for Journals by Title or ISSN
for Articles by Keywords
help
Followed Journals
Journal you Follow: 0
 
Sign Up to follow journals, search in your chosen journals and, optionally, receive Email Alerts when new issues of your Followed Journals are published.
Already have an account? Sign In to see the journals you follow.
Journal Cover The Lancet
  [SJR: 14.638]   [H-I: 600]   [2137 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3043 journals]
  • Nobel Prize awarded for discoveries in circadian rhythm
    • Authors: Talha Burki
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Talha Burki


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32661-2
       
  • 2017 Roux Prize recipient announced: Samba Sow
    • Authors: Andrew Green
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Andrew Green


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32662-4
       
  • The impact of IMPACT-AF
    • Authors: Michael D Ezekowitz; Anthony P Kent
      Pages: 1717 - 1718
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Michael D Ezekowitz, Anthony P Kent


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32248-1
       
  • Dual antiplatelet therapy guided by platelet function testing
    • Authors: Dominick J Angiolillo
      Pages: 1718 - 1720
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Dominick J Angiolillo


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32279-1
       
  • A hopeful therapy for Niemann-Pick C diseases
    • Authors: Robert P Erickson; Maria Teresa Fiorenza
      Pages: 1720 - 1721
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Robert P Erickson, Maria Teresa Fiorenza


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)31631-8
       
  • Towards a smoke-free world' Philip Morris International's new
           Foundation is not credible
    • Authors: Mike Daube; Rob Moodie; Martin McKee
      Pages: 1722 - 1724
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Mike Daube, Rob Moodie, Martin McKee


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32561-8
       
  • Catastrophic medical insurance in China
    • Authors: Hongmei Li; Lixin Jiang
      Pages: 1724 - 1725
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Hongmei Li, Lixin Jiang


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32603-x
       
  • Offline: Jim Kim finds his voice
    • Authors: Richard Horton
      First page: 1726
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Richard Horton


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32664-8
       
  • The ACA after the expiry of the budget reconciliation
    • Authors: Susan Jaffe
      Pages: 1727 - 1728
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Susan Jaffe


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32660-0
       
  • Jiang Baoguo: one, two, three against trauma in China
    • Authors: Geoff Watts
      First page: 1729
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Geoff Watts


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32597-7
       
  • Spatial awareness
    • Authors: Niall Boyce
      First page: 1730
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Niall Boyce


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32598-9
       
  • Sir David Todd
    • Authors: Alison Snyder
      First page: 1732
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Alison Snyder


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32600-4
       
  • Condemning industry attempts to subvert public policy for a tobacco-free
           world
    • Authors: David Wood; Jean-Luc Eiselé
      First page: 1733
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): David Wood, Jean-Luc Eiselé


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32604-1
       
  • Nuclear war and public health: rebalancing priorities and global health
           leadership
    • Authors: John Jungpa Park; Kee B Park; Nagi Shafik
      Pages: 1733 - 1734
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): John Jungpa Park, Kee B Park, Nagi Shafik


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32605-3
       
  • Charlie Gard and the limits of medicine
    • Authors: Brendan D Kelly
      First page: 1734
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Brendan D Kelly


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32454-6
       
  • Severity of illness and the weekend effect
    • Authors: William J Kostis; Abel E Moreyra
      Pages: 1734 - 1735
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): William J Kostis, Abel E Moreyra


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32642-9
       
  • Severity of illness and the weekend effect – Authors' reply
    • Authors: A Sarah Walker; Peter Watkinson; Martin Llewelyn; Nicole Stoesser; Tim Peto
      First page: 1735
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): A Sarah Walker, Peter Watkinson, Martin Llewelyn, Nicole Stoesser, Tim Peto


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32425-x
       
  • Medical education: what about the barefoot doctors'
    • Authors: Le Yang; Hongman Wang
      First page: 1736
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Le Yang, Hongman Wang


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32416-9
       
  • Guided de-escalation of antiplatelet treatment in patients with acute
           coronary syndrome undergoing percutaneous coronary intervention
           (TROPICAL-ACS): a randomised, open-label, multicentre trial
    • Authors: Dirk Sibbing; Dániel Aradi; Claudius Jacobshagen; Lisa Gross; Dietmar Trenk; Tobias Geisler; Martin Orban; Martin Hadamitzky; Béla Merkely; Róbert Gábor Kiss; András Komócsi; Csaba A Dézsi; Lesca Holdt; Stephan B Felix; Radoslaw Parma; Mariusz Klopotowski; Robert H G Schwinger; Johannes Rieber; Kurt Huber; Franz-Josef Neumann; Lukasz Koltowski; Julinda Mehilli; Zenon Huczek; Steffen Massberg; Radoslaw Parma; Zofia Parma; Maciej Lesiak; Anna Komosa; Zenon Huczek; Lukasz Koltowski; Michal Kowara; Bartosz Rymuza; Mariusz Klopotowski; Lukasz Malek; Daniel Aradi; Gábor Veress; András Döme Dézsi; Béla Merkely; Árpád Lux; Róbert Gábor Kiss; Judit Papp; Andrea Kovács; Csaba András Dézsi; Sayour Amer; Zoltán Ruzsa; Szilárd Róna; András Komócsi; Renáta Ili; Imre Ungi; Ferenc Nagy; Robert Zweiker; Gábor Tóth-Gayor; Kurt Huber; Paul Haller; Wolfgang von Scheidt; Andreas Blüthgen; Franz-Josef Neumann; Dietmar Trenk; Stefan Leggewie; Hans Ulrich Kreider-Stempfle; Thomas Remp; Kaffer Kara; Andreas Mügge; Alexander Wutzler; Stephan Fichtlscherer; Andreas M. Zeiher; Florian Seeger; Martin Hinterseer; Andreas König; Susanne Lederle; Claudius Jacobshagen; Frauke Czepluch; Lars Maier; Wolfgang Schillinger; Samuel Sossalla; Astrid Hummel; Stephan Felix; Mahir Karakas; Karsten Sydow; Tanja Rudolph; Marcel Halbach; Tommaso Gori; Thomas Münzel; Andreas May; Carsten-Manuel Gerstenberg; David Pilecky; Johannes Rieber; Markus Deichstetter; Dirk Sibbing; Julinda Mehilli; Lisa Gross; Stefan Kääb; Anja Löw; Martin Orban; Matthias Orban; Stefan Sattler; Sabine Deuschl; Daniel Teupser; Lesca Holdt; Harald Mudra; Thomas Räder; Torsten Schütz; Felix Vahldiek; Dimitar Divchev; Hüseyin Ince; Christoph A Nienaber; Henning Radunski; Peter Boekstegers; Jan Horstkotte; Ralf Mueller; Tobias Geisler; Karin Müller; Robert Schwinger; Oliver Rasp
      Pages: 1747 - 1757
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Dirk Sibbing, Dániel Aradi, Claudius Jacobshagen, Lisa Gross, Dietmar Trenk, Tobias Geisler, Martin Orban, Martin Hadamitzky, Béla Merkely, Róbert Gábor Kiss, András Komócsi, Csaba A Dézsi, Lesca Holdt, Stephan B Felix, Radoslaw Parma, Mariusz Klopotowski, Robert H G Schwinger, Johannes Rieber, Kurt Huber, Franz-Josef Neumann, Lukasz Koltowski, Julinda Mehilli, Zenon Huczek, Steffen Massberg
      Background Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT). Methods In this investigator-initiated, randomised, open-label, assessor-blinded, multicentre trial (TROPICAL-ACS) done at 33 sites in Europe, patients were enrolled if they had biomarker-positive acute coronary syndrome with successful PCI and a planned duration of dual antiplatelet treatment of 12 months. Enrolled patients were randomly assigned (1:1) using an internet-based randomisation procedure with a computer-generated block randomisation with stratification across study sites to either standard treatment with prasugrel for 12 months (control group) or a step-down regimen (1 week prasugrel followed by 1 week clopidogrel and PFT-guided maintenance therapy with clopidogrel or prasugrel from day 14 after hospital discharge; guided de-escalation group). The assessors were masked to the treatment allocation. The primary endpoint was net clinical benefit (cardiovascular death, myocardial infarction, stroke or bleeding grade 2 or higher according to Bleeding Academic Research Consortium [BARC]) criteria) 1 year after randomisation (non-inferiority hypothesis; margin of 30%). Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT01959451, and EudraCT, 2013-001636-22. Findings Between Dec 2, 2013, and May 20, 2016, 2610 patients were assigned to study groups; 1304 to the guided de-escalation group and 1306 to the control group. The primary endpoint occurred in 95 patients (7%) in the guided de-escalation group and in 118 patients (9%) in the control group (pnon-inferiority=0·0004; hazard ratio [HR] 0·81 [95% CI 0·62–1·06], psuperiority=0·12). Despite early de-escalation, there was no increase in the combined risk of cardiovascular death, myocardial infarction, or stroke in the de-escalation group (32 patients [3%]) versus in the control group (42 patients [3%]; pnon-inferiority=0·0115). There were 64 BARC 2 or higher bleeding events (5%) in the de-escalation group versus 79 events (6%) in the control group (HR 0·82 [95% CI 0·59–1·13]; p=0·23). Interpretation Guided de-escalation of antiplatelet treatment was non-inferior to standard treatment with prasugrel at 1 year after PCI in terms of net clinical benefit. Our trial shows that early de-escalation of antiplatelet treatment can be considered as an alternative approach in patients with acute coronary syndrome managed with PCI. Funding Klinikum der Universität München, Roche Diagnostics, Eli Lilly, and Daiichi Sankyo.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32155-4
       
  • Intrathecal 2-hydroxypropyl-β-cyclodextrin decreases neurological disease
           progression in Niemann-Pick disease, type C1: a non-randomised,
           open-label, phase 1–2 trial
    • Authors: Daniel S Ory; Elizabeth A Ottinger; Nicole Yanjanin Farhat; Kelly A King; Xuntian Jiang; Lisa Weissfeld; Elizabeth Berry-Kravis; Cristin D Davidson; Simona Bianconi; Lee Ann Keener; Ravichandran Rao; Ariane Soldatos; Rohini Sidhu; Kimberly A Walters; Xin Xu; Audrey Thurm; Beth Solomon; William J Pavan; Bernardus N Machielse; Mark Kao; Steven A Silber; John C McKew; Carmen C Brewer; Charles H Vite; Steven U Walkley; Christopher P Austin; Forbes D Porter
      Pages: 1758 - 1768
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Daniel S Ory, Elizabeth A Ottinger, Nicole Yanjanin Farhat, Kelly A King, Xuntian Jiang, Lisa Weissfeld, Elizabeth Berry-Kravis, Cristin D Davidson, Simona Bianconi, Lee Ann Keener, Ravichandran Rao, Ariane Soldatos, Rohini Sidhu, Kimberly A Walters, Xin Xu, Audrey Thurm, Beth Solomon, William J Pavan, Bernardus N Machielse, Mark Kao, Steven A Silber, John C McKew, Carmen C Brewer, Charles H Vite, Steven U Walkley, Christopher P Austin, Forbes D Porter
      Background Niemann-Pick disease, type C1 (NPC1) is a lysosomal storage disorder characterised by progressive neurodegeneration. In preclinical testing, 2-hydroxypropyl-β-cyclodextrins (HPβCD) significantly delayed cerebellar Purkinje cell loss, slowed progression of neurological manifestations, and increased lifespan in mouse and cat models of NPC1. The aim of this study was to assess the safety and efficacy of lumbar intrathecal HPβCD. Methods In this open-label, dose-escalation phase 1–2a study, we gave monthly intrathecal HPβCD to participants with NPC1 with neurological manifestation at the National Institutes of Health (NIH), Bethesda, MD, USA. To explore the potential effect of 2-week dosing, three additional participants were enrolled in a parallel study at Rush University Medical Center (RUMC), Chicago, IL, USA. Participants from the NIH were non-randomly, sequentially assigned in cohorts of three to receive monthly initial intrathecal HPβCD at doses of 50, 200, 300, or 400 mg per month. A fifth cohort of two participants received initial doses of 900 mg. Participants from RUMC initially received 200 or 400 mg every 2 weeks. The dose was escalated based on tolerance or safety data from higher dose cohorts. Serum and CSF 24(S)-hydroxycholesterol (24[S]-HC), which serves as a biomarker of target engagement, and CSF protein biomarkers were evaluated. NPC Neurological Severity Scores (NNSS) were used to compare disease progression in HPβCD-treated participants relative to a historical comparison cohort of 21 NPC1 participants of similar age range. Findings Between Sept 21, 2013, and Jan 19, 2015, 32 participants with NPC1 were assessed for eligibility at the National Institutes of Health. 18 patients were excluded due to inclusion criteria not met (six patients), declined to participate (three patients), pursued independent expanded access and obtained the drug outside of the study (three patients), enrolled in the RUMC cohort (one patient), or too late for the trial enrolment (five patients). 14 patients were enrolled and sequentially assigned to receive intrathecal HPβCD at a starting dose of 50 mg per month (three patients), 200 mg per month (three patients), 300 mg per month (three patients), 400 mg per month (three patients), or 900 mg per month (two patients). During the first year, two patients had treatment interrupted for one dose, based on grade 1 ototoxicity. All 14 patients were assessed at 12 months. Between 12 and 18 months, one participant had treatment interrupted at 17 months due to hepatocellular carcinoma, one patient had dose interruption for 2 doses based on caregiver hardship and one patient had treatment interrupted for 1 dose for mastoiditis. 11 patients were assessed at 18 months. Between Dec 11, 2013, and June 25, 2014, three participants were assessed for eligibility and enrolled at RUMC, and were assigned to receive intrathecal HPβCD at a starting dose of 200 mg every 2 weeks (two patients), or 400 mg every two weeks (one patient). There were no dropouts in this group and all 3 patients were assessed at 18 months. Biomarker studies were consistent with improved neuronal cholesterol homoeostasis and decreased neuronal pathology. Post-drug plasma 24(S)-HC area under the curve (AUC8-72) values, an indicator of neuronal cholesterol homoeostasis, were significantly higher than post-saline plasma 24(S)-HC AUC8-72 after doses of 900 mg (p=0·0063) and 1200 mg (p=0·0037). CSF 24(S)-HC concentrations in three participants given either 600 or 900 mg of HPβCD were increased about two fold (p=0·0032) after drug administration. No drug-related serious adverse events were observed. Mid-frequency to high-frequency hearing loss, an expected adverse event, was documented in all participants. When managed with hearing aids, this did not have an appreciable effect on daily communication. The NNSS for the 14 participants treated monthly increased at a rate of 1·22, SEM 0·34 points per year compared with 2·92, SEM 0·27 points per year (p=0·0002) for the 21 patient comparison group. Decreased progression was observed for NNSS domains of ambulation (p=0·0622), cognition (p=0·0040) and speech (p=0·0423).
      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)31465-4
       
  • Generalised cowpox virus infection
    • Authors: Lisa-Lena Grönemeyer; Anne Baltzer; Sigrid Broekaert; Livia Schrick; Lars Möller; Andreas Nitsche; Rotraut Mössner; Michael P Schön; Timo Buhl
      First page: 1769
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Lisa-Lena Grönemeyer, Anne Baltzer, Sigrid Broekaert, Livia Schrick, Lars Möller, Andreas Nitsche, Rotraut Mössner, Michael P Schön, Timo Buhl


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)31428-9
       
  • Neonatal sepsis
    • Authors: Andi L Shane; Pablo J Sánchez; Barbara J Stoll
      Pages: 1770 - 1780
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Andi L Shane, Pablo J Sánchez, Barbara J Stoll
      Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by setting. Differing estimates of disease burden have been reported from high-income countries compared with reports from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection, acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure, inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents. This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)31002-4
       
  • Transport and public health in China: the road to a healthy future
    • Authors: Baoguo Jiang; Song Liang; Zhong-Ren Peng; Haozhe Cong; Morgan Levy; Qu Cheng; Tianbing Wang; Justin V Remais
      Pages: 1781 - 1791
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Baoguo Jiang, Song Liang, Zhong-Ren Peng, Haozhe Cong, Morgan Levy, Qu Cheng, Tianbing Wang, Justin V Remais
      Transportation-related risk factors are a major source of morbidity and mortality in China, where the expansion of road networks and surges in personal vehicle ownership are having profound effects on public health. Road traffic injuries and fatalities have increased alongside increased use of motorised transport in China, and accident injury risk is aggravated by inadequate emergency response systems and trauma care. National air quality standards and emission control technologies are having a positive effect on air quality, but persistent air pollution is increasingly attributable to a growing and outdated vehicle fleet and to famously congested roads. Urban design favours motorised transport, and physical activity and its associated health benefits are hindered by poor urban infrastructure. Transport emissions of greenhouse gases contribute substantially to regional and global climate change, which compound public health risks from multiple factors. Despite these complex challenges, technological advances and innovations in planning and policy stand to make China a leader in sustainable, healthy transportation.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)31958-x
       
  • Building the foundations for sustainable development: a case for global
           investment in the capabilities of adolescents
    • Authors: Peter Sheehan; Kim Sweeny; Bruce Rasmussen; Annababette Wils; Howard S Friedman; Jacqueline Mahon; George C Patton; Susan M Sawyer; Eric Howard; John Symons; Karin Stenberg; Satvika Chalasani; Neelam Maharaj; Nicola Reavley; Hui Shi; Masha Fridman; Alison Welsh; Emeka Nsofor; Laura Laski
      Pages: 1792 - 1806
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Peter Sheehan, Kim Sweeny, Bruce Rasmussen, Annababette Wils, Howard S Friedman, Jacqueline Mahon, George C Patton, Susan M Sawyer, Eric Howard, John Symons, Karin Stenberg, Satvika Chalasani, Neelam Maharaj, Nicola Reavley, Hui Shi, Masha Fridman, Alison Welsh, Emeka Nsofor, Laura Laski
      Investment in the capabilities of the world's 1·2 billion adolescents is vital to the UN's Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8–6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3–6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions—investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6–12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)30872-3
       
  • Foundation for a smoke-free world
    • Authors: Derek Yach
      Pages: 1807 - 1810
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Derek Yach


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32602-8
       
  • A multifaceted intervention to improve treatment with oral anticoagulants
           in atrial fibrillation (IMPACT-AF): an international, cluster-randomised
           trial
    • Authors: Dragos Vinereanu; Hussein R. Al-Khalidi; Meena P. Rao; Wensheng He; Renato D. Lopes; Cecilia M. Bahit; Andrea O. Ciobanu; Kathleen A. Fox; Sean D. Pokorney; Ying Xian; Jie Jiang; Deepak Y. Kamath; Otavio Berwanger; Carlos Tajer; Yong Huo; Denis Xavier; Christopher B. Granger
      Pages: 38 - 47
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Dragos Vinereanu, Renato D Lopes, M Cecilia Bahit, Denis Xavier, Jie Jiang, Hussein R Al-Khalidi, Wensheng He, Ying Xian, Andrea O Ciobanu, Deepak Y Kamath, Kathleen A Fox, Meena P Rao, Sean D Pokorney, Otavio Berwanger, Carlos Tajer, Pedro G M de Barros e Silva, Mayme L Roettig, Yong Huo, Christopher B Granger
      Background Oral anticoagulation is underused in patients with atrial fibrillation. We assessed the impact of a multifaceted educational intervention, versus usual care, on oral anticoagulant use in patients with atrial fibrillation. Methods This study was a two-arm, prospective, international, cluster-randomised, controlled trial. Patients were included who had atrial fibrillation and an indication for oral anticoagulation. Clusters were randomised (1:1) to receive a quality improvement educational intervention (intervention group) or usual care (control group). Randomisation was carried out centrally, using the eClinicalOS electronic data capture system. The intervention involved education of providers and patients, with regular monitoring and feedback. The primary outcome was the change in the proportion of patients treated with oral anticoagulants from baseline assessment to evaluation at 1 year. The trial is registered at ClinicalTrials.gov, number NCT02082548. Findings 2281 patients from five countries (Argentina, n=343; Brazil, n=360; China, n=586; India, n=493; and Romania, n=499) were enrolled from 48 clusters between June 11, 2014, and Nov 13, 2016. Follow-up was at a median of 12·0 months (IQR 11·8–12·2). Oral anticoagulant use increased in the intervention group from 68% (804 of 1184 patients) at baseline to 80% (943 of 1184 patients) at 1 year (difference 12%), whereas in the control group it increased from 64% (703 of 1092 patients) at baseline to 67% (732 of 1092 patients) at 1 year (difference 3%). Absolute difference in the change between groups was 9·1% (95% CI 3·8–14·4); odds ratio of change in the use of oral anticoagulation between groups was 3·28 (95% CI 1·67–6·44; adjusted p value=0·0002). Kaplan-Meier estimates showed a reduction in the secondary outcome of stroke in the intervention versus control groups (HR 0·48, 95% CI 0·23–0·99; log-rank p value=0·0434). Interpretation A multifaceted and multilevel educational intervention, aimed to improve use of oral anticoagulation in patients with atrial fibrillation and at risk for stroke, resulted in a significant increase in the proportion of patients treated with oral anticoagulants. Such an intervention has the potential to improve stroke prevention around the world for patients with atrial fibrillation. Funding Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/j.ahj.2017.07.004
       
  • Tobacco control: a Foundation too far'
    • Authors: Lancet
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • WHO launches new leadership, new priorities
    • Authors: Lancet
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • The link between cancer and obesity
    • Authors: Lancet
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Doubt
    • Authors: Sam Guglani
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Sam Guglani


      PubDate: 2017-10-13T21:22:08Z
       
  • HPV vaccination in China needs to be more cost-effective
    • Authors: Yue Yin
      Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104
      Author(s): Yue Yin


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: 14–20 October 2017
      Source:The Lancet, Volume 390, Issue 10104


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Felicia Marie Knaul: advocate for better pain relief and palliative care
    • Authors: Rachael Davies
      Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet
      Author(s): Rachael Davies


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32663-6
       
  • Department of Error
    • Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Department of Error
    • Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Can the Antimicrobial Resistance Benchmark blaze a new trail'
    • Authors: Jayasree K Iyer; Marc Mendelson
      Abstract: Publication date: Available online 13 October 2017
      Source:The Lancet
      Author(s): Jayasree K Iyer, Marc Mendelson


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32670-3
       
  • Tackling viral haemorrhagic fever in Africa
    • Authors: Chikwe Ihekweazu; Ibrahim Abubakar
      Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet
      Author(s): Chikwe Ihekweazu, Ibrahim Abubakar


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32475-3
       
  • Department of Error
    • Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Xanthoma disseminatum
    • Authors: Hui Zi Gong; He Yi Zheng; Jun Li
      Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet
      Author(s): Hui Zi Gong, He Yi Zheng, Jun Li


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)31934-7
       
  • Local, national, and regional viral haemorrhagic fever pandemic potential
           in Africa: a multistage analysis
    • Authors: David M Pigott; Aniruddha Deshpande; Ian Letourneau; Chloe Morozoff; Robert C Reiner; Moritz U G Kraemer; Shannon E Brent; Isaac I Bogoch; Kamran Khan; Molly H Biehl; Roy Burstein; Lucas Earl; Nancy Fullman; Jane P Messina; Adrian Q N Mylne; Catherine L Moyes; Freya M Shearer; Samir Bhatt; Oliver J Brady; Peter W Gething; Daniel J Weiss; Andrew J Tatem; Luke Caley; Tom De Groeve; Luca Vernaccini; Nick Golding; Peter Horby; Jens H Kuhn; Sandra J Laney; Edmond Ng; Peter Piot; Osman Sankoh; Christopher J L Murray; Simon I Hay
      Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet
      Author(s): David M Pigott, Aniruddha Deshpande, Ian Letourneau, Chloe Morozoff, Robert C Reiner, Moritz U G Kraemer, Shannon E Brent, Isaac I Bogoch, Kamran Khan, Molly H Biehl, Roy Burstein, Lucas Earl, Nancy Fullman, Jane P Messina, Adrian Q N Mylne, Catherine L Moyes, Freya M Shearer, Samir Bhatt, Oliver J Brady, Peter W Gething, Daniel J Weiss, Andrew J Tatem, Luke Caley, Tom De Groeve, Luca Vernaccini, Nick Golding, Peter Horby, Jens H Kuhn, Sandra J Laney, Edmond Ng, Peter Piot, Osman Sankoh, Christopher J L Murray, Simon I Hay
      Background Predicting when and where pathogens will emerge is difficult, yet, as shown by the recent Ebola and Zika epidemics, effective and timely responses are key. It is therefore crucial to transition from reactive to proactive responses for these pathogens. To better identify priorities for outbreak mitigation and prevention, we developed a cohesive framework combining disparate methods and data sources, and assessed subnational pandemic potential for four viral haemorrhagic fevers in Africa, Crimean–Congo haemorrhagic fever, Ebola virus disease, Lassa fever, and Marburg virus disease. Methods In this multistage analysis, we quantified three stages underlying the potential of widespread viral haemorrhagic fever epidemics. Environmental suitability maps were used to define stage 1, index-case potential, which assesses populations at risk of infection due to spillover from zoonotic hosts or vectors, identifying where index cases could present. Stage 2, outbreak potential, iterates upon an existing framework, the Index for Risk Management, to measure potential for secondary spread in people within specific communities. For stage 3, epidemic potential, we combined local and international scale connectivity assessments with stage 2 to evaluate possible spread of local outbreaks nationally, regionally, and internationally. Findings We found epidemic potential to vary within Africa, with regions where viral haemorrhagic fever outbreaks have previously occurred (eg, western Africa) and areas currently considered non-endemic (eg, Cameroon and Ethiopia) both ranking highly. Tracking transitions between stages showed how an index case can escalate into a widespread epidemic in the absence of intervention (eg, Nigeria and Guinea). Our analysis showed Chad, Somalia, and South Sudan to be highly susceptible to any outbreak at subnational levels. Interpretation Our analysis provides a unified assessment of potential epidemic trajectories, with the aim of allowing national and international agencies to pre-emptively evaluate needs and target resources. Within each country, our framework identifies at-risk subnational locations in which to improve surveillance, diagnostic capabilities, and health systems in parallel with the design of policies for optimal responses at each stage. In conjunction with pandemic preparedness activities, assessments such as ours can identify regions where needs and provisions do not align, and thus should be targeted for future strengthening and support. Funding Paul G Allen Family Foundation, Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32092-5
       
  • A milestone for palliative care and pain relief
    • Authors: Richard Horton
      Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet
      Author(s): Richard Horton


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32560-6
       
  • Alleviating the access abyss in palliative care and pain relief—an
           imperative of universal health coverage: the Lancet Commission report
    • Authors: Felicia Marie Knaul; Paul E Farmer; Eric L Krakauer; Liliana De Lima; Afsan Bhadelia; Xiaoxiao Jiang Kwete; Héctor Arreola-Ornelas; Octavio Gómez-Dantés; Natalia M Rodriguez; George A O Alleyne; Stephen R Connor; David J Hunter; Diederik Lohman; Lukas Radbruch; María del Rocío Sáenz Madrigal; Rifat Atun; Kathleen M Foley; Julio Frenk; Dean T Jamison; M R Rajagopal; Felicia Marie Knaul; Paul E Farmer; Huda Abu-Saad Huijer; George A O Alleyne; Rifat Atun; Agnes Binagwaho; Snežana M Bošnjak; David Clark; James F Cleary; José R Cossío Díaz; Liliana De Lima; Kathleen M Foley; Julio Frenk; Cynthia Goh; Pascal J Goldschmidt-Clermont; Mary Gospodarowicz; Liz Gwyther; Irene J Higginson; Thomas Hughes-Hallett; David J Hunter; Dean T Jamison; Eric L Krakauer; Diederik Lohman; Emmanuel B K Luyirika; Maria E Medina Mora; Faith N Mwangi-Powell; Sania Nishtar; Megan E O'Brien; Lukas Radbruch; M R Rajagopal; K Srinath Reddy; María del Rocío Sáenz Madrigal; Judith A Salerno; Afsan Bhadelia; Silvia Allende; Héctor Arreola-Ornelas; Nahid Bhadelia; Mariana Calderon; Stephen R Connor; Victoria Y Fan; Octavio Gómez-Dantés; Jorge Jiménez; Christian R Ntizimira; Pedro E Perez-Cruz; Isaias Gerardo Salas-Herrera; Dingle Spence; Mark R Steedman; Stéphane Verguet; Julia D Downing; Bishnu D Paudel; Maia Elsner; James Andrew Gillespie; Karen J Hofman; Xiaoxiao Jiang Kwete; Quach Thanh Khanh; Karl A Lorenz; Oscar Méndez Carniado; Rachel Nugent; Natalia M Rodriguez; Emily B Wroe; Camilla Zimmerman
      Abstract: Publication date: Available online 12 October 2017
      Source:The Lancet
      Author(s): Felicia Marie Knaul, Paul E Farmer, Eric L Krakauer, Liliana De Lima, Afsan Bhadelia, Xiaoxiao Jiang Kwete, Héctor Arreola-Ornelas, Octavio Gómez-Dantés, Natalia M Rodriguez, George A O Alleyne, Stephen R Connor, David J Hunter, Diederik Lohman, Lukas Radbruch, María del Rocío Sáenz Madrigal, Rifat Atun, Kathleen M Foley, Julio Frenk, Dean T Jamison, M R Rajagopal


      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32513-8
       
  • Department of Error
    • Abstract: Publication date: Available online 10 October 2017
      Source:The Lancet


      PubDate: 2017-10-13T21:22:08Z
       
  • Worldwide trends in body-mass index, underweight, overweight, and obesity
           from 1975 to 2016: a pooled analysis of 2416 population-based measurement
           studies in 128·9 million children, adolescents, and adults
    • Authors: NCD Risk; Factor Collaboration AAbdeenZargar AbdulHamidNiveen MAbu-RmeilehBenjaminAcosta-CazaresCeciliaAcuinRobert JAdamsWichaiAekplakornKaosarAfsanaCarlos AAguilar-SalinasCharlesAgyemangAlirezaAhmadvandWolfgangAhrensKamelAjlouniNazgulAkhtaevaHazzaa MAl-HazzaaAmani
      Abstract: Publication date: Available online 10 October 2017
      Source:The Lancet
      Author(s): NCD Risk Factor Collaboration (NCD-RisC)LeandraAbarca-GómezZiad AAbdeenZargar AbdulHamidNiveen MAbu-RmeilehBenjaminAcosta-CazaresCeciliaAcuinRobert JAdamsWichaiAekplakornKaosarAfsanaCarlos AAguilar-SalinasCharlesAgyemangAlirezaAhmadvandWolfgangAhrensKamelAjlouniNazgulAkhtaevaHazzaa MAl-HazzaaAmani RashedAl-OthmanRajaaAl-RaddadiFadiaAl BuhairanShahlaAl DhukairMohamed MAliOsmanAliAla'aAlkerwiMarAlvarez-PedrerolEmanAlyDeepak NAmarapurkarPhilippeAmouyelAntoinetteAmuzuLars BoAndersenSigmund AAnderssenDolores SAndradeLars HÄngquistRanjit MohanAnjanaHajerAounallah-SkhiriJoanaAraújoIngerAriansenTahirArisNimmathotaArlappaDominiqueArveilerKrishna KAryalThorAspelundFelix KAssahMaria Cecília FAssunçãoMay SoeAungMáriaAvdicováAnaAzevedoFereidounAziziBontha VBabuSuhadBahijriJennifer LBakerNagallaBalakrishnaMohamedBamoshmooshMaciejBanachPiotrBandoszJosé RBanegasCarlo MBarbagalloAlbertoBarcelóAminaBarkatAluisio JDBarrosMauro VGBarrosIqbalBataAnwar MBatiehaRosangela LBatistaAssembekovBatyrbekLouise ABaurRobertBeagleholeHabiba BenRomdhaneJudithBenedicsMikhailBenetJames EBennettAntonioBernabe-OrtizGailuteBernotieneHeloisaBettiolAroorBhagyalaxmiSumitBharadwajSantosh KBhargavaZaidBhattiZulfiqar ABhuttaHongshengBiYufangBiAnnaBiehlMukharramBikbovBihungumBistaDusko JBjelicaPeterBjerregaardEspenBjertnessMarius BBjertnessCeciliaBjörkelundAnnekeBlokstraSimonaBoMartinBobakLynne MBoddyBernhard OBoehmHeinerBoeingJose GBoggiaCarlos PBoissonnetMarialauraBonaccioVaninaBongardPascalBovetLienBraeckeveltLutgartBraeckmanMarjolijn CEBragtImperiaBrajkovichFrancescoBrancaJuergenBreckenkampJoãoBredaHermannBrennerLizzy MBrewsterGarry RBrianLacramioaraBrinduseGraziellaBrunoH B(as)Bueno-de-MesquitaAnnaBuggeMartaBuoncristianoGencBurazeriConBurnsAntonio Cabrerade LeónJosephCacciottoloHuiCaiTilemaCamaChristineCameronJoséCamolasGünayCanAna Paula CCândidoMarioCapanzanaVincenzoCapuanoViviane CCardosoAxel CCarlssonMaria JCarvalhoFelipe FCasanuevaJuan-PabloCasasCarmelo ACasertaSnehalathaChamukuttanAngelique WChanQueenieChanHimanshu KChaturvediNishiChaturvediChien-JenChenFangfangChenHuashuaiChenShuohuaChenZhengmingChenChing-YuChengAngelaChetritEkaterinaChikova-IscenerArnaudChioleroShu-TiChiouAdelaChirita-EmandiMaría-DoloresChirlaqueBelongChoYumiChoKaareChristensenDiego GChristofaroJerzyChudekRenataCifkovaElizaCintezaFrankClaessensElsClaysHansConcinSusana CConfortinCyrusCooperRachelCooperTara CCoppingerSimonaCostanzoDominiqueCottelChrisCowellCora LCraigAna BCrujeirasAlexandraCucuGraziellaD'ArrigoEleonorad'OrsiJeanDallongevilleAlbertinoDamascenoCamilla TDamsgaardGoodarzDanaeiRachelDanknerThomas MDantoftSaeedDastgiriLucDauchetKairatDavletovGuyDe BackerDirkDe BacquerAmaliaDe CurtisGiovannide GaetanoStefaanDe HenauwPaula Duartede OliveiraKarinDe RidderDelphineDe SmedtMohanDeepaAlexander DDeevAbbasDehghanHélèneDelisleFrancisDelpeuchValérieDeschampsKlodianDhanaAugusto FDi CastelnuovoJuvenal SoaresDias-da-CostaAlejandroDiazZivkaDikaShirinDjalaliniaHa TPDoAnnette JDobsonMaria BenedettaDonatiChiaraDonfrancescoSilvana PDonosoAngelaDöringMariaDorobantuAhmad RezaDorostyKouamelanDouaWojciechDrygasJia LiDuanCharmaineDuanteVesselkaDulevaVirginijaDulskieneVilnisDzerveElzbietaDziankowska-ZaborszczykEruke EEgbagbeRobertEggertsenGabrieleEibenUlfEkelundJalilaEl AtiPaulElliottReinaEngle-StoneRajiv TErasmusCihangirEremLouiseEriksenJohan GErikssonJorge Escobedo-dela PeñaAlunEvansDavidFaehCaroline HFallVictoria FarrugiaSant'AngeloFarshadFarzadfarFrancisco JFelix-RedondoTrevor SFergusonRomulo AFernandesDanielFernández-BergésDanielFerranteMarikaFerrariCatterinaFerreccioJeanFerrieresJoseph DFinnKristaFischerEric MonterubioFloresBernhardFögerLeng HuatFooAnn-SofieForslundMariaForsnerHeba MFouadDamian KFrancisMaria do CarmoFrancoOscar HFrancoGuillermoFronteraFlavio DFuchsSandra CFuchsYukiFujitaTakuroFurusawaZbigniewGaciongMihaiGafencuDanielaGaleoneFabioGalvanoManoliGarcia-de-la-HeraDickmanGaretaSarah PGarnettJean-MichelGaspozMagdaGasullLouiseGatesHaraldGeigerJohanna MGeleijnseAnooshehGhasemianSimonaGiampaoliFrancescoGianfagnaTiffany KGillJonathanGiovannelliAleksanderGiwercmanJustynaGodosSibelGogenRebecca AGoldsmithDavidGoltzmanHelenGonçalvesMargotGonzález-LeonJuan PGonzález-RivasMarcelaGonzalez-GrossFredericGottrandAntonio PedroGraçaSidselGraff-IversenDušanGrafnetterAnetaGrajdaMaria GGrammatikopoulouRonald DGregorTomaszGrodzickiAndersGrøntvedGiuseppeGrossoGabriellaGrudenVeraGrujicDongfengGuEmanuelaGualdi-RussoPilarGuallar-CastillónOng PengGuanElias FGudmundssonVilmundurGudnasonRamiroGuerreroIdrisGuessousAndre LGuimaraesMartin CGullifordJohannaGunnlaugsdottirMarcGunterXiuhuaGuoYinGuoPrakash CGuptaRajeevGuptaOyeGurejeBeataGurzkowskaLauraGutierrezFelixGutzwillerFarzadHadaeghCharalambos AHadjigeorgiouKhairilSi-RamleeJytteHalkjærIan RHambletonRebeccaHardyRachakulla HariKumarMariaHassapidouJunHataAlison JHayesJiangHeReginaHeidinger-FelsoMirjamHeinenMarleen ElisabethHendriksAnaHenriquesLeticia HernandezCadenaSauliHerralaVictor MHerreraIsabelleHerter-AeberliRaminHeshmatIlpo TapaniHihtaniemiSai YinHoSuzanne CHoMichaelHobbsAlbertHofmanWilma MHopmanAndrea RVRHorimotoClaudia MHormigaBernardo LHortaLeilaHoutiChristinaHowittThein TheinHtayAung SoeHtetMaung Maung ThanHtikeYonghuaHuJosé MaríaHuertaConstanta HuidumacPetrescuMartijnHuismanAbdullatifHusseiniChinh NguyenHuuIngeHuybrechtsNahlaHwallaJolandaHyskaLiciaIacovielloAnna GIannoneJesús MIbarluzeaMohsen MIbrahimNayuIkedaM ArfanIkramVilma EIrazolaMuhammadIslamAziz al-SafiIsmailVanjaIvkovicMasanoriIwasakiRod TJacksonJeremy MJacobsHashemJaddouTazeenJafarKazi MJamilKonradJamrozikImreJanszkyJuelJaraniGrazynaJasienskaAnaJelakovicBojanJelakovicGarryJenningsSeung-LyealJeongChao QiangJiangSanta MagalyJiménez-AcostaMichelJoffresMattiasJohan...
      PubDate: 2017-10-13T21:22:08Z
       
  • Clemastine fumarate as a remyelinating therapy for multiple sclerosis
           (ReBUILD): a randomised, controlled, double-blind, crossover trial
    • Authors: Ari J Green; Jeffrey M Gelfand; Bruce A Cree; Carolyn Bevan; W John Boscardin; Feng Mei; Justin Inman; Sam Arnow; Michael Devereux; Aya Abounasr; Hiroko Nobuta; Alyssa Zhu; Matt Friessen; Roy Gerona; Hans Christian von Büdingen; Roland G Henry; Stephen L Hauser; Jonah R Chan
      Abstract: Publication date: Available online 10 October 2017
      Source:The Lancet
      Author(s): Ari J Green, Jeffrey M Gelfand, Bruce A Cree, Carolyn Bevan, W John Boscardin, Feng Mei, Justin Inman, Sam Arnow, Michael Devereux, Aya Abounasr, Hiroko Nobuta, Alyssa Zhu, Matt Friessen, Roy Gerona, Hans Christian von Büdingen, Roland G Henry, Stephen L Hauser, Jonah R Chan
      Background Multiple sclerosis is a degenerative inflammatory disease of the CNS characterised by immune-mediated destruction of myelin and progressive neuroaxonal loss. Myelin in the CNS is a specialised extension of the oligodendrocyte plasma membrane and clemastine fumarate can stimulate differentiation of oligodendrocyte precursor cells in vitro, in animal models, and in human cells. We aimed to analyse the efficacy and safety of clemastine fumarate as a treatment for patients with multiple sclerosis. Methods We did this single-centre, 150-day, double-blind, randomised, placebo-controlled, crossover trial (ReBUILD) in patients with relapsing multiple sclerosis with chronic demyelinating optic neuropathy on stable immunomodulatory therapy. Patients who fulfilled international panel criteria for diagnosis with disease duration of less than 15 years were eligible. Patients were randomly assigned (1:1) via block randomisation using a random number generator to receive either clemastine fumarate (5·36 mg orally twice daily) for 90 days followed by placebo for 60 days (group 1), or placebo for 90 days followed by clemastine fumarate (5·36 mg orally twice daily) for 60 days (group 2). The primary outcome was shortening of P100 latency delay on full-field, pattern-reversal, visual-evoked potentials. We analysed by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT02040298. Findings Between Jan 1, 2014, and April 11, 2015, we randomly assigned 50 patients to group 1 (n=25) or group 2 (n=25). All patients completed the study. The primary efficacy endpoint was met with clemastine fumarate treatment, which reduced the latency delay by 1·7 ms/eye (95% CI 0·5–2·9; p=0·0048) when analysing the trial as a crossover. Clemastine fumarate treatment was associated with fatigue, but no serious adverse events were reported. Interpretation To our knowledge, this is the first randomised controlled trial to document efficacy of a remyelinating drug for the treatment of chronic demyelinating injury in multiple sclerosis. Our findings suggest that myelin repair can be achieved even following prolonged damage. Funding University of California, San Francisco and the Rachleff Family.

      PubDate: 2017-10-13T21:22:08Z
      DOI: 10.1016/s0140-6736(17)32346-2
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 54.166.150.10
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016