Bibliometric analysis of transforaminal lumbar interbody fusion in lumbar spine surgery.

OBJECTIVE: The objective of this study is to conduct a bibliometric analysis to examine the current condition, areas of interest, and rising trends of transforaminal lumbar interbody fusion in lumbar spine surgery (TLIF), as well as its importance in associated research domains. MATERIALS AND METHODS: An extensive collection of academic papers on the use of TLIF was obtained from the Web of Science between January 1, 2000, and November 5, 2023. Then, using a variety of tools like HisCite, VOSviewer, CiteSpace, and the bibliometrix package, a bibliometric study was carried out. This study included the collection of information on country, institution, author, journal, and keywords. RESULTS: A comprehensive analysis was undertaken on a total of 1,907 publications obtained from 181 journals, encompassing the contributions of 7,232 authors affiliated with 1,775 institutes spanning 57 countries/regions. Notably, the USA exhibited the highest number of publications, with 763 (40.03%) articles on TLIF. The most productive institution was Rush University, with 96 (5.03%) publications. The author with the highest publication output was Singh, Kern with 75 (3.93%) publications. World Neurosurgery demonstrated the highest level of productivity, having published a total of 211 (11.06%) articles. The most frequently used keywords were "TLIF", "spondylolisthesis" and "complication". Meanwhile, "workflow", "technical note" and "hidden blood loss" have been identified as the research frontiers for the forthcoming years. CONCLUSIONS: This paper provides a thorough evaluation of current research trends and advancements in TLIF. It includes relevant research findings and emphasizes collaborative efforts among authors, institutions, and countries.

Use of free flaps with supermicrosurgery for oncological reconstruction of the maxillofacial region.

Supermicrosurgery involves the dissection and anastomosis of vessels<0.8 mm in diameter with minimal donor site morbidity. This study evaluated the feasibility and outcomes of free flaps using supermicrosurgery to repair oncological defects in the maxillofacial region. Forty-two patients were treated with supermicrosurgery to repair oncological defects in the maxillofacial region between December 2015 and February 2021. The supermicrosurgery technique was used for different types of free flap, including 24 superficial circumflex iliac artery perforator flaps, seven anterolateral thigh flaps, three peroneal artery perforator flaps, five medial femoral condyle osteo-adipofascial flaps, and three profunda artery perforator flaps. An artery-to-artery approach was used in 38 patients; venous grafts for anastomosis were used in four patients to resolve an arterial discrepancy. Forty-one flaps (97.6%) survived. Thirty-six patients (85.7%) healed without any complications; three flaps required revision surgery including one lost, one demonstrated wound dehiscence, and two demonstrated wound infection. Supermicrosurgery is a useful complement to conventional microsurgery in head and neck reconstruction.

Retraction Note: MicroRNA-132 stimulates the growth and invasiveness of trophoblasts by targeting DAPK-1.

The article "MicroRNA-132 stimulates the growth and invasiveness of trophoblasts by targeting DAPK-1, by Y.-P. Wang, P. Zhao, J.-Y. Liu, S.-M. Liu, Y.-X. Wang, published in Eur Rev Med Pharmacol Sci 2020; 24 (19): 9837-9843-DOI: 10.26355/eurrev_202010_23193-PMID: 33090386" has been retracted by the authors due to some inaccuracies in the miRNA-132 primer sequence. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/23193.

Percutaneously placed lumbar interspinous stabilization devices - a review of current clinical research.

OBJECTIVE: There are generally two categories of interspinous stabilization devices widely used in clinics: (1) Static spacing systems, such as X-STOP, Wallis. (2) Dynamic stabilization systems, such as Coflex, DIAM, stenofix. However, with the advancement of minimally invasive techniques, interspinous stabilization devices paced through percutaneous minimally invasive approach have been invented and applied in daily clinic. Its advantages, such as simple operation, small trauma and short hospitalization time are gradually recognized by doctors and patients. Percutaneous minimally invasive approach will become the future direction in the field of interspinous stabilization devices. This paper therefore reviewed the current clinical research progress of interspinous stabilization devices performed under percutaneous minimally invasive approach. MATERIALS AND METHODS: We searched studies related to percutaneously placed lumbar interspinous stabilization devices from PubMed, since January 1, 2007. RESULTS: The main types and characteristics of currently used and percutaneously placed interspinous stabilization devices were summarized. Meanwhile, clinical studies relevant to currently used and percutaneously placed interspinous stabilization devices were also summarized. CONCLUSIONS: The future of interspinous stabilization devices is bright, we would like to see more advanced and newly invented percutaneously placed interspinous stabilization devices, meanwhile, it is fundamentally crucial to enroll more clinical studies with long-term follow-up to determine the best indications for each device therefore to achieve more satisfactory clinical outcomes.

[In vitro evaluation of positioning accuracy of trephine bur at different depths by dynamic navigation].

OBJECTIVE: To evaluate the accuracy of trephine bur drilling at different depths guided by dynamic navigation system in 3D printing in vitro model. METHODS: A model at the depth of 5 mm, 10 mm, and 15 mm from the outer surface of which hemispherical cavities was reserved and the 3D printing technology was used to make the standardized model with Veroclear resin. The cone beam CT (CBCT) was taken and the data were imported into the dynamic navigation software (DCARER, China) to establish navigation path programming. Under the guidance of dynamic navigation, a trephine bur with a diameter of 4.5 mm was used to complete the access operation. At each depth, 10 approaches were completed. The postoperative model CBCT was taken. The approach trajectory under navigation was reconstructed and compared with the designed path. The two-dimensional distance deviation, depth deviation, three-dimensional distance deviation, and angle deviation between the actually prepared path and the designed path were calculated. RESULTS: At the depth of 5 mm, the two-dimensional distance deviation between the end position of the prepared path and the designed path was (0.37±0.06) mm, the depth deviation was (0.06±0.05) mm, the three-dimensional distance deviation was (0.38±0.07) mm, and the angle deviation was 2.46°±0.54°; At the depth of 10 mm, the four deviations between the end position of prepared path and the designed path were (0.44±0.05) mm, (0.16±0.06) mm, (0.47±0.05) mm, and 2.45°±1.21°, respectively; At the depth of 15 mm, the four deviations were (0.52±0.14) mm, (0.16±0.07) mm, (0.55±0.15) mm, and 3.25°±1.22°, respectively. With the increase of entry depth, the three-dimensional and depth accuracy of dynamic navigation system decreased (P < 0.01), and the positioning angle deviation had no relation with the entry depth (P>0.01). CONCLUSION: Dynamic navigation technology can achieve high positioning accuracy in the depth range of 15 mm, but its deviation increases with the increase of entry depth.

Venous superdrainage using superficial circumflex iliac vein in deep circumflex iliac artery perforator flap with iliac crest for oromandibular reconstruction.

The deep circumflex iliac artery perforator flap with iliac crest (DCIAPF) is considered a favourable single-flap option for oromandibular reconstruction. The aim of this study was to evaluate the effectiveness of venous superdrainage using the superficial circumflex iliac vein (SCIV) in the DCIAPF for oromandibular reconstruction. The data of 22 patients (12 female, 10 male) aged 10-76 years (median 53 years) who underwent simultaneous oromandibular reconstruction with a DCIAPF were reviewed retrospectively. Eleven patients received the DCIAPF with SCIV for superdrainage (group A) and another 11 patients received the conventional single-pedicled DCIAPF flap (group B). No flap loss occurred in either group. Venous congestion due to relative venous insufficiency was significantly more frequent in group B (P=0.045). There was no significant difference in the incidence of partial flap necrosis and wound dehiscence, or in the total operation time between the two groups. Superdrainage using the SCIV has the potential to reduce the incidence of venous congestion due to relative venous insufficiency in DCIAPF used for oromandibular reconstruction.

Er-Xian decoction exhibits protective activity in a rat model of asthenospermia through a mechanism associated with DJ-1 protein upregulation.

Asthenozoospermia (AZS) remains a significant clinical problem of male factor infertility. Er-Xian decoction (EXD) is a traditional Chinese medicine with potent antioxidant activity to treat AZS. To investigate the protective effects of EXD on sperm motility and deglycase (DJ)-1 expression in AZS model rats. Sixty mature male Sprague-Dawley rats (200 - 250 g) were randomized into five equally sized groups, including ornidazole (ORN)-induced AZS model group, or L-carnitine (0.1 g/kg) treated group or EXD group (7.5, 15, or 30 g crude drug/kg). Oxidative stress was assessed by measuring superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px). DJ-1 expression in testis and epididymis tissue was measured via qRT-PCR, Western blotting, and immunofluorescence staining. Hematoxylin and eosin staining was used to gauge morphological changes of testis and epididymis. Sperm motility was significantly reduced the AZS model group, while increased in the low-, intermediate-, and high-dose EXD treatment groups by 45.51%, 49.43%, and 58.31%, respectively (P < 0.001), which with a similar increase of 57.21% being observed in the L-carnitine treatment group. Relative to the control group, oxidative stress indices were significantly altered in AZS model rats, which exhibited significant reductions in SOD and GSH-Px levels and significantly increased MDA levels (49.44 ± 1.38 U/ml, 14.02 ± 0.70 U/ml, and 26.37 ± 1.03 nmol/ml, respectively). After EXD treatment, oxidative stress indexes were significantly improved relative to those in these model rats, with high-dose EXD yielding more significant improvements in these oxidative stress indices relative to L-carnitine treatment. While AZS model rats exhibited morphological abnormalities, tissue disorder, and reduced cell counts in the testis and epididymis, these were reversed by EXD treatment in a dose-dependent manner. EXD treatment was also associated with a significant increase in DJ-1 protein expression in testis and epididymis tissue samples relative to the levels observed in AZS model rats. EXD is firstly reported could significantly improve sperm motility in AZS rats and is more effective at higher dosage, even better than L-carnitine. The protective effect of EXD on sperm motility is based on the DJ-1 expression.

[Preoperative treatment of uterine fibroids with low-dose mifepristone: a multicenter, randomized, double-blind, placebo-controlled, parallel-group study].

Objective: To evaluate the clinical efficacy and safety of oral mifepristone (10 mg/day) versus placebo in the preoperative treatment of uterine fibroids. Methods: This study was a multi-center, randomized, double-blind, placebo, parallel controlled trial. A total of 132 patients with uterine fibroids were randomly divided into study group and control group, with 66 cases in each group. The patients in the study group orally took 1 tablet/day of mifepristone (dose of 10 mg/tablet), the patients in the control group orally took 1 tablet/day of placebo, and both groups were treated for 3 months. The primary efficacy evaluation indicators were the change rate of maximum fibroid volume; the secondary efficacy evaluation indicators included amenorrhea rate, improvement of subjective symptoms and anemia; the safety evaluation indicators included the analysis of adverse events and changes in laboratory biochemical indicators. Results: At the end of treatment, the maximum leiomyoma volume was reduced by 25.97% (95%CI: -34.79%--15.95%) in the study group and reduced by 1.51% (95%CI: -13.03%-11.54%) in the control group. The change rate of the maximum leiomyoma volume before and after treatment in the study group was significantly greater than that in the control group, and the difference in the change rate of the maximum leiomyoma volume between the two groups was -24.84% (95%CI: -36.56%--10.94%), which was much higher than the 10% superiority threshold goal set by this study within the 95%CI interval. At the end of treatment, the complete amenorrhea rate [84% (52/62)], dysmenorrhea elimination rate [98% (61/62)], and menstrual blood loss disappearance rate [87% (54/62)] in the study group were significantly higher than those in the control group (all P<0.05). At the end of treatment, the mean hemoglobin [(131±13) g/L], red blood cell count [(4.5±0.4)×1012/L] and hematocrit (0.39±0.03) in the study group were significantly increased compared with the baseline, and the differences had statistical significance (all P<0.05); after treatment, the differences in the above three indicators between the two groups had statistical significance (all P<0.01). The serum estradiol level in the study group was significantly lower than that in the control group at the end of treatment, and the difference was statistically significant (P<0.01). There were no significant differences in follicle-stimulating hormone and cortisol levels before and after treatment between the two groups (P>0.05). The overall incidences of any adverse event were not significantly different between the two groups (all P>0.05). Abdominal pain was the most common adverse event in the study group [9% (6/65)], but the incidence was not significantly increased compared with the control group [3% (2/64); P>0.05]. Conclusion: Compared with placebo, oral mifepristone 10 mg/day is significantly superior to placebo in reducing the size of uterine fibroids and improving anemia, without significant adverse reactions, and could be used as a drug treatment for patients with of uterine fibroids before surgery.

Comparison of outcomes using radiotherapy or brachytherapy after resection of primary adenoid cystic carcinoma in oral and maxillofacial regions.

We wished to investigate the outcome of surgery combined with external-beam radiotherapy (EBRT) or brachytherapy (125I seeds) for the treatment of primary adenoid cystic carcinoma (ACC) of the oral and maxillofacial region. Data of patients with primary ACC were reviewed retrospectively. Patients were divided into EBRT and brachytherapy groups. Wide tumor excision was done to achieve negative margins. Standard radiotherapy in the EBRT group was 60 Gy. A treatment-planning system was used to create implantation plans with a prescribed dose of 60-120 Gy and 125I seeds were implanted postoperatively. Kaplan-Meier method and log-rank tests were used to analyze local control and survival. The median duration of followup was 66.1 and 46.8 months for the EBRT group and brachytherapy group, respectively. There was no significant difference in local control, control of metastasis to regional lymph nodes, or control of distant metastasis between the two groups. There was no significant difference in overall survival, disease-specific survival, or disease-free survival in the two groups at 3 years and 5 years. The prevalence of complications in the brachytherapy group was lower than that in the EBRT group. Both methods elicited good treatment effects, but the prevalence of adverse events was lower in the brachytherapy group.

MicroRNA-132 stimulates the growth and invasiveness of trophoblasts by targeting DAPK-1.

OBJECTIVE: The purpose of this study was to elucidate the regulatory effects of microRNA-132 on the growth and invasiveness of trophoblasts, thus influencing the development of preeclampsia (PE). PATIENTS AND METHODS: Placenta tissues from 24 PE pregnancies and 24 healthy pregnancies were collected. Expression levels of microRNA-132 and DAPK-1 in collected placenta tissues were detected. Then, the regulatory effects of microRNA-132 and DAPK-1 on expression levels of apoptosis-associated genes, viability, and invasiveness in trophoblasts were assessed. Finally, through Dual-Luciferase reporter assay, the binding relationship between microRNA-132 and DAPK-1 was determined. RESULTS: The results showed that microRNA-132 was downregulated in placenta of PE pregnancies, while DAPK-1 was upregulated. Overexpression of microRNA-132 stimulated viability and invasiveness, but inhibited apoptosis in trophoblasts. Besides, it was found that DAPK-1 was the target gene binding microRNA-132, and a negative correlation was identified between their expression levels. Notably, the overexpression of DAPK-1 inhibited viability and invasiveness, but stimulated apoptosis in trophoblasts. CONCLUSIONS: MicroRNA-132 stimulates proliferative and invasive capacities and inhibits apoptosis in trophoblasts by targeting DAPK-1.

[Advances in the research of virtual reality technology for pain intervention after burns].

Pain is one of the most common complications of burn patients. Burn from onset to rehabilitation is a long and complex process, during which dressing change, debridement, operation, and rehabilitation may cause different degrees of pain to the patients. As one of the means of non-pharmaceutical pain management, the interventional effect of virtual reality technology has gradually been recognized by more and more researchers. This paper reviewed the definition, the interventional mechanisms, and the interventional effect on burn pain of virtual reality technology, to provide a reference for clinical application of virtual reality technology in pain management of burn patients.

Aspirin protects human coronary artery endothelial cells by inducing autophagy.

Although the use of aspirin has substantially reduced the risks of cardiovascular events and death, its potential mechanisms have not been fully elucidated. In a previous study, we found that aspirin triggers cellular autophagy. In the present study, we aimed to determine the protective effects of aspirin on human coronary artery endothelial cells (HCAECs) and explore its underlying mechanisms. HCAECs were treated with oxidized low-density lipoprotein (ox-LDL), angiotensin II (Ang-II), or high glucose (HG) with or without aspirin stimulation. The expression levels of endothelial nitric oxide (NO) synthase (eNOS), p-eNOS, LC3, p62, phosphor-nuclear factor kappa B (p-NF-κB), p-p38 mitogen-activated protein kinase (p-p38 MAPK), and Beclin-1 were detected via immunoblotting analysis. Concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured via ELISA. NO levels were determined using the Griess reagent. Autophagic flux was tracked by tandem mRFP-GFP-tagged LC3. Results showed that aspirin increased eNOS level and reduced injury to the endothelial cells (ECs) caused by ox-LDL, Ang-II, and HG treatment in a dose-dependent manner. Aspirin also increased the LC3II/LC3I ratio, decreased p62 expression, and enhanced autophagic flux (autophagosome and autolysosome puncta) in the HCAECs. p-NF-κB and p-p38 mitogen-activated protein kinase inhibition, sVCAM-1 and sICAM-1 secretion, and eNOS activity promotion by aspirin treatment were found to be dependent on Beclin-1. These results suggested that aspirin can protect ECs from ox-LDL-, Ang-II-, and HG-induced injury by activating autophagy in a Beclin-1-dependent manner.

Development and application of isothermal amplification methods for rapid detection of F4 fimbriae producing Escherichia coli.

Enterotoxigenic Escherichia coli (ETEC) is the causative agent of a wide range of diseases, which are the important cause of illness and mortality in piglets. ETEC strains expressing F4 fimbriae are frequently associated with post-weaning diarrhea (PWD) and lead to great economic losses in swine production industry worldwide. The aim of this study was to establish a rapid and effective isothermal amplification method for detection of F4 fimbriae. Loop-mediated isothermal amplification (LAMP), Polymerase spiral reaction (PSR) and cross-priming ampli- fication (CPA) were used to develop and optimize the detection method first time. Subsequently, the specificity and sensitivity of these methods were evaluated, and the clinical samples were detected with these methods. All the F4-positive samples could produce ladder-like amplifica- tions products and lead the chromogenic substrate SYBR Green I produce green fluorescence, while in blank control and negative samples lack of this pattern or remained orange. The sensi- tivity of LAMP and CPA were 10 times higher than PSR method. Meanwhile, these three methods were validated with clinical samples, 7 were found positive, while 125 samples were negative, the testing results were consisted with the real-time PCR method. These findings suggested that the isothermal amplification based on the F4 fimbriae is a rapid, effective and sensitive method under resource constrains.

Plasma mtDNA copy numbers are associated with GSTK1 expression and inflammation in type 2 diabetes.

AIMS: Mitochondrial dysfunction is involved in the pathogenesis of type 2 diabetes. Glutathione S-transferase kappa 1 (GSTK1) is critical to maintain mitochondrial function and homeostasis. We aimed to investigate whether a potential link exists between mitochondrial DNA (mtDNA) copy numbers and inflammation, non-esterified fatty acids (NEFA) and GSTK1 expression in type 2 diabetes. METHODS: We assessed mtDNA copy numbers in plasma and GSTK1 expression in white blood cells in 123 people with type 2 diabetes and in 121 healthy controls using a quantitative polymerase chain reaction (qPCR). An automatic chemistry or immunoassay analyser was used to determine serum glucose, lipids and inflammatory markers. Multiple linear regression and multivariable logistic regression models were used to evaluate associations and risks. RESULTS: Compared with healthy controls, individuals with diabetes showed higher mtDNA copy numbers (t = -3.938, P < 0.001) and lower GSTK1 expression (Z = -2.985, P = 0.002). mtDNA copy number was associated with type 2 diabetes risk [odds ratio (OR) = 1.80, 95% confidence intervals (CI) 1.25-2.58, P = 0.001] after controlling for confounding factors. In individuals with diabetes, mtDNA copy number was negatively associated with GSTK1 expression (ß = -0.235, P = 0.036) and positively associated with serum high-sensitive C-reactive protein (hsCRP) (ß = 0.839, P < 0.001), tumour necrosis factor alpha (TNF-α) (ß = 0.549, P < 0.001), interleukin-6 (IL-6) (ß = 0.589, P = 0.006) and NEFA (ß = 0.001, P = 0.020). In the diabetic group, individuals with an abnormal increase in NEFA, hsCRP, TNF-α and IL-6 showed significantly elevated mtDNA copy numbers (all P < 0.05). CONCLUSIONS: mtDNA copy numbers in plasma might have an important role in the progression of diabetic chronic inflammation via inhibition of GSTK1 and could be a potential biomarker for type 2 diabetes.

Operation of RF-driven negative hydrogen ion source in China Spallation Neutron Source.

The China Spallation Neutron Source started delivering neutron beams to users in March 2018. To upgrade the beam power to 500 kW and improve the performance of the ion source, an RF-driven negative hydrogen (H-) ion source is under development. The source has a silicon nitride ceramic plasma chamber surrounded by a 4.5-turn antenna. The plasma is ignited by a pulsed DC spark gap and then driven by a 2 MHz solid-state amplifier with a repetition rate of 25 Hz. The commissioning of the source started in January 2019. When uncesiated, it produced about 20 mA beam at an RF power of 32 kW and pulse width of 450 µs. This paper describes the configuration of the ion source, several peculiar technologies used in it, and the first negative hydrogen (H-) ion beam extraction.

[A randomized controlled study of peramivir, oseltamivir and placebo in patients with mild influenza].

Objectives: To evaluate the effectiveness and safety of peramivir trihydrate in patients with influenza. Methods: This was a randomized, double-blind, double-dummy, placebo and positive control, multicenter clinical trial, comparing peramivir trihydrate with oseltamivir and placebo. The inclusive criteria were 15-70 years old, onset within 48 h, positive rapid influenza antigen test, and febrile (>38℃) accompanied with at least two associated symptoms. The severe cases complicated with chronic pulmonary and cardiac diseases, malignancies, organ transplantation, hemodialysis, uncontrolled diabetes, immunocompromised status, pregnancy and coexistence of bacterium infections were excluded. All patients were randomized 2∶2∶1 to receive peramivir, oseltamivir and placebo respectively. The primary endpoint was the disease duration, the secondary endpoints included time to normal axillary temperature and normal living activities, viral response, and adverse effects. Results: Following informed consent, 133 patients were included in this study. Four patients were exclude due to missing medical records, not fitting inclusion or exclusion criteria and poor compliance. A total of 129 patients were finally analyzed, including 49 cases, 54 cases and 26 cases in peramivir group, oseltamivir group and placebo group. The median disease duration were 96 (76, 120) hours, 105 (90,124) hours, and 124 (104, 172) hours in three groups respectively (P>0.05) . The time to normal axillary temperature, normal living activities and viral response were not significantly different in three groups (P>0.05) . Conclusion: The value of antiviral therapy in patients with mild influenza needs to be further determined.

[Study of surgery combined with 125I brachytherapy for adenoid cystic carcinoma of oral and maxillofacial region].

OBJECTIVE: To retrospectively analyze the results of treatment outcome by surgery combined with 125I brachytherapy and correlative factors of adenoid cystic carcinoma (ACC). METHODS: In the study, 75 patients with primary ACC of oral and maxillofacial region were treated by surgery combined with 125I seeds brachytherapy. Radical resection or subtotal resection was applied for the tumor. The brachytherapy treatment planning system was used to create implant plans with the prescribed dose of 60 Gy to 120 Gy. The 125I seeds were implanted intraoperatively or postoperatively. The regular follow-up was required. The Kaplan-Meier method was used to assess the tumor control rate and the patients' survival rates. Meanwhile, the Cox regression analysis was used to find out the prognostic factors. RESULTS: Local control rates at the end of 3 and 5 years were as follows: T1-T2, 92.2% and 82.0%; T3-T4, 82.6% and 82.6%; and overall, 90.0% and 78.8%. The disease-free survival rates were 74.9% and 54.3%, respectively. The overall survival rates for all the patients were 86.0% and 79.6%, respectively at the end of 3 and 5 years and were 91.3% and 91.3% for T1-T2 patients vs. 73.9% and 59.7% for T3-T4 patients. Distant metastasis-free survival rates at the end of 3 and 5 years were 84.4% and 76.7%, respectively. The distant metastasis-free survival rates at the end of 3 and 5 years were 83.4% and 79.6% with T1-T2 lesion compared with 86.0% and 67.8% with T3-T4 lesion. According to the COX univariate analysis and multivariate analysis, the risk of local recurrence would be raised by the age. Tumor stage and tumor site were the prognostic factors of the overall survival rates. CONCLUSION: 125I brachytherapy conducted as an adjuvant therapy postoperatively of ACC of oral and maxillofacial region can acquire satisfactory localregional control, distant metastasis-free survival, disease-free survival and overall survival. Tumors are prone to recur on the older patients. Patients having advanced tumor stage or tumor located in the nasal cavity or sinuses will suffer lower survival rates.