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[World Report] Syria: 7 years into a civil war
Years of conflict have killed thousands, but the toll of war on Syria's health systems extends the cost of war beyond the front lines as de-escalation efforts seem to be faltering. Sharmila Devi reports. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Authors: Sharmila Devi Tags: World Report Source Type: research

[Comment] Offline: From 1918 to 2018 —the lessons of influenza
Estimates of mortality during the 1918 –20 influenza pandemic range from 20 million to 100 million deaths. Mortality between countries varied enormously. A large part of this variation was related to wealth. Resource-poor countries, with weak health systems, pervasive undernutrition, and widespread poverty, had higher death rates. When 1918 mortality rates are modelled for the modern era, an epidemic of influenza with similar virulence and pathogenicity would cause around 62 million deaths, with younger age groups especially vulnerable. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] The polio endgame: securing a world free of all polioviruses
The global effort to eradicate poliomyelitis has reduced the incidence of cases caused by wild poliovirus by more than 99% since its launch in 1988, from 350  000 annual cases in 125 endemic countries to 20 cases in two countries in 2017.1 More than 16 million people who would otherwise have been paralysed by poliovirus infection are today walking, and 80%2 of the world's population lives in regions certified as polio free by WHO. Wild poliovirus now c irculates in only a few areas and remains endemic in Nigeria, Pakistan, and Afghanistan. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Authors: Michel Zaffran, Michael McGovern, Reza Hossaini, Rebecca Martin, Jay Wenger Tags: Comment Source Type: research

[Comment] Renewing the focus on health care for sexually assaulted children and adolescents
Sexual assault and rape are in the media spotlight in the face of unfolding revelations of abuse of women in the entertainment industry and sports. These disclosures by public figures highlight some aspects of sexual abuse —namely, that it is often pervasive, an expression of power (rather than just about sex) and rooted in ideas of male sexual entitlement, and an experience that victims find shameful and often conceal.1,2 Far from the lights of Hollywood, many children and adolescents in low-income and middle-incom e countries (LMICs) face sexual abuse and often have little recourse to assistance. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Authors: Rachel Jewkes Tags: Comment Source Type: research

[Editorial] Tuberculosis: criteria for global leadership?
Tereza Kasaeva is to be the new Director of WHO's Global Tuberculosis (TB) Programme. She joins WHO from Russia's Ministry of Health. But instead of a warm welcome, she will arrive in Geneva amid potentially disabling controversy. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Vision quest: gene therapy for inherited vision loss
Biomedical research and clinical trials are fundamentally high-stakes endeavours, the results of which are often portrayed in hyperbolic categories. Failed phase 3 trials are called epic disappointments, while successful treatments become game changers or magic bullets. Better still, they receive US Food and Drug Administration (FDA) approval. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Tags: Editorial Source Type: research

[Editorial] The NHS at 70 and Alma-Ata at 40
2018 welcomes two important anniversaries for health. In the UK, the National Health Service (NHS) will be 70 years old in July, and the global health community will mark the 40th anniversary of the Alma-Ata Declaration at a conference on Oct 25 –26 in Almaty, Kazakhstan. Common to both anniversaries will be recognition of universal health coverage (UHC) as a goal, and the place of primary health care in achieving that goal. (Source: LANCET)
Source: LANCET - January 5, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Wakley Prize Essay] You don't know me
“You don't know who I am, do you?” (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Kate Rowland Tags: Wakley Prize Essay Source Type: research

[Correspondence] Concerns about cardiotoxicity in the HERA trial – Authors' reply
We would like to thank Antonin Levy and colleagues for their interest in our Article reporting the 11-year outcome data from the HERceptin Adjuvant (HERA) trial,1 and their expressed concern that we might not have recorded all long-term cardiac consequences of treatment for early breast cancer, specifically, some that could be secondary to the use of radiotherapy. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: David A Cameron, Richard D Gelber, Marion Procter, Thomas Suter Tags: Correspondence Source Type: research

[Correspondence] Concerns about cardiotoxicity in the HERA trial
In the HERceptin Adjuvant (HERA) trial (Feb 16, p 1195),1 the investigators reported that cardiac toxicity remained low in all groups and occurred mostly during the treatment phase. Cardiac assessments included repeated use of the New York Heart Association classification and left ventricular ejection fraction assessed by a cardiologist. However, the absence of information regarding radiation-related cardiac hazard might have caused misinterpretation of the data. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Antonin Levy, Cyrus Chargari, Eric Deutsch, Sofia Rivera Tags: Correspondence Source Type: research

[Correspondence] Changes to NHS charges: what does this mean for our most vulnerable patients?
August, 2017, saw the introduction of new regulations on health-care charges to migrants and overseas visitors in England.1 Patients who are unable to prove entitlement to free care will receive an estimated treatment bill, which must be fully paid before receipt of care, and might increase exponentially. Urgent treatment, as defined by the treating clinician, should be provided and billed for afterwards. These regulations are the outcome of only 418 responses obtained by the Department of Health from their consultation exploring the extension of charging overseas visitors and migrants who use the National Health Service (...
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Behrouz Miguel Nezafat Maldonado, Lisa Murphy, Lucy Jones, Anna Miller, Deman Le Deaut Tags: Correspondence Source Type: research

[Correspondence] Are new technologies translatable to point-of-care testing?
The point-of-care testing (PoCT) market is rapidly expanding and its predicted worth by 2021 is US$36 ·96 billion.1 This market has many facets, one of which is tumour and cancer markers. To develop a new test for clinical use, a biomarker needs to be identified and a quick and simple detection method developed. This biomarker then goes through many steps before clinical use including the all-impor tant step—can it detect cancer earlier than existing methods? (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Danielle Bury, Pierre L Martin-Hirsch, Francis L Martin, Timothy P Dawson Tags: Correspondence Source Type: research

[Correspondence] WHO leadership is essential for the elimination of NTDs
The second director of the Department of Control of Neglected Tropical Diseases (NTDs) of WHO retired at the end of September, 2017. He was appointed in 2014 to ensure administrative stability after 9 years of innovative growth of this WHO department, which was established in 2005 after the retirement of the first director.1 Sustaining the momentum for elimination of NTDs requires a timely appointment of a new director to lead an effective Department of NTDs in WHO. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Lorenzo Savioli, Denis Daumerie Tags: Correspondence Source Type: research

[Highlights] Highlights 2017: health in focus
The fleeting moments captured in a photograph can tell powerful stories. Earlier this year we asked readers to send us striking pictures on any health topic for The Lancet's annual photography competition, Highlights. We were delighted by the response. Lancet editors selected these ten winning pictures from the varied and interesting photographs you sent us. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Joanna Palmer Tags: Highlights Source Type: research

[World Report] US Children's Health Insurance Program in jeopardy
Without adequate federal funding, CHIP is on the verge of collapse in several states. Susan Jaffe, The Lancet's Washington correspondent, reports. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Susan Jaffe Tags: World Report Source Type: research

[This Year in Medicine] 2017: a year in review
2017 was not only a year marred by conflict-driven humanitarian crises and political quagmires but also a year for biomedical innovation and women's empowerment. Farhat Yaqub looks back. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Farhat Yaqub Tags: This Year in Medicine Source Type: research

[Comment] Offline: Are China's global ambitions good for global health?
A bitter argument is taking place between two nations, a dispute that could have profound effects for the future of global health. China and Australia are geographic neighbours. During the past decade, both countries have worked hard to build strong trading and diplomatic relationships. They have succeeded. But those relationships are now being torn apart. China's Xinhua News Agency last week claimed that Australia's Government was “obsessed” with “criticising China”. Xinhua argued that Australia's Government was trying “to undermine bilateral political trust”. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] 2017 Wakley Prize Essay
We would like to thank the many readers who entered the 2017 Wakley Prize Essay. The winning essay published in this issue was selected by Lancet editors and is “You Don't Know Me” by Kate Rowland, an Assistant Professor at the Department of Family Medicine at Rush University, Chicago, IL, USA. Kate is board certified in family medicine and is a Fellow of the American Academy of Family Physicians. She's worked as a family physician for 10 years and her professional interests include understanding how doctors make decisions during patient care and learning about how new medical evidence is taken up in practice. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Joanna Palmer, Niall Boyce, Phoebe Hall, Rhiannon Howe Tags: Comment Source Type: research

[Comment] Is WHO ready to improve its country work?
The health status of people has changed dramatically across the world —in most cases for the better. People live longer and sometimes also healthier lives. In most countries, capacity to manage health issues has improved and health priorities have changed. However, WHO has not yet fully adjusted to these changing realities, but there is an opportunity now with a new Director-General and leadership team in place. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: Anders Nordstr öm Tags: Comment Source Type: research

[Editorial] Dangerous words
Medicine is underpinned by both art and science. Art that relies upon strong therapeutic relationships with patients and populations. And science that brings statistical rigour to clinical and public health practice. If allegations reported in The Washington Post on Dec 15 are credible, the Trump administration has seriously undermined both foundations by banning the words “vulnerable”, “entitlement”, “diversity”, “transgender”, “fetus”, “evidence-based”, and “science-based” from government documents for the US$7 billion budget discussions ...
Source: LANCET - December 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Our responsibility to protect the Rohingya
Much has been made of the Rohingya being stateless. But how they are being treated is utterly heartless. The almost 1 million Rohingya Muslims displaced from Myanmar's Rakhine State to Bangladesh are housed in squalid camps quickly becoming reservoirs of disease and despair. A new outbreak of diphtheria comes on the heels of cholera and measles outbreaks. Insufficient food, shelter, health care, and hope add to the almost unimaginable suffering of these most disenfranchised refugees. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Artificial intelligence in health care: within touching distance
Replacing the doctor with an intelligent medical robot is a recurring theme in science fiction, but the idea of individualised medical advice from digital assistants like Alexa or Siri, supported by self-surveillance smartphone data, no longer seems implausible. A scenario in which medical information, gathered at the point of care, is analysed using sophisticated machine algorithms to provide real-time actionable analytics seems to be within touching distance. The creation of data-driven predictions underpins personalised medicine and precision public health. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Department of Error] Department of Error
Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 391: 205 –18—In this Article (published online first on Nov 10, 2017) the TIMI score was calculated incorrectly, without the use of all nine factors that made up the score, which resulted in changes to the composite primary outcome described in the text and shown in figure 4. There were also a few GUSTO bleeds that qualified in one of the categories, which resulted in changes to table 3. (Source: LANCET)
Source: LANCET - December 21, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Editorial] Personalised medicine in the UK
The future of personalised and genomic medicine in the UK was debated on Dec 14 in a seminar organised by the Westminster Health Forum. (Source: LANCET)
Source: LANCET - December 21, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Correspondence] Timely sensory stimulation and early childhood development
The Review by Wilson and colleagues (Dec 2, 2017)1 provides useful insights on the plight of people with or at risk of hearing loss globally, and outlines a comprehensive blueprint for intervention, especially in low-income and middle-income countries. The timing is auspicious because, in May, the World Health Assembly renewed the 1995 resolution on the prevention of hearing impairment, urging member states and the director-general of WHO to take specific steps to curtail the disease burden.2 However, we wish to draw attention to the implications of this Review for the prevailing disability-inclusive Sustainable Developmen...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Bolajoko O Olusanya, Tony Sirimanna, Bradley McPherson Tags: Correspondence Source Type: research

[Correspondence] Targeted-release budesonide therapy for IgA nephropathy – Authors' reply
Kenji Tsuda and colleagues correctly report that the NEFIGAN study1 investigated the use of corticosteroid therapy outside of the current guidelines,2 which endorse the use of systemic corticosteroids in patients with urinary protein excretion of more than 1 g/day. However, the NEFIGAN study was not a trial of systemic corticosteroids but rather a trial of steroid therapy that targeted the intestinal mucosal immune system, with minimal systemic effects, in patients with optimised RAS blockade. We were conducting a proof-of-concept study; thus the choice of reduction in proteinuria rather than the proportion of patients ent...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Bengt Fellstr öm, Jonathan Barratt, Jürgen Flöge, Alan Jardine Tags: Correspondence Source Type: research

[Correspondence] Targeted-release budesonide therapy for IgA nephropathy
Bengt Fellstr öm and colleagues (May 27, p 2117)1 report that the addition of a targeted-release formulation of budesonide (TRF-budesonide) to an optimised renin-angiotensin system (RAS) blockade reduced proteinuria in patients with IgA nephropathy. However, whether patients with proteinuria of 0·5–1·0 g/day , as were enrolled in this study, need further treatments in addition to RAS blockade therapy remains debatable.2,3 The 2012 Kidney Disease Improving Global Outcome guidelines4 suggest giving corticosteroids to patients with persistent proteinuria of more than 1 g/day who do not respond to opti...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Kenji Tsuda, Tetsuya Tanimoto, Jinichi Mori, Kazuhiro Kosugi, Tsunehiko Komatsu Tags: Correspondence Source Type: research

[Correspondence] Time for WHO to renew its commitment to health research
WHO's global Advisory Committee on Health Research (ACHR) —established in 1959 in Geneva, Switzerland, as the Advisory Committee on Medical Research (ACMR) and renamed ACHR in 1986—is one of the oldest institutions in the organisation. After establishment of the global committee, ACHRs were established in all of WHO's regional offices. As it approaches its 60th anniversary, the global ACHR can be proud of its many achievements. However, the committee has not convened in the past 7 years, with the last full meeting held in 2010. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Tikki Pang, Mahmoud Fathalla, Judith Whitworth, Luis-Gabriel Cuervo Tags: Correspondence Source Type: research

[Correspondence] A call to reinstate Pakistan's death penalty moratorium
The death penalty remains a subject of contention in the public forum, and most countries have chosen to abolish it. However, Pakistan is one of 58 countries to continue to practise the death penalty, with an estimated 6000 –8000 prisoners on death row in 2015.1 In 2008, a moratorium was declared against the death penalty by the new Pakistani Government. However, after the devastating attack on an Army Public School on Dec 17, 2014, the moratorium was lifted for terrorism cases, and for all cases the following year, with the number of executions increasing steadily since. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Syed Ibaad Ali, Ariba Khan, Huda Fatima, Syed Ather Hussain Tags: Correspondence Source Type: research

[Obituary] Joan Bicknell
Pioneering psychiatrist in learning disability. She was born in Isleworth, UK, on April 10, 1939, and died of cancer in Stalbridge, UK, on June 12, 2017, aged 78 years. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] The disaster artists
In Case of Emergency is a timely exhibition on natural disasters and their human antecedents and consequences. Antibiotic resistance, global warming, and post-extinction revival are all covered in this exhibition at the Science Gallery, Trinity College Dublin, Ireland. The gallery is a bright and dynamic space now firmly established as a leading element in the cultural and intellectual life of the city. Compact in size and smart in design, the gallery has woven a unique and original spell with the Irish public and international visitors since opening in 2008. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Desmond O'Neill Tags: Perspectives Source Type: research

[Perspectives] They died as they walked
Edwin Landseer's Man Proposes, God Disposes, first shown in 1864, now hangs in the Picture Gallery at Royal Holloway, University of London. Against a sublime and stormy Arctic landscape two monstrous polar bears root through the wreckage of an expedition, one of them devouring a human ribcage. Student folklore claims the picture has driven viewers mad, and when exams are held in the Picture Gallery it is covered with a Union Jack. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Richard Barnett Tags: Perspectives Source Type: research

[Perspectives] Elizabeth Garrett Anderson: early pioneer of women in medicine
Today, about 55% of medical students in the UK are women. While change is needed to address issues such as the representation of women in leadership positions in medicine, career progression, and gender differences in pay and grant funding, women are now entering medicine in increasing numbers. Given the important role of women in the medical profession, it might be easy to forget the struggles experienced by early women doctors in trying to attain medical qualifications. Elizabeth Garrett Anderson, who died on Dec 17, 1917, was one of these early pioneers. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Laura Kelly Tags: Perspectives Source Type: research

[World Report] The cost of mass-casualty attacks
Mass-casualty attacks incur heavy human costs and impact on weakened health systems. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: John Zarocostas Tags: World Report Source Type: research

[Comment] Public availability of trial protocols
The Lancet has improved efforts to reduce research waste and increase the importance of scientific contributions through the Reward Campaign. One of the targets of this campaign is to make the methods of studies more accessible, which could be accomplished by increasing the public availability of research protocols. A protocol is a document that describes the aims, interventions, outcomes, statistical procedures, ethical considerations, and planned use and dissemination of data before the start of a clinical trial. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Morgan Lucey, Jocalyn Clark, Paul Glasziou Tags: Comment Source Type: research

[Comment] Offline: The unspoken dangers facing UK medical science
Hope. Clarity. Certainty. Reassurance. Don't be fooled. Brexit is not over yet. The hard part is yet to come. And many medical scientists remain anxious. A professor at one of the UK's top universities frowned. He was born in Germany and moved to Britain (soon after receiving his PhD) where his field of research was thriving. He had recently offered a senior leadership role in his institution to another German scientist. She had declined his offer based on the worry that her team would not wish to move to a country that was exiting the European Union (EU). (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Editorial] The balancing act of orphan drug pricing
In the past year, the high price tag of orphan drugs has come under severe scrutiny. Global industry players have used incentive schemes such as the USA's Orphan Drug Act (which offers a 50% tax rebate to help cover research and development costs and 7 years of marketing exclusivity from approval), and the EU Regulation on orphan medicinal products (which offers exclusive access to market for 10 years when approved) to drive up profits in the sector. Health-care systems, under increasing pressure from under-resourcing, ageing populations, and high-price biomedical advances, can be tempted to reduce costly orphan drug progr...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Dementia burden coming into focus
WHO announced the launch of the Global Dementia Observatory (GDO) on Dec 7. This new internet-focused platform aims to provide a constant monitoring service for data relating to dementia planning around the world. The GDO currently features data from 21 countries, with the aim to expand monitoring to 50 countries by the end of 2018. Important data, such as government policy, treatment and care infrastructure, and disease burden, will be accessible online and kept constantly updated. The first sets of data are positive: 81% of the participating countries have a dementia awareness campaign, and 71% provide support and traini...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Achieving sustainable solidarity development goals
The meaning of social security varies nationally. In the USA, it might bring to mind the eponymous agency that administers social insurance providing benefits for retired individuals and those living with disability. In 1934, in the wake of the Great Depression when as many as 25% of Americans were unemployed, President Franklin D Roosevelt announced his plans to create a social security programme for the nation to “encourage a greater security for each individual who composes it”. He proclaimed: “This seeking for a greater measure of welfare and happiness does not indicate a change in values. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial
Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. (Source: LANCET)
Source: LANCET - December 14, 2017 Category: General Medicine Authors: Guy E Thwaites, Matthew Scarborough, Alexander Szubert, Emmanuel Nsutebu, Robert Tilley, Julia Greig, Sarah A Wyllie, Peter Wilson, Cressida Auckland, Janet Cairns, Denise Ward, Pankaj Lal, Achyut Guleri, Neil Jenkins, Julian Sutton, Martin Wiselka, Gonza Tags: Articles Source Type: research

[Comment] Rifampicin for Staphylococcus aureus bacteraemia: give it ARREST
Although Staphylococcus aureus bacteraemia is both common and potentially lethal, clinical decisions involving its treatment remain largely unencumbered by high-quality data.1 With the ARREST multicentre, randomised, double-blind, placebo-controlled trial, Guy Thwaites and colleagues2 have contributed high-quality evidence and addressed an unresolved question involving the role of adjunctive rifampicin in treatment regimens for patients with S aureus bacteraemia. (Source: LANCET)
Source: LANCET - December 14, 2017 Category: General Medicine Authors: Thomas L Holland, Vance G Fowler Tags: Comment Source Type: research

[Perspectives] Tony Capon: the world's first professor of planetary health
Speaking to The Lancet from the University of Sydney, where he is the world's first Professor of Planetary Health, Tony Capon says: “Planetary health is about safeguarding the health and wellbeing of current and future generations through good stewardship of Earth's natural systems and by rethinking the way we feed, move, house, power, and care for the world.” Capon hopes his new team in Sydney can make a real difference. (Source: LANCET)
Source: LANCET - December 12, 2017 Category: General Medicine Authors: Tony Kirby Tags: Perspectives Source Type: research

[Articles] Acalabrutinib in relapsed or refractory mantle cell lymphoma (ACE-LY-004): a single-arm, multicentre, phase 2 trial
Acalabrutinib treatment provided a high rate of durable responses and a favourable safety profile in patients with relapsed or refractory mantle cell lymphoma. These findings suggest an important role for acalabrutinib in the treatment of this disease population. (Source: LANCET)
Source: LANCET - December 11, 2017 Category: General Medicine Authors: Michael Wang, Simon Rule, Pier Luigi Zinzani, Andre Goy, Olivier Casasnovas, Stephen D Smith, Gandhi Damaj, Jeanette Doorduijn, Thierry Lamy, Franck Morschhauser, Carlos Panizo, Bijal Shah, Andrew Davies, Richard Eek, Jehan Dupuis, Eric Jacobsen, Arnon P Tags: Articles Source Type: research

[Comment] Acalabrutinib in mantle cell lymphoma
Mantle cell lymphoma is a rare, distinct subtype of non-Hodgkin lymphoma, with a disparate clinical course that varies from indolent at times to frequently aggressive. No standard of care exists; most patients relapse and ultimately die as a result of their disease. Notable strides in the past few years, however, have ushered an era of unprecedented progress, with swift approval of new therapies from a variety of drug classes. One such drug that has catapulted to prominence is ibrutinib, the first-in-class, irreversible inhibitor of Bruton tyrosine kinase (BTK), a crucial component of the B-cell-receptor signalling pathway...
Source: LANCET - December 11, 2017 Category: General Medicine Authors: Prashant Kapoor, Stephen M Ansell Tags: Comment Source Type: research

[Review] China's Silk Road and global health
In 2013, China proposed its Belt and Road Initiative to promote trade, infrastructure, and commercial associations with 65 countries in Asia, Africa, and Europe. This initiative contains important health components. Simultaneously, China launched an unprecedented overseas intervention against Ebola virus in west Africa, dispatching 1200 workers, including Chinese military personnel. The overseas development assistance provided by China has been increasing by 25% annually, reaching US$7 billion in 2013. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Kun Tang, Zhihui Li, Wenkai Li, Lincoln Chen Tags: Review Source Type: research

[Review] The primary health-care system in China
China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidi...
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Xi Li, Jiapeng Lu, Shuang Hu, KK Cheng, Jan De Maeseneer, Qingyue Meng, Elias Mossialos, Dong Roman Xu, Winnie Yip, Hongzhao Zhang, Harlan M Krumholz, Lixin Jiang, Shengshou Hu Tags: Review Source Type: research

[Department of Error] Department of Error
Pearson M, Metcalfe C, Jayamanne S, et al. Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial. Lancet 2017; 390: 1863 –72—In this Article (published online first on Aug 11, 2017), Martin Wilks (Swiss Centre for Applied Human Toxicology, University of Basel, Switzerland) should have been cited in the Data Monitoring Committee. This correction has been made to the online version as of Dec 7, 2017. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people – Authors' reply
We agree with Cody Magnusson that little evidence exists to suggest that long-term use of aspirin in primary prevention of vascular events is effective in people older than 70 years. Indeed, we previously suggested that aspirin might be used for primary prevention of vascular events and cancer in people who are middle-aged,1,2 but should then be gradually withdrawn because of the high risk of bleeding at older ages. We await the results of the ASPREE trial,3 which should provide definitive evidence of the short-term benefits and harms of aspirin use in people older than 70 years. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Linxin Li, Peter M Rothwell Tags: Correspondence Source Type: research

[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people
In their Article in The Lancet, Linxin Li and colleagues (June 13, p 490)1 postulated that the increased risk of bleeding events with antiplatelet therapy in patients older than 75 years is sufficient to routinely prescribe proton-pump inhibitors (PPIs) in this group. This assumption is based on extrapolation from data showing the efficacy of PPIs in prevention of upper gastrointestinal bleeding in a younger population (mean age 68 ·4 years).2 What the authors do not consider is the opposite solution: cessation of antiplatelet therapy. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Cody Magnusson Tags: Correspondence Source Type: research

[Correspondence] Overestimation of cardiovascular outcome incidence – Authors' reply
We thank Yuanzi Ye and Ricardo Fonseca for their interest in our Article.1 We agree that the cumulative incidence of each outcome is slightly overestimated when the simple technique for calculating Kaplan-Meier curves is used instead of a more sophisticated method accounting for competing risks. However, the effect of overestimation is modest and, because it affects all strata simultaneously, the hazard ratios (HRs) between strata are nearly unchanged. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Helmut Schumacher, Felix Mahfoud, Michael B öhm Tags: Correspondence Source Type: research