Implementation and dissemination of an African American popular opinion model to improve lupus awareness: an academic-community partnership.

OBJECTIVE: Lupus is a chronic, autoimmune disease that disproportionately affects African Americans. We adapted the Centers for Disease Control and Prevention's Popular Opinion Leader model to implement an intervention tailored for African American individuals that leverages an academic-community partnership and community-based social networks to disseminate culturally appropriate lupus education. METHODS: Academic rheumatologists, social scientists, and researchers in Boston, MA and Chicago, IL partnered with local lupus support groups, community organizations, and churches in neighborhoods with higher proportions of African Americans to develop curriculum and recruit community leaders with and without lupus (Popular Opinion Leaders; POLs). POLs attended four training sessions focused on lupus education, strategies to educate others, and a review of research methods. POLs disseminated information through their social networks and recorded their impact, which was mapped using a geographic information system framework. RESULTS: We trained 18 POLs in greater Boston and 19 in greater Chicago: 97% were African American, 97% were female; and the mean age was 57 years. Fifty-nine percent of Boston POLs and 68% of Chicago POLs had lupus. POLs at both sites engaged members of their social networks and communities in conversations about lupus, health disparities, and the importance of care. Boston POLs documented 97 encounters with 547 community members reached. Chicago POLs documented 124 encounters with 4083 community members reached. CONCLUSIONS: An adapted, community-based POL model can be used to disseminate lupus education and increase awareness in African American communities. Further research is needed to determine the degree to which this may begin to reduce disparities in access to care and outcomes.

Cytologic changes in the conjunctiva mimicking malignancy after topical mitomycin C chemotherapy.

PURPOSE: To describe the epithelial changes observed in the conjunctiva secondary to the use of topical mitomycin C (MMC) for treatment of primary acquired melanosis with atypia. DESIGN: Retrospective comparative case series. PARTICIPANTS AND CONTROLS: Conjunctival biopsy specimens (18) were taken during the follow-up of ten patients treated with MMC drops (0.02% or 0.04%) during 14 or 21 days for primary acquired melanosis with atypia. An equal number of age- and sex-matched patients with normal conjunctival biopsy findings were included for control. Conjunctival biopsy specimens from patients treated with MMC were compared with the morphologic changes already described in the urothelium following the use of the same chemotherapeutic agent. METHODS: Hematoxylin and eosin-stained biopsy samples were evaluated for recurrent neoplasm and chemotherapeutic effect in the epithelium using the following criteria: nuclear enlargement, nuclear hyperchromasia, smudging of the chromatin, presence of nucleoli, cytoplasmic eosinophilia, and individual cell necrosis. MAIN OUTCOME MEASURES: The presence or absence of morphologic changes in the conjunctival epithelium related to the use of MMC. RESULTS: Morphologic features consistent with chemotherapy effect were seen in the biopsy specimens of nine patients. Nuclear enlargement and chromatin smudging-hyperchromasia localized in the superficial layers of the epithelium were the main features observed (9 patients). Cytoplasmic eosinophilia, single cell necrosis, and occasionally subepithelial chronic inflammation were also seen. CONCLUSIONS: Secondary changes with the topical use of MMC are seen in the conjunctival epithelium and are similar to the changes described in the urothelium. These changes are important to recognize and to differentiate from recurrent neoplasm. The localization of the described features in the superficial layers of the conjunctival epithelium is the key feature in the differential diagnosis.

A germination bioassay as a toxicological screening system for studying the effects of potential prodrugs of naproxen.

A germination bioassay with radish (Raphanus sativus L.) seeds was developed as a toxicological screening system for assessing the effects of new potential prodrugs of naproxen, as an alternative to animals and animal cell toxicity screens. Both enantiomers of naproxen (6-methoxy-α-methyl-2-naphthaleneacetic acid) and naproxol (6-methoxy-ß-2-naphthaleneethanol), and their racemic mixtures, inhibited the radicle growth of R. sativus at a concentration of 1mM, while only (R)-(+ )-naproxol and racemic naproxol inhibited the hypocotyl growth of R. sativus at the same concentration. Four novel combinatorial esters, naproxen naproxyl esters (6-methoxy-ß-methyl-2-naphthaleneethyl 6-methoxy-α-methyl-2-naphthaleneacetate), resulting from the combinatorial chemistry of the esterification reaction between naproxen and naproxol, were synthesised and then tested in the germination bioassay, at a concentration of 0.5mM. It was found that they did not inhibit either the radicle or the hypocotyl growth of R. sativus.

Hepatocyte growth factor and hepatocyte growth factor receptor in the lacrimal gland, tears, and cornea.

PURPOSE: The purpose of this study was to characterize the expression of hepatocyte growth factor (HGF) and HGF receptor proteins in lacrimal gland, tears, and cornea. METHODS: The reverse transcription-polymerase chain reaction method was used to detect HGF and HGF receptor messenger RNA in human lacrimal gland tissue. HGF and HGF (c-met) receptor monoclonal antibody specificity was demonstrated with fluorescent antibody sorting of cells engineered to express HGF or HGF receptor compared with control cell lines, enzyme-linked immunoadsorbent assay (ELISA), immunoprecipitation, and immunohistology with preabsorption. Immunohistochemistry was applied to study the distribution of HGF and HGF receptor expression in rabbit lacrimal gland tissue and in wounded and unwounded rabbit cornea. An ELISA was used to detect HGF in pooled samples of human tears and individual aliquots of tears collected from patients 1 day after anterior segment surgery. RESULTS: Amplification products of the expected size for HGF and HGF receptor mRNAs were detected in lacrimal tissue and were confirmed to be specific by hot blotting and nucleic acid sequencing. Hepatocyte growth factor protein was detected in interalveolar and interlobular connective tissue cells adjacent to glandular alveolar (acinar) cells and associated with the cells lining the interlobular ducts. Hepatocyte growth factor receptor protein was expressed in the glandular alveolar and interlobular ductal cells in the lacrimal gland and all three cell types of the cornea. It was detected in keratocyte and endothelial cells, and expression was increased in keratocytes after epithelial wounding. Hepatocyte growth factor was not present in corneal epithelial cells, but in the unwounded cornea a strong signal was associated with the epithelial cell surface. It was detected by ELISA in pooled normal tears at levels 186 to 290 pg/ml and in individual postoperative tear samples at 453 to 619 pg/ml. In some tear samples, HGF levels were below the sensitivity of the assay (97.5 pg/ml). CONCLUSIONS: The distribution of HGF receptor protein expression in the lacrimal gland suggests that HGF secreted by interalveolar connective tissue cells traverses the acinar cells and modulates functions in acinar and ductal epithelial cells. Hepatocyte growth factor likely collects within the interlobular ducts and becomes a component in normal tears. Thus, lacrimal gland HGF probably modulates corneal epithelial cell proliferation, motility, and differentiation. Its expression in keratocytes is upregulated after corneal epithelial wounding and probably contributes to the epithelial wound healing process.

Corneal wound healing after excimer laser ablation in rabbits: expanding versus contracting apertures.

BACKGROUND: Photorefractive keratectomy for myopia can be performed using an expanding or contracting iris diaphragm, either of which allows for greater ablation centrally and less tissue ablation toward the edge of the treatment zone. METHODS: To compare the effects of these two strategies, eight rabbits underwent bilateral 5.00-diopter myopic ablations, performed with a contracting diaphragm in one eye and an expanding diaphragm in the other. RESULTS: The rate of epithelial healing and degree of anterior stromal haze, monitored by a masked observer, were similar for the two groups, as was the amount of corneal flattening. CONCLUSIONS: These results in rabbit corneas do not suggest a particular advantage of either the expanding or contracting apertures for achieving central corneal flattening in photorefractive keratectomy.

Corneal wound healing after excimer laser ablation. Effects of nitrogen gas blower.

PURPOSE: To examine the effects of blowing nitrogen gas over the cornea during photorefractive keratectomy. METHODS: Excimer laser ablations for myopia were performed on rabbit corneas with or without the blowing of nitrogen across the surface of the cornea. All eyes underwent a 5-diopter myopic ablation; in 8 eyes, a ring was used to blow nitrogen gas across the cornea, and, in 8 eyes, the same ring was used, but no nitrogen gas was blown. RESULTS: Epithelial healing occurred more rapidly in the eyes that were not treated with the gas (3.8 +/- 1.3 days) than in the gas-treated group (6.1 +/- 0.8 days; P = 0.0025). Corneal haze was greater in the group treated with gas. Results of histologic examination showed the ablated area to have a smoother surface when nitrogen was not blown across the cornea surface. CONCLUSION: Superficial corneal deturgescence produced by the nitrogen gas appears to result in a rougher surface immediately postoperatively with undesirable effects on surface healing, but further studies will be necessary to determine the applicability of these results to humans.