Hot off the presses! Apr 08 LANCET

The Apr 08 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:

• Guiding the guidelines
  - LANCET 377(9772):1125 (2011)
  
• Public reporting of surgical outcomes
  - LANCET 377(9772):1126 (2011)
  
• A list to save the lives of mothers and children
  - LANCET 377(9772):1126 (2011)
  
• Midlevel health-care providers key to MDG 5
  - LANCET 377(9772):1127-1128 (2011)
  
• A better understanding of mortality in young people
  - LANCET 377(9772):1128-1130 (2011)
  
• The next step in urethral reconstruction
  - LANCET 377(9772):1130-1131 (2011)
  
• Ageing faster with AIDS in Africa
  - LANCET 377(9772):1131-1133 (2011)
  
• The future of HIV/AIDS in Africa: a shared responsibility
  - LANCET 377(9772):1133-1134 (2011)
  
• Children's environmental health—from knowledge to action
  - LANCET 377(9772):1134-1136 (2011)
  
• The Australian alcopops tax revisited
  - LANCET 377(9772):1136-1137 (2011)
  
• Offline: Evidence-based atrophy
  - LANCET 377(9772):1138 (2011)
  
• Mongolia's struggle with liver cancer
  - LANCET 377(9772):1139-1140 (2011)
  
• Facebook friend request from a patient?
  - LANCET 377(9772):1141-1142 (2011)
  
• Art comes naturally
  - LANCET 377(9772):1143 (2011)
  
• A transformative tale of patients and doctors in China
  - LANCET 377(9772):1144 (2011)
  
• Mitch Besser—helping mothers with HIV become mentors
  - LANCET 377(9772):1145 (2011)
  
• Diagnosing Bertolt Brecht
  - LANCET 377(9772):1146-1147 (2011)
  
• Charles Joseph Epstein
  - LANCET 377(9772):1148 (2011)
  
• Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK
  - LANCET 377(9772):1149 (2011)
  
• Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK
  - LANCET 377(9772):1149 (2011)
  
• Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK – Authors' reply
  - LANCET 377(9772):1149-1150 (2011)
  
• Rituximab maintenance therapy for follicular lymphoma
  - LANCET 377(9772):1150-1151 (2011)
  
• Rituximab maintenance therapy for follicular lymphoma
  - LANCET 377(9772):1151 (2011)
  
• Rituximab maintenance therapy for follicular lymphoma – Authors' reply
  - LANCET 377(9772):1151-1152 (2011)
  
• Is 21% oxygen best for newborn resuscitation?
  - LANCET 377(9772):1152-1153 (2011)
  
• Is 21% oxygen best for newborn resuscitation? – Author's reply
  - LANCET 377(9772):1153 (2011)
  
• Artesunate for severe malaria in African children
  - LANCET 377(9772):1153-1154 (2011)
  
• Artesunate for severe malaria in African children – Authors' reply
  - LANCET 377(9772):1154 (2011)
  
• Department of Error
  - LANCET 377(9772):1154 (2011)
  
• Department of Error
  - LANCET 377(9772):1154 (2011)
  
• Department of Error
  - LANCET 377(9772):1154 (2011)
  
• Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal
  - LANCET 377(9772):1155-1161 (2011)
  Background Medical abortion is under-used in developing countries. We assessed whether early first-trimester medical abortion provided by midlevel providers (government-trained, certified nurses and auxiliary nurse midwives) was as safe and effective as that provided by doctors in Nepal. Methods This multicentre randomised controlled equivalence trial was done in five rural district hospitals in Nepal. Women were eligible for medical abortion if their pregnancy was of less than 9 weeks (63 days) and if they resided less than 90 min journey away from the study clinic. Women were ineligible if they had any contraindication to medical abortion. We used a computer-generated randomisation scheme stratified by study centre with a block size of six. Women were randomly assigned to a doctor or a midlevel provider for oral administration of 200 mg mifepristone followed by 800 μg misoprostol vaginally 2 days later, and followed up 10–14 days later. The primary endpoint was complete abortion without manual vacuum aspiration within 30 days of treatment. The study was not masked. Abortions were recorded as complete, incomplete, or failed (continuing pregnancy). Analyses for primary and secondary endpoints were by intention to treat, supplemented by per-protocol analysis of th! e primary endpoint. This trial is registered with ClinicalTrials.gov, NCT01186302. Findings Of 1295 women screened, 535 were randomly assigned to a doctor and 542 to a midlevel provider. 514 and 518, respectively, were included in the analyses of the primary endpoint. Abortions were judged complete in 504 (97·3%) women assigned to midlevel providers and in 494 (96·1%) assigned to physicians. The risk difference for complete abortion was 1·24% (95% CI −0·53 to 3·02), which falls within the predefined equivalence range (−5% to 5%). Five cases (1%) were recorded as failed abortion in the doctor cohort and none in the midlevel provider cohort; the remaining cases were recorded as incomplete abortions. No serious complications were noted. Interpretation The provision of medical abortion up to 9 weeks' gestation by midlevel providers and doctors was similar in safety and effectiveness. Where permitted by law, appropriately trained midlevel health-care providers can provide safe, low-technology medical abortion services for women independently from doctors. Funding UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization.
• 50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries
  - LANCET 377(9772):1162-1174 (2011)
  Background Global attention has focused on mortality in children younger than 5 years. We analysed global mortality data for people aged 1–24 years across a 50-year period. Methods The WHO mortality database was used to obtain mortality data from 1955 to 2004, by age-group (1–4, 5–9, 10–14, 15–19, and 20–24 years) and stratified by sex. To analyse change in mortality, we calculated mortality rates averaged over three 5-year periods (1955–59, 1978–82, and 2000–04) to investigate trends in deaths caused by communicable and non-communicable diseases and injury. Findings Data were available for 50 countries (ten high income, 22 middle income, eight low income, seven very low income, and three unclassified), grouped as Organisation for Economic Co-operation and Development (OECD) countries, Central and South American countries, eastern European countries and ex-Soviet states, and other countries. In 1955, mortality was highest in the 1–4-year age-group. Across the study period, all-cause mortality reduced by 85–93% in children aged 1–4 years, 80–87% in children aged 5–9 years, and 68–78% in young people aged 10–14 years in OECD, Central and South American, and other countries. Smaller declines (41–48%) were recorded in young men (15–24 years), and by 2000–04, mortality in this group was two-to-three times higher than that in young boys (1–4 years). Mortality in young women (15–24 years) was equal to that of young girls (1–4 years) from 2000 onwards. Substantial declines in death caused by communicable diseases were s! een in all age-groups and regions, although communicable and non-communicable diseases remained the main causes of death in children (1–9 years) and young women (10–24 years). Injury was the dominant cause of death in young men (10–24 years) in all regions by the late 1970s. Interpretation Adolescents and young adults have benefited from the epidemiological transition less than children have, with a reversal of traditional mortality patterns over the past 50 years. Future global health targets should include a focus on the health problems of people aged 10–24 years. Funding None.
• Tissue-engineered autologous urethras for patients who need reconstruction: an observational study
  - LANCET 377(9772):1175-1182 (2011)
  Background Complex urethral problems can occur as a result of injury, disease, or congenital defects and treatment options are often limited. Urethras, similar to other long tubularised tissues, can stricture after reconstruction. We aimed to assess the effectiveness of tissue-engineered urethras using patients' own cells in patients who needed urethral reconstruction. Methods Five boys who had urethral defects were included in the study. A tissue biopsy was taken from each patient, and the muscle and epithelial cells were expanded and seeded onto tubularised polyglycolic acid:poly(lactide-co-glycolide acid) scaffolds. Patients then underwent urethral reconstruction with the tissue-engineered tubularised urethras. We took patient history, asked patients to complete questionnaires from the International Continence Society (ICS), and did urine analyses, cystourethroscopy, cystourethrography, and flow measurements at 3, 6, 12, 24, 36, 48, 60, and 72 months after surgery. We did serial endoscopic cup biopsies at 3, 12, and 36 months, each time in a different area of the engineered urethras. Findings Patients had surgery between March 19, 2004, and July 20, 2007. Follow-up was completed by July 31, 2010. Median age was 11 years (range 10–14) at time of surgery and median follow-up was 71 months (range 36–76 months). AE1/AE3, α actin, desmin, and myosin antibodies confirmed the presence of cells of epithelial and muscle lineages on all cultures. The median end maximum urinary flow rate was 27·1 mL/s (range 16–28), and serial radiographic and endoscopic studies showed the maintenance of wide urethral calibres without strictures. Urethral biopsies showed that the engineered grafts had developed a normal appearing architecture by 3 months after implantation. Interpretation Tubularised urethras can be engineered and remain functional in a clinical setting for up to 6 years. These engineered urethras can be used in patients who need complex urethral reconstruction. Funding National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
• Lingua villosa nigra
  - LANCET 377(9772):1183 (2011)
  
• Chronic pancreatitis
  - LANCET 377(9772):1184-1197 (2011)
  Chronic pancreatitis is a progressive fibroinflammatory disease that exists in large-duct (often with intraductal calculi) or small-duct form. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals) and genetic factors (eg, mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator); a few patients have hereditary or autoimmune disease. Pain in the form of recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells) or constant and disabling pain is usually the main symptom. Management of the pain is mainly empirical, involving potent analgesics, duct drainage by endoscopic or surgical means, and partial or total pancreatectomy. However, steroids rapidly reduce symptoms in patients with autoimmune pancreatitis, and micronutrient therapy to correct electrophilic stress is emerging as a promising treatment in the other patients! . Steatorrhoea, diabetes, local complications, and psychosocial issues associated with the disease are additional therapeutic challenges.
• Increasing burden of liver disease in patients with HIV infection
  - LANCET 377(9772):1198-1209 (2011)
  Introduction of effective combined antiretroviral therapy has made HIV infection a chronic illness. Substantial reductions in the number of AIDS-related deaths have been accompanied by an increase in liver-related morbidity and mortality due to co-infection with chronic hepatitis B and C viruses. Increases in non-alcoholic fatty liver disease and drug-induced hepatotoxicity, together with development of hepatocellular carcinoma, also potentiate the burden of liver disease in individuals with HIV infection. We provide an overview of the key causes, disease mechanisms of pathogenesis, and recommendations for treatment options including the evolving role of liver transplantation.
• The nursing instructor's speech
  - LANCET 377(9772):1210 (2011)