[Case Report] The empress of subterfuge: cancer of the fallopian tube presenting with malapropism
A 58-year-old realtor presented to her community hospital with an acute left-sided facial droop in December, 2015. She reported that in the past 2 months her children had noticed (and teased her for) malapropisms (video 1), but she had no other symptoms and had continued to manage complicated sales. She did not smoke and consumed alcohol occasionally. Her body-mass index was 23 kg/m2. On examination she had a left lower facial weakness and made occasional paraphasic errors during speech. Her platelet count was 117  × 109 per L (normal range 140–450 × 109 cells L), and blood glucose, cholesterol, a...
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Lucy Gilbert, Timoth ée Revil, Charles Meunier, Kris Jardon, Xing Zeng, Claudia Martins, Jocelyne Arseneau, Lili Fu, Krystle North, Alicia Schiavi, Eric Ehrensperger, Giovanni Artho, Todd Lee, David Morris, Jiannis Ragoussis Tags: Case Report Source Type: research

[Series] Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease
People with advanced chronic obstructive pulmonary disease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns, patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Matthew Maddocks, Natasha Lovell, Sara Booth, William D-C Man, Irene J Higginson Tags: Series Source Type: research

[Series] What does endotyping mean for treatment in chronic obstructive pulmonary disease?
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, both at the clinical and biological level. However, COPD is still diagnosed and treated according to simple clinical measures (level of airflow limitation, symptoms, and frequency of previous exacerbations). To address this clinical and biological complexity and to move towards precision medicine in COPD, we need to integrate (bioinformatics) and interpret (clinical science) the vast amount of high-throughput information that existing technology provides (systems biology and network medicine) so diagnosis, stratification, and treatment of ...
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Alvar Agust í, Bartolome Celli, Rosa Faner Tags: Series Source Type: research

[Correspondence] Prevention of hearing loss in patients with multidrug-resistant tuberculosis
In their Lancet Review, Blake S Wilson and colleagues (July 10)1 describe the growing global burden of hearing loss caused by a range of possible factors. The use of ototoxic medication is a considerable contributor to hearing loss for both children and adults. The authors suggest a primary prevention strategy for reducing hearing loss, which includes the use of ototoxic drugs only when no alternatives are available and only for serious conditions. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Helen Cox, Anja Reuter, Jennifer Furin, James Seddon Tags: Correspondence Source Type: research

[Correspondence] What can Japan learn from tobacco control in the UK?
A Lancet Editorial (July 8, p 96)1 on tobacco control in the UK described how people are protected from second-hand smoke as a result of the country going smoke free in 2007. This is in stark contrast to people in Japan who, unfortunately, are likely to continue to be affected by passive smoking in public spaces for the next decade. Japan, and other countries that are currently struggling to introduce policies for the prevention of second-hand smoke in public places, might be able to learn from the success of tobacco control in the UK. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Yusuke Tsugawa, Ken Hashimoto, Takahiro Tabuchi, Kenji Shibuya Tags: Correspondence Source Type: research

[Correspondence] Naming of the victims of Nazi medicine
I read with great interest the Perspectives piece by Philip Ball (June 3, p 2182),1 who reported on the Science and Suffering exhibition at the Wiener Library for the Study of the Holocaust and Genocide in London. He rightly highlighted the goal of discovering the names and life stories of victims of the Nazi-era medical experiments. He stated that some of their 15  000—perhaps as many as 27 000—names are projected onto the library's wall. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Claude Matuchansky Tags: Correspondence Source Type: research

[Correspondence] Anchors aweigh
Cognitive biases frequently result in diagnostic inaccuracies and medical mismanagement, resulting in adverse outcomes or inadequate use of resources. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Jason Chertoff, Abhishek Biswas, Divya Patel Tags: Correspondence Source Type: research

[Correspondence] Intertwining migration, ethnicity, racism, and health
Johanna Hanefeld and colleagues' Comment (June 17, p 2358)1 on research into migration, mobility, and health, and Richard Horton's Offline Comment (July 1, p 14)2 on racism need integrating. Racism is not in Hanefeld and colleagues' research agenda;1 their agenda is researcher orientated, which is similar to those agendas proposed for ethnicity,3 but distant from the grave threats and challenges in Horton's piece2 on racism. Hanefeld and colleagues1 contend, correctly in my view, that the resolutions of the 2008 World Health Assembly and the WHO global consultation of Migrant Health4 in 2010 have had little effect. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Raj S Bhopal Tags: Correspondence Source Type: research

[Correspondence] Addressing racism: a new approach to promotion of positive policies is needed
The Lancet Offline Comment by Richard Horton (July 1, p 14)1 denouncing racism is important. Little seems to have been learned since institutional racism was identified in the Stephen Lawrence murder inquiry in 1999.2 (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Michael J Rigby Tags: Correspondence Source Type: research

[Correspondence] Public health must confront racism and xenophobia
We welcome Richard Horton's call (July 1, p 14)1 for public health professionals to engage more fully and visibly in the political arena and agree that our community has paid too little attention to the “broader political influences shaping health”. This imperative underpinned the Vienna Declaration,2 issued by the European Public Health Association (EUPHA) and the Austrian Public Health Association in 2016, which was subsequently endorsed by public health organisations across Europe. The Decla ration explicitly highlights the political and commercial determinants of health, calling on public health professiona...
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Natasha Azzopardi Muscat, Dineke Zeegers Paget, Martin McKee Tags: Correspondence Source Type: research

[Obituary] Herbert Leroy Needleman
Paediatric psychiatrist and campaigner against lead. Born in Philadelphia, PA, USA, on Dec 13, 1927, he died of pulmonary oedema in Pittsburgh, PA, on July 18, 2017, aged 89 years. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Everything is illuminated
Although light permeates and sustains our lives, it rarely intrudes on clinical consciousness. This is despite our discourse that is rich in luminary references, such as shedding light on a challenging diagnosis, and an increasing awareness of the therapeutic value of daylight, including the nature of views from windows, in clinical settings. The positive impact of light is multifactorial in nature, drawing not only on psychophysical aspects such as circadian rhythms but also on important but underappreciated elements of wellbeing such as aesthetics. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Desmond O'Neill Tags: Perspectives Source Type: research

[Perspectives] Lung cancer
At the intellectual heart of the new scientific medicine of the late 19th century was the idea of specificity: each disease had a single specific cause, and in time medicine would generate a specific and effective cure. This idea transformed the diagnosis and treatment of infectious diseases, but through the 20th century, as the burden of mortality shifted towards chronic diseases, its limitations became abundantly clear —nowhere more so than in the case of lung cancer. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Richard Barnett Tags: Perspectives Source Type: research

[Perspectives] Alvar Agusti: bringing systems biology to COPD
“Some people think he's a bit too wild, a bit too radical”, says Jørgen Vestbo. “He's an unconventional thinker. When most of us start discussing things from a particular starting point he'll often question the starting point as well.” Peter Sterk takes a similar view. “He thinks out of t he box and ahead of the crowd. He's a clinician who's open to fundamental innovative developments that will change clinical practice dramatically in 5 or 10 years. He's one of the frontrunners shaping that future.” Professors Vestbo and Sterk are both respiratory physicians, the former at the UK'...
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Geoff Watts Tags: Perspectives Source Type: research

[World Report] Over 60 children die in a hospital in north India
Although investigations are still ongoing to assess the chain of responsibility, the Gorakhpur tragedy exposes the malaise of India's health system. Dinesh C Sharma reports. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Dinesh C Sharma Tags: World Report Source Type: research

[Comment] Offline: Terrorism and Syria —“a crisis of the world”
August 9, France: six soldiers injured by a car in Levallois-Perret. August 17, Spain: 16 people killed and 120 injured by vehicles driven into pedestrians in Barcelona and Cambrils. It has not been a quiet summer in Europe. Terrorist attacks on the continent have surged since the killing of four people at the Jewish Museum in Brussels in May, 2014. The perpetrator of that attack had recently returned from fighting for Islamic extremists in Syria. Indeed, the origins of recent European terrorism are attributed largely to the collapse of the Syrian Arab Republic and its colonisation by the Islamic State of Iraq and the Leva...
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Classification of maternal deaths: where does the chain of events start?
In several countries, confidential enquiry into maternal deaths, combined with rigorous classification, has become a valued method to improve the quality of maternity care. The death of Mrs X (panel) is a case of maternal mortality —ie, “the death of a woman while pregnant or within 42 days of termination of pregnancy…from any cause related to or aggravated by the pregnancy or its management”.1 However, who would predict that her underlying cause of the death would be classified differently, depending on the country wh ere she died? (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Thomas van den Akker, Kitty W M Bloemenkamp, Jos van Roosmalen, Marian Knight, Netherlands Audit Committee Maternal Mortality and Morbidity, UK Confidential Enquiry into Maternal Deaths Tags: Comment Source Type: research

[Editorial] Supporting the need for nation-building in Afghanistan
In a presidential address delivered on Aug 21, President Donald Trump declared that the USA would be maintaining and expanding its military presence in Afghanistan. In his speech, the President was very clear: his goal is “not nation-building again; we are killing terrorists”. Once more, the people of Afghanistan seem to have been relegated to the backdrop of the conflict. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Palliative care in chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is increasing in prevalence, and is associated with a high mortality rate. The latest data from the Global Burden of Disease Study 2015, published on Aug 16 in The Lancet Respiratory Medicine, show that 3 ·2 million people died from COPD worldwide in 2015, an increase of 11·6% com-pared with 1990. From 1990 to 2015, the prevalence of COPD increased by 44·2%, although age-standardised death and prevalence rates have fallen overall. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Problem gambling is a public health concern
Archaeological finds from China, Egypt, and Persia show that gambling has been a pastime for 5 millennia. Most readers will have gambled at some time, and 63% of people older than 16 years of age in Great Britain did so in the past year. But at what financial, social, and health cost is poorly understood. Gambling Behaviour in Great Britain in 2015, a report by NatCen for the Gambling Commission, published on Aug 24, provides a glimpse of who gambles, where, and how in England, Scotland, and Wales (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study
In patients with resistant hypertension, endovascular baroreceptor amplification with the MobiusHD device substantially lowered blood pressure with an acceptable safety profile. Randomised, double-blind, sham-controlled trials are warranted to investigate the use of this treatment further. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Wilko Spiering, Bryan Williams, Jan Van der Heyden, Monique van Kleef, Rob Lo, Jorie Versmissen, Adriaan Moelker, Abraham Kroon, Hannes Reuter, Gary Ansel, Gregg W Stone, Mark Bates, CALM-FIM_EUR investigators Tags: Articles Source Type: research

[Comment] Stretching the carotid sinus to treat resistant hypertension
Around a quarter of adults have hypertension, and by 2025, the number affected might be more than 1 ·5 billion people worldwide.1 Despite important advances in pharmacotherapy in the past 40 years, resistant hypertension—that is, persistently raised ambulatory blood pressure despite treatment with at least three antihypertensive drugs, including a diuretic—occurs in about 13% of treated adult s.2 Optimisation of treatment is crucial in people with resistant hypertension because of the increased risk of cardiovascular disease. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Pierre-Yves Courand, Pierre Lantelme Tags: Comment Source Type: research

[World Report] The dangers of unregulated stem-cell marketing
Exploiting a gap in regulation, clinics offering risky, unproven stem-cell treatments are spreading across the world, as researchers and regulatory bodies call for action. Dara Mohammadi reports. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Dara Mohammadi Tags: World Report Source Type: research

[World Report] Alleged acoustic attack on US diplomats puzzling experts
The reported silent acoustic attack that allegedly caused US officials stationed in Cuba to lose hearing surprises experts, as they claim such a weapon is not thought to exist. Rita Rubin reports. (Source: LANCET)
Source: LANCET - September 1, 2017 Category: General Medicine Authors: Rita Rubin Tags: World Report Source Type: research

[Articles] Coformulated bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir with emtricitabine and tenofovir alafenamide, for initial treatment of HIV-1 infection (GS-US-380 –1490): a randomised, double-blind, multicentre, phase 3, non-inferiority trial
At 48 weeks, virological suppression with the bictegravir regimen was achieved and was non-inferior to the dolutegravir regimen in previously untreated adults. There was no emergent resistance to either regimen. The fixed-dose combination of bictegravir, emtricitabine, and tenofovir alafenamide was safe and well tolerated compared with the dolutegravir regimen. (Source: LANCET)
Source: LANCET - August 31, 2017 Category: General Medicine Authors: Paul E Sax, Anton Pozniak, M Luisa Montes, Ellen Koenig, Edwin DeJesus, Hans-J ürgen Stellbrink, Andrea Antinori, Kimberly Workowski, Jihad Slim, Jacques Reynes, Will Garner, Joseph Custodio, Kirsten White, Devi SenGupta, Andrew Cheng, Erin Quirk Tags: Articles Source Type: research

[Articles] Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection (GS-US-380-1489): a double-blind, multicentre, phase 3, randomised controlled non-inferiority trial
At 48 weeks, coformulated bictegravir, emtricitabine, and tenofovir alafenamide achieved virological suppression in 92% of previously untreated adults and was non-inferior to coformulated dolutegravir, abacavir, and lamivudine, with no treatment-emergent resistance. Bictegravir, emtricitabine, and tenofovir alafenamide was safe and well tolerated with better gastrointestinal tolerability than dolutegravir, abacavir, and lamivudine. Because coformulated bictegravir, emtricitabine, and tenofovir alafenamide does not require HLA B*5701 testing and provides guideline-recommended treatment for individuals co-infected with HIV a...
Source: LANCET - August 31, 2017 Category: General Medicine Authors: Joel Gallant, Adriano Lazzarin, Anthony Mills, Chloe Orkin, Daniel Podzamczer, Pablo Tebas, Pierre-Marie Girard, Indira Brar, Eric S Daar, David Wohl, J ürgen Rockstroh, Xuelian Wei, Joseph Custodio, Kirsten White, Hal Martin, Andrew Cheng, Erin Quirk Tags: Articles Source Type: research

[Comment] The triumph of HIV treatment: another new antiretroviral
Since the approval of the first integrase strand inhibitor (INSTI) raltegravir for the treatment of HIV 10 years ago, INSTIs have become agents of choice in combination with two nucleoside reverse transcriptase inhibitors (NRTIs) in many international guidelines.1,2 This was driven by the sound real-world experience of this antiretroviral class, especially following the introduction of the most recently licensed INSTI, dolutegravir. (Source: LANCET)
Source: LANCET - August 31, 2017 Category: General Medicine Authors: Marta Boffito, Francois Venter Tags: Comment Source Type: research

[Articles] Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study
High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings. (Source: LANCET)
Source: LANCET - August 29, 2017 Category: General Medicine Authors: Mahshid Dehghan, Andrew Mente, Xiaohe Zhang, Sumathi Swaminathan, Wei Li, Viswanathan Mohan, Romaina Iqbal, Rajesh Kumar, Edelweiss Wentzel-Viljoen, Annika Rosengren, Leela Itty Amma, Alvaro Avezum, Jephat Chifamba, Rafael Diaz, Rasha Khatib, Scott Lear, Tags: Articles Source Type: research

[Articles] Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375 –500 g/day). (Source: LANCET)
Source: LANCET - August 29, 2017 Category: General Medicine Authors: Victoria Miller, Andrew Mente, Mahshid Dehghan, Sumathy Rangarajan, Xiaohe Zhang, Sumathi Swaminathan, Gilles Dagenais, Rajeev Gupta, Viswanathan Mohan, Scott Lear, Shrikant I Bangdiwala, Aletta E Schutte, Edelweiss Wentzel-Viljoen, Alvaro Avezum, Yuksel Tags: Articles Source Type: research

[Comment] PURE study challenges the definition of a healthy diet: but key questions remain
The relationships between diet, cardiovascular disease, and death are topics of major public health importance, and subjects of great controversy.1,2 In European and North American countries, the most enduring and consistent diet advice is to restrict saturated fatty acids, by replacing animal fats with vegetable oils and complex carbohydrates (and more recently whole grains).1,3 In The Lancet, Mahshid Dehghan and colleagues4 echo the views of a growing number of scientists by stating that advice to restrict saturated fatty acids “is largely based on selective emphasis on some observational and clinical data, despite...
Source: LANCET - August 29, 2017 Category: General Medicine Authors: Christopher E Ramsden, Anthony F Domenichiello Tags: Comment Source Type: research

[Comment] Fruits, vegetables, and legumes: sound prevention tools
Cardiovascular disease is the leading cause of death worldwide, accounting for a third of all deaths. Three of four cardiovascular deaths and more than 80% of premature deaths attributable to non-communicable diseases occur in low-income and middle-income countries.1 Thus, preventive strategies to tackle premature mortality and, particularly, cardiovascular mortality represent a major public health goal not only for high-income countries, but also for low-income and middle-income countries. The most effective and sustainable preventive strategies should rely on healthy diet and lifestyle. (Source: LANCET)
Source: LANCET - August 29, 2017 Category: General Medicine Authors: Estefania Toledo, Miguel A Mart ínez-González Tags: Comment Source Type: research

[Department of Error] Department of Error
Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet 2017; 390: 793 –809—In the margin information of this Series paper, the corresponding email should read gmintz@crf.org. This correction has been made to the online version as of Aug 29, 2017. (Source: LANCET)
Source: LANCET - August 29, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial
The observed reduction of mortality risk from abdominal aortic aneurysm, peripheral arterial disease, and hypertension has never been seen before in the population screening literature and can be linked primarily to initiation of pharmacological therapy. Health policy makers should consider implementing combined screening whether no screening or isolated abdominal aortic aneurysm screening is currently offered. (Source: LANCET)
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Jes S Lindholt, Rikke S øgaard Tags: Articles Source Type: research

[Comment] Population-based screening for vascular disease
In The Lancet, Jes Lindholt and Rikke S øgaard1 report the Viborg Vascular (VIVA) trial in which 50 156 Danish men aged 65–74 years were randomly allocated to combined screening for abdominal aortic aneurysm, peripheral arterial disease, and systemic hypertension or to no screening. After a median follow-up of 4·4 years (IQR 3·9– 4·8), screening and subsequent intervention reduced absolute risk of overall mortality by 0·006 (95% CI 0·001–0·011), with a number needed to invite (NNI) to screening to save one life of 169 (89–1811). (Source: LANCET)
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Chadi Ayoub, M Hassan Murad Tags: Comment Source Type: research

[Articles] Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial
Results from SPYRAL HTN-OFF MED provide biological proof of principle for the blood-pressure-lowering efficacy of renal denervation. (Source: LANCET)
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Raymond R Townsend, Felix Mahfoud, David E Kandzari, Kazuomi Kario, Stuart Pocock, Michael A Weber, Sebastian Ewen, Konstantinos Tsioufis, Dimitrios Tousoulis, Andrew S P Sharp, Anthony F Watkinson, Roland E Schmieder, Axel Schmid, James W Choi, Cara East Tags: Articles Source Type: research

[Comment] Catheter-based renal denervation for treatment of hypertension
After the initial unprecedented enthusiasm for catheter-based renal denervation for the treatment of resistant hypertension, the negative results of the sham-controlled SYMPLICITY HTN-3 trial1 with the single-electrode radiofrequency Symplicity catheter have cast major doubts on the efficacy of this technique to treat these patients. Various factors might have contributed to these negative results.2 By contrast, the DENERHTN trial,3 which compared renal denervation plus stepped care standardised antihypertensive treatment with stepped care standardised antihypertensive treatment alone in patients with resistant hypertensio...
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Michel Azizi Tags: Comment Source Type: research

[Articles] Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial
There was a monotonic relationship between achieved LDL cholesterol and major cardiovascular outcomes down to LDL-cholesterol concentrations of less than 0 ·2 mmol/L. Conversely, there were no safety concerns with very low LDL-cholesterol concentrations over a median of 2·2 years. These data support further LDL-cholesterol lowering in patients with cardiovascular disease to well below current recommendations. (Source: LANCET)
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Robert P Giugliano, Terje R Pedersen, Jeong-Gun Park, Gaetano M De Ferrari, Zbigniew A Gaciong, Richard Ceska, Kalman Toth, Ioanna Gouni-Berthold, Jose Lopez-Miranda, Fran çois Schiele, François Mach, Brian R Ott, Estella Kanevsky, Armando Lira Pineda, Tags: Articles Source Type: research

[Comment] Very low LDL-cholesterol concentrations achieved: which target is next?
It has been a long and winding road towards acceptance of LDL cholesterol as a pivotal and causal factor in the development of atherosclerosis and cardiovascular disease. The evidence was first derived from experimental, epidemiological, and genetic studies, as well as from clinical trials with statins and ezetimibe.1 The Further cardiovascular OUtcomes Research with PCSK9 Inhibition in subjects with Elevated Risk (FOURIER) trial2 extended the body of evidence, showing that evolocumab, a fully human proprotein convertase subtilisin-kexin type 9 (PCSK9) monoclonal antibody, when added to conventional lipid-lowering therapy,...
Source: LANCET - August 28, 2017 Category: General Medicine Authors: G Kees Hovingh, S Matthijs Boekholdt, Erik S Stroes Tags: Comment Source Type: research

[Articles] A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial
A multifaceted and multilevel educational intervention, aimed to improve use of oral anticoagulation in patients with atrial fibrillation and at risk for stroke, resulted in a significant increase in the proportion of patients treated with oral anticoagulants. Such an intervention has the potential to improve stroke prevention around the world for patients with atrial fibrillation. (Source: LANCET)
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Dragos Vinereanu, Renato D Lopes, M Cecilia Bahit, Denis Xavier, Jie Jiang, Hussein R Al-Khalidi, Wensheng He, Ying Xian, Andrea O Ciobanu, Deepak Y Kamath, Kathleen A Fox, Meena P Rao, Sean D Pokorney, Otavio Berwanger, Carlos Tajer, Pedro G M de Barros Tags: Articles Source Type: research

[Comment] The impact of IMPACT-AF
We are living in an era when the science of medicine has never been better. Medical textbooks are regularly being updated and rewritten to accommodate advances. However, scientific advances are often not translated into medical practice or medical education. With a global burden in excess of 30 million people, atrial fibrillation could be considered a modern-day epidemic.1 But evidence shows that physicians considering anticoagulation treatments for patients are more influenced by the events they induce (bleeds) than the events potentially prevented, in this case devastating strokes. (Source: LANCET)
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Michael D Ezekowitz, Anthony P Kent Tags: Comment Source Type: research

[Articles] Effect of interleukin-1 β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind, placebo-controlled trial
Our hypothesis-generating data suggest the possibility that anti-inflammatory therapy with canakinumab targeting the interleukin-1 β innate immunity pathway could significantly reduce incident lung cancer and lung cancer mortality. Replication of these data in formal settings of cancer screening and treatment is required. (Source: LANCET)
Source: LANCET - August 27, 2017 Category: General Medicine Authors: Paul M Ridker, Jean G MacFadyen, Tom Thuren, Brendan M Everett, Peter Libby, Robert J Glynn, CANTOS Trial Group Tags: Articles Source Type: research

[Comment] Potential efficacy of interleukin-1 β inhibition in lung cancer
Over the past two decades, a wealth of experimental and clinical data have intimately linked dysregulated production of the potent proinflammatory cytokine interleukin 1 β with several chronic inflammatory and autoimmune diseases, of which the most evidence is available for rheumatoid arthritis and cardiovascular disease (eg, atherosclerosis).1–3 Notably, these disease associations have provided the impetus to develop clinical grade inhibitors against interleukin 1β or its receptor, with the intereukin-1-receptor antagonist anakinra being the first such inhibitor approved for clinical use (in 2001). (Source: LANCET)
Source: LANCET - August 27, 2017 Category: General Medicine Authors: Brendan J Jenkins Tags: Comment Source Type: research

[Articles] Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial
Guided de-escalation of antiplatelet treatment was non-inferior to standard treatment with prasugrel at 1 year after PCI in terms of net clinical benefit. Our trial shows that early de-escalation of antiplatelet treatment can be considered as an alternative approach in patients with acute coronary syndrome managed with PCI. (Source: LANCET)
Source: LANCET - August 27, 2017 Category: General Medicine Authors: Dirk Sibbing, D ániel Aradi, Claudius Jacobshagen, Lisa Gross, Dietmar Trenk, Tobias Geisler, Martin Orban, Martin Hadamitzky, Béla Merkely, Róbert Gábor Kiss, András Komócsi, Csaba A Dézsi, Lesca Holdt, Stephan B Felix, Radoslaw Parma, Mariusz Klo Tags: Articles Source Type: research

[Comment] Dual antiplatelet therapy guided by platelet function testing
Oral P2Y12 receptor inhibitors are key for secondary prevention of atherothrombotic events in patients with acute coronary syndromes, in particular those undergoing percutaneous coronary intervention (PCI)1. Prasugrel and ticagrelor are more potent than clopidogrel, which is characterised by increased rates of high on-treatment platelet reactivity (HPR), a known marker for recurrent ischaemic events, including stent thrombosis.2 This characteristic could explain the greater reduction in atherothrombotic events, albeit at the expense of more bleeding, associated with prasugrel and ticagrelor therapy among patients with acut...
Source: LANCET - August 27, 2017 Category: General Medicine Authors: Dominick J Angiolillo Tags: Comment Source Type: research

[Articles] Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin, durable polymer everolimus-eluting stents in patients undergoing coronary revascularisation (BIOFLOW V): a randomised trial
The outperformance of the ultrathin, bioresorbable polymer sirolimus-eluting stent over the durable polymer everolimus-eluting stent in a complex patient population undergoing percutaneous coronary intervention suggests a new direction in improving next generation drug-eluting stent technology. (Source: LANCET)
Source: LANCET - August 26, 2017 Category: General Medicine Authors: David E Kandzari, Laura Mauri, Jacques J Koolen, Joseph M Massaro, Gheorghe Doros, Hector M Garcia-Garcia, Johan Bennett, Ariel Roguin, Elie G Gharib, Donald E Cutlip, Ron Waksman, BIOFLOW V Investigators Tags: Articles Source Type: research

[Department of Error] Department of Error
Russell S, Bennet J, Wellman JA, et al. Efficacy and safety of voretigene neparvovec (AAV2-hRPE65v2) in patients with RPE65-mediated inherited retinal dystrophy: a randomised, controlled, open-label, phase 3 trial. Lancet 2017; 390: 849 –60—In this Article (published Online First on July 13, 2017), the affiliation for Francesca Simonelli should have been Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. This correction has been made to the online version as of Aug 24, 2017, and the printed version is correct. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Improving post-surgical management of resected pancreatic cancer
We read with interest the results of the ESPAC-4 trial and congratulate John Neoptolemos and colleagues (March 11, p 1011)1 on having done this challenging investigation. On the basis of overall survival, the primary study endpoint, ESPAC-4 was a positive trial favouring the gemcitabine plus capecitabine group more than the gemcitabine monotherapy group (hazard ratio [HR] 0 ·82, 95% CI 0·68–0·98; p=0·032). However, in contrast to other previous randomised trials in the adjuvant setting, the secondary endpoint—ie, relapse-free survival—was not different between the two comparato...
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Stefan Boeck, Volker Heinemann Tags: Correspondence Source Type: research

[Correspondence] The oldest-old in China – Authors' reply
We agree with Fuzhong Li and Peter Harmer that our data1 have limitations, including the unmeasured burden of non-communicable disease. In fact, we acknowledge this in our paper, and conclude that “further studies need to include chronic diseases”. Li and Harmer also point out that we did not assess the magnitude of rural–urban differences, and Tomohiro Morita and colleagues describe our rural–urban dichotomy as “too simplistic”. We agree that an investigation of rural–urban dif ferences is important, which is why we adjusted for rural–urban residence as a covariate in our st...
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Yi Zeng, Qiushi Feng, Therese Hesketh, Kaare Christensen, James W Vaupel Tags: Correspondence Source Type: research

[Correspondence] The oldest-old in China
Yi Zeng and colleagues1 analysed three pairs of oldest-old Chinese cohorts born 10 years apart, and showed coexistence and mixed effects of compression of disability in activities of daily living, and expansion of disability in physical and cognitive functioning with increased longevity. We propose two additional viewpoints to enhance the significance of this research. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Tomohiro Morita, Kana Yamamoto, Akihiko Ozaki, Kenji Tsuda, Tetsuya Tanimoto Tags: Correspondence Source Type: research

[Correspondence] The oldest-old in China
In The Lancet (April 22, p 1619), Yi Zeng and colleagues1 focus on an important segment of the rapidly ageing population in China. From a public health perspective, their study is valuable because the oldest-old age group represents the most neglected and socially disadvantaged people, who have the greatest burden of non-communicable disease, in Chinese society. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Fuzhong Li, Peter Harmer Tags: Correspondence Source Type: research