[Perspectives] Leo Martinez: striving to end childhood tuberculosis
Not only can Leo Martinez work opponents on the chess board —he began playing aged 8 and reached national level—he's also a talented scientist who was awarded the 2017 Stephen Lawn TB-HIV Research Leadership Prize for his contributions to reducing the burden of tuberculosis (TB) and HIV/AIDS in Africa. “Leo has done outstanding innovative research on r educing the childhood TB burden—a much needed and underappreciated area”, says Professor Heather Zar, Chair of the Department of Paediatrics and Director of the MRC Unit on Child& Adolescent Health at the University of Cape Town in South Afr...
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Rachael Davies Tags: Perspectives Source Type: research

[Department of Error] Department of Error
Thiele EA, Marsh ED, French JA, et al. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2018; 391: 1085 –96—In this Article (published online first on Jan 24, 2018), J Sullivan should have been listed as a member of the GWPCARE4 Study Group. This correction has been made to the online version as of March 15, 2018, and the printed Article is correct. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Questionable efficacy of the rVSV-ZEBOV Ebola vaccine – Authors' reply
We thank Wolfram Metzger and Sarai Vivas-Mart ínez for expressing their concern about potential sources of bias in the final analysis of our ring vaccination trial of an rVSV-vectored vaccine for Ebola virus disease (rVSV-ZEBOV).1 In that trial, the point estimate of vaccine efficacy was 100%, with no confirmed cases of Ebola virus disease det ected in vaccinated people 10 days or more after vaccination in the entire trial. We were careful to ascertain that the risk of exposure to Ebola virus and case ascertainment were low and statistically the same in the rings (clusters) that received immediate and delayed vaccin...
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Ira M Longini, John-Arne R øttingen, Marie Paule Kieny, W John Edmunds, Ana Maria Henao-Restrepo Tags: Correspondence Source Type: research

[Correspondence] Questionable efficacy of the rVSV-ZEBOV Ebola vaccine
We read with great interest the final report by Ana Maria Henao-Restrepo and colleagues (Feb 4, 2017, p 505)1 on the ring vaccination trial of an rVSV-vectored vaccine for Ebola virus disease (rVSV-ZEBOV). Briefly, among 2119 people who received the vaccine immediately, no cases of Ebola virus disease were identified in a period of 11 days (10 –21 days after vaccination). By contrast, 16 cases were identified within the same time frame among 2041 people who did not receive the vaccine immediately. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Wolfram G Metzger, Sarai Vivas-Mart ínez Tags: Correspondence Source Type: research

[Correspondence] Good intentions do not replace ethical conduct in research
The Dutch disciplinary tribunal officially warned two Dutch physicians following their study with a Kenyan collaborator on the efficacy of the homeopathic substance Iquilai ( “a potentised mineral supplement”) in 228 patients with HIV/AIDS in Kenya.1–3 The case was brought forward by the Dutch Health Inspectorate that launched an investigation into the practice of the two involved physicians. The tribunal deemed the study incompatible with basic medical ethical pri nciples for research on human beings, as specified in the World Medical Association's Declaration of Helsinki: the study did not have a proper...
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Joyce L Browne, Menno R Smit, Francis Angira, Rieke van der Graaf, Elizabeth A Bukusi Tags: Correspondence Source Type: research

[Obituary] Walter Werner Holland
Pioneer of UK health services research. He was born in Teplice-Sanov, Czech Republic, on March 5, 1929, and died of prostate cancer in London, UK, on Feb 9, 2017, aged 88 years. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Giving meaning to art in hospital care
Care units are not generally noted for their visual appeal. But Garnet Ward, a dementia care unit in north London, UK, run by the Camden and Islington NHS Foundation Trust, is different. On the walls of one room, stylised paintings of exotic plants from around the world conjure up scenes of travel and exploration. Elsewhere, a landscape mural full of intrigue and wonder glows like stained glass. The wall of one little nook is a swirling wash of abstract blues, pinks, and greens that could be one of J M W Turner's skies at sunrise. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Philip Ball Tags: Perspectives Source Type: research

[Perspectives] Sadness and silencing
With the #MeToo and #blacklivesmatter campaigns, it feels as if the world is finally cracking open for human beings to speak their truths. An increasing number of people are working for and demanding change, but wider society does not always want to hear these voices. One part of the world where justice for past and present injury is sorely needed is Australia. What is widely known as Australia Day passed in January —the day in 1788 when the British first stuck a colonial flag in the soil. To many Indigenous Australians, it is known as Invasion Day or Survival Day. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Tania Glyde Tags: Perspectives Source Type: research

[Perspectives] The power of medical storytelling
Over two decades ago a surgeon told me the story of a young man with a spinal injury. The young man had a potentially catastrophic injury and either having surgery, or not, was risky. He had the surgery and recovered, but subsequently the surgeon was informed that the young man's sexual function was entirely lost. The patient fell into depression and despair. The surgeon was devastated and blamed himself. The senior ward nurse on the Nightingale ward observed all this. She listened to her patient's anguish and the surgeon's distress. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Margaret McCartney Tags: Perspectives Source Type: research

[Perspectives] Rethinking the medical record
Electronic health records (EHR) and patient portals, which epitomise the digitisation of medical care, are, ironically, major roadblocks for better health care. Much has been written about the shortcomings of EHRs, yet the unmet needs are broader and include not only the objective of control and ownership but also the capacity to search and share records by patients. The announcement earlier this year that Apple has launched a personal health record feature on its Health app that aggregates existing patient-generated data with a user's electronic medical record is a step in that direction. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Amalio Telenti, Steven R Steinhubl, Eric J Topol Tags: Perspectives Source Type: research

[World Report] Frontline: a Safe Hospital on the border with Haiti
The Caribbean island of Hispaniola is split by a border that separates the Dominican Republic and Haiti. It sits above a major fault zone, which puts the two countries at constant risk of earthquakes, such as the catastrophic tremor of 2010 that brought Haiti to its knees. Over the past 500 years, the island has been hit by several tsunamis generated by earthquakes. Hurricanes also pass through Hispaniola almost every year, further battering the vulnerable island. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Joe Parkin Daniels Tags: World Report Source Type: research

[World Report] Life after death —surviving the attacks on civilians in Syria
Now entering its eigth year, there is no end to the Syrian war in sight. Civilian casualties are rising, as the bereaved see no respite in the violence that robbed them of their families. Sharmila Devi reports. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Sharmila Devi Tags: World Report Source Type: research

[Comment] Offline: Owning up on gender equality
There are moments to admit failure. Gender equality is one of those moments. Last week, the first report on gender-responsiveness among the world's most influential global health organisations —The Global Health 50/50 Report—was launched in London. Led by Sarah Hawkes and Kent Buse, together with a largely voluntary team of researchers, strategists, and communications experts, and housed within the University College London Centre for Gender and Global Health, Global Health 50/50 exam ines seven domains of gender equality across 140 organisations. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] The future of the NHS: no longer the envy of the world?
The UK's National Health Service (NHS) is one of the most comprehensive public health-care systems in the world and has provided free, high-quality care to millions of people since its inception. It was established on July 5, 1948, with the National Health Service Act based on the bold assumption within the 1942 Beveridge Report that a post-war UK would have “a national health service for prevention and for cure of disease and disability” that “will ensure that for every citizen there is available whatever medical treatment he requires, in whatever form he requires”. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Elias Mossialos, Alistair McGuire, Michael Anderson, Emma Pitchforth, Astrid James, Richard Horton Tags: Comment Source Type: research

[Editorial] End of the road for daclizumab in multiple sclerosis
On March 7, the European Medicines Agency (EMA) recommended the immediate suspension and recall of the multiple sclerosis drug daclizumab. The announcement follows reports of serious inflammatory brain disorders in 12 patients worldwide, including three deaths, and comes shortly after the voluntary withdrawal of the drug by Biogen and AbbVie on March 2. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] The scars of violence on children
In the first 11 weeks of 2018, there have been 12 school shootings. Although shootings on school campuses only make up a tiny fraction of gun injuries and deaths annually, a March report from the Giffords Law Center focuses on the deep impact of gun violence on children in the USA, elaborating on how it extends far beyond the classroom. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] China through the lens of health in 2018 and beyond
On March 11, China's National People's Congress, the top legislative body, approved major constitutional changes that would enable President Xi Jinping to stay in power for more than two terms in office. The healthy China strategy was reviewed in the annual government work report, released by Chinese Premier Li Keqiang at the National People's Congress on March 5, with several key aspects highlighted. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Series] Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action
Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achiev...
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Susan Horton, Richard Sullivan, John Flanigan, Kenneth A Fleming, Modupe A Kuti, Lai Meng Looi, Sanjay A Pai, Mark Lawler Tags: Series Source Type: research

[Series] Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions
Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income co...
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Shahin Sayed, William Cherniak, Mark Lawler, Soo Yong Tan, Wafaa El Sadr, Nicholas Wolf, Shannon Silkensen, Nathan Brand, Lai Meng Looi, Sanjay A Pai, Michael L Wilson, Danny Milner, John Flanigan, Kenneth A Fleming Tags: Series Source Type: research

[Series] Access to pathology and laboratory medicine services: a crucial gap
As global efforts accelerate to implement the Sustainable Development Goals and, in particular, universal health coverage, access to high-quality and timely pathology and laboratory medicine (PALM) services will be needed to support health-care systems that are tasked with achieving these goals. This access will be most challenging to achieve in low-income and middle-income countries (LMICs), which have a disproportionately large share of the global burden of disease but a disproportionately low share of global health-care resources, particularly PALM services. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Michael L Wilson, Kenneth A Fleming, Modupe A Kuti, Lai Meng Looi, Nestor Lago, Kun Ru Tags: Series Source Type: research

[Perspectives] Kenneth Fleming: making the global case for pathology
Some years ago, and while still occupying a senior post in the administration of medical training and research at the UK's University of Oxford, pathologist Kenneth Fleming was at a meeting in Bangkok. He got talking to a fellow Oxford academic who was living and working in Thailand. On enquiring if he could help locally in any way, Fleming learned that the country had a pressing need for more staff and resources in pathology. This was the first time he realised that the provision of pathology services was a major but neglected problem not only in that part of Asia but also over much of the globe. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Geoff Watts Tags: Perspectives Source Type: research

[Comment] Pathology and laboratory medicine in partnership with global surgery: working towards universal health coverage
Pathology and laboratory medicine (PALM) is the backbone of high-quality care across many specialties, particularly surgery. In surgery, PALM provides the cross-match to keep patients with bleeding ectopic pregnancies alive, the histopathology that differentiates a benign colonic polyp from a malignancy, the biochemistry that allows safe titration of anaesthetics, and the forensic pathology that quantifies the burden of disease. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Isabelle Citron, Kristin Sonderman, John G Meara Tags: Comment Source Type: research

[Comment] Laboratory medicine in low-income and middle-income countries: progress and challenges
Laboratory medicine is essential for disease detection, surveillance, control, and management.1 However, access to quality-assured laboratory diagnosis has been a challenge in low-income and middle-income countries (LMICs) resulting in delayed or inaccurate diagnosis and ineffective treatment with consequences for patient safety.1 In the new Lancet Series2 –4 on pathology and laboratory medicine (PALM) in LMICs, Michael Wilson and colleagues2 provide a comprehensive analysis of the challenges and gaps that limit access to PALM services. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: John N Nkengasong, Katy Yao, Philip Onyebujoh Tags: Comment Source Type: research

[Comment] Pathology and laboratory medicine: the Cinderella of health systems
High-quality pathology and laboratory medicine (PALM) services are an integral part of health systems in high-income countries. New molecular diagnostic techniques, advances in precision cancer treatments, and population-based screening programmes for disease prevention or early detection have made PALM an even more important part of modern medicine and health care. And yet, even in high-income countries, the role of PALM is not well understood by the general public, and pathology remains a somewhat unpopular specialty in medicine. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Sabine Kleinert, Richard Horton Tags: Comment Source Type: research

[Department of Error] Department of Error
Park KB, Khan U, Seung K. Open letter to The Global Fund about its decision to end DPRK grants. Lancet 2018; 391: 1257 —In this Correspondence (published online first on March 14, 2018), the following sentence should have read “UK is a Director of Interactive Research& Development. ” This correction has been made to the online version as of March 15, 2018, and the printed Correspondence is correct. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Sirolimus in patients with clinically active systemic lupus erythematosus resistant to, or intolerant of, conventional medications: a single-arm, open-label, phase 1/2 trial
These data show that a progressive improvement in disease activity is associated with correction of pro-inflammatory T-cell lineage specification in patients with active systemic lupus erythematosus during 12 months of sirolimus treatment. Follow-up placebo-controlled clinical trials in diverse patient populations are warranted to further define the role of mTOR blockade in treatment of systemic lupus erythematosus. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: Zhi-Wei Lai, Ryan Kelly, Thomas Winans, Ivan Marchena, Ashwini Shadakshari, Julie Yu, Maha Dawood, Ricardo Garcia, Hajra Tily, Lisa Francis, Stephen V Faraone, Paul E Phillips, Andras Perl Tags: Articles Source Type: research

[Comment] CD8 T cells and mTOR: new concepts and targets for systemic lupus erythematosus
Management of systemic lupus erythematosus and its variable clinical manifestations remain considerable challenges for clinicians and patients. Advances in characterising mechanisms of immune system regulation have been applied to studies of systemic lupus erythematosus, implicating type I interferon and highlighting the contributions of T and B lymphocytes to autoantibody production and tissue damage.1 Despite such progress, the pace of development of more effective therapies for patients has been slow. (Source: LANCET)
Source: LANCET - March 15, 2018 Category: General Medicine Authors: David R Fernandez, Mary K Crow Tags: Comment Source Type: research

[Department of Error] Department of Error
Zarocostas J. Libya: war and migration strain a broken health system. Lancet 2018; 391: 824 –25—In this World Report, the third paragraph should have read “Libya is now entering its eighth year of conflict and instability, which first engulfed the nation when in February, 2011, dictator of 42 years Muammar Gaddafi used violence to crush pro-democracy demonstrations. The violent clamp down sparked a civil war that led to Gaddafi's ouster from power in August, 2011, by his rebel opponents—backed by strong aerial and naval support from western powers.” This correction has been made to the online ...
Source: LANCET - March 14, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Open letter to The Global Fund about its decision to end DPRK grants
Dear Peter Sands and Aida Kurtovi ć, (Source: LANCET)
Source: LANCET - March 14, 2018 Category: General Medicine Authors: Kee B Park, Uzma Khan, Kwonjune Seung Tags: Correspondence Source Type: research

[Perspectives] Rehumanising the Syrian conflict: photographs of war, health, and life in Syria
The Syrian conflict, which marked its seventh anniversary on March 15, is one of the most live-imaged wars in modern times. Syrian citizen-activists and others have transmitted images extensively to tell the story of the conflict with the hope that this may draw support and change their plight. International media also draw heavily on images —themes of violence, suffering, destruction, and displacement dominate. (Source: LANCET)
Source: LANCET - March 14, 2018 Category: General Medicine Authors: Samer Jabbour, Marvin Gate, Ammar Sabouni, Saeed al-Batal, Humans of Syria Network Tags: Perspectives Source Type: research

[Articles] 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial
The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care. (Source: LANCET)
Source: LANCET - March 12, 2018 Category: General Medicine Authors: Joo-Yong Hahn, Young Bin Song, Ju-Hyeon Oh, Deok-Kyu Cho, Jin Bae Lee, Joon-Hyung Doh, Sang-Hyun Kim, Jin-Ok Jeong, Jang-Ho Bae, Byung-Ok Kim, Jang Hyun Cho, Il-Woo Suh, Doo-il Kim, Hoon-Ki Park, Jong-Seon Park, Woong Gil Choi, Wang Soo Lee, Jihoon Kim, K Tags: Articles Source Type: research

[Comment] 12 months of DAPT after acute coronary syndrome still beats 6 months
Why does the topic of optimal duration of dual antiplatelet therapy (DAPT) after an acute coronary syndrome treated by coronary stenting continue to generate such intense interest? We have sufficient evidence that acute coronary syndrome is caused by atherothrombosis. We also know that coronary stenting leads to further atherosclerotic plaque disruption, triggering thrombosis. Data from large registries have confirmed that the risk of recurrent myocardial infarction persists in the long term. Results of multiple trials have shown that DAPT reduces this risk. (Source: LANCET)
Source: LANCET - March 12, 2018 Category: General Medicine Authors: Zuzana Motovska, Deepak L Bhatt Tags: Comment Source Type: research

[Series] Out-of-hospital cardiac arrest: in-hospital intervention strategies
The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Christian Hassager, Ken Nagao, David Hildick-Smith Tags: Series Source Type: research

[Series] Out-of-hospital cardiac arrest: prehospital management
Sudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services' staff. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Marcus Eng Hock Ong, Gavin D Perkins, Alain Cariou Tags: Series Source Type: research

[Series] Out-of-hospital cardiac arrest: current concepts
Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Regional variations in reporting frameworks and survival mean the exact burden of OHCA to public health is unknown. Nevertheless, overall prognosis and neurological outcome are relatively poor following OHCA and have remained almost static for the past three decades. In this Series paper, we explore the aetiology of OHCA. Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Aung Myat, Kyoung-Jun Song, Thomas Rea Tags: Series Source Type: research

[Articles] Outcome and undertreatment of mitral regurgitation: a community cohort study
In the community, isolated mitral regurgitation is common and is associated with excess mortality and frequent heart failure postdiagnosis in all patient subsets, even in those with normal left-ventricular ejection fraction and low comorbidity. Despite these poor outcomes, only a minority of affected patients undergo mitral (or any type of cardiac) surgery even in a community with all means of diagnosis and treatment readily available and accessible. This suggests that in a wider population there might be a substantial unmet need for treatment for this disorder. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Volha Dziadzko, Marie-Annick Clavel, Mikhail Dziadzko, Jose R Medina-Inojosa, Hector Michelena, Joseph Maalouf, Vuyisile Nkomo, Prabin Thapa, Maurice Enriquez-Sarano Tags: Articles Source Type: research

[Department of Error] Department of Error
Annane D, Fuchs-Buder T, Zoellner C, Kaukonen M, Scheeren TWL. EMA recommendation to suspend HES is hazardous. Lancet 2018; 391: 736 –37—Although all authors provided competing interests statements prior to publication of this Correspondence, these details were not included in the published version. The online version of this Correspondence has been updated to include the competing interests statements for all authors as of M arch 8, 2018. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
Cossu G, Birchall M, Brown T, et al. Lancet Commission: Stem cells and regenerative medicine. Lancet 2018; 391: 883 –910—In this Commission (published online first on Oct 4, 2017), the EC (PluriMes) has been added to the Acknowledgments. This correction has been made to the online version as of March 8, 2018. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Safe travels during hurricanes
On the evening of Sept 10, 2017, in Miami (FL, USA), at a time when Hurricane Irma had reached category 4 status, a 91-year-old woman had a stroke. As per local hurricane protocol, emergency medical services are halted when storm winds reach category 3 status or higher. With no viable alternative transportation to navigate through strong winds and the substantial storm surge (appendix), the patient was brought to the emergency room in the backseat of her granddaughter's car. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Ayush Amin, Robert M Starke, Jason T Salsamendi Tags: Correspondence Source Type: research

[Correspondence] Direct visualisation of thrombi for diagnosis of tissue valve thrombosis
Tarun Chakravarty and colleagues (June 17, 2017, p 2383)1 used restricted leaflet motion on CT as the principal surrogate measure to estimate the frequency of subclinical thrombosis after surgical and transcatheter aortic valve replacement. Although restricted leaflet motion (by fluoroscopy) is integral to the diagnosis of symptomatic mechanical heart valve thrombosis,2 it might be less sensitive than direct visualisation for the detection of tissue valve thrombosis, particularly in asymptomatic patients. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Ganesan Karthikeyan Tags: Correspondence Source Type: research

[Correspondence] Subclinical leaflet thrombosis
Tarun Chakravarty and colleagues (June 17, 2017, p 2383)1 reported that anticoagulation was superior to dual antiplatelet therapy in the prevention of subclinical valve thrombosis. This highly relevant analysis added much-needed evidence regarding optimal antithrombotic medication in patients with transcatheter aortic valve replacement. In these patients, ischaemic events are rare and bleeding events are frequent. Unfortunately, bleeding was not investigated and interindividual pharmacodynamic response to antiplatelet medication varies substantially. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Kerstin Piayda, Tobias Zeus, Horst Sievert, Malte Kelm, Amin Polzin Tags: Correspondence Source Type: research

[Correspondence] Bioresorbable polymer drug-eluting stents – Authors' reply
We thank Rahman Shah and Mohammed Alkhalil for their interest and thoughtful comments regarding the results of the BIOFLOW V trial1 and appreciate the opportunity to respond with further perspective. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: David E Kandzari, Laura Mauri, Jacques J Koolen, Gheorghe Doros, Ron Waksman Tags: Correspondence Source Type: research

[Correspondence] Bioresorbable polymer drug-eluting stents
In the BIOFLOW V randomised trial,1 ultrathin bioresorbable polymer sirolimus-eluting stents (Orsiro; BIOTRONIK, Buelach, Switzerland) were found to be superior to durable polymer everolimus-eluting stents (Xience; Abbott Vascular, Santa Clara, CA, USA) in combined composite endpoints of cardiovascular death, target vessel-related myocardial infarction, or ischaemia-driven target lesion revascularisation at 12 months (95% CI −6·84 to −0·29, p=0·0399). The Kaplan-Meier plot for the primary composite endpoints revealed that most events occurred 1–2 days after patients were randomly assi...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Mohammad Alkhalil Tags: Correspondence Source Type: research

[Correspondence] Bioresorbable polymer drug-eluting stents
I read with great interest the results of the BIOFLOW V trial (Oct 21, 2017, p 1843).1 David Kandzari and colleagues should be congratulated on such an important study. The authors concluded that an ultrathin bioresorbable polymer drug-eluting stent (BRP-DES) outperformed a durable polymer-eluting stent (DP-DES) because the proportion of patients who had target-vessel myocardial infarctions at 12 months was lower in the BRP-DES group than in the DP-DES group. However, the proportion of patients who had myocardial infarction at 12 months was substantially higher in the DP-DES group than in previous trials comparing a BRP-DE...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Rahman Shah Tags: Correspondence Source Type: research

[Correspondence] Clinical benefits of evolocumab appear less than hoped – Authors' reply
Our analysis1 of the association between LDL-cholesterol concentrations at 4 weeks and cardiovascular outcomes reported in FOURIER2 complemented the primary data from the randomised comparison between evolocumab and placebo. Unlike previous epidemiological studies and the selected studies cited by Simon B Dimmitt and colleagues, we analysed the association between the reduction of LDL-cholesterol concentrations to unprecedented low levels and clinical outcomes, adjusting for differences in baseline characteristics. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Robert P Giugliano, Anthony C Keech, Peter S Sever, Terje R Pedersen, Marc S Sabatine Tags: Correspondence Source Type: research

[Correspondence] Clinical benefits of evolocumab appear less than hoped
The strong correlation between on-treatment LDL cholesterol and cardiovascular events observed in the prespecified secondary analysis of the FOURIER trial published in The Lancet (Oct 28, 2017, p 1962)1 is no different from that reported on treatment in several previous clinical trials of statins and on no treatment in epidemiological studies. The on treatment correlation conflates the epidemiology with pharmacological lowering of LDL2 by evolocumab and the co-prescribed statin. In FOURIER,3 the addition of evolocumab to statin therapy lowered LDL by 59%, but the risk of myocardial infarction was only reduced by 27% compar...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Simon B Dimmitt, Hans G Stampfer, Jennifer H Martin, John B Warren Tags: Correspondence Source Type: research

[Correspondence] Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis
Immune checkpoint inhibitors have greatly improved clinical outcomes in multiple cancer types and are increasingly being used in earlier disease settings and in combination with other therapies.1 However, high-grade immune-related adverse events can occur. Fulminant cases of immune checkpoint inhibitor-related myocarditis have been reported,2 –4 but the characteristics, timing, and outcomes of this new clinical entity are unknown. We used VigiBase,5 WHO's database of individual case safety reports, to identify 101 cases of severe myocarditis following treatment with immune checkpoint inhibitors, and observed early on...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Javid J Moslehi, Joe-Elie Salem, Jeffrey A Sosman, B énédicte Lebrun-Vignes, Douglas B Johnson Tags: Correspondence Source Type: research

[Obituary] Francis Fontan
Cardiac surgeon who devised the Fontan procedure. He was born in Nay, France, on July 3, 1929, and died at home in Bordeaux, France, on Jan 14, 2017, aged 88 years. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] BioArt: materials and molecules
Anna Dumitriu: BioArt and Bacteria at the University of Oxford's Museum of the History of Science is the first time, according to Silke Ackermann, the Museum Director, that the special exhibition space has been wholly given over to artworks, without directly referencing objects from the museum. Dumitriu's work, the exhibition declares, “combines traditional artistic media with contemporary science to produce artwork that is not only about bacteria but actually fused with them”. The show follows on from Back from the Dead, a 2017 special exhibition at the museum that examined the nature of antibiotics from the 1...
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Kelley Swain Tags: Perspectives Source Type: research

[Perspectives] The promissory nature of artificial hearts
“The Artificial Heart is Here” announced LIFE magazine in September, 1981. An image of the Utah total artificial heart (TAH), also known as the Jarvik-7 heart, dominated the issue cover against a vivid red background. The inside story, bolstered with large, colourful photographs, predicted a bre akthrough decade for this technology. Such anticipation was not entirely off-base, given the promissory nature of the technology as a curative fix for end-stage heart failure that aligned with the view of the body as an entity of replacement parts and the confidence of artificial heart researchers i n these devices. (Source: LANCET)
Source: LANCET - March 9, 2018 Category: General Medicine Authors: Shelley McKellar Tags: Perspectives Source Type: research