Strengthening Sn-MOF with SiO2/GeO2 Nanoparticles for Synergistically Enhanced High Capacity and Cycle Stability.

Metal-organic frameworks (MOFs) based on tin (Sn) have shown great potential as materials for lithium storage, thanks to their ability to alleviate volume expansion due to the homogeneous distribution of Sn in a porous matrix framework. However, the weak mechanical strength of the porous Sn-MOF structure has been a major challenge, leading to pulverization during the discharging/charging process. To overcome this issue, we have developed a feasible strategy to strengthen the Sn-MOF mechanical properties by incorporating SiO2/GeO2 nanoparticles during the synthesis process. The resulting composites of Sn-Si and Sn-Ge exhibited high energy density and long-term cycle stability, thanks to their synergistic effect in alloying and conversion reactions. Our density functional theory (DFT) calculations have revealed that the rigid SiO2/GeO2 nanoparticles enhance the Sn-MOF mechanical properties, including Young's and shear moduli, which contribute to the long-term cycle stability of these composites.

Optical Second Harmonic Generation of Low-Dimensional Semiconductor Materials.

In recent years, the phenomenon of optical second harmonic generation (SHG) has attracted significant attention as a pivotal nonlinear optical effect in research. Notably, in low-dimensional materials (LDMs), SHG detection has become an instrumental tool for elucidating nonlinear optical properties due to their pronounced second-order susceptibility and distinct electronic structure. This review offers an exhaustive overview of the generation process and experimental configurations for SHG in such materials. It underscores the latest advancements in harnessing SHG as a sensitive probe for investigating the nonlinear optical attributes of these materials, with a particular focus on its pivotal role in unveiling electronic structures, bandgap characteristics, and crystal symmetry. By analyzing SHG signals, researchers can glean invaluable insights into the microscopic properties of these materials. Furthermore, this paper delves into the applications of optical SHG in imaging and time-resolved experiments. Finally, future directions and challenges toward the improvement in the NLO in LDMs are discussed to provide an outlook in this rapidly developing field, offering crucial perspectives for the design and optimization of pertinent devices.

Application of Oxygen Saturation Test after Replantation of Avulsed Immature Permanent Teeth: A Prospective Observational Study.

INTRODUCTION: The evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth. METHODS: A prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit. RESULTS: Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged. CONCLUSIONS: The oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation.

The Global Environmental Impacts of China's Accession to the WTO: A 20-Year Review.

Robust empirical assessments of the long-term cumulative global effects of free trade and economic globalization on the environment are limited. This account fills this gap by constructing a dynamic computable general equilibrium model to estimate the environmental effects of a milestone in the recent history of trade liberalization: China's 20-year World Trade Organization (WTO) accession. The modeling shows that China's accession could have resulted in an increase in the global cumulative greenhouse gases (GHGs), sulfur dioxide (SO2), and nitrogen oxide (NOx) emissions by roughly 14,000 Mt CO2-eq, 64 Mt, and 46 Mt, respectively. The global production scale effect contributed to most of these estimated increases. The regional total output composition effect also caused higher emissions. Meanwhile, the sectoral output composition effect helped reduce total emissions to a limited extent. Fortunately, a package of emission abatement measures led to a decrease in emission factors and a drop in the global cumulative emissions of GHGs, SO2, and NOx. The findings suggest that to enjoy the free trade and economic globalization benefits and minimize the induced emission increases, it is vitally important to systemically reduce emissions across the entire economy and nurture a low-carbon trade regime.

TGFß-induced EN1 promotes tumor budding of adenoid cystic carcinoma in patient-derived organoid model.

Adenoid cystic carcinoma (ACC) and basal cell adenoma (BCA) share many histological characteristics and often need a differential diagnosis in clinical pathology. Recently, we found homeobox protein engrailed-1 (EN1) was a potential diagnostic marker for ACC in an organoids library of salivary gland tumors (SGTs). Here we aim to confirm EN1 as a differential diagnostic marker for ACC, and further investigate the regulatory mechanism and biological function of EN1 in tumor progression. The transcriptional analysis, quantitative polymerase chain reaction, Western blot and immunohistochemistry staining were performed and revealed that EN1 was specifically and highly expressed in ACC, and accurately differentiated ACC from BCA. Furthermore, TGFß signaling pathway was found associated with ACC, and the regulation of EN1 through TGFß was detected in the human ACC cell lines and patient-derived organoids (PDOs). TGFß-induced EN1 was important in promoting tumor budding in the PDOs model. Interestingly, a high level of EN1 and TGFß1 in the budding tips was observed in ACC clinical samples, and the expression of EN1 and TGFß1 in ACC was significantly associated with the clinical stage. In summary, our study verified EN1 is a good diagnostic marker to differentiate ACC from BCA. TGFß-induced EN1 facilitates the tumor budding of ACC, which might be an important mechanism related to the malignant phenotype of ACC.

Advances in the Involvement of Metals and Metalloids in Plant Defense Response to External Stress.

Plants, as sessile organisms, uptake nutrients from the soil. Throughout their whole life cycle, they confront various external biotic and abiotic threats, encompassing harmful element toxicity, pathogen infection, and herbivore attack, posing risks to plant growth and production. Plants have evolved multifaceted mechanisms to cope with exogenous stress. The element defense hypothesis (EDH) theory elucidates that plants employ elements within their tissues to withstand various natural enemies. Notably, essential and non-essential trace metals and metalloids have been identified as active participants in plant defense mechanisms, especially in nanoparticle form. In this review, we compiled and synthetized recent advancements and robust evidence regarding the involvement of trace metals and metalloids in plant element defense against external stresses that include biotic stressors (such as drought, salinity, and heavy metal toxicity) and abiotic environmental stressors (such as pathogen invasion and herbivore attack). We discuss the mechanisms underlying the metals and metalloids involved in plant defense enhancement from physiological, biochemical, and molecular perspectives. By consolidating this information, this review enhances our understanding of how metals and metalloids contribute to plant element defense. Drawing on the current advances in plant elemental defense, we propose an application prospect of metals and metalloids in agricultural products to solve current issues, including soil pollution and production, for the sustainable development of agriculture. Although the studies focused on plant elemental defense have advanced, the precise mechanism under the plant defense response still needs further investigation.

Extraction, Identification and Antioxidant Activity of 3-Deoxyanthocyanidins from Sorghum bicolor L. Moench Cultivated in China.

3-deoxyanthocyanidins (3-DAs) are typical flavonoids found in sorghum bran, and they have received much attention in recent years owing to their bioactivities. To further enhance the resource utilization of sorghums cultivated in China, three brewing sorghum cultivars (Liaoza-48, Liaonuo-11, and Liaonian-3) commonly used in China were selected as raw materials for the construction of an extraction technology system for 3-DAs and the clarification of their structures and bioactivities. Based on single-factor experiments and response surface analysis, the optimized system for the extraction of 3-DAs from sorghum grains was as follows: a hydrochloric acid-methanol solution (1:100, v/v) was the extraction solvent, the solid-liquid ratio was 1:20 (g/mL), the extraction time was 130 min, and the temperature was 40 °C. This extraction system was simple and feasible. High performance liquid chromatography analysis suggested that the main monomeric compounds of the extracted 3-DAs were Apigeninidin (AE) and Luteolinidin (LE). Among the three selected sorghum grains, Liaoza-48 had the highest amount of AE (329.64 µg/g) and LE (97.18 µg/g). Antioxidant experiments indicated that the 3-DAs extracted from Liaoza-48 showed higher free-radical scavenging activities for DPPH, ABTS+, and hydroxyl radicals than those extracted from Liaonuo-11 and Liaonian-3. These results provide basic data and technical support for the high-value and comprehensive utilization of sorghums in China.

An organoid library of salivary gland tumors reveals subtype-specific characteristics and biomarkers.

BACKGROUND: Salivary gland tumors (SGTs) include a large group of rare neoplasms in the head and neck region, and the heterogeneous and overlapping features among the subtypes frequently make diagnostic difficulties. There is an urgent need to understand the cellular mechanisms underlying the heterogeneity and overlap among the subtypes, and explore the subtype-specific diagnostic biomarkers. METHODS: The tumor tissue and the adjacent normal tissue from the 6 most common types of SGTs were processed for organoid culture which only maintained tumor epithelial cells. Organoids were histologically evaluated based on phenotype markers, followed by transcriptional profiling using RNA-sequencing. The transcriptomic similarities and differences among the subtypes were analyzed by subtype consensus clustering and hierarchical clustering. Furthermore, by comparative transcriptional analysis for these 6 types of SGTs and the matched organoids, the potential diagnostic biomarkers from tumor epithelium were identified, in which two selected biomarkers were evaluated by qPCR and confirmed by immunohistochemistry staining using a tissue microarray. RESULTS: We generated a biobank of patient-derived organoids (PDOs) with 6 subtypes of SGTs, including 21 benign and 24 malignant SGTs. The PDOs recapitulated the morphological and transcriptional characteristics of the parental tumors. The overlap in the cell types and the heterogenous growth patterns were observed in the different subtypes of organoids. Comparing the bulk tissues, the cluster analysis of the PDOs remarkably revealed the epithelial characteristics, and visualized the intrinsic relationship among these subtypes. Finally, the exclusive biomarkers for the 6 most common types of SGTs were uncovered by comparative analysis, and PTP4A1 was demonstrated as a useful diagnostic biomarker for mucoepidermoid carcinoma. CONCLUSIONS: We established the first organoid biobank with multiple subtypes of SGTs. PDOs of SGTs recapitulate the morphological and transcriptional characteristics of the original tumors, which uncovers subtype-specific biomarkers and reveals the molecular distance among the subtype of SGTs.

Different effects of maternal homocysteine concentration, MTHFR and MTRR genetic polymorphisms on the occurrence of fetal aneuploidy.

RESEARCH QUESTION: Do maternal homocysteine (Hcy) concentrations, MTHFR and MTRR genes have effects on the occurrence of fetal aneuploidy? DESIGN: A total of 619 aneuploidy mothers and 192 control mothers were recruited in this study. Differences in distributions of maternal MTHFR 677C>T, MTHFR 1298A>C and MTRR 66A>G genetic polymorphisms and maternal Hcy concentrations between aneuploidy mothers and control mothers were analysed. RESULTS: The maternal MTHFR 677C>T polymorphism was found to be a risk factor for the occurrence of many fetal non-mosaic aneuploidies studied here, including trisomies 13, 15, 16, 18, 21, 22, TRA and TS. The maternal MTHFR 1298A>C polymorphism was found to be a risk factor specifically associated with the occurrence of fetal trisomy 15 and fetal TS. The maternal MTRR 66A>G polymorphism was found to be a risk factor only specifically associated with the occurrence of fetal trisomy 21. The Hcy concentrations of mothers of trisomies 22, 21, 18, 16, 15 and TS fetuses were significantly higher than the Hcy concentrations of control mothers. CONCLUSIONS: Overall, data suggested an association between these maternal polymorphisms and the susceptibility of fetal non-mosaic trisomy and Turner syndrome. However, these three maternal polymorphisms had different associations with the susceptibility of different fetal aneuploidies, and the elevated maternal Hcy concentration appeared to be a likely risk factor for fetal Turner syndrome and fetal trisomies.

Disruption of Functional Brain Networks Underlies the Handwriting Deficit in Children With Developmental Dyslexia.

Developmental dyslexia (DD) is a neurological-based learning disorder that affects 5-17.5% of children. Handwriting difficulty is a prevailing symptom of dyslexia, but its neural mechanisms remain elusive. Using functional magnetic resonance imaging (fMRI), this study examined functional brain networks associated with handwriting in a copying task in Chinese children with DD (n = 17) and age-matched children (n = 36). We found that dyslexics showed reduced network connectivity between the sensory-motor network (SMN) and the visual network (VN), and between the default mode network (DMN) and the ventral attention network (VAN) during handwriting, but not during drawing geometric figures. Moreover, the connectivity strength of the networks showing group differences was correlated with handwriting speed, reading and working memory, suggesting that the handwriting deficit in DD is linked with disruption of a large-scale brain network supporting motoric, linguistic and executive control processes. Taken together, this study demonstrates the alternations of functional brain networks that underly the handwriting deficit in Chinese dyslexia, providing a new clue for the neural basis of DD.

Dairy Trade Helps to Alleviate Global Carbon Emission Pressure.

Global dairy production, consumption, and trade are growing rapidly, driven by population and per capita income growth and increasing health concerns mainly from developing countries, which has aroused concerns about the related carbon emission (mostly in the form of methane) increase. If all of the dairy products consumed were produced locally/domestically in the developing countries/economies (a counterfactual scenario), the carbon emissions in 2018 would be 28 Mt CO2-equiv higher than its status quo (a factual scenario). The present study indicates that unlike in many global trade cases in which carbon leakages are from developed to developing countries, global dairy trade is characterized by net embodied carbon flows from developed to developing countries/economies due to the fact that there is an overwhelming one-way-flow of dairy products from developed to developing countries/economies. The differences in the carbon emission factors between the developed and developing countries/economies provide an opportunity that global dairy trade and production specialization can help to reduce carbon emissions from increasing dairy product demand, and the total reduction potential is estimated to be about 414 Mt CO2-equiv from 2018 to 2030. Free trade agreements such as the Regional Comprehensive Economic Partnership will incentivize larger carbon emission reduction benefits through promoting dairy trade.

Breaking down barriers on PV trade will facilitate global carbon mitigation.

The global trade of solar photovoltaic (PV) products substantially contributes to increases in solar power generation and carbon emissions reductions. This paper depicts global PV product trade patterns, explores emissions reduction potential, and evaluates the impeding effect of tariff barriers on global PV product trade and emissions reductions. Solar power generation will result in a reduction of emissions in a range of 50-180 gigatons of carbon dioxide equivalent (GtCO2e) between 2017 and 2060 in a business as usual (BAU) scenario. Compared with BAU, during 2017-2060, global total solar cell and module production and installation will increase by roughly 750 gigawatts (GW) if half of the status quo trade barrier are removed, while it will decrease by 160-370 GW under tensioned trade barrier scenarios. Trade barrier reduction by half from the 2017 status quo level will increase the net carbon emissions mitigation potential by 4-12 GtCO2e by 2060, while extra trade barrier imposition will result in global net carbon emissions mitigation potential decreasing by up to 3-4 GtCO2e by 2060. Well-coordinated policy and institutional reforms are recommended to facilitate PV product trade and to deliver the related global environmental benefits.

Removal of dimethyl sulfide by post-plasma catalysis over CeO2-MnOx catalysts and reaction mechanism analysis.

The combination of a multistage rod plasma reactor and post CeO2-MnOx catalysts is studied to treat dimethyl sulfide (DMS). The physicochemical properties of all catalysts and the effect of the catalytic performance of CeO2-MnOx catalysts on DMS removal efficiency are studied. Placing CeO2-MnOx catalysts after the non-thermal plasma system can improve the capability of DMS degradation. The results exhibit that CeO2-MnOx (1:1) catalyst presents a higher catalytic activity than that of CeO2, MnOx, CeO2-MnOx (1:0.5) and CeO2-MnOx (1:3). At the power of 21.7 W, the combination of dielectric barrier discharge and CeO2-MnOx (1:1) catalyst could improve the DMS removal efficiency and CO2 selectivity by 16.2% and 18.2%, respectively. This result maybe closely related with its specific surface area, redox properties and oxygen mobility. In addition, the degradation mechanism of DMS over CeO2-MnOx catalysts is proposed. Finally, the stability of the CeO2-MnOx (1:1) catalyst is investigated, and the reason for the decreased activity of the used catalyst is analyzed.

Global and National Environmental Impacts of the US-China Trade War.

The recent "US-China trade war" has aroused concern over trade-related environmental impacts. This study built a multiregional computable general equilibrium model to simulate environmental impacts of the "US-China trade war" under different scenarios of tariff and nontariff barriers and the battlefield spreading ranges. The present study found that although the trade war will cause a global economic downturn, which will seemingly reduce environmental pressure globally, global carbon emissions are expected to increase rather than decline. On the one hand, the CO2 emission increase caused by land-use changes in Brazil and Argentina will far exceed the emission reduction because of decreased global production. On the other hand, some countries/economies especially those developing countries such as Vietnam, Russia, and India will face emission increases driven by scale effects. Countries such as Korea, the UK, and France will enjoy a reduction in emissions driven by structural effects. China and the US will face a reduction in production and CO2 emissions, but their CO2 emission intensities will rise. The results remind us that as global production and supply chains are formed, it is important to closely monitor trade-related environmental impacts. Efforts should be made to balance the interests of trade and the environment.

Enhanced removal of toluene by pulse discharge plasma coupled with MgO cathode and graphene Mn-Ce bimetallic oxide.

Herein, MgO cathode and graphene Mn-Ce bimetallic oxide were utilized to jointly enhance the removal of toluene in pulsed discharge plasma (PDP). Compared to the common cathode, the MgO cathode enhanced the density of high energy electrons, and then induced to higher removal of toluene. However, the removal of toluene by PDP/MgO system was still insufficient, and there was a large amount of underutilized O3 in the products. Based on this, Mn-Ce/graphene catalysts were introduced into PDP/MgO system. The Mn-Ce (8:1)/graphene catalyst had the highest catalytic activity. Under the discharge power of 2.1 W, toluene degradation rate and CO2 selectivity increased by 27.5% and 22.0%, respectively. This was ascribed to the synergistic effect of the solid solution formed between MnOx and CeOx, increasing the proportion of Oads on the surface of the catalyst. The higher Oads/Olatt ratio lead to the better catalytic activity, which was conducive to the complete transformation of the intermediate products to CO2 and H2O. According to the detected products, the degradation pathway and the mechanism of toluene degradation were proposed finally. The PDP itself, field emission effect of MgO cathode and catalytic effect of Mn-Ce/graphene for jointly improve the toluene removal and CO2 selectivity.

GHGs and air pollutants embodied in China's international trade: Temporal and spatial index decomposition analysis.

Temporal index decomposition analysis and spatial index decomposition analysis were applied to understand the driving forces of the emissions embodied in China's exports and net exports during 2002-2011, respectively. The accumulated emissions embodied in exports accounted for approximately 30% of the total emissions in China; although the contribution of the sectoral total emissions intensity (technique effect) declined, the scale effect was largely responsible for the mounting emissions associated with export, and the composition effect played a largely insignificant role. Calculations of the emissions embodied in net exports suggest that China is generally in an environmentally inferior position compared with its major trade partners. The differences in the economy-wide emission intensities between China and its major trade partners were the biggest contribution to this reality, and the trade balance effect played a less important role. However, a lower degree of specialization in pollution intensive products in exports than in imports helped to reduce slightly the emissions embodied in net exports. The temporal index decomposition analysis results suggest that China should take effective measures to optimize export and supply-side structure and reduce the total emissions intensity. According to spatial index decomposition analysis, it is suggested that a more aggressive import policy was useful for curbing domestic and global emissions, and the transfer of advanced production technologies and emission control technologies from developed to developing countries should be a compulsory global environmental policy option to mitigate the possible leakage of pollution emissions caused by international trade.

Spinal myxopapillary ependymomas: a retrospective clinical and immunohistochemical study.

BACKGROUND: Myxopapillary ependymoma (MPE) is a rare subtype of ependymoma that develops almost exclusively within the spinal cord. Despite its benign biological nature, MPE has a propensity to recur locally or distantly. Although variables influencing the prognosis, such as age, the extent of surgery and radiotherapy, have been widely discussed, no definitive standard has been established. Compared to other spinal tumors, many fewer histological markers have been elucidated to assist the determination of the prognosis. METHODS: Twenty-seven patients who underwent resection of MPE were enrolled. We determined their demographic features, imaging characteristics, clinical presentations and outcomes, surgical procedures and histological properties by chart review, telephone contact, reviewing of surgical notes, pre-/postoperative imaging and immunohistological staining. RESULTS: GTR (gross total resection) was achieved in 18 patients (66.7 %) and STR (subtotal resection) in 9 (33.3 %). Although GTR rendered a better disease control rate, the difference was not significant. Pediatric patients suffered from a greater risk of recurrence as well as a shorter period to disease relapse. In the majority of cases, we observed the overexpression of platelet-derived growth factor receptor α (PDGFRα), matrix metalloproteinase-2 (MMP2) and matrix metalloproteinase-14 (MMP14). Epidermal growth factor receptor (EGFR) was observed in the tumors of 7 of 23 nonrecurrent patients, but not in any recurrent tumors. CONCLUSIONS: The results of the present study indicate that the extent of resection and age are major factors related to tumor recurrence. Therefore, gross total resection is recommended whenever possible unless following neurological dysfunction is predictable. Moreover, pediatric patients need considerable attention after surgery, particularly in the early stages. PDGFRα, MMP2 and MMP14 may be new diagnostic and therapeutic targets and EGFR a potential predictor of improved prognosis for MPE.

Suppression of glioblastoma by targeting the overactivated protein neddylation pathway.

BACKGROUND: The neddylation pathway has been recently identified as an attractive anticancer target, and MLN4924, a specific NEDD8-activating enzyme inhibitor, has been developed as a first-in-class anticancer agent. However, neither the status of the neddylation pathway in glioblastoma (GBM) nor the effect of MLN4924 against GBM has been systematically investigated yet. METHODS: To measure the activation state of the neddylation pathway in GBM, expression of the NEDD8-activating enzyme (E1), NEDD8-conjugating enzyme (E2), and global protein neddylation in GBM tumor tissues versus adjacent tissues were examined by immunoblotting analysis and immunohistochemistry staining. To assess the therapeutic efficacy of neddylation inhibition in GBM, cell proliferation in vitro and tumor growth in vivo were determined upon neddylation inhibition by MLN4924, an investigational NEDD8-activating enzyme inhibitor. RESULTS: The neddylation pathway was overactivated in a majority of GBM tumor tissues when compared with adjacent normal tissues. The upregulation of this pathway in GBM tissues was positively correlated with high-grade disease and postoperative recurrence but was negatively associated with patient overall survival. MLN4924 treatment inhibited cullin neddylation, inactivated cullin-RING E3 ligase, and led to the accumulation of tumor-suppressive cullin-RING E3 ligase substrates to trigger cell-cycle arrest and senescence or apoptosis in a cell-line dependent manner. Moreover, inhibition of neddylation by MLN4924 significantly suppressed tumor growth in an orthotopic xenograft model of human GBM. CONCLUSION: Our study indicates that an overactivated neddylation pathway may be involved in GBM progression and that inhibition of this oncogenic pathway is a potentially new therapeutic approach for GBM.

Partial least squares based identification of Duchenne muscular dystrophy specific genes.

Large-scale parallel gene expression analysis has provided a greater ease for investigating the underlying mechanisms of Duchenne muscular dystrophy (DMD). Previous studies typically implemented variance/regression analysis, which would be fundamentally flawed when unaccounted sources of variability in the arrays existed. Here we aim to identify genes that contribute to the pathology of DMD using partial least squares (PLS) based analysis. We carried out PLS-based analysis with two datasets downloaded from the Gene Expression Omnibus (GEO) database to identify genes contributing to the pathology of DMD. Except for the genes related to inflammation, muscle regeneration and extracellular matrix (ECM) modeling, we found some genes with high fold change, which have not been identified by previous studies, such as SRPX, GPNMB, SAT1, and LYZ. In addition, downregulation of the fatty acid metabolism pathway was found, which may be related to the progressive muscle wasting process. Our results provide a better understanding for the downstream mechanisms of DMD.

Primary intrinsic optic chiasm germinoma.

We report a 30-year-old woman with a primary intrinsic optic chiasm germinoma. The patient underwent a biopsy, and the pathology was determined to be a germinoma. Adjuvant radiation therapy was then carried out.