Hot off the presses! Aug 08 Lancet

The Aug 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:

• Getting to the heart of high-quality care
  - Lancet 374(9688):427 (2009)
  
• A community strategy to prevent obesity
  - Lancet 374(9688):428 (2009)
  
• Organic food—eat the emotion, but question the evidence
  - Lancet 374(9688):428 (2009)
  
• Pandemic H1N1 infection in pregnant women in the USA
  - Lancet 374(9688):429-430 (2009)
  
• Rheumatoid arthritis: strategy more important than agent
  - Lancet 374(9688):430-432 (2009)
  
• Minimally invasive autopsy
  - Lancet 374(9688):432-433 (2009)
  
• Call for global health-systems impact assessments
  - Lancet 374(9688):433-435 (2009)
  
• Health and development financing in Africa
  - Lancet 374(9688):435-437 (2009)
  
• Health care for refused asylum seekers: evidence over ideology
  - Lancet 374(9688):437-438 (2009)
  
• Remedy at UCSF: a sustainable student-run initiative
  - Lancet 374(9688):438-440 (2009)
  
• South Africa tries new approach to resistant tuberculosis
  - Lancet 374(9688):441 (2009)
  
• Bolivia tackles maternal and child deaths
  - Lancet 374(9688):442 (2009)
  
• Peter Pronovost: champion of checklists in critical care
  - Lancet 374(9688):443 (2009)
  
• Reality check for checklists
  - Lancet 374(9688):444-445 (2009)
  
• David Cornelius Morley
  - Lancet 374(9688):446 (2009)
  
• Ratification of human rights treaties: the beginning not the end
  - Lancet 374(9688):447 (2009)
  
• Ratification of human rights treaties: the beginning not the end
  - Lancet 374(9688):447 (2009)
  
• Ratification of human rights treaties: the beginning not the end
  - Lancet 374(9688):447-448 (2009)
  
• Voglibose for prevention of type 2 diabetes mellitus
  - Lancet 374(9688):448 (2009)
  
• Voglibose for prevention of type 2 diabetes mellitus
  - Lancet 374(9688):448-449 (2009)
  
• 3-monthly azithromycin administration for trachoma
  - Lancet 374(9688):449 (2009)
  
• 3-monthly azithromycin administration for trachoma – Authors' reply
  - Lancet 374(9688):449-450 (2009)
  
• Climate change and population growth
  - Lancet 374(9688):450 (2009)
  
• Department of Error
  - Lancet 374(9688):450 (2009)
  
• Department of Error
  - Lancet 374(9688):450 (2009)
  
• H1N1 2009 influenza virus infection during pregnancy in the USA
  Jamieson DJ Honein MA Rasmussen SA Williams JL Swerdlow DL Biggerstaff MS Lindstrom S Louie JK Christ CM Bohm SR Fonseca VP Ritger KA Kuhles DJ Eggers P Bruce H Davidson HA Lutterloh E Harris ML Burke C Cocoros N Finelli L Macfarlane KF Shu B Olsen SJ the Novel Influenza A (H1N1) Pregnancy Working Group - Lancet 374(9688):451-458 (2009)
  Background Pandemic H1N1 2009 influenza virus has been identified as the cause of a widespread outbreak of febrile respiratory infection in the USA and worldwide. We summarised cases of infection with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak, and deaths associated with this virus during the first 2 months of the outbreak. Methods After initial reports of infection in pregnant women, the US Centers for Disease Control and Prevention (CDC) began systematically collecting additional information about cases and deaths in pregnant women in the USA with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A, but negative for H1 and H3. We used population estimates derived from the 2007 census data to calculate rates of admission to hospital and illness. Findings From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states. 11 (32%) women were admitted to hospital. The estimated rate of admission for pandemic H1N1 influenza virus infection in pregnant women during the first month of the outbreak was higher than it was in the general population (0·32 per 100 000 pregnant women, 95% CI 0·13–0·52 vs 0·076 per 100 000 population at risk, 95% CI 0·07–0·09). Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation. Interpretation Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs. Funding US CDC.
• Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial
  - Lancet 374(9688):459-466 (2009)
  Background New treatment strategies for early rheumatoid arthritis are evolving rapidly. We aimed to compare addition of conventional disease-modifying antirheumatic drugs (sulfasalazine and hydroxychloroquine) with addition of a tumour necrosis factor antagonist (infliximab) to methotrexate in patients with early rheumatoid arthritis. Methods We undertook a randomised trial in 15 rheumatology units in Sweden. We enrolled patients with early rheumatoid arthritis (symptom duration <1 year) and administered methotrexate (up to 20 mg per week). After 3–4 months, those who had not achieved low disease activity but who could tolerate methotrexate were randomly allocated by computer addition of either sulfasalazine and hydroxychloroquine or infliximab. Primary outcome was achievement of a good response according to European League Against Rheumatism (EULAR) criteria at 12 months. Patients were followed up to 24 months; here, we present findings at 12 months. Analysis was by intention to treat and we used non-responder imputation. The Swefot (Swedish Pharmacotherapy) study is registered in the WHO database at the Karolinska University Hospital, number CT20080004. Findings 487 patients were initially enrolled. Of 258 who had not achieved low disease activity with methotrexate, 130 were allocated sulfasalazine and hydroxychloroquine and 128 were assigned infliximab. 32 of 130 (25%) patients allocated sulfasalazine and hydroxychloroquine achieved the primary outcome compared with 50 of 128 (39%) assigned infliximab (risk ratio 1·59 [95% CI 1·10–2·30], p=0·0160). Adverse events were balanced fairly well between the two groups and accorded with known adverse events of the drugs used. No deaths occurred in either group. Interpretation In patients with early rheumatoid arthritis in whom methotrexate treatment failed, addition of a tumour necrosis factor antagonist to methotrexate monotherapy is clinically superior to addition of conventional disease-modifying antirheumatic drugs. Funding Swedish Rheumatism Association, Schering-Plough.
• Post-mortem examination of human fetuses: a comparison of whole-body high-field MRI at 9·4 T with conventional MRI and invasive autopsy
  - Lancet 374(9688):467-475 (2009)
  Background Conventional whole-body MRI at 1·5 T does not provide adequate image quality of small fetuses, thus reducing its potential for use as an alternative to invasive autopsy. High-field whole-body MRI at 9·4 T provides good images of small animals. We therefore compared the diagnostic usefulness of high-field MRI with conventional MRI for post-mortem examination of human fetuses. Methods We did whole-body MRI at 9·4 T and 1·5 T on 18 fetuses of less than 22 weeks' gestation, using three-dimensional T2-weighted fast-spin echo sequences, before doing invasive autopsy. Images obtained with MRI for each system were compared with the findings of invasive autopsy in a blinded manner. Tissue contrast of 14 different regions was compared on 1·5 T and 9·4 T images that were provided by paediatric radiologists separately and in a random order, and image quality was scored on a four-point scale. The primary endpoint was diagnostic accuracy. Findings Spatial resolution, tissue contrast, and image quality of all organ systems were much better with high-field MRI than with conventional MRI. All structural abnormalities that were detected with invasive autopsy and internal examination of visceral organs were also detected with high-field MRI, whereas conventional MRI was not diagnostically useful in 14 (78%) cases. Interpretation Whole-body high-field MRI is a feasible option for post-mortem examination of human fetuses, and can provide good tissue characterisation even in small fetuses (5 g). The use of MRI at 9·4 T might be helpful in the development of a minimally invasive perinatal autopsy system. Funding Department of Health Policy Research Programme, British Heart Foundation, National Institute of Health Research, Higher Education Funding Council for England, Biotechnology and Biological Sciences Research Council, Engineering and Physical Sciences Research Council, Great Ormond Street Hospital, University College London (UCL) Institute of Child Health, UCL Hospital, and UCL.
• Chest radiography of life-supporting medical interventions
  - Lancet 374(9688):476 (2009)
  
• Gastric cancer
  - Lancet 374(9688):477-490 (2009)
  Gastric cancer is the second most frequent cause of cancer death worldwide, although much geographical variation in incidence exists. Prevention and personalised treatment are regarded as the best options to reduce gastric cancer mortality rates. Prevention strategies should be based on specific risk profiles, including Helicobacter pylori genotype, host gene polymorphisms, presence of precursor lesions, and environmental factors. Although adequate surgery remains the cornerstone of gastric cancer treatment, this single modality treatment seems to have reached its maximum achievable effect for local control and survival. Minimally invasive techniques can be used for treatment of early gastric cancers. Achievement of locoregional control for advanced disease remains very difficult. Extended resections that are standard practice in some Asian countries have not been shown to be as effective in other developed countries. We present an update of the incidence, causes, path! ology, and treatment of gastric cancer, consisting of surgery, new strategies with neoadjuvant and adjuvant chemotherapy or radiotherapy, or both, novel treatment strategies using gene signatures, and the effect of caseload on patient outcomes.
• Obsessive-compulsive disorder
  - Lancet 374(9688):491-499 (2009)
  Obsessive-compulsive disorder is a severe and disabling clinical condition that usually arises in late adolescence or early adulthood and, if left untreated, has a chronic course. Whether this disorder should be classified as an anxiety disorder or in a group of putative obsessive-compulsive-related disorders is still a matter of debate. Biological models of obsessive-compulsive disorder propose anomalies in the serotonin pathway and dysfunctional circuits in the orbito-striatal area and dorsolateral prefrontal cortex. Support for these models is mixed and they do not account for the symptomatic heterogeneity of the disorder. The cognitive-behavioural model of obsessive-compulsive disorder, which has some empirical support but does not fully explain the disorder, emphasises the importance of dysfunctional beliefs in individuals affected. Both biological and cognitive models have led to empirical treatments for the disorder—ie, serotonin-reuptake inhibitors and variou! s forms of cognitive-behavioural therapy. New developments in the treatment of obsessive-compulsive disorder involve medications that work in conjuction with cognitive-behavioural therapy, the most promising of which is D-cycloserine.
• Steroids for acute spinal cord injury: revealing silent pathology
  - Lancet 374(9688):500 (2009)