Hot off the presses! Dec 10 LANCET

The Dec 10 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:

• Late-stage cancer detection in the USA is costing lives
  - LANCET 376(9756):1873 (2010)
  
• Cardiovascular health crisis
  - LANCET 376(9756):1874 (2010)
  
• HIV: the fight is far from over
  - LANCET 376(9756):1874 (2010)
  
• A new epoch for health professionals' education
  - LANCET 376(9756):1875-1877 (2010)
  
• Health professionals for the 21st century: a students' view
  - LANCET 376(9756):1877-1878 (2010)
  
• Renal sympathetic denervation: the jury is still out
  - LANCET 376(9756):1878-1880 (2010)
  
• Cost-effective use of prereferral treatment for severe malaria
  - LANCET 376(9756):1880-1881 (2010)
  
• Liver tests are irrelevant when prescribing statins
  - LANCET 376(9756):1882-1883 (2010)
  
• Eliminating malaria—all of them
  - LANCET 376(9756):1883-1885 (2010)
  
• Spying at the UN: why America should be punished
  - LANCET 376(9756):1885 (2010)
  
• Offline: Tandem repeats
  - LANCET 376(9756):1886 (2010)
  
• UK aid—security, scrutiny, and the challenge of Afghanistan
  - LANCET 376(9756):1887-1888 (2010)
  
• Pilots of the future: suicide prevention and the internet
  - LANCET 376(9756):1889-1890 (2010)
  
• We're all in this—are we together?
  - LANCET 376(9756):1891-1892 (2010)
  
• Miriam Frank's memoir
  - LANCET 376(9756):1892 (2010)
  
• Behaviour
  - LANCET 376(9756):1893 (2010)
  
• Abi Walker
  - LANCET 376(9756):1893 (2010)
  
• Eyewitness accounts of the 1510 influenza pandemic in Europe
  - LANCET 376(9756):1894-1895 (2010)
  
• Monica Glenshaw
  - LANCET 376(9756):1896 (2010)
  
• Rotavirus vaccine efficacy in African and Asian countries
  - LANCET 376(9756):1897 (2010)
  
• Rotavirus vaccine efficacy in African and Asian countries
  - LANCET 376(9756):1897 (2010)
  
• Rotavirus vaccine efficacy in African and Asian countries – Authors' reply
  - LANCET 376(9756):1898 (2010)
  
• International health organisations and recruitment of health workers
  - LANCET 376(9756):1898-1899 (2010)
  
• International health organisations and recruitment of health workers
  - LANCET 376(9756):1899 (2010)
  
• International health organisations and recruitment of health workers – Authors' reply
  - LANCET 376(9756):1899-1900 (2010)
  
• Japan's health policy
  - LANCET 376(9756):1900 (2010)
  
• Japan's health policy
  - LANCET 376(9756):1900 (2010)
  
• Post-MBBS exit test for doctors in India
  - LANCET 376(9756):1900-1901 (2010)
  
• Rural MBBS degree in India: ignoring the real problem?
  - LANCET 376(9756):1901 (2010)
  
• Simian viruses and emerging diseases in human beings
  - LANCET 376(9756):1901-1902 (2010)
  
• On eating potatoes
  - LANCET 376(9756):1902 (2010)
  
• Department of Error
  - LANCET 376(9756):1902 (2010)
  
• Department of Error
  - LANCET 376(9756):1902 (2010)
  
• Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial
  - LANCET 376(9756):1903-1909 (2010)
  Background Activation of renal sympathetic nerves is key to pathogenesis of essential hypertension. We aimed to assess effectiveness and safety of catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension. Methods In this multicentre, prospective, randomised trial, patients who had a baseline systolic blood pressure of 160 mm Hg or more (≥150 mm Hg for patients with type 2 diabetes), despite taking three or more antihypertensive drugs, were randomly allocated in a one-to-one ratio to undergo renal denervation with previous treatment or to maintain previous treatment alone (control group) at 24 participating centres. Randomisation was done with sealed envelopes. Data analysers were not masked to treatment assignment. The primary effectiveness endpoint was change in seated office-based measurement of systolic blood pressure at 6 months. Primary analysis included all patients remaining in follow-up at 6 months. This trial is registered with ClinicalTrials.gov, number NCT00888433. Findings 106 (56%) of 190 patients screened for eligibility were randomly allocated to renal denervation (n=52) or control (n=54) groups between June 9, 2009, and Jan 15, 2010. 49 (94%) of 52 patients who underwent renal denervation and 51 (94%) of 54 controls were assessed for the primary endpoint at 6 months. Office-based blood pressure measurements in the renal denervation group reduced by 32/12 mm Hg (SD 23/11, baseline of 178/96 mm Hg, p<0·0001), whereas they did not differ from baseline in the control group (change of 1/0 mm Hg [21/10], baseline of 178/97 mm Hg, p=0·77 systolic and p=0·83 diastolic). Between-group differences in blood pressure at 6 months were 33/11 mm Hg (p<0·0001). At 6 months, 41 (84%) of 49 patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm Hg or more, compared with 18 (35%) of 51 controls (p<0·0001). We noted no serious procedure-related or device-related complications and occurrence of adverse events did not ! differ between groups; one patient who had renal denervation had possible progression of an underlying atherosclerotic lesion, but required no treatment. Interpretation Catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatment-resistant hypertensive patients. Funding Ardian.
• Prereferral rectal artesunate for treatment of severe childhood malaria: a cost-effectiveness analysis
  - LANCET 376(9756):1910-1915 (2010)
  Background Severely ill patients with malaria with vomiting, prostration, and altered consciousness cannot be treated orally and need injections. In rural areas, access to health facilities that provide parenteral antimalarial treatment is poor. Safe and effective treatment of most severe malaria cases is delayed or not achieved. Rectal artesunate interrupts disease progression by rapidly reducing parasite density, but should be followed by further antimalarial treatment. We estimated the cost-effectiveness of community-based prereferral artesunate treatment of children suspected to have severe malaria in areas with poor access to formal health care. Methods We assessed the cost-effectiveness (in international dollars) of the intervention from the provider perspective. We studied a cohort of 1000 newborn babies until 5 years of age. The analysis assessed how the cost-effectiveness results changed with low (25%), moderate (50%), high (75%), and full (100%) referral compliance and intervention uptake. Findings At low intervention uptake and referral compliance (25%), the intervention was estimated to avert 19 disability-adjusted life-years (DALYs; 95% CI 16–21) and to cost I$1173 (95% CI 1050–1297) per DALY averted. Under the full uptake and compliance scenario (100%), the intervention could avert 967 DALYs (884–1050) at a cost of I$77 (73–81) per DALY averted. Interpretation Prereferral artesunate treatment is a cost-effective, life-saving intervention, which can substantially improve the management of severe childhood malaria in rural African settings in which programmes for community health workers are in place. Funding The Disease Control Priorities Project; Fogarty International Center; US National Institutes of Health; and the Peter Paul Career Development Professorship, Boston University.
• Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis
  - LANCET 376(9756):1916-1922 (2010)
  Background Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. We assessed whether statin therapy is safe and effective for these patients through post-hoc analysis of the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study population. Methods GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged <75 years, with serum concentrations of LDL cholesterol >2·6 mmol/L and triglycerides <4·5 mmol/L) at the Hippokration University Hospital, Thessaloniki, Greece to receive statin or usual care, which could include statins. The primary outcome of our post-hoc analysis was risk reduction for first recurrent cardiovascular event in patients treated with a statin who had moderately abnormal liver tests (defined as serum alanine aminotransferase or aspartate aminotransferase concentrations of less than three times the upper limit of normal) compared with patients with abnormal liver tests who did not receive a statin. This risk reduction was compared with that for patients treated (or not) with statin and normal liver tests. Findings Of 437 patients with moderately abnormal liver tests at baseline, which were possibly associated with non-alcoholic fatty liver disease, 227 who were treated with a statin (mainly atorvastatin 24 mg per day) had substantial improvement in liver tests (p<0·0001) whereas 210 not treated with a statin had further increases of liver enzyme concentrations. Cardiovascular events occurred in 22 (10%) of 227 patients with abnormal liver tests who received statin (3·2 events per 100 patient-years) and 63 (30%) of 210 patients with abnormal liver tests who did not receive statin (10·0 events per 100 patient-years; 68% relative risk reduction, p<0·0001). This cardiovascular disease benefit was greater (p=0·0074) than it was in patients with normal liver tests (90 [14%] events in 653 patients receiving a statin [4·6 per 100 patient-years] vs 117 [23%] in 510 patients not receiving a statin [7·6 per 100 patient-years]; 39% relative risk reduction, p<0·0001). Seven (<1%) of 880 pa! rticipants who received a statin discontinued statin treatment because of liver-related adverse effects (transaminase concentrations more than three-times the upper limit of normal). Interpretation Statin treatment is safe and can improve liver tests and reduce cardiovascular morbidity in patients with mild-to-moderately abnormal liver tests that are potentially attributable to non-alcoholic fatty liver disease. Funding None.
• Health professionals for a new century: transforming education to strengthen health systems in an interdependent world
  - LANCET 376(9756):1923-1958 (2010)