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[The Lancet Commissions] The UCL–Lancet Commission on Migration and Health: the health of a world on the move

Gi, 06/12/2018 - 00:30
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations.

[Comment] Forgotten needs of children left behind by migration

Gi, 06/12/2018 - 00:30
Little evidence is available about the impact parental migration has on children who are left behind. Although parents leaving children in the care of their extended families while they seek employment—either within their origin country or internationally—is common in low-income and middle-income countries (LMICs), few studies have investigated the impact this has on the health outcomes of these children.

[Perspectives] Bernadette Nirmal Kumar: making migrant health mainstream

Gi, 06/12/2018 - 00:30
Migration has been a natural part of Bernadette Kumar's life, which, along with her diverse and sometimes extraordinary experiences as a former physician turned public health leader, gives her a unique perspective as an author on the UCL–Lancet Commission on Migration and Health, now published in The Lancet. “I've never lived in one place for more than 5 years at a time. Migration is just part of me; I see life as being all about exploration and expanding horizons”, she says.

[Articles] Global patterns of mortality in international migrants: a systematic review and meta-analysis

Gi, 06/12/2018 - 00:30
Our study showed that international migrants have a mortality advantage compared with general populations, and that this advantage persisted across the majority of ICD-10 disease categories. The mortality advantage identified will be representative of international migrants in high-income countries who are studying, working, or have joined family members in these countries. However, our results might not reflect the health outcomes of more marginalised groups in low-income and middle-income countries because little data were available for these groups, highlighting an important gap in existing research.

[Comment] Fluoxetine and recovery after stroke

Me, 05/12/2018 - 10:00
In 2011, publication of the randomised placebo-controlled FLAME trial in The Lancet Neurology fuelled hope that new and effective treatment strategies for stroke could be developed through repositioning of approved and often inexpensive drugs. The FLAME trial was done in nine centres in France, in 118 patients with ischaemic stroke and unilateral weakness. Treatment with the selective serotonin-reuptake inhibitor (SSRI) fluoxetine, started between days 5 and 10 after symptom onset, improved motor recovery and increased the chances of functional independence after 3 months.

[Articles] Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Me, 05/12/2018 - 10:00
Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.

[Comment] Uterus transplantation from a deceased donor

Me, 05/12/2018 - 00:30
Since 2015, when the first livebirth after uterus transplantation from a live donor was published in The Lancet,1 at least ten other livebirths have been reported in scientific journals2,3 or in the general media. This is the result of an acceleration in the number of uterus transplantation procedures that have been completed in the past 3 years, with 50 procedures being done since then, both from live and deceased donors (appendix).

[Articles] Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility

Me, 05/12/2018 - 00:30
We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.

[Perspectives] 2018 Global Health Film Festival: pictures of power and paternalism

Me, 05/12/2018 - 00:30
Picture a cartoon drawing of a wigwam. Under it are a mother and father, bent low by the burden of their ten cartoon children. Below the kids, a single, lonely cartoon horse. Next to this sits another vision: the same wigwam sits at the apex. Under it are a mum and dad, contentedly holding hands, next to their single, happy child. Ranged under them, ten prancing horses. This cartoon features in Amá, a documentary about coercive sterilisation in Native American women directed by British filmmaker Lorna Tucker and the opening night film for the 2018 Global Health Film Festival in London, UK.

[Articles] Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial

Ma, 04/12/2018 - 03:15
Front-line treatment with A+CHP is superior to CHOP for patients with CD30-positive peripheral T-cell lymphomas as shown by a significant improvement in progression-free survival and overall survival with a manageable safety profile.

[Comment] Confronting the most challenging risk factor: non-adherence

Ma, 04/12/2018 - 00:30
Despite advances in cardiovascular therapies, coronary heart disease remains the leading cause of death in almost all countries. Two of the most remarkable recent treatments, percutaneous coronary intervention and the availability of proprotein convertase subtilisin/kexin type 9 inhibitor drugs, have revolutionised cardiology practice. Although life-saving and now essential therapies,1 whether they will be able to reduce the incidence and associated morbidity and mortality of coronary heart disease remains unlikely since the increase in prevalence of obesity and diabetes is raising the background level of cardiovascular risk.

[Articles] Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial

Ma, 04/12/2018 - 00:30
This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

[Correspondence] Chinese Academy of Engineering calls for actions on the birth of gene-edited infants

Lu, 03/12/2018 - 09:44
At the Second International Summit on Human Genome Editing held in Hong Kong, China, on Nov 27–29, 2018, Jiankui He, the leading researcher involved in the birth of what he claims are gene-edited infants, described their work using CRISPR-Cas9 mediated genome editing of CCR5 gene in human germ cells and embryos.1 This claim has caused outrage among the scientific community and society worldwide.

[Correspondence] Gene-edited babies: Chinese Academy of Medical Sciences’ response and action

Lu, 03/12/2018 - 09:44
CRISPR-Cas9, a powerful tool for genome editing, has provided novel strategies and potential for treating human diseases. However, the ethical challenges remain unsolved for many clinical applications. As researchers from the Chinese Academy of Medical Sciences, the national biomedical research institution in China, we and our colleagues are deeply concerned about media reports of the claim of the first gene-edited twin babies “immune to HIV” by Jiankui He and colleagues.1 At the Second International Summit on Human Genome Editing in Hong Kong, China, Jiankui He disclosed their work on CRISPR-Cas9 mediated genome editing of the CCR5 gene in human germ cells and embryos.

[Correspondence] Open letter from Chinese HIV professionals on human genome editing

Lu, 03/12/2018 - 09:44
On Nov 28, 2018, during the Second International Summit on Human Genome Editing in Hong Kong, He Jiankui and colleagues from China claimed that they have edited the human embryonic genome to disable the CCR5 gene in work that resulted in the birth of twin sisters.1 The announcement generated serious concerns relating to scientific ethics. As Chinese professionals engaged in HIV research and prevention, we strongly oppose genome editing on healthy human germline cells and embryos for reproductive purposes and HIV prevention.

[Comment] PD-1 antibodies in head-and-neck cancer

Sa, 01/12/2018 - 00:30
Mortality in head-and-neck squamous cell carcinoma has remained unaltered throughout the past and is predominantly associated with early onset of locoregional recurrence. Since the first publication of the beneficial use of checkpoint inhibitors in melanoma, patients have developed high hopes for the treatment of head-and-neck squamous cell carcinoma. To date, several checkpoint inhibitors are being evaluated in clinical studies testing diverse drug and treatment combinations at different timepoints of the disease.

[Articles] Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study

Sa, 01/12/2018 - 00:30
The clinically meaningful prolongation of overall survival and favourable safety profile of pembrolizumab in patients with recurrent or metastatic head and neck squamous cell carcinoma support the further evaluation of pembrolizumab as a monotherapy and as part of combination therapy in earlier stages of disease.

[Comment] Use of morphine before retinopathy of prematurity examinations

Sa, 01/12/2018 - 00:30
Understanding optimum ways to reduce pain and stress associated with medical procedures in paediatric populations reflects health-care providers' inherent mandate to do no harm. This is especially urgent in vulnerable preterm populations who undergo an average of 12 painful procedures daily while receiving neonatal care,1 given our increasing understanding of the adverse effects of early pain exposure on later neurodevelopment and behaviour.2 Several interventions—such as breastfeeding,3 parent–infant skin-to-skin contact,4 and sweet-tasting solutions5—have been shown to reduce biobehavioural pain response associated with needle-related procedures.

[Articles] Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial

Sa, 01/12/2018 - 00:30
Administration of oral morphine (100 μg/kg) to non-ventilated premature infants has the potential for harm without analgesic efficacy. We do not recommend oral morphine for retinopathy of prematurity screening and strongly advise caution if considering its use for other acute painful procedures in non-ventilated premature infants.

[Editorial] Type 2 diabetes: the urgent need to protect young people

Sa, 01/12/2018 - 00:00
With over 400 million people living with the disease and accounting for around 90% of diabetes cases worldwide, type 2 diabetes is complex and costly. It can cause blindness, cardiovascular disease, kidney failure, lower limb amputation, and other long-term consequences that substantially impact quality of life and years of life lived with disability. Worryingly, the global prevalence of type 2 diabetes is estimated to have doubled over the past 30 years and now includes rapidly rising numbers of children and adolescents.