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1.
Journal of Public Health and Preventive Medicine ; (6): 25-28, 2020.
Article in Chinese | WPRIM | ID: wpr-820931

ABSTRACT

Objective To explore the prevalence trend of male prostate cancer mortality in China during the 25 years from 1992 to 2017. Methods The age-period-cohort (APC) model and the Intrinsic Estimator (IE) algorithm were used to estimate the age effect, period effect and cohort effect of prostate cancer mortality risk in Chinese men. Results The overall mortality rate of prostate cancer in Chinese men was on the rise from 1992 to 2017, with the crude mortality rate rising from 3.39‰ to 7.17‰. The results of the APC model analysis showed that the age effect of prostate cancer mortality increased with age in Chinese men after the age of 40. The period effect was generally on the rise. The cohort effect indicated that men born in China after 1980 experienced a declining risk of prostate cancer death. Conclusions The period effect of prostate cancer mortality risk was dominant in Chinese men. Changes in lifestyle and sexual attitudes, population aging, smoking, environmental pollution and other factors may be the main reasons for the increase in the period effect. The attention should be paid to improve these aspects in the prevention and treatment of prostate cancer, and at the same time the awareness rate of PSA screening should be strengthened. Comprehensive prevention with health education can help reduce overall prostate cancer mortality in men.

2.
Chinese Journal of Epidemiology ; (12): 1578-1584, 2019.
Article in Chinese | WPRIM | ID: wpr-800275

ABSTRACT

Objective@#To investigate the prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetic patients under community management programs.@*Methods@#A cross-sectional study was conducted on T2DM patients in eight communities in Wuhan and Changshu cities. Data would included questionnaire, body measurement, blood testing and clinical examination. The criterion of diabetic peripheral neuropathy was under the combination of symptoms with five physical examinations. Binary logistic regression model was used to analyze the influential factors.@*Results@#The overall prevalence of peripheral neuropathy was 71.2% among the diabetic patients who were managed in primary care health services in the two cities. The binary logistic regression method identified older age (≥60 years, OR=2.39, 95%CI:1.95-2.94), longer diabetic duration (≥10 years, OR=1.25, 95%CI: 1.02-1.54), and worse postprandial glucose control (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.65, 95%CI:1.33-2.04) (all P<0.05) as risk factors for the presence of diabetic peripheral neuropathy, while higher education level was protective factor (compared to patients with education levels of primary school or below, OR=0.52, 95%CI: 0.41-0.66; OR=0.59, 95%CI: 0.44-0.79; OR=0.64, 95%CI: 0.44-0.94 for those with education levels of junior high school, senior high school, and college, respectively).@*Conclusions@#High rates of diabetic peripheral neuropathy among T2DM patients suggested the urgent need for early screening and standardized management at the community levels. It is necessary to promote appropriate screening techniques and methods to identify the peripheral neuropathy, in the primary health service institutions.

3.
Chinese Journal of Epidemiology ; (12): 1240-1244, 2019.
Article in Chinese | WPRIM | ID: wpr-796765

ABSTRACT

Objective@#To examine the association between long-term exposure to ambient PM2.5 combined with indoor air pollution and handgrip strength among people aged 50 and over.@*Methods@#Data were from the first wave of World Health Organization Study on global AGEing and adult health in China. Ambient annual concentration of PM2.5 was estimated by using the satellite data we also investigated the use of fuels and chimneys as indoor air pollution. A two-level (individual level and community level) linear model was applied to examine the association between long-term exposure to ambient PM2.5 combined with indoor air pollution and the handgrip strength.@*Results@#A total of 13 175 individuals aged 50 years and over were included for analysis. The handgrip strength was (26.67±0.54) kg. Ambient PM2.5 was found to be significantly associated with the risk of decreased handgrip strength. Outdoor PM2.5 concentration was negatively correlated with handgrip strength (β=-0.23, 95%CI: -0.31 - -0.14) decrease in handgrip strength after adjusting for gender, age, residence, education, household assets, intake of vegetables and fruits, smoking and drinking, physical activity. In rural area, compared to those who used solid fuel, use of clean fuel increased (β=1.41, 95%CI: 0.36-2.46) handgrip strength. But in urban area, we did not find any statistically significant association between the use of clean fuel and handgrip strength (β=0.19, 95%CI: -0.95-1.32).@*Conclusion@#This study found that long-term exposure to ambient PM2.5 combined with indoor air pollution was significantly associated with low handgrip strength among people aged 50 years and over, this suggested that ambient PM2.5 might serve as one of the risk factors for low physical function seen in the people aged 50 years and over.

4.
Chinese Journal of Endocrine Surgery ; (6): 289-292, 2019.
Article in Chinese | WPRIM | ID: wpr-752003

ABSTRACT

Objective To investigate the application effect of glucocorticoids on perioperative period of complicated thyroid cancer surgery.Methods All patients were from Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University.A total of 373 patients with thyroid surgery longer than 3 hours from Jan.2017 to Dec.2017 were as the control group.386 patients with thyroid surgery longer than 3 hours from Jan.2018 to Dec.2018 were included in the observation group.Patients in the control group were not treated with glucocorticoids during perioperative period,and patients in the observation group were treated with glucocorticoids during perioperative period.Several factors were compared between the two groups,including postoperative drain removal time,postoperative hospitalization time,postoperative complication rate,the incidence of postoperative infection and delayed wound healing.Results The postoperative drain removal time [(2.5±0.42) vs (3.2±0.63),t=25.72,P<0.001)] and the postoperative hospitalization time [(3.6±0.57) vs (4.8±0.71),t=18.07,P<0.001)] in the observation group was shorter than in the control group.The incidence of complications in the observation group was lower than that in the control group,such as postoperative coarse respiratory sounds (3.1% vs 6.7%,x2=4.790,P=0.029),mild to moderate dyspnea (1.0% vs 3.2%,x2=4.191,P=0.041),cough (8.3% vs 14.2%,x2=5.366,P=0.021),sore throat (4.9% vs 9.4%,x2=4.952,P=0.026),headache (8.8% vs 11.5%,x2=4.392,P=0.036) and nausea (3.6% vs 8.6%,x2=7.235,P=0.007),however,the incidence of hoarseness between the two groups was statistically significant (1.6% vs 2.1%,x2=0.352,P=0.553).There was no significant difference in the incidence of postoperative infection (2 cases vs 1 case,x2=0.299,P=0.585) or delayed wound healing (3 cases vs 3 cases,x2=0.002,P=0.964) between the two groups.Conclusion The application of glucocorticoids in patients with complicated thyroid cancer surgery can effectively reduce the incidence of complications and shorten the hospitalization time of patients.

5.
Chinese Journal of Epidemiology ; (12): 258-263, 2018.
Article in Chinese | WPRIM | ID: wpr-737945

ABSTRACT

Objective To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological,psychological and social risk factors.Methods Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China.Two-level hierarchical logistic model was used to identify the related factors for fall-related injury.All the models were stratified by living area (urban/rural).Results Estimated incidence of fall related injury (road traffic injury was not included) was 3.2%.Ageing and multiple chronic conditions (OR=2.55,95%CI:1.41-4.64) was significantly associated with the incidence of fall related injury in urban area.In rural area,depression (OR=4.33,95% CI:2.52-7.42) and multiple chronic conditions (OR=2.46,95%CI:1.37-4.41) were associated with the incidence of fall related injury.Conclusions This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China.A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents.Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.

6.
Chinese Journal of Epidemiology ; (12): 258-263, 2018.
Article in Chinese | WPRIM | ID: wpr-736477

ABSTRACT

Objective To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological,psychological and social risk factors.Methods Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China.Two-level hierarchical logistic model was used to identify the related factors for fall-related injury.All the models were stratified by living area (urban/rural).Results Estimated incidence of fall related injury (road traffic injury was not included) was 3.2%.Ageing and multiple chronic conditions (OR=2.55,95%CI:1.41-4.64) was significantly associated with the incidence of fall related injury in urban area.In rural area,depression (OR=4.33,95% CI:2.52-7.42) and multiple chronic conditions (OR=2.46,95%CI:1.37-4.41) were associated with the incidence of fall related injury.Conclusions This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China.A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents.Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.

7.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (24): 1545-1548, 2015.
Article in Chinese | WPRIM | ID: wpr-747852

ABSTRACT

OBJECTIVE@#To investigate the expression of Survivin, p53 and Ki67 in laryngeal carcinoma and the relation with clinical data.@*METHOD@#Immunohistochemical staining (SP) was used to detect expression of Survivin, p53 and Ki67 of 64 cases with laryngeal carcinoma, 26 cases with precancerosis, 34 cases with vocal polyps.@*RESULT@#The positive expression rates of Survivin, p53 and Ki67 were 59.4%, 68.8%, 65.6% respectively in laryngeal carcinoma, which were significantly higher than those in precancerosis and vocal polyps (P 0.05). The expression of Survivin, Ki-67 and p53 was positively correlated (r = 0.607, 0.541, 0.648, P < 0.01) in laryngeal carcinoma.@*CONCLUSION@#Survivin, p53 and Ki-67 may play an important role in the carcinogenesis and progress of laryngeal carcinoma. They may play synergetic roles in the process of carcinogenesis of laryngeal carcinoma.


Subject(s)
Humans , Carcinoma, Squamous Cell , Metabolism , Immunohistochemistry , Inhibitor of Apoptosis Proteins , Metabolism , Ki-67 Antigen , Metabolism , Laryngeal Neoplasms , Metabolism , Larynx , Lymphatic Metastasis , Polyps , Metabolism , Survivin , Tumor Suppressor Protein p53 , Metabolism
8.
Asian Pacific Journal of Tropical Biomedicine ; (12): 626-631, 2015.
Article in Chinese | WPRIM | ID: wpr-499635

ABSTRACT

Objective:To investigate the mechanism of survivin, p53 and Ki-67 on Hep-2 human laryngeal cancer endothelial cell proliferation and invasion.Methods:Laryngeal squamous cell carcinoma and paracancerous normal tissues were collected, total RNA was extracted from tissues,survivin,p53and Ki-67gene mRNA expression levels in laryngeal cancer and the adjacent tissues were detected by Real-time PCR. Human laryngeal cancer Hep-2 epithelial cells were selected,survivin gene was overexpressed, and cell proliferation was detected by MTT.p53 andKi-67gene expression changes in overexpressedsurvivin gene were detected by Western blot. Changes in Hep-2 cell invasive ability were studied whensurvivin was overexpressed as detected by Transwell invasion assay.Results: In the adjacent tissues, survivin,p53andKi-67 gene relative expression levels were 1.72 ± 0.9, 13.7 ± 5.7 and 5.7 ± 1.3, respectively; while in cancer tissues, gene relative expression levels were 53.7 ± 8.3, 66.7 ± 5.2 and 61.0 ± 3.1, respectively, which was significantly increased. As detected by MTT, relative cell survival rate within 12 h ofsurvivinoverexpression were: load control group, (88.5±1.6)%; overexpressed group, (90.3±1.9)%. Transwell invasion assay results indicated that overexpressedsurvivincould significantly increase the relative survival rate of cells. Conclusions:Expressions ofp53,Ki67 and survivin are increased in cancer; and there is a positive correlation betweensurvivin, p53andKi67 expressions in laryngeal carcinoma.

9.
Chongqing Medicine ; (36): 2057-2059, 2015.
Article in Chinese | WPRIM | ID: wpr-463497

ABSTRACT

Objective To compare the clinical therapeutic effect of LigaSure vessel sealing system ,ultrasonic scalpel and mo‐nopolar high frequency electrocautery in open thyroid operation .Methods 293 cases of thyroid operation sequentially admitted in our hospital and in accordance with the inclusion criteria were collected and divided into three groups by the method of random dig ‐its table .There were 98 cases in the LigaSure vessel sealing system group (L‐Sure group) ,100 cases in the ultrasonic scalpel (US group) and 95 cases in the monopolar high frequency electrocautery (M‐E group) .The intraoperative and postoperative conditions were compared among 3 groups .Results The operation time ,intraoperative amount of bleeding and postoperative drainage in the L‐S group and the US group were significantly less than those in the M‐E group (P0 .05) .Conclusion The LigaSure vessel sealing system and ultrasonic scalpel can shorten the operation time ,reduce the amount of bleeding and postoperative drainage ,relieve pain and reduce the hospitalization duration .

10.
International Journal of Cerebrovascular Diseases ; (12): 188-193, 2014.
Article in Chinese | WPRIM | ID: wpr-445946

ABSTRACT

Objective To investigate the clinical features of complex posterior communicating artery aneurysms and the outcome of microsurgical clipping.Methods The clinical and imaging data of the patients with posterior communicating artery aneurysm treated by craniotomy microsurgical clipping were analyzed retrospectively.The patients were divided into either a complex type group or a simple type group according to whether they had complex factors of surgical clipping or not.They were divided into a good outcome group and a poor outcome group according to their Glasgow Outcome Scale scores.Results A total of 55 patients with posterior communicating artery aneurysm were enrolled,and 17 (30.9%) of them were in the simple type group and 38 (69.1%) were in the complex type group.The proportion of higher Fisher grade in the patients of the simple type group was significantly lower than that of the complex type group (Z =-2.068,P=0.019).However,there were no significant differences in the proportions of age,sex,preoperative rupture,and Hunt-Hess grade between the two groups (all P > 0.05).In the complex type group,the complex clipping (73.68%) and anterior clinoidectomy (42.11%) were the most common complex factors.Twenty-four patients (63.16%) had a number of complex factors.In the complex type cases,32 had good outcome,6 had poor outcome (3 of them died); in the simple type cases,15 had good outcome,2 had poor outcome (1 of them died).There was no significant difference in the good outcome rate between the complex type group and the simple type group (84.21% vs.88.24%;x2 =0.153,P=0.696).In 55 patients with posterior communicating artery aneurysm,the age of the good outcome group was significantly lower than that of the poor outcome group (58.23 ± 12.41 years vs.68.38 ± 8.68 years,t =-2.212; P =0.031),and there were no significant differences in sex,Fisher grade,Hunt-Hess grade,factors of surgical complexity,and surgical clipping level (all P > 0.05).Multivariate logistic regression analysis showed that only age was the independent risk factor for poor outcome of the complex posterior communicating artery aneurysm (odds ratio 1.142,95% confidence interval 1.029-1.266; P =0.012).Conclusions Using the advanced microsurgical techniques,such as anterior clinoidectomy,anterior choroidal artery microdissection,and complex clipping for the treatment of complex posterior communicating artery aneurysm are no less favorable than the simple type,and age is an independent risk factor for the poor outcome of posterior communicating artery aneurysm.

11.
Military Medical Sciences ; (12): 368-370, 2014.
Article in Chinese | WPRIM | ID: wpr-451490

ABSTRACT

Objective To detect the dynamic visual acuity ( DVA) before and after vestibular habituation of subjects in order to optimize the DVA assessment criteria .Methods The vestibular function examination system was applied to the detection of static and dynamic visual function in 16 healthy subjects .Results When the speed of left or right swinging was fast enough , DVA before and after vestibular habituation was different .Conclusion Subjects with vestibular habituation can reduce their sensitivity to the vestibular system , the changes in DVA are better than before habituation , and the vestib-ular function adaptability training may have effect on DVA .

12.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (24): 49-49, 2013.
Article in Chinese | WPRIM | ID: wpr-749599

ABSTRACT

The presenting symptom of calcifying epithelioma was a hard, slowly growing subcutaneous mass. The two cases in this paper were both girls. The five and eight year-old girls were occurred in anteri or inferior of ear lobe and in preauricular respectively. This tumor was composed of two cell types: the shadow cells and basophilic cells with small calcifying areas. The tumor was finally removed without replase in a year follow-up.


Subject(s)
Child, Preschool , Female , Humans , Carcinoma , Pilomatrixoma , Skin Neoplasms
13.
Chinese Journal of Health Management ; (6): 338-341, 2011.
Article in Chinese | WPRIM | ID: wpr-423139

ABSTRACT

Objective To investigate current dietary and dyslipidemia status of air force pilots.Methods Energy expenditure was calculated by using daily-activity-recording method.Dietary survey was performed through weighing method.Body measurements were carried out according to military criteria.Double agent enzymic method was used to detect blood lipid profiles.The results were compared in 1997 and 1982.t or x2 test was used for data analysis.Results Excessive energy consumption and highprotein and fat or low-carbohydrate intake was found in the participants.Energy from fat or carbohydrate accounted for 47.3% and 37.9%,respectively.Obesity and overweight was found in 20.8% air force pilots,and hypertriglyceridemia and hypercholesterolemia occurred in 47.9% and 17.7%,respectively.Conclusion Dietary pattern and energy metabolism are inappropriate in air force pilots as a result of dyslipidemia.

14.
Chinese Journal of Endocrine Surgery ; (6): 253-254, 2011.
Article in Chinese | WPRIM | ID: wpr-622259

ABSTRACT

ObjectiveTo explore the effects of steroids for hyperthyroidism management during the perioperative period. Methods198 cases were analyzed in terms of the perioperative use of steroids such as dexamethasone for hyperthyroidism. ResultsFT3 and FT4 decreased gradually to the nomal level after use of dexamethasone. 15 cases had hypokalemic limb paralysis, 2 cases had hyperthyroidism crises, 9 cases had transient numbness of mouth, lip and limb, and the rest resumed normal. ConclusionsThe use of steroids such as dexamethasone for hyperthyroidism can shorten the preoperative preparation time, improve the success rate, and reduce postoperative complications.

15.
Chinese Journal of Rehabilitation Theory and Practice ; (12): 136-139, 2010.
Article in Chinese | WPRIM | ID: wpr-959251

ABSTRACT

@#Ammonia toxicity has been generally accepted as one of the classic theories of the pathogenesis of hepatic encephalopathy (HE). Ammonia induces changes in neurological system energy metabolism, oxidative stress, mitochondrial permeability transition (MPT), GABA and Glutamatergic neurotransmission, intracellular signal transduction and Aquaporin 4 (AQP4) expression, astrocyte swelling is another important consequence of ammonia neurotoxicity. This article reviewed the role of these factors in the mechanism of HE and ammonia toxicity.

16.
Basic & Clinical Medicine ; (12): 215-218, 2010.
Article in Chinese | WPRIM | ID: wpr-440648

ABSTRACT

Recent research found that human umbilical cord is rich in mesenchymal stem cells. These cells have the potencies of expressing many surface markers of mesenchymal stem cell and of differentiating into a variety of cells of three germ layers, synthesizing and secreting a set of trophic factors and other cytokines, and supporting the expansion and function of other cells hematopoietic stem cells and other cells. In addition, immunogenicity of these cells is realatively low.

17.
Chinese Journal of Rehabilitation Theory and Practice ; (12): 431-433, 2009.
Article in Chinese | WPRIM | ID: wpr-965093

ABSTRACT

@# Objective To study the oxidative stress and apoptosis relative protein expression in rat striatum during the pathogenesis of Parkinson's disease (PD) induced by 6-hydroxydopamine (6-OHDA). Methods 6-OHDA was stereotacticly injected into the right striatum of the rats at two sites to produce PD models. Activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), contents of reduced glutathione (GSH) and malondialdehyde (MDA) in the injured and normal striatum were measured using assay kits; and levels of Bax and Bcl-2 were detected by Western blotting in injured striatum. Results In 10 successful PD rats, compared with either the sham group or the normal group, activities of SOD and GSH-Px and contents of GSH in the right striatum significantly decreased while contents of MDA increased obviously (P<0.05); And levels of Bax significantly increased while expression of Bcl-2 obviously decreased. Conclusion Oxidative stress plays a key role in the pathogenesis of PD. Furthermore, Bax and Bcl-2 were involved in the regulation of apoptosis under oxidative stress induced by 6-OHDA.

18.
Journal of Biomedical Engineering ; (6): 925-929, 2008.
Article in Chinese | WPRIM | ID: wpr-342713

ABSTRACT

A set of L-band electron spin resonance imaging (ESRI) equipment suitable for biological species was developed and an ESRI experiment model for viable skin samples was established. The mechanic process of nitroxide free radical TEMPO (2,2, 6, 6-tetramethyl-1-piperidinyloxy) penetrating through skin sample and the spin density distribution of TEMPO after it interacted with skin sample were detected by the developed ESRI method. Skin samples were extracted from mice back. The experimental samples were prepared by cutting the skin pieces into square shape of 2 x 2 cm2 and then the samples were divided into three groups by treating them with three different methods: Method A, simple treatment by simply cutting the hair; method B, 8% Na2S depilation treatment for 10 min; method C, 8% Na2S depilation and then 5% pancreatic digestion treatment for 2 hours. The liposoluble solvent DMSO (dimethyl sulfoxide) and distilled water were used as two kinds of solvent for the TEMPO liquor. The results indicated that the skin-penetration properties of TEMPO were significantly different among samples treated with different methods and the surface cornifin of skin offered remarkable resistance to TEMPO. The TEMPO liquor of water could hardly penetrate through skins, whereas about 20%-30% of the original TEMPO compounds that solved in liposoluble solvent DMSO could penetrate through the skin sample treated with method C after 16 hours of interaction. Furthermore, the penetration rate of TEMPO through the skin tissue was a strong time dependent process. The preliminary application results suggested that ESRI technique could provide an effective and applicable method for dynamically researching skin-penetration properties of some special kinds of materials such as paramagnetic compounds.


Subject(s)
Animals , Mice , Cyclic N-Oxides , Pharmacokinetics , Dimethyl Sulfoxide , Chemistry , Electron Spin Resonance Spectroscopy , Methods , Free Radical Scavengers , Pharmacokinetics , Piperidines , Pharmacokinetics , Skin Absorption , Physiology , Skin Physiological Phenomena , Spin Labels
19.
Journal of Peking University(Health Sciences) ; (6)2004.
Article in Chinese | WPRIM | ID: wpr-561310

ABSTRACT

Objective:To investigate the expression of AQP4 during the development of presyrinx state of experimental syringomyelia in rabbits.Methods:The experimental syringomyelia models of rabbits were established by intra-cisternal injection of Kaolin.The expression of AQP4,AQP4mRNA and the water content of upper cervical spinal cord were measured with immunohistochemistry,Western blot,RT-PCR and dry-wet measurement on days 1,3,7,14,and 21 after operation,respectively.Results:Compared with animals of control group,the water content increased in those of Kaolin group from the 1st day(68.35%?0.70%),reached its peak on the 7th day(72.92%?0.86%),lasted to the 14th day(72.58%?0.55%),and then began to drop on the 21st day(70.03%?0.77%),while AQP-4 immunoreactive expression decreased on the 3st day[integral optical density(IOD)320.5?44.2],reached its minimum on the 7th day(IOD 258.7?26.5),lasted to the 14th day,and recovered partially on the 21th day approximately(IOD 321.5?46.1).RT-PCR found the decreasing of AQP4 mRNA coincided well with that of AQP4 immunoreactive expression in presyrinx state.The linear regression analysis indicated that expression of AQP4 and its mRNA in cervical cord had a negtive correlation with the change of spinal water content(r=-0.769,P

20.
Journal of Peking University(Health Sciences) ; (6)2003.
Article in Chinese | WPRIM | ID: wpr-557710

ABSTRACT

Objective: To summarize the clinical characteristics and therapeutic experience of optic gliomas. Methods: The clinical data of 7 patients of our department in the past 3 years were analyzed. Results: In this series of optic glioma patients, the average age was 18.7 years, the ratio of men to women was 4∶3,and 100% of the tumors were sub-totally removed. Diabetes inspidus was the most comman postoperative complication. Conclusion: The optic glioma is benign intracranial tumor with good prognosis. The key point of treatment is surgical resection combined with proper postoperative radiotherapy.

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