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Journal Cover The Lancet
  [SJR: 14.638]   [H-I: 600]   [1749 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3039 journals]
  • Randomised trials in left main disease: a NOBLE effort
    • Authors: Michael Mack; David R Holmes
      Pages: 2715 - 2716
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Michael Mack, David R Holmes


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32067-0
       
  • Ménière's disease: damaged hearing but reduced vertigo
    • Authors: Steven D Rauch
      Pages: 2716 - 2717
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Steven D Rauch


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32166-3
       
  • EXXELERATE: a negative trial with importance for clinical practice
    • Authors: Tore K Kvien; Till Uhlig
      Pages: 2718 - 2719
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Tore K Kvien, Till Uhlig


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31923-7
       
  • 4CMenB vaccine effectiveness: reasons for optimism
    • Authors: Nicole E Basta; Hannah Christensen
      Pages: 2719 - 2721
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Nicole E Basta, Hannah Christensen


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32061-x
       
  • Precision medicine to precision care: managing multimorbidity
    • Authors: Arlene S Bierman; Mary E Tinetti
      Pages: 2721 - 2723
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Arlene S Bierman, Mary E Tinetti


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32232-2
       
  • India's new health systems knowledge platform—making research matter
    • Authors: Kabir Sheikh; Sanjiv Kumar; Rajani Ved; Satish Kumar; V R Raman; Abdul Ghaffar; Nhan Tran; Srinath Reddy; Soumya Swaminathan
      Pages: 2724 - 2725
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Kabir Sheikh, Sanjiv Kumar, Rajani Ved, Satish Kumar, V R Raman, Abdul Ghaffar, Nhan Tran, Srinath Reddy, Soumya Swaminathan


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32391-1
       
  • Offline: Looking forward to Donald Trump
    • Authors: Richard Horton
      First page: 2726
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Richard Horton


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32462-x
       
  • India's changing clinical trials scene
    • Authors: Charu Bahri
      Pages: 2727 - 2728
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Charu Bahri


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32461-8
       
  • Joan Marston: don't forget the children
    • Authors: Dara Mohammadi
      First page: 2733
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Dara Mohammadi


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32428-x
       
  • Health, welfare, and the state—the dangers of forgetting history
    • Authors: Simon Szreter; Ann Louise Kinmonth; Natasha M Kriznik; Michael P Kelly
      Pages: 2734 - 2735
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Simon Szreter, Ann Louise Kinmonth, Natasha M Kriznik, Michael P Kelly


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32429-1
       
  • Susan Lindquist
    • Authors: Alison Snyder
      First page: 2736
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Alison Snyder


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32430-8
       
  • AIDS in eastern Europe and central Asia: time to face the facts
    • Authors: Vinay P Saldanha; Kent Buse
      Pages: 2737 - 2738
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Vinay P Saldanha, Kent Buse


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32421-7
       
  • Estimating the burden of hepatitis
    • Authors: Bertrand Livinec
      Pages: 2738 - 2739
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Bertrand Livinec


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31649-x
       
  • Urgent need for reform in Nepal's medical education
    • Authors: Bipin Adhikari; Shiva Raj Mishra
      Pages: 2739 - 2740
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Bipin Adhikari, Shiva Raj Mishra


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32423-0
       
  • Protecting public health in Yemen
    • Authors: Tila Khan Ahmadzai; Zvidzai Maburutse; Laura Miller; Ruwan Ratnayake
      First page: 2739
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Tila Khan Ahmadzai, Zvidzai Maburutse, Laura Miller, Ruwan Ratnayake


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32422-9
       
  • Chronic obstructive pulmonary disease: time to discuss new concepts
    • Authors: Jose Baddini-Martinez; Adriana I de Pádua
      Pages: 2740 - 2741
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Jose Baddini-Martinez, Adriana I de Pádua


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32424-2
       
  • Severe asthma and asthma-chronic obstructive pulmonary disease syndrome
    • Authors: Yang Xia; Chao Cao; Wen Li; Huahao Shen
      Pages: 2741 - 2742
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Yang Xia, Chao Cao, Wen Li, Huahao Shen


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32425-4
       
  • Severe asthma and asthma-chronic obstructive pulmonary disease syndrome
           – Authors' reply
    • Authors: Sally E Wenzel; Shyamalie Jayawardena; Neil M H Graham; Gianluca Pirozzi; Ariel Teper
      First page: 2742
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Sally E Wenzel, Shyamalie Jayawardena, Neil M H Graham, Gianluca Pirozzi, Ariel Teper


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31720-2
       
  • Percutaneous coronary angioplasty versus coronary artery bypass grafting
           in treatment of unprotected left main stenosis (NOBLE): a prospective,
           randomised, open-label, non-inferiority trial
    • Authors: Timo Mäkikallio; Niels R Holm; Mitchell Lindsay; Mark S Spence; Andrejs Erglis; Ian B A Menown; Thor Trovik; Markku Eskola; Hannu Romppanen; Thomas Kellerth; Jan Ravkilde; Lisette O Jensen; Gintaras Kalinauskas; Rikard B A Linder; Markku Pentikainen; Anders Hervold; Adrian Banning; Azfar Zaman; Jamen Cotton; Erlend Eriksen; Sulev Margus; Henrik T Sørensen; Per H Nielsen; Matti Niemelä; Kari Kervinen; Jens F Lassen; Michael Maeng; Keith Oldroyd; Geoff Berg; Simon J Walsh; Colm G Hanratty; Indulis Kumsars; Peteris Stradins; Terje K Steigen; Ole Fröbert; Alastair N J Graham; Petter C Endresen; Matthias Corbascio; Olli Kajander; Uday Trivedi; Juha Hartikainen; Vesa Anttila; David Hildick-Smith; Leif Thuesen; Evald H Christiansen
      Pages: 2743 - 2752
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Timo Mäkikallio, Niels R Holm, Mitchell Lindsay, Mark S Spence, Andrejs Erglis, Ian B A Menown, Thor Trovik, Markku Eskola, Hannu Romppanen, Thomas Kellerth, Jan Ravkilde, Lisette O Jensen, Gintaras Kalinauskas, Rikard B A Linder, Markku Pentikainen, Anders Hervold, Adrian Banning, Azfar Zaman, Jamen Cotton, Erlend Eriksen, Sulev Margus, Henrik T Sørensen, Per H Nielsen, Matti Niemelä, Kari Kervinen, Jens F Lassen, Michael Maeng, Keith Oldroyd, Geoff Berg, Simon J Walsh, Colm G Hanratty, Indulis Kumsars, Peteris Stradins, Terje K Steigen, Ole Fröbert, Alastair N J Graham, Petter C Endresen, Matthias Corbascio, Olli Kajander, Uday Trivedi, Juha Hartikainen, Vesa Anttila, David Hildick-Smith, Leif Thuesen, Evald H Christiansen
      Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. Findings Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1·48 (95% CI 1·11–1·96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0066). As-treated estimates were 28% versus 19% (1·55, 1·18–2·04, p=0·0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1·07, 0·67–1·72, p=0·77) for all-cause mortality, 7% versus 2% (2·88, 1·40–5·90, p=0·0040) for non-procedural myocardial infarction, 16% versus 10% (1·50, 1·04–2·17, p=0·032) for any revascularisation, and 5% versus 2% (2·25, 0·93–5·48, p=0·073) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease. Funding Biosensors, Aarhus University Hospital, and participating sites.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32052-9
       
  • Intratympanic methylprednisolone versus gentamicin in patients with
           unilateral Ménière's disease: a randomised, double-blind, comparative
           effectiveness trial
    • Authors: Mitesh Patel; Kiran Agarwal; Qadeer Arshad; Mohamed Hariri; Peter Rea; Barry M Seemungal; John F Golding; Jonny P Harcourt; Adolfo M Bronstein
      Pages: 2753 - 2762
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Mitesh Patel, Kiran Agarwal, Qadeer Arshad, Mohamed Hariri, Peter Rea, Barry M Seemungal, John F Golding, Jonny P Harcourt, Adolfo M Bronstein
      Background Ménière's disease is characterised by severe vertigo attacks and hearing loss. Intratympanic gentamicin, the standard treatment for refractory Ménière's disease, reduces vertigo, but damages vestibular function and can worsen hearing. We aimed to assess whether intratympanic administration of the corticosteroid methylprednisolone reduces vertigo compared with gentamicin. Methods In this double-blind comparative effectiveness trial, patients aged 18–70 years with refractory unilateral Ménière's disease were enrolled at Charing Cross Hospital (London, UK) and Leicester Royal Infirmary (Leicester, UK). Patients were randomly assigned (1:1) by a block design to two intratympanic methylprednisolone (62·5 mg/mL) or gentamicin (40 mg/mL) injections given 2 weeks apart, and were followed up for 2 years. All investigators and patients were masked to treatment allocation. The primary outcome was vertigo frequency over the final 6 months (18–24 months after injection) compared with the 6 months before the first injection. Analyses were done in the intention-to-treat population, and then per protocol. This trial is registered with ClinicalTrials.gov, number NCT00802529. Findings Between June 19, 2009, and April 15, 2013, 256 patients with Ménière's disease were screened, 60 of whom were enrolled and randomly assigned: 30 to gentamicin and 30 to methylprednisolone. In the intention-to-treat analysis (ie, all 60 patients), the mean number of vertigo attacks in the final 6 months compared with the 6 months before the first injection (primary outcome) decreased from 19·9 (SD 16·7) to 2·5 (5·8) in the gentamicin group (87% reduction) and from 16·4 (12·5) to 1·6 (3·4) in the methylprednisolone group (90% reduction; mean difference −0·9, 95% CI −3·4 to 1·6). Patients whose vertigo did not improve after injection (ie, non-responders) after being assessed by an unmasked clinician were eligible for additional injections given by a masked clinician (eight patients in the gentamicin group vs 15 in the methylprednisolone group). Two non-responders switched from methylprednisolone to gentamicin. Both drugs were well tolerated with no safety concerns. Six patients reported one adverse event each: three in the gentamicin group and three in the methylprednisolone group. The most common adverse event was minor ear infections, which was experienced by one patient in the gentamicin group and two in the methylprednisolone group. Interpretation Methylprednisolone injections are a non-ablative, effective treatment for refractory Ménière's disease. The choice between methylprednisolone and gentamicin should be made based on clinical knowledge and patient circumstances. Funding Ménière's Society and National Institute for Health Research Imperial Biomedical Research Centre.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31461-1
       
  • Head-to-head comparison of certolizumab pegol versus adalimumab in
           rheumatoid arthritis: 2-year efficacy and safety results from the
           randomised EXXELERATE study
    • Authors: Josef S Smolen; Gerd-Rüdiger Burmester; Bernard Combe; Jeffrey R Curtis; Stephen Hall; Boulos Haraoui; Ronald van Vollenhoven; Christopher Cioffi; Cécile Ecoffet; Leon Gervitz; Lucian Ionescu; Luke Peterson; Roy Fleischmann
      Pages: 2763 - 2774
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Josef S Smolen, Gerd-Rüdiger Burmester, Bernard Combe, Jeffrey R Curtis, Stephen Hall, Boulos Haraoui, Ronald van Vollenhoven, Christopher Cioffi, Cécile Ecoffet, Leon Gervitz, Lucian Ionescu, Luke Peterson, Roy Fleischmann
      Background To date, head-to-head trials comparing the efficacy and safety of biological disease-modifying antirheumatic drugs within the same class, including TNF inhibitors, in patients with active rheumatoid arthritis despite methotrexate therapy are lacking. We aimed to compare the efficacy and safety of two different TNF inhibitors and to assess the efficacy and safety of switching to the other TNF inhibitor without a washout period after insufficient primary response to the first TNF inhibitor at week 12. Methods In this 104-week, randomised, single-blind (double-blind until week 12 and investigator blind thereafter), parallel-group, head-to-head superiority study (EXXELERATE), eligible patients from 151 centres worldwide were aged 18 years or older with a diagnosis of rheumatoid arthritis at screening, as defined by the 2010 ACR/EULAR criteria, and had prognostic factors for severe disease progression, including a positive rheumatoid factor, or anti-cyclic citrullinated peptide antibody result, or both. Participants were randomly assigned (1:1) via an interactive voice and web response system with no stratification to receive certolizumab pegol plus methotrexate or adalimumab plus methotrexate. All study staff were kept masked throughout the study and participants were masked until week 12. At week 12, patients were classified as responders (by either achieving low disease activity [LDA] according to Disease Activity Score 28-erythrocyte sedimentation rate [DAS28-ESR] ≤3·2 or DAS28-ESR reduction ≥1·2 from baseline) or as non-responders. Non-responders to the first TNF inhibitor to which they were randomised were switched to the other TNF inhibitor with no washout period. Primary endpoints were the percentage of patients achieving a 20% improvement according to the American College of Rheumatology criteria (ACR20) at week 12 and LDA at week 104 (week 12 non-responders were considered LDA non-responders). This study is registered with ClinicalTrials.gov, number NCT01500278. Findings Between Dec 14, 2011, and Nov 11, 2013, 1488 patients were screened of whom 915 were randomly assigned; 457 to certolizumab pegol plus methotrexate and 458 to adalimumab plus methotrexate. No statistically significant difference was observed in ACR20 response at week 12 (314 [69%] of 454 patients and 324 [71%] of 454 patients; odds ratio [OR] 0·90 [95% CI 0·67–1·20]; p=0·467) or DAS28-ESR LDA at week 104 (161 [35%] of 454 patients and 152 [33%] of 454 patients; OR 1·09 [0·82–1·45]; p=0·532) between certolizumab pegol plus methotrexate and adalimumab plus methotrexate, respectively. At week 12, 65 non-responders to certolizumab pegol were switched to adalimumab and 57 non-responders to adalimumab were switched to certolizumab pegol; 33 (58%) of 57 patients switching to certolizumab pegol and 40 (62%) of 65 patients switching to adalimumab responded 12 weeks later by achieving LDA or a DAS28-ESR reduction 1·2 or greater. 389 [75%] of 516 patients who received certolizumab pegol plus methotrexate and 386 [74%] of 523 patients who received adalimumab plus methotrexate reported treatment-emergent adverse events. Three deaths (1%) occurred in each group. No serious infection events were reported in the 70-day period after treatment switch. Interpretation These results show that certolizumab pegol plus methotrexate is not superior to adalimumab plus methotrexate. The data also show the clinical benefit and safety of switching to a second TNF inhibitor without a washout period after primary failure to a first TNF inhibitor. Funding UCB Pharma.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31651-8
       
  • Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine
           against group B meningococcal disease in England: a national observational
           cohort study
    • Authors: Sydel R Parikh; Nick J Andrews; Kazim Beebeejaun; Helen Campbell; Sonia Ribeiro; Charlotte Ward; Joanne M White; Ray Borrow; Mary E Ramsay; Shamez N Ladhani
      Pages: 2775 - 2782
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Sydel R Parikh, Nick J Andrews, Kazim Beebeejaun, Helen Campbell, Sonia Ribeiro, Charlotte Ward, Joanne M White, Ray Borrow, Mary E Ramsay, Shamez N Ladhani
      Background In September, 2015, the UK became the first country to introduce the multicomponent group B meningococcal (MenB) vaccine (4CMenB, Bexsero) into a publicly funded national immunisation programme. A reduced two-dose priming schedule was offered to infants at 2 months and 4 months, alongside an opportunistic catch-up for 3 month and 4 month olds. 4CMenB was predicted to protect against 73–88% of MenB strains. We aimed to assess the effectiveness and impact of 4CMenB in vaccine-eligible infants in England. Methods Public Health England (PHE) undertakes enhanced surveillance of meningococcal disease through a combination of clinical, public health, and laboratory reporting. Laboratory-confirmed cases of meningococcal disease are followed up with PHE local health protection teams, general practitioners, and hospital clinicians to collect demographic data, vaccination history, clinical presentation, and outcome. For cases diagnosed between Sept 1, 2015, and June 30, 2016, vaccine effectiveness was assessed using the screening method. Impact was assessed by comparing numbers of cases of MenB in vaccine-eligible children to equivalent cohorts in the previous 4 years and to cases in vaccine-ineligible children. Findings Coverage of 4CMenB in infants eligible for routine vaccination was high, achieving 95·5% for one dose and 88·6% for two doses by 6 months of age. Two-dose vaccine effectiveness was 82·9% (95% CI 24·1–95·2) against all MenB cases, equivalent to a vaccine effectiveness of 94·2% against the highest predicted MenB strain coverage of 88%. Compared with the prevaccine period, there was a 50% incidence rate ratio (IRR) reduction in MenB cases in the vaccine-eligible cohort (37 cases vs average 74 cases; IRR 0·50 [95% CI 0·36–0·71]; p=0·0001), irrespective of the infants’ vaccination status or predicted MenB strain coverage. Similar reductions were observed even after adjustment for disease trends in vaccine-eligible and vaccine-ineligible children. Interpretation The two-dose 4CMenB priming schedule was highly effective in preventing MenB disease in infants. Cases in vaccine-eligible infants halved in the first 10 months of the programme. While ongoing national surveillance will continue to monitor the longer-term impact of the programme, these findings represent a step forward in the battle against meningococcal disease and will help reassure that the vaccine protects against this deadly infection. Funding Public Health England.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31921-3
       
  • Thyroid cancer
    • Authors: Maria E Cabanillas; David G McFadden; Cosimo Durante
      Pages: 2783 - 2795
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Maria E Cabanillas, David G McFadden, Cosimo Durante
      Thyroid cancer is the fifth most common cancer in women in the USA, and an estimated over 62 000 new cases occurred in men and women in 2015. The incidence continues to rise worldwide. Differentiated thyroid cancer is the most frequent subtype of thyroid cancer and in most patients the standard treatment (surgery followed by either radioactive iodine or observation) is effective. Patients with other, more rare subtypes of thyroid cancer—medullary and anaplastic—are ideally treated by physicians with experience managing these malignancies. Targeted treatments that are approved for differentiated and medullary thyroid cancers have prolonged progression-free survival, but these drugs are not curative and therefore are reserved for patients with progressive or symptomatic disease.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)30172-6
       
  • Bladder cancer
    • Authors: Ashish M Kamat; Noah M Hahn; Jason A Efstathiou; Seth P Lerner; Per-Uno Malmström; Woonyoung Choi; Charles C Guo; Yair Lotan; Wassim Kassouf
      Pages: 2796 - 2810
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Ashish M Kamat, Noah M Hahn, Jason A Efstathiou, Seth P Lerner, Per-Uno Malmström, Woonyoung Choi, Charles C Guo, Yair Lotan, Wassim Kassouf
      Bladder cancer is a complex disease associated with high morbidity and mortality rates if not treated optimally. Awareness of haematuria as the major presenting symptom is paramount, and early diagnosis with individualised treatment and follow-up is the key to a successful outcome. For non-muscle-invasive bladder cancer, the mainstay of treatment is complete resection of the tumour followed by induction and maintenance immunotherapy with intravesical BCG vaccine or intravesical chemotherapy. For muscle-invasive bladder cancer, multimodal treatment involving radical cystectomy with neoadjuvant chemotherapy offers the best chance for cure. Selected patients with muscle-invasive tumours can be offered bladder-sparing trimodality treatment consisting of transurethral resection with chemoradiation. Advanced disease is best treated with systemic cisplatin-based chemotherapy; immunotherapy is emerging as a viable salvage treatment for patients in whom first-line chemotherapy cannot control the disease. Developments in the past 2 years have shed light on genetic subtypes of bladder cancer that might differ from one another in response to various treatments.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)30512-8
       
  • Reproductive, maternal, newborn, and child health: key messages from
           Disease Control Priorities 3rd Edition
    • Authors: Robert E Black; Carol Levin; Neff Walker; Doris Chou; Li Liu; Marleen Temmerman
      Pages: 2811 - 2824
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Robert E Black, Carol Levin, Neff Walker, Doris Chou, Li Liu, Marleen Temmerman
      As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention). Scaling up all interventions in these packages from coverage in 2015 to hypothetically immediately achieve 90% coverage would avert 149 000 maternal deaths, 849 000 stillbirths, 1 498 000 neonatal deaths, and 1 515 000 additional child deaths. In alternative calculations that consider only the effects of reducing the number of pregnancies by provision of contraceptive services as part of a Reproductive Health package, meeting 90% of the unmet need for contraception would reduce global births by almost 28 million and consequently avert deaths that could have occurred at 2015 rates of fertility and mortality. Thus, 67 000 maternal deaths, 440 000 neonatal deaths, 473 000 child deaths, and 564 000 stillbirths could be averted from avoided pregnancies. Particularly effective interventions in the Maternal and Newborn Health and Child Health packages would be management of labour and delivery, care of preterm births, and treatment of serious infectious diseases and acute malnutrition. Nearly all of these essential interventions can be delivered by health workers in the community or in primary health centres, which can increase population access to needed services. The annual incremental cost of immediately scaling up these essential interventions would be US$6·2 billion in low-income countries, $12·4 billion in lower-middle-income countries, and $8·0 billion in upper-middle-income countries. With the additional funding, greater focus on high-effect integrated interventions and innovations in service delivery, such as task shifting to other groups of health workers and supply and demand incentives, can help rectify major gaps in accessibility and quality of care. In recent decades, reduction of avoidable maternal and child deaths has been a global priority. With continued priority and expansion of essential reproductive, maternal, newborn, and child health interventions to high coverage, equity, and quality, as well as interventions to address underlying problems such as women's low status in society and violence against women, these deaths and substantial morbidity can be largely eliminated in another generation.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)00738-8
       
  • Transfusion reactions: prevention, diagnosis, and treatment
    • Authors: Meghan Delaney; Silvano Wendel; Rachel S Bercovitz; Joan Cid; Claudia Cohn; Nancy M Dunbar; Torunn O Apelseth; Mark Popovsky; Simon J Stanworth; Alan Tinmouth; Leo Van De Watering; Jonathan H Waters; Mark Yazer; Alyssa Ziman
      Pages: 2825 - 2836
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Meghan Delaney, Silvano Wendel, Rachel S Bercovitz, Joan Cid, Claudia Cohn, Nancy M Dunbar, Torunn O Apelseth, Mark Popovsky, Simon J Stanworth, Alan Tinmouth, Leo Van De Watering, Jonathan H Waters, Mark Yazer, Alyssa Ziman
      Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(15)01313-6
       
  • Metastatic breast cancer: focus on endocrine sensitivity
    • Authors: Massimo Cristofanilli
      Abstract: Publication date: Available online 29 November 2016
      Source:The Lancet
      Author(s): Massimo Cristofanilli


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32418-7
       
  • Department of Error
    • Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061


      PubDate: 2016-12-04T08:16:37Z
       
  • Department of Error
    • Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061


      PubDate: 2016-12-04T08:16:37Z
       
  • Department of Error
    • Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061


      PubDate: 2016-12-04T08:16:37Z
       
  • Mixed diagnosis for Serbian health system
    • Authors: Rob Hyde
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Rob Hyde


      PubDate: 2016-12-04T08:16:37Z
       
  • Don't get angry get…active
    • Authors: Michael Marmot
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): Michael Marmot


      PubDate: 2016-12-04T08:16:37Z
       
  • Alzheimer's disease: expedition into the unknown
    • Authors: Lancet
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): The Lancet


      PubDate: 2016-12-04T08:16:37Z
       
  • Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive
           advanced breast cancer (FALCON): an international, randomised,
           double-blind, phase 3 trial
    • Authors: John F R Robertson; Igor M Bondarenko; Ekaterina Trishkina; Mikhail Dvorkin; Lawrence Panasci; Alexey Manikhas; Yaroslav Shparyk; Servando Cardona-Huerta; Kwok-Leung Cheung; Manuel Jesus Philco-Salas; Manuel Ruiz-Borrego; Zhimin Shao; Shinzaburo Noguchi; Jacqui Rowbottom; Mary Stuart; Lynda M Grinsted; Mehdi Fazal; Matthew J Ellis
      Abstract: Publication date: Available online 29 November 2016
      Source:The Lancet
      Author(s): John F R Robertson, Igor M Bondarenko, Ekaterina Trishkina, Mikhail Dvorkin, Lawrence Panasci, Alexey Manikhas, Yaroslav Shparyk, Servando Cardona-Huerta, Kwok-Leung Cheung, Manuel Jesus Philco-Salas, Manuel Ruiz-Borrego, Zhimin Shao, Shinzaburo Noguchi, Jacqui Rowbottom, Mary Stuart, Lynda M Grinsted, Mehdi Fazal, Matthew J Ellis
      Background Aromatase inhibitors are a standard of care for hormone receptor-positive locally advanced or metastatic breast cancer. We investigated whether the selective oestrogen receptor degrader fulvestrant could improve progression-free survival compared with anastrozole in postmenopausal patients who had not received previous endocrine therapy. Methods In this phase 3, randomised, double-blind trial, we recruited eligible patients with histologically confirmed oestrogen receptor-positive or progesterone receptor-positive, or both, locally advanced or metastatic breast cancer from 113 academic hospitals and community centres in 20 countries. Eligible patients were endocrine therapy-naive, with WHO performance status 0–2, and at least one measurable or non-measurable lesion. Patients were randomly assigned (1:1) to fulvestrant (500 mg intramuscular injection; on days 0, 14, 28, then every 28 days thereafter) or anastrozole (1 mg orally daily) using a computer-generated randomisation scheme. The primary endpoint was progression-free survival, determined by Response Evaluation Criteria in Solid Tumors version 1·1, intervention by surgery or radiotherapy because of disease deterioration, or death from any cause, assessed in the intention-to-treat population. Safety outcomes were assessed in all patients who received at least one dose of randomised treatment (including placebo). This trial is registered with ClinicalTrials.gov, number NCT01602380. Findings Between Oct 17, 2012, and July 11, 2014, 524 patients were enrolled to this study. Of these, 462 patients were randomised (230 to receive fulvestrant and 232 to receive anastrozole). Progression-free survival was significantly longer in the fulvestrant group than in the anastrozole group (hazard ratio [HR] 0·797, 95% CI 0·637–0·999, p=0·0486). Median progression-free survival was 16·6 months (95% CI 13·83–20·99) in the fulvestrant group versus 13·8 months (11·99–16·59) in the anastrozole group. The most common adverse events were arthralgia (38 [17%] in the fulvestrant group vs 24 [10%] in the anastrozole group) and hot flushes (26 [11%] in the fulvestrant group vs 24 [10%] in the anastrozole group). 16 (7%) of 228 patients in in the fulvestrant group and 11 (5%) of 232 patients in the anastrozole group discontinued because of adverse events. Interpretation Fulvestrant has superior efficacy and is a preferred treatment option for patients with hormone receptor-positive locally advanced or metastatic breast cancer who have not received previous endocrine therapy compared with a third-generation aromatase inhibitor, a standard of care for first-line treatment of these patients. Funding AstraZeneca.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32389-3
       
  • Recognising the Rohingya people
    • Authors: Lancet
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): The Lancet


      PubDate: 2016-12-04T08:16:37Z
       
  • Scale of Europe's air pollution problem demands more action
    • Authors: Lancet
      Abstract: Publication date: 3–9 December 2016
      Source:The Lancet, Volume 388, Issue 10061
      Author(s): The Lancet


      PubDate: 2016-12-04T08:16:37Z
       
  • Management of patients with early mild asthma and infrequent symptoms
    • Authors: Alberto Papi; Leonardo M Fabbri
      Abstract: Publication date: Available online 30 November 2016
      Source:The Lancet
      Author(s): Alberto Papi, Leonardo M Fabbri


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32111-0
       
  • Should recommendations about starting inhaled corticosteroid treatment for
           mild asthma be based on symptom frequency: a post-hoc efficacy analysis of
           the START study
    • Authors: Helen K Reddel; William W Busse; Søren Pedersen; Wan C Tan; Yu-Zhi Chen; Carin Jorup; Dan Lythgoe; Paul M O'Byrne
      Abstract: Publication date: Available online 30 November 2016
      Source:The Lancet
      Author(s): Helen K Reddel, William W Busse, Søren Pedersen, Wan C Tan, Yu-Zhi Chen, Carin Jorup, Dan Lythgoe, Paul M O'Byrne
      Background Low-dose inhaled corticosteroids (ICS) are highly effective for reducing asthma exacerbations and mortality. Conventionally, ICS treatment is recommended for patients with symptoms on more than 2 days per week, but this criterion has scant evidence. We aimed to assess the validity of the previous symptom-based cutoff for starting ICS by establishing whether there was a differential response to budesonide versus placebo for severe asthma exacerbations, lung function, and asthma symptom control across subgroups identified by baseline asthma symptom frequency. Methods We did a post-hoc analysis of the 3 year inhaled Steroid Treatment As Regular Therapy (START) study, done in 32 countries, with clinic visits every 3 months. Patients (aged 4–66 years) with mild asthma diagnosed within the previous 2 years and no previous regular corticosteroids were randomised to receive once daily, inhaled budesonide 400 μg (those aged <11 years 200 μg) or placebo. Coprimary outcomes for this analysis were time to first severe asthma-related event (SARE; hospital admission, emergency treatment, or death) and change from baseline in lung function after bronchodilator. Interaction with baseline symptom frequency was investigated, with patients grouped by more than two symptom days per week and two or fewer symptom days per week (divided into no days to 1 day, and more than 1 day to 2 days). Analysis was done by intention to treat. Findings Of 7138 patients (n=3577 budesonide; n=3561 placebo), baseline symptom frequency was 0–1 days per week for 2184 (31%) participants, more than 1 and less than or equal to 2 symptom days per week for 1914 (27%) participants, and more than 2 symptom days per week for 3040 (43%) participants. For budesonide versus placebo, time to first SARE was longer across symptom frequency subgroups (hazard ratios 0·54 [95% CI 0·34–0·86] for 0–1 symptom days per week, 0·60 [0·39–0·93] for >1 to ≤2 symptom days per week, 0·57 [0·41–0·79] >2 symptom days per week, pinteraction=0·94), and the decline in postbronchodilator lung function was less at 3 years' follow-up (pinteraction=0·32). For budesonide versus placebo, severe exacerbations requiring oral or systemic corticosteroids were reduced (rate ratio 0·48 [0·38–0·61] 0–1 symptom days per week, 0·56 [0·44–0·71] >1 to ≤2 symptom days per week, and 0·66 [0·55–0·80] >2 symptom days per week, pinteraction=0·11), prebronchodilator lung function was higher, and symptom-free days were more frequent (p<0·0001 for all three subgroups), with no interaction by symptom frequency (prebronchodilator pinteraction=0·43; symptom-free days pinteraction=0·53). Similar results were noted when participants were classified by any guidelines criterion as so-called persistent versus so-called intermittent asthma. Interpretation In mild recent-onset asthma, once daily, low-dose budesonide decreases SARE risk, reduces lung function decline, and improves symptom control similarly across all symptom subgroups. The results do not support restriction of inhaled corticosteroids to patients with symptoms on more than 2 days per week and suggest that treatment recommendations for mild asthma should consider both risk reduction and symptoms. Funding AstraZeneca.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31399-x
       
  • Hypertrophic obstructive cardiomyopathy
    • Authors: Josef Veselka; Nandan S Anavekar; Philippe Charron
      Abstract: Publication date: Available online 30 November 2016
      Source:The Lancet
      Author(s): Josef Veselka, Nandan S Anavekar, Philippe Charron
      Hypertrophic obstructive cardiomyopathy is an inherited myocardial disease defined by cardiac hypertrophy (wall thickness ≥15 mm) that is not explained by abnormal loading conditions, and left ventricular obstruction greater than or equal to 30 mm Hg. Typical symptoms include dyspnoea, chest pain, palpitations, and syncope. The diagnosis is usually suspected on clinical examination and confirmed by imaging. Some patients are at increased risk of sudden cardiac death, heart failure, and atrial fibrillation. Patients with an increased risk of sudden cardiac death undergo cardioverter-defibrillator implantation; in patients with severe symptoms related to ventricular obstruction, septal reduction therapy (myectomy or alcohol septal ablation) is recommended. Life-long anticoagulation is indicated after the first episode of atrial fibrillation.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31321-6
       
  • Searching for the perfect agent to improve cardiac contractility
    • Authors: Douglas L Mann
      Abstract: Publication date: Available online 1 December 2016
      Source:The Lancet
      Author(s): Douglas L Mann


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31725-1
       
  • Ulcerative colitis
    • Authors: Ryan Ungaro; Saurabh Mehandru; Patrick B Allen; Laurent Peyrin-Biroulet; Jean-Frédéric Colombel
      Abstract: Publication date: Available online 1 December 2016
      Source:The Lancet
      Author(s): Ryan Ungaro, Saurabh Mehandru, Patrick B Allen, Laurent Peyrin-Biroulet, Jean-Frédéric Colombel
      Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. The aim of management is to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immunosuppressants. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is expanding, and the number of drugs with new targets will rapidly increase in coming years.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32126-2
       
  • Crohn's disease
    • Authors: Joana Torres; Saurabh Mehandru; Jean-Frédéric Colombel; Laurent Peyrin-Biroulet
      Abstract: Publication date: Available online 1 December 2016
      Source:The Lancet
      Author(s): Joana Torres, Saurabh Mehandru, Jean-Frédéric Colombel, Laurent Peyrin-Biroulet
      Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract, with increasing incidence worldwide. Crohn's disease might result from a complex interplay between genetic susceptibility, environmental factors, and altered gut microbiota, leading to dysregulated innate and adaptive immune responses. The typical clinical scenario is a young patient presenting with abdominal pain, chronic diarrhoea, weight loss, and fatigue. Assessment of disease extent and of prognostic factors for complications is paramount to guide therapeutic decisions. Current strategies aim for deep and long-lasting remission, with the goal of preventing complications, such as surgery, and blocking disease progression. Central to these strategies is the introduction of early immunosuppression or combination therapy with biologicals in high-risk patients, combined with a tight and frequent control of inflammation, and adjustment of therapy on the basis of that assessment (treat to target strategy). The therapeutic armamentarium for Crohn's disease is expanding, and therefore the need to develop biomarkers that can predict response to therapies will become increasingly important for personalised medicine decisions in the near future. In this Seminar, we provide a physician-oriented overview of Crohn's disease in adults, ranging from epidemiology and cause to clinical diagnosis, natural history, patient stratification and clinical management, and ending with an overview of emerging therapies and future directions for research.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31711-1
       
  • A rapid evidence review of the effectiveness and cost-effectiveness of
           alcohol control policies: an English perspective
    • Authors: Robyn Burton; Clive Henn; Don Lavoie; Rosanna O'Connor; Clare Perkins; Kate Sweeney; Felix Greaves; Brian Ferguson; Caryl Beynon; Annalisa Belloni; Virginia Musto; John Marsden; Nick Sheron
      Abstract: Publication date: Available online 2 December 2016
      Source:The Lancet
      Author(s): Robyn Burton, Clive Henn, Don Lavoie, Rosanna O'Connor, Clare Perkins, Kate Sweeney, Felix Greaves, Brian Ferguson, Caryl Beynon, Annalisa Belloni, Virginia Musto, John Marsden, Nick Sheron
      This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32420-5
       
  • Chronic Oral Study of Myosin Activation to Increase Contractility in Heart
           Failure (COSMIC-HF): a phase 2, pharmacokinetic, randomised,
           placebo-controlled trial
    • Authors: John Teerlink; Michael Felker John McMurray Scott Solomon Kirkwood Adams
      Abstract: Publication date: Available online 1 December 2016
      Source:The Lancet
      Author(s): John R Teerlink, G Michael Felker, John J V McMurray, Scott D Solomon, Kirkwood F Adams, John G F Cleland, Justin A Ezekowitz, Assen Goudev, Peter Macdonald, Marco Metra, Veselin Mitrovic, Piotr Ponikowski, Pranas Serpytis, Jindrich Spinar, János Tomcsányi, Hans J Vandekerckhove, Adriaan A Voors, Maria Laura Monsalvo, James Johnston, Fady I Malik, Narimon Honarpour
      Background Impaired contractility is a feature of heart failure with reduced ejection fraction. We assessed the pharmacokinetics and effects on cardiac function and structure of the cardiac myosin activator, omecamtiv mecarbil. Methods In this randomised, double-blind study, done at 87 sites in 13 countries, we recruited patients with stable, symptomatic chronic heart failure and left ventricular ejection fraction 40% or lower. Patients were randomly assigned equally, via an interactive web response system, to receive 25 mg oral omecamtiv mecarbil twice daily (fixed-dose group), 25 mg twice daily titrated to 50 mg twice daily guided by pharmacokinetics (pharmacokinetic-titration group), or placebo for 20 weeks. We assessed the maximum concentration of omecamtiv mecarbil in plasma (primary endpoint) and changes in cardiac function and ventricular diameters. This trial is registered with ClinicalTrials.gov, number NCT01786512. Findings From March 17, 2014, to March 5, 2015, we enrolled 150 patients in the fixed-dose omecamtiv mecarbil group and 149 in the pharmacokinetic-titration and placebo groups. Mean maximum concentration of omecamtiv mecarbil at 12 weeks was 200 (SD 71) ng/mL in the fixed-dose group and 318 (129) ng/mL in the pharmacokinetic-titration group. For the pharmacokinetic-titration group versus placebo group at 20 weeks, least square mean differences were as follows: systolic ejection time 25 ms (95% CI 18–32, p<0·0001), stroke volume 3·6 mL (0·5–6·7, p=0·0217), left ventricular end-systolic diameter −1·8 mm (−2·9 to −0·6, p=0·0027), left ventricular end-diastolic diameter −1·3 mm, (−2·3 to 0·3, p=0·0128), heart rate −3·0 beats per min (−5·1 to −0·8, p=0·0070), and N-terminal pro B-type natriuretic peptide concentration in plasma −970 pg/mL (−1672 to −268, p=0·0069). The frequency of adverse clinical events did not differ between groups. Interpretation Omecamtiv mecarbil dosing guided by pharmacokinetics achieved plasma concentrations associated with improved cardiac function and decreased ventricular diameter. Funding Amgen.

      PubDate: 2016-12-04T08:16:37Z
       
  • Augmented reality for treatment of phantom limb pain—are we there
           yet'
    • Authors: Melita Giummarra
      Abstract: Publication date: Available online 2 December 2016
      Source:The Lancet
      Author(s): Melita Giummarra


      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)32416-3
       
  • Phantom motor execution facilitated by machine learning and augmented
           reality as treatment for phantom limb pain: a single group, clinical trial
           in patients with chronic intractable phantom limb pain
    • Authors: Max Ortiz-Catalan; Rannveig A Guðmundsdóttir; Morten B Kristoffersen; Alejandra Zepeda-Echavarria; Kerstin Caine-Winterberger; Katarzyna Kulbacka-Ortiz; Cathrine Widehammar; Karin Eriksson; Anita Stockselius; Christina Ragnö; Zdenka Pihlar; Helena Burger; Liselotte Hermansson
      Abstract: Publication date: Available online 2 December 2016
      Source:The Lancet
      Author(s): Max Ortiz-Catalan, Rannveig A Guðmundsdóttir, Morten B Kristoffersen, Alejandra Zepeda-Echavarria, Kerstin Caine-Winterberger, Katarzyna Kulbacka-Ortiz, Cathrine Widehammar, Karin Eriksson, Anita Stockselius, Christina Ragnö, Zdenka Pihlar, Helena Burger, Liselotte Hermansson
      Background Phantom limb pain is a debilitating condition for which no effective treatment has been found. We hypothesised that re-engagement of central and peripheral circuitry involved in motor execution could reduce phantom limb pain via competitive plasticity and reversal of cortical reorganisation. Methods Patients with upper limb amputation and known chronic intractable phantom limb pain were recruited at three clinics in Sweden and one in Slovenia. Patients received 12 sessions of phantom motor execution using machine learning, augmented and virtual reality, and serious gaming. Changes in intensity, frequency, duration, quality, and intrusion of phantom limb pain were assessed by the use of the numeric rating scale, the pain rating index, the weighted pain distribution scale, and a study-specific frequency scale before each session and at follow-up interviews 1, 3, and 6 months after the last session. Changes in medication and prostheses were also monitored. Results are reported using descriptive statistics and analysed by non-parametric tests. The trial is registered at ClinicalTrials.gov, number NCT02281539. Findings Between Sept 15, 2014, and April 10, 2015, 14 patients with intractable chronic phantom limb pain, for whom conventional treatments failed, were enrolled. After 12 sessions, patients showed statistically and clinically significant improvements in all metrics of phantom limb pain. Phantom limb pain decreased from pre-treatment to the last treatment session by 47% (SD 39; absolute mean change 1·0 [0·8]; p=0·001) for weighted pain distribution, 32% (38; absolute mean change 1·6 [1·8]; p=0·007) for the numeric rating scale, and 51% (33; absolute mean change 9·6 [8·1]; p=0·0001) for the pain rating index. The numeric rating scale score for intrusion of phantom limb pain in activities of daily living and sleep was reduced by 43% (SD 37; absolute mean change 2·4 [2·3]; p=0·004) and 61% (39; absolute mean change 2·3 [1·8]; p=0·001), respectively. Two of four patients who were on medication reduced their intake by 81% (absolute reduction 1300 mg, gabapentin) and 33% (absolute reduction 75 mg, pregabalin). Improvements remained 6 months after the last treatment. Interpretation Our findings suggest potential value in motor execution of the phantom limb as a treatment for phantom limb pain. Promotion of phantom motor execution aided by machine learning, augmented and virtual reality, and gaming is a non-invasive, non-pharmacological, and engaging treatment with no identified side-effects at present. Funding Promobilia Foundation, VINNOVA, Jimmy Dahlstens Fond, PicoSolve, and Innovationskontor Väst.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)31598-7
       
  • Importance of endogenous compensatory vasoactive peptides in broadening
           the effects of inhibitors of the renin-angiotensin system for the
           treatment of heart failure
    • Authors: Milton Packer; John J V McMurray
      Abstract: Publication date: Available online 3 December 2016
      Source:The Lancet
      Author(s): Milton Packer, John J V McMurray
      The magnitude of the clinical benefits produced by inhibitors of the renin-angiotensin system in heart failure has been modest, possibly because of the ability of renin-angiotensin activity to escape from suppression during long-term treatment. Efforts to intensify pharmacological blockade by use of dual inhibitors that interfere with the renin-angiotensin system at multiple sites have not yielded consistent incremental clinical benefits, but have been associated with serious adverse reactions. By contrast, potentiation of endogenous compensatory vasoactive peptides can act to enhance the survival effects of inhibitors of the renin-angiotensin system, as evidenced by trials that have compared angiotensin-converting enzyme inhibitors with drugs that inhibit both the renin-angiotensin system and neprilysin. Several endogenous vasoactive peptides act as adaptive mechanisms, and their augmentation could help to broaden the benefits of renin-angiotensin system inhibitors for patients with heart failure.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)30969-2
       
  • The Rohingya people of Myanmar: health, human rights, and identity
    • Authors: Syed S Mahmood; Emily Wroe; Arlan Fuller; Jennifer Leaning
      Abstract: Publication date: Available online 2 December 2016
      Source:The Lancet
      Author(s): Syed S Mahmood, Emily Wroe, Arlan Fuller, Jennifer Leaning
      The Rohingya people of Myanmar (known as Burma before 1989) were stripped of citizenship in 1982, because they could not meet the requirement of proving their forefathers settled in Burma before 1823, and now account for one in seven of the global population of stateless people. Of the total 1·5 million Rohingya people living in Myanmar and across southeast Asia, only 82 000 have any legal protection obtained through UN-designated refugee status. Since 2012, more than 159 000 people, most of whom are Rohingya, have fled Myanmar in poorly constructed boats for journeys lasting several weeks to neighbouring nations, causing hundreds of deaths. We outline historical events preceding this complex emergency in health and human rights. The Rohingya people face a cycle of poor infant and child health, malnutrition, waterborne illness, and lack of obstetric care. In December, 2014, a UN resolution called for an end to the crisis. We discuss the Myanmar Government's ongoing treatment of Rohingya through the lens of international law, and the steps that the newly elected parliament must pursue for a durable solution.

      PubDate: 2016-12-04T08:16:37Z
      DOI: 10.1016/s0140-6736(16)00646-2
       
  • Addressing addiction in the USA
    • Authors: Lancet
      Abstract: Publication date: 26 November–2 December 2016
      Source:The Lancet, Volume 388, Issue 10060
      Author(s): The Lancet


      PubDate: 2016-11-26T13:55:15Z
       
  • The unacceptable reality of care for people living with dementia
    • Authors: Lancet
      Abstract: Publication date: 26 November–2 December 2016
      Source:The Lancet, Volume 388, Issue 10060
      Author(s): The Lancet


      PubDate: 2016-11-26T13:55:15Z
       
 
 
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