (Group N) intraoperatively and postoperatively. The time to first passage of flatus, the time to first defaecation, the time to toleration of diet, the serum gastrin level, and the duration of hospital stay of the groups were compared. The Visual Analogue Scale (VAS) score for postoperative pain, the number of dispensed patient-controlled analgaesics (PCAs), and the prevalence of postoperative nausea, vomiting, and dizziness of the groups were also compared. The time to first passage of flatus (P = .551), time to first defaecation (P = .310), time to toleration of diet (P = .182), serum gastrin level (P = .397), prevalence of postoperative nausea (P = .920) and vomiting (P = .334), number of dispensed PCAs (P = .167), and the duration of hospital stay (P = .482) of the two groups were not significantly different. The VAS scores at 6 hours (P = .008), 12 hours (P = .002), and 24 hours (P = .013) postoperatively were lower in Group N than in Group S. In conclusion, nalbuphine was not associated with improved postoperative GI dysfunction after laparoscopic surgery for gynaecological malignancies, but it was associated with reduced postoperative pain.

20.
Surg Endosc ; 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33030588

RESUMO

BACKGROUND: Suprapancreatic lymphadenectomy is the essence of D2 radical gastric cancer surgery. The present study aimed to describe clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area. METHODS: The data from gastric cancer patients who underwent surgical treatment from September 2016 to December 2018 were collected. Patients were divided into clockwise modularized lymphadenectomy (CML) and traditional open gastrectomy (OG) groups according to the surgical treatment strategy. The propensity score matching method was utilized to balance the baseline characteristics between the two groups. RESULTS: Finally, 551 gastric cancer patients were included in the present study. Following propensity score matching, 106 pairs of patients in the CML group and OG group were included in the final analysis. The CML group had more total examined lymph nodes (36, IQR 28-44.74 vs. 29, IQR 29-39.5, p = 0.002) and no. 9 station nodes (2, IQR 1-5 vs. 2, IQR 1-3, p = 0.007) than the OG group. There was less intraoperative blood loss (30, IQR 20-80 ml vs. 80, IQR 50-80 ml, p < 0.001) and a longer surgical duration (262.5 min, IQR 220-303.25 min vs. 232, IQR 220-255 min, p < 0.001) in the CML group than in the OG group. The incidence of postoperative complications (19.8% vs. 16.0%, p = 0.591) and postoperative hospital stay (8, IQR 7-9 days vs. 8, IQR 7-9 days, p = 0.452) were comparable between the CML and OG groups. CONCLUSION: Laparoscopic lymphadenectomy for gastric cancer surgery is technically demanding. Clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area can attain similar effects as traditional open surgery and without an increase in postoperative adverse events.

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