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Objective— The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura. Design— An observational study, based on women having caesarean sections for clinical reasons. Subjects— 17 normal pregnant women, 43 with gestational hypertension, of whom 39 had proteinuria, 17 with chronic hypertension, of whom 6 had proteinuria, and 5 with unclassified hypertension. Interventions— Placental bed biopsies obtained during caesarean section. Main outcome measures— Histological appearance of sections stained with haematoxylin and eosin PAS and Lendrum's MSB. Results— Biopsies containing spiral arteries were obtained from 6 normotensive and 44 hypertensive women. Trophoblastic invasion was present in 5 of the 6 normotensive biopsies but absent in the majority of those with hypertension. Subintimal proliferation was seen in all the normotensive biopsies but in only 8 of 28 from those with gestational hypertension and proteinuria. Other features seen predominantly or only in the hypertensive biopsies, in order of frequency, were medial hyperplasia, fibrin deposits, acute atherosis, endothelial vacuolation and thrombosis. Conclusion— Absence of physiological changes may not be peculiar to preeclampsia but may be associated or even a result of various forms of hypertension in pregnancy. Spiral arteries show a spectrum of changes in hypertensive pregnancies that do not appear to bear a clear‐cut relation to the clinical signs.

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Major advances in menopause hormone therapy (MHT) hold promise in the future of better and safer care for women at and after the menopause. The principal advances are: (1) the critical window or 'window of opportunity' in the 10 years or so after the menopause, during which the benefits of MHT in healthy women exceed any risks; (2) use of transdermal instead of oral administration of estrogen to reduce the risk of venous thromboembolism; (c) investigation of the use of oral micronized progesterone (MP) and vaginal MP to prevent endometrial hyperplasia and carcinoma without any increased risk of breast cancer and venous thromboembolism in postmenopausal women receiving estrogens; vaginal MP prevents endometrial proliferation in the short term but the long-term effects in MHT remain to be established; (4) investigation into the use of intrauterine levonorgestrel-releasing devices (LNG-IUDs), which are an attractive form of MHT in perimenopausal women, providing contraception and reducing uterine bleeding, although the risk of breast cancer with LNG-IUDs requires clarification. Women in the future can look forward to a symptom-free menopause and to safer and more beneficial MHT.

Summary. The effect of nifedipine on uteroplacental blood flow was investigated in nine hypertensive women in the third trimester of pregnancy and compared with the effects of a placebo in nine similar hypertensive women. An index of uteroplacental blood flow was obtained, twice before treatment and once after treatment, by measuring the increase in radioactivity in the region of the placenta with a gamma camera following an intravenous injection of indium‐113m. There was no significant change in the blood flow index in either the nifedipine‐ or the placebo‐treated groups despite a significant fall in blood pressure with nifedipine. Nifedipine lowers the blood pressure without any apparent reduction in uteroplacental blood flow.

Alzheimer's disease (AD) is not an inevitable consequence of aging and may be modified by both adverse and protective factors. The pathological changes of AD commence in midlife and AD has a long preclinical phase that may be diagnosed by biomarkers in the cerebrospinal fluid and by brain MRI. New clinical criteria for the diagnosis of AD dementia and AD mild cognitive impairment (MCI) have been proposed. MCI and dementia are frequently the result of AD and cerebrovascular disease combined. Over the age of 85 years, MCI and dementia are more common in women than in men. Women with a surgical premature menopause have an increased risk of MCI and AD. Menopausal hormone therapy from the menopause to the age of 60 years, when any risks of menopausal hormone therapy are extremely small, may provide a 'window of opportunity' to reduce the risk of MCI and AD in later life. Many measures may help to prevent, delay or minimize AD in both women and men and should be actively encouraged.

HIV testing coverage in sub-Saharan Africa is lower among men than women. We investigated the impact of a peer-delivered U = U (undetectable equals untransmittable) message on men’s HIV testing uptake through a cluster randomised trial with individual mobile clinic days as unit of randomisation. On standard of care (SOC) days, peer promoters informed men about the availability of HIV testing at the mobile clinic. On intervention days, peer promoters delivered U = U messages. We used logistic regression adjusting for mobile clinic location, clustering by study day, to determine the percentage of invited men who tested for HIV at the mobile clinic. Peer promoters delivered 1048 invitations over 12 days. In the SOC group, 68 (13%) of 544 men invited tested for HIV (3, 4.4% HIV-positive). In the U = U group, 112 (22%) of 504 men invited tested for HIV (7, 6.3% HIV-positive). Men in the U = U group had greater odds of testing for HIV (adjusted odds ratio = 1.89, 95% CI 1.21–2.95; p = 0.01). Tailored, peer-delivered messages that explain the benefits of HIV treatment in reducing HIV transmission can increase men’s HIV testing uptake.

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