Riviste scientifiche

[Correspondence] Checkpoint blockade therapy resistance in Hodgkin's lymphoma

The Lancet - Sa, 06/10/2018 - 00:00
About 50 years ago, the enigma of Hodgkin's lymphoma was depicted as the Hodgkin maze in two editorials in The Lancet.1,2 The uncertainties of the time were expressed through two questions: “Infection or neoplasm?” and “One entity or two (or more)?”.2 Subsequently, advances in cell biology and molecular pathology provided answers to these questions. Substantial evidence now indicates that classical Hodgkin's lymphoma is a distinct neoplastic entity, with heterogeneous pathological features, which might be associated with Epstein-Barr virus infection.

[Correspondence] The myth that shames us all

The Lancet - Sa, 06/10/2018 - 00:00
Any aspect of care demands a wise balance between benefits and risks, but problems arise when these are exaggerated, minimised, ignored, or hidden. Although arguments over most drugs have been settled through evidence, the arguments over opioids have persisted despite half a century of evidence.

[Department of Error] Department of Error

The Lancet - Sa, 06/10/2018 - 00:00
Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet 2018; 392: 866–79—In figure 1 of this Series paper, “feedback breathing exercise” has been changed to “full blood count”. In the management section, under Monitoring treatment response, the interval with which to reassess children was incorrect and should have said “Regular and frequent reassessment (every 3–6 months) of the child is essential”. These corrections have been made to the online version as of Oct 4, 2018.

[Department of Error] Department of Error

The Lancet - Sa, 06/10/2018 - 00:00
Opoku NO, Bakajika DK, Kanza EM, et al. Single dose moxidectin versus ivermectin for Onchocerca volvulus infection in Ghana, Liberia, and the Democratic Republic of the Congo: a randomised, controlled, double-blind phase 3 trial. Lancet 2018; 392: 1207–16—In this Article (published online first on Jan 17, 2018), the number of people who received ivermectin in 2014 should have been more than 110 million, and George Olipoh and Asare Sampson should have been included as authors rather than listed in the Acknowledgments section.

[Clinical Picture] Stone in urethra causing chronic pelvic pain

The Lancet - Sa, 06/10/2018 - 00:00
A 50-year-old man presented to the hospital with perineal pain that had been troubling him for 5 years. He described it as a mild, dull ache that was aggravated by riding his motorcycle. The patient did not report any bothersome lower urinary tract symptoms. He was able to generate a reasonable urinary stream, and preoperative uroflowmetry showed a maximum flow rate of 11·2mL/s, a voided volume of 215 mL, and a post-void residual volume of 20 mL.

[Series] Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke

The Lancet - Sa, 06/10/2018 - 00:00
Even though stroke presents as a variety of clinical syndromes, neuroimaging is the most important biomarker to help differentiate between stroke subtypes and assess treatment eligibility. Therapeutic advances have led to intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation being standard care for acute ischaemic stroke. Providing access to this care has implications for existing systems of care for stroke and their organisation and has reintroduced the possibility of adjuvant and neuroprotective treatment strategies in acute ischaemic stroke.

[Series] Intracerebral haemorrhage: current approaches to acute management

The Lancet - Sa, 06/10/2018 - 00:00
Acute spontaneous intracerebral haemorrhage is a life-threatening illness of global importance, with a poor prognosis and few proven treatments. As a heterogeneous disease, certain clinical and imaging features help identify the cause, prognosis, and how to manage the disease. Survival and recovery from intracerebral haemorrhage are related to the site, mass effect, and intracranial pressure from the underlying haematoma, and by subsequent cerebral oedema from perihaematomal neurotoxicity or inflammation and complications from prolonged neurological dysfunction.

[Series] Prevention of stroke: a global perspective

The Lancet - Sa, 06/10/2018 - 00:00
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries.

Long-term trends in incidence and risk factors for ischaemic stroke subtypes: Prospective population study of the South London Stroke Register

PLoS Medicine - Ve, 05/10/2018 - 23:00

by Hatem A. Wafa, Charles D. A. Wolfe, Anthony Rudd, Yanzhong Wang

Background

As the average life expectancy increases, more people are predicted to have strokes. Recent studies have shown an increasing incidence in certain types of cerebral infarction. We aimed to estimate time trends in incidence, prior risk factors, and use of preventive treatments for ischaemic stroke (IS) aetiological subtypes and to ascertain any demographic disparities.

Methods and findings

Population-based data from the South London Stroke Register (SLSR) between 2000 and 2015 were studied. IS was classified, based on the underlying mechanism, into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). After calculation of age-, sex-, and ethnicity-specific incidence rates by subtype for the 16-year period, we analysed trends using Cochran-Armitage tests, Poisson regression models, and locally estimated scatterplot smoothers (loess). A total of 3,088 patients with first IS were registered. Between 2000–2003 and 2012–2015, the age-adjusted incidence of IS decreased by 43% from 137.3 to 78.4/100,000/year (incidence rate ratio [IRR] 0.57, 95% CI 0.5–0.64). Significant declines were observed in all subtypes, particularly in SVO (37.4–18; p < 0.0001) and less in CE (39.3–25; p < 0.0001). Reductions were recorded in males and females, younger (<55 years old) and older (≥55 years old) individuals, and white and black ethnic groups, though not significantly in the latter (144.6–116.2; p = 0.31 for IS). A 4-fold increase in prior-to-stroke use of statins was found (adjusted odds ratio [OR] 4.39, 95% CI 3.29–5.86), and despite the increasing prevalence of hypertension (OR 1.54, 95% CI 1.21–1.96) and atrial fibrillation (OR 1.7, 95% CI 1.22–2.36), preventive use of antihypertensive and antiplatelet drugs was declining. A smaller number of participants in certain subgroup-specific analyses (e.g., black ethnicity and LAA subtype) could have limited the power to identify significant trends.

Conclusions

The incidence of ISs has been declining since 2000 in all age groups but to a lesser extent in the black population. The reported changes in medication use are unlikely to fully explain the reduction in stroke incidence; however, innovative prevention strategies and better management of risk factors may contribute further reduction.

Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study

PLoS Medicine - Ve, 05/10/2018 - 23:00

by Ana Basto-Abreu, Ariela Braverman-Bronstein, Dalia Camacho-García-Formentí, Rodrigo Zepeda-Tello, Barry M. Popkin, Juan Rivera-Dommarco, Mauricio Hernández-Ávila, Tonatiuh Barrientos-Gutiérrez

Background

Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity.

Methods and findings

Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI −1.4 to −1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; −12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term.

Conclusions

Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.

We’ve spotted the shock wave from an invisible explosion in space

New Scientist - Ve, 05/10/2018 - 20:12
For the first time, astronomers have spotted the shock wave from a powerful space explosion called a gamma ray burst without being able to see the burst itself

Cassini revealed three big surprises before diving into Saturn

New Scientist - Ve, 05/10/2018 - 17:00
Before the Cassini spacecraft melted away in Saturn’s atmosphere, it hurtled between the planet and its rings 22 times - and made some strange discoveries

Hundreds of physicists condemn sexist talk at CERN on women in physics

New Scientist - Ve, 05/10/2018 - 16:29
Following a talk by Alessandro Strumia at particle physics lab CERN that sparked outrage about sexism, hundreds of researchers have rallied together to push back against his claims

How should we control the power to genetically eliminate a species?

New Scientist - Ve, 05/10/2018 - 16:00
The power to re-engineer or eliminate wild species using a “gene drive” needs to be brought under international governance, say Simon Terry and Stephanie Howard

IVF success boosted by drug that helps embryos implant in the womb

New Scientist - Ve, 05/10/2018 - 15:07
Women given a drug that increases blood flow to the womb have a significantly higher chance of giving birth through IVF

Conquer your fear of public speaking by practising in virtual reality

New Scientist - Ve, 05/10/2018 - 14:23
Practising public speaking in virtual reality lets people confront their fears in a safe environment and become more confident in front of real-life audiences

People in Chile are currently evolving the ability to digest goat milk

New Scientist - Ve, 05/10/2018 - 12:35
Most Europeans have a genetic mutation that allows adults to digest milk, but it is less common elsewhere. Now it is spreading through Chile, and we don't know why

Smartphone with a finger crawls across the table to stroke your wrist

New Scientist - Ve, 05/10/2018 - 11:32
MobiLimb is a fake finger that plugs into a phone's USB port. It can provide extra interaction, including stroking your wrist and dragging itself across a table

Hundreds of tonnes of UK hospital waste piles up including human limbs

New Scientist - Ve, 05/10/2018 - 10:38
A huge backlog of NHS hospital waste has been revealed in a leaked report. It is believed to include pharmaceutical waste and a small number of amputated limbs

[Comment] Lipoprotein(a): lodestar for future clinical trials

The Lancet - Ve, 05/10/2018 - 00:30
Lipoprotein(a) is an LDL-like particle with a covalently bound, unique glycoprotein called apolipoprotein(a).1 Concentrations of lipoprotein(a) in plasma are under tight genetic control, and in the population these amounts can be skewed positively in distribution, with one in four individuals inheriting levels that increase their lifetime risk of atherosclerotic cardiovascular disease by more than 50%.2 Interest in lipoprotein(a) has been rekindled by findings of large epidemiological3 and Mendelian randomisation4 studies that confirm the causal role of lipoprotein(a) in the development of atherosclerotic cardiovascular disease and calcific aortic valve disease.
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