Hot off the presses! May 16 Lancet

The May 16 issue of the Lancet is now up on Pubget (About Lancet): if you're at a subscribing institution, just click the link in the latest link at the home page. (Note you'll only be able to get all the PDFs in the issue if your institution subscribes to Pubget.)

Latest Articles Include:

• A Commission on climate change
  - Lancet 373(9676):1659 (2009)
  
• Obama's health universalism
  - Lancet 373(9676):1660 (2009)
  
• Leadership needed to reduce inequalities in health
  - Lancet 373(9676):1660 (2009)
  
• The importance of VTE prevention after orthopaedic surgery
  - Lancet 373(9676):1661-1662 (2009)
  
• Unravelling the mystery of the TACT trial
  - Lancet 373(9676):1662-1663 (2009)
  
• Health and climate change: a roadmap for applied research
  - Lancet 373(9676):1663-1665 (2009)
  
• Compensation for the brain drain from developing countries
  - Lancet 373(9676):1665-1666 (2009)
  
• Sri Lanka's twin humanitarian crises
  - Lancet 373(9676):1667-1668 (2009)
  
• Anthony Costello: making climate change part of global health
  - Lancet 373(9676):1669 (2009)
  
• William B Schwartz
  - Lancet 373(9676):1670 (2009)
  
• Effectiveness of secondary prevention programmes in CHD
  - Lancet 373(9676):1671 (2009)
  
• Effectiveness of secondary prevention programmes in CHD – Authors' reply
  - Lancet 373(9676):1671 (2009)
  
• Can one get amnesia from canned tuna? What are we forgetting?
  - Lancet 373(9676):1672 (2009)
  
• Can one get amnesia from canned tuna? What are we forgetting? – Authors' reply
  - Lancet 373(9676):1672 (2009)
  
• Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial
  - Lancet 373(9676):1673-1680 (2009)
  Background Prophylaxis for venous thromboembolism is recommended for at least 10 days after total knee arthroplasty; oral regimens could enable shorter hospital stays. We aimed to test the efficacy and safety of oral rivaroxaban for the prevention of venous thromboembolism after total knee arthroplasty. Methods In a randomised, double-blind, phase III study, 3148 patients undergoing knee arthroplasty received either oral rivaroxaban 10 mg once daily, beginning 6–8 h after surgery, or subcutaneous enoxaparin 30 mg every 12 h, starting 12–24 h after surgery. Patients had mandatory bilateral venography between days 11 and 15. The primary efficacy outcome was the composite of any deep-vein thrombosis, non-fatal pulmonary embolism, or death from any cause up to day 17 after surgery. Efficacy was assessed as non-inferiority of rivaroxaban compared with enoxaparin in the per-protocol population (absolute non-inferiority limit −4%); if non-inferiority was shown, we assessed whether rivaroxaban had superior efficacy in the modified intention-to-treat population. The primary safety outcome was major bleeding. This trial is registered with ClinicalTrials.gov, number NCT00362232. Findings The primary efficacy outcome occurred in 67 (6·9%) of 965 patients given rivaroxaban and in 97 (10·1%) of 959 given enoxaparin (absolute risk reduction 3·19%, 95% CI 0·71–5·67; p=0·0118). Ten (0·7%) of 1526 patients given rivaroxaban and four (0·3%) of 1508 given enoxaparin had major bleeding (p=0·1096). Interpretation Oral rivaroxaban 10 mg once daily for 10–14 days was significantly superior to subcutaneous enoxaparin 30 mg given every 12 h for the prevention of venous thromboembolism after total knee arthroplasty. Funding Bayer Schering Pharma AG, Johnson & Johnson Pharmaceutical Research & Development.
• Sequential docetaxel as adjuvant chemotherapy for early breast cancer (TACT): an open-label, phase III, randomised controlled trial
  - Lancet 373(9676):1681-1692 (2009)
  Background Incorporation of a taxane as adjuvant treatment for early breast cancer offers potential for further improvement of anthracycline-based treatment. The UK TACT study (CRUK01/001) investigated whether sequential docetaxel after anthracycline chemotherapy would improve patient outcome compared with standard chemotherapy of similar duration. Methods In this multicentre, open-label, phase III, randomised controlled trial, 4162 women (aged >18 years) with node-positive or high-risk node-negative operable early breast cancer were randomly assigned by computer-generated permuted block randomisation to receive FEC (fluorouracil 600 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 600 mg/m2 at 3-weekly intervals) for four cycles followed by docetaxel (100 mg/m2 at 3-weekly intervals) for four cycles (n=2073) or control (n=2089). For the control regimen, centres chose either FEC for eight cycles (n=1265) or epirubicin (100 mg/m2 at 3-weekly intervals) for four cycles followed by CMF (cyclophosphamide 600 mg/m2, methotrexate 40 mg/m2, and fluorouracil 600 mg/m2 at 4-weekly intervals) for four cycles (n=824). The primary endpoint was disease-free survival. Analysis was by intention to treat (ITT). This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN79718493. Findings All randomised patients were included in the ITT population. With a median follow-up of 62 months, disease-free survival events were seen in 517 of 2073 patients in the experimental group compared with 539 of 2089 controls (hazard ratio [HR] 0·95, 95% CI 0·85–1·08; p=0·44). 75·6% (95% CI 73·7–77·5) of patients in the experimental group and 74·3% (72·3–76·2) of controls were alive and disease-free at 5 years. The proportion of patients who reported any acute grade 3 or 4 adverse event was significantly greater in the experimental group than in the control group (p<0·0001); the most frequent events were neutropenia (937 events vs 797 events), leucopenia (507 vs 362), and lethargy (456 vs 272). Interpretation This study did not show any overall gain from the addition of docetaxel to standard anthracycline chemotherapy. Exploration of predictive biomarker-defined subgroups might have the potential to better target the use of taxane-based therapy. Funding Cancer Research UK (CRUK 01/001), Sanofi-Aventis, Pfizer, and Roche.
• Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission
  - Lancet 373(9676):1693-1733 (2009)
  
• Blue episodes in a neonate
  - Lancet 373(9676):1734 (2009)