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[Articles] Clearance of Treponema pallidum from oral and anal sites after treatment of secondary syphilis: results from a multi-centre, prospective, cross-sectional study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00406-2/fulltext?rss=yes
During secondary syphilis, most MSM had T. pallidum DNA detected in oral and anal mucosa. Bacterial load dropped markedly 3 days post-treatment and cleared in almost all samples by 7 days.
[Articles] Obesity at antiretroviral therapy initiation and long-term risk of cardiovascular disease, cancer, or death in people with HIV in Italy: a prospective cohort study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00403-7/fulltext?rss=yes
Obesity at ART initiation may be associated with a clinically meaningful increase in the risk of CVD, cancer, and death. We found weak evidence of a possible age-related gradient, with larger effect size in PWH under 60 years of age, which warrants further investigation.
[Articles] Diagnosis, management, and prevention of Crimean-Congo haemorrhagic fever: a Delphi-based consensus study in Türkiye
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00409-8/fulltext?rss=yes
These findings should not be interpreted as formal guidelines. By transparently quantifying expert agreement and non-consensus, this study synthesises specialist clinical experience from a high incidence country and delineates areas of convergence and ongoing uncertainty relevant to both endemic and newly affected regions. Prospective studies are needed to validate key therapeutic and management strategies identified in this work.
[Articles] Long term outcome following pulmonary TB or lower respiratory tract illness in children: a prospective South African study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00389-5/fulltext?rss=yes
Children with PTB demonstrated significant lung function impairment, predominantly restrictive, that persisted over time. These findings highlight the importance of ongoing respiratory evaluation and stronger preventative interventions to mitigate long-term pulmonary sequelae in paediatric PTB.
[Articles] Sex inequality in disease burden attributable to smoking, secondhand smoke and chewing tobacco: A systematic analysis for the Global Burden of Disease Study 2023
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00402-5/fulltext?rss=yes
While smoking- and SHS-attributable ASDRs have declined and chewing tobacco-attributable ASDR has remained stable, sex disparities have varied by time, region, and life stage. These findings may inform the integration of sex-specific perspectives into tobacco control strategies, which could strengthen the implementation of the Framework Convention on Tobacco Control and help mitigate the future burden of tobacco use.
[Articles] Longitudinal patterns of fentanyl utilisation (medical versus illicit sources) in the United States 2015–2023: a retrospective cohort study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00394-9/fulltext?rss=yes
Illicit-source fentanyl exposure is associated with a markedly higher risk of opioid-related harmful outcomes than medical-source exposure, providing evidence that illicit fentanyl is a driver of adverse patient outcomes. Whilst acknowledging the limitations of this analysis, these findings underscore the substantial contribution of illicit fentanyl to the ongoing opioid epidemic and highlight the need for deeper investigation of how medical and illicit fentanyl use interact over time. Further research is warranted.
[Articles] Belzutifan plus lenvatinib versus cabozantinib in patients with previously treated advanced renal cell carcinoma (LITESPARK-011): an open-label, randomised, controlled, phase 3 trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01089-5/fulltext?rss=yes
Belzutifan–lenvatinib represents a novel and efficacious treatment option. Although overall survival was not significantly different between the groups, belzutifan–lenvatinib might be a new standard of care for patients with advanced clear-cell renal cell carcinoma with disease progression after previous anti-PD-1 or anti-PD-L1 therapy. The safety profile of belzutifan–lenvatinib was consistent with those of the individual drugs.
[Articles] Switch to once-weekly, single-tablet islatravir–lenacapavir from daily standard of care for HIV-1 (ISLEND-2): a multicentre, randomised, open-label, active-controlled, phase 3 non-inferiority trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01442-X/fulltext?rss=yes
Once-weekly islatravir–lenacapavir showed non-inferior efficacy to the standard of care and was generally well tolerated. Longer-term safety data will provide further valuable insights beyond the week 48 data presented here. Islatravir–lenacapavir has potential to be the first once-weekly complete oral single-tablet regimen for HIV-1 treatment.
[Comment] Towards a joint classification of neurological and psychiatric disorders
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01498-4/fulltext?rss=yes
Psychiatry has been called the other half of medicine,1 reflecting the separation of mental health services from the rest of health care. Patients with a mental illness are treated in different clinics and hospitals to those with physical illnesses. Advances in neuroscience and medicine have gradually eroded the justification for this divide, but the compelling evidence for the interdependence of brain and mind is easily neglected within our siloed specialties and services. We believe this separation causes harm to patients with disorders on either side of the line and propose that a joint classification of neurological and psychiatric disorders is theoretically justified, practically feasible, and would benefit psychiatry, neurology, and medicine more broadly.
[Articles] RAS/MAPK pathway modulation with simvastatin in children with Noonan syndrome: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00367-6/fulltext?rss=yes
In children with NS, 12 months of simvastatin did not result in significant improvements in the primary endpoint or in major outcomes of clinical relevance under the conditions tested. Changes in DKK1 concentrations and the Ea/Aa ratio should be interpreted cautiously as exploratory secondary findings requiring confirmation in adequately powered studies. Further research is needed to explore alternative treatment strategies and more direct approaches to RAS/MAPK pathway modulation.
[Articles] Efficacy and safety of sublingual cilostazol and dexborneol for the treatment of acute ischaemic stroke: a randomised phase 2 trial in China
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00368-8/fulltext?rss=yes
Our findings indicate that, for patients with ischaemic stroke undergoing endovascular treatment for large vessel occlusion, Y-6 sublingual tablets (cilostazol and dexborneol) were safe with tolerance. Although the trial did not demonstrate statistically significant efficacy on the primary outcome, the signal toward improved functional outcomes without haemorrhage risk supports the biological plausibility of the intervention and justifies further investigation. Large-scale phase 3 clinical trials are warranted to further this research.
[Review] The silent zone of paediatric asthma: integrating small airway dysfunction assessment into clinical practice
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00385-8/fulltext?rss=yes
Small airway dysfunction (SAD) is increasingly recognised as a clinically relevant component of paediatric asthma because peripheral airway abnormalities may precede spirometric impairment and contribute to poor disease control despite preserved FEV1. This narrative review summarises current evidence on the assessment and clinical implications of SAD in children, based on studies identified through PubMed/MEDLINE and the Cochrane Library. Spirometry remains the cornerstone of asthma evaluation but has limited sensitivity for early peripheral airway disease.
[Articles] [177Lu]Lu-DOTA-TATE plus long-acting octreotide in patients with newly diagnosed, advanced, grade 2–3, gastroenteropancreatic neuroendocrine tumours: preplanned and post-hoc efficacy analyses from the randomised, phase 3 NETTER-2 trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00362-7/fulltext?rss=yes
These findings support the use of first-line 177Lu-DOTATATE for patients with advanced, well-differentiated, higher grade 2–3 (Ki67 ≥10% and ≤55%), somatostatin receptor-positive GEP-NETs, and for whom chemotherapy is not considered the most appropriate treatment option, regardless of NET grade (2/3) or origin (pancreas/gastrointestinal).
[Articles] Mediterranean lifestyle and risk of adverse cardiovascular events, all-cause and cardiovascular mortality among individuals with type 2 diabetes
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00387-1/fulltext?rss=yes
Higher adherence to the MEDLIFE was associated with significantly lower risks of MACE, all-cause and CVD mortality among British individuals with type 2 diabetes. Our findings support the MEDLIFE as a promising and accessible tool for type 2 diabetes management.
[Comment] [177Lu]Lu-PSMA-617 in metastatic androgen pathway modulator-sensitive prostate cancer
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01231-6/fulltext?rss=yes
Lutetium-177 (177Lu)-PSMA-617 is a radioligand therapy that targets prostate-specific membrane antigen (PSMA) and delivers β-particle radiation to PSMA-expressing cells and the surrounding tumour microenvironment.1 177Lu-PSMA-617 was initially approved in 2022, based on the results of the phase 3 VISION trial1 in patients with PSMA-positive metastatic castration resistant prostate cancer (or metastatic androgen pathway modulator-resistant prostate cancer (APMR) according to the recently updated Prostate Cancer Working Group 4 (PCWG4) nomenclature)2 who had progressed on at least one previous androgen receptor pathway inhibitor (ARPI) and one to two taxanes.
[Review] Quality of life assessment in individuals with schizophrenia: a COSMIN-based systematic review of S-QoL41 and S-QoL18 incorporating neurobiological support
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00405-0/fulltext?rss=yes
S-QoL41, S-QoL18, and S-QoL-MCAT demonstrate robust psychometric properties and are suitable for clinical research and practice. S-QoL18 offers the best balance between psychometric performance and feasibility. Further research should address cross-cultural validity, measurement error, and thresholds for individual-level change.
[Review] Bone marrow failure syndromes across the age spectrum: diagnostic and therapeutic principles
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00392-5/fulltext?rss=yes
Bone marrow failure syndromes (BMFS) are a diverse group of disorders that commonly present with pancytopenia and require a structured approach to evaluation. Initial assessment focuses on excluding reversible causes, followed by consideration of inherited and acquired conditions. Although the diagnostic approach is broadly similar across age groups, the underlying BMF etiology frequently differs: younger patients are more likely to have immune-mediated or inherited disease, whereas older adults more often have immune or clonal hematopoietic disorders.
[Correspondence] Authors’ reply: Concerns about “BIOFIRE FILMARRAY Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: a systematic review and diagnostic test accuracy meta-analysis” by Trujillo-Gomez, et al
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00410-4/fulltext?rss=yes
We have carefully reviewed the letter submitted by Hueth and colleagues regarding our Article1 published in 2022. In this letter, we respond to the authors' concerns.
[Articles] Pancreatic enzymes and bile acids alone and in combination for acutely ill, severely malnourished children: a multi-country double-blind randomised placebo-controlled trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00363-9/fulltext?rss=yes
Pancreatic enzymes and/or ursodeoxycholic acid do not reduce mortality, serious adverse events, or improve other clinical outcomes in hospitalised, acutely ill, severely malnourished children. Future trials should consider testing a package of interventions that include multiple domains to reduce mortality in this vulnerable population.
[Articles] Intergenerational contact and depressive symptoms in midlife and older adults: an analysis of six cohort studies across 33 countries
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00401-3/fulltext?rss=yes
The association between intergenerational contact and depressive symptoms among midlife and older adults is context dependent. Residential separation combined with infrequent contact may reflect reduced emotional support and is linked to an increased burden of depressive symptoms across various settings. Conversely, frequent intergenerational contact can help mitigate this risk in certain cultural contexts. Future research is needed to clarify causal pathways across diverse settings.
[Correspondence] The 2026 Kumamoto earthquake: rescue alone is not enough
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01590-4/fulltext?rss=yes
On July 28, 2026, a magnitude 7·1 earthquake struck Kumamoto Prefecture in southern Japan.1 By the next morning, at least 13 people were confirmed dead; more than 30 000 households remained without power, more than 80 000 without water, and damage or utility outages were reported at 46 health-care facilities.1 In 2016, the same region was struck by successive magnitude 6·5 and 7·3 earthquakes.2 A large shopping mall, which was damaged in 2016 and reopened in June 2026, partly collapsed before an explosion, exposing the fragility of rebuilt infrastructure.
[Comment] Redefining therapy for previously treated renal cell carcinoma
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01246-8/fulltext?rss=yes
For more than a decade, the question of what to offer patients with metastatic clear-cell renal cell carcinoma after front-line therapy was familiar. Treatment consisted of a VEGFR-tyrosine-kinase inhibitor, frequently sequenced after another. The framework began with the TARGET trial1 in patients with cytokine-refractory disease, and matured in the post-VEGFR-tyrosine-kinase inhibitor population through the AXIS trial,2 which showed superiority of axitinib over sorafenib, and the pivotal METEOR trial,3 which established cabozantinib as a second-line standard of care.
[Comment] Once-weekly oral antiretroviral therapy for HIV
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01557-6/fulltext?rss=yes
For the past four decades, oral antiretroviral therapy for HIV has required daily doses. Long-acting injectable cabotegravir and rilpivirine has ended that obligation,1 requiring an injection every month or every 2 months. In The Lancet, Amy E Colson and colleagues2 report ISLEND-2, a randomised, open-label trial in which 626 virologically suppressed adults with HIV-1 either switched to a once-weekly, single oral tablet containing islatravir, a nucleoside reverse transcriptase translocation inhibitor, and lenacapavir, a capsid inhibitor, or continued daily standard-of-care therapy.
[Articles] Intensive versus standard blood pressure control and overall brain small vessel disease burden: a post-hoc analysis of the SPRINT randomized clinical trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00396-2/fulltext?rss=yes
Among hypertensive adults, targeting an SBP of <120 mmHg, compared with <140 mmHg, was associated with less progression of SVD burden. Even modest SBP reductions of ≤10 mmHg conferred measurable brain benefits, with larger reductions providing incrementally greater protection against SVD progression.
[Review] Hepatitis A vaccination and its public-health impact in routine prevention and outbreak control: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00397-4/fulltext?rss=yes
Hepatitis A vaccination provides very high protection in pre-exposure settings. Post-exposure vaccination may also be effective, but confidence in this estimate is limited by very low-certainty evidence and substantial heterogeneity. Population-level findings support the public health value of routine immunisation and suggest potential benefit in outbreak response.
[Health Policy] Building a genomics-capable cancer workforce: a competency-based framework for education and training in precision oncology
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00395-0/fulltext?rss=yes
This framework provides an implementation-oriented structure to support workforce development, curriculum design, continuing professional education, role mapping, competency assessment, and service planning in precision oncology. Its application may support scalable, equitable, and sustainable integration of genomics into routine cancer care.
[Articles] Machine learning to predict adverse perinatal outcomes: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00391-3/fulltext?rss=yes
ML prediction models showed moderate performance, were at high risk of bias and did not always outperform traditional statistical methods. To improve perinatal outcome prediction, methodological improvements and better predictors are needed.
[Articles] Chronic obstructive pulmonary disease and risk of incident cardiovascular disease, chronic kidney disease, and death: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00384-6/fulltext?rss=yes
COPD is associated with an increased risk for a range of incident cardiovascular diseases, chronic kidney disease and mortality. The impact of current and novel treatments on a broader range of cardiovascular and kidney outcomes in patients with COPD requires prospective randomised assessment.
[Articles] [177Lu]Lu-PSMA-617 in patients with PSMA-positive metastatic androgen pathway modulator-naive/sensitive prostate cancer (PSMAddition): a phase 3 randomised, controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01092-5/fulltext?rss=yes
Combining 177Lu-PSMA-617 with ADT plus ARPI prolonged radiographic progression-free survival in patients with PSMA-positive metastatic APMN/S prostate cancer. Although adverse events were more frequent, there were no unexpected safety findings associated with the drug combination. Therefore, combining 177Lu-PSMA-617 with ADT plus ARPI might be a new treatment option in metastatic APMN/S prostate cancer.
[Articles] Artificial intelligence in cardiovascular care: a systematic review and meta-analysis of randomised controlled trials
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00376-7/fulltext?rss=yes
AI demonstrated potential benefits in intermediate process measures in cardiovascular care but evidence of its effect on hard clinical outcomes remains limited. Current evidence is constrained by high risk of bias, trial heterogeneity, inadequate reporting of AI-specific components, limited generalisability, and a scarcity of trials with clinically meaningful endpoints. More rigorous, representative, and transparently reported RCTs with longer follow-up and long-term clinical outcomes are needed.