Patients' Views on how to Run Hospital Outpatient Clinics

To investigate patients' views and expectations when attending outpatient clinics a questionnaire-based study was performed. The questionnaires asked about appointment systems, continuity of care, staff appearance, chaperons and medical students. Patients wanted fixed appointment times, to see the same doctor on successive visits, for the staff to be formally dressed and to have chaperons during examination. The number of medical students should be restricted especially for women patients. Staff should be sensitive to patients' needs.

Changes in the balance of the tissue inhibitor of matrix metalloproteinases (TIMPs)-1 and -3 may promote keratocyte apoptosis in keratoconus

Keratoconus is a disease in which the central cornea becomes thinned. This could result from corneal stromal cell apoptosis or be induced or perpetuated by the activation of matrix degrading enzymes, particularly members of the matrix metalloproteinase (MMP) family. In some circumstances, the MMP inhibitors TIMP-1 and TIMP-3 exhibit anti-apoptotic and pro-apoptotic properties, respectively. Because they potentially influence keratoconus progression, the effects of TIMP-1 and TIMP-3 on stromal cell viability were investigated. The TIMP-1 and TIMP-3 proteins were over-expressed in cultured corneal stromal cells by using the adenoviral vectors RAdTIMP-1 and RAdTIMP-3 and quantified by enzyme-linked immunosorbant assay (ELISA). Apoptotic cells were detected by TUNEL and caspase-3 activity. The anti-apoptotic effects of TIMP-1 were investigated by co-infecting it with RAdTIMP-1 and RAdTIMP-3 and by adding TIMP-1 protein to stromal cell cultures prior to infecting them with RAdTIMP-3. Immunohistochemistry was used to localise and determine relative numbers of apoptotic and TIMP producing stromal cells in sections of normal and keratoconic corneas. The results showed that over-expression of TIMP-3 induced apoptosis in corneal stromal cell cultures. Up-regulated TIMP-1 production or the addition of exogenous TIMP-1 protein prevented stromal cell overgrowth, changed stromal cell morphology and reduced the extent of TIMP-3 induced apoptosis. Localised relative concentrations of TIMP-1/TIMP-3 could thus determine whether these cells remain viable or become apoptotic. This may be relevant to the keratoconic condition since significantly more apoptotic cells were identified in the anterior stroma of keratoconic corneas than normal corneas and the majority of theTIMP-1 and TIMP-3 producing stromal cells were also located in this region.

Tissue inhibitor of metalloproteinase-3 differentially binds to components of Bruch's membrane

BACKGROUND

Sorsby's fundus dystrophy (SFD) is caused by mutations in tissue inhibitor of metalloproteinase (TIMP)-3 and, with the exception of early onset, is similar to age-related macular degeneration. The pathological features of this condition relate to the accumulation of TIMP-3 in Bruch's membrane.

AIMS

To compare the extracellular membrane-binding characteristics of wild-type and four SFD-mutant TIMP-3s.

METHODS

COS-7 cells were transfected with wild-type, Ser-181, Gly-167, Ser-156 and Tyr-168 SFD-mutant TIMP-3 cDNA. The TIMP-3 proteins subsequently synthesised were harvested, analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis, semiquantified by ELISA and used in binding assays on the basis of the retention of the wild-type and SFD-mutant TIMP-3 proteins by components of Bruch's membrane.

RESULTS

SFD-mutant TIMP-3s could not be distinguished from wild-type TIMP-3 by the extents to which they aggregated or adhered to type-I collagen, type-IV collagen, fibronectin, laminin, elastin, chondroitin sulphates A, B and C, and heparin sulphate. Of these macromolecules, the wild-type and SFD-mutant TIMP-3s exhibited greatest affinity for elastin and laminin.

CONCLUSION

The similarity in the physical and extracellular membrane-binding characteristics of wild-type and SFD-mutant TIMP-3s indicates that these properties are not responsible for the difference in timing of onset of SFD and age-related macular degeneration.

Keratoconus: Matrix metalloproteinase-2 activation and TIMP modulation

Keratoconus is an ocular condition that causes corneal thinning, cone formation and scarring. In view of a hypothesis that activated MMP-2 may initiate or facilitate disease progression, the MMP-2/TIMP systems of stromal cells derived from normal and keratoconic corneas have been compared. To achieve this, stromal cell cultures were established from normal, clear keratoconic (KCS-1) and scarred keratoconic (KCS-2) corneas. The secreted MMP-2 was assayed using [(3)H]Type IV collagen and analysed by zymography. Optimally maintained and nutrient deprived cells were subsequently incubated with [(3)H]lysine. The secreted radiolabelled macromolecules were separated and quantified. The results obtained indicated that optimally maintained KCS-1 stromal cells produced more MMP-2 than normal stromal cells but not TIMP. Nutrient deprivation induced MMP-2 activation and cell death. Surviving cells upregulated TIMP-1 synthesis and in this respect became similar to the KCS-2 stromal cells that did not excessively generate activated MMP-2 or die as a consequence of nutrient deprivation. From these results, it was concluded that KCS-1 stromal cells over-expressed MMP-2 without increasing TIMP production. This may facilitate MMP-2 activation in vivo and hence advance the keratoconic condition. KCS-2 cultures over-expressed both MMP-2 and TIMP-1. Because TIMP-1 inhibits MMP-2 activity and protects against cell death it may be of significance in initiating repair processes and curtailing keratoconus.

Are we wasting time in out-patients departments?

Patients and people accompanying them to out-patient departments face an inevitable wait. We investigated the time people have to wait and if they would be interested in health education during that period. We discovered that patients want health education in the form of both videos and leaflets, but not posters. Patients and those accompanying them are particularly interested in heart disease and its prevention.