China's childhood hepatitis B virus (HBV) vaccination programme is a great public health success, resulting in a prevalence of HBsAg of only 1% in children under 5 years. However, the burden of HBV infection in China is still the highest in the world, with one third of the world's 240 million people with chronic HBV living in China.1 Nevertheless, most people with HBV infection in China are unaware that they carry the disease, making HBV infection a truly silent epidemic.2
In the 2-year follow-up of the PRIMA (PRImary Mesh closure of Abdominal midline wounds) trial (Aug 5, 2017, p 567),1 prophylactic onlay mesh augmentation for midline abdominal closure significantly reduced the risk of incisional hernia, with similar risks of surgical site infection compared with primary closure. Consequently, An Jairam and colleagues1 conclude that onlay mesh augmentation has the potential to become the standard treatment for patients at high risk of incisional hernia.
The PRIMA (PRImary Mesh closure of Abdominal midline wounds) trial by An Jairam and colleagues (Aug 5, 2017, p 567),1 provides relevant information on the outcomes of prophylactic repair of midline laparotomies for the prevention of incisional hernia. The trial shows significant reduction in the incidence of incisional hernia with onlay and sublay mesh reinforcement compared with primary suture only repair in patients with abdominal aortic aneurysm, but not in patients with a body mass index (BMI) greater than 27 kg/m2, contrary to the claim made by the authors of the PRIMA trial (ie, superior outcome of onlay mesh repair in patients with BMI greater than 27 kg/m2).
The conclusions of the PRIMA (PRImary Mesh closure of Abdominal midline wounds) trial1 (Aug 5, 2017, p 567) need to be taken with caution for several reasons. The rate of 18% of incisional hernia in patients receiving prophylactic sublay mesh implantation is very high compared with frequencies below 5% in many other reports.2,3 Furthermore, most series report a lower recurrence rate after sublay than onlay mesh implantation in the repair of incisional hernia.4,5 Therefore, the technical problems or insufficient training with the sublay group does not allow the conclusion that onlay mesh reinforcement has the potential to become the standard treatment for high-risk patients having elective midline laparotomy.
The report by Gill Livingston and colleagues (Dec 16, 2017 p 2673)1 is a valuable collation of a large body of medical research evidence that aims to combat the dementia epidemic, the greatest global challenge for health and social care in the 21st century. One of the key messages of the Commission is the need to be ambitious in terms of prevention. Using population attributable fractions (PAF), the authors estimate that as much as 35% of dementia cases could be prevented by targeting nine modifiable risk factors.
The Lancet Commission (Dec 16, 2017, p 2673)1 on prevention and management of dementia reviews the mounting evidence that hearing loss is a major risk factor for cognitive decline. Crucial information is still absent about the nature of this linkage and what factors might modify the cognitive effect of peripheral hearing loss. Particularly, the potential relevance of central hearing impairment should not be underestimated. As Gill Livingston and colleagues1 acknowledge, on pathophysiological and neuroanatomical grounds, central auditory processing is likely to be susceptible early in the course of Alzheimer's disease and other dementias.
We welcome the opportunity to respond to the letters about The Lancet Commission1 on dementia prevention, intervention, and care.
Cohen AJ, Brauer M, Burnett R, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet 2017; 389: 1907–18—In this Article (published online first on April 10, 2017), the mathematical form for the IER has been corrected. This correction has been made to the online version as of April 19, 2018.
Chen I, Cooney R, Feachem RGA, Lal A, Mpanju-Shumbusho W. The Lancet Commission on malaria eradication. Lancet 2018; 391: 1556–58—In this Comment (published online first on April 16, 2018), the affiliation for Winnie Mpanju-Shumbusho should be RBM Partnership to End Malaria, and the weblink should be RBM Partnership to End Malaria. These corrections have been made to the online version as of April 19, 2018, and the printed Comment is correct.
20 years ago, infectious diseases dominated the global health agenda. Policy makers, researchers, implementers, and donors united in the fight against infectious diseases, creating the Millennium Development Goals, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Vaccine Alliance, the US President's Emergency Plan For AIDS Relief (PEPFAR), the Roll Back Malaria Partnership, the Multilateral Initiative on Malaria (MIM),1 and more. Tremendous progress was made. Malaria benefited spectacularly and there has been a 47% reduction in global deaths from the disease since 2000.
Stimulation of entorhinal cortex–dentate gyrus circuitry is antidepressive
Stimulation of entorhinal cortex–dentate gyrus circuitry is antidepressive, Published online: 16 April 2018; doi:10.1038/s41591-018-0002-1
In mouse models of stress-induced depression, molecular and chemogenetic stimulation of the entorhinal cortex induces the production of adult-born hippocampal neurons and generates antidepressive-like effects.
Targeting sphingosine-1-phosphate lyase as an anabolic therapy for bone loss
Targeting sphingosine-1-phosphate lyase as an anabolic therapy for bone loss, Published online: 16 April 2018; doi:10.1038/s41591-018-0005-y
Promoting more bone growth is of keen interest in the treatment of osteoporosis, and preventing the degradation of S1P offers a new therapeutic avenue for this approach.
Differential glucose requirement in skin homeostasis and injury identifies a therapeutic target for psoriasis
Differential glucose requirement in skin homeostasis and injury identifies a therapeutic target for psoriasis, Published online: 16 April 2018; doi:10.1038/s41591-018-0003-0
Keratinocytes require glucose for injury- or inflammation-driven but not homeostatic proliferation, and glucose-transport blockade blocks psoriasis-like pathology in experimental models.
A single injection of crystallizable fragment domain–modified antibodies elicits durable protection from SHIV infection
A single injection of crystallizable fragment domain–modified antibodies elicits durable protection from SHIV infection, Published online: 16 April 2018; doi:10.1038/s41591-018-0001-2
Long-lived antibodies that can prevent viral infection of monkeys for 6 months may be a future alternative to an HIV vaccine.
Potent antitumor efficacy of anti-GD2 CAR T cells in H3-K27M+ diffuse midline gliomas
Potent antitumor efficacy of anti-GD2 CAR T cells in H3-K27M<sup>+</sup> diffuse midline gliomas, Published online: 16 April 2018; doi:10.1038/s41591-018-0006-x
Lethal pediatric tumors bearing a particular histone H3 mutation upregulate the disialoganglioside GD2, thereby making these tumors susceptible to chimeric antigen receptor T cell–based immunotherapy.
The most recent estimates by the World Economic Forum indicate that the global economic gender gap will take 217 years to close, and that this gap widened in 2017. That pay inequality is pervasive in the UK is therefore unsurprising. The UK median gender pay gap—the difference in average hourly earnings between men and women—is 18%. To address this disparity, the UK became the first country to mandate individual employers to release their gender pay gap data. All public and private sector employers with at least 250 employees had to report by April 4, 2018.
On March 28, the tragic case of Jack Adcock—a 6-year-old boy with Down's syndrome who died of sepsis in Leicester Royal Infirmary in 2011—and Dr Hadiza Bawa-Garba took another turn. Bawa-Garba, the paediatric trainee convicted of gross negligence manslaughter by a jury in 2015, was given permission to appeal a January High Court ruling to permanently strike her off the medical register. The General Medical Council (GMC), the UK's licensing body for doctors, had successfully appealed its own but independent Medical Practitioners Tribunal Service's decision from last July to suspend the doctor for 12 months but not revoke her licence.
After nearly two decades of progress following the abolishment of apartheid, South Africa's societal gains are now deteriorating. These are the conclusions of a report published on March 28 by The World Bank that analysed the country's progress in reducing poverty and inequality from 1994 to 2015. While overall the country's poverty levels have fallen since 1994, at least 2·5 million more South Africans since then have become poor. Over half the population lives under the poverty line, many of whom are black or South Africans of mixed race.
Guidelines for levels of alcohol use that pose a low risk to drinkers' health are provided by many countries, usually based on meta-analyses of epidemiological studies.1–3 However, to devise such guidelines is challenging because alcohol is linked to poor health in various and complex ways. Injury, suicide, and assault, for example, are associated with drinking to intoxication, whereas regular alcohol consumption increases the risks of liver cirrhosis, gastrointestinal diseases, cardiovascular disease, dementia, and some types of cancer.
Humanities and social sciences have had many positive influences on health experiences, care, and expenditure. These include on self-management for diabetes, provision of psychological therapy, handwashing, hospital checklists, the Scottish Government's stroke guidelines, England's tobacco control strategy, the response to the Ebola outbreak in west Africa and Zika virus in Brazil, and many more.1 Researchers have shown time and time again the political, practical, economic, and civic value of education and research in disciplines like anthropology, history, and philosophy.