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[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.
[Articles] Adherence and efficacy outcomes in young Australians with suicidal ideation using a self-management app and digital engagement strategy compared with a sham app: a three-arm randomised controlled trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00542-X/fulltext?rss=yes
A third wave CBT app helped to reduce ideation severity, however providing additional online resources to promote therapeutic engagement did not enhance these effects.
[Department of Error] Department of Error
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02667-9/fulltext?rss=yes
Xu R, Ye T, Huang W, et al. Global, regional, and national mortality burden attributable to air pollution from landscape fires: a health impact assessment study. Lancet 2024; published online Nov 27. https://doi.org/10.1016/S0140-6736(24)02251-7—In this Article, Yuming Guo and Shanshan Li should have been marked as Joint senior authors; the third sentence of the Summary Findings section should have read “Over 90% of all attributable deaths were in low-income and middle-income countries, particularly in sub-Saharan Africa (606 769 deaths per year), southeast Asia (206 817 deaths), south Asia (170 762 deaths), and east Asia (147 291 deaths)”; and in figure 2, the title should have read “Global and regional trends of annual ADs attributable to exposure to landscape fire-sourced air pollution from 2000 to 2019” and the y-axes titles should have read “Number of ADs (in 10 000s)”.
[Seminar] Chronic pancreatitis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02187-1/fulltext?rss=yes
Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. The diagnosis is based on the presence of typical symptoms and multiple morphological manifestations of the pancreas, including pancreatic duct stones and strictures, parenchymal calcifications, and pseudocysts. Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care.
[Articles] Treatable traits in idiopathic pulmonary fibrosis: focus on respiratory tract infections—a systematic review and a meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00545-5/fulltext?rss=yes
RTIs are frequently reported adverse events in IPF patients over a one-year period, with different investigated treatments showing no profound impact compared to placebo. Future clinical trials should focus on targeting treatable traits like RTIs.
[Articles] When to stop immunotherapy for advanced melanoma: the emulated target trials
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00539-X/fulltext?rss=yes
These results suggest that a one-year course of immunotherapy is both necessary and sufficient for patients with advanced melanoma. Prolonged treatment beyond 2 years does not appear to be beneficial in terms of survival and could even be detrimental.
[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.
[Corrigendum] Real-life efficacy of immunotherapy for Sézary syndrome: a multicenter observational cohort study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00558-3/fulltext?rss=yes
In this article, an error is lying in the legend of Figure 2.
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[Comment] Harnessing faith-based organisations for global health equity
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02614-X/fulltext?rss=yes
The global health landscape spans high-income, middle-income, and low-income and middle-income countries (LMICs) and has pervasive disparities in health outcomes and access to care, particularly among underserved and marginalised populations, including minoritised ethnic groups. The COVID-19 pandemic underscored these inequities, revealing that underserved communities often have high levels of unmet health needs, which are exacerbated by socioeconomic inequalities, cultural barriers, and low access to health-care services.
[Comment] Now is the time to build on CDC's progress, not halt it
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02668-0/fulltext?rss=yes
From preventing the spread of malaria in the USA during the early 1950s1 to protecting the public from avian influenza, the US Centers for Disease Control and Prevention (CDC) has worked for almost 80 years to take care of the US public's health. However, health threats are ever present and ever changing, and CDC has changed over the past 4 years to stay ahead of them. After the COVID-19 pandemic, in which the clarity of the agency's guidance and timeliness of its communications were questioned, CDC listened, learned lessons, and took action—to be more effective, more responsive, and more transparent.
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[Articles] TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02100-7/fulltext?rss=yes
The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment.