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Journal Cover The Lancet
  [SJR: 14.638]   [H-I: 600]   [2277 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3123 journals]
  • Making sense of the latest evidence on electronic cigarettes
    • Authors: John N Newton; Martin Dockrell; Tim Marczylo
      Pages: 639 - 642
      Abstract: Publication date: Available online 6 February 2018
      Source:The Lancet
      Author(s): John N Newton, Martin Dockrell, Tim Marczylo


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30202-2
      Issue No: Vol. 391, No. 10121 (2018)
       
  • Jimmie Coker Holland
    • Authors: Geoff Watts
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Geoff Watts


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30197-1
       
  • Remission of type 2 diabetes: mission not impossible
    • Authors: Matti Uusitupa
      Pages: 515 - 516
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Matti Uusitupa


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)33100-8
       
  • Tradition and innovation in development of a Zika vaccine
    • Authors: Ernesto T A Marques; Donald S Burke
      Pages: 516 - 517
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Ernesto T A Marques, Donald S Burke


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)33107-0
       
  • Rising incidence of heart failure demands action
    • Authors: Faiez Zannad
      Pages: 518 - 519
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Faiez Zannad


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32873-8
       
  • Mentoring women in medicine: a personal perspective
    • Authors: Janet E Pope
      Pages: 520 - 521
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Janet E Pope


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30243-5
       
  • Offline: Welcome to the new Age of Romanticism
    • Authors: Richard Horton
      First page: 522
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Richard Horton


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30203-4
       
  • National Health Protection Scheme revealed in India
    • Authors: Patralekha Chatterjee
      Pages: 523 - 524
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Patralekha Chatterjee


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30241-1
       
  • Health under austerity in Greece
    • Authors: Talha Burki
      Pages: 525 - 526
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Talha Burki


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30242-3
       
  • A global girl gang
    • Authors: Heidi J Larson
      Pages: 527 - 528
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Heidi J Larson


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30193-4
       
  • Bright life
    • Authors: Noren Zakiya Khamis
      First page: 528
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Noren Zakiya Khamis


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30194-6
       
  • Robin West breaks gender barriers in US football and baseball
    • Authors: Rita Rubin
      First page: 529
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Rita Rubin


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30195-8
       
  • Art and oncology: one life
    • Authors: Michael Peckham
      Pages: 530 - 531
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Michael Peckham


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30196-x
       
  • Protecting Rohingya: lives, minds, and the future
    • Authors: Md Mahbub Hossain; Neetu Purohit
      First page: 533
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Md Mahbub Hossain, Neetu Purohit


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30209-5
       
  • Reducing health disparities: Bar Ilan Medical School's care transition
           service
    • Authors: Marc Rivo; Mary Rudolf; Sivan Spitzer-Shohat; Micky Weingarten; Barbara Schuster; Robert Schwartz; David Nash; Mina Silberberg
      Pages: 533 - 534
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Marc Rivo, Mary Rudolf, Sivan Spitzer-Shohat, Micky Weingarten, Barbara Schuster, Robert Schwartz, David Nash, Mina Silberberg


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32178-5
       
  • Health equity in Israel
    • Authors: Michelle Morse; Bram Wispelwey
      First page: 534
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Michelle Morse, Bram Wispelwey


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32171-2
       
  • Health equity in Israel
    • Authors: Nihaya Daoud
      First page: 534
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Nihaya Daoud


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32173-6
       
  • Health equity in Israel
    • Authors: Hatim Kanaaneh; Maxine Fookson; Alan Meyers; Alice Rothchild; Rachel Rubin; Peter Sporn
      Pages: 534 - 535
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Hatim Kanaaneh, Maxine Fookson, Alan Meyers, Alice Rothchild, Rachel Rubin, Peter Sporn


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32468-6
       
  • Health equity in Israel – Authors' reply
    • Authors: A Mark Clarfield; Fuad Basis; Avi Israeli; Orly Manor; Shifra Shvarts
      Pages: 535 - 536
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): A Mark Clarfield, Fuad Basis, Avi Israeli, Orly Manor, Shifra Shvarts


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30187-9
       
  • Inequalities in non-communicable diseases in Israel
    • Authors: John S Yudkin
      Pages: 536 - 537
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): John S Yudkin


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32473-x
       
  • Inequalities in non-communicable diseases in Israel – Authors' reply
    • Authors: Khitam Muhsen; Manfred S Green; Varda Soskolne; Yehuda Neumark
      First page: 537
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Khitam Muhsen, Manfred S Green, Varda Soskolne, Yehuda Neumark


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32452-2
       
  • Shared values cannot redress the occupier–occupied imbalance
    • Authors: Angelo Stefanini
      Pages: 537 - 538
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Angelo Stefanini


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32467-4
       
  • Women's health in Israel
    • Authors: Ronit Calderon-Margalit; Ora Paltiel
      Pages: 538 - 539
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Ronit Calderon-Margalit, Ora Paltiel


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32446-7
       
  • Medical ethics in Israel
    • Authors: Zohar Lederman
      First page: 539
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Zohar Lederman


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32412-1
       
  • Medical ethics in Israel – Author's reply
    • Authors: Alan B Jotkowitz
      First page: 539
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Alan B Jotkowitz


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30188-0
       
  • Deaths of children and women in Gaza hostilities
    • Authors: Iain Chalmers
      Pages: 539 - 540
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Iain Chalmers


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32179-7
       
  • Deaths of children and women in Gaza hostilities – Authors' reply
    • Authors: Lisa Rubin; Ilana Belmaker; Eli Somekh; Mary Rudolf; Zachi Grossman
      First page: 540
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Lisa Rubin, Ilana Belmaker, Eli Somekh, Mary Rudolf, Zachi Grossman


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30186-7
       
  • Primary care-led weight management for remission of type 2 diabetes
           (DiRECT): an open-label, cluster-randomised trial
    • Authors: Michael EJ Lean; Wilma S Leslie; Alison C Barnes; Naomi Brosnahan; George Thom; Louise McCombie; Carl Peters; Sviatlana Zhyzhneuskaya; Ahmad Al-Mrabeh; Kieren G Hollingsworth; Angela M Rodrigues; Lucia Rehackova; Ashley J Adamson; Falko F Sniehotta; John C Mathers; Hazel M Ross; Yvonne McIlvenna; Renae Stefanetti; Michael Trenell; Paul Welsh; Sharon Kean; Ian Ford; Alex McConnachie; Naveed Sattar; Roy Taylor
      Pages: 541 - 551
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Michael EJ Lean, Wilma S Leslie, Alison C Barnes, Naomi Brosnahan, George Thom, Louise McCombie, Carl Peters, Sviatlana Zhyzhneuskaya, Ahmad Al-Mrabeh, Kieren G Hollingsworth, Angela M Rodrigues, Lucia Rehackova, Ashley J Adamson, Falko F Sniehotta, John C Mathers, Hazel M Ross, Yvonne McIlvenna, Renae Stefanetti, Michael Trenell, Paul Welsh, Sharon Kean, Ian Ford, Alex McConnachie, Naveed Sattar, Roy Taylor
      Background Type 2 diabetes is a chronic disorder that requires lifelong treatment. We aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes. Methods We did this open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. Practices were randomly assigned (1:1), via a computer-generated list, to provide either a weight management programme (intervention) or best-practice care by guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (>5700 or ≤5700). Participants, carers, and research assistants who collected outcome data were aware of group allocation; however, allocation was concealed from the study statistician. We recruited individuals aged 20–65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27–45 kg/m2, and were not receiving insulin. The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825–853 kcal/day formula diet for 3–5 months), stepped food reintroduction (2–8 weeks), and structured support for long-term weight loss maintenance. Co-primary outcomes were weight loss of 15 kg or more, and remission of diabetes, defined as glycated haemoglobin (HbA1c) of less than 6·5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications, from baseline to 12 months. These outcomes were analysed hierarchically. This trial is registered with the ISRCTN registry, number 03267836. Findings Between July 25, 2014, and Aug 5, 2017, we recruited 306 individuals from 49 intervention (n=23) and control (n=26) general practices; 149 participants per group comprised the intention-to-treat population. At 12 months, we recorded weight loss of 15 kg or more in 36 (24%) participants in the intervention group and no participants in the control group (p<0·0001). Diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group (odds ratio 19·7, 95% CI 7·8–49·8; p<0·0001). Remission varied with weight loss in the whole study population, with achievement in none of 76 participants who gained weight, six (7%) of 89 participants who maintained 0–5 kg weight loss, 19 (34%) of 56 participants with 5–10 kg loss, 16 (57%) of 28 participants with 10–15 kg loss, and 31 (86%) of 36 participants who lost 15 kg or more. Mean bodyweight fell by 10·0 kg (SD 8·0) in the intervention group and 1·0 kg (3·7) in the control group (adjusted difference −8·8 kg, 95% CI −10·3 to −7·3; p<0·0001). Quality of life, as measured by the EuroQol 5 Dimensions visual analogue scale, improved by 7·2 points (SD 21·3) in the intervention group, and decreased by 2·9 points (15·5) in the control group (adjusted difference 6·4 points, 95% CI 2·5–10·3; p=0·0012). Nine serious adverse events were reported by seven (4%) of 157 participants in the intervention group and two were reported by two (1%) participants in the control group. Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention. No serious adverse events led to withdrawal from the study. Interpretation Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care. Funding Diabetes UK.

      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)33102-1
       
  • Safety, tolerability, and immunogenicity of two Zika virus DNA vaccine
           candidates in healthy adults: randomised, open-label, phase 1 clinical
           trials
    • Authors: Martin R Gaudinski; Katherine V Houser; Kaitlyn M Morabito; Zonghui Hu; Galina Yamshchikov; Ro Shauna Rothwell; Nina Berkowitz; Floreliz Mendoza; Jamie G Saunders; Laura Novik; Cynthia S Hendel; LaSonji A Holman; Ingelise J Gordon; Josephine H Cox; Srilatha Edupuganti; Monica A McArthur; Nadine G Rouphael; Kirsten E Lyke; Ginny E Cummings; Sandra Sitar; Robert T Bailer; Bryant M Foreman; Katherine Burgomaster; Rebecca S Pelc; David N Gordon; Christina R DeMaso; Kimberly A Dowd; Carolyn Laurencot; Richard M Schwartz; John R Mascola; Barney S Graham; Theodore C Pierson; Julie E Ledgerwood; Grace L Chen; Sarah Plummer; Pamela Costner; Kathryn Zephir; Joseph Casazza; Abidemi Ola; Milalynn Victorino; Carol Levinson; William Whalen; Xiaolin Wang; Jennifer Cunningham; Olga Vasilenko; Maria Burgos Florez; Somia Hickman; Iris Pittman; Lam Le; Brenda Larkin; Charla Andrews; Preeti Apte; Renunda Hicks; Cora Trelles Cartagena; Pernell Williams; Catina R Boyd; Michelle Conan-Cibotti; Judy Stein; Florence Kaltovich; Hope DeCederfelt; Stacey McAdams; Phyllis Renehan; Wilbur Chen; Nancy Greenberg; Nancy Wymer; Linda Wadsworth; Melissa Billington; Toni Robinson; Colleen Boyce; Faith Pa'ahana Brown; Lisa Chrisley; Alyson Kwon; Prashant Patel; Panagoita Kominou; Brenda Dorsey; Staci Eddington; Shinyi Telscher; Myoughee Lee; Regina Mosely; April Ross; Geoffrey Ford; Briyana Domjahn; Jianguo Xu; Allison Beck; Rebecca Fineman; Shiela Heeke; Jean Winter; Shashi Nagar; Colleen Kelley; Mark Mulligan; Sarah Plummer; Pamela Costner; Kathryn Zephir; Joseph Casazza; Abidemi Ola; Milalynn Victorino; Carol Levinson; William Whalen; Xiaolin Wang; Jennifer Cunningham; Olga Vasilenko; Maria Burgos Florez; Somia Hickman; Iris Pittman; Lam Le; Brenda Larkin; Charla Andrews; Preeti Apte; Renunda Hicks; Cora Trelles Cartagena; Pernell Williams; Catina R Boyd; Michelle Conan-Cibotti; Judy Stein; Florence Kaltovich; Hope DeCederfelt; Stacey McAdams; Phyllis Renehan
      Pages: 552 - 562
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Martin R Gaudinski, Katherine V Houser, Kaitlyn M Morabito, Zonghui Hu, Galina Yamshchikov, Ro Shauna Rothwell, Nina Berkowitz, Floreliz Mendoza, Jamie G Saunders, Laura Novik, Cynthia S Hendel, LaSonji A Holman, Ingelise J Gordon, Josephine H Cox, Srilatha Edupuganti, Monica A McArthur, Nadine G Rouphael, Kirsten E Lyke, Ginny E Cummings, Sandra Sitar, Robert T Bailer, Bryant M Foreman, Katherine Burgomaster, Rebecca S Pelc, David N Gordon, Christina R DeMaso, Kimberly A Dowd, Carolyn Laurencot, Richard M Schwartz, John R Mascola, Barney S Graham, Theodore C Pierson, Julie E Ledgerwood, Grace L Chen
      Background The Zika virus epidemic and associated congenital infections have prompted rapid vaccine development. We assessed two new DNA vaccines expressing premembrane and envelope Zika virus structural proteins. Methods We did two phase 1, randomised, open-label trials involving healthy adult volunteers. The VRC 319 trial, done in three centres, assessed plasmid VRC5288 (Zika virus and Japanese encephalitis virus chimera), and the VRC 320, done in one centre, assessed plasmid VRC5283 (wild-type Zika virus). Eligible participants were aged 18–35 years in VRC19 and 18–50 years in VRC 320. Participants were randomly assigned 1:1 by a computer-generated randomisation schedule prepared by the study statistician. All participants received intramuscular injection of 4 mg vaccine. In VRC 319 participants were assigned to receive vaccinations via needle and syringe at 0 and 8 weeks, 0 and 12 weeks, 0, 4, and 8 weeks, or 0, 4, and 20 weeks. In VRC 320 participants were assigned to receive vaccinations at 0, 4, and 8 weeks via single-dose needle and syringe injection in one deltoid or split-dose needle and syringe or needle-free injection with the Stratis device (Pharmajet, Golden, CO, USA) in each deltoid. Both trials followed up volunteers for 24 months for the primary endpoint of safety, assessed as local and systemic reactogenicity in the 7 days after each vaccination and all adverse events in the 28 days after each vaccination. The secondary endpoint in both trials was immunogenicity 4 weeks after last vaccination. These trials are registered with ClinicalTrials.gov, numbers NCT02840487 and NCT02996461. Findings VRC 319 enrolled 80 participants (20 in each group), and VRC 320 enrolled 45 participants (15 in each group). One participant in VRC 319 and two in VRC 320 withdrew after one dose of vaccine, but were included in the safety analyses. Both vaccines were safe and well tolerated. All local and systemic symptoms were mild to moderate. In both studies, pain and tenderness at the injection site was the most frequent local symptoms (37 [46%] of 80 participants in VRC 319 and 36 [80%] of 45 in VRC 320) and malaise and headache were the most frequent systemic symptoms (22 [27%] and 18 [22%], respectively, in VRC 319 and 17 [38%] and 15 [33%], respectively, in VRC 320). For VRC5283, 14 of 14 (100%) participants who received split-dose vaccinations by needle-free injection had detectable positive antibody responses, and the geometric mean titre of 304 was the highest across all groups in both trials. Interpretation VRC5283 was well tolerated and has advanced to phase 2 efficacy testing. Funding Intramural Research Program of the Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)33105-7
       
  • Preliminary aggregate safety and immunogenicity results from three trials
           of a purified inactivated Zika virus vaccine candidate: phase 1,
           randomised, double-blind, placebo-controlled clinical trials
    • Authors: Kayvon Modjarrad; Leyi Lin; Sarah L George; Kathryn E Stephenson; Kenneth H Eckels; Rafael A De La Barrera; Richard G Jarman; Erica Sondergaard; Janice Tennant; Jessica L Ansel; Kristin Mills; Michael Koren; Merlin L Robb; Jill Barrett; Jason Thompson; Alison E Kosel; Peter Dawson; Andrew Hale; C Sabrina Tan; Stephen R Walsh; Keith E Meyer; James Brien; Trevor A Crowell; Azra Blazevic; Karla Mosby; Rafael A Larocca; Peter Abbink; Michael Boyd; Christine A Bricault; Michael S Seaman; Anne Basil; Melissa Walsh; Veronica Tonwe; Daniel F Hoft; Stephen J Thomas; Dan H Barouch; Nelson L Michael
      Pages: 563 - 571
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Kayvon Modjarrad, Leyi Lin, Sarah L George, Kathryn E Stephenson, Kenneth H Eckels, Rafael A De La Barrera, Richard G Jarman, Erica Sondergaard, Janice Tennant, Jessica L Ansel, Kristin Mills, Michael Koren, Merlin L Robb, Jill Barrett, Jason Thompson, Alison E Kosel, Peter Dawson, Andrew Hale, C Sabrina Tan, Stephen R Walsh, Keith E Meyer, James Brien, Trevor A Crowell, Azra Blazevic, Karla Mosby, Rafael A Larocca, Peter Abbink, Michael Boyd, Christine A Bricault, Michael S Seaman, Anne Basil, Melissa Walsh, Veronica Tonwe, Daniel F Hoft, Stephen J Thomas, Dan H Barouch, Nelson L Michael
      Background A safe, effective, and rapidly scalable vaccine against Zika virus infection is needed. We developed a purified formalin-inactivated Zika virus vaccine (ZPIV) candidate that showed protection in mice and non-human primates against viraemia after Zika virus challenge. Here we present the preliminary results in human beings. Methods We did three phase 1, placebo-controlled, double-blind trials of ZPIV with aluminium hydroxide adjuvant. In all three studies, healthy adults were randomly assigned by a computer-generated list to receive 5 μg ZPIV or saline placebo, in a ratio of 4:1 at Walter Reed Army Institute of Research, Silver Spring, MD, USA, or of 5:1 at Saint Louis University, Saint Louis, MO, USA, and Beth Israel Deaconess Medical Center, Boston, MA, USA. Vaccinations were given intramuscularly on days 1 and 29. The primary objective was safety and immunogenicity of the ZPIV candidate. We recorded adverse events and Zika virus envelope microneutralisation titres up to day 57. These trials are registered at ClinicalTrials.gov, numbers NCT02963909, NCT02952833, and NCT02937233. Findings We enrolled 68 participants between Nov 7, 2016, and Jan 25, 2017. One was excluded and 67 participants received two injections of Zika vaccine (n=55) or placebo (n=12). The vaccine caused only mild to moderate adverse events. The most frequent local effects were pain (n=40 [60%]) or tenderness (n=32 [47%]) at the injection site, and the most frequent systemic reactogenic events were fatigue (29 [43%]), headache (26 [39%]), and malaise (15 [22%]). By day 57, 52 (92%) of vaccine recipients had seroconverted (microneutralisation titre ≥1:10), with peak geometric mean titres seen at day 43 and exceeding protective thresholds seen in animal studies. Interpretation The ZPIV candidate was well tolerated and elicited robust neutralising antibody titres in healthy adults. Funding Departments of the Army and Defense and National Institute of Allergy and Infectious Diseases.

      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)33106-9
       
  • Temporal trends and patterns in heart failure incidence: a
           population-based study of 4 million individuals
    • Authors: Nathalie Conrad; Andrew Judge; Jenny Tran; Hamid Mohseni; Deborah Hedgecott; Abel Perez Crespillo; Moira Allison; Harry Hemingway; John G Cleland; John J V McMurray; Kazem Rahimi
      Pages: 572 - 580
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Nathalie Conrad, Andrew Judge, Jenny Tran, Hamid Mohseni, Deborah Hedgecott, Abel Perez Crespillo, Moira Allison, Harry Hemingway, John G Cleland, John J V McMurray, Kazem Rahimi
      Background Large-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014. Methods For this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years). Findings From 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91–0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37–1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9–2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58–1·64), and did so earlier in life than those from the most affluent group (adjusted difference −3·51 years, 95% CI −3·77 to −3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age. Interpretation Despite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled. Funding British Heart Foundation and National Institute for Health Research.

      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32520-5
       
  • The Lancet Countdown on health and climate change: from 25 years of
           inaction to a global transformation for public health
    • Authors: Nick Watts; Markus Amann; Sonja Ayeb-Karlsson; Kristine Belesova; Timothy Bouley; Maxwell Boykoff; Peter Byass; Wenjia Cai; Diarmid Campbell-Lendrum; Jonathan Chambers; Peter M Cox; Meaghan Daly; Niheer Dasandi; Michael Davies; Michael Depledge; Anneliese Depoux; Paula Dominguez-Salas; Paul Drummond; Paul Ekins; Antoine Flahault; Howard Frumkin; Lucien Georgeson; Mostafa Ghanei; Delia Grace; Hilary Graham; Rébecca Grojsman; Andy Haines; Ian Hamilton; Stella Hartinger; Anne Johnson; Ilan Kelman; Gregor Kiesewetter; Dominic Kniveton; Lu Liang; Melissa Lott; Robert Lowe; Georgina Mace; Maquins Odhiambo Sewe; Mark Maslin; Slava Mikhaylov; James Milner; Ali Mohammad Latifi; Maziar Moradi-Lakeh; Karyn Morrissey; Kris Murray; Tara Neville; Maria Nilsson; Tadj Oreszczyn; Fereidoon Owfi; David Pencheon; Steve Pye; Mahnaz Rabbaniha; Elizabeth Robinson; Joacim Rocklöv; Stefanie Schütte; Joy Shumake-Guillemot; Rebecca Steinbach; Meisam Tabatabaei; Nicola Wheeler; Paul Wilkinson; Peng Gong; Hugh Montgomery; Anthony Costello
      Pages: 581 - 630
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): Nick Watts, Markus Amann, Sonja Ayeb-Karlsson, Kristine Belesova, Timothy Bouley, Maxwell Boykoff, Peter Byass, Wenjia Cai, Diarmid Campbell-Lendrum, Jonathan Chambers, Peter M Cox, Meaghan Daly, Niheer Dasandi, Michael Davies, Michael Depledge, Anneliese Depoux, Paula Dominguez-Salas, Paul Drummond, Paul Ekins, Antoine Flahault, Howard Frumkin, Lucien Georgeson, Mostafa Ghanei, Delia Grace, Hilary Graham, Rébecca Grojsman, Andy Haines, Ian Hamilton, Stella Hartinger, Anne Johnson, Ilan Kelman, Gregor Kiesewetter, Dominic Kniveton, Lu Liang, Melissa Lott, Robert Lowe, Georgina Mace, Maquins Odhiambo Sewe, Mark Maslin, Slava Mikhaylov, James Milner, Ali Mohammad Latifi, Maziar Moradi-Lakeh, Karyn Morrissey, Kris Murray, Tara Neville, Maria Nilsson, Tadj Oreszczyn, Fereidoon Owfi, David Pencheon, Steve Pye, Mahnaz Rabbaniha, Elizabeth Robinson, Joacim Rocklöv, Stefanie Schütte, Joy Shumake-Guillemot, Rebecca Steinbach, Meisam Tabatabaei, Nicola Wheeler, Paul Wilkinson, Peng Gong, Hugh Montgomery, Anthony Costello


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(17)32464-9
       
  • Department of Error
    • Abstract: Publication date: Available online 14 February 2018
      Source:The Lancet


      PubDate: 2018-02-15T16:04:54Z
       
  • Primary sclerosing cholangitis
    • Authors: Jessica K Dyson; Ulrich Beuers; David E J Jones; Ansgar W Lohse; Mark Hudson
      Abstract: Publication date: Available online 13 February 2018
      Source:The Lancet
      Author(s): Jessica K Dyson, Ulrich Beuers, David E J Jones, Ansgar W Lohse, Mark Hudson
      Primary sclerosing cholangitis is a rare, chronic cholestatic liver disease characterised by intrahepatic or extrahepatic stricturing, or both, with bile duct fibrosis. Inflammation and fibrosis of bile ducts and the liver are followed by impaired bile formation or flow and progressive liver dysfunction. Patients might be asymptomatic at presentation or might have pruritus, fatigue, right upper quadrant pain, recurrent cholangitis, or sequelae of portal hypertension. The key diagnostic elements are cholestatic liver biochemistry and bile duct stricturing on cholangiography. Genetic and environmental factors are important in the cause of the disease, with the intestinal microbiome increasingly thought to play a pathogenetic role. Approximately 70% of patients have concurrent inflammatory bowel disease and patients require colonoscopic screening and surveillance. Primary sclerosing cholangitis is associated with increased malignancy risk and surveillance strategies for early cholangiocarcinoma detection are limited. No single drug has been proven to improve transplant-free survival. Liver transplantation is effective for advanced disease but at least 25% of patients develop recurrent disease in the graft.

      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30300-3
       
  • EMA recommendation to suspend HES is hazardous
    • Authors: Djillali Annane; Thomas Fuchs-Buder; Christian Zoellner; Maija Kaukonen; Thomas W L Scheeren
      Abstract: Publication date: Available online 12 February 2018
      Source:The Lancet
      Author(s): Djillali Annane, Thomas Fuchs-Buder, Christian Zoellner, Maija Kaukonen, Thomas W L Scheeren


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30254-x
       
  • Hydroxyethyl starch solutions and patient harm
    • Authors: Ian Roberts; Haleema Shakur; Rinaldo Bellomo; Julian Bion; Simon Finfer; Beverley Hunt; John Myburgh; Anders Perner; Konrad Reinhart
      Abstract: Publication date: Available online 12 February 2018
      Source:The Lancet
      Author(s): Ian Roberts, Haleema Shakur, Rinaldo Bellomo, Julian Bion, Simon Finfer, Beverley Hunt, John Myburgh, Anders Perner, Konrad Reinhart


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30255-1
       
  • Year of reckoning for women in science
    • Authors: Lancet
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): The Lancet


      PubDate: 2018-02-15T16:04:54Z
       
  • Turkish Medical Association—detained for peace
    • Authors: Lancet
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): The Lancet


      PubDate: 2018-02-15T16:04:54Z
       
  • Stroke—acting FAST at all ages
    • Authors: Lancet
      Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120
      Author(s): The Lancet


      PubDate: 2018-02-15T16:04:54Z
       
  • Department of Error
    • Abstract: Publication date: 10–16 February 2018
      Source:The Lancet, Volume 391, Issue 10120


      PubDate: 2018-02-15T16:04:54Z
       
  • Department of Error
    • Abstract: Publication date: Available online 9 February 2018
      Source:The Lancet


      PubDate: 2018-02-15T16:04:54Z
       
  • Lenvatinib: can a non-inferiority trial change clinical practice'
    • Authors: María Reig; Jordi Bruix
      Abstract: Publication date: Available online 9 February 2018
      Source:The Lancet
      Author(s): María Reig, Jordi Bruix


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30208-3
       
  • Stop the toasts: the Global Fund's disturbing new partnership
    • Authors: Robert Marten; Ben Hawkins
      Abstract: Publication date: Available online 9 February 2018
      Source:The Lancet
      Author(s): Robert Marten, Ben Hawkins


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30253-8
       
  • Extrafine inhaled triple therapy versus dual bronchodilator therapy in
           chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel
           group, randomised controlled trial
    • Authors: Alberto Papi; Jørgen Vestbo; Leonardo Fabbri; Massimo Corradi; Hélène Prunier; Géraldine Cohuet; Alessandro Guasconi; Isabella Montagna; Stefano Vezzoli; Stefano Petruzzelli; Mario Scuri; Nicolas Roche; Dave Singh
      Abstract: Publication date: Available online 9 February 2018
      Source:The Lancet
      Author(s): Alberto Papi, Jørgen Vestbo, Leonardo Fabbri, Massimo Corradi, Hélène Prunier, Géraldine Cohuet, Alessandro Guasconi, Isabella Montagna, Stefano Vezzoli, Stefano Petruzzelli, Mario Scuri, Nicolas Roche, Dave Singh
      Background Evidence is scarce on the relative risk-benefit of inhaled triple therapy, consisting of inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2-agonist, versus dual bronchodilation for chronic obstructive pulmonary disease (COPD). We aimed to compare a single-inhaler triple combination of beclometasone dipropionate, formoterol fumarate, and glycopyrronium (BDP/FF/G) versus a single-inhaler dual bronchodilator combination of indacaterol plus glycopyrronium (IND/GLY) in terms of the rate of moderate-to-severe COPD exacerbations over 52 weeks of treatment. Methods This randomised, parallel-group, double-blind, double-dummy study was done at 187 sites across 17 countries. Eligible patients had symptomatic COPD, severe or very severe airflow limitation, at least one moderate or severe exacerbation in the previous year, and were receiving inhaled maintenance medication. After a 2 week run-in period with one inhalation per day of IND/GLY (85 μg/43 μg), patients were randomly assigned (1:1), via an interactive response technology system, to receive 52 weeks of treatment with two inhalations of extrafine BDP/FF/G (87 μg/5 μg/9 μg) twice per day or one inhalation of IND/GLY (85 μg/43 μg) per day. Randomisation was stratified by country and severity of airflow limitation. The primary endpoint was the rate of moderate-to-severe COPD exacerbations across 52 weeks of treatment in all randomised patients who received at least one dose of study drug and had at least one post-baseline efficacy assessment. Safety was assessed in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT02579850. Findings Between May, 29 2015, and July 10, 2017, 1532 patients received BDP/FF/G (n=764) or IND/GLY (n=768). Moderate-to-severe exacerbation rates were 0·50 per patient per year (95% CI 0·45–0·57) for BDP/FF/G and 0·59 per patient per year (0·53–0·67) for IND/GLY, giving a rate ratio of 0·848 (0·723–0·995, p=0·043) in favour of BDP/FF/G. Adverse events were reported by 490 (64%) of 764 patients receiving BDP/FF/G and 516 (67%) of 768 patients receiving IND/GLY. Pneumonia occurred in 28 (4%) patients receiving BDP/FF/G versus 27 (4%) patients receiving IND/GLY. One treatment-related serious adverse event occurred in each group: dysuria in a patient receiving BDP/FF/G and atrial fibrillation in a patient receiving IND/GLY. Interpretation In patients with symptomatic COPD, severe or very severe airflow limitation, and an exacerbation history despite maintenance therapy, extrafine BDP/FF/G significantly reduced the rate of moderate-to-severe exacerbations compared with IND/GLY, without increasing the risk of pneumonia. Funding Chiesi Farmaceutici.

      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30206-x
       
  • Filling the gaps in COPD: the TRIBUTE study
    • Authors: Alvar Agusti
      Abstract: Publication date: Available online 9 February 2018
      Source:The Lancet
      Author(s): Alvar Agusti


      PubDate: 2018-02-15T16:04:54Z
      DOI: 10.1016/s0140-6736(18)30252-6
       
  • Changing culture to end FGM
    • Authors: Lancet
      Abstract: Publication date: 3–9 February 2018
      Source:The Lancet, Volume 391, Issue 10119
      Author(s): The Lancet


      PubDate: 2018-02-05T15:45:43Z
       
  • Yellow fever: a major threat to public health
    • Authors: Lancet
      Abstract: Publication date: 3–9 February 2018
      Source:The Lancet, Volume 391, Issue 10119
      Author(s): The Lancet


      PubDate: 2018-02-05T15:45:43Z
       
  • Editing the human genome: balancing safety and regulation
    • Authors: Lancet
      Abstract: Publication date: 3–9 February 2018
      Source:The Lancet, Volume 391, Issue 10119
      Author(s): The Lancet


      PubDate: 2018-02-05T15:45:43Z
       
  • Turkish Medical Association central council detained for demanding peace
    • Authors: Caghan Kizil
      Abstract: Publication date: Available online 2 February 2018
      Source:The Lancet
      Author(s): Caghan Kizil


      PubDate: 2018-02-05T15:45:43Z
      DOI: 10.1016/s0140-6736(18)30201-0
       
  • Department of Error
    • Abstract: Publication date: Available online 1 February 2018
      Source:The Lancet


      PubDate: 2018-02-05T15:45:43Z
       
 
 
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