Background The purpose of this study was to test whether cryotherapy is superior to a sham procedure for reducing symptoms of chronic rhinitis. Methods This study was a prospective, multicenter, 1:1 randomized, sham‐controlled, patient‐blinded trial. The predetermined sample size was 61 participants per arm. Adults with moderate/severe symptoms of chronic rhinitis who were candidates for cryotherapy under local anesthesia were enrolled. Participants were required to have minimum reflective Total Nasal Symptom Scores (rTNSSs) of 4 for total, 2 for rhinorrhea, and 1 for nasal congestion. Follow‐up visits occurred at 30 and 90 days postprocedure. Patient‐reported outcome measures included the rTNSS, standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)], and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires. Adverse events were also recorded. The primary endpoint was the comparison between the treatment and sham arms for the percentage of responders at 90 days. Responders were defined as participants with a 30% or greater reduction in rTNSS relative to baseline. Results Twelve US investigational centers enrolled 133 participants. The primary endpoint analysis included 127 participants (64 active, 63 sham) with 90‐day results. The treatment arm was superior at the 90‐day follow‐up with 73.4% (47 of 64) responders compared with 36.5% (23 of 63) in the sham arm (p < 0.001). There were greater improvements in the rTNSS, RQLQ(S), and NOSE scores for the active arm over the sham arm at the 90‐day follow‐up (p < 0.001). One serious procedure‐related adverse event of anxiety/panic attack was reported. Conclusion Cryotherapy is superior to a sham procedure for improving chronic rhinitis symptoms and patient quality of life.
This study examined discrepancies in educational opportunity for gifted students at the program services level. School districts in the study (N = 1,029) varied in expenditures for gifted education and the allocation of faculty for gifted education. The relationships of variables representing funding and staffing gifted education and school contextual variables such as locale (city, suburban, town, rural) were examined. Pairwise comparisons among locales revealed effect sizes as high as 0.31 with respect to funding and staffing variables. Multiple regression analyses and bivariate correlations were examined to estimate the relative strength of the predictor variables on the funding and staffing variables. Data in this study indicated that locale, school size, and economic disadvantage were the strongest predictors of variance in funding and staffing gifted education programs. Rural schools, small schools, and schools with larger economically disadvantaged populations allocate proportionally less fiscal and human resources to gifted education services. Racial/ethnic diversity, property wealth, and overall expenditures per student accounted for relatively little of the variance in funding and staffing gifted programs.
Background Sub-superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, compared with less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection. Objectives The authors sought to aggregate and summarize data on complications among different SMAS facelift techniques. Methods A broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total 183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rates of temporary nerve injury and were the only techniques to show a statistically significant difference compared with SMAS plication (odds ratio [OR] = 2.71 and 2.22, respectively, P < 0.05). Risk of permanent injury did not differ among techniques. An increase in major hematoma was found for the deep plane (1.22%, OR = 1.67, P < 0.05) and SMAS imbrication (1.92%, OR = 2.65, P < 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR = 2.29, P < 0.01). Conclusions There are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Technique should be selected based on quality of results and not the complication profile. Level of Evidence: 2
Importance Several recent studies have documented disparities in head and neck cancer outcomes for Black patients in the United States. However, few studies have been conducted to evaluate for differences in long-term survival from salivary gland cancer (SGCA) for racial/ethnic minorities compared to Whites. Objective To determine if patient race or ethnicity impact SGCA survival. Design, Setting, and Participants Retrospective survival analysis of all patients with SGCA from 1988–2010 in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, a population-level database of cancer registries covering approximately 28 percent of the US population. Intervention None Main Outcomes and Measures The primary outcome measured was disease-specific survival. Patients with SGCA were grouped according to race and ethnicity. The end points assessed in each group included age at diagnosis, gender, tumor grade, tumor size at diagnosis, extension at diagnosis, lymph node involvement at diagnosis, and treatment modalities. The racial/ethnic groups were further analyzed by histologic subtype of the SGCAs. Results Of 11,007 patients with SGCA, 1,073 (9.7%) and 1,068 (9.7%) were Black and Hispanic, respectively. The mean age at diagnosis for Whites was 63 years old compared to 53 and 52 years old for Blacks and Hispanics, respectively (p < 0.0001). Twenty-year disease-specific survival rates for all SGCA histologies combined for Whites, Blacks, and Hispanics were 78%, 79%, and 81%, respectively. The log-rank test of the unadjusted survival curves showed no significant difference in survival between Black and White patients and an apparent survival advantage for Hispanic compared to White patients. However, using multivariable Cox regression models to control for patient, tumor, and treatment characteristics, we demonstrated that Black patients actually have significantly poorer disease-specific survival for SGCA compared to White patients, while Hispanic patients have no significant difference in disease-specific survival compared to White patients. Further analyses of the individual SGCA histological subtypes identified poorer disease-specific survival for Black compared to White patients with mucoepidermoid and squamous cell carcinomas as the source of the overall poorer disease-specific survival for Black compared to White patients with SGCA. Less surgical treatment for Black compared to White patients was a significant source of the survival disparity for squamous cell SGCA, but not for mucoepidermoid SGCA. Conclusions and Relevance This is the largest study to date to explore racial and ethnic disparities in SGCA survival. Our results show that for patients diagnosed with SGCA, Black race is a risk factor for poorer disease-specific survival for those with mucoepidermoid or squamous cell carcinoma, while Hispanic ethnicity has no effect on disease-specific survival for any SGCA histology. Differences in treatment regimens between Black and White patients play a significant rol...
Black race is a risk factor for poorer disease-specific survival when all sinonasal histologic subtypes are examined together. Specifically for sinonasal squamous cell carcinoma, both black race and Hispanic ethnicity are risk factors for poorer disease-specific survival. When tumor characteristics are controlled for in this cohort, the survival disparity is eliminated, demonstrating that the disparity can be accounted for exclusively by more advanced disease at presentation, opposed to the more complex effect seen in other subsites of the head and neck.
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