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Journal Cover The Lancet
   [1031 followers]  Follow    
   Full-text available via subscription Subscription journal
     ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
     Published by Elsevier Homepage  [2563 journals]   [SJR: 7.074]   [H-I: 477]
  • Gerald Edelman
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Alison Snyder



      PubDate: 2014-06-27T14:44:30Z
       
  • Electronic cigarettes and history
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Virginia Berridge



      PubDate: 2014-06-27T14:44:30Z
       
  • Victor Dzau: change and controversy at the Institute of Medicine
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Geoff Watts



      PubDate: 2014-06-27T14:44:30Z
       
  • The chemotherapy experience JohnMoleTreatment2013Shoestring
           Press9781907356896Pp 16. £5·00.
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Tom Roques



      PubDate: 2014-06-27T14:44:30Z
       
  • Shooting, crushing, gnawing, piercing, searing JoannaBourkeThe Story of
           Pain: From Prayer to Painkillers2014Oxford University Press9780199689422Pp
           382. £20·00.
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Richard Barnett



      PubDate: 2014-06-27T14:44:30Z
       
  • Changing landscape for sexual minorities in India
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Dinesh C Sharma



      PubDate: 2014-06-27T14:44:30Z
       
  • Reforming health care in Kazakhstan
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Sharmila Devi



      PubDate: 2014-06-27T14:44:30Z
       
  • Offline: Why the Sustainable Development Goals will fail
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Richard Horton



      PubDate: 2014-06-27T14:44:30Z
       
  • Treating tuberculosis as a social disease
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Mohsin Ali



      PubDate: 2014-06-27T14:44:30Z
       
  • Colchicine for treatment of acute or recurrent pericarditis
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Patrice P Cacoub



      PubDate: 2014-06-27T14:44:30Z
       
  • FLAMINGO: how much rosier can antiretroviral therapy get'
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Anton L Pozniak , Jose R Arribas



      PubDate: 2014-06-27T14:44:30Z
       
  • Modifying disability in progressive multiple sclerosis
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Jacqueline Palace , Neil Robertson



      PubDate: 2014-06-27T14:44:30Z
       
  • A needed Convention against trafficking in human organs
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Marta López-Fraga , Beatriz Domínguez-Gil , Alexander M Capron , Kristof Van Assche , Dominique Martin , Emanuele Cozzi , Francis L Delmonico



      PubDate: 2014-06-27T14:44:30Z
       
  • Indian generic drug manufacturers in the spotlight
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): The Lancet



      PubDate: 2014-06-27T14:44:30Z
       
  • PTSD care, out of service
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): The Lancet



      PubDate: 2014-06-27T14:44:30Z
       
  • Addressing global dementia
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): The Lancet



      PubDate: 2014-06-27T14:44:30Z
       
  • Once-daily dolutegravir versus darunavir plus ritonavir in
           antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week
           results from the randomised open-label phase 3b study
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Bonaventura Clotet , Judith Feinberg , Jan van Lunzen , Marie-Aude Khuong-Josses , Andrea Antinori , Irina Dumitru , Vadim Pokrovskiy , Jan Fehr , Roberto Ortiz , Michael Saag , Julia Harris , Clare Brennan , Tamio Fujiwara , Sherene Min
      Background Dolutegravir has been shown to be non-inferior to an integrase inhibitor and superior to a non-nucleoside reverse transcriptase inhibitor (NNRTI). In FLAMINGO, we compared dolutegravir with darunavir plus ritonavir in individuals naive for antiretroviral therapy. Methods In this multicentre, open-label, phase 3b, non-inferiority study, HIV-1-infected antiretroviral therapy-naive adults with HIV-1 RNA concentration of 1000 copies per mL or more and no resistance at screening were randomly assigned (1:1) to receive either dolutegravir 50 mg once daily or darunavir 800 mg plus ritonavir 100 mg once daily, with investigator-selected tenofovir–emtricitabine or abacavir–lamivudine. Randomisation was stratified by screening HIV-1 RNA (≤100 000 or >100 000 copies per mL) and nucleoside reverse transcriptase inhibitor (NRTI) selection. The primary endpoint was the proportion of patients with HIV-1 RNA concentration lower than 50 copies per mL (Food and Drug Administration [FDA] snapshot algorithm) at week 48 with a 12% non-inferiority margin. This trial is registered with ClinicalTrials.gov, NCT01449929. Findings Recruitment began on Oct 31, 2011, and was completed on May 24, 2012, in 64 research centres in nine countries worldwide. Of 595 patients screened, 484 patients were included in the analysis (242 in each group). At week 48, 217 (90%) patients receiving dolutegravir and 200 (83%) patients receiving darunavir plus ritonavir had HIV-1 RNA of less than 50 copies per mL (adjusted difference 7·1%, 95% CI 0·9–13·2), non-inferiority and on pre-specified secondary analysis dolutegravir was superior (p=0·025). Confirmed virological failure occurred in two (<1%) patients in each group; we recorded no treatment-emergent resistance in either group. Discontinuation due to adverse events or stopping criteria was less frequent for dolutegravir (four [2%] patients) than for darunavir plus ritonavir (ten [4%] patients) and contributed to the difference in response rates. The most commonly reported (≥10%) adverse events were diarrhoea (dolutegravir 41 [17%] patients vs darunavir plus ritonavir 70 [29%] patients), nausea (39 [16%] vs 43 [18%]), and headache (37 [15%] vs 24 [10%]). Patients receiving dolutegravir had significantly fewer low-density lipoprotein values of grade 2 or higher (11 [2%] vs 36 [7%]; p=0·0001). Interpretation Once-daily dolutegravir was superior to once-daily darunavir plus ritonavir. Once-daily dolutegravir in combination with fixed-dose NRTIs represents an effective new treatment option for HIV-1-infected, treatment-naive patients. Funding ViiV Healthcare and Shionogi & Co.


      PubDate: 2014-06-27T14:44:30Z
       
  • Effect of high-dose simvastatin on brain atrophy and disability in
           secondary progressive multiple sclerosis (MS-STAT): a randomised,
           placebo-controlled, phase 2 trial
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Jeremy Chataway , Nadine Schuerer , Ali Alsanousi , Dennis Chan , David MacManus , Kelvin Hunter , Val Anderson , Charles R M Bangham , Shona Clegg , Casper Nielsen , Nick C Fox , David Wilkie , Jennifer M Nicholas , Virginia L Calder , John Greenwood , Chris Frost , Richard Nicholas
      Background Secondary progressive multiple sclerosis, for which no satisfactory treatment presently exists, accounts for most of the disability in patients with multiple sclerosis. Simvastatin, which is widely used for treatment of vascular disease, with its excellent safety profile, has immunomodulatory and neuroprotective properties that could make it an appealing candidate drug for patients with secondary progressive multiple sclerosis. Methods We undertook a double-blind, controlled trial between Jan 28, 2008, and Nov 4, 2011, at three neuroscience centres in the UK. Patients aged 18–65 years with secondary progressive multiple sclerosis were randomly assigned (1:1), by a centralised web-based service with a block size of eight, to receive either 80 mg of simvastatin or placebo. Patients, treating physicians, and outcome assessors were masked to treatment allocation. The primary outcome was the annualised rate of whole-brain atrophy measured from serial volumetric MRI. Analyses were by intention to treat and per protocol. This trial is registered with ClinicalTrials.gov, number NCT00647348. Findings 140 participants were randomly assigned to receive either simvastatin (n=70) or placebo (n=70). The mean annualised atrophy rate was significantly lower in patients in the simvastatin group (0·288% per year [SD 0·521]) than in those in the placebo group (0·584% per year [0·498]). The adjusted difference in atrophy rate between groups was −0·254% per year (95% CI −0·422 to −0·087; p=0·003); a 43% reduction in annualised rate. Simvastatin was well tolerated, with no differences between the placebo and simvastatin groups in proportions of participants who had serious adverse events (14 [20%] vs nine [13%]). Interpretation High-dose simvastatin reduced the annualised rate of whole-brain atrophy compared with placebo, and was well tolerated and safe. These results support the advancement of this treatment to phase 3 testing. Funding The Moulton Foundation [charity number 1109891], Berkeley Foundation [268369], the Multiple Sclerosis Trials Collaboration [1113598], the Rosetrees Trust [298582] and a personal contribution from A Pidgley, UK National Institute of Health Research (NIHR) University College London Hospitals/UCL Biomedical Research Centres funding scheme.


      PubDate: 2014-06-27T14:44:30Z
       
  • Department of Error
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936




      PubDate: 2014-06-27T14:44:30Z
       
  • Shale gas regulation in the UK and health implications of fracking
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Michael Hill



      PubDate: 2014-06-27T14:44:30Z
       
  • Towards the end of “red envelopes” in China'
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Ke-Jia Hu , Wen-Dong Xu



      PubDate: 2014-06-27T14:44:30Z
       
  • Diagnostic and treatment challenges in giant cell arteritis –
           Authors' reply
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Colm McAlinden , Eirini Skiadaresi



      PubDate: 2014-06-27T14:44:30Z
       
  • Diagnostic and treatment challenges in giant cell arteritis
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Philip J Banerjee , Petros Petrou , Gordon T Plant



      PubDate: 2014-06-27T14:44:30Z
       
  • Polio vaccination coverage in Somalia
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Harry Jeene , Abdirizak Hersi Hassan



      PubDate: 2014-06-27T14:44:30Z
       
  • Polio will go, acute flaccid paralysis will stay
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): James A Ayukekbong , Tomas Bergström



      PubDate: 2014-06-27T14:44:30Z
       
  • Public health or political health'
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Richard A Cash



      PubDate: 2014-06-27T14:44:30Z
       
  • A platform for a Framework Convention on Global Health
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Eric A Friedman , K Srinath Reddy , Juliana Nantaba , Geetanjali Misra , Armando De Negri Filho



      PubDate: 2014-06-27T14:44:30Z
       
  • Commission on Global Governance for Health: what about power'
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Robert Marten , Johanna Hanefeld , Richard Smith



      PubDate: 2014-06-27T14:44:30Z
       
  • June 28–July 4, 2014
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936




      PubDate: 2014-06-27T14:44:30Z
       
  • Petra ten Hoope-Bender: a “midwife's midwife”
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): David Holmes



      PubDate: 2014-06-27T14:44:30Z
       
  • The power of midwifery
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Richard Horton , Olaya Astudillo



      PubDate: 2014-06-27T14:44:30Z
       
  • Country experience with strengthening of health systems and deployment of
           midwives in countries with high maternal mortality
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Wim Van Lerberghe , Zoe Matthews , Endang Achadi , Chiara Ancona , James Campbell , Amos Channon , Luc de Bernis , Vincent De Brouwere , Vincent Fauveau , Helga Fogstad , Marge Koblinsky , Jerker Liljestrand , Abdelhay Mechbal , Susan F Murray , Tung Rathavay , Helen Rehr , Fabienne Richard , Petra ten Hoope-Bender , Sabera Turkmani
      This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.


      PubDate: 2014-06-27T14:44:30Z
       
  • Improvement of maternal and newborn health through midwifery
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Petra ten Hoope-Bender , Luc de Bernis , James Campbell , Soo Downe , Vincent Fauveau , Helga Fogstad , Caroline S E Homer , Holly Powell Kennedy , Zoe Matthews , Alison McFadden , Mary J Renfrew , Wim Van Lerberghe
      In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and beyond 2015.


      PubDate: 2014-06-27T14:44:30Z
       
  • Rituximab for childhood-onset, complicated, frequently relapsing nephrotic
           syndrome or steroid-dependent nephrotic syndrome: a multicentre,
           double-blind, randomised, placebo-controlled trial
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Kazumoto Iijima , Mayumi Sako , Kandai Nozu , Rintaro Mori , Nao Tuchida , Koichi Kamei , Kenichiro Miura , Kunihiko Aya , Koichi Nakanishi , Yoshiyuki Ohtomo , Shori Takahashi , Ryojiro Tanaka , Hiroshi Kaito , Hidefumi Nakamura , Kenji Ishikura , Shuichi Ito , Yasuo Ohashi
      Background Rituximab could be an effective treatment for childhood-onset, complicated, frequently relapsing nephrotic syndrome (FRNS) and steroid-dependent nephrotic syndrome (SDNS). We investigated the efficacy and safety of rituximab in patients with high disease activity. Methods We did a multicentre, double-blind, randomised, placebo-controlled trial at nine centres in Japan. We screened patients aged 2 years or older experiencing a relapse of FRNS or SDNS, which had originally been diagnosed as nephrotic syndrome when aged 1–18 years. Patients with complicated FRNS or SDNS who met all other criteria were eligible for inclusion after remission of the relapse at screening. We used a computer-generated sequence to randomly assign patients (1:1) to receive rituximab (375 mg/m2) or placebo once weekly for 4 weeks, with age, institution, treatment history, and the intervals between the previous three relapses as adjustment factors. Patients, guardians, caregivers, physicians, and individuals assessing outcomes were masked to assignments. All patients received standard steroid treatment for the relapse at screening and stopped taking immunosuppressive agents by 169 days after randomisation. Patients were followed up for 1 year. The primary endpoint was the relapse-free period. Safety endpoints were frequency and severity of adverse events. Patients who received their assigned intervention were included in analyses. This trial is registered with the University Hospital Medical Information Network clinical trials registry, number UMIN000001405. Findings Patients were centrally registered between Nov 13, 2008, and May 19, 2010. Of 52 patients who underwent randomisation, 48 received the assigned intervention (24 were given rituximab and 24 placebo). The median relapse-free period was significantly longer in the rituximab group (267 days, 95% CI 223–374) than in the placebo group (101 days, 70–155; hazard ratio: 0·27, 0·14–0·53; p<0·0001). Ten patients (42%) in the rituximab group and six (25%) in the placebo group had at least one serious adverse event (p=0·36). Interpretation Rituximab is an effective and safe treatment for childhood-onset, complicated FRNS and SDNS. Funding Japanese Ministry of Health, Labour and Welfare.


      PubDate: 2014-06-27T14:44:30Z
       
  • Department of Error
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet




      PubDate: 2014-06-27T14:44:30Z
       
  • Rituximab for childhood-onset nephrotic syndrome
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Elisabeth M Hodson , Jonathan C Craig



      PubDate: 2014-06-27T14:44:30Z
       
  • Disrespect and abuse of women in childbirth: challenging the global
           quality and accountability agendas
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Lynn P Freedman , Margaret E Kruk



      PubDate: 2014-06-27T14:44:30Z
       
  • The projected effect of scaling up midwifery
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Caroline S E Homer , Ingrid K Friberg , Marcos Augusto Bastos Dias , Petra ten Hoope-Bender , Jane Sandall , Anna Maria Speciale , Linda A Bartlett
      We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.


      PubDate: 2014-06-27T14:44:30Z
       
  • STEMI care in China: a world opportunity
    • Abstract: Publication date: Available online 23 June 2014
      Source:The Lancet
      Author(s): Ajay J Kirtane , Gregg W Stone



      PubDate: 2014-06-27T14:44:30Z
       
  • Department of Error
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet




      PubDate: 2014-06-27T14:44:30Z
       
  • Midwifery and quality care: findings from a new evidence-informed
           framework for maternal and newborn care
    • Abstract: Publication date: Available online 22 June 2014
      Source:The Lancet
      Author(s): Mary J Renfrew , Alison McFadden , Maria Helena Bastos , James Campbell , Andrew Amos Channon , Ngai Fen Cheung , Deborah Rachel Audebert Delage Silva , Soo Downe , Holly Powell Kennedy , Address Malata , Felicia McCormick , Laura Wick , Eugene Declercq
      In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.


      PubDate: 2014-06-27T14:44:30Z
       
  • Improving the assessment and attribution of effects of development
           assistance for health
    • Abstract: Publication date: Available online 25 June 2014
      Source:The Lancet
      Author(s): Nour Ataya , Christoph Aluttis , Antoine Flahault , Rifat Atun , Andy Haines



      PubDate: 2014-06-27T14:44:30Z
       
  • ST-segment elevation myocardial infarction in China from 2001 to 2011 (the
           China PEACE-Retrospective Acute Myocardial Infarction Study): a
           retrospective analysis of hospital data
    • Abstract: Publication date: Available online 23 June 2014
      Source:The Lancet
      Author(s): Jing Li , Xi Li , Qing Wang , Shuang Hu , Yongfei Wang , Frederick A Masoudi , John A Spertus , Harlan M Krumholz , Lixin Jiang
      Background Despite the importance of ST-segment elevation myocardial infarction (STEMI) in China, no nationally representative studies have characterised the clinical profiles, management, and outcomes of this cardiac event during the past decade. We aimed to assess trends in characteristics, treatment, and outcomes for patients with STEMI in China between 2001 and 2011. Methods In a retrospective analysis of hospital records, we used a two-stage random sampling design to create a nationally representative sample of patients in China admitted to hospital for STEMI in 3 years (2001, 2006, and 2011). In the first stage, we used a simple random-sampling procedure stratified by economic–geographical region to generate a list of participating hospitals. In the second stage we obtained case data for rates of STEMI, treatments, and baseline characteristics from patients attending each sampled hospital with a systematic sampling approach. We weighted our findings to estimate nationally representative rates and assess changes from 2001 to 2011. This study is registered with ClinicalTrials.gov, number NCT01624883. Findings We sampled 175 hospitals (162 participated in the study) and 18 631 acute myocardial infarction admissions, of which 13 815 were STEMI admissions. 12 264 patients were included in analysis of treatments, procedures, and tests, and 11 986 were included in analysis of in-hospital outcomes. Between 2001 and 2011, estimated national rates of hospital admission for STEMI per 100 000 people increased (from 3·7 in 2001, to 8·1 in 2006, to 15·8 in 2011; ptrend<0·0001) and the prevalence of risk factors—including smoking, hypertension, diabetes, and dyslipidaemia—increased. We noted significant increases in use of aspirin within 24 h (79·3% [95% CI 77·3–81·3] in 2001 vs 91·2% [90·5–91·9] in 2011, ptrend<0·0001) and clopidogrel (95% CI 1·5% [0·9–2·1] in 2001 vs 80·7% [79·8–81·6] in 2011, ptrend<0·0001) in patients without documented contraindications. Despite an increase in the use of primary percutaneous coronary intervention (10·2% [95% CI 8·1–12·3] in 2001 vs 27·6% [26·1–29·1] in 2011, ptrend<0·0001), the proportion of patients who did not receive reperfusion did not significantly change (44·8% [95% CI 41·3–48·3] in 2001 vs 45·0% [43·3–46·7] in 2011, ptrend=0·82). The median length of hospital stay decreased from 13 days (IQR 7–18) in 2001 to 11 days (7–14) in 2011 (ptrend<0·0001). Adjusted in-hospital mortality did not significantly change between 2001 and 2011 (odds ratio 0·84, 95% CI 0·62–1·12, ptrend=0·06). Interpretation During the past decade in China, hospital admissions for STEMI have risen; in these patients, comorbidities and the intensity of testing and treatment have increased. Quality of care has improved for some treatments, but important gaps persist and in-hospital mortality has not decreased. National efforts are needed to improve the care and outcomes for patients with STEMI in China. Funding National Health and Family Planning Commission of China.


      PubDate: 2014-06-27T14:44:30Z
       
  • Human schistosomiasis
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Daniel G Colley , Amaya L Bustinduy , W Evan Secor , Charles H King
      Human schistosomiasis—or bilharzia—is a parasitic disease caused by trematode flukes of the genus Schistosoma. By conservative estimates, at least 230 million people worldwide are infected with Schistosoma spp. Adult schistosome worms colonise human blood vessels for years, successfully evading the immune system while excreting hundreds to thousands of eggs daily, which must either leave the body in excreta or become trapped in nearby tissues. Trapped eggs induce a distinct immune-mediated granulomatous response that causes local and systemic pathological effects ranging from anaemia, growth stunting, impaired cognition, and decreased physical fitness, to organ-specific effects such as severe hepatosplenism, periportal fibrosis with portal hypertension, and urogenital inflammation and scarring. At present, preventive public health measures in endemic regions consist of treatment once every 1 or 2 years with the isoquinolinone drug, praziquantel, to suppress morbidity. In some locations, elimination of transmission is now the goal; however, more sensitive diagnostics are needed in both the field and clinics, and integrated environmental and health-care management will be needed to ensure elimination.


      PubDate: 2014-06-27T14:44:30Z
       
  • Improving access to vaccines through tiered pricing
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Seth Berkley



      PubDate: 2014-06-27T14:44:30Z
       
  • Whipple's disease: an unexpected finding in a peripheral lymph node biopsy
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Sarah Walters , Talal Valliani , Robert Przemioslo , Nicholas Rooney



      PubDate: 2014-06-27T14:44:30Z
       
  • A modest but meaningful decision for Indian drug patents
    • Abstract: Publication date: Available online 26 June 2014
      Source:The Lancet
      Author(s): Amir Attaran



      PubDate: 2014-06-27T14:44:30Z
       
  • Delayed presentation of acute aortic syndrome
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Srinivasan Sattiraju , Emil Missov



      PubDate: 2014-06-27T14:44:30Z
       
  • Myelodysplastic syndromes
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Lionel Adès , Raphael Itzykson , Pierre Fenaux
      Myelodysplastic syndromes are clonal marrow stem-cell disorders, characterised by ineffective haemopoiesis leading to blood cytopenias, and by progression to acute myeloid leukaemia in a third of patients. 15% of cases occur after chemotherapy or radiotherapy for a previous cancer; the syndromes are most common in elderly people. The pathophysiology involves cytogenetic changes with or without gene mutations and widespread gene hypermethylation at advanced stages. Clinical manifestations result from cytopenias (anaemia, infection, and bleeding). Diagnosis is based on examination of blood and bone marrow showing blood cytopenias and hypercellular marrow with dysplasia, with or without excess of blasts. Prognosis depends largely on the marrow blast percentage, number and extent of cytopenias, and cytogenetic abnormalities. Treatment of patients with lower-risk myelodysplastic syndromes, especially for anaemia, includes growth factors, lenalidomide, and transfusions. Treatment of higher-risk patients is with hypomethylating agents and, whenever possible, allogeneic stem-cell transplantation.


      PubDate: 2014-06-27T14:44:30Z
       
  • Efficacy and safety of colchicine for treatment of multiple recurrences of
           pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled,
           randomised trial
    • Abstract: Publication date: 28 June–4 July 2014
      Source:The Lancet, Volume 383, Issue 9936
      Author(s): Massimo Imazio , Riccardo Belli , Antonio Brucato , Roberto Cemin , Stefania Ferrua , Federico Beqaraj , Daniela Demarie , Silvia Ferro , Davide Forno , Silvia Maestroni , Davide Cumetti , Ferdinando Varbella , Rita Trinchero , David H Spodick , Yehuda Adler
      Background Colchicine is effective for the treatment of acute pericarditis and first recurrences. However, conclusive data are lacking for the efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis. Methods We did this multicentre, double-blind trial at four general hospitals in northern Italy. Adult patients with multiple recurrences of pericarditis (≥two) were randomly assigned (1:1) to placebo or colchicine (0·5 mg twice daily for 6 months for patients weighing more than 70 kg or 0·5 mg once daily for patients weighing 70 kg or less) in addition to conventional anti-inflammatory treatment with aspirin, ibuprofen, or indometacin. Permuted block randomisation (size four) was done with a central computer-based automated sequence. Patients and all investigators were masked to treatment allocation. The primary outcome was recurrent pericarditis in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT00235079. Findings 240 patients were enrolled and 120 were assigned to each group. The proportion of patients who had recurrent pericarditis was 26 (21·6%) of 120 in the colchicine group and 51 (42·5%) of 120 in the placebo group (relative risk 0·49; 95% CI 0·24–0·65; p=0·0009; number needed to treat 5). Adverse effects and discontinuation of study drug occurred in much the same proportions in each group. The most common adverse events were gastrointestinal intolerance (nine patients in the colchicine group vs nine in the placebo group) and hepatotoxicity (three vs one). No serious adverse events were reported. Interpretation Colchicine added to conventional anti-inflammatory treatment significantly reduced the rate of subsequent recurrences of pericarditis in patients with multiple recurrences. Taken together with results from other randomised controlled trials, these findings suggest that colchicine should be probably regarded as a first-line treatment for either acute or recurrent pericarditis in the absence of contraindications or specific indications. Funding Azienda Sanitaria 3 of Torino (now ASLTO2).


      PubDate: 2014-06-27T14:44:30Z
       
 
 
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