Riviste scientifiche

Silicon Valley billionaires want to geoengineer the world's oceans

New Scientist - Ma, 01/09/2020 - 16:34
A New Scientist investigation has found that some of the world's richest people are funding geoengineering plans that would transform the world's oceans to combat climate change

Factors associated with implant survival following total hip replacement surgery: A registry study of data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man

PLoS Medicine - Lu, 31/08/2020 - 23:00

by Jonathan Thomas Evans, Ashley William Blom, Andrew John Timperley, Paul Dieppe, Matthew James Wilson, Adrian Sayers, Michael Richard Whitehouse

Background

Nearly 100,000 people underwent total hip replacement (THR) in the United Kingdom in 2018, and most can expect it to last at least 25 years. However, some THRs fail and require revision surgery, which results in worse outcomes for the patient and is costly to the health service. Variation in the survival of THR implants has been observed between units and reducing this unwarranted variation is one focus of the “Getting it Right First Time” (GIRFT) program in the UK. We aimed to investigate whether the statistically improved implant survival of THRs in a high-performing unit is associated with the implants used or other factors at that unit, such as surgical skill.

Methods and findings

We analyzed a national, mandatory, prospective, cohort study (National Joint Registry for England, Wales, Northern Ireland and the Isle of Man [NJR]) of all THRs performed in England and Wales. We included the 664,761 patients with records in the NJR who have received a stemmed primary THR between 1 April 2003 and 31 December 2017 in one of 461 hospitals, with osteoarthritis as the only indication. The exposure was the unit (hospital) in which the THR was implanted. We compared survival of THRs implanted in the “exemplar” unit with THRs implanted anywhere else in the registry. The outcome was revision surgery of any part of the THR construct for any reason. Net failure was calculated using Kaplan–Meier estimates, and adjusted analyses employed flexible parametric survival analysis.The mean age of patients contributing to our analyses was 69.9 years (SD 10.1), and 61.1% were female. Crude analyses including all THRs demonstrated better implant survival at the exemplar unit with an all-cause construct failure of 1.7% (95% CI 1.3–2.3) compared with 2.9% (95% CI 2.8–3.0) in the rest of the country after 13.9 years (log-rank test P < 0.001). The same was seen in analyses adjusted for age, sex, and American Society of Anesthesiology (ASA) score (difference in restricted mean survival time 0.12 years [95% CI 0.07–0.16; P < 0.001]). Adjusted analyses restricted to the same implants as the exemplar unit show no demonstrable difference in restricted mean survival time between groups after 13.9 years (P = 0.34).A limitation is that this study is observational and conclusions regarding causality cannot be inferred. Our outcome is revision surgery, and although important, we recognize it is not the only marker of success of a THR.

Conclusions

Our results suggest that the “better than expected” implant survival results of this exemplar center are associated with implant choice. The survival results may be replicated by adopting key treatment decisions, such as implant selection. These decisions are easier to replicate than technical skills or system factors.

Travelling through a wormhole without dying may actually be possible

New Scientist - Lu, 31/08/2020 - 09:00
Most of the wormholes that could theoretically exist cannot be traversed, but adding an extra dimension makes it possible to make one you could pass through without dying

[Articles] Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial

The Lancet - Do, 30/08/2020 - 14:00
Our results show that the routine use of oral trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy, after successful PCI, does not influence the recurrence of angina or the outcome; these findings should be taken into account when considering the place of trimetazidine in clinical practice. However, the long-term prescription of this treatment does not appear to be associated with any statistically significant safety concerns in the population studied.

[Articles] SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials

The Lancet - Do, 30/08/2020 - 13:00
The effects of empagliflozin and dapagliflozin on hospitalisations for heart failure were consistent in the two independent trials and suggest that these agents also improve renal outcomes and reduce all-cause and cardiovascular death in patients with HFrEF.

[Comment] Mavacamten: treatment aspirations in hypertrophic cardiomyopathy

The Lancet - Sa, 29/08/2020 - 15:30
Managing dynamic left ventricular outflow tract (LVOT) obstruction remains one of the most challenging therapeutic aspects of hypertrophic cardiomyopathy. Individuals who are affected frequently present with disabling symptoms, which can be ameliorated following reduction of LVOT obstruction. Pharmacological treatment currently comprises non-disease specific therapies such as β blockers, negatively inotropic calcium channel blockers, and disopyramide, which offer a variable degree of symptomatic relief and are often limited by side-effects.

[Articles] Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial

The Lancet - Sa, 29/08/2020 - 15:30
Treatment with mavacamten improved exercise capacity, LVOT obstruction, NYHA functional class, and health status in patients with obstructive hypertrophic cardiomyopathy. The results of this pivotal trial highlight the benefits of disease-specific treatment for this condition.

Elon Musk demonstrated a Neuralink brain implant in a live pig

New Scientist - Sa, 29/08/2020 - 04:38
A pig named Gertrude demonstrated a working Neuralink brain implant for the first time, and Elon Musk says the next step is to move into human trials soon

[Correspondence] Testing for responses to the wrong SARS-CoV-2 antigen?

The Lancet - Sa, 29/08/2020 - 00:30
Two commercial antibody tests (Abbott SARS-CoV-2 IgG, Abbott Diagnostics, Abbott Park, IL, USA; and Roche Elecsys Anti-SARS-CoV-2, Roche Diagnostics, Basel, Switzerland), both targeting antibodies to nucleoprotein (anti-NP), constitute the cornerstone of the UK Government's response to the COVID-19 pandemic. The test manufactured by Abbott, which is widely used in Europe and the USA, claims a specificity and sensitivity of greater than 99% at 14 days or more after symptoms started and has been validated by Public Health England.

[Editorial] Research and higher education in the time of COVID-19

The Lancet - Sa, 29/08/2020 - 00:00
The COVID-19 pandemic has propelled the research and higher education sectors to the forefront of public attention. Laboratory capacity has been crucial for diagnostic testing; experts in infectious diseases, epidemiology, public health, mathematical modelling, and economics are central to national policy making and media coverage; clinical research has been vital to improving COVID-19 management; and our collective global future relies heavily on the development of an effective vaccine against severe acute respiratory syndrome coronavirus 2.

[Comment] A leap of faith for more effective mental health care

The Lancet - Sa, 29/08/2020 - 00:00
Traditional and faith healers (TFHs) play an important, but contested, part in the response to mental health problems around the globe. Particularly for severe mental health conditions, such as psychosis, TFHs are often the first contact when help is sought by individuals and families in many countries of sub-Saharan Africa.1 In part, TFHs inhabit this privileged position due to a scarcity of accessible alternatives, but their approach might also be more acceptable to communities because of shared world views about causes of mental ill-health and processes of healing.

[Comment] Acute coronary syndromes in older patients: does older age matter?

The Lancet - Sa, 29/08/2020 - 00:00
Ischaemic heart disease is common in people aged 80 years or older, and is a major cause of morbidity and mortality in this age group worldwide. As this patient group grows, with an increase in life expectancy of up to 10 years or more, the absolute prevalence of cardiovascular disease is expected to increase.1 According to present guidelines, medical optimisation followed by an invasive strategy—including coronary angiography and subsequent revascularisation with percutaneous coronary intervention or coronary artery bypass graft—is recommended for eligible patients with acute coronary syndromes without ST-segment elevation (NSTE-ACS).

[World Report] Bangladesh's COVID-19 testing criticised

The Lancet - Sa, 29/08/2020 - 00:00
Experts say that the government's approach to testing and surveillance, including charging patients a fee, is hampering the response. Sophie Cousins reports.

[World Report] Questions over health response to Mauritius oil spill

The Lancet - Sa, 29/08/2020 - 00:00
The government has denied that symptoms are a direct result of oil exposure and experts have criticised the response. Sima Barmania reports.

[Perspectives] Seven more things organisations should be doing to combat racism

The Lancet - Sa, 29/08/2020 - 00:00
The previous The Penumbra column outlined seven steps that organisations can take to address racism. In this month's column, we offer additional actions likely to be helpful in creating an anti-racist climate. With these suggestions, we highlight actions that fill obvious gaps in thinking and practice in our health-care environments.

[Perspectives] Jonathan Miller: finding the considerable in the negligible

The Lancet - Sa, 29/08/2020 - 00:00
When Jonathan Miller was a little boy, he asked his novelist mother Betty—as she sat typing—what she was doing. “Well, what I am trying to do is make the negligible considerable”, she replied. Throughout his long career in the theatre and opera, Miller did the very same. He hadn't planned on a career as a director. After a brilliant preclinical career at Cambridge University, Cambridge, UK, Miller graduated as a doctor from University College Hospital (UCH), London, UK, in 1959, but abandoned medicine after less than 3 years because of the staggering success of Beyond the Fringe, the comedy review which was planned to last for the duration of the 1960 Edinburgh festival, but went on to run for 4 years with the original performers in London and New York.

[Obituary] Roger Stanley Williams

The Lancet - Sa, 29/08/2020 - 00:00
Leading influence in UK liver medicine. He was born in Bexleyheath, UK, on Aug 28, 1931, and died in Southampton, UK, from a heart attack on July 26, 2020, aged 88 years.

[Correspondence] Health and medicine cannot solve COVID-19

The Lancet - Sa, 29/08/2020 - 00:00
Richard Horton argues that combination prevention and global health collaboration are required to address the COVID-19 pandemic.1 We agree and suggest this should incorporate further measures. Thinking closely in terms of medical solutions could create false public expectations of a return to normal, and risks closing out non-health interventions that could lead to substantial improvements.

[Correspondence] Predilatation and paravalvular leakage risk in TAVR

The Lancet - Sa, 29/08/2020 - 00:00
Jonas Lanz and colleagues1 compared the effect of a self-expanding valve with a balloon-expandable valve for transcatheter aortic valve replacement (TAVR) in patients with symptomatic severe aortic stenosis. According to the results, the incidence of paravalvular leakage was higher in the group of patients using the self-expanding ACURATE neo device than in the group of patients using the balloon-expandable SAPIEN 3 prosthesis. However, we are concerned that this finding might be at least partly caused by differences in predilatation between the groups.

[Correspondence] Predilatation and paravalvular leakage risk in TAVR – Authors' reply

The Lancet - Sa, 29/08/2020 - 00:00
We thank Liang Yao and colleagues for their interest in our Article.1
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