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Background: CTX0E03 is an immortalised human neural stem-cell line from which a drug product (CTX-DP) was developed for allogeneic therapy. Dose-dependent improvement in sensorimotor function in rats implanted with CTX-DP 4 weeks after middle cerebral artery occlusion stroke prompted investigation of the safety and tolerability of this treatment in stroke patients.Methods: We did an open-label, single-site, dose-escalation study. Men aged 60 years or older with stable disability (National Institutes of Health Stroke Scale [NIHSS] score ≥6 and modified Rankin Scale score 2-4) 6-60 months after ischaemic stroke were implanted with single doses of 2 million, 5 million, 10 million, or 20 million cells by stereotactic ipsilateral putamen injection. Clinical and brain imaging data were collected over 2 years. The primary endpoint was safety (adverse events and neurological change). This trial is registered with ClinicalTrials.gov, number NCT01151124.Findings: 13 men were recruited between September, 2010, and January, 2013, of whom 11 (mean age 69 years, range 60-82) received CTX-DP. Median NIHSS score before implantation was 7 (IQR 6-8) and the mean time from stroke was 29 (SD 14) months. Three men had subcortical infarcts only and seven had right-hemisphere infarcts. No immunological or cell-related adverse events were seen. Other adverse events were related to the procedure or comorbidities. Hyperintensity around the injection tracts on T2-weighted fluid-attenuation inversion recovery MRI was seen in five patients. At 2 years, improvement in NIHSS score ranged from 0 to 5 (median 2) points.Interpretation: Single intracerebral doses of CTX-DP up to 20 million cells induced no adverse events and were associated with improved neurological function. Our observations support further investigation of CTX-DP in stroke patients.Funding: ReNeuron Limited. [ABSTRACT FROM AUTHOR]

This article presents a seminar on stillbirth in Great Britain which has been increasing. The authors believe the increase may be due to older maternal ages, obesity and diabetes. Many stillbirths are the result of placental dysfunction which in some women is evident early on and in others is not. There is no effective screening method to identify high-risk women or to then offer them successful treatment. The definition of stillbirth is given along with classifications. The largest number of stillbirth are still unexplained. Rates and causes of stillbirth are compared between developed and developing countries.

SummaryBackground Although the benefits of water fluoridation for dental health are widely accepted, concerns remain about possible adverse effects, particularly effects on bone. Several investigators have suggested increased rates of hip fracture in places with high concentrations of fluoride in drinking water, but this finding has not been consistent, possibly because of unrecognised confounding effects.MethodsWe did a case-control study of men and women aged 50 years and older from the English county of Cleveland, and compared patients with hip fracture with community controls. Current addresses were ascertained for all participants; for those who agreed to an interview and who passed a mental test, more detailed information was obtained about lifetime residential history and exposure to other known and suspected risk factors for hip fracture. Exposures to fluoride in water were estimated from the residential histories and from information provided by water suppliers. Analysis was by logistic regression.Findings914 cases and 1196 controls were identified, of whom 514 and 527, respectively, were interviewed. Among those interviewed, hip fracture was strongly associated with low body-mass index (p for trend <0.001) and physical inactivity (p for trend <0.001). Estimated average lifetime exposure to fluoride in drinking water ranged from 0.15 to 1.79 ppm. Current residence in Hartlepool was a good indicator for high lifetime exposure to fluoride. After adjustment for potential confounders, the odds ratio associated with an average lifetime exposure to fluoride [> OR =]0.9 ppm was 1.0 [95% CI 0.7-1.5].InterpretationThere is a low risk of hip fracture for people ingesting fluoride in drinking water at concentrations of about 1 ppm. This low risk should not be a reason for withholding fluoridation of water supplies. [ABSTRACT FROM AUTHOR]

Presents the results of a study investigating the nature and cause of symptoms suggestive of occupational asthma of workers in a 3-month old salmon processing plant in Great Britain. Exposure to respirable aerosols containing salmon-serum antigens generated by processing machinery; Enclosed ventilation system of factory; Elimination of noxious aerosols; Salmon serum as allergen.

Compares the effect of the prostaglandin E1 analogues gemeprost and misoprostol on the human cervix. Benefits of cervical priming before evacuation of the uterus during delivery; Pharmacology of gemeprost and misoprostol; Medical induction of abortion; Estimates on the number of pregnancy terminations in the United Kingdom; Safety of surgical abortions.

Presents an editorial on the catastrophic failures of public health as they manifest themselves in the inability to control obesity in developed countries. Background on early public health measures which eradicated many diseases; Figures from the Centers for Disease Control and Prevention which confirm that more than 60% of adult Americans are overweight or obese; Lack of a coordinated strategy for dealing with the issue which has tremendous health repercussions; Derk Wanless report for the UK government, "Securing Good Health for the Whole Population which attacks the short-term target culture; Belief that public health has become complacent and is failing; Suggestion of two approaches one of which includes turning cities and towns into safe places for pedestrians.

Discusses how a person with an untreatable mental disorder who is a potential danger to the public should be supervised in Great Britain. The importance of risk assessment in the selection of people for compulsory treatment; The false-positive rate of prediction of violence compared to the true-positive rate; The need of a controlled study before reforms are introduced.

Discusses how prion protein (PrP), the infectious protein responsible for variant Creutzfeldt-Jakob disease (CJD), was reported to have been detected in the appendix removed from a man eight months before he developed symptoms of CJD; Response for the Health Department in London, England; Comments by Sir Kenneth Calman; Plans to test appendixes and tonsils held in hospital laboratory tissue banks for infection; Hospital waiting lists in the United Kingdom.

Examines a conflict between the Cochrane Injuries Group and Great Britain's Medicines Control Agency (MCA). Report of the Cochrane Injuries Group regarding the administration of albumin in critically ill patients; Response of critical-care specialists; Policy issue of how bodies responsible for products like albumin should respond to medical criticism; Response of the British government; Need for freedom of information; Role of the MCA.

Looks at the trend of pregnancies with neural-tube defects in women of Indian or Pakistani origin in North Thames (West) Region of the United Kingdom. The effect of red-cell folate deficiency on pregnancy and coronary heart disease; The need for identification of the cause of the trend in North West Thames, education in folate supplementation, and investigation of folate supplementation as a cardioprotective measure.

Highlights topics of interest in the field of medicine. The new cases of Creutzfeldt-Jakob disease reported by the United Kingdom Department of Health; The reduction of arterial stiffness related to hormone replacement therapy; The possibility of presymptomatic dementia diagnosis.