No abstract

OBJECTIVE -To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care.RESEARCH DESIGN AND METHODS -This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure (Ն140/80 mmHg), raised total cholesterol (Ն5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4 -6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention.RESULTS -Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11-1.69], P ϭ 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P ϭ 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia , P ϭ 0.0007) than for hypertension , P ϭ 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality , P ϭ 0.02).CONCLUSIONS -This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

Aphelids are little-known phagotrophic parasites of algae whose life cycle and morphology resemble those of the parasitic rozellids (Cryptomycota, Rozellomycota). In previous phylogenetic analyses of RNA polymerase and rRNA genes, aphelids, rozellids and Microsporidia (parasites of animals) formed a clade, named Opisthosporidia, which appeared as the sister group to Fungi. However, the statistical support for the Opisthosporidia was always moderate. Here, we generated full life-cycle transcriptome data for the aphelid species Paraphelidium tribonemae. In-depth multi-gene phylogenomic analyses using several protein datasets place this aphelid as the closest relative of fungi to the exclusion of rozellids and Microsporidia. In contrast with the comparatively reduced Rozella allomycis genome, we infer a rich, free-living-like aphelid proteome, with a metabolism similar to fungi, including cellulases likely involved in algal cell-wall penetration and enzymes involved in chitin biosynthesis. Our results suggest that fungi evolved from complex aphelid-like ancestors that lost phagotrophy and became osmotrophic.

Ophthalmic complications of (131)I therapy, including ocular dryness, have been recently investigated and described. However, nasolacrimal drainage system obstruction (NDSO), complicating (131)I therapy, has not been previously well appreciated or characterized. One of our patients developed bilateral complete nasolacrimal duct obstruction after (131)I therapy that prompted awareness of this potential complication. Over 16 months, 423 patients with epithelial-derived thyroid cancer were provided routine clinical care; 390 of these patients had received (131)I ablation or therapy, and 10 patients subsequently reported epiphora. All had evidence of NDSO disease after a mean cumulative (131)I dose of 17,279 +/- 2,923 MBq (467 +/- 79 mCi), with a mean individual (131)I dose of 6,660 +/- 555 MBq (180 +/- 15 mCi). Symptoms appeared 6.5 +/- 1.4 (range, 3-16) months after the last (131)I dose, whereas the mean time from symptom onset to correct diagnosis was 18 +/- 5 months. A causal relationship between (131)I administration and NDSO is strongly suspected. Patients reporting epiphora should be evaluated promptly by an oculoplastic surgeon.

With the current explosion of genomic data, there is a greater need to draw inference on phenotypic information based on DNA sequence alone. We considered complete genomes from 35 diverse eukaryotic lineages, and discovered sets of proteins predictive of trophic mode, including a set of 485 proteins that are enriched among phagocytotic eukaryotes (organisms that internalize large particles). Our model is also predictive of other aspects of trophic mode, including photosynthesis and the ability to synthesize a set of organic compounds needed for growth (prototrophy for those molecules). We applied our model to the Asgard archaea, a group of uncultured microorganisms that show close affinities to eukaryotes, to test whether the organisms are capable of phagocytosis, a phenotypic trait often considered a prerequisite for mitochondrial acquisition. Our analyses suggest that members of the Asgard archaea-despite having some eukaryote-specific protein families not found in other prokaryotes-do not use phagocytosis. Moreover, our data suggest that the process of phagocytosis arose from a combination of both archaeal and bacterial components, but also required additional eukaryote-specific innovations.