identification, mainly if there is a mixed infestation. Travel clinics should give priority to this neglected high-risk group, and educational strategies would be necessary amongst the immigrant population to provide information regarding the risks and the preventive measures. Culturally adapted health promotion campaigns at strategic locations, such as national embassies or non-governmental organizations, may successfully target these issues. The authors would like to express their gratitude to Dra. Miriam Navarro and Dra. Maria Sastre for their input to the revision of this article. They also thank Dr Agustin

Benito, Dra. Aida de Lucio, and Dra. Mercedes Rodríguez from the Parasitology Department of the National Microbiology Centre at the Carlos III Health Institute for their collaboration in the performance of the PCR for Plasmodium. The authors state they have no conflicts of interest to declare. ”
“Wiwanitkit Bioactive Compound Library supplier makes three interesting observations, each from different studies or papers. The two papers from the Queensland Social Science Survey2,3 reported separate studies with different questions. Bortezomib clinical trial Both took advantage of the same state-wide survey mechanism, but otherwise they cannot be directly compared. Leggat and colleagues4

studied travel during pandemic (H1N1) 2009 and indeed found that the majority of Queensland travelers surveyed reported that they would not postpone their own travel, even if they had symptoms that could have been pandemic (H1N1) 2009. This was certainly consistent with Australian travel plans and short-term resident departures, which appeared to remain relatively unaffected during the height of pandemic (H1N1)

2009.1 Brown and colleagues3 Olopatadine investigated staying home from work, school or other every-day activities, not specifically travel. We were impressed that 95% of people would stay home from work for 7 days, if they were diagnosed with pandemic (H1N1) 2009 or avian influenza. This compliance dropped considerably; however, in response to the same questions in relation to seasonal influenza and the “common cold.”3 In relation to the third paper by Morikane,5 Wiwanitkit’s comments do not seem to relate to the comments on our papers, but we agree that passenger screening at airports is of limited value, as confirmed by a recent study of infrared thermal scanning by McBride and colleagues.6 Peter A. Leggat, * Lawrence H. Brown, * Peter Aitken, *† and Richard Speare * ”
“Background. Members of New Zealand Police (NZP) deploy overseas in a variety of roles. There is limited published data on travel-related morbidity in police as a subgroup of travelers. Methods. An audit of pre- and postdeployment medical files for all NZP personnel deploying overseas during 2004 to 2010 was undertaken. Of all deployments, 58.9% were within Oceania. Results.

In stage 2, the questionnaire was piloted to determine its validity and reliability. Finally, the questionnaire was sent to a random sample of community pharmacists to test the generalizability of the findings of the focus group interviews. The design (sequential) and the rationale for choosing mixed-methods approach were clearly described. The use of the mixed-methods approach provided a rich and generalizable

description of pharmacist prescribing in Canada by overcoming the limitations of qualitative (generalizability) and quantitative (in-depth understanding) methodology. Complementarity seeks elaboration, enhancement, illustration and clarification of the AZD9291 nmr results from one method with the results from the other method.’[1] Bruhn et al. reported a pilot randomized controlled trial which was complemented with qualitative interviews to evaluate the effectiveness of pharmacist-led management of chronic pain in primary care (the PIPPC study).[6, 7] The patients were randomized to

one of three arms: (1) pharmacist find more medication review with pharmacist prescribing, (2) pharmacist medication review with feedback to GP and (3) treatment as usual. The qualitative component consisted of face-to-face interviews with the pharmacists, GPs and patients to explore their experiences. It is noteworthy that the qualitative interviews did not contribute towards answering the effectiveness question (the primary aim of the study); rather, they helped to understand and explain how the intervention might have worked. The two datasets were described separately in two different conference proceedings and were therefore not integrated. Integration of the

two datasets may have allowed researchers to draw more meaningful inferences from the findings and authors may do so in a full report. However, if the purpose of a mixed-methods study is to answer different research questions within the same study (embedded design), as in this example, the authors may choose to present findings separately.[8] Again, neither the rationale nor the design was reported. Initiation seeks the discovery of the paradox and contradiction, new perspectives of frameworks, the recasting of questions or Roflumilast results from one method with questions or results from the other method.’ It generates ideas by initiating new interpretations, highlighting areas for additional investigation and reshaping the entire research question. Initiation is predominantly used in the disciplines of social sciences and psychology. We were unable to find an example in the area of pharmacy practice to illustrate initiation. It should be noted that in these examples we have tied each example to only one reason or rationale for choosing a mixed-methods design, which in practice is not always true, as researchers might use a mixed-methods approach for more than one reason.

, 2004). Cellulolytic communities have been identified in a wide variety of sources such as biocompost, soil, decaying lignocellulose materials, and the feces of ruminants (Maki et al., 2009; Izquierdo et al., 2010). Although

the digestion of lignocellulose by terrestrial microorganisms has been widely studied, cellulolytic microorganisms in marine environments have received less attention. Early studies indicated that bacteria were the predominant degraders of lignocellulose in marine ecosystems, with the exception of marine animals such as teredinid bivalves (Benner et al., 1986; Distel, 2003). Recently, Selumetinib datasheet an aerobic and mesophilic bacterium Saccharophagus degradans has been intensively studied (Taylor et al., 2006). However, few bacteria with strong cellulolytic activities have been isolated and characterized, especially anaerobic species. Given the diversity of habitats of the ocean, there exists the possibility of some efficient cellulose enzymatic digestion system in the marine ecosystems. For example, mangroves have been considered to be an important location for lignocellulose decomposition (Pointing & Hyde, 2000). The exploration of novel cellulose-degrading microbial communities is of particular importance in the identification of novel microorganisms. Because of its

high salinity (3%), the marine environment is likely to have evolved different cellulose-degrading microorganisms than the terrestrial environment. Studies of lignocellulose degradation under saline conditions have a great potential in the search Ku-0059436 manufacturer for enzymes with novel catalytic properties and microorganisms with novel metabolic pathways. In this paper, an anaerobic and thermophilic cellulolytic community was enriched from a coastal marine sediment sample. To explore the community members of the unusual consortium, libraries of 16S rRNA gene and functional gene glycosyl hydrolase family 48 (GHF48) gene were constructed and analyzed. Edoxaban Samples collected from marine sediment of a coastal region of the Yellow Sea (36°5′N, 120°32′E), China, in July 2011, were used as inocula in 100 mL of basal

medium containing 1 g Avicel (PH-101; Sigma Aldrich, Shanghai, China) or a piece of filter paper (FP) (No. 1, Whatman) as the carbon source. The medium consisted of 0.1 g L−1 KH2PO4, 0.1 g L−1 K2HPO4, 1 g L−1 NaHCO3, 2 g L−1 (NH4)2SO4, 0.5 g L−1 l-cysteine, and 0.0001 (w/v) resazurin. Vitamins were added in the following concentrations (in mg L−1): pyridoxamine dihydrochloride, 1; p-aminobenzoic acid (PABA), 0.5; d-biotin, 0.2; vitamin B12, 0.1; thiamine-HCl-2 × H2O, 0.1; folic acid, 0.2; pantothenic acid calcium salt, 0.5; nicotinic acid, 0.5; pyridoxine-HCl, 0.1; thioctic acid, 0.5; riboflavin, 0.1. The samples were incubated under thermophilic (60 °C) and anaerobic conditions. Samples showing FP degradation were selected for further transfers. Cultures showing FP degradation were transferred five times to ensure their cellulose degradation ability.

Histological examination showed tubular adenomas in 21.9% of patients, tubulovillous adenomas in 3.1% and serrated adenomas in 1%. Hyperplastic polyps were found in 15.6% of patients, a nonspecific colitis in 16.7% and diverticulosis in 12.5%. In four cases there was even an early-stage carcinoma (two anal, one rectal and one colon cancer). In univariate analysis,

no significant differences with regard to immune status, highly active antiretroviral therapy, family history, personal risk factors or comedication were found between patients with dysplastic click here and normal mucosas. The high acceptance rate of screening colonoscopy and the in comparison with the HIV-negative population comparably higher rate of abnormalities in this cohort of HIV-infected patients justify enhanced implementation of screening colonoscopy in clinical practice. ”
“The prevalence and factors associated with an increased

risk of renal dysfunction in HIV-infected patients receiving or not receiving antiretroviral therapy (ART) have been poorly evaluated in observational settings. Patients in the ICONA Foundation cohort with at least two creatinine values available while still ART-naïve were enrolled in the study. A logistic regression analysis was performed to identify predictors of an estimated glomerular filtration rate (eGFR)<90 mL/min/1.73 m2 at baseline. The incidence and predictors of a >20% reduction in eGFR from pre-combination ART (cART) levels (or a decrease from ≥90 to <90 mL/min/1.73 m2) were evaluated by Poisson regression. A total of 1505 patients Selleckchem BAY 80-6946 were included in the study; 363 (24%) had eGFR<90 mL/min/1.73 m2 at baseline. Older patients [odds ratio (OR) 1.58 per 10 years older; P<0.00001], female patients (OR 2.41 vs. male patients; P<0.00001), those Dynein who had diabetes and/or hypertension (OR 2.36 vs. neither; P<0.03) and patients with higher baseline CD4 count (OR 1.06 per 100 cells/μL higher; P<0.03) showed a greater risk of

eGFR<90 mL/min/1.73 m2. Ninety-six patients experienced an eGFR decrease of >20% from pre-cART levels (6.8 per 100 person-years). Older age [relative risk (RR) 1.41 per 10 years older; P=0.005], female gender (RR 2.25 vs. male; P=0.003) and current exposure to didanosine (ddI), tenofovir and protease inhibitors were the major determinants. We observed a relatively high rate of mild renal dysfunction in the absence of ART. In addition to traditional risk factors such as older age and diabetes/hypertension, female gender and current use of ddI, tenofovir and protease inhibitors were associated with a greater risk of decreased renal function as measured by eGFR. Prior to the introduction of highly active antiretroviral therapy (HAART), HIV-associated nephropathy (HIVAN) represented the most frequent cause of renal disease in HIV-infected patients and the most important cause of end-stage renal disease (ESRD) in black Americans [2,3].

, 2007). In fact, survival of bacteria in natural settings largely depends on its phenotypic plasticity, because altered phenotype Selleck Galunisertib influences the interaction of bacteria with its surrounding physicochemical environment, and thereby affects the ecological fitness of organism (Henderson et al., 1999; Palkova, 2004; Chantratita et al., 2007). Thus, from health as well as ecological perspectives, bacterial

genes involved in community establishment have received much attention. Pseudomonas alkylphenolia KL28 degrades 4-n-alkylphenol (C1–C5) using a novel catabolic pathway encoded by the lap catabolic gene cluster, which is distantly related to phenol and methyl-phenol-degrading genes of other Pseudomonas sp. (Jeong et al., 2003). This bacterium forms specialized aerial structures (SAS), which are beneficial for the utilization of vapor substrates and for survival under drying and starvation conditions. Under such conditions, P. alkylphenolia KL28 can survive for more than

a year and their SAS has been shown to form ultramicrocells by reductive division (Lee & Veeranagouda, 2009). In this study, a transposon mutant showing defect in SAS development was characterized to determine the gene(s) involved in SAS formation. Pseudomonas RAD001 alkylphenolia strain KL28 (Jeong et al., 2003) was cultured either in Luria–Bertani (LB) medium or in minimal salts basal (MSB) medium (Stanier et al., nearly 1966) with an appropriate carbon source. For growth on agar surfaces, cells were cultured on MSB or LB medium with 1.5% agar. Congo red (CR) at a final concentration of 80 mg L−1 was added to prepare LB-CR agar medium. The detailed culture

conditions for strains KL28 and Escherichia coli and the concentration of antibiotics for plasmid maintenance have been described previously (Yun et al., 2007). A KL28 transposon mutant library was generated using the transposon delivery vector pRL27 (Larsen et al., 2002), and disrupted genes were identified as described previously (Yun et al., 2007). Sequence homology between proteins was calculated using the bioedit program (http://www.mbio.ncsu.edu/BioEdit/page2.html). The nucleotide sequence identified in this study was deposited in the NCBI GenBank database and the accession number is HM172486. An in-frame ssg deletion mutant of KL28 was constructed by allelic replacement as described by Schafer et al. (1994). For this study, a gene fragment containing about 70% deletion of the internal region of ssg was created by overlap extension PCR as described previously (Ho et al., 1989). The primers used were dSsgFBHI, 5′-GGATCCTGGCCCATGACTGTT-3′, (BamHI, underlined); dSsgIR, 5′ GCCGATGCGCAGGTTGCGCTGATCGGC-3′; dSsgIF, 5′-GCGACCCTGGCGATCGGCAGCACCGGT-3′ and dSsgRSphI, 5′- GCATGCGGCTTCCAGTGTTCC-3′ (SphI, underlined).

For example, deletion and homologous overproduction experiments have shown that red light absorption by the RsbP protein can activate a stress response in Bacillus subtilis (Avila-Perez et al., 2010). Blue light, either sensed by a photoreceptor or initiating photosynthetic electron transport, has the opposite effect on the transcription of photosynthesis-related genes in Rhodobacter sphaeroides (Happ et al., 2005). Furthermore, a blue light–activated histidine kinase (HK), frequently used for environmental sensing by bacterial two-component transduction systems (TCSTS), has been shown to regulate Brucella abortus virulence (Swartz et al.,

2007). Blue light photoreceptors are of the utmost importance for some organisms, allowing the development of DNA-repair find more systems in light illumination (Weber, 2005), the formation of protective (shielding) substances or for allowing selleck chemicals llc motile organisms to escape from regions with a high UV/blue light intensity (Armitage & Hellingwerf, 2003). Per-ARNT-Sim (PAS) domains are important signalling modules that monitor changes in light, oxygen, voltage (LOV), small ligands and the overall

energy level of a cell (Taylor & Zhulin, 1999). Prokaryotic genome analysis with bioinformatics methods has revealed the presence of PAS-domain-containing proteins (thereafter PAS proteins) in approximately 15% of all sequenced genomes, and 81.36% of the more than 22 000 identified PAS domains were found in bacteria (Letunic et al., 2006). Increasing experimental evidence suggests

that many PAS domains act as photoreceptors. Although sequence identity is low in the PAS superfamily (Taylor & Zhulin, 1999), the three-dimensional structures of PAS domains are highly conserved (Zhong et al., 2003), suggesting that common mechanisms may be used for signalling. The revealed general secondary structure of a PAS domain is ββααααβββ, and cofactors frequently interact with α helixes (Möglich et al., 2009; Jaiswal et al., 2010). Light promotes the detachment of the Jα helix from the central beta-sheet Carnitine palmitoyltransferase II (Harper et al., 2003) and its subsequent unfolding of the second PAS domain in oat phototropin (Hoersch et al., 2010). Therefore, the secondary structure topology (SST) of the PAS domain is valuable to reveal the activation sites of PAS domains and further to analyse functions of PAS proteins. The integration of SST analysis and determining the sequence of PAS domains will be an effective and promising methodology. Xanthomonas campestris pv. campestris (Xcc) is the causative agent of crucifer black rot disease, which causes severe losses in agricultural yield worldwide (Swings et al., 1993). This organism generally invades and multiplies in cruciferous plant vascular tissues, resulting in the characteristic ‘black rot’ symptoms of blackened veins and V-shaped necrotic lesions at the foliar margin (Alvarez, 2000).

, 2009). Cry2Ab mutants; V307I, N309S, F311I, A314T, N318I and A334S, yielded toxin size bands within only 2 min of

chymotrypsin digestion (Fig. 3). Neither Cry2AbWT nor any mutants were toxic to either Cx. pipiens or Ae. aegypti up to 6000 ng mL−1 http://www.selleckchem.com/products/r428.html (Table 2). In contrast, Cry2AbWT showed toxicity (LC50 of 540 ng mL−1) to Anopheles (Table 2). Cry2Aa, a known mosquitocidal protein (Liang & Dean, 1994), was used as a control. Cry2Ab mutants V307I, N309S and A314T demonstrated LC50 values similar to that of the wild type. Mutant protein N318I demonstrated approximately threefold decrease in toxicity, still showing slight mosquitocidal activity. Mutant proteins F311I and A334S displayed approximately three- and sevenfold increase selleck chemicals in toxicity to Anopheles, respectively, as compared to wild type. Cry2Ab mutant proteins, V324G and L336N, displayed a marked decrease in toxicity. Single-residue changes at position 324 or 336 of Cry2AbWT resulted in a marked decrease in toxicity to Anopheles by at least c. 65-fold. The

CD spectra for Cry2AbWT and L336N mutant exhibited similar secondary structure (Fig. 4). Mosquito bioassays with Cry proteins are complicated by several factors. Because mosquitoes are filter feeders, the toxins must be applied as crystals, not as soluble proteins. This makes quantification difficult. To address this, we used the densitometry method described in the ‘Materials and methods’. Secondly, the age of the larvae is critical, both because sensitivity decreases with larval age and instars and because very young larvae are particularly cannibalistic. Further, late-instar larvae (late fourth instar) do not eat 24 h prior to pupation. Finally, the volume to larval number has a critical effect on larval stress and sensitivity to toxin. For these reasons, the World Health Organization (WHO/CDS/WHOPES/GCDPP/2005.13) has recommended a 24-h bioassay period and a volume to larval ratio of 4 : 1 with third instar CYTH4 larvae. We have used the time period and instar number recommended

and, for convenience, a volume to larvae ratio of 2 : 1. When interpreting the mortality values given in the literature (Table 2), differences in time of bioassay and instar of larvae must be considered. Although Aedes has shown susceptibility to Cry2Aa, single-residue exchanges were unable to confer Cry2Ab specificity to Aedes (Widner & Whiteley, 1990). Cry2Ab mutants N309S, V307I and A314T did not significantly alter wild-type toxicity to Anopheles. N318I demonstrated approximately threefold decrease in mosquitocidal activity, possibly revealing the importance of the amide group, when Asn was exchanged for Ile, an aliphatic amino acid of similar size. F311I and A334S both exhibited an increase in toxicity to Anopheles.

maritimum will undoubtedly provide new insights

into the evolutionary history of QS. The production of AHLs was demonstrated for all isolates of T. maritimum analysed (Table 1), therefore being a conserved trait within this species, which is not the case in some other marine pathogens such as Aeromonas salmonicida (Bruhn et al., 2005). Some contradictory results have been published Olaparib solubility dmso previously regarding the production of AHLs by the genus Flavobacterium belonging to the Bacteroidetes group. While AHL-like activity was detected in a planktonic isolate of Flavobacterium sp. using E. coli MT102 carrying the biosensor plasmid pJBA132 based on the luxR gene from Vibrio fischeri, the presence of AHLs could not be demonstrated by GC-MS (Wagner-Döbler et al., 2005). Furthermore, no AHL activity was found in different pathogenic strains of Flavobacterium psychrophilum using the sensor strains C. violaceum CV026 and Agrobacterium tumefaciens NT1 (Bruhn et al.,

2005). The differences in the AHL activity described probably depend on the assay conditions and the sensor strain utilized. In our experience, data based on the direct evaluation of culture media of marine bacteria, usually MB, should be interpreted with caution, as the media composition could result in inhibition of growth or bioluminescence production by the sensor strain (unpublished data). On the other hand, due to the ability of different compounds to activate the AHL biosensors (Holden et al., 1999), the results should be viewed with caution unless the presence of AHLs can be confirmed by analytical chemical methods. On the basis of our results and as TSA HDAC molecular weight the detection of the QS activity is strongly dependent on the biosensor strain used and on the culture conditions, it is possible that Bumetanide AHL-based QS systems are more widespread than described so far (Wagner-Döbler

et al., 2005). An in vivo degradation assay was carried out using two biosensor strains of C. violaceum. Chromobacterium violaceum CV026 was used to detect degradation of short AHLs (C6-HSL), and C. violaceum VIR07 was used to detect degradation of long AHLs (C10-HSL). Complete degradation of C10-HSL was observed after 24 h, but no changes in C6-HSL activity were observed (Fig. 4a). The activity should be cell bound, as no significant degradation was obtained when the C10-HSL was added to cell-free spent culture medium (Fig. 2a). HPLC analysis of the degradation of C10-HSL revealed that 90% of the AHL was degraded after 24 h of exposition to T. maritimum cultures, and no recovery of the AHL could be achieved by medium acidification, which may discard a lactonase-type degrading enzyme (Fig. 4b). Further analyses are required to confirm an acylase-type activity. The presence of AHL degradation enzymes has been described in Gram-negative bacteria, possibly as a mechanism to outcompete Gram-positive neighbours (Roche et al., 2004).

We now have five FDA approved TNFi for use click here in AS patients. Certolizumab, a PEGylated monoclonal

antibody, is the most recent addition to this family. Certolizumab had similar efficacy in both AS and nrAxSpA in clinical trials, thus adding this agent to the club of other TNFi like Adalimumab, Infliximab and Etanercept[5, 13-15]. Data from early SpA trials also show clearly better response rates with TNFi as compared to the results of trials with these agents in AS patients with mean disease durations of 10 years or longer[16]. Thus, a role for the early initiation of treatment with TNFi in achieving higher efficacy is now well recognized. The other major advance in the field of TNFi therapy is the recent recognition that these biologics are not

only symptom controlling, but also disease modifying in AS. Earlier studies have looked at this question and failed to show this effect due to short duration of follow up and lack of adequately matched contemporaneous controls[17-20]. A major study involving patients from five large North-American centres addressed this issue. Stringent statistical techniques and adjustments for baseline characteristics in this study showed a significant reduction in radiographic progression in patients on TNFi compared to those receiving other standard of care[9]. Interestingly, patients who started these agents within Erastin cell line the first 5 years of disease did much better than those starting them later[9]. This observation now makes a strong case for the existence of a therapeutic window in AS much like that in rheumatoid arthritis. Subsequently a smaller study from the German cohort GESPIC

also showed similar results and strikingly, both these studies needed a follow up period of >4 years to demonstrate the effect of TNFi on disease progression[20]. The title of this editorial is definitely catchy, but we need to remember that replication of these results from other longitudinal well-controlled cohorts are needed. A Interleukin-17 (IL-17) blocker is the latest drug studied and Vitamin B12 it was published after a proof-of-concept double blind study in 30 patients with AS[21]. Efficacy in reducing the signs and symptoms of AS were demonstrated in this study and larger studies on IL-17 blockade are needed before any firm conclusions are made. A phosphodiesterase-4 (PDE4) inhibitor apremilast was the first oral small molecule inhibitor to be studied in AS. In a double blind randomized controlled phase II study, 36 AS patients were enrolled[22]. Although there were some differences in the clinical outcomes as compared to placebo, these were not significant enough to favour apremilast therapy. Albeit the nonsignificant changes, discontinuation of the drug led to rapid deterioration. Larger studies and longer follow up will be required for decisive conclusions.

Copyright © 2013 John Wiley & Sons. ”
“There is a limited evidence base as to the benefits of continuous glucose monitoring (CGM) in clinical practice,

but it is clear that in order to realise improvements in glycaemic control when using CGM there is a requirement for both health care professionals and patients to have the ability to interpret the data obtained from CGM. This article describes a personal approach to analysing selleck chemicals CGM data using a structured approach and reporting tool, with examples to demonstrate how this system is implemented in practice. By viewing the daily overlay, then breaking the CGM traces into overnight, fasting/pre-meal and post-meal phases, and finally looking at the impact of other factors such as exercise, alcohol and work patterns, the user can be educated to make changes to NVP-LDE225 cell line both their insulin regimen and lifestyle to optimise glycaemic control. Those offered CGM as a real-time adjunct to their intensive insulin regimen need to have such a structured approach to get

positive re-inforcement and thus use CGM sufficiently frequently to gain real benefit from it. Copyright © 2012 John Wiley & Sons. ”
“Our aim was to study the impact of adding twice-daily exenatide in obese patients with type 2 diabetes and poor glycaemic control who were taking insulin therapy, either alone or in combination with oral hypoglycaemic agents (OHAs), in routine clinical pentoxifylline practice. Outcomes evaluated

were glycaemic control, body weight, insulin dose, tolerability, safety and incidence of hypoglycaemia. In an open-label prospective study, twice-daily exenatide was added to existing therapy in individuals with type 2 diabetes, suboptimal glycaemic control (HbA1c >7% [53mmol/mol]) and obesity (body mass index [BMI] <30kg/m2), who were receiving insulin therapy alone or in combination with OHA(s). Thirty-one patients (18 male) were mean (SD) age 55.7(8.6)years, weight 114.6(22.0)kg, BMI 39.1(5.6)kg/m2, waist circumference 128(13)cm and fasting capillary glucose 11.1(3.4)mmol/L. Median (IQR) known diabetes duration was 10.0(8.0, 17.9)years, HbA1c 9.5(8.8, 10.7)% and daily insulin dose 120(74, 230)units/day. Twenty patients were also taking metformin. One-month data were available for 29 patients, three-month data for 23 patients, six-month data for 28 patients and 12-month data for 21 patients. There was a mean (SD) reduction in weight from 1.1(2.6)kg (p=0.043) at one month to 4.8(7.3)kg (p=0.007) at 12 months, with a maximal reduction at six months (5.3[5.9]kg, p<0.001). Total daily insulin dose was reduced significantly by 31.8(56.5)units (p=0.010) at one month and 49.5(85.3)units (p=0.015) at 12 months. At three months there was a significant reduction in HbA1c (1.2[1.