Medicine

[Comment] 12 months of DAPT after acute coronary syndrome still beats 6 months

Lancet - 12 March 2018 - 3:45pm
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.
Categories: Medicine

[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

Lancet - 12 March 2018 - 3:45pm
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.
Categories: Medicine

Microenvironmental control of breast cancer subtype elicited through paracrine platelet-derived growth factor-CC signaling

Nature Medicine - 12 March 2018 - 12:00am

Microenvironmental control of breast cancer subtype elicited through paracrine platelet-derived growth factor-CC signaling

Microenvironmental control of breast cancer subtype elicited through paracrine platelet-derived growth factor-CC signaling, Published online: 12 March 2018; doi:10.1038/nm.4494

Paracrine signaling networks in the breast cancer microenvironment uncover determinants of hormone receptor status and offer opportunities for therapeutic intervention.
Categories: Medicine

Dentate granule cell recruitment of feedforward inhibition governs engram maintenance and remote memory generalization

Nature Medicine - 12 March 2018 - 12:00am

Dentate granule cell recruitment of feedforward inhibition governs engram maintenance and remote memory generalization

Dentate granule cell recruitment of feedforward inhibition governs engram maintenance and remote memory generalization, Published online: 12 March 2018; doi:10.1038/nm.4491

Dynamic regulation of the cytoskeletal factor ABLIM3 controls the precision of memory representations in rodent models of post-traumatic stress disorder and age-related cognitive impairment.
Categories: Medicine

[Editorial] Out-of-hospital cardiac arrest: a unique medical emergency

Lancet - 10 March 2018 - 12:00am
In 1891, Friedrich Maass performed the first chest compressions on a human being. 80 years later, the first mass citizen training in cardiopulmonary resuscitation (CPR) was held in Seattle; over 100 000 members of the public were taught CPR. Out-of-hospital cardiac arrest (OHCA) describes the loss of mechanical cardiac function and the absence of systemic circulation. Time is crucial, with a lack of perfusion leading to continual cell death; with each second that passes the possibility of a good outcome decreases.
Categories: Medicine

[Editorial] The Global Fund under Peter Sands

Lancet - 10 March 2018 - 12:00am
Within the space of a few short weeks, the reputation of Peter Sands, incoming Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has gone from respected to reckless according to some critics. In an Offline column last November, The Lancet's Editor offered an unreserved welcome to Sands, praising his “credibility” and “refreshing new vision”. Sands had assiduously built a compelling argument for governments to take the economic costs of infectious diseases more seriously.
Categories: Medicine

[Editorial] Suicide in prisons: NICE fights fires

Lancet - 10 March 2018 - 12:00am
In February, 2018, NICE released draft guidelines addressing suicide in custodial and detention settings, looking at methods of reducing death by suicide, and offering help to those affected by suicide. In 2016, the likelihood of self-inflicted death of offenders in custody was 8·6 times greater than the likelihood of suicide in the general population.
Categories: Medicine

[Comment] Mitral meets mortality

Lancet - 10 March 2018 - 12:00am
Cardiologists and collaborating medical device and pharmaceutical companies have had much success in identifying new and profitable fields of engagement. The mitral valve space is one of those areas, following the previous successful occupation by cardiologists and the medical device industry of specialties such as coronary heart disease, arrhythmias, and the aortic valve.
Categories: Medicine

[Comment] Offline: The health of our societies is in peril

Lancet - 10 March 2018 - 12:00am
A single “s” makes all the difference. In 1969, it was Civilisation: the view of one man, Kenneth Clark, who took his television audience through a personal grand tour of the history of art—the only history of consequence then being western art. In 2018, the pluralism of human creativity was acknowledged in the BBC's new venture, Civilisations. In place of the perspective of one (white) man, the audience today can enjoy the less linear (and certainly more global) narratives offered by Simon Schama, Mary Beard, and David Olusoga.
Categories: Medicine

[World Report] Access to family planning in Senegal

Lancet - 10 March 2018 - 12:00am
In a jail in Senegal, a woman is imprisoned, convicted with infanticide. Access to family planning could help to prevent this societal woe. Amy Yee reports from Dakar.
Categories: Medicine

[World Report] Canada's federal budget under review

Lancet - 10 March 2018 - 12:00am
Canada champions science, women, and Indigenous health, while sidestepping pharmacare.
Categories: Medicine

[World Report] Rheumatic heart disease in the Pacific island nations

Lancet - 10 March 2018 - 12:00am
A pending motion from WHO might seek to eradicate rheumatic heart disease, which is still prevalent in Pacific island nations where progress is lagging. Chris McCall reports.
Categories: Medicine

[Perspectives] Peter Sands: charting a new course for The Global Fund

Lancet - 10 March 2018 - 12:00am
Peter Sands had a stormy start before taking up his new position as Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria on March 5, 2018. He was plunged into controversy last month after the decision by The Global Fund's senior management team to partner with Heineken, among other multinationals, and the implications for global health. The organisation, which invests and raises almost US$4 billion each year, is the world's largest public–private partnership set up to finance programmes to treat and prevent these three diseases and strengthen national health systems in the long term.
Categories: Medicine

[Perspectives] Resistance to injustice

Lancet - 10 March 2018 - 12:00am
Some of the most compelling films at this year's Human Rights Watch Film Festival in London, UK, show women battling the established political, social, or moral order. “We have not just women directors this year, we have a group of films that show central female characters very strongly pushing back against society in one way or another”, said John Biaggi, the festival's creative director. Half of the 14 award-winning international documentary and feature films in the festival, which Biaggi and his team selected from more than 500 entries, are directed by women.
Categories: Medicine

[Perspectives] The promissory nature of artificial hearts

Lancet - 10 March 2018 - 12:00am
“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 breakthrough 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 in these devices.
Categories: Medicine

[Perspectives] BioArt: materials and molecules

Lancet - 10 March 2018 - 12:00am
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 1940s to the present day.
Categories: Medicine

[Obituary] Francis Fontan

Lancet - 10 March 2018 - 12:00am
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.
Categories: Medicine

[Correspondence] Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis

Lancet - 10 March 2018 - 12:00am
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 onset of symptoms, frequent deaths, and substantially increased reporting in 2017.
Categories: Medicine

[Correspondence] Clinical benefits of evolocumab appear less than hoped

Lancet - 10 March 2018 - 12:00am
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% compared with studies of statin versus placebo, which lowered LDL by 30% and myocardial infarction risk by 38% in the Heart Protection Study4 and 50% and 54%, respectively, in the JUPITER trial.
Categories: Medicine

[Correspondence] Clinical benefits of evolocumab appear less than hoped – Authors' reply

Lancet - 10 March 2018 - 12:00am
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.
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