Background: Data for potential cross-infection risk of non-invasive ventilation (NIV) use is limited.Our previous practice involved internal ethylene oxide (ETO) sterilisation of NIV devices after use by CF adults with significant airway infection e.g.Burkholderia cepacia complex (BCC) or if outlet bacterial/viral filter use not feasible (if integral humidifier used).Changes in Trust sterilisation protocol necessitated practice review.Objective: To investigate levels of microbial contamination of patient environment and NIV devices.Method: Settle plates were placed and air sampling performed during airway clearance in 2 patients, 1 Pseudomonas aeruginosa (PsA) and 1 BCC infected.7 NIV devices (VPAP III and III/IV ST, BiPAP Harmony S/T) used by PsA or BCC infected patients were swabbed in a controlled environment at 7 internal/ external sites, 5 devices pre-and 2 post-ETO sterilisation.Results: Environmental flora (>300 colonies) were cultured from 2 air sample plates; settle plates had minimal growth (<11 colonies).Most swabs had no/minimal growth (0-4 colonies).Exceptions: inlet filter housing of 1 device (pre-ETO); inlet filter of another (post-ETO) which both grew >8 colonies of environmental flora.No common CF pathogens were isolated. Conclusion:This small study shows no evidence of significant NIV device contamination, even without ETO sterilisation.Our centre has now ceased practice of ETO sterilisation but uses separate devices for BCC infected patients.We now always: use single patient use circuits with bacterial/viral filters (and separate single use humidifiers); replace inlet filters and continue to surface clean devices between patients.

References 1. Paul R, Rutter S. Standards of peripheral nerve block procedure documentation. EJA 2006; Volume 23, Supplement 37, page 129. 2. Gerancher JC et al. Development of a standardised peripheral nerve block procedure note form. RAPM 2005; 30(1): 67-71 3. Ridgway S and Herrick M. Perioperative nerve dysfunction and peripheral nerve blockade. BJA; CEACCP, Volume 6, Number 2, 2006, pp. 71-74

Theileria annulata and T. parva are closely related protozoan parasites that cause lymphoproliferative diseases of cattle. We sequenced the genome of T. annulata and compared it with that of T. parva to understand the mechanisms underlying transformation and tropism. Despite high conservation of gene sequences and synteny, the analysis reveals unequally expanded gene families and species-specific genes. We also identify divergent families of putative secreted polypeptides that may reduce immune recognition, candidate regulators of host-cell transformation, and a Theileria -specific protein domain [frequently associated in Theileria (FAINT)] present in a large number of secreted proteins.

Leishmania species cause a spectrum of human diseases in tropical and subtropical regions of the world. We have sequenced the 36 chromosomes of the 32.8-megabase haploid genome of Leishmania major (Friedlin strain) and predict 911 RNA genes, 39 pseudogenes, and 8272 protein-coding genes, of which 36% can be ascribed a putative function. These include genes involved in host-pathogen interactions, such as proteolytic enzymes, and extensive machinery for synthesis of complex surface glycoconjugates. The organization of protein-coding genes into long strand-specific, polycistronic clusters and lack of general transcription factors in the L. major, Trypanosoma brucei, and Trypanosoma cruzi (Tritryp) genomes suggest that the mechanisms regulating RNA polymerase II-directed transcription are distinct from those operating in other eukaryotes, although the trypanosomatids appear capable of chromatin remodeling. Abundant RNA-binding proteins are encoded in the Tritryp genomes, consistent with active posttranscriptional regulation of gene expression.

Objective To compare the diagnostic accuracy of the current reference standard-ultrasound with in utero magnetic resonance imaging, in a selected group of patients.Design Prospective study.Setting Five fetal maternal tertiary referral centres and an academic radiology unit.Sample One hundred cases of fetuses with central nervous system abnormalities where there has been diagnostic difficulties on ultrasound. In 48 cases the women were less than 24 weeks of gestation and in 52 cases later in pregnancy.Methods All women were imaged on a 1.5 T clinical system using a single shot fast spin echo technique. The results of antenatal ultrasound and in utero magnetic resonance were compared.Main outcome measures The definitive diagnosis was made either at autopsy or by postmortem magnetic resonance imaging, in cases that went to termination of pregnancy, or a combination of postnatal imaging and clinical follow up in the others.Results In 52 of cases, ultrasound and magnetic resonance gave identical results and in a further 12, magnetic resonance provided extra information that was judged not to have had direct effects on management. In 35 of cases, magnetic resonance either changed the diagnosis (29) or gave extra information that could have altered management (6). In 11 of the 30 cases where magnetic resonance changed the diagnosis, the brain was described as normal on magnetic resonance.Conclusions In utero magnetic resonance imaging is a powerful tool in investigating fetal brain abnormalities. Our results suggest that in selected cases of brain abnormalities, detected by ultrasound, antenatal magnetic resonance may provide additional, clinically useful information that may alter management.

AIMS: To corroborate the findings of in utero magnetic resonance imaging (MRI) with autopsy and post-mortem MRI in cases of known or suspected central nervous system (CNS) abnormalities on ultrasound and to compare the diagnostic accuracy of ante-natal ultrasound and in utero MRI.

BACKGROUND:Subdural haematomas are thought to be uncommon in babies born at term. This view is mainly based on findings in symptomatic neonates and babies in whom subdural haemorrhages are detected fortuitously. We aimed to establish the frequency of subdural haemorrhages in asymptomatic term neonates; to study the natural history of such subdural haematomas; and to ascertain which obstetric factors, if any, are associated with presence of subdural haematoma. METHODS:We did a prospective study in babies who were born in the Jessop wing of the Central Sheffield University Hospitals between March, 2001, and November, 2002. We scanned neonates with a 0.2 T magnetic resonance machine. FINDINGS:111 babies underwent MRI in this study. 49 were born by normal vertex delivery without instrumentation, 25 by caesarean section, four with forceps, 13 ventouse, 18 failed ventouse leading to forceps, one failed ventouse leading to caesarean section, and one failed forceps leading to caesarean section. Nine babies had subdural haemorrhages: three were normal vaginal deliveries (risk 6.1%), five were delivered by forceps after an attempted ventouse delivery (27.8%), and one had a traumatic ventouse delivery (7.7%). All babies with subdural haemorrhage were assessed clinically but no intervention was needed. All were rescanned at 4 weeks and haematomas had completely resolved. INTERPRETATION:Presence of unilateral and bilateral subdural haemorrhage is not necessarily indicative of excessive birth trauma.

We have sequenced and annotated the genome of fission yeast (Schizosaccharomyces pombe), which contains the smallest number of protein-coding genes yet recorded for a eukaryote: 4,824. The centromeres are between 35 and 110 kilobases (kb) and contain related repeats including a highly conserved 1.8-kb element. Regions upstream of genes are longer than in budding yeast (Saccharomyces cerevisiae), possibly reflecting more-extended control regions. Some 43% of the genes contain introns, of which there are 4,730. Fifty genes have significant similarity with human disease genes; half of these are cancer related. We identify highly conserved genes important for eukaryotic cell organization including those required for the cytoskeleton, compartmentation, cell-cycle control, proteolysis, protein phosphorylation and RNA splicing. These genes may have originated with the appearance of eukaryotic life. Few similarly conserved genes that are important for multicellular organization were identified, suggesting that the transition from prokaryotes to eukaryotes required more new genes than did the transition from unicellular to multicellular organization.

This study aimed (1) to image clinically normal newborn infants to detect the presence of any intracranial bleed and (2) to establish the natural history of the bleed. Newborn babies were imaged within 48 hours of delivery and all details of the labour and delivery were recorded. MR imaging was carried out on a dedicated 0.2T Niche MR system on the special care baby unit. Images were obtained in axial and coronal planes using T1, T2 plus gradient echo weighted images; similarly for the follow-up imaging. χ2 test was used for analysis. One hundred and two newborn infants were scanned. Forty-five had a normal vaginal delivery, 10 were ventouse (three metal cup, seven silastic), 10 were emergency sections, 15 were elective sections, 22 were forceps (19 Neville Barnes, three Keillands). Five had subdural collections that were clinically silent throughout their duration and had resolved fully within 4 weeks.All five babies with subdural collections had been delivered by forceps following an attempt at a ventouse delivery. In total 15 babies were delivered by forceps following a ventouse delivery and one by emergency caesarian section following an attempted ventouse delivery. The method of delivery was the only statistically significant factor in these babies (duration of labour, fetal blood pH, etc. were not statistically significant) for the presence of a subdural collection, using the χ2 test (P < 0.001).

BACKGROUND:Whipple's disease is a rare multisystem chronic infection, involving the intestinal tract as well as various other organs. The causative agent, Tropheryma whipplei, is a Gram-positive bacterium about which little is known. Our aim was to investigate the biology of this organism by generating and analysing the complete DNA sequence of its genome. METHODS:We isolated and propagated T whipplei strain TW08/27 from the cerebrospinal fluid of a patient diagnosed with Whipple's disease. We generated the complete sequence of the genome by the whole genome shotgun method, and analysed it with a combination of automatic and manual bioinformatic techniques. FINDINGS:Sequencing revealed a condensed 925938 bp genome with a lack of key biosynthetic pathways and a reduced capacity for energy metabolism. A family of large surface proteins was identified, some associated with large amounts of non-coding repetitive DNA, and an unexpected degree of sequence variation. INTERPRETATION:The genome reduction and lack of metabolic capabilities point to a host-restricted lifestyle for the organism. The sequence variation indicates both known and novel mechanisms for the elaboration and variation of surface structures, and suggests that immune evasion and host interaction play an important part in the lifestyle of this persistent bacterial pathogen.