[Department of Error] Department of Error
Kandzari DE, Mauri L, Koolen JJ, et al, for the BIOFLOW V Investigators. Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin, durable polymer everolimus-eluting stents in patients undergoing coronary revascularisation (BIOFLOW V): a randomised trial. Lancet 2017; 390: 1843 –52—In this Article (published online first on August 26), the online publication date in the footer should have been August 26, 2017, the y-axis scale in figure 2 has been corrected, and a number of typological errors have been corrected. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
Woodcock A, Vestbo J, Bakerly ND, et al. Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. Lancet 2017; 390: 2247 –55—In table 1 of this Article (published Online First on Sept 10, 2017), the number of patients in the fluticasone furoate and vilanterol group who did not have any exacerbations in the previous year before randomisation should be 1378. In figure 3, the data should be as follows: HR=0·96 (95% CI 0·86–1·07); p=0·5041. (Source: LANCET)
Source: LANCET - September 14, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[The Lancet Commissions] The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa
Sub-Saharan Africa's health challenges are numerous and wide-ranging. Most sub-Saharan countries face a double burden of traditional, persisting health challenges, such as infectious diseases, malnutrition, and child and maternal mortality, and emerging challenges from an increasing prevalence of chronic conditions, mental health disorders, injuries, and health problems related to climate change and environmental degradation. Although there has been real progress on many health indicators, life expectancy and most population health indicators remain behind most low-income and middle-income countries in other parts of the w...
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Irene Akua Agyepong, Nelson Sewankambo, Agnes Binagwaho, Awa Marie Coll-Seck, Tumani Corrah, Alex Ezeh, Abebaw Fekadu, Nduku Kilonzo, Peter Lamptey, Felix Masiye, Bongani Mayosi, Souleymane Mboup, Jean-Jacques Muyembe, Muhammad Pate, Myriam Sidibe, Bright Tags: The Lancet Commissions Source Type: research

[Correspondence] Response to an African-driven health agenda
There is no question that Africa faces a myriad of health challenges and The Lancet Editorial (July 8, p 96)1 captured it well in the statement that “health is much more than just health care,” which reflects the absence of systems for health. (Source: LANCET)
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Githinji Gitahi Tags: Correspondence Source Type: research

[Perspectives] Irene Agyepong: building capacity in Ghana's public health system
As a lead author of the Lancet Commission on the future of health in sub-Saharan Africa, Irene Agyepong's ambition is to make a lasting contribution to health in Africa. “One of my driving passions is building health policy and systems research, policy, and practice capacity in west Africa. To conduct research, to advance research evidence and decision making, and ultimately to improve outcomes”, she says. “I am really interested in transformation and health o utcomes, and human development in sub-Saharan Africa. (Source: LANCET)
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Tamara Lucas Tags: Perspectives Source Type: research

[Comment] Longer and healthier lives for all Africans by 2030: perspectives and action of WHO AFRO
The Path to Longer and Healthier Lives for All Africans by 2030: the Lancet Commission on the Future of Health in sub-Saharan Africa1 is of great interest to the WHO Regional Office for Africa (WHO AFRO). This Commission by Irene Agyepong and colleagues expresses its conviction that a health system ensuring positive health outcomes for everyone, irrespective of socioeconomic class, gender, religion, or location, is possible and realisable in the African Region, despite many challenges. It identifies immense opportunities, which will foster health development if acted upon without delay. (Source: LANCET)
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Matshidiso Moeti Tags: Comment Source Type: research

[Comment] Africa and health: a Commission to accelerate success
The final results of a 4-year project to analyse the challenges and opportunities for health in sub-Saharan Africa are now published as a Lancet Commission —The Path to Longer and Healthier Lives for All Africans by 2030—led by African physicians, health scientists, and policy makers.1 Their conclusion is one of qualified optimism, grounded in a rigorous appraisal of new evidence and past experience. The vision of the Commission is that Africans sh ould expect the same opportunities for health by 2030 as all other peoples. (Source: LANCET)
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Richard Horton, Selina Lo Tags: Comment Source Type: research

[Perspectives] Betty Kirkwood: trailblazer in global health epidemiology
After 38 years at the London School of Hygiene& Tropical Medicine (LSHTM), Betty Kirkwood is still in love with her academic home. “It's the mission—shared by everyone from cleaners to refectory staff to academic staff—to improve health worldwide that brings a unique atmosphere to the school”, she says. Kirkwood is head of LSHTM's Maternal and Child Health Intervention Research Group, and has been Professor of Epidemiol ogy and International Health at LSHTM since 1995. (Source: LANCET)
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Richard Lane Tags: Perspectives Source Type: research

[Perspectives] Ann Ashworth: pioneer in child nutrition
Ann Ashworth may have retired in 2005, but is still closely involved with work in the sphere in which she has made such a contribution over the past half century. She currently co-convenes an international malnutrition taskforce, which aims to build capacity to prevent and treat malnutrition and to highlight malnutrition as a major cause of child death. “Sub-Saharan Africa remains a major problem, but awareness has increased since the launch of the taskforce”, she says. (Source: LANCET)
Source: LANCET - September 13, 2017 Category: General Medicine Authors: Richard Lane Tags: Perspectives Source Type: research

[Viewpoint] Saving an additional 100 million lives
10 years ago, we suggested a way to prevent 100 million deaths from tobacco.1 That initiative, grounded on the WHO Framework Convention on Tobacco Control, led to the creation of the MPOWER technical package, which in the past decade has newly protected about 3 ·5 billion people with effective tobacco control strategies, reduced tobacco use prevalence substantially, and prevented 30 million deaths.2,3 As that work continues, today, along with global partners, we are launching a new cardiovascular health initiative—Resolve—to prevent an additional 100 million deaths globally. (Source: LANCET)
Source: LANCET - September 12, 2017 Category: General Medicine Authors: Thomas R Frieden, Michael R Bloomberg Tags: Viewpoint Source Type: research

[Articles] Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial
To the best of our knowledge, ramucirumab plus docetaxel is the first regimen in a phase 3 study to show superior progression-free survival over chemotherapy in patients with platinum-refractory advanced urothelial carcinoma. These data validate inhibition of VEGFR-2 signalling as a potential new therapeutic treatment option for patients with urothelial carcinoma. (Source: LANCET)
Source: LANCET - September 12, 2017 Category: General Medicine Authors: Daniel P Petrylak, Ronald de Wit, Kim N Chi, Alexandra Drakaki, Cora N Sternberg, Hiroyuki Nishiyama, Daniel Castellano, Syed Hussain, Aude Fl échon, Aristotelis Bamias, Evan Y Yu, Michiel S van der Heijden, Nobuaki Matsubara, Boris Alekseev, Andrea Necc Tags: Articles Source Type: research

[Comment] Antiangiogenesis to curb urothelial cancer
Angiogenesis has been associated with clinicopathological factors and features of biological aggressiveness in urothelial cancer.1,2 Although several agents targeting the vascular endothelial growth factor (VEGF) pathway have been investigated in phase 1 and 2 trials in advanced urothelial cancer and as maintenance,1,3 –5 the overall clinical benefit has been small, with occasional disease stabilisation seen in some patients.1,3 (Source: LANCET)
Source: LANCET - September 12, 2017 Category: General Medicine Authors: Joaquim Bellmunt Tags: Comment Source Type: research

[Articles] Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial
Across all primary analysis groups, rucaparib significantly improved progression-free survival in patients with platinum-sensitive ovarian cancer who had achieved a response to platinum-based chemotherapy. ARIEL3 provides further evidence that use of a poly(ADP-ribose) polymerase inhibitor in the maintenance treatment setting versus placebo could be considered a new standard of care for women with platinum-sensitive ovarian cancer following a complete or partial response to second-line or later platinum-based chemotherapy. (Source: LANCET)
Source: LANCET - September 12, 2017 Category: General Medicine Authors: Robert L Coleman, Amit M Oza, Domenica Lorusso, Carol Aghajanian, Ana Oaknin, Andrew Dean, Nicoletta Colombo, Johanne I Weberpals, Andrew Clamp, Giovanni Scambia, Alexandra Leary, Robert W Holloway, Margarita Amenedo Gancedo, Peter C Fong, Jeffrey C Goh, Tags: Articles Source Type: research

[Comment] PARP inhibitors for targeted treatment in ovarian cancer
Poly(ADP-ribose) polymerase (PARP) inhibitors emerged as the first targeted treatment for ovarian cancer, and are selectively active for women with mutations in BRCA1 and BRCA2 (mBRCA). On the basis of data showing activity (measured by the proportion of patients who achieved an objective response),1 the PARP inhibitor olaparib received US Food and Drug Administration (FDA) approval in 2014 specifically for women with germline mBRCA-associated (gBRCA) recurrent ovarian cancer.2 However, subsequent findings from clinical trials of PARP inhibitors have suggested that the importance of mBRCA as a predictive biomarker has dimi...
Source: LANCET - September 12, 2017 Category: General Medicine Authors: Don S Dizon Tags: Comment Source Type: research

[Global Health Metrics] Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016
GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. (Source: LANCET)
Source: LANCET - September 12, 2017 Category: General Medicine Authors: GBD 2016 SDG Collaborators Tags: Global Health Metrics Source Type: research

[The Lancet Commissions] After asthma: redefining airways diseases
Asthma is responsible for considerable global morbidity and health-care costs. Substantial progress was made against key outcomes such as hospital admissions with asthma and mortality in the 1990s and early 2000s, but little improvement has been observed in the past 10 years, despite escalating treatment costs. New assessment techniques are not being adopted and new drug discovery has progressed more slowly than in other specialties. (Source: LANCET)
Source: LANCET - September 11, 2017 Category: General Medicine Authors: Ian D Pavord, Richard Beasley, Alvar Agusti, Gary P Anderson, Elisabeth Bel, Guy Brusselle, Paul Cullinan, Adnan Custovic, Francine M Ducharme, John V Fahy, Urs Frey, Peter Gibson, Liam G Heaney, Patrick G Holt, Marc Humbert, Clare M Lloyd, Guy Marks, Fer Tags: The Lancet Commissions Source Type: research

[Perspectives] Andrew Bush: a broad portfolio in paediatric respirology
Although it's trivial, the first thing I notice on meeting Andrew Bush is his colourful bow tie. All sorts of motives are ascribed to men who favour this form of neckwear, and few are entirely flattering. So the succeeding 40 minutes come as a relief. Far from an attention seeker, Bush is a quietly spoken and thoughtful man: a self-declared work junkie with a commitment to paediatric respirology that's equally divided between research and clinical work. “For me, they go hand in hand. It's like someone asking me if I prefer running with my right leg or my left leg. (Source: LANCET)
Source: LANCET - September 11, 2017 Category: General Medicine Authors: Geoff Watts Tags: Perspectives Source Type: research

[Perspectives] Ian Pavord: engaging with the eosinophil
It says something for Ian Pavord's modesty, self-confidence, or both that when talking of the insight with which he's most closely associated, he cheerfully volunteers that it was a rediscovery of something first noted more than 50 years ago. In the 1990s, as a consultant respiratory physician and later an honorary professor at the UK's University of Leicester, Pavord was studying eosinophils and inflammation. He'd acquired an interest in the topic during a fellowship at McMaster University in Hamilton, ON, Canada, where he worked for Freddy Hargreave, an inspirational English physician who, Pavord says, “probably tr...
Source: LANCET - September 11, 2017 Category: General Medicine Authors: Geoff Watts Tags: Perspectives Source Type: research

[Comment] Transformational thinking about asthma
Although asthma has been recognised for thousands of years, the disorder was widely misunderstood until the 20th century.1 The first widely accepted disease definition was released only 30 years ago.2 Although this definition continues to be cited, most clinicians do not actually measure airway inflammation and hyper-responsiveness when they examine a patient with asthma. Yet most patients, clinicians, and researchers claim to recognise “asthma” when they see it—and surveillance programmes continue to document enormous morbidity and costs worldwide. (Source: LANCET)
Source: LANCET - September 11, 2017 Category: General Medicine Authors: Carlos A Camargo Tags: Comment Source Type: research

[Comment] After asthma: airways diseases need a new name and a revolution
Asthma remains a frightening diagnosis with an unclear prognosis and outcome. The estimated global burden of asthma is substantial1 and reductions in mortality from asthma have stalled since 2006, with wide variations between countries.2 Causes are multifactorial, triggers and symptoms are varied, and the disease course over a lifetime is unpredictable. Severity can fluctuate with sudden asthma attacks leading to death in previously well controlled patients or those with very few symptoms on no medication. (Source: LANCET)
Source: LANCET - September 11, 2017 Category: General Medicine Authors: Sabine Kleinert, Richard Horton Tags: Comment Source Type: research

[Comment] Using data to tackle the burden of amputation in diabetes
On Sept 5, 2017, Public Health England (PHE) published 2010 –16 data on the incidence of amputation for diabetic foot ulcers in Clinical Commissioning Groups (CCGs) throughout the country, using data adjusted for known non-modifiable risk factors.1 The differences between localities revealed by these data highlight both the need for continued close surveil lance of diabetes-related amputation rates and the opportunity for improvement. (Source: LANCET)
Source: LANCET - September 11, 2017 Category: General Medicine Authors: William Jeffcoate, Emma Barron, John Lomas, Jonathan Valabhji, Bob Young Tags: Comment Source Type: research

[Articles] Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial
In patients with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy, initiation of a once-daily treatment regimen of combined fluticasone furoate and vilanterol improved asthma control without increasing the risk of serious adverse events when compared with optimised usual care. (Source: LANCET)
Source: LANCET - September 10, 2017 Category: General Medicine Authors: Ashley Woodcock, J ørgen Vestbo, Nawar Diar Bakerly, John New, J Martin Gibson, Sheila McCorkindale, Rupert Jones, Susan Collier, James Lay-Flurrie, Lucy Frith, Loretta Jacques, Joanne L Fletcher, Catherine Harvey, Henrik Svedsater, David Leather, Salfor Tags: Articles Source Type: research

[Comment] Effectiveness trials in asthma: time to SaLSA?
In your next clinical consultation, you may well find yourself asking the question “What is the likelihood that this treatment will benefit this patient at this time?” Evidence-based practice answers this question with data collected under ideal conditions from a double-blind, randomised, placebo-controlled trial (RCT). However, what evidence-based practice doesn't tell us is that, when it comes to asthma and many other chronic diseases, only a minority of patients in your clinic would ever meet the eligibility criteria for these RCTs. (Source: LANCET)
Source: LANCET - September 10, 2017 Category: General Medicine Authors: Peter Gibson Tags: Comment Source Type: research

[Series] Advances in paediatric gastroenterology
Recent developments in paediatric gastrointestinal surgery have focused on minimally invasive surgery, the accumulation of high-quality clinical evidence, and scientific research. The benefits of minimally invasive surgery for common disorders like appendicitis and hypertrophic pyloric stenosis are all supported by good clinical evidence. Although minimally invasive surgery has been extended to neonatal surgery, it is difficult to establish its role for neonatal disorders such as oesophageal atresia and biliary atresia through clinical trials because of the rarity of these disorders. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Paul K H Tam, Patrick H Y Chung, Shawn D St Peter, Christopher P Gayer, Henri R Ford, Greta C H Tam, Kenneth K Y Wong, Mikko P Pakarinen, Mark Davenport Tags: Series Source Type: research

[Series] Advances in paediatric urology
Paediatric urological surgery is often required for managing congenital and acquired disorders of the genitourinary system. In this Series paper, we highlight advances in the surgical management of six paediatric urological disorders. The management of vesicoureteral reflux is evolving, with advocacy ranging from a less interventional assessment and antimicrobial prophylaxis to surgery including endoscopic injection of a bulking agent and minimally invasive ureteric reimplantation. Evidence supports early orchidopexy to improve fertility and reduce malignancy in boys with undescended testes. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: David A Diamond, Ivy H Y Chan, Andrew J A Holland, Michael P Kurtz, Caleb Nelson, Carlos R Estrada, Stuart Bauer, Paul K H Tam Tags: Series Source Type: research

[Articles] Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial
No differences in quality of life after surgery for chronic pancreatitis were seen between the interventions. Results from single-centre trials showing superiority for DPPHR were not confirmed in the multicentre setting. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Markus K Diener, Felix J H üttner, Meinhard Kieser, Phillip Knebel, Colette Dörr-Harim, Marius Distler, Robert Grützmann, Uwe A Wittel, Rebekka Schirren, Hans-Michael Hau, Axel Kleespies, Claus-Dieter Heidecke, Ales Tomazic, Christopher M Halloran, Tor Tags: Articles Source Type: research

[Correspondence] Conscious sedation or general anaesthesia for lumbar puncture in children in Poland
Children with acute lymphoblastic leukaemia who are treated according to the intercontinental ALL-IC-BFM-2009 protocol have between 15 and 22 lumbar punctures with intrathecal drug administration during the first 12 months of therapy, depending on risk group and central nervous system involvement. Families in Poland are putting considerable pressure on paediatric oncology centres to do lumbar punctures under general anaesthesia, instead of using conscious sedation alone. Conscious sedation is usually done with midazolam, analgesics, and topical anaesthetic ointment. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Jan Styczynski Tags: Correspondence Source Type: research

[Correspondence] Life-sustaining technologies in resource-limited settings – Authors' reply
The achievement of equity in the distribution of renal replacement therapies and nephrology care for patients with end-stage kidney disease in resource-limited settings is a complex ethical and clinical problem.1 John W Stanifer and Abhinav Sharma draw attention to the substantial burden of mortality associated with acute kidney injury in such settings, the demographic factors that can distinguish between populations requiring dialysis for acute or chronic kidney failure, and the consequences of the non-availability of dialysis for the two groups. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Dominique Martin, Vivekanand Jha Tags: Correspondence Source Type: research

[Correspondence] Life-sustaining technologies in resource-limited settings
Vivekanand Jha and colleagues (Feb 23, p 1851)1 highlighted several issues on global dialysis. As stated in their Health Policy paper, more than 2 million people died in 2010 because of insufficient access to dialysis, most of whom were from resource-limited settings.2 However, several issues remain unaddressed, particularly factors related to dialysis in resource-limited settings, where more than 80% of people affected by kidney diseases live.3,4 (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: John W Stanifer, Abhinav Sharma Tags: Correspondence Source Type: research

[Correspondence] The Global Gag Rule: placing the health and lives of women and girls at risk
The Lancet Editorial (July 1, p 1)1 and Obituary (July 1, p 24)2 published following the death of Babatunde Osotimehin —the Executive Director of the UN Population Fund—gave a fitting tribute to his huge contribution to sexual and reproductive health and rights, but also provided a timely reminder of how the current political climate in the USA threatens to undermine gender equality, jeopardise the health, right s, and wellbeing of girls and women, and reverse years of hard work and progress. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Katja Iversen Tags: Correspondence Source Type: research

[Correspondence] The physician as dictator
In the wake of the atrocities committed by the regime of ophthalmologist-cum-dictator Bashar al-Assad, the medical community has been horrified by the devastation caused by one of its own.1 Considering the frequent criticisms of the hierarchical power structure in medicine, we sought to establish whether physicians disproportionately tend to be the leaders of autocracies. We analysed the governments of 176 countries over 71 years (1945 –2015), identifying the de-facto ruler of every country for each year. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Ethan B Ludmir, Muhammad Ali Elahi, Barak D Richman Tags: Correspondence Source Type: research

[Obituary] Gordon Ostlere, alias Richard Gordon
Anaesthetist and author of the successful series of Doctor books. Born in London on Sept 15, 1921, he died after a stroke in Kent, UK, on Aug 11, 2017, aged 95 years. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Barbara Casassus Tags: Obituary Source Type: research

[Perspectives] The history of anaesthesia and the patient —reduced to a body?
“When the dreadful steel was plunged into my breast…I needed no injunctions not to restrain my cries”, writer Fanny Burney famously wrote about the mastectomy she underwent on the hands of Napoleon's surgeon Dominique-Jean Larrey on Sept 30, 1811. “I began a scream that lasted unintermitting ly during the whole time of the incision—& I almost marvel that it rings not in my Ears still! So excruciating was the agony. ” This account is very different from what happened when, on Dec 21, 1846, the 36-year-old butler Frederick Churchill had his thigh amputated by Robert Liston using ether...
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Thomas Schlich Tags: Perspectives Source Type: research

[Perspectives] The best editors get fired
Jerry Kassirer was fired as Editor-in-Chief of The New England Journal of Medicine (NEJM) in 1999. Two decades later, he has written, in the guise of a memoir, a blistering attack on his former employer, the Massachusetts Medical Society. Revenge, it is often said, is a dish best served cold. Kassirer relives old battles and settles outstanding scores. He savages the present state of medicine and medical journals. And he offers a bleak view of the future for a profession he clearly loves. Unanticipated Outcomes: A Medical Memoir is a painful autoautopsy of a successful life brought down by the greed of small minds and the ...
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Richard Horton Tags: Perspectives Source Type: research

[World Report] High stakes for research in US 2018 budget negotiations
As Congress considers how to fund the government next year, scientists hope spending for research will not be curtailed. Susan Jaffe, The Lancet's Washington correspondent, reports. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Susan Jaffe Tags: World Report Source Type: research

[Comment] Offline: North Korea —the case for health diplomacy
President Trump's August 30 tweet was blunt: “Talking is not the answer!” He was referring to North Korea (the Democratic People's Republic of Korea, DPRK). “The US has been talking to North Korea, and paying them extortion money, for 25 years”, he wrote. Meanwhile, as punishment for North Korea's firing of a missile over Japan's Hokka ido island, UK Prime Minister Theresa May threatened further economic sanctions to end the DPRK's nuclear provocations. The goal of western nations, united with China and Russia on the UN Security Council, is to squeeze Pyongyang to such an extent that the regime capi...
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Long-term implications and global impact of paediatric surgery
Irrespective of variations across geography, culture, and socioeconomic status, paediatric surgery differs from other surgical subspecialties. Children are not small adults. Surgery for infants and children is typically undertaken for congenital, rare, and complex conditions and the consequences of both the condition and its treatment can affect that individual for life. Above all, the surgical outcome needs to stand the test of time. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Paul K H Tam, Mark Davenport, Ivy H Y Chan, Alp Numanoglu, Piet Hoebeke, David A Diamond Tags: Comment Source Type: research

[Comment] Surgical trials for chronic pancreatitis
Chronic pancreatitis is associated with a heavy burden for patients and substantial economic costs.1,2 Patients with chronic pancreatitis might have debilitating pain, opioid dependence, and reduced quality of life; be recurrently admitted to hospital; and be unable to work.3,4 Yet, for patients and physicians, chronic pancreatitis remains a difficult disease to manage, with few medical options and little consensus on the optimum timing or type of surgical intervention. Reports5,6 suggest potential superiority of surgical intervention over endoscopic drainage for long-term pain relief. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Melena D Bellin, Gregory J Beilman Tags: Comment Source Type: research

[Editorial] CAR T-cells: an exciting frontier in cancer therapy
On Aug 30, the US Food and Drug Administration (FDA) approved tisagenlecleucel (marketed by Novartis as Kymriah) as the first ever treatment that genetically modifies patients' own T cells. The approval is for children and young adults (up to 25 years of age) with relapsed or refractory acute B-cell lymphoblastic leukaemia —a leading cause of childhood cancer deaths. This treatment option is currently limited to 20 specially certified centres in the USA because of the complexity of the procedure and potentially serious side-effects. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Pushing the boundaries in paediatric surgery
Aside from the difficult psychosocial aspects of illness in babies and children, paediatric surgery and paediatric surgical research face inimitable challenges. These include the consequences of anaesthesia and radiation exposure in children, the implications of long-term complications, and, in many cases, the necessity of long-term care despite the inevitability of a transition to adult services. Diseases requiring paediatric surgery are sometimes rare and heterogenous in nature, with complex cases requiring multidisciplinary management. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Extreme rain, flooding, and health
The unprecedented volume of rain and floods during the past few weeks is difficult to comprehend. More than 1400 people in south Asia are dead and tens of millions more have been affected by extreme monsoon rains. The worst flooding in 100 years has left one third of Bangladesh submerged. In Nepal, almost half a million people are food insecure. More than 7000 schools have been damaged in India at the height of the exam season, with the result that many children will not complete their education. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Perspectives] Taking control through drama
There is something magical about theatre. It transports you to a different place and into a different mind. Some say drama is the magic ingredient. Whatever you cook with it, it makes it better. It has the ability to provoke debate, raise questions, and reveal ambiguities in our lives. Theatre allows the audience to live through others' emotions and understand their motivations. We decided to explore the potential of drama to move the minds of adolescents about asthma and its image. (Source: LANCET)
Source: LANCET - September 8, 2017 Category: General Medicine Authors: Gioia Mosler, Tunde Euba Tags: Perspectives Source Type: research

[Articles] The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE)
The burden of CHCs in survivors of childhood cancer is substantial and highly variable. Our assessment of total cumulative burden in survivors of paediatric cancer, with detailed characterisation of long-term CHCs, provide data to better inform future clinical guidelines, research investigations, and health services planning for this vulnerable, medically complex population. (Source: LANCET)
Source: LANCET - September 7, 2017 Category: General Medicine Authors: Nickhill Bhakta, Qi Liu, Kirsten K Ness, Malek Baassiri, Hesham Eissa, Frederick Yeo, Wassim Chemaitilly, Matthew J Ehrhardt, Johnnie Bass, Michael W Bishop, Kyla Shelton, Lu Lu, Sujuan Huang, Zhenghong Li, Eric Caron, Jennifer Lanctot, Carrie Howell, Tim Tags: Articles Source Type: research

[Comment] Childhood cancer: the long-term costs of cure
Survival after childhood cancer has substantially improved over the past several decades, and more than 80% of children diagnosed with cancer in the USA now survive at least 5 years.1 This improvement comes at a cost, however, because the curative therapies used to achieve such successful survival proportions are associated with adverse late effects, with previous research finding increased risks of morbidity,2 poor health status,3 and premature mortality4 compared with sibling and population comparison groups. (Source: LANCET)
Source: LANCET - September 7, 2017 Category: General Medicine Authors: Miranda M Fidler, Michael M Hawkins Tags: Comment Source Type: research

[Clinical Picture] Acral retiform purpura
A 68-year-old man with a 10-year history of progressive IgG λ multiple myeloma and chronic kidney disease presented with a 3-week history of a painful rash on both his soles and palms, on a background of acute renal failure requiring haemodialysis. On examination he had petechiae and stellate macular purpura coalescing into retiform patches on both feet, wo rse on the soles (figure). A punch biopsy sample of the left palm showed mild perivascular inflammation with sparse karyorrhectic debris, extravasated red blood cells, and intravascular eosinophilic non-polarisable crystals (figure). (Source: LANCET)
Source: LANCET - September 7, 2017 Category: General Medicine Authors: Janet Y Li, Doina Ivan, Anisha B Patel Tags: Clinical Picture Source Type: research

[World Report] Lasker foundation announces award winners for 2017
This year's Lasker awards recognise the work of Michael Hall, Douglas Lowy, and John Shiller, and the US health-care provider Planned Parenthood. Talha Burki reports. (Source: LANCET)
Source: LANCET - September 6, 2017 Category: General Medicine Authors: Talha Burki Tags: World Report Source Type: research

[Articles] Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16 –26 years: a randomised, double-blind trial
The 9vHPV vaccine prevents infection, cytological abnormalities, high-grade lesions, and cervical procedures related to HPV 31, 33, 45, 52, and 58. Both the 9vHPV vaccine and qHPV vaccine had a similar immunogenicity profile with respect to HPV 6, 11, 16, and 18. Vaccine efficacy was sustained for up to 6 years. The 9vHPV vaccine could potentially provide broader coverage and prevent 90% of cervical cancer cases worldwide. (Source: LANCET)
Source: LANCET - September 5, 2017 Category: General Medicine Authors: Warner K Huh, Elmar A Joura, Anna R Giuliano, Ole-Erik Iversen, Rosires Pereira de Andrade, Kevin A Ault, Deborah Bartholomew, Ramon M Cestero, Edison N Fedrizzi, Angelica L Hirschberg, Marie-H élène Mayrand, Angela Maria Ruiz-Sternberg, Jack T Stapleto Tags: Articles Source Type: research

[Comment] Nine-valent human papillomavirus vaccine: great science, but will it save lives?
In The Lancet, Warner K Huh and colleagues1 report their final analysis of a randomised, double-blind trial of 14  215 women, aged 16–26 years, testing the quadrivalent human papillomavirus (qHPV; HPV types 6, 11, 16, and 18) vaccine compared with the nine-valent HPV (9vHPV; HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine. The women were recruited from 105 study sites located in 18 countries and re ceived vaccination on day 1 and months 2 and 6. The 9vHPV vaccine consists of virus-like particles of HPV 6, 11, 16, and 18 (as found in the qHPV vaccine) and an additional five types, HPV 31, 33, 45, 52, and 58...
Source: LANCET - September 5, 2017 Category: General Medicine Authors: Lynette Denny Tags: Comment Source Type: research

[Seminar] Soil-transmitted helminth infections
More than a quarter of the world's population is at risk of infection with the soil-transmitted helminths Ascaris lumbricoides, hookworm (Ancylostoma duodenale and Necator americanus), Trichuris trichiura, and Strongyloides stercoralis. Infected children and adults present with a range of medical and surgical conditions, and clinicians should consider the possibility of infection in individuals living in, or returning from, endemic regions. Although safe and effective drugs are donated free to endemic countries, only half of at-risk children received treatment in 2016. (Source: LANCET)
Source: LANCET - September 4, 2017 Category: General Medicine Authors: Peter Mark Jourdan, Poppy H L Lamberton, Alan Fenwick, David G Addiss Tags: Seminar Source Type: research

[Comment] Detangling and detailing sexual health in the SDG era
Sexual health, as an area of health and as a concept, has evolved during the past 40 years. WHO's earliest deliberations on sexual health, in 1974, urged a positive approach to human sexuality, with an emphasis on pleasure, the enhancement of personal relationships, and the right to information.1 Subsequent considerations described the concept in terms of its relation with reproductive health. The 1994 International Conference on Population and Development (ICPD) positioned sexual health as a subset of reproductive health. (Source: LANCET)
Source: LANCET - September 3, 2017 Category: General Medicine Authors: Rob Stephenson, Lianne Gonsalves, Ian Askew, Lale Say, WHO Working Group for Operationalizing Sexual Health Tags: Comment Source Type: research