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[Articles] Faecal microbiota transplantation for patients with diabetes type 1 and severe gastrointestinal neuropathy (FADIGAS): a randomised, double-blinded, placebo-controlled trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00579-0/fulltext?rss=yes
FMT was safe and improved clinical outcomes for patients with type 1 diabetes suffering from bowel symptoms.
[Articles] Panitumumab plus 5-fluorouracil and folinic acid or 5-fluorouracil and folinic acid alone as maintenance therapy in RAS wild-type metastatic colorectal cancer (PanaMa, AIO KRK 0212): final efficacy analysis of a randomised, open-label, phase 2 trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00583-2/fulltext?rss=yes
Panitumumab plus FU/FA might be considered a standard of care maintenance regimen since a potential re-induction therapy with panitumumab cannot be guaranteed at the time of maintenance treatment decision.
[Correspondence] Possible factors influencing on the effect of minimally invasive sacroiliac joint fusion – a call for further research and discussion
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00555-8/fulltext?rss=yes
We thank Kampkuiper et al., and Dr Capel, for their comments and questions regarding our double-blind randomized placebo-controlled trial comparing minimally invasive sacroiliac joint fusion to sham surgery. Our response focuses on five main points: bilateralism of SIJ symptoms; individual response to SIJ fusion; diagnostic procedures; per-protocol treatment and post-intervention care procedures; and bias and generalizability.
[Articles] The impact of war on people with type 2 diabetes in Ukraine: a survey study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00587-X/fulltext?rss=yes
This study demonstrated a dramatic cumulative effect of the war on T2D patients’ health. Uncovered direct and indirect war-related risk factors can guide further adjustment of diabetic care in Ukraine to improve T2D patient support.
[Corrigendum] Correction of meta-analysis after retraction of article on the effects of anti-androgens in polycystic ovary syndrome
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00588-1/fulltext?rss=yes
In our published article,1 we evaluated the use of anti-androgens (e.g., finasteride, flutamide, spironolactone) compared with various interventions in the management of polycystic ovary syndrome (PCOS). Our meta-analysis concluded that anti-androgens should not be preferred over combined oral contraceptive pills (COCPs) for treating hyperandrogenism, but may be considered for treating hirsutism when COCPs are contraindicated, poorly tolerated or ineffective after six months.1
[Articles] Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02352-3/fulltext?rss=yes
During 2000–20, NHS coverage of new drugs displaced more population health than it generated. Our results highlight the inherent trade-offs between individuals who directly benefit from new drugs and those who forgo health due to the reallocation of resources towards new drugs.
[Articles] Endovascular therapy for acute vertebrobasilar occlusion (VERITAS): a systematic review and individual patient data meta-analysis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01820-8/fulltext?rss=yes
VERITAS supports the robust benefit of endovascular therapy in patients with vertebrobasilar artery occlusion with moderate to severe symptoms, with approximately 2·5-times increased likelihood of achieving a favourable functional outcome. Despite a significant increase in symptomatic intracranial haemorrhage risk, endovascular therapy for vertebrobasilar artery occlusion was associated with a significant reduction in both overall disability and mortality. Although the benefit of endovascular therapy remains uncertain for patients vertebrobasilar artery occlusion presenting with mild stroke severity and extensive infarcts on neuroimaging, we found a significant clinical benefit across a range of patients with vertebrobasilar artery occlusion.
[Comment] Regional action needed to halt antimalarial drug resistance in Africa
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02706-5/fulltext?rss=yes
The rapid spread of artemisinin partial resistance (ART-R) across east Africa, the Horn of Africa, and southern Africa threatens to undermine malaria control and elimination efforts,1–5 potentially increasing deaths and economic costs by an estimated more than US$2 billion by 2050 (Winskill P, Imperial College London, UK, personal communication). The African Leaders Malaria Alliance (ALMA), a coalition of African heads of state and governments, has warned of a “perfect storm” of financial shortfalls, climate change, and growing resistance to insecticides and antimalarials.
[Articles] Durvalumab and tremelimumab in patients with advanced rare cancer: a multi-centre, non-blinded, open-label phase II basket trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00570-4/fulltext?rss=yes
Durvalumab + tremelimumab treatment resulted in meaningful responses in salivary carcinoma and CCCO and deserves further exploration in front-line studies.
[Articles] Global, regional, and national burdens of heart failure in adolescents and young adults aged 10–24 years from 1990 to 2021: an analysis of data from the Global Burden of Disease Study 2021
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00577-7/fulltext?rss=yes
The burden of HF in adolescents and young adults aged 10–24 years was still increasing globally, which may be obscured by the burden trend of general population. According to different underlying causes of HF, both high-income countries and low- and middle-income countries need to better prevent HF in adolescents and young adults.
[Articles] Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01821-X/fulltext?rss=yes
Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding.
[Comment] Re-envisioning the response to natural disasters by leveraging WHO emergency medical teams
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02572-8/fulltext?rss=yes
The frequency, intensity, and economic effects of extreme weather events, fuelled by global temperature rise, have been increasing over the past 40 years.1–4 2023 saw record high temperatures in 24 countries, sparking wildfires that had substantial effects on individuals' medical and mental health.5 According to the 2024 Lancet Countdown on health and climate change, the intersection of severe droughts and unprecedented heatwaves has triggered a global food security crisis affecting 151 million people across 124 nations.
[Articles] Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00578-9/fulltext?rss=yes
Current moderate certainty evidence suggested that surgical intervention of spontaneous supratentorial ICH, may be associated with improved functional outcomes and a reduced risk of death at 6 months. The advantages of surgical haematoma removal are particularly pronounced when MIS including ES and MIPS are employed. ES could improve functional outcomes, reduce the risk of mortality and pulmonary infection, and have a high hematoma evacuation rate, suggesting that it might be an optimal surgical treatment.
[Articles] Effectiveness of the BNT162b2 XBB.1.5-adapted vaccine against COVID-19 hospitalization related to the JN.1 variant in Europe: a test-negative case-control study using the id.DRIVE platform
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00574-1/fulltext?rss=yes
BNT162b2 XBB.1.5-adapted vaccine provided protection against JN.1-related hospitalization, regardless of prior vaccination history, with no evidence of waning through five months. These data support yearly vaccination against COVID-19 to prevent severe illness during the respiratory virus season.
[Articles] Novel type 2 diabetes prediction score based on traditional risk factors and circulating metabolites: model derivation and validation in two large cohort studies
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00550-9/fulltext?rss=yes
Adding 11 metabolites to the clinical CDRS led to a novel type 2 diabetes prediction model, we called UK Biobank Diabetes Risk Score (UKB-DRS), substantially outperformed the clinical CDRS. The concise version with 4 metabolites performed comparably. As only very few clinical information and a blood sample are needed for the UKB-DRS, and as high-throughput NMR metabolomics are becoming increasingly available at low costs, these models have considerable potential for routine clinical application in diabetes risk assessment.
[Articles] Prediction accuracy of discrete choice experiments in health-related research: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00544-3/fulltext?rss=yes
DCEs are valuable for capturing health-related preferences and possess reasonable external validity to predict health-related behaviours, particularly for opt-in choices. Contextual factors (e.g., type of intervention, study setting, analysis method) influenced the predictive accuracy.
[Correspondence] Concerns regarding sham-controlled trial of SI joint fusion procedure
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00556-X/fulltext?rss=yes
I congratulate Randers et al. on completing their sham-controlled study on SI joint fusion.1 However, several points warrant further discussion.
[Correspondence] Contrasting results in sacroiliac joint fusion studies: the role of bilateral complaints
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00557-1/fulltext?rss=yes
Randers et al. conducted a double-blind randomized sham surgery-controlled trial to assess the effectiveness of sacroiliac joint fusion (SIJF).1 In their study, 72% of the patients in the surgery group and 65% in the sham group had bilateral complaints. This contrasts with the European RCT where only 35% of surgery group patients had bilateral complaints.2 Notably, the European RCT reported 39% of surgery group patients with bilateral complaints underwent bilateral SIJF. These differences might explain the contradictory results.
[World Report] Making CAR T-cell therapies more affordable
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02719-3/fulltext?rss=yes
CAR T-cell therapies have revolutionised treatment of many diseases, but their expense means many patients are unable to benefit. Kathryn Senior reports.
[Comment] What price is society willing to pay for new drugs?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02562-5/fulltext?rss=yes
The purpose of England's National Health Service (NHS) is to improve the health and wellbeing of the nation through provision of health care.1 The money available to achieve this purpose is restricted and the cost of providing all possible health care to all possible citizens would vastly exceed the NHS budget. As new drugs emerge, decisions therefore need to be made about whether the health benefits that these drugs offer are sufficient to justify the health benefits that will be foregone elsewhere in the NHS to free up the resources required to pay for them.
[Comment] Endovascular therapy for ischaemic stroke due to vertebrobasilar artery occlusion
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02137-8/fulltext?rss=yes
A decade ago, the landmark results of the MR-CLEAN trial of endovascular therapy within 6 h of onset of ischaemic stroke caused by intracranial internal carotid or proximal middle cerebral artery occlusion were presented at the 9th World Stroke Conference.1 The findings were soon replicated in concurrent randomised controlled trials (RCTs)2 and later extended to patients treated within 24 h of stroke onset3 and patients with a large infarct core.4 However, the effectiveness and safety of endovascular therapy for patients with ischaemic stroke due to posterior circulation vertebrobasilar artery occlusion (VBAO) is less certain.
[Review] Concurrent outbreaks of mpox in Africa—an update
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02353-5/fulltext?rss=yes
In this Review, we examine the concurrent outbreaks of mpox in Africa, focusing on clade 1a, the newly emerged clade 1b, and clade 2b lineage A, and how they differ from the 2022 global outbreak caused by clade 2b lineage B.1. Historically, clades 1a and 2a have caused sporadic, small outbreaks in central and west Africa, respectively, primarily through zoonotic transmission. Clade 2b first caused an outbreak in Nigeria in 2017, and later spread globally via sexual contact in 2022. In August, 2024, WHO declared a global health emergency due to the newly identified clade 1b outbreak in eastern Democratic Republic of the Congo.
[Comment] One term to transform: universal health coverage through professional community health workers
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02713-2/fulltext?rss=yes
With a shortage of 43 million health workers and half the global population without adequate access to essential health services, now is the moment for boldness that can reshape health care for generations.1,2 Currently, millions of experienced and trusted community health workers (CHWs) operate outside formal systems with most unsupervised, unequipped, and undertrained; this situation limits their impact and harms their wellbeing.3 CHWs provide door-to-door care, link people to facilities, and offer social support.
[Articles] Life course socioeconomic position and care dependency in later life: a longitudinal multicohort study from 17 countries
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00573-X/fulltext?rss=yes
Changing socioeconomic status over the lifespan was associated with care dependency risk in later life. Promoting equal educational opportunities from an early age to equitably benefit the most socioeconomically disadvantaged could help mitigate care burdens. Encouraging participation in social activities has the potential to reduce socioeconomic differences in care dependency.
[World Report] Ukrainian battlefield medicine
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02677-1/fulltext?rss=yes
More than 1000 days of combat have transformed the medical care of Ukrainian soldiers. Rebecca Sers reports.
[Comment] The uncertainties of monitoring progress towards achieving global nutrition targets
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02180-9/fulltext?rss=yes
The 65th World Health Assembly in 2012 established six global nutrition targets (GNTs) related to birthweight, exclusive breastfeeding, child growth (stunting, wasting and overweight), and anaemia in women of reproductive age as key indicators of maternal and child health.1 Therefore, evaluations of progress towards achieving these targets, and their forward projections are of great interest to governments, public health policy makers, scientists, and clinical practitioners. Although some other bodies have reported on progress towards these targets,2 the recent analysis by the Global Nutrition Target Collaborators, as part of the Global Burden of Disease Study (GBD),3 is a comprehensive effort to provide changes in the prevalence of GNT indicators and their attributable burden at a regional, national, and global level from 2012 to 2021, with projections to 2050 in 204 countries and territories, using GBD 2021 data.
[Articles] Efficacy and safety of perioperative sintilimab plus platinum-based chemotherapy for potentially resectable stage IIIB non-small cell lung cancer (periSCOPE): an open-label, single-arm, phase II trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00576-5/fulltext?rss=yes
Perioperative sintilimab plus platinum-based chemotherapy is an emerging treatment option for patients with potentially resectable stage IIIB NSCLC; it has a high response rate and tolerable treatment-related toxic effects, and enables radical resection in most patients.
[Articles] Acceptance and safety of the RSV-preventive treatment of newborns with nirsevimab in the maternity department: a prospective longitudinal cohort study in France
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00565-0/fulltext?rss=yes
The nirsevimab acceptance rate for newborns in the maternity unit was high during the first season of implementation. The safety profile was very good, with no significant differences between the nirsevimab group and the control group.
[Articles] Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00560-1/fulltext?rss=yes
No score demonstrated enough diagnostic accuracy to be used alone to identify sepsis. However, obstetric—and sepsis-specific EWS performed better for early identification of maternal sepsis than non-obstetric and non-sepsis-specific scoring systems. There are limitations to applying EWS to real-world data, mainly due to the incompleteness of medical data that hinders EWS effectiveness. There is a need to continue developing and testing criteria for early identification of maternal sepsis.
[Articles] Global, regional, and national epidemiology of childhood neuroblastoma (1990–2021): a statistical analysis of incidence, mortality, and DALYs
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00543-1/fulltext?rss=yes
The global trends for incidence, mortality, and DALYs related to pediatric neuroblastoma initially increased and then decreased, although an overall increasing trend was observed. However, the burden of disease remains significant in low-, low-middle-, and middle-SDI regions. A comprehensive understanding of the epidemiology of neuroblastoma in children is crucial for enhancing disease prevention and control efforts.