Highlights

Helmets do not meet CSA requirements

Helmets are a no-brainer for skiers and snowboarders, but they do not meet the stringent requirements set by the Canadian Standards Association. See Editorial, page 627

Stem cells for neurodegenerative disorders

Extravagant claims have been made of the potential for using stem cells to treat neurodegenerative disorders of the central nervous system. Barker argues that it is critical we understand the limitations of the technologies at our disposal, as well as the inherent difficulties in trying to take an in vitro cell culture system from the laboratory to the complexities of patients in the clinic. See Commentary, page 631

Ambulatory blood pressure monitoring

Hypertension is a major preventable cause of premature death and disability. Home and ambulatory blood pressure monitoring are useful in the diagnosis, but there is uncertainty about the exact therapeutic threshold, say Campbell and Hemmelgarn. See Commentary, page 633

Flu vaccination good for pregnancy outcomes

Vaccinating pregnant women during the flu season reduced the number of babies who were small for gestational age. This finding comes from a secondary analysis of a subgroup of women in a randomized controlled trial of seasonal flu vaccination in 340 pregnant women in Bangladesh. These data need confirmation, but they suggest that preventing influenza infection can influence intrauterine growth, say Steinhoff and colleagues. See Research, page 645

Atrial fibrillation and mental decline

Atrial fibrillation can cause cognitive and functional decline, even in the absence of overt stroke. This post-hoc analysis of two large randomized controlled trials involved more than 31 000 patients and measured cognitive decline during treatment with two blood pressure–lowering agents. Clinical trials involving patients with atrial fibrillation should include cognitive and functional measures, say Marzona and colleagues. See Research, page E329

Chronic opioid dependence

Treating chronic opioid dependence with diacetylmorphine instead of methadone may result in lower societal costs and increased duration and quality of life. This cost-effectiveness analysis used a semi-Markov cohort model and data from a trial conducted in two Canadian cities. Cost savings were realized primarily because of reductions in crime, say Nosyk and colleagues. See Research, page E317

Ethical guidelines for research with humans

Canada and the US have recently strengthened their guidelines and regulations for human research, but how they will be applied remains an issue. Canada’s updated Tri-Council Policy Statement covers more current ethical issues than the US Advance Notice of Proposed Rulemaking, but both still apply to government-funded research only. According to Millum, the institution-based model of ethics review may lead to potential conflicts of interest in research ethics committees as well as underreview and overreview. Solutions put forward in these documents will require greater efforts for implementation by institutions and governments. See Analysis, page 657

Edema and elevated CA 125

A 56-year-old woman had an 18-month history of generalized edema with ascites. An elevated CA 125 level and an ovarian mass were suggestive of ovarian cancer, but the final diagnosis was something quite different. See Practice, page 671

Scombroid poisoning

People who have symptoms such as flushing, rash and urticaria after eating certain types of fish may be experiencing scombroid poisoning, a form of histamine poisoning. Despite elevated levels of histamine in the fish due to improper processing or storage, the fish may look, smell and taste normal, say Stratta and Badino. Most instances are self-limited and require no treatment. However, rapid-acting antihistamines and supportive care are commonly used for more severe symptoms. See Practice, page 674