Hot off the presses! Sep 23 Lancet

The Sep 23 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:

• Japan: universal health care at 50 years
  - Lancet 378(9796):1049 (2011)
  
• The Arab uprisings and health
  - Lancet 378(9796):1050 (2011)
  
• Pancreatic cancer in the UK
  - Lancet 378(9796):1050 (2011)
  
• 50 years of pursuing a healthy society in Japan
  - Lancet 378(9796):1051-1053 (2011)
  
• Stents and failing vein grafts: are we any wiser after ISAR?
  - Lancet 378(9796):1054-1055 (2011)
  
• Combination chemotherapy for older adults with advanced non-small-cell lung cancer
  - Lancet 378(9796):1055-1057 (2011)
  
• A German outbreak of haemolytic uraemic syndrome
  - Lancet 378(9796):1057-1058 (2011)
  
• Discrimination against hepatitis B carriers in China
  - Lancet 378(9796):1059 (2011)
  
• Offline: Where is public health leadership in England?
  - Lancet 378(9796):1060 (2011)
  
• Anxiety over radiation exposure remains high in Japan
  - Lancet 378(9796):1061-1062 (2011)
  
• Hope after Hiroshima
  - Lancet 378(9796):1063 (2011)
  
• Kenji Shibuya: promoting global health in Japan
  - Lancet 378(9796):1064 (2011)
  
• Keizo Takemi: a catalytic charisma
  - Lancet 378(9796):1065 (2011)
  
• Baruj Benacerraf
  - Lancet 378(9796):1066 (2011)
  
• Antibiotics versus surgery for appendicitis
  - Lancet 378(9796):1067 (2011)
  
• Antibiotics versus surgery for appendicitis
  - Lancet 378(9796):1067 (2011)
  
• Antibiotics versus surgery for appendicitis
  - Lancet 378(9796):1067-1068 (2011)
  
• Antibiotics versus surgery for appendicitis â€" Author's reply
  - Lancet 378(9796):1068 (2011)
  
• HbA1c: what do the numbers really mean?
  - Lancet 378(9796):1068-1069 (2011)
  
• HbA1c: what do the numbers really mean? â€" Authors' reply
  - Lancet 378(9796):1069-1070 (2011)
  
• Are Japan's hikikomori and depression in young people spreading abroad?
  - Lancet 378(9796):1070 (2011)
  
• Department of Error
  - Lancet 378(9796):1070 (2011)
  
• Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial
  - Lancet 378(9796):1071-1078 (2011)
  Background Comparative assessment of clinical outcomes after use of drug-eluting stents versus bare-metal stents for treatment of aortocoronary saphenous vein graft lesions has not been undertaken in large randomised trials. We aimed to undertake a comparison in a randomised trial powered for clinical endpoints. Methods In this randomised superiority trial, patients with de-novo saphenous vein graft lesions were assigned by computer-generated sequence (1:1:1:3) to receive either drug-eluting stents (one of three types: permanent-polymer paclitaxel-eluting stents, permanent-polymer sirolimus-eluting stents, or biodegradable-polymer sirolimus-eluting stents) or bare-metal stents. Randomisation took place immediately after crossing of the lesion with a guidewire, and was stratified for each participating centre. Investigators assessing data were masked to treatment allocation; patients were not masked to allocation. The primary endpoint was the combined incidence of death, myocardial infarction, and target lesion revascularisation at 1 year. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00611910. Findings 610 patients were allocated to treatment groups (303 drug-eluting stent, 307 bare-metal stent). Drug-eluting stents reduced the incidence of the primary endpoint compared with bare-metal stents (44 [15%] vs 66 [22%] patients; hazard ratio [HR] 0·64, 95% CI 0·44–0·94; p=0·02). Target lesion revascularisation rate was reduced by drug-eluting stents (19 [7%] vs 37 [13%] patients; HR 0·49, 95% CI 0·28–0·86; p=0·01). No significant differences were seen between drug-eluting stents and bare-metal stents regarding all-cause mortality (15 [5%] vs 14 [5%] patients; HR 1·08, 95% CI 0·52–2·24; p=0·83), myocardial infarction (12 [4%] vs 18 [6%]; HR 0·66, 95% CI 0·32–1·37; p=0·27), or definite or probable stent thrombosis (2 [1%] in both groups; HR 1·00, 95% CI 0·14–7·10; p=0·99). Interpretation In patients undergoing percutaneous coronary intervention for de-novo saphenous vein graft lesions, drug-eluting stents are the preferred treatment option because they reduce the risk of adverse events compared with bare-metal stents. Funding Deutsches Herzzentrum.
• Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial
  - Lancet 378(9796):1079-1088 (2011)
  Background Platinum-based doublet chemotherapy is recommended to treat advanced non-small-cell lung cancer (NSCLC) in fit, non-elderly adults, but monotherapy is recommended for patients older than 70 years. We compared a carboplatin and paclitaxel doublet chemotherapy regimen with monotherapy in elderly patients with advanced NSCLC. Methods In this multicentre, open-label, phase 3, randomised trial we recruited patients aged 70–89 years with locally advanced or metastatic NSCLC and WHO performance status scores of 0–2. Patients received either four cycles (3 weeks on treatment, 1 week off treatment) of carboplatin (on day 1) plus paclitaxel (on days 1, 8, and 15) or five cycles (2 weeks on treatment, 1 week off treatment) of vinorelbine or gemcitabine monotherapy. Randomisation was done centrally with the minimisation method. The primary endpoint was overall survival, and analysis was done by intention to treat. This trial is registered, number NCT00298415. Findings 451 patients were enrolled. 226 were randomly assigned monotherapy and 225 doublet chemotherapy. Median age was 77 years and median follow-up was 30·3 months (range 8·6–45·2). Median overall survival was 10·3 months for doublet chemotherapy and 6·2 months for monotherapy (hazard ratio 0·64, 95% CI 0·52–0·78; p<0·0001); 1-year survival was 44·5% (95% CI 37·9–50·9) and 25·4% (19·9–31·3), respectively. Toxic effects were more frequent in the doublet chemotherapy group than in the monotherapy group (most frequent, decreased neutrophil count (108 [48·4%] vs 28 [12·4%]; asthenia 23 [10·3%] vs 13 [5·8%]). Interpretation Despite increased toxic effects, platinum-based doublet chemotherapy was associated with survival benefits compared with vinorelbine or gemcitabine monotherapy in elderly patients with NSCLC. We feel that the current treatment paradigm for these patients should be reconsidered. Funding Intergroupe Francophone de Cancérologie Thoracique, Institut National du Cancer.
• Management of an acute outbreak of diarrhoea-associated haemolytic uraemic syndrome with early plasma exchange in adults from southern Denmark: an observational study
  - Lancet 378(9796):1089-1093 (2011)
  Background Diarrhoea-associated haemolytic uraemic syndrome in adults is a life-threatening, but rare multisystem disorder that is characterised by acute haemolytic anaemia, thrombocytopenia, and renal insufficiency. We aimed to assess the success of management of this disorder with plasma exchange therapy. Methods Patients diagnosed with diarrhoea-associated haemolytic uraemic syndrome in southern Denmark were treated with daily plasma exchange by centrifugation and substitution with fresh frozen plasma. Stool culture and serological testing was done to identify the cause of disease, and the success of management with plasma exchange therapy was assessed from change in platelet count, glomerular filtration rate, and lactate dehydrogenase. Findings During May 25–28, 2011, five patients with a median age of 62 years (range 44–70) presented with diarrhoea-associated haemolytic uraemic syndrome, which was caused by an unusual Shiga-toxin-producing Escherichia coli serotype O104:H4. Strains of E coli showed a high resistance to third-generation cephalosporins because the strains had extended-spectrum 硫 lactamases. After plasma exchange, median platelet count and glomerular filtration rate increased, median lactate dehydrogenase concentration decreased, and neurological status improved. The time interval from onset of bloody diarrhoea to start of plasma exchange had an inverse correlation with reduction of lactate dehydrogenase concentrations by plasma exchange (p=0·02). All patients were discharged with normal neurological status at 7 days (range 5–8) after starting plasma exchange. Interpretation Early plasma exchange might ameliorate the course of diarrhoea-associated haemolytic uraemic syndrome in adults. However, this finding should be verified in randomised controlled trials Funding None.
• What has made the population of Japan healthy?
  - Lancet 378(9796):1094-1105 (2011)
  People in Japan have the longest life expectancy at birth in the world. Here, we compile the best available evidence about population health in Japan to investigate what has made the Japanese people healthy in the past 50 years. The Japanese population achieved longevity in a fairly short time through a rapid reduction in mortality rates for communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates. Japan had moderate mortality rates for non-communicable diseases, with the exception of stroke, in the 1950s. The improvement in population health continued after the mid-1960s through the implementation of primary and secondary preventive community public health measures for adult mortality from non-communicable diseases and an increased use of advanced medical technologies through the universal insurance scheme. Reduction in health inequalities with improved average population health was partly attributable to equal e! ducational opportunities and financial access to care. With the achievement of success during the health transition since World War 2, Japan now needs to tackle major health challenges that are emanating from a rapidly ageing population, causes that are not amenable to health technologies, and the effects of increasing social disparities to sustain the improvement in population health.
• Japanese universal health coverage: evolution, achievements, and challenges
  - Lancet 378(9796):1106-1115 (2011)
  Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to finance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times difference in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitab! le coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans.
• Tsunami sinusitis
  - Lancet 378(9796):1116 (2011)