Journal Cover The Lancet
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   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3043 journals]
  • Timing of revascularisation for acute coronary syndrome
    • Authors: Peter Damman; Robbert J de Winter
      Pages: 717 - 718
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Peter Damman, Robbert J de Winter


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31632-x
       
  • Intravenous fibrinolytics in STEMI: a 25-year perspective
    • Authors: Saurav Chatterjee; Jay Giri
      Pages: 718 - 720
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Saurav Chatterjee, Jay Giri


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32214-6
       
  • Bioresorbable scaffolds: in search of event-free dissolution
    • Authors: Raffaele Piccolo; Peter Jüni; Stephan Windecker
      Pages: 720 - 722
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Raffaele Piccolo, Peter Jüni, Stephan Windecker


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31871-8
       
  • Expansion of the treatment toolbox for mitral regurgitation
    • Authors: Ottavio Alfieri; Nicola Buzzatti
      Pages: 722 - 724
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Ottavio Alfieri, Nicola Buzzatti


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31797-x
       
  • Hunting hidden parasites: Trypanosoma cruzi
    • Authors: Miriam Navarro; Begoña Monge-Maíllo; María D Flores-Chavez; Rogelio López-Vélez
      Pages: 724 - 726
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Miriam Navarro, Begoña Monge-Maíllo, María D Flores-Chavez, Rogelio López-Vélez


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31536-2
       
  • The cost of complacency—black lung in Australia
    • Authors: Chris McCall
      Pages: 727 - 729
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Chris McCall


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32237-7
       
  • Jeroen Bax: inspiring the next generation of cardiologists
    • Authors: Rachael Davies
      First page: 730
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Rachael Davies


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32094-9
       
  • Fat and heart disease: challenging the dogma
    • Authors: Stuart Spencer
      First page: 731
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Stuart Spencer


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32095-0
       
  • Prudence Mabele
    • Authors: Andrew Green
      First page: 732
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Andrew Green


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32096-2
       
  • Global health: generation men
    • Authors: Nina Schwalbe
      First page: 733
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Nina Schwalbe


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31939-6
       
  • China, Africa, and US academia join hands to advance global health
    • Authors: Liu Peilong; Yemane Berhane; Wafaie Fawzi
      Pages: 733 - 734
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Liu Peilong, Yemane Berhane, Wafaie Fawzi


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31931-1
       
  • PubMed should raise the bar for journal inclusion
    • Authors: Andrea Manca; Lucia Cugusi; Zeevi Dvir; Franca Deriu
      Pages: 734 - 735
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Andrea Manca, Lucia Cugusi, Zeevi Dvir, Franca Deriu


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31943-8
       
  • The BLISTER study: possible overestimation of tetracycline efficacy
    • Authors: Michael J Sladden; Peter E Hutchinson
      First page: 735
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Michael J Sladden, Peter E Hutchinson


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31808-1
       
  • The BLISTER study: possible overestimation of tetracycline efficacy
           – Authors' reply
    • Authors: Hywel C Williams; Joanne R Chalmers; Andrew J Nunn; Gudula Kirtschig; Enno Schmidt
      Pages: 735 - 736
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Hywel C Williams, Joanne R Chalmers, Andrew J Nunn, Gudula Kirtschig, Enno Schmidt


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31790-7
       
  • Forgotten episodes of euthanasia in the 19th century
    • Authors: Marta Licata; Federico Nicoli; Giuseppe Armocida
      First page: 736
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Marta Licata, Federico Nicoli, Giuseppe Armocida


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32168-2
       
  • Optimal timing of an invasive strategy in patients with non-ST-elevation
           acute coronary syndrome: a meta-analysis of randomised trials
    • Authors: Alexander Jobs; Shamir R Mehta; Gilles Montalescot; Eric Vicaut; Arnoud W J van't Hof; Erik A Badings; Franz-Josef Neumann; Adnan Kastrati; Alessandro Sciahbasi; Paul-Georges Reuter; Frédéric Lapostolle; Aleksandra Milosevic; Goran Stankovic; Dejan Milasinovic; Reinhard Vonthein; Steffen Desch; Holger Thiele
      Pages: 737 - 746
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Alexander Jobs, Shamir R Mehta, Gilles Montalescot, Eric Vicaut, Arnoud W J van't Hof, Erik A Badings, Franz-Josef Neumann, Adnan Kastrati, Alessandro Sciahbasi, Paul-Georges Reuter, Frédéric Lapostolle, Aleksandra Milosevic, Goran Stankovic, Dejan Milasinovic, Reinhard Vonthein, Steffen Desch, Holger Thiele
      Background A routine invasive strategy is recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, optimal timing of invasive strategy is less clearly defined. Individual clinical trials were underpowered to detect a mortality benefit; we therefore did a meta-analysis to assess the effect of timing on mortality. Methods We identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD42015018988). Findings We included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180–360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 0·81, 95% CI 0·64–1·03; p=0·0879). In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0·761, 95% CI 0·581–0·996), diabetes (0·67, 0·45–0·99), a GRACE risk score more than 140 (0·70, 0·52–0·95), and aged 75 years older (0·65, 0·46–0·93), although tests for interaction were inconclusive. Interpretation An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients. Funding None.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31490-3
       
  • Comparative efficacy and safety of reperfusion therapy with fibrinolytic
           agents in patients with ST-segment elevation myocardial infarction: a
           systematic review and network meta-analysis
    • Authors: Peerawat Jinatongthai; Junporn Kongwatcharapong; Chee Yoong Foo; Arintaya Phrommintikul; Surakit Nathisuwan; Ammarin Thakkinstian; Christopher M Reid; Nathorn Chaiyakunapruk
      Pages: 747 - 759
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Peerawat Jinatongthai, Junporn Kongwatcharapong, Chee Yoong Foo, Arintaya Phrommintikul, Surakit Nathisuwan, Ammarin Thakkinstian, Christopher M Reid, Nathorn Chaiyakunapruk
      Background Fibrinolytic therapy offers an alternative to mechanical reperfusion for ST-segment elevation myocardial infarction (STEMI) in settings where health-care resources are scarce. Comprehensive evidence comparing different agents is still unavailable. In this study, we examined the effects of various fibrinolytic drugs on clinical outcomes. Methods We did a network meta-analysis based on a systematic review of randomised controlled trials comparing fibrinolytic drugs in patients with STEMI. Several databases were searched from inception up to Feb 28, 2017. We included only randomised controlled trials that compared fibrinolytic agents as a reperfusion therapy in adult patients with STEMI, whether given alone or in combination with adjunctive antithrombotic therapy, against other fibrinolytic agents, a placebo, or no treatment. Only trials investigating agents with an approved indication of reperfusion therapy in STEMI (streptokinase, tenecteplase, alteplase, and reteplase) were included. The primary efficacy outcome was all-cause mortality within 30–35 days and the primary safety outcome was major bleeding. This study is registered with PROSPERO (CRD42016042131). Findings A total of 40 eligible studies involving 128 071 patients treated with 12 different fibrinolytic regimens were assessed. Compared with accelerated infusion of alteplase with parenteral anticoagulants as background therapy, streptokinase and non-accelerated infusion of alteplase were significantly associated with an increased risk of all-cause mortality (risk ratio [RR] 1·14 [95% CI 1·05–1·24] for streptokinase plus parenteral anticoagulants; RR 1·26 [1·10–1·45] for non-accelerated alteplase plus parenteral anticoagulants). No significant difference in mortality risk was recorded between accelerated infusion of alteplase, tenecteplase, and reteplase with parenteral anticoagulants as background therapy. For major bleeding, a tenecteplase-based regimen tended to be associated with lower risk of bleeding compared with other regimens (RR 0·79 [95% CI 0·63–1·00]). The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy increased the risk of major bleeding by 1·27–8·82-times compared with accelerated infusion alteplase plus parenteral anticoagulants (RR 1·47 [95% CI 1·10–1·98] for tenecteplase plus parenteral anticoagulants plus glycoprotein inhibitors; RR 1·88 [1·24–2·86] for reteplase plus parenteral anticoagulants plus glycoprotein inhibitors). Interpretation Significant differences exist among various fibrinolytic regimens as reperfusion therapy in STEMI and alteplase (accelerated infusion), tenecteplase, and reteplase should be considered over streptokinase and non-accelerated infusion of alteplase. The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy should be discouraged. Funding None.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31441-1
       
  • 2-year outcomes with the Absorb bioresorbable scaffold for treatment of
           coronary artery disease: a systematic review and meta-analysis of seven
           randomised trials with an individual patient data substudy
    • Authors: Ziad A Ali; Patrick W Serruys; Takeshi Kimura; Runlin Gao; Stephen G Ellis; Dean J Kereiakes; Yoshinobu Onuma; Charles Simonton; Zhen Zhang; Gregg W Stone
      Pages: 760 - 772
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Ziad A Ali, Patrick W Serruys, Takeshi Kimura, Runlin Gao, Stephen G Ellis, Dean J Kereiakes, Yoshinobu Onuma, Charles Simonton, Zhen Zhang, Gregg W Stone
      Background Bioresorbable vascular scaffolds (BVS) offer the potential to improve long-term outcomes of percutaneous coronary intervention after their complete bioresorption. Randomised trials have shown non-inferiority between BVS and metallic drug-eluting stents at 1 year in composite safety and effectiveness outcomes, although some increases in rates of target vessel-related myocardial infarction and device thrombosis were identified. Outcomes of BVS following the first year after implantation are unknown. We sought to ascertain whether BVS are as safe and effective as drug-eluting stents within 2 years after implantation and between 1 and 2 years. Methods We did a systematic review and meta-analysis of randomised trials in which patients were randomly assigned to everolimus-eluting Absorb BVS or metallic everolimus-eluting stents (EES) and followed up for at least 2 years. We searched MEDLINE, the Cochrane database, TCTMD, ClinicalTrials.gov, Clinical Trial Results, CardioSource, and abstracts and presentations from major cardiovascular meetings up to April 1, 2017, to identify relevant studies. The primary efficacy outcome measure was the device-oriented composite endpoint (cardiac mortality, target vessel-related myocardial infarction, or ischaemia-driven target lesion revascularisation) and the primary safety outcome measure was definite or probable device thrombosis. Individual patient data from the four ABSORB trials were used for landmark and subgroup analysis and multivariable modelling. Findings We identified seven randomised trials in which 5583 patients were randomly assigned to Absorb BVS (n=3261) or metallic EES (n=2322) and followed up for 2 years. BVS had higher 2-year relative risks of the device-oriented composite endpoint than did EES (9·4% [304 of 3217] vs 7·4% [169 of 2299]; relative risk [RR] 1·29 [95% CI 1·08–1·56], p=0·0059). These differences were driven by increased rates of target vessel-related myocardial infarction (5·8% [187 of 3218] vs 3·2% [74 of 2299]; RR 1·68 [95% CI 1·29–2·19], p=0·0003) and ischaemia-driven target lesion revascularisation (5·3% [169 of 3217] vs 3·9% [90 of 2300]; 1·40 [1·09–1·80], p=0·0090) with BVS, with non-significant differences in cardiac mortality. The cumulative 2-year incidence of device thrombosis was higher with BVS than with EES (2·3% [73 of 3187] vs 0·7% [16 of 2281]; RR 3·35 [95% CI 1·96–5·72], p<0·0001). Landmark analysis between 1 and 2 years also showed higher rates of the device-oriented composite endpoint (3·3% [69 of 2100] vs 1·9% [23 of 1193]; RR 1·64 [95% CI 1·03–2·61], p=0·0376) and device thrombosis (0·5% [11 of 2085] vs none [0 of 1183], p<0·0001) in BVS-treated patients than in EES-treated patients. Interpretation BVS was associated with increased rates of composite device-oriented adverse events and device thrombosis cumulatively at 2 years and between 1 and 2 years of follow-up compared with EES. Funding Abbott Vascular.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31470-8
       
  • Compassionate use of the PASCAL transcatheter mitral valve repair system
           for patients with severe mitral regurgitation: a multicentre, prospective,
           observational, first-in-man study
    • Authors: Fabien Praz; Konstantinos Spargias; Michael Chrissoheris; Lutz Büllesfeld; Georg Nickenig; Florian Deuschl; Robert Schueler; Neil P Fam; Robert Moss; Moody Makar; Robert Boone; Jeremy Edwards; Aris Moschovitis; Saibal Kar; John Webb; Ulrich Schäfer; Ted Feldman; Stephan Windecker
      Pages: 773 - 780
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Fabien Praz, Konstantinos Spargias, Michael Chrissoheris, Lutz Büllesfeld, Georg Nickenig, Florian Deuschl, Robert Schueler, Neil P Fam, Robert Moss, Moody Makar, Robert Boone, Jeremy Edwards, Aris Moschovitis, Saibal Kar, John Webb, Ulrich Schäfer, Ted Feldman, Stephan Windecker
      Background Severe mitral regurgitation is associated with impaired prognosis if left untreated. Using the devices currently available, transcatheter mitral valve repair (TMVr) remains challenging in complex anatomical situations. We report the procedural and 30-day results of the first-in-man study of the Edwards PASCAL TMVr system. Methods In this multicentre, prospective, observational, first-in-man study, we collected data from seven tertiary care hospitals in five countries that had a compassionate use programme in which patients underwent transcatheter mitral valve repair using the Edwards PASCAL TMVr system. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation deemed at high risk or inoperable. Safety and efficacy of the procedure were prospectively assessed at device implantation, discharge, and 30 days after device implantation. The key study endpoints were technical success assessed at the end of the procedure and device success 30 days after implantation using the Mitral Valve Academic Research Consortium definitions. Findings Between Sept 1, 2016, and March 31, 2017, 23 patients (median age 75 years [IQR 61–82]) had treatment for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the Edwards PASCAL TMVr system. At baseline, the median EuroScore II score was 7·1% (IQR 3·6–12·8) and the median Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair was 4·8% (2·1–9·0) and 6·8% (2·9–10·1) for mitral valve replacement. 22 (96%) of 23 patients were New York Heart Association (NYHA) class III or IV at baseline. The implantation of at least one device was successful in all patients, resulting in procedural residual mitral regurgitation of grade 2+ or less in 22 (96%) patients. Six (26%) of 23 patients had two implants. Periprocedural complications occurred in two (9%) of 23 patients (one minor bleeding event and one transient ischaemic attack). Despite the anatomical complexity of mitral regurgitation in the patients in this compassionate use cohort, technical success was achieved in 22 (96%) of 23 patients, and device success at 30 days was achieved in 18 (78%) patients. Three patients (13%) died during the 30 day follow-up. 19 (95%) of 20 patients alive 30 days after implantation were NYHA class I or II. Interpretation This study establishes feasibility of the Edwards PASCAL TMVr system with a high rate of technical success and reduction of mitral regurgitation severity. Further research is needed on procedural and long-term clinical outcomes. Funding None.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31600-8
       
  • Coronary balloon angioplasty, stents, and scaffolds
    • Authors: Robert A Byrne; Gregg W Stone; John Ormiston; Adnan Kastrati
      Pages: 781 - 792
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Robert A Byrne, Gregg W Stone, John Ormiston, Adnan Kastrati
      Since the first coronary angioplasty on Sept 16, 1977, the field of percutaneous coronary intervention has evolved rapidly. Now marking its 40th anniversary, percutaneous coronary intervention has become one of the most common medical procedures worldwide. Much of this progress has been due to the iteration and improvement of angioplasty technologies. Balloon angioplasty was limited by unpredictable procedural outcomes due to vessel dissection and recoil, and a high rate of restenosis. The introduction of stents resulted in more stable early results and lower rates of restenosis, although early stent thrombosis and neointimal hyperplasia causing vessel renarrowing were key limitations. Drug-eluting stents delivering antiproliferative agents significantly lowered the rates of restenosis, permitting widespread use of percutaneous coronary intervention in more advanced and complex disease. Although fully bioresorbable scaffolds have the potential to further improve long-term outcomes, they have not yet achieved results equivalent to those of conventional metallic drug-eluting stents in the early years after implantation. Progress in catheter technology did not occur in isolation, and the success of percutaneous coronary intervention is also due to important advances in intracoronary imaging, and adjunct pharmacotherapy—each of which is reviewed in other papers in this Series.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31927-x
       
  • Intravascular imaging in coronary artery disease
    • Authors: Gary S Mintz; Giulio Guagliumi
      Pages: 793 - 809
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Gary S Mintz, Giulio Guagliumi
      Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging—intravascular ultrasound and more recently optical coherence tomography—provide a tomographical or cross-sectional image of the coronary arteries. These techniques are clinically useful to answer questions such as whether the stenosis is clinically relevant; the identification of the culprit lesion; or whether the plaque (or patient) is at high risk of future adverse events. They can also be used to optimise stent implantation to minimise stent-related adverse events, provide answers to the likelihood of distal embolisation or peri-procedural myocardial infarction during stent implantation, and provide reasons for stent thrombosis or restenosis. This review considers the usefulness of intravascular imaging in day-to-day practice.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31957-8
       
  • Update on antithrombotic therapy after percutaneous coronary
           revascularisation
    • Authors: Thomas Cuisset; Freek W A Verheugt; Laura Mauri
      Pages: 810 - 820
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): Thomas Cuisset, Freek W A Verheugt, Laura Mauri
      For relief of coronary obstruction, percutaneous coronary intervention has become a standard-of-care procedure over the past 40 years. Nonetheless, optimal outcomes after coronary stenting require careful attention to antithrombotic therapy. This review aims to summarise the current available evidence and discusses how to integrate scientific knowledge into clinical decisions. In recent years, improvement and modifications of drugs and devices have changed the field tremendously, and substantially benefitted patient outcomes. The key challenge of how to provide optimal protection against thrombotic events without excessive increases in bleeding risk has remained the same for decades. Alternative strategies with new drugs, both antiplatelet and anticoagulant agents, and new coronary stents will continue the journey to achieve this ultimate goal.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31936-0
       
  • Influenza vaccine: going through a sticky patch
    • Authors: Katja Höschler; Maria C Zambon
      Pages: 627 - 628
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Katja Höschler, Maria C Zambon


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31364-8
       
  • Azithromycin in uncontrolled asthma
    • Authors: Guy Brusselle; Ian Pavord
      Pages: 629 - 630
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Guy Brusselle, Ian Pavord


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31547-7
       
  • Oral misoprostol for induction of labour in hypertensive pregnancies
    • Authors: Vanita Suri; Pooja Sikka
      Pages: 630 - 632
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Vanita Suri, Pooja Sikka


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31453-8
       
  • Building virtual communities of practice for health
    • Authors: Bruce Struminger; Sanjeev Arora; Sarah Zalud-Cerrato; David Lowrance; Tedd Ellerbrock
      Pages: 632 - 634
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Bruce Struminger, Sanjeev Arora, Sarah Zalud-Cerrato, David Lowrance, Tedd Ellerbrock


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31666-5
       
  • Born to run: our future depends on it
    • Authors: Alejandro Santos-Lozano; Alejandro Lucia; Luis Ruilope; Yannis P Pitsiladis
      Pages: 635 - 636
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Alejandro Santos-Lozano, Alejandro Lucia, Luis Ruilope, Yannis P Pitsiladis


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32103-7
       
  • Treating and preventing cholera in Bangladesh
    • Authors: Sam Loewenberg
      Pages: 637 - 638
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Sam Loewenberg


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32208-0
       
  • Insight into autism: a view from inside
    • Authors: Anna Remington
      Pages: 639 - 640
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Anna Remington


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31968-2
       
  • Reflex hammer
    • Authors: Bill Bynum; Helen Bynum
      First page: 641
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Bill Bynum, Helen Bynum


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31969-4
       
  • Arts-based learning for a Circle of Care
    • Authors: Suzy Willson; Peter Jaye
      Pages: 642 - 643
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Suzy Willson, Peter Jaye


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31970-0
       
  • Angela Mary Hartley Brodie
    • Authors: Geoff Watts
      First page: 644
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Geoff Watts


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31971-2
       
  • Defending academic and medical independence in Turkey
    • Authors: Alexis Benos; Chiara Bodini; Hannah Cowan; David McCoy; Penelope Milsom; David Sanders
      First page: 645
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Alexis Benos, Chiara Bodini, Hannah Cowan, David McCoy, Penelope Milsom, David Sanders


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)32093-7
       
  • Preventing stolen childhood
    • Authors: Helen Lazaratou; Konstantina Magklara
      Pages: 645 - 646
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Helen Lazaratou, Konstantina Magklara


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31952-9
       
  • George Gershwin's death and Duret haemorrhage
    • Authors: Takahiro Mezaki
      First page: 646
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Takahiro Mezaki


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31623-9
       
  • Can post-mortem CT and angiography provide all the answers'
    • Authors: Chris O'Donnell; Matthew Lynch; Noel Woodford
      Pages: 646 - 647
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): Chris O'Donnell, Matthew Lynch, Noel Woodford


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31828-7
       
  • 40 years of percutaneous coronary intervention: where next'
    • Authors: Lancet
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
  • The rising north–south divide in health in the UK
    • Authors: Lancet
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
  • Nicotine addiction, reduction, and smoking cessation
    • Authors: Lancet
      Abstract: Publication date: 19–25 August 2017
      Source:The Lancet, Volume 390, Issue 10096
      Author(s): The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
  • Penile allotransplantation for penis amputation following ritual
           circumcision: a case report with 24 months of follow-up
    • Authors: André van der Merwe; Frank Graewe; Alexander Zühlke; Nicola W Barsdorf; Amir D Zarrabi; Jeremy T Viljoen; Hilgard Ackermann; Pieter V Spies; Dedan Opondo; Talal Al-Qaoud; Karla Bezuidenhout; Johan D Nel; Bertha Bailey; M Rafique Moosa
      Abstract: Publication date: Available online 17 August 2017
      Source:The Lancet
      Author(s): André van der Merwe, Frank Graewe, Alexander Zühlke, Nicola W Barsdorf, Amir D Zarrabi, Jeremy T Viljoen, Hilgard Ackermann, Pieter V Spies, Dedan Opondo, Talal Al-Qaoud, Karla Bezuidenhout, Johan D Nel, Bertha Bailey, M Rafique Moosa
      Introduction Ritual circumcision complicated by gangrene is a leading cause of penile loss in young men in South Africa. This deeply rooted cultural tradition is unlikely to be abolished. Conventional reconstructive techniques using free vascularised tissue flaps with penile implants are undesirable in this often socioeconomically challenged group because donor site morbidity can hinder manual labour and vigorous sexual activity might lead to penile implant extrusion. The psychosociological effects of penile loss in a young man are devastating and replacing it with the same organ is likely to produce the maximum benefit. Methods We first performed a cadaver-to-cadaver penile transplantation as preparation. After approval from the Human Research Ethics Committee was obtained, we recruited potential recipients. We screened the potential participants for both physical and psychological characteristics, including penile stump length, and emotional suitability for the procedure. A suitable donor became available and the penis was harvested. We surgically prepared the penile stump of the recipient and attached the penile graft. Immunosuppression treatment with antithymyocyte globulin, methylprednisolone, tacrolimus, mycophenolate mofetil, and prednisone were commenced. Tadalafil at 5 mg once per day was commenced after 1 week as penile rehabilitation and was continued for 3 months. We collected on quality-of-life scores (Short Form 36 version 2 [SF-36v2] questionnaires) before surgery and during follow-up and measured erectile function (International Index for Erectile Function [IIEF] score) and urine flow rates at 24 months post transplant. Findings The warm ischaemia time for the graft after removal was 4 min and the cold ischaemia time was 16 h. The surgery lasted 9 h. An arterial thrombus required urgent revision 8 h after the operation. On post operative day 6, an infected haematoma and an area of proximal skin necrosis were surgically treated. The recipient was discharged after 1 month and first reported satisfactory sexual intercourse 1 week later (despite advice to the contrary). The recipient reported regular sexual intercourse from 3 months after the operation. An episode of acute kidney injury at 7 months was reversed by reducing the tacrolimus dose to 14 mg twice per day. At 8 months after surgery, the patient had a skin infection with phaeohyphomycosis due to Alternaria alternata, which we treated with topical antifungal medication. Quality-of-life scores improved substantially after the operation (SF-36v2 mental health scores improved from 25 preoperatively, to 57 at 6 months and 46 at 24 months post transplant; physical health scores improved from 37 at baseline to 60 at 6 months and 59 at 24 months post-transplant). At 24 months, measured maximum urine flow rate (16·3 mL/s from a volume voided of 109 mL) and IIEF score (overall satisfaction score of 8 from a maximum of 10) were normal, showing normal voiding and erectile function, respectively. Interpretation Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months. Funding Department of Health, Western Cape Government.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31807-x
       
  • Penile transplantation is here
    • Authors: Nikolai A Sopko; Arthur L Burnett
      Abstract: Publication date: Available online 17 August 2017
      Source:The Lancet
      Author(s): Nikolai A Sopko, Arthur L Burnett


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31933-5
       
  • Department of Error
    • Abstract: Publication date: Available online 17 August 2017
      Source:The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
  • Pembrolizumab versus ipilimumab for advanced melanoma: final overall
           survival results of a multicentre, randomised, open-label phase 3 study
           (KEYNOTE-006)
    • Authors: Jacob Schachter; Antoni Ribas; Georgina V Long; Ana Arance; Jean-Jacques Grob; Laurent Mortier; Adil Daud; Matteo S Carlino; Catriona McNeil; Michal Lotem; James Larkin; Paul Lorigan; Bart Neyns; Christian Blank; Teresa M Petrella; Omid Hamid; Honghong Zhou; Scot Ebbinghaus; Nageatte Ibrahim; Caroline Robert
      Abstract: Publication date: Available online 16 August 2017
      Source:The Lancet
      Author(s): Jacob Schachter, Antoni Ribas, Georgina V Long, Ana Arance, Jean-Jacques Grob, Laurent Mortier, Adil Daud, Matteo S Carlino, Catriona McNeil, Michal Lotem, James Larkin, Paul Lorigan, Bart Neyns, Christian Blank, Teresa M Petrella, Omid Hamid, Honghong Zhou, Scot Ebbinghaus, Nageatte Ibrahim, Caroline Robert
      Background Interim analyses of the phase 3 KEYNOTE-006 study showed superior overall and progression-free survival of pembrolizumab versus ipilimumab in patients with advanced melanoma. We present the final protocol-specified survival analysis. Methods In this multicentre, open-label, randomised, phase 3 trial, we recruited patients from 87 academic institutions, hospitals, and cancer centres in 16 countries (Australia, Austria, Belgium, Canada, Chile, Colombia, France, Germany, Israel, Netherlands, New Zealand, Norway, Spain, Sweden, UK, and USA). We randomly assigned participants (1:1:1) to one of two dose regimens of pembrolizumab, or one regimen of ipilimumab, using a centralised, computer-generated allocation schedule. Treatment assignments used blocked randomisation within strata. Eligible patients were at least 18 years old, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, at least one measurable lesion per Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1), unresectable stage III or IV melanoma (excluding ocular melanoma), and up to one previous systemic therapy (excluding anti-CTLA-4, PD-1, or PD-L1 agents). Secondary eligibility criteria are described later. Patients were excluded if they had active brain metastases or active autoimmune disease requiring systemic steroids. The primary outcome was overall survival (defined as the time from randomisation to death from any cause). Response was assessed per RECIST v1.1 by independent central review at week 12, then every 6 weeks up to week 48, and then every 12 weeks thereafter. Survival was assessed every 12 weeks, and final analysis occurred after all patients were followed up for at least 21 months. Primary analysis was done on the intention-to-treat population (all randomly assigned patients) and safety analyses were done in the treated population (all randomly assigned patients who received at least one dose of study treatment). Data cutoff date for this analysis was Dec 3, 2015. This study was registered with ClinicalTrials.gov, number NCT01866319. Findings Between Sept 18, 2013, and March 3, 2014, 834 patients with advanced melanoma were enrolled and randomly assigned to receive intravenous pembrolizumab every 2 weeks (n=279), intravenous pembrolizumab every 3 weeks (n=277), or intravenous ipilimumab every 3 weeks (ipilimumab for four doses; n=278). One patient in the pembrolizumab 2 week group and 22 patients in the ipilimumab group withdrew consent and did not receive treatment. A total of 811 patients received at least one dose of study treatment. Median follow-up was 22·9 months; 383 patients died. Median overall survival was not reached in either pembrolizumab group and was 16·0 months with ipilimumab (hazard ratio [HR] 0·68, 95% CI 0·53–0·87 for pembrolizumab every 2 weeks vs ipilimumab; p=0·0009 and 0·68, 0·53–0·86 for pembrolizumab every 3 weeks vs ipilimumab; p=0·0008). 24-month overall survival rate was 55% in the 2-week group, 55% in the 3-week group, and 43% in the ipilimumab group. Interpretation Substantiating the results of the interim analyses of KEYNOTE-006, pembrolizumab continued to provide superior overall survival versus ipilimumab, with no difference between pembrolizumab dosing schedules. These conclusions further support the use of pembrolizumab as a standard of care for advanced melanoma. Funding Merck & Co.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31601-x
       
  • KEYNOTE-006: a success in melanoma, but a long way to go
    • Authors: Kilian Wistuba-Hamprecht; Graham Pawelec
      Abstract: Publication date: Available online 16 August 2017
      Source:The Lancet
      Author(s): Kilian Wistuba-Hamprecht, Graham Pawelec


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31816-0
       
  • Is late-life dependency increasing or not' A comparison of the
           Cognitive Function and Ageing Studies (CFAS)
    • Authors: Andrew Kingston; Pia Wohland; Raphael Wittenberg; Louise Robinson; Carol Brayne; Fiona E Matthews; Carol Jagger; E Green; L Gao; R Barnes; A Arthur; C Baldwin; L E Barnes; C Brayne; A Comas-Herrera; T Dening; G Forster; S Harrison; P G Ince; C Jagger; F E Matthews; I G McKeith; B Parry; J Pickett; L Robinson; B C M Stephan; S Wharton; R Wittenberg; B Woods; R Weller
      Abstract: Publication date: Available online 15 August 2017
      Source:The Lancet
      Author(s): Andrew Kingston, Pia Wohland, Raphael Wittenberg, Louise Robinson, Carol Brayne, Fiona E Matthews, Carol Jagger
      Background Little is known about how the proportions of dependency states have changed between generational cohorts of older people. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care. Methods In this population-based study, we compared two Cognitive Function and Ageing Studies (CFAS I and CFAS II) of older people (aged ≥65 years) who were permanently registered with a general practice in three defined geographical areas (Cambridgeshire, Newcastle, and Nottingham; UK). These studies were done two decades apart (1991 and 2011). General practices provided lists of individuals to be contacted and were asked to exclude those who had died or might die over the next month. Baseline interviews were done in the community and care homes. Participants were stratified by age, and interviews occurred only after written informed consent was obtained. Information collected included basic sociodemographics, cognitive status, urinary incontinence, and self-reported ability to do activities of daily living. CFAS I was assigned as the 1991 cohort and CFAS II as the 2011 cohort, and both studies provided prevalence estimates of dependency in four states: high dependency (24-h care), medium dependency (daily care), low dependency (less than daily), and independent. Years in each dependency state were calculated by Sullivan's method. To project future demands for social care, the proportions in each dependency state (by age group and sex) were applied to the 2014 England population projections. Findings Between 1991 and 2011, there were significant increases in years lived from age 65 years with low dependency (1·7 years [95% CI 1·0–2·4] for men and 2·4 years [1·8–3·1] for women) and increases with high dependency (0·9 years [0·2–1·7] for men and 1·3 years [0·5–2·1] for women). The majority of men's extra years of life were spent independent (36·3%) or with low dependency (36·3%) whereas for women the majority were spent with low dependency (58·0%), and only 4·8% were independent. There were substantial reductions in the proportions with medium and high dependency who lived in care homes, although, if these dependency and care home proportions remain constant in the future, further population ageing will require an extra 71 215 care home places by 2025. Interpretation On average older men now spend 2·4 years and women 3·0 years with substantial care needs, and most will live in the community. These findings have considerable implications for families of older people who provide the majority of unpaid care, but the findings also provide valuable new information for governments and care providers planning the resources and funding required for the care of their future ageing populations. Funding Medical Research Council (G9901400) and (G06010220), with support from the National Institute for Health Research Comprehensive Local research networks in West Anglia and Trent, UK, and Neurodegenerative Disease Research Network in Newcastle, UK.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31575-1
       
  • The burden of triumph: meeting health and social care needs
    • Authors: Andrew Dilnot
      Abstract: Publication date: Available online 15 August 2017
      Source:The Lancet
      Author(s): Andrew Dilnot


      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31938-4
       
  • Current approach of the axilla in patients with early-stage breast cancer
    • Authors: Eleftherios P Mamounas; Thorsten Kuehn; Emiel J T Rutgers; Gunter von Minckwitz
      Abstract: Publication date: Available online 14 August 2017
      Source:The Lancet
      Author(s): Eleftherios P Mamounas, Thorsten Kuehn, Emiel J T Rutgers, Gunter von Minckwitz
      The surgical approach of the axilla in patients with early-stage breast cancer has witnessed considerable evolution during the past 25 years. The previously undisputed gold standard of axillary-lymph-node dissection for staging has now been replaced by sentinel-lymph-node biopsy for patients with clinically negative axilla. For selected patients with limited sentinel-lymph-node involvement, completion axillary-lymph-node dissection can be omitted or replaced by axillary radiotherapy, reducing morbidity. The clinical interest of axillary staging after neoadjuvant chemotherapy is increasing and this approach might contribute to morbidity reduction, and to the further tailoring of future systemic and locoregional treatment decisions by response assessment. Refinement of the sentinel-lymph-node biopsy technique might overcome the slightly impaired success rates in this setting. New techniques for lymphatic mapping attempt to further simplify the procedure. In view of the declining influence of axillary nodal status on adjuvant therapy decision-making, ongoing clinical trials will evaluate whether sentinel-lymph-node biopsy can be avoided altogether in selected patients.

      PubDate: 2017-08-19T18:06:45Z
      DOI: 10.1016/s0140-6736(17)31451-4
       
  • Genome editing: science, ethics, and public engagement
    • Authors: Lancet
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
  • Yemen and cholera: a modern humanity test
    • Authors: Lancet
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
  • Losing the fight against HIV in the Philippines
    • Authors: Lancet
      Abstract: Publication date: 12–18 August 2017
      Source:The Lancet, Volume 390, Issue 10095
      Author(s): The Lancet


      PubDate: 2017-08-19T18:06:45Z
       
 
 
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