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The Lancet    [907 followers]  Follow    
  Full-text available via subscription Subscription journal
     ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
     Published by Elsevier Homepage  [2556 journals]   [SJR: 7.074]   [H-I: 477]
  • Recombinant phenylalanine ammonia lyase in phenylketonuria
    • Abstract: Publication date: Available online 14 April 2014
      Source:The Lancet
      Author(s): Francjan J van Spronsen , Terry G J Derks



      PubDate: 2014-04-17T06:49:05Z
       
  • Transformation of HIV from pandemic to low-endemic levels: a public health
           approach to combination prevention
    • Abstract: Publication date: Available online 14 April 2014
      Source:The Lancet
      Author(s): Alexandra Jones , Ide Cremin , Fareed Abdullah , John Idoko , Peter Cherutich , Nduku Kilonzo , Helen Rees , Timothy Hallett , Kevin O'Reilly , Florence Koechlin , Bernhard Schwartlander , Barbara de Zalduondo , Susan Kim , Jonathan Jay , Jacqueline Huh , Peter Piot , Mark Dybul
      Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.


      PubDate: 2014-04-17T06:49:05Z
       
  • Single-dose, subcutaneous recombinant phenylalanine ammonia lyase
           conjugated with polyethylene glycol in adult patients with
           phenylketonuria: an open-label, multicentre, phase 1 dose-escalation trial
           
    • Abstract: Publication date: Available online 14 April 2014
      Source:The Lancet
      Author(s): Nicola Longo , Cary O Harding , Barbara K Burton , Dorothy K Grange , Jerry Vockley , Melissa Wasserstein , Gregory M Rice , Alejandro Dorenbaum , Jutta K Neuenburg , Donald G Musson , Zhonghua Gu , Saba Sile
      Background Phenylketonuria is an inherited disease caused by impaired activity of phenylalanine hydroxylase, the enzyme that converts phenylalanine to tyrosine, leading to accumulation of phenylalanine and subsequent neurocognitive dysfunction. Phenylalanine ammonia lyase is a prokaryotic enzyme that converts phenylalanine to ammonia and trans-cinnamic acid. We aimed to assess the safety, tolerability, pharmacokinetic characteristics, and efficacy of recombinant Anabaena variabilis phenylalanine ammonia lyase (produced in Escherichia coli) conjugated with polyethylene glycol (rAvPAL-PEG) in reducing phenylalanine concentrations in adult patients with phenylketonuria. Methods In this open-label, phase 1, multicentre trial, single subcutaneous injections of rAvPAL-PEG were given in escalating doses (0·001, 0·003, 0·010, 0·030, and 0·100 mg/kg) to adults with phenylketonuria. Participants aged 18 years or older with blood phenylalanine concentrations of 600 μmol/L or higher were recruited from among patients attending metabolic disease clinics in the USA. The primary endpoints were safety and tolerability of rAvPAL-PEG. Secondary endpoints were the pharmacokinetic characteristics of the drug and its effect on concentrations of phenylalanine. Participants and investigators were not masked to assigned dose group. This study is registered with ClinicalTrials.gov, number NCT00925054. Findings 25 participants were recruited from seven centres between May 6, 2008, and April 15, 2009, with five participants assigned to each escalating dose group. All participants were included in the safety population. The most frequently reported adverse events were injection-site reactions and dizziness, which were self-limited and without sequelae. Two participants had serious adverse reactions to intramuscular medroxyprogesterone acetate, a drug that contains polyethylene glycol as an excipient. Three of five participants given the highest dose of rAvPAL-PEG (0·100 mg/kg) developed a generalised skin rash. By the end of the study, all participants had developed antibodies against polyethylene glycol, and some against phenylalanine ammonia lyase as well. Drug concentrations peaked about 89–106 h after administration of the highest dose. Treatment seemed to be effective at reducing blood phenylalanine in all five participants who received the highest dose (mean reduction of 54·2% from baseline), with a nadir about 6 days after injection and an inverse correlation between drug and phenylalanine concentrations in plasma. Phenylalanine returned to near-baseline concentrations about 21 days after the injection. Interpretation Subcutaneous administration of rAvPAL-PEG in a single dose of up to 0·100 mg/kg was fairly safe and well tolerated in adult patients with phenylketonuria. At the highest dose tested, rAvPAL-PEG reduced blood phenylalanine concentrations. In view of the development of antibodies against polyethylene glycol (and in some cases against phenylalanine ammonia lyase), future studies are needed to assess the effect of repeat dosing. Funding BioMarin Pharmaceutical.


      PubDate: 2014-04-17T06:49:05Z
       
  • Tackling violence against health-care workers
    • Abstract: Publication date: Available online 15 April 2014
      Source:The Lancet
      Author(s): Roxanne Nelson



      PubDate: 2014-04-17T06:49:05Z
       
  • Functional brain imaging: gatecrashing the clinical party'
    • Abstract: Publication date: Available online 15 April 2014
      Source:The Lancet
      Author(s): Jamie Sleigh , Catherine E Warnaby



      PubDate: 2014-04-17T06:49:05Z
       
  • Delayed cord clamping: does gravity matter'
    • Abstract: Publication date: Available online 17 April 2014
      Source:The Lancet
      Author(s): Tonse N K Raju



      PubDate: 2014-04-17T06:49:05Z
       
  • Diagnostic precision of PET imaging and functional MRI in disorders of
           consciousness: a clinical validation study
    • Abstract: Publication date: Available online 15 April 2014
      Source:The Lancet
      Author(s): Johan Stender , Olivia Gosseries , Marie-Aurélie Bruno , Vanessa Charland-Verville , Audrey Vanhaudenhuyse , Athena Demertzi , Camille Chatelle , Marie Thonnard , Aurore Thibaut , Lizette Heine , Andrea Soddu , Mélanie Boly , Caroline Schnakers , Albert Gjedde , Steven Laureys
      Background Bedside clinical examinations can have high rates of misdiagnosis of unresponsive wakefulness syndrome (vegetative state) or minimally conscious state. The diagnostic and prognostic usefulness of neuroimaging-based approaches has not been established in a clinical setting. We did a validation study of two neuroimaging-based diagnostic methods: PET imaging and functional MRI (fMRI). Methods For this clinical validation study, we included patients referred to the University Hospital of Liège, Belgium, between January, 2008, and June, 2012, who were diagnosed by our unit with unresponsive wakefulness syndrome, locked-in syndrome, or minimally conscious state with traumatic or non-traumatic causes. We did repeated standardised clinical assessments with the Coma Recovery Scale–Revised (CRS–R), cerebral 18F-fluorodeoxyglucose (FDG) PET, and fMRI during mental activation tasks. We calculated the diagnostic accuracy of both imaging methods with CRS–R diagnosis as reference. We assessed outcome after 12 months with the Glasgow Outcome Scale–Extended. Findings We included 41 patients with unresponsive wakefulness syndrome, four with locked-in syndrome, and 81 in a minimally conscious state (48=traumatic, 78=non-traumatic; 110=chronic, 16=subacute). 18F-FDG PET had high sensitivity for identification of patients in a minimally conscious state (93%, 95% CI 85–98) and high congruence (85%, 77–90) with behavioural CRS–R scores. The active fMRI method was less sensitive at diagnosis of a minimally conscious state (45%, 30–61) and had lower overall congruence with behavioural scores (63%, 51–73) than PET imaging. 18F-FDG PET correctly predicted outcome in 75 of 102 patients (74%, 64–81), and fMRI in 36 of 65 patients (56%, 43–67). 13 of 42 (32%) of the behaviourally unresponsive patients (ie, diagnosed as unresponsive with CRS–R) showed brain activity compatible with (minimal) consciousness (ie, activity associated with consciousness, but diminished compared with fully conscious individuals) on at least one neuroimaging test; 69% of these (9 of 13) patients subsequently recovered consciousness. Interpretation Cerebral 18F-FDG PET could be used to complement bedside examinations and predict long-term recovery of patients with unresponsive wakefulness syndrome. Active fMRI might also be useful for differential diagnosis, but seems to be less accurate. Funding The Belgian National Funds for Scientific Research (FNRS), Fonds Léon Fredericq, the European Commission, the James McDonnell Foundation, the Mind Science Foundation, the French Speaking Community Concerted Research Action, the University of Copenhagen, and the University of Liège.


      PubDate: 2014-04-17T06:49:05Z
       
  • Effect of gravity on volume of placental transfusion: a multicentre,
           randomised, non-inferiority trial
    • Abstract: Publication date: Available online 17 April 2014
      Source:The Lancet
      Author(s): Nestor E Vain , Daniela S Satragno , Adriana N Gorenstein , Juan E Gordillo , Juan P Berazategui , M Guadalupe Alda , Luis M Prudent
      Background Delayed cord clamping allows for the passage of blood from the placenta to the baby and reduces the risk of iron deficiency in infancy. To hold the infant for more than 1 min at the level of the vagina (as is presently recommended), on the assumption that gravity affects the volume of placental transfusion, is cumbersome, might result in low compliance, and interferes with immediate contact of the infant with the mother. We aimed to assess whether gravity affects the volume of placental transfusion Methods We did a multicentre non-inferiority trial at three university-affiliated hospitals in Argentina. We obtained informed consent from healthy mothers with normal term pregnancies admitted early in labour. Vigorous babies born vaginally were randomly assigned in a 1:1 ratio by computer-generated blocks and sequentially numbered sealed opaque envelopes to be held for 2 min before clamping the umbilical cord, at the level of the vagina (introitus group) or on the mother's abdomen or chest (abdomen group). Newborn babies were weighed immediately after birth and after cord clamping. The primary outcome was the difference in weight (as a proxy of placental transfusion volume). The prespecified non-inferiority margin was 18 g (20%). We used t test and χ2 test for group comparison, and used a multivariable linear regression analysis to control for covariables. This trial is registered with ClinicalTrials.gov, number NCT01497353. Findings Between Aug 1, 2011, and Aug 31, 2012, we allocated 274 newborn babies to the introitus group and 272 to the abdomen group. 77 newborn babies in the introitus group and 78 in the abdomen group were ineligible after randomisation (eg, caesarean section, forceps delivery, short umbilical cord or nuchal cord). Mean weight change was 56 g (SD 47, 95% CI 50–63) for 197 babies in the introitus group compared with 53 g (45, 46–59) for 194 babies in the abdomen group, supporting non-inferiority of the two approaches (difference 3 g, 95% CI −5·8 to 12·8; p=0·45). We did not note any serious adverse events during the study. Interpretation Position of the newborn baby before cord clamping does not seem to affect volume of placental transfusion. Mothers could safely be allowed to hold their baby on their abdomen or chest. This change in practice might increase obstetric compliance with the procedure, enhance maternal-infant bonding, and decrease iron deficiency in infancy. Funding Foundation for Maternal and Child Health (FUNDASAMIN).


      PubDate: 2014-04-17T06:49:05Z
       
  • Protection against varicella with two doses of combined
           measles-mumps-rubella-varicella vaccine versus one dose of monovalent
           varicella vaccine: a multicentre, observer-blind, randomised, controlled
           trial
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Roman Prymula , Marianne Riise Bergsaker , Susanna Esposito , Leif Gothefors , Sorin Man , Nadezhda Snegova , Mária Štefkovičova , Vytautas Usonis , Jacek Wysocki , Martine Douha , Ventzislav Vassilev , Ouzama Nicholson , Bruce L Innis , Paul Willems
      Background Rates of varicella have decreased substantially in countries implementing routine varicella vaccination. Immunisation is possible with monovalent varicella vaccine or a combined measles-mumps-rubella-varicella vaccine (MMRV). We assessed protection against varicella in naive children administered one dose of varicella vaccine or two doses of MMRV. Methods This study was done in ten European countries with endemic varicella. Healthy children aged 12–22 months were randomised (3:3:1 ratio, by computer-generated randomisation list, with block size seven) to receive 42 days apart (1) two doses of MMRV (MMRV group), or (2) MMR at dose one and monovalent varicella vaccine at dose two (MMR+V group), or (3) two doses of MMR (MMR group; control). Participants and their parents or guardians, individuals involved in assessment of any outcome, and sponsor staff involved in review or analysis of data were masked to treatment assignment. The primary efficacy endpoint was occurrence of confirmed varicella (by detection of varicella zoster virus DNA or epidemiological link) from 42 days after the second vaccine dose to the end of the first phase of the trial. Cases were graded for severity. Efficacy analyses were per protocol. Safety analyses included all participants who received at least one vaccine dose. This trial is registered with ClinicalTrials.gov, number NCT00226499. Findings Between Sept 1, 2005, and May 10, 2006, 5803 children (mean age 14·2 months, SD 2·5) were vaccinated. In the efficacy cohort of 5285 children, the mean duration of follow-up in the MMRV group was 36 months (SD 8·8), in the MMR+V group was 36 months (8·5) and in the MMR group was 35 months (8·9). Varicella cases were confirmed for 37 participants in the MMRV group (two moderate to severe), 243 in the MMR+V group, and 201 in the MMR group. Second cases occurred for three participants (all in the MMR+V group). Varicella cases were moderate to severe for two participants in the MMRV group, 37 in the MMR+V group (one being a second case that followed a mild first case); and 117 in the MMR group. Efficacy of two-dose MMRV against all varicella was 94·9% (97·5% CI 92·4–96·6), and against moderate to severe varicella was 99·5% (97·5–99·9). Efficacy of one-dose varicella vaccine against all varicella was 65·4% (57·2–72·1), and against moderate to severe varicella (post hoc) was 90·7% (85·9–93·9). The most common adverse event in all groups was injection-site redness (up to 25% of participants). Within 15 days after dose one, 57·4% (95% CI 53·9–60·9) of participants in the MMRV group reported fever of 38°C or more, by contrast with 44·5% (41·0–48·1) with MMR+V, and 39·8% (33·8–46·1) with MMR. Eight serious adverse events were deemed related to vaccination (three MMRV, four MMR+V, one MMR). All resolved within the study period. Interpretation These results support the implementation of two-dose varicella vaccination on a short course, to ensure optimum protection from all forms of varicella disease. Funding GlaxoSmithKline Vaccines.


      PubDate: 2014-04-12T06:47:54Z
       
  • Acute myocardial infarction: a comparison of short-term survival in
           national outcome registries in Sweden and the UK
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Sheng-Chia Chung , Rolf Gedeborg , Owen Nicholas , Stefan James , Anders Jeppsson , Charles Wolfe , Peter Heuschmann , Lars Wallentin , John Deanfield , Adam Timmis , Tomas Jernberg , Harry Hemingway
      Background International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK. Methods We used data from national registries on consecutive patients registered between 2004 and 2010 in all hospitals providing care for acute coronary syndrome in Sweden and the UK. The primary outcome was all-cause mortality 30 days after admission. We compared effectiveness of treatment by indirect casemix standardisation. This study is registered with ClinicalTrials.gov, number NCT01359033. Findings We assessed data for 119 786 patients in Sweden and 391 077 in the UK. 30-day mortality was 7·6% (95% CI 7·4–7·7) in Sweden and 10·5% (10·4–10·6) in the UK. Mortality was higher in the UK in clinically relevant subgroups defined by troponin concentration, ST-segment elevation, age, sex, heart rate, systolic blood pressure, diabetes mellitus status, and smoking status. In Sweden, compared with the UK, there was earlier and more extensive uptake of primary percutaneous coronary intervention (59% vs 22%) and more frequent use of β blockers at discharge (89% vs 78%). After casemix standardisation the 30-day mortality ratio for UK versus Sweden was 1·37 (95% CI 1·30–1·45), which corresponds to 11 263 (95% CI 9620–12 827) excess deaths, but did decline over time (from 1·47, 95% CI 1·38–1·58 in 2004 to 1·20, 1·12–1·29 in 2010; p=0·01). Interpretation We found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths. Funding Seventh Framework Programme for Research, National Institute for Health Research, Wellcome Trust (UK), Swedish Association of Local Authorities and Regions, Swedish Heart-Lung Foundation.


      PubDate: 2014-04-12T06:47:54Z
       
  • Assessing the efficacy of oral immunotherapy for the desensitisation of
           peanut allergy in children (STOP II): a phase 2 randomised controlled
           trial
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Katherine Anagnostou , Sabita Islam , Yvonne King , Loraine Foley , Laura Pasea , Simon Bond , Chris Palmer , John Deighton , Pamela Ewan , Andrew Clark
      Background Small studies suggest peanut oral immunotherapy (OIT) might be effective in the treatment of peanut allergy. We aimed to establish the efficacy of OIT for the desensitisation of children with allergy to peanuts. Methods We did a randomised controlled crossover trial to compare the efficacy of active OIT (using characterised peanut flour; protein doses of 2–800 mg/day) with control (peanut avoidance, the present standard of care) at the NIHR/Wellcome Trust Cambridge Clinical Research Facility (Cambridge, UK). Randomisation (1:1) was by use of an audited online system; group allocation was not masked. Eligible participants were aged 7–16 years with an immediate hypersensitivity reaction after peanut ingestion, positive skin prick test to peanuts, and positive by double-blind placebo-controlled food challenge (DBPCFC). We excluded participants if they had a major chronic illness, if the care provider or a present household member had suspected or diagnosed allergy to peanuts, or if there was an unwillingness or inability to comply with study procedures. Our primary outcome was desensitisation, defined as negative peanut challenge (1400 mg protein in DBPCFC) at 6 months (first phase). Control participants underwent OIT during the second phase, with subsequent DBPCFC. Immunological parameters and disease-specific quality-of-life scores were measured. Analysis was by intention to treat. Fisher's exact test was used to compare the proportion of those with desensitisation to peanut after 6 months between the active and control group at the end of the first phase. This trial is registered with Current Controlled Trials, number ISRCTN62416244. Findings The primary outcome, desensitisation, was recorded for 62% (24 of 39 participants; 95% CI 45–78) in the active group and none of the control group after the first phase (0 of 46; 95% CI 0–9; p<0·001). 84% (95% CI 70–93) of the active group tolerated daily ingestion of 800 mg protein (equivalent to roughly five peanuts). Median increase in peanut threshold after OIT was 1345 mg (range 45–1400; p<0·001) or 25·5 times (range 1·82–280; p<0·001). After the second phase, 54% (95% CI 35–72) tolerated 1400 mg challenge (equivalent to roughly ten peanuts) and 91% (79–98) tolerated daily ingestion of 800 mg protein. Quality-of-life scores improved (decreased) after OIT (median change −1·61; p<0·001). Side-effects were mild in most participants. Gastrointestinal symptoms were, collectively, most common (31 participants with nausea, 31 with vomiting, and one with diarrhoea), then oral pruritus after 6·3% of doses (76 participants) and wheeze after 0·41% of doses (21 participants). Intramuscular adrenaline was used after 0·01% of doses (one participant). Interpretation OIT successfully induced desensitisation in most children within the study population with peanut allergy of any severity, with a clinically meaningful increase in peanut threshold. Quality of life improved after intervention and there was a good safety profile. Immunological changes corresponded with clinical desensitisation. Further studies in wider populations are recommended; peanut OIT should not be done in non-specialist settings, but it is effective and well tolerated in the studied age group. Funding MRC-NIHR partnership.


      PubDate: 2014-04-12T06:47:54Z
       
  • HPV-based screening for prevention of invasive cervical cancer –
           Authors' reply
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Guglielmo Ronco , Chris J L Meijer , Nereo Segnan , Henry Kitchener , Paolo Giorgi-Rossi , Julian Peto , Joakim Dillner



      PubDate: 2014-04-12T06:47:54Z
       
  • Cognitive behaviour therapy for health anxiety
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Peter Tyrer , Paul Salkovskis , Helen Tyrer , Simon Dupont , David Murphy



      PubDate: 2014-04-12T06:47:54Z
       
  • Founding of the Global Health Film initiative
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Joseph R Fitchett , Lalitha Bhagavatheeswaran , Maysoon Dahab , Andy P Haines , W John Edmunds



      PubDate: 2014-04-12T06:47:54Z
       
  • Vitamin D supplements and bone mineral density – Authors' reply
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Ian R Reid , Mark J Bolland , Andrew Grey



      PubDate: 2014-04-12T06:47:54Z
       
  • HPV-based screening for prevention of invasive cervical cancer
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Mario Sideri , Sarah Igidbashian



      PubDate: 2014-04-12T06:47:54Z
       
  • HPV-based screening for prevention of invasive cervical cancer
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Achim Schneider , Ulrich Petry , Evrim Erdemoglu , Jorma Paavonen



      PubDate: 2014-04-12T06:47:54Z
       
  • Vitamin D supplements and bone mineral density
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Spyridon N Karras , Panagiotis Anagnostis , Olivier Beauchet , Dimitrios G Goulis , Cedric Annweiler



      PubDate: 2014-04-12T06:47:54Z
       
  • Vitamin D supplements and bone mineral density
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Mir Sadat-Ali , Haifa A Al-Turki



      PubDate: 2014-04-12T06:47:54Z
       
  • Vitamin D supplements and bone mineral density
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Colin Robert Dunstan



      PubDate: 2014-04-12T06:47:54Z
       
  • Vitamin D supplements and bone mineral density
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Helen Macdonald , Terence J Aspray



      PubDate: 2014-04-12T06:47:54Z
       
  • Africans in south China face social and health barriers
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Brian J Hall , Wen Chen , Carl Latkin , Li Ling , Joseph D Tucker



      PubDate: 2014-04-12T06:47:54Z
       
  • Mental health services in South Sudan
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Ashok N Singh , Shobha Singh



      PubDate: 2014-04-12T06:47:54Z
       
  • The English Vesalius AndreasVesaliusDHGarrisonMHHastThe Fabric of the
           Human Body: An Annotated Translation of the 1543 and 1555 Editions of De
           Humani Corporis Fabrica Libri Septem2
           vols2014Karger978331802246-91338€1250·00
           ($1650·00)http://www.vesaliusfabrica.com/
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Brian Hurwitz , Ruth Richardson



      PubDate: 2014-04-12T06:47:54Z
       
  • Diana Farmer: pioneer of fetal surgery
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): David Holmes



      PubDate: 2014-04-12T06:47:54Z
       
  • Childbirth in the UK: suffering and citizenship before the 1950s
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Joanna Bourke



      PubDate: 2014-04-12T06:47:54Z
       
  • Anthony Clifford Allison
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Geoff Watts



      PubDate: 2014-04-12T06:47:54Z
       
  • Prevention of varicella: time for two-dose vaccination
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Kristine Macartney



      PubDate: 2014-04-12T06:47:54Z
       
  • Chronic kidney disease and the ageing population
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Marcello Tonelli , Miguel Riella



      PubDate: 2014-04-12T06:47:54Z
       
  • Expression of concern: the SCIPIO trial
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): The Lancet Editors



      PubDate: 2014-04-12T06:47:54Z
       
  • Offline: The future for Africa
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Richard Horton



      PubDate: 2014-04-12T06:47:54Z
       
  • Health gets greater attention in the 2014 Indian elections
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Dinsa Sachan



      PubDate: 2014-04-12T06:47:54Z
       
  • Nephrology in developing countries: the ISN's story
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): John Feehally , William Couser , Sophie Dupuis , Fredric Finkelstein , Paul Harden , David Harris , Norbert Lameire , Sarala Naicker , Giuseppe Remuzzi , Luca Segantini , Marcello Tonelli



      PubDate: 2014-04-12T06:47:54Z
       
  • STOPping peanut allergy: the saga of food oral immunotherapy
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Matthew J Greenhawt



      PubDate: 2014-04-12T06:47:54Z
       
  • International comparisons of acute myocardial infarction
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Chris P Gale , Keith A A Fox



      PubDate: 2014-04-12T06:47:54Z
       
  • April 12–18, 2014
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925




      PubDate: 2014-04-12T06:47:54Z
       
  • Neglected tropical diseases: becoming less neglected
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): The Lancet



      PubDate: 2014-04-12T06:47:54Z
       
  • A new direction for hepatitis C
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): The Lancet



      PubDate: 2014-04-12T06:47:54Z
       
  • Sound advice for public health
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): The Lancet



      PubDate: 2014-04-12T06:47:54Z
       
  • Auditory and non-auditory effects of noise on health
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Mathias Basner , Wolfgang Babisch , Adrian Davis , Mark Brink , Charlotte Clark , Sabine Janssen , Stephen Stansfeld
      Noise is pervasive in everyday life and can cause both auditory and non-auditory health effects. Noise-induced hearing loss remains highly prevalent in occupational settings, and is increasingly caused by social noise exposure (eg, through personal music players). Our understanding of molecular mechanisms involved in noise-induced hair-cell and nerve damage has substantially increased, and preventive and therapeutic drugs will probably become available within 10 years. Evidence of the non-auditory effects of environmental noise exposure on public health is growing. Observational and experimental studies have shown that noise exposure leads to annoyance, disturbs sleep and causes daytime sleepiness, affects patient outcomes and staff performance in hospitals, increases the occurrence of hypertension and cardiovascular disease, and impairs cognitive performance in schoolchildren. In this Review, we stress the importance of adequate noise prevention and mitigation strategies for public health.


      PubDate: 2014-04-12T06:47:54Z
       
  • Advancing social and economic development by investing in women's and
           children's health: a new Global Investment Framework
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Karin Stenberg , Henrik Axelson , Peter Sheehan , Ian Anderson , A Metin Gülmezoglu , Marleen Temmerman , Elizabeth Mason , Howard S Friedman , Zulfiqar A Bhutta , Joy E Lawn , Kim Sweeny , Jim Tulloch , Peter Hansen , Mickey Chopra , Anuradha Gupta , Joshua P Vogel , Mikael Ostergren , Bruce Rasmussen , Carol Levin , Colin Boyle , Shyama Kuruvilla , Marjorie Koblinsky , Neff Walker , Andres de Francisco , Nebojsa Novcic , Carole Presern , Dean Jamison , Flavia Bustreo
      A new Global Investment Framework for Women's and Children's Health demonstrates how investment in women's and children's health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending.


      PubDate: 2014-04-12T06:47:54Z
       
  • Children growing up with HIV infection: the responsibility of success
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Sarah Bernays , Prudence Jarrett , Katharina Kranzer , Rashida A Ferrand



      PubDate: 2014-04-12T06:47:54Z
       
  • Commotio cordis: a case of ventricular fibrillation caused by a cricket
           ball strike to the chest
    • Abstract: Publication date: 12–18 April 2014
      Source:The Lancet, Volume 383, Issue 9925
      Author(s): Ryan J Spencer , Hariharan Sugumar , Elizabeth Jones , Omar Farouque



      PubDate: 2014-04-12T06:47:54Z
       
  • Engineered autologous cartilage tissue for nasal reconstruction after
           tumour resection: an observational first-in-human trial
    • Abstract: Publication date: Available online 10 April 2014
      Source:The Lancet
      Author(s): Ilario Fulco , Sylvie Miot , Martin D Haug , Andrea Barbero , Anke Wixmerten , Sandra Feliciano , Francine Wolf , Gernot Jundt , Anna Marsano , Jian Farhadi , Michael Heberer , Marcel Jakob , Dirk J Schaefer , Ivan Martin
      Background Autologous native cartilage from the nasal septum, ear, or rib is the standard material for surgical reconstruction of the nasal alar lobule after two-layer excision of non-melanoma skin cancer. We assessed whether engineered autologous cartilage grafts allow safe and functional alar lobule restoration. Methods In a first-in-human trial, we recruited five patients at the University Hospital Basel (Basel, Switzerland). To be eligible, patients had to be aged at least 18 years and have a two-layer defect (≥50% size of alar subunit) after excision of non-melanoma skin cancer on the alar lobule. Chondrocytes (isolated from a 6 mm cartilage biopsy sample from the nasal septum harvested under local anaesthesia during collection of tumour biopsy sample) were expanded, seeded, and cultured with autologous serum onto collagen type I and type III membranes in the course of 4 weeks. The resulting engineered cartilage grafts (25 mm × 25 mm × 2 mm) were shaped intra-operatively and implanted after tumour excision under paramedian forehead or nasolabial flaps, as in standard reconstruction with native cartilage. During flap refinement after 6 months, we took biopsy samples of repair tissues and histologically analysed them. The primary outcomes were safety and feasibility of the procedure, assessed 12 months after reconstruction. At least 1 year after implantation, when reconstruction is typically stabilised, we assessed patient satisfaction and functional outcomes (alar cutaneous sensibility, structural stability, and respiratory flow rate). Findings Between Dec 13, 2010, and Feb 6, 2012, we enrolled two women and three men aged 76–88 years. All engineered grafts contained a mixed hyaline and fibrous cartilage matrix. 6 months after implantation, reconstructed tissues displayed fibromuscular fatty structures typical of the alar lobule. After 1 year, all patients were satisfied with the aesthetic and functional outcomes and no adverse events had been recorded. Cutaneous sensibility and structural stability of the reconstructed area were clinically satisfactory, with adequate respiratory function. Interpretation Autologous nasal cartilage tissues can be engineered and clinically used for functional restoration of alar lobules. Engineered cartilage should now be assessed for other challenging facial reconstructions. Funding Foundation of the Department of Surgery, University Hospital Basel; and Krebsliga beider Basel.


      PubDate: 2014-04-12T06:47:54Z
       
  • Hanging by threads: ectopia lentis
    • Abstract: Publication date: Available online 10 April 2014
      Source:The Lancet
      Author(s): Dipika V Patel , Charles N J McGhee



      PubDate: 2014-04-12T06:47:54Z
       
  • Tissue-engineered autologous vaginal organs in patients: a pilot cohort
           study
    • Abstract: Publication date: Available online 10 April 2014
      Source:The Lancet
      Author(s): Atlántida M Raya-Rivera , Diego Esquiliano , Reyna Fierro-Pastrana , Esther López-Bayghen , Pedro Valencia , Ricardo Ordorica-Flores , Shay Soker , James J Yoo , Anthony Atala
      Background Several disorders might require vaginal reconstruction, such as congenital abnormalities, injury, or cancer. Reconstructive techniques for which non-vaginal tissue is used can be associated with complications. We assessed the use of engineered vaginal organs in four patients with vaginal aplasia caused by Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS). Methods We invited to participate four consecutive patients who presented over a 3-year period with congenital vaginal aplasia due to MRKHS. Patients were aged 13–18 years. We obtained a vulvar biopsy of autologous tissue from every patient. We cultured, expanded, and seeded epithelial and muscle cells onto biodegradable scaffolds. The organs were constructed and allowed to mature in an incubator in a facility approved for human-tissue manufacturing. We used a perineal approach to surgically implant these organs. We recorded history, physical examination, vaginoscopy, serial tissue biopsies, MRIs, and self-administered Female Sexual Function Index questionnaire results for all patients, with a follow-up of up to 8 years. Findings We noted no long-term postoperative surgical complications. Yearly serial biopsies showed a tri-layered structure, consisting of an epithelial cell-lined lumen surrounded by matrix and muscle, with expected components of vaginal tissue present. Immunohistochemical analysis confirmed the presence of phenotypically normal smooth muscle and epithelia. The MRIs, which showed the extent of the vaginal aplasia before surgery, showed the engineered organs and the absence of abnormalities after surgery, which was confirmed with yearly vaginoscopy. A validated self-administered Female Sexual Function Index questionnaire showed variables in the normal range in all areas tested, such as desire, arousal, lubrication, orgasm, satisfaction, and painless intercourse. Interpretation Vaginal organs, engineered from the patient's own cells and implanted, showed normal structural and functional variables with a follow-up of up to 8 years. These technologies could be useful in patients requiring vaginal reconstruction. Funding Wake Forest University and Hospital Infantil de México Federico Gómez.


      PubDate: 2014-04-12T06:47:54Z
       
  • Tissue engineering's green shoots of disruptive innovation
    • Abstract: Publication date: Available online 10 April 2014
      Source:The Lancet
      Author(s): Martin A Birchall , Alexander M Seifalian



      PubDate: 2014-04-12T06:47:54Z
       
  • Standardised packaging and tobacco-industry-funded research
    • Abstract: Publication date: Available online 9 April 2014
      Source:The Lancet
      Author(s): Anthony A Laverty , Hilary C Watt , Deborah Arnott , Nicholas S Hopkinson



      PubDate: 2014-04-12T06:47:54Z
       
  • Should at-risk patients be paid to receive interventions'
    • Abstract: Publication date: Available online 8 April 2014
      Source:The Lancet
      Author(s): A Thomas McLellan



      PubDate: 2014-04-12T06:47:54Z
       
  • Rethinking mental health care for young offenders
    • Abstract: Publication date: Available online 4 April 2014
      Source:The Lancet
      Author(s): Ted Alcorn



      PubDate: 2014-04-07T06:46:12Z
       
 
 
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