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Journal Cover The Lancet
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     ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
     Published by Elsevier Homepage  [2570 journals]   [SJR: 7.074]   [H-I: 477]
  • Maternal mortality in Bangladesh: a Countdown to 2015 country case study
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Shams El Arifeen , Kenneth Hill , Karar Zunaid Ahsan , Kanta Jamil , Quamrun Nahar , Peter Kim Streatfield
      Background Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use. Methods We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression. Findings The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253–391) in 1998–2001 to 194 deaths per 100 000 livebirths (149–238) in 2007–10, an annual rate of decrease of 5·6%. This decrease rate is slightly higher than that required (5·5%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal death. Interpretation The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This finding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in Bangladesh. Funding United States Agency for International Development, UK Department for International Development, Bill & Melinda Gates Foundation.


      PubDate: 2014-10-13T01:39:44Z
       
  • Clinical efficacy and safety of a novel tetravalent dengue vaccine in
           healthy children in Asia: a phase 3, randomised, observer-masked,
           placebo-controlled trial
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Maria Rosario Capeding , Ngoc Huu Tran , Sri Rezeki S Hadinegoro , Hussain Imam HJ Muhammad Ismail , Tawee Chotpitayasunondh , Mary Noreen Chua , Chan Quang Luong , Kusnandi Rusmil , Dewa Nyoman Wirawan , Revathy Nallusamy , Punnee Pitisuttithum , Usa Thisyakorn , In-Kyu Yoon , Diane van der Vliet , Edith Langevin , Thelma Laot , Yanee Hutagalung , Carina Frago , Mark Boaz , T Anh Wartel , Nadia G Tornieporth , Melanie Saville , Alain Bouckenooghe
      Background An estimated 100 million people have symptomatic dengue infection every year. This is the first report of a phase 3 vaccine efficacy trial of a candidate dengue vaccine. We aimed to assess the efficacy of the CYD dengue vaccine against symptomatic, virologically confirmed dengue in children. Methods We did an observer-masked, randomised controlled, multicentre, phase 3 trial in five countries in the Asia-Pacific region. Between June 3, and Dec 1, 2011, healthy children aged 2–14 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratified by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective efficacy against symptomatic, virologically confirmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine efficacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281. Findings We randomly assigned 10 275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confirmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 56·5% (95% CI 43·8–66·4) efficacy. We recorded 647 serious adverse events (402 [62%] in the vaccine group and 245 [38%] in the control group). 54 (1%) children in the vaccine group and 33 (1%) of those in the control group had serious adverse events that happened within 28 days of vaccination. Serious adverse events were consistent with medical disorders in this age group and were mainly infections and injuries. Interpretation Our findings show that dengue vaccine is efficacious when given as three injections at months 0, 6, and 12 to children aged 2–14 years in endemic areas in Asia, and has a good safety profile. Vaccination could reduce the incidence of symptomatic infection and hospital admission and has the potential to provide an important public health benefit. Funding Sanofi Pasteur.


      PubDate: 2014-10-13T01:39:44Z
       
  • Department of Error
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951




      PubDate: 2014-10-13T01:39:44Z
       
  • Once-weekly dulaglutide versus once-daily liraglutide in metformin-treated
           patients with type 2 diabetes (AWARD-6): a randomised, open-label, phase
           3, non-inferiority trial
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Kathleen M Dungan , Santiago Tofé Povedano , Thomas Forst , José G González González , Charles Atisso , Whitney Sealls , Jessie L Fahrbach
      Background Dulaglutide and liraglutide, both glucagon-like peptide-1 (GLP-1) receptor agonists, improve glycaemic control and reduce weight in patients with type 2 diabetes. In a head-to-head trial, we compared the safety and efficacy of once-weekly dulaglutide with that of once-daily liraglutide in metformin-treated patients with uncontrolled type 2 diabetes. Methods We did a phase 3, randomised, open-label, parallel-group study at 62 sites in nine countries between June 20, 2012, and Nov 25, 2013. Patients with inadequately controlled type 2 diabetes receiving metformin (≥1500 mg/day), aged 18 years or older, with glycated haemoglobin (HbA1c) 7·0% or greater (≥53 mmol/mol) and 10·0% or lower (≤86 mmol/mol), and body-mass index 45 kg/m2 or lower were randomly assigned to receive once-weekly dulaglutide (1·5 mg) or once-daily liraglutide (1·8 mg). Randomisation was done according to a computer-generated random sequence with an interactive voice response system. Participants and investigators were not masked to treatment allocation. The primary outcome was non-inferiority (margin 0·4%) of dulaglutide compared with liraglutide for change in HbA1c (least-squares mean change from baseline) at 26 weeks. Safety data were collected for a further 4 weeks' follow-up. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01624259. Findings We randomly assigned 599 patients to receive once-weekly dulaglutide (299 patients) or once-daily liraglutide (300 patients). 269 participants in each group completed treatment at week 26. Least-squares mean reduction in HbA1c was −1·42% (SE 0·05) in the dulaglutide group and −1·36% (0·05) in the liraglutide group. Mean treatment difference in HbA1c was −0·06% (95% CI −0·19 to 0·07, pnon-inferiority<0·0001) between the two groups. The most common gastrointestinal adverse events were nausea (61 [20%] in dulaglutide group vs 54 [18%] in liraglutide group), diarrhoea (36 [12%] vs 36 [12%]), dyspepsia (24 [8%] vs 18 [6%]), and vomiting (21 [7%] vs 25 [8%]), with similar rates of study or study drug discontinuation because of adverse events between the two groups (18 [6%] in each group). The hypoglycaemia rate was 0·34 (SE 1·44) and 0·52 (3·01) events per patient per year, respectively, and no severe hypoglycaemia was reported. Interpretation Once-weekly dulaglutide is non-inferior to once-daily liraglutide for least-squares mean reduction in HbA1c, with a similar safety and tolerability profile. Funding Eli Lilly and Company.


      PubDate: 2014-10-13T01:39:44Z
       
  • Ebola: a call for blood transfusion strategy in sub-Saharan Africa
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Thierry Burnouf , Jean Emmanuel , Dora Mbanya , Magdy El-Ekiaby , William Murphy , Stephen Field , Jean-Pierre Allain



      PubDate: 2014-10-13T01:39:44Z
       
  • Did René Descartes have a giant ethmoidal sinus osteoma'
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Philippe Charlier , Philippe Froesch , Nadia Benmoussa , Alain Froment , Russell Shorto , Isabelle Huynh-Charlier



      PubDate: 2014-10-13T01:39:44Z
       
  • Chlorhexidine's role in skin antisepsis: questioning the evidence
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Matthias Maiwald , Pryseley N Assam , Edwin S-Y Chan , Stephanie J Dancer



      PubDate: 2014-10-13T01:39:44Z
       
  • Chlorhexidine's role in skin antisepsis: questioning the
           evidence–Author's reply
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Dennis G Maki



      PubDate: 2014-10-13T01:39:44Z
       
  • Chronic whiplash-associated disorders
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Andreas Otte , David Vállez Garcia , Rudi A J O Dierckx , Gert Holstege



      PubDate: 2014-10-13T01:39:44Z
       
  • Equity in health care in Nepal
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Sudan Prasad Neupane



      PubDate: 2014-10-13T01:39:44Z
       
  • In praise of Muswell Hillbillies
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Athar Yawar



      PubDate: 2014-10-13T01:39:44Z
       
  • Julia Margaret Polak
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Jeremy Laurance



      PubDate: 2014-10-13T01:39:44Z
       
  • The burden of tuberculosis disease in children
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Charalambos Sismanidis , Philippe Glaziou , Irwin Law , Katherine Floyd



      PubDate: 2014-10-13T01:39:44Z
       
  • The burden of tuberculosis disease in children–Authors' reply
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Helen E Jenkins , Marcello Pagano , Courtney M Yuen , Mercedes C Becerra , Ted Cohen



      PubDate: 2014-10-13T01:39:44Z
       
  • Tobacco advertising still rife in southeast Asia
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Chris McCall



      PubDate: 2014-10-13T01:39:44Z
       
  • A dark dystopian tale J Howard Jacobson. Jonathan Cape, 2014. Pp 336.
           £18·99.ISBN 0224102052
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Terry Eagleton



      PubDate: 2014-10-13T01:39:44Z
       
  • A kaleidoscopic imagination DavidMitchellThe Bone
           Clocks2014Sceptre/Hodder9781473604889608£20·00.
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Jonathan Barnes



      PubDate: 2014-10-13T01:39:44Z
       
  • Janet Hemingway: putting the bite back into insect vector biology
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Geoff Watts



      PubDate: 2014-10-13T01:39:44Z
       
  • Ebola: towards an International Health Systems Fund
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Lawrence O Gostin



      PubDate: 2014-10-13T01:39:44Z
       
  • Discoverers of brain navigation network win Nobel prize
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Anna Petherick



      PubDate: 2014-10-13T01:39:44Z
       
  • Indian generic drugs debate heats up
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Sanjeet Bagcchi



      PubDate: 2014-10-13T01:39:44Z
       
  • Which incretin-based therapy for type 2 diabetes'
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): André J Scheen



      PubDate: 2014-10-13T01:39:44Z
       
  • Dengue vaccines: dawning at last'
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Annelies Wilder-Smith



      PubDate: 2014-10-13T01:39:44Z
       
  • Challenges of achieving and tracking MDG 5
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Saifuddin Ahmed



      PubDate: 2014-10-13T01:39:44Z
       
  • Offline: People to people
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Richard Horton



      PubDate: 2014-10-13T01:39:44Z
       
  • Securing better, safer blood supplies in Latin America
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): The Lancet



      PubDate: 2014-10-13T01:39:44Z
       
  • Health technologies and computer security
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): The Lancet



      PubDate: 2014-10-13T01:39:44Z
       
  • Ebola: a crisis in global health leadership
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Lawrence O Gostin , Eric A Friedman



      PubDate: 2014-10-13T01:39:44Z
       
  • Ebola: what lessons for the International Health Regulations'
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): The Lancet



      PubDate: 2014-10-13T01:39:44Z
       
  • October 11–17, 2014
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951




      PubDate: 2014-10-13T01:39:44Z
       
  • Ischaemic scalp ulceration and hair loss
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Çağdaş Ünlü , Jean-Paul P M de Vries



      PubDate: 2014-10-13T01:39:44Z
       
  • Ovarian cancer
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Gordon C Jayson , Elise C Kohn , Henry C Kitchener , Jonathan A Ledermann
      Epithelial ovarian cancer is the commonest cause of gynaecological cancer-associated death. The disease typically presents in postmenopausal women, with a few months of abdominal pain and distension. Most women have advanced disease (International Federation of Gynecology and Obstetrics [FIGO] stage III), for which the standard of care remains surgery and platinum-based cytotoxic chemotherapy. Although this treatment can be curative for most patients with early stage disease, most women with advanced disease will develop many episodes of recurrent disease with progressively shorter disease-free intervals. These episodes culminate in chemoresistance and ultimately bowel obstruction, the most frequent cause of death. For women whose disease continues to respond to platinum-based drugs, the disease can often be controlled for 5 years or more. Targeted treatments such as antiangiogenic drugs or poly (ADP-ribose) polymerase inhibitors offer potential for improved survival. The efficacy of screening, designed to detect the disease at an earlier and curable stage remains unproven, with key results expected in 2015.


      PubDate: 2014-10-13T01:39:44Z
       
  • Current status of rabies and prospects for elimination
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Anthony R Fooks , Ashley C Banyard , Daniel L Horton , Nicholas Johnson , Lorraine M McElhinney , Alan C Jackson
      Rabies is one of the most deadly infectious diseases, with a case-fatality rate approaching 100%. The disease is established on all continents apart from Antarctica; most cases are reported in Africa and Asia, with thousands of deaths recorded annually. However, the estimated annual figure of almost 60 000 human rabies fatalities is probably an underestimate. Almost all cases of human rabies result from bites from infected dogs. Therefore, the most cost-effective approach to elimination of the global burden of human rabies is to control canine rabies rather than expansion of the availability of human prophylaxis. Mass vaccination campaigns with parenteral vaccines, and advances in oral vaccines for wildlife, have allowed the elimination of rabies in terrestrial carnivores in several countries worldwide. The subsequent reduction in cases of human rabies in such regions advocates the multidisciplinary One Health approach to rabies control through the mass vaccination of dogs and control of canine populations.


      PubDate: 2014-10-13T01:39:44Z
       
  • Dyspnoea, weight loss, fever, and headache caused by extrapulmonary
           tuberculosis in a prison inmate
    • Abstract: Publication date: 11–17 October 2014
      Source:The Lancet, Volume 384, Issue 9951
      Author(s): Musharaf Tarajia , Fabio Jaramillo , Amaranta Pernett , Nelson Santamaría , Amador Goodridge



      PubDate: 2014-10-13T01:39:44Z
       
  • Exercises to improve function of the rheumatoid hand (SARAH): a randomised
           controlled trial
    • Abstract: Publication date: Available online 9 October 2014
      Source:The Lancet
      Author(s): Sarah E Lamb , Esther M Williamson , Peter J Heine , Jo Adams , Sukhdeep Dosanjh , Melina Dritsaki , Matthew J Glover , Joanne Lord , Christopher McConkey , Vivien Nichols , Anisur Rahman , Martin Underwood , Mark A Williams
      Background Disease-modifying biological agents and other drug regimens have substantially improved control of disease activity and joint damage in people with rheumatoid arthritis of the hand. However, commensurate changes in function and quality of life are not always noted. Tailored hand exercises might provide additional improvements, but evidence is lacking. We estimated the effectiveness and cost-effectiveness of tailored hand exercises in addition to usual care during 12 months. Methods In this pragmatic, multicentre, parallel-group trial, at 17 National Health Service sites across the UK we randomly assigned 490 adults with rheumatoid arthritis who had pain and dysfunction of the hands and had been on a stable drug regimen for at least 3 months, to either usual care or usual care plus a tailored strengthening and stretching hand exercise programme. Participants were randomly assigned with stratification by centre. Allocation was computer generated and unmasked to participants and therapists delivering treatment after randomisation. Outcome assessors and all investigators were masked to allocation. Physiotherapists or occupational therapists gave the treatments. The primary outcome was the Michigan Hand Outcomes Questionnaire overall hand function score at 12 months. The analysis was by intention to treat. We calculated cost per quality-adjusted life-year. This trial is registered as ISRCTN 89936343. Findings Between Oct 5, 2009, and May 10, 2011, we screened 1606 people, of whom 490 were randomly assigned to usual care (n=244) or tailored exercises (n=246). 438 of 490 participants (89%) provided 12 month follow-up data. Improvements in overall hand function were 3·6 points (95% CI 1·5–5·7) in the usual care group and 7·9 points (6·0–9·9) in the exercise group (mean difference between groups 4·3, 95% CI 1·5–7·1; p=0·0028). Pain, drug regimens, and health-care resource use were stable for 12 months, with no difference between the groups. No serious adverse events associated with the treatment were recorded. The cost of tailored hand exercise was £156 per person; cost per quality-adjusted life-year was £9549 with the EQ-5D (£17 941 with imputation for missing data). Interpretation We have shown that a tailored hand exercise programme is a worthwhile, low-cost intervention to provide as an adjunct to various drug regimens. Maximisation of the benefits of biological and DMARD regimens in terms of function, disability, and health-related quality of life should be an important treatment aim. Funding UK National Institute of Health Research Health Technology Assessment Programme (NIHR HTA), project number 07/32/05.


      PubDate: 2014-10-13T01:39:44Z
       
  • Towards evidence-based hand exercises in rheumatoid arthritis
    • Abstract: Publication date: Available online 9 October 2014
      Source:The Lancet
      Author(s): Christina H Opava , Mathilda Björk



      PubDate: 2014-10-13T01:39:44Z
       
  • Controlling Ebola: next steps
    • Abstract: Publication date: Available online 9 October 2014
      Source:The Lancet
      Author(s): Ranu S Dhillon , Devabhaktuni Srikrishna , Jeffrey Sachs



      PubDate: 2014-10-13T01:39:44Z
       
  • Getting human rights right in global health policy
    • Abstract: Publication date: Available online 9 October 2014
      Source:The Lancet
      Author(s): John Tasioulas , Effy Vayena



      PubDate: 2014-10-13T01:39:44Z
       
  • Blue–black eyes and legs
    • Abstract: Publication date: Available online 9 October 2014
      Source:The Lancet
      Author(s): Cassandra C Gauer , Hector I Michelena



      PubDate: 2014-10-13T01:39:44Z
       
  • Uterine transplant: new medical and ethical considerations
    • Abstract: Publication date: Available online 7 October 2014
      Source:The Lancet
      Author(s): Ruth M Farrell , Tommaso Falcone



      PubDate: 2014-10-13T01:39:44Z
       
  • Livebirth after uterus transplantation
    • Abstract: Publication date: Available online 6 October 2014
      Source:The Lancet
      Author(s): Mats Brännström , Liza Johannesson , Hans Bokström , Niclas Kvarnström , Johan Mölne , Pernilla Dahm-Kähler , Anders Enskog , Milan Milenkovic , Jana Ekberg , Cesar Diaz-Garcia , Markus Gäbel , Ash Hanafy , Henrik Hagberg , Michael Olausson , Lars Nilsson
      Background Uterus transplantation is the first available treatment for absolute uterine infertility, which is caused by absence of the uterus or the presence of a non-functional uterus. Eleven human uterus transplantation attempts have been done worldwide but no livebirth has yet been reported. Methods In 2013, a 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) underwent transplantation of the uterus in Sahlgrenska University Hospital, Gothenburg, Sweden. The uterus was donated from a living, 61-year-old, two-parous woman. In-vitro fertilisation treatment of the recipient and her partner had been done before transplantation, from which 11 embryos were cryopreserved. Findings The recipient and the donor had essentially uneventful postoperative recoveries. The recipient's first menstruation occurred 43 days after transplantation and she continued to menstruate at regular intervals of between 26 and 36 days (median 32 days). 1 year after transplantation, the recipient underwent her first single embryo transfer, which resulted in pregnancy. She was then given triple immunosuppression (tacrolimus, azathioprine, and corticosteroids), which was continued throughout pregnancy. She had three episodes of mild rejection, one of which occurred during pregnancy. These episodes were all reversed by corticosteroid treatment. Fetal growth parameters and blood flows of the uterine arteries and umbilical cord were normal throughout pregnancy. The patient was admitted with pre-eclampsia at 31 full weeks and 5 days, and 16 h later a caesarean section was done because of abnormal cardiotocography. A male baby with a normal birthweight for gestational age (1775 g) and with APGAR scores 9, 9, 10 was born. Interpretation We describe the first livebirth after uterus transplantation. This report is a proof-of-concept for uterus transplantation as a treatment for uterine factor infertility. Furthermore, the results show the feasibility of live uterus donation, even from a postmenopausal donor. Funding Jane and Dan Olsson Foundation for Science.


      PubDate: 2014-10-13T01:39:44Z
       
  • Self-reported quality of life of adolescents with cerebral palsy: a
           cross-sectional and longitudinal analysis
    • Abstract: Publication date: Available online 6 October 2014
      Source:The Lancet
      Author(s): Allan Colver , Marion Rapp , Nora Eisemann , Virginie Ehlinger , Ute Thyen , Heather O Dickinson , Jackie Parkes , Kathryn Parkinson , Malin Nystrand , Jérôme Fauconnier , Marco Marcelli , Susan I Michelsen , Catherine Arnaud
      Background Children with cerebral palsy who can self-report have similar quality of life (QoL) to their able-bodied peers. Is this similarity also found in adolescence' We examined how self-reported QoL of adolescents with cerebral palsy varies with impairment and compares with the general population, and how factors in childhood predict adolescent QoL. Methods We report QoL outcomes in a longitudinal follow-up and cross-sectional analysis of individuals included in the SPARCLE1 (childhood) and SPARCLE2 (adolescent) studies. In 2004 (SPARCLE1), a cohort of 818 children aged 8–12 years were randomly selected from population-based cerebral palsy registers in nine European regions. We gathered data from 500 participants about QoL with KIDSCREEN (ten domains); frequency of pain; child psychological problems (Strengths and Difficulties Questionnaire); and parenting stress (Parenting Stress Index). At follow-up in 2009 (SPARCLE2), 355 (71%) adolescents aged 13–17 years remained in the study and self-reported QoL (longitudinal sample). 76 additional adolescents self-reported QoL in 2009, providing data for 431 adolescents in the cross-sectional sample. Researchers gathered data at home visits. We compared QoL against matched controls in the general population. We used multivariable regression to relate QoL of adolescents with cerebral palsy to impairments (cross-sectional analysis) and to childhood QoL, pain, psychological problems, and parenting stress (longitudinal analysis). Findings Severity of impairment was significantly associated (p<0·01) with reduced adolescent QoL on only three domains (Moods and emotions, Autonomy, and Social support and peers); average differences in QoL between the least and most able groups were generally less than 0·5 SD. Adolescents with cerebral palsy had significantly lower QoL than did those in the general population in only one domain (Social support and peers; mean difference −2·7 [0·25 SD], 95% CI −4·3 to −1·4). Pain in childhood or adolescence was strongly associated with low adolescent QoL on eight domains. Childhood QoL was a consistent predictor of adolescent QoL. Child psychological problems and parenting stress in childhood or their worsening between childhood and adolescence predicted only small reductions in adolescent QoL. Interpretation Individual and societal attitudes should be affected by the similarity of the QoL of adolescents with and without cerebral palsy. Adolescents with cerebral palsy need particular help to maintain and develop peer relationships. Interventions in childhood to alleviate psychological difficulties, parenting stress, and especially pain, are justified for their intrinsic value and for their longer term effect on adolescent QoL. Funding SPARCLE1 was funded by the European Union Research Framework 5 Program (grant number QLG5-CT-2002-00636), the German Ministry of Health GRR-58640-2/14, and the German Foundation for the Disabled Child. SPARCLE2 was funded by: Wellcome Trust WT 086315 A1A (UK and Ireland); Medical Faculty of the University of Lübeck E40-2009 and E26-2010 (Germany); CNSA, INSERM, MiRe–DREES, and IRESP (France); Ludvig and Sara Elsass Foundation, The Spastics Society and Vanforefonden (Denmark); Cooperativa Sociale “Gli Anni in Tasca” and Fondazione Carivit, Viterbo (Italy); Göteborg University—Riksforbundet for Rorelsehindrade Barn och Ungdomar and the Folke Bernadotte Foundation (Sweden).
      PubDate: 2014-10-13T01:39:44Z
       
  • Quality of life in adolescents with cerebral palsy
    • Abstract: Publication date: Available online 6 October 2014
      Source:The Lancet
      Author(s): Alexander H Hoon Jr , Elaine E Stashinko



      PubDate: 2014-10-13T01:39:44Z
       
  • October 4–10, 2014
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950




      PubDate: 2014-10-13T01:39:44Z
       
  • Fertility: progress and uncertainty
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950
      Author(s): The Lancet



      PubDate: 2014-10-13T01:39:44Z
       
  • Concerns about UK emergency surgery death rates
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950
      Author(s): The Lancet



      PubDate: 2014-10-13T01:39:44Z
       
  • Tuberculosis rates still high in the UK
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950
      Author(s): The Lancet



      PubDate: 2014-10-13T01:39:44Z
       
  • The Institut Pasteur network: a crucial partner against Ebola
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950
      Author(s): Audrey Ceschia



      PubDate: 2014-10-13T01:39:44Z
       
  • Continuous subcutaneous insulin infusion for type 2 diabetes
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950
      Author(s): Pratik Choudhary



      PubDate: 2014-10-13T01:39:44Z
       
  • Rituximab for childhood-onset nephrotic syndrome
    • Abstract: Publication date: 4–10 October 2014
      Source:The Lancet, Volume 384, Issue 9950
      Author(s): Elisabeth M Hodson , Jonathan C Craig



      PubDate: 2014-10-13T01:39:44Z
       
 
 
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