Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study.

OBJECTIVE: To assess the impact of diabetic retinopathy (DR) and its severity on health-related quality of life (HRQOL) in a population-based sample of Latinos with type 2 diabetes mellitus (DM). DESIGN: Cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES). PARTICIPANTS: We included 1064 LALES participants with DM. METHODS: We measured HRQOL by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-item Short Form Health Survey (SF-12). We assessed DR by masked standardized grading of stereoscopic photographs from 7 standard fields. Severity of DR in eyes was graded using a modified Airlie House classification. The severity scores from each eye were then concatenated to create a single per person grade ranging from 1 (no DR in either eye) to 15 (bilateral PDR). Multiple linear regression analyses were performed to determine the independent relationship between severity of DR and HRQOL after adjusting for covariates. MAIN OUTCOME MEASURES: Scores on the NEI-VFQ-25 and SF-12. RESULTS: More severe DR was associated with worse HRQOL scores on all of the NEI-VFQ-25 and SF-12 subscales (P<0.05). Individuals with DR from grade 2 (minimum nonproliferative diabetic retinopathy [NPDR]) through grade 8 (unilateral moderate NPDR) show a modest decline in HRQOL. However, the decline becomes significantly steeper between steps 8 (unilateral moderate NPDR) and 9-15 (bilateral moderate NPDR to bilateral PDR). The domains with the most significant impact were for vision-related daily activities, dependency, and mental health. CONCLUSIONS: Greater severity of DR was associated with lower general and vision-specific HRQOL. Persons with bilateral moderate NPDR had the most substantial decrease in quality of life compared with those with less severe DR. The prevention of incident DR and, more important, its progression from unilateral to bilateral NPDR is likely to have a positive impact on a person's HRQOL and should be considered an important goal in management of individuals with DM.

Self-reported use of eye care among Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To identify the prevalence and determinants of self-reported eye care use in Latinos. DESIGN: Population-based ocular epidemiologic study in Latinos aged 40+ years living in La Puente, California. PARTICIPANTS: A total of 5455 participants. METHODS: Univariate, multivariable, and stepwise logistic regression analyses were conducted to identify predisposing, enabling, and need variables associated with self-reported eye care use. MAIN OUTCOME MEASURES: Prevalence of self-reported use: eye care visit, having had a dilated examination in the past 12 months, ever having had a dilated examination, and odds ratios for factors associated with self-reported use. RESULTS: Overall, 36% of participants reported an eye care visit and 19% reported having a dilated examination in the past year. Fifty-seven percent reported ever having had a dilated eye examination. Greater eye care use was associated with older age, female gender, bilingual language proficiency (English and Spanish), more education, having health insurance, having a usual place for care, having a regular provider of care, a greater number of comorbidities, visual impairment, and lower vision-specific quality of life scores. CONCLUSIONS: Multiple modifiable factors are associated with greater use and access to eye care for Latinos. Modification of these factors should be a priority because visual impairment has significant impacts on well-being and mortality.

Visual acuity outcomes after cataract extraction in adult latinos. The Los Angeles Latino Eye Study.

PURPOSE: To determine prevalence, primary causes, and risk indicators of visual impairment in cataract-operated eyes. DESIGN: Population-based cross-sectional study of adult Latinos. PARTICIPANTS: Two hundred sixty-one participants with cataract extraction. METHODS: Participants underwent an in-home interview and a comprehensive ophthalmologic examination. Visual impairment in the cataract-operated eye was defined by presenting visual acuity (PVA) of 20/40 or less or best-corrected visual acuity (BCVA) of 20/40 or less. The association of cataract extraction status (aphakic, pseudophakic) and severity of visual impairment was evaluated. Risk indicators associated with visual impairment by BCVA in the worse-seeing cataract-operated eye were evaluated. MAIN OUTCOME MEASURES: Visual acuity, causes of visual impairment, and risk indicators associated with visual impairment. RESULTS: Of the 261 participants with at least one cataract extraction and a complete clinical examination, 100 (38%) participants had undergone a unilateral extraction and 161 (62%) had undergone bilateral extractions. The prevalence of visual impairment was 41% (n = 107) defined by BCVA and 60.5% (n = 158) defined by PVA in the worse-seeing cataract-operated eye, and 32.2% (n = 136) defined by BCVA versus 48.1% (n = 203) defined by PVA in all cataract-operated eyes. Uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy were the primary causes of visual impairment, accounting for 49% in worse-seeing cataract-operated eyes and 57% in all cataract-operated eyes. Self-reported history of glaucoma, barriers to eye care, and unmarried participants were independent risk indicators associated with visual impairment (P<0.05). CONCLUSIONS: Despite cataract surgery, a significant proportion of participants had residual visual impairment. Refractive correction eliminated visual impairment in 15% to 20% of the participants, demonstrating the need for regular ophthalmologic examinations in cataract-operated patients.

The association between elevated EphB4 expression, smoking status, and advanced-stage disease in patients with head and neck squamous cell carcinoma.

OBJECTIVE: To examine the expression of EphB4 in tumor tissue, surrounding normal tissue, and metastatic lymph node in patients with head and neck squamous cell carcinoma (HNSCC) and to evaluate its association with disease stage and smoking. DESIGN: A retrospective study. SETTING: University of Southern California-University Hospital, University of Southern California and Los Angeles County Medical Center, and Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles. PATIENTS: Forty-eight patients with different stages of HNSCC (I-IV) were enrolled into this study. Staging was based on the staging system of the American Joint Committee on Cancer. MAIN OUTCOME MEASURES: EphB4 expression in tumor tissue, surrounding normal tissue, and metastatic lymph node was evaluated by immunohistochemical analysis, Western blot, and real-time polymerase chain reaction. EphB4 expression was then compared between patients based on disease stage and smoking status. RESULTS: EphB4 expression was detected in all tumor specimens and metastatic lymph nodes of patients with HNSCC, but expression levels were higher in the metastatic lymph nodes. There was a statistically significantly higher mean EphB4 protein expression and EphB4 gene amplification in patients with advanced disease (stage III or IV) vs patients with initial disease (stage I or II) and in smokers vs nonsmokers. CONCLUSIONS: Overexpression of EphB4 is associated with advanced stages of HNSCC as well as with patients who smoke. These data are the first to demonstrate the association of EphB4 with advanced stages of disease and smoking in HNSCC and hence provide a strong rationale for targeting EphB4 for HNSCC therapies.

Use of the supraclavicular artery island flap for reconstruction of cervicofacial defects.

OBJECTIVE: To describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervicofacial defects. STUDY DESIGN: Case series with chart review. SETTING: Academic, tertiary referral center. SUBJECTS AND METHODS: Twenty-two patients with defects of the face, temporal bone, and neck were reconstructed with an SAI flap. Each defect was deemed unsuitable for primary or local flap closure and would require regional or free tissue transfer. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Mean follow-up was 7.4 months (range, 1-31 months). Statistical analysis was performed using SAS 9.1 (SAS Institute, Cary, North Carolina). RESULTS: Defects of the cervical skin (n = 10), face (n = 8), and temporal bone (n = 4) were reconstructed. Mean flap dimensions were 6.1 cm (range, 5-7 cm) wide and 21.8 cm (range, 16-28 cm) long. The proximal portion of the flap was deepithelialized to match the defect, resulting in a mean skin paddle length of 9.6 cm (range, 5-18 cm). Minor donor site dehiscence occurred in 3 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was no statistical correlation between flap necrosis and flap length (P = .3, χ(2)) or defect location (P = .13, χ(2)). CONCLUSION: The SAI flap is a viable alternative to cervicofacial advancement or microvascular reconstruction of cervicofacial defects in select cases. This flap is reliable, easy to harvest, and versatile, and it provides a good color match for cervicofacial defects.

Bacterial biofilms and increased bacterial counts are associated with airway stenosis.

OBJECTIVES: Most airway stenoses are acquired secondary to the use of prolonged endotracheal intubation. Antibiotics have been shown to decrease local inflammation and granulation tissue formation in the trachea. However, antibiotic therapy is not 100% effective in preventing or treating granulation tissue formation. Development of bacterial biofilms may explain this finding. This study evaluates the difference between tracheal stenotic segments and normal trachea in terms of (1) presence of bacterial biofilms, (2) quantitative bacterial counts, and (3) inflammatory markers. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care academic medical center. SUBJECTS: A total of 12 patients were included in the study. Tissue from stenotic segments from 6 patients with airway stenosis undergoing open airway procedures were compared with tracheal tissue from 6 patients without airway stenosis undergoing tracheostomy. METHODS: Scanning electron microscopy for biofilm detection, quantitative polymerase chain reaction for quantitative analysis of bacterial count, and immunohistochemistry were performed for inflammatory markers transforming growth factor ß1 (TGF-ß1) and SMAD3. RESULTS: Compared with the patients without airway stenosis, patients in the airway stenosis group showed presence of bacterial biofilms, a significantly higher expression of 16S rRNA gene copies per microgram of tissue (187.5 vs 7.33, P = .01), and higher expression of TGF-ß1 (91% vs 8%, P < .001) and SMAD3 (83.5% vs 17.8%, P < .001). CONCLUSION: Bacterial biofilms, increased bacterial counts, and higher expression of TGF-ß1 and SMAD3 are associated with airway stenosis.

The supraclavicular artery island flap in head and neck reconstruction: applications and limitations.

IMPORTANCE: The supraclavicular artery island (SAI) rotational flap may have advantages compared with free-tissue transfer in head and neck reconstruction. Because this flap has not been extensively described for head and neck reconstruction of oncologic defects, guidelines for its indications would benefit the reconstructive surgeon. OBJECTIVE: To describe the applications and limitations of the SAI flap as an alternative to free-tissue transfer in reconstruction of head and neck defects. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series of 45 patients with defects related to malignant and nonmalignant disease undergoing reconstructive surgery from August 18, 2010, through September 28, 2012, at an academic, tertiary referral center. Each defect was deemed unsuitable for primary or local flap closure and would require regional tissue or free-tissue transfer. Mean follow-up was 10.3 (range, 1-31) months. INTERVENTION: Use of the SAI flap for reconstruction of soft-tissue defects of the head and neck. MAIN OUTCOMES AND MEASURES: Defect site, flap dimensions, time to raise the flap, and complications. RESULTS: Defects of the oral cavity, oropharynx, laryngopharynx, esophagus, trachea, temporal bone, and cervicofacial skin underwent reconstruction. Mean flap dimensions were 6.1 cm wide and 21.4 cm long, with a mean skin paddle length of 7.9 cm. Harvest time was less than 1 hour. Donor-site complications included minor dehiscence in 6 patients and prolonged wound care in 2. Partial skin flap necrosis occurred in 8 patients, whereas 2 had complete loss of the skin paddle. Seven patients developed a salivary fistula, 4 of which healed spontaneously. Flap length greater than 22 cm correlated with flap necrosis (P = .02). A history positive for smoking correlated with an increased risk of flap dehiscence (P = .02). CONCLUSIONS AND RELEVANCE: The SAI flap provides an alternative to free-tissue transfer for soft-tissue reconstruction after head and neck oncologic surgery. This flap is easy to harvest and versatile. However, the SAI flap has limitations in length and, because it is a rotational flap, is less capable of reconstructing some complex head and neck defects.

Relationship of eosinophils and plasma cells to biofilm in chronic rhinosinusitis.

BACKGROUND: This study investigates the relationship of eosinophils and plasma cells to biofilm in chronic rhinosinusitis (CRS). A prospective observational study was performed at the Keck Hospital, University of Southern California, Department of Otolaryngology, Los Angeles, CA. METHODS: A total of 29 patients, 20 undergoing endoscopic sinus surgery for CRS and 9 control patients undergoing septoplasty for nasal obstruction without history or evidence of CRS, were included in this study. Contiguous sinonasal mucosa sample sections were examined by hematoxylin and eosin (H&E), fluorescence in situ hybridization (FISH), and immunohistochemistry (IHC) for biofilm, microbes, eosinophil major basic protein (EMBP), and cluster designation 27 (CD27). EMBP and CD27 were used as eosinophil and plasma cell markers, respectively. RESULTS: Biofilm was visualized in 15 of 20 patients with CRS on H&E sections, confirmed by microbial presence using FISH. Biofilm was not identified in tissue samples of the nine control patients. On IHC analysis, CD27 and EMBP expression were significantly higher in patients with CRS compared with control (p < 0.05) and had greater expression in biofilm-positive patients compared with biofilm-negative patients. Nasal polyps correlated with higher expression of CD27 and EMBP, but in CRS patients without polyps CD27 and EMBP was also significantly greater in biofilm-positive specimens compared with biofilm-negative specimens. CONCLUSION: Biofilm presence in CRS appears to correlate to host inflammatory response involving plasma cell and eosinophil recruitment.

Accuracy of preoperative computer imaging in rhinoplasty.

OBJECTIVE: To quantitatively measure the accuracy of preoperative computer imaging (PCI) as a reflection of postoperative rhinoplasty results. METHODS: Thirty-eight patients underwent primary and revision rhinoplasty. Six-month postoperative photographs and "morphed" PCI images were graded on a 5-point Likert scale by 2 panels of judges, one composed of surgeons and the other of nonsurgeons. Twelve parameters were assessed. Results were stratified based on primary vs revision rhinoplasty and degree of difficulty of the rhinoplasties. Patient surveys were conducted to determine correlation between satisfaction and PCI accuracy. RESULTS: Mean overall accuracy was 2.98 by the expert panel, indicating moderate PCI accuracy. Supratip height was the lowest-rated parameter, while measurements of the upper third were most accurate. The accuracy in primary rhinoplasty was comparable to that found in revision surgery, although tougher cases were rated lower in overall accuracy and projection score. Satisfied patients had significantly higher PCI accuracy scores, and most patients found the PCI extremely useful. CONCLUSIONS: Preoperative computer imaging is a useful exercise, valued by patients during the rhinoplasty consultation. Accuracy is moderate in both primary and revision cases, although supratip edema is a limiting factor at the 6-month mark.