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Background: This multicentre randomised trial is examining the effect of single flexible sigmoidoscopy (FS) screening on colorectal cancer (CRC) incidence and mortality. Previous analyses of this and other trials have only reported follow-up after FS for a maximum of 12 years. The objective of this analysis was to examine the long-term effects of FS after 17 years of follow-up. Methods: Between 1994 and 1999, 170,432 eligible men and women, who had indicated on a previous questionnaire that they would probably attend for screening if invited, were randomised to an intervention group (offered FS screening) or a control group (not contacted) in a 1:2 ratio. Randomisation was performed centrally in blocks of 12, and stratified by trial centre, general practice and household type. The primary outcomes were incidence and mortality of CRC. Hazard ratios (HR) and 95% confidence intervals (CI) for CRC incidence and mortality were estimated for intention-to-treat and per-protocol analyses. The trial is registered, number ISRCTN28352761. Findings: This analysis included 170,034 people (57,098 in the intervention and 112,936 in the control group). During screening and a median of 17.1 years’ follow-up, CRC was diagnosed in 1,230 individuals in the intervention and 3,253 in the control group, and 353 vs. 996 respectively died from CRC. In intention-to-treat analyses, CRC incidence was reduced by 26% (HR 0.74, 95% CI 0.70-0.80) and CRC mortality by 30% (HR 0.70, 95% CI 0.62-0.79). In per-protocol analyses, adjusted for non-compliance, CRC incidence and mortality were 35% (HR 0.65, 95% CI 0.59-0.71) and 41% (HR 0.59, 95% CI 0.49-0.70) lower in attenders. Interpretation: A single FS continues to provide substantial protection from CRC diagnosis and death, with protection lasting at least 17 years.

T his article is the second summarising the main findings and conclusions of the review of the role(s) and responsibilities of infection prevention and control nurses (IPCN) commissioned by the Department of Health (England) in 2000. It describes the activities that form the core work of IPCN, discusses the strengths and constraints of the current role and makes suggestions for the future development of IPCN roles within the Health Protection Agency (HPA) and Primary Care Trusts (PCT).

Peptidoglycan-polysaccharide polymers derived from group A streptococcal cell walls (PG-PS) were opsonized with either purified C3 or normal human serum and were used as a probe to investigate the mobility of CR1 and CR3, the C3b and iC3b receptors, respectively, on human neutrophils. Incubation of monolayers or cell suspensions of neutrophils with PG-PS opsonized with C3b or serum resulted in capping of PG-PS, as detected by fluorescein-labeled antibody to PS. No binding of PG-PS to neutrophils was observed with heat-inactivated serum. By 30 min the cell walls were internalized and observed in one to three vacuoles. Capping was totally inhibited when PG-PS opsonized with C3b or serum was preincubated with Fab'-anti-C3b. Similar inhibition was observed when C3b-opsonized PG-PS was incubated with neutrophils that were preincubated with anti-CR1 or fluid-phase C3b; only partial inhibition of neutrophil capping was observed by using serum-opsonized PG-PS. Because anti-CR1 blocks only the C3b receptor, the cap formation observed with serum-opsonized PG-PS is probably due to CR3. These results suggest that both CR1 and CR3 on neutrophils cap after stimulation by group A streptococcal cell wall fragments.

Serum-opsonized group A streptococcal cell walls, consisting of peptidoglycan-polysaccharide polymers (PG-APS), induced monolayers of human neutrophils, monocytes, and eosinophils to aggregate. When erythrocytes were present in the incubation medium, they also were associated with the leukocyte aggregates. By immunofluorescence staining, PG-APS was localized at the site of cell-to-cell contact. By scanning electron microscopy the cells appeared to adhere to one another by surface contact; filopodia often acted as connectors, particularly in leukocyte-erythrocyte interaction. Cellular binding of PG-APS and aggregation were dependent upon C3 fixation. No aggregation was observed when heat-inactivated serum was used as an opsonin. In contrast to peptidoglycan, an activator of the alternative complement pathway, the group-specific polysaccharide moiety of PG-APS induced no cellular aggregation. Rosette formation was observed in suspensions when neutrophils were incubated with erythrocytes coated with C3b-opsonized PG-APS. Cell monolayers bound serum-opsonized PG-APS, but aggregation was observed only when serum was present in the incubation medium. Similar results were obtained with C5-deficient serum. No aggregation was observed with heat-inactivated serum or bovine serum albumin. A heat-labile serum component(s) appears to be required to elicit leukocyte aggregation. It is suggested that C3 fixed to PG-APS acts as a bridge to link cells together in clusters as a result of common recognition of C3 by leukocyte and erythrocyte complement receptors.

Background : Information about patterns of HIV-1 drug resistance among treatment-exposed patients is crucial for the development of novel effective drugs. Currently no system exists that monitors patterns of resistance in patients failing therapy. Methods : The study included 1,988 HIV-1 sequences from patients experiencing therapy failure collected between 2000 and 2004 in 15 European countries. Genotypic resistance was interpreted using the ANRS algorithm. Phenotypic resistance was predicted using the Virco geno- to phenotype system. Results : 80.7% of the sequences included at least one drug-resistance mutation. Mutations were found for NRTIs (73.5%), NNRTIs (48.5%), and protease inhibitors (35.8%). Ninety percent of sequences with genotypic resistance harbored M184V, M41L, K103N, D67N, and/or T215Y. Among NRTIs, resistance was most frequently predicted for lamivudine. About half of all sequences had reduced susceptibility for NNRTIs. Resistance to most boosted protease inhibitors was found in < 25%. No sequence had resistance to all currently available drugs. Conclusion : Levels of resistance among patients with therapy failure were high. The patterns of resistance reflect resistance to drugs available for a longer time. Fully suppressive regimens can be designed even for the most mutated HIV because boosted protease inhibitors have remained active against most circulating viruses and new drug classes have become available.