Riviste scientifiche

[Correspondence] The YOMEGA non-inferiority trial

The Lancet - Sa, 19/10/2019 - 00:00
Results of the YOMEGA trial1 showed that one anastomosis gastric bypass (OAGB), compared with Roux-en-Y gastric bypass (RYGB), induces better outcomes (even if not significant) in terms of weight loss and diabetes improvement at 2 years. However, we feel some issues regarding the design of this study should be addressed.

[Correspondence] The YOMEGA non-inferiority trial – Authors' reply

The Lancet - Sa, 19/10/2019 - 00:00
We thank all the correspondents for their interest in the YOMEGA trial.1 Randomised trials can often take years to be published and we have to analyse the study within the context at the time the protocol was written.

[Correspondence] Health risks of Rohingya children in Bangladesh: 2 years on

The Lancet - Sa, 19/10/2019 - 00:00
The Rohingya crisis is a concern for Bangladesh, currently hosting more than 1·1 million Rohingya people who have been subjected to genocide, ethnic cleansing, and systematic discrimination for years in Rakhine, Myanmar.1 Children make up 55% of the population, and there is little doubt about the magnitude of their health problems.

[Department of Error] Department of Error

The Lancet - Sa, 19/10/2019 - 00:00
Cooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019; 394: 1425–36—In this Article, symbols for footnotes were incorrectly included in table 1. This correction has been made to the online version as of Oct 17, 2019, and the printed version is correct.

[Clinical Picture] A double blow for a patient with leprosy: a reversal reaction and an adverse drug reaction

The Lancet - Sa, 19/10/2019 - 00:00
A 28-year-old man from the rural area of Tamil Nadu attended our specialist hospital, complaining of multiple, copper-coloured patches on his skin, forehead, arms, and the front and back of his torso (figure). On examination he also had bilateral thickening of his ulnar and median nerves, without any functional impairment; multiple slit skin smear tests were positive for acid-fast bacilli in most of the patches on his body. We made a diagnosis of multibacillary, or lepromatous, leprosy, and started the patient on a 12-month course of multidrug therapy (MDT)—rifampicin 600 mg once a month, dapsone 100 mg daily, and clofazimine 300 mg once a month and 50 mg daily.

[Seminar] Hepatitis C

The Lancet - Sa, 19/10/2019 - 00:00
Hepatitis C is a global health problem, and an estimated 71·1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23·7 cases per 100 000 population (95% uncertainty interval 21·3–28·7) in 2015, with an estimated 1·75 million new HCV infections diagnosed in 2015. Globally, the most common infections are with HCV genotypes 1 (44% of cases), 3 (25% of cases), and 4 (15% of cases). HCV transmission is most commonly associated with direct percutaneous exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use.

[Seminar] Colorectal cancer

The Lancet - Sa, 19/10/2019 - 00:00
Several decades ago, colorectal cancer was infrequently diagnosed. Nowadays, it is the world's fourth most deadly cancer with almost 900 000 deaths annually. Besides an ageing population and dietary habits of high-income countries, unfavourable risk factors such as obesity, lack of physical exercise, and smoking increase the risk of colorectal cancer. Advancements in pathophysiological understanding have increased the array of treatment options for local and advanced disease leading to individual treatment plans.

Redesigning care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care

PLoS Medicine - Ve, 18/10/2019 - 23:00

by Jotheeswaran Amuthavalli Thiyagarajan, Islene Araujo de Carvalho, Juan Pablo Peña-Rosas, Shelly Chadha, Silvio Paolo Mariotti, Tarun Dua, Emiliano Albanese, Olivier Bruyère, Matteo Cesari, Alan Dangour, Amit Dias, Mariella Guerra, Jill Keeffe, Ngaire Kerse, Qurat ul Ain Khan, Chiung-ju Liu, Gudlavalleti V. S. Murthy, Serah Nyambura Ndegwa, Jean-Yves Reginster, Luis Miguel F. Gutiérrez Robledo, Kelly Tremblay, Jean Woo, Martin Prince, John R. Beard

Islene Araujo de Carvalho and coauthors discuss the WHO guidelines on integrated care for older people.

Association of preterm birth with lipid disorders in early adulthood:  A Swedish cohort study

PLoS Medicine - Ve, 18/10/2019 - 23:00

by Casey Crump, Jan Sundquist, Kristina Sundquist

Background

Preterm birth has previously been linked with cardiovascular disease (CVD) in adulthood. However, associations with lipid disorders (e.g., high cholesterol or triglycerides), which are major risk factors for CVD, have seldom been examined and are conflicting. Clinicians will increasingly encounter adult survivors of preterm birth and will need to understand the long-term health sequelae. We conducted the first large population-based study to determine whether preterm birth is associated with an increased risk of lipid disorders.

Methods and findings

A retrospective national cohort study was conducted of all 2,235,012 persons born as singletons in Sweden during 1973 to 1995 (48.6% women), who were followed up for lipid disorders identified from nationwide inpatient, outpatient, and pharmacy data through 2016 (maximum age 44 years). Cox regression was used to adjust for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. A total of 25,050 (1.1%) persons were identified with lipid disorders in 30.3 million person-years of follow-up. Each additional 5 weeks of gestation were associated with a 14% reduction in risk of lipid disorders (adjusted hazard ratio [HR], 0.86; 95% CI, 0.83–0.89; P < 0.001). Relative to full-term birth (gestational age 39–41 weeks), the adjusted HR associated with preterm birth (<37 weeks) was 1.23 (95% CI, 1.16–1.29; P < 0.001), and further stratified was 2.00 (1.41–2.85; P < 0.001) for extremely preterm (22–27 weeks), 1.33 (1.19–1.49; P < 0.001) for very preterm (28–33 weeks), and 1.19 (1.12–1.26; P < 0.001) for late preterm (34–36 weeks). These findings were similar in men and women (e.g., preterm versus full-term, men: HR, 1.22; 95% CI, 1.14–1.31; P < 0.001; women: HR, 1.23; 1.12–1.32; P < 0.001). Co-sibling analyses suggested that they were substantially though not completely explained by shared genetic or environmental factors in families. The main study limitation was the unavailability of laboratory data to assess specific types or severity of lipid disorders.

Conclusions

In this large national cohort, preterm birth was associated with an increased risk of lipid disorders in early- to midadulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for lipid disorders to reduce their future cardiovascular risks.

Genetically determined serum urate levels and cardiovascular and other diseases in UK Biobank cohort: A phenome-wide mendelian randomization study

PLoS Medicine - Ve, 18/10/2019 - 23:00

by Xue Li, Xiangrui Meng, Yazhou He, Athina Spiliopoulou, Maria Timofeeva, Wei-Qi Wei, Aliya Gifford, Tian Yang, Tim Varley, Ioanna Tzoulaki, Peter Joshi, Joshua C. Denny, Paul Mckeigue, Harry Campbell, Evropi Theodoratou

Background

The role of urate in cardiovascular diseases (CVDs) has been extensively investigated in observational studies; however, the extent of any causal effect remains unclear, making it difficult to evaluate its clinical relevance.

Methods and findings

A phenome-wide association study (PheWAS) together with a Bayesian analysis of tree-structured phenotypic model (TreeWAS) was performed to examine disease outcomes related to genetically determined serum urate levels in 339,256 unrelated White British individuals (54% female) in the UK Biobank who were aged 40–69 years (mean age, 56.87; SD, 7.99) when recruited from 2006 to 2010. Mendelian randomization (MR) analyses were performed to replicate significant findings using various genome-wide association study (GWAS) consortia data. Sensitivity analyses were conducted to examine possible pleiotropic effects on metabolic traits of the genetic variants used as instruments for urate. PheWAS analysis, examining the association with 1,431 disease outcomes, identified 13 distinct phecodes representing 4 disease groups (inflammatory polyarthropathies, hypertensive disease, circulatory disease, and metabolic disorders) and 9 disease outcomes (gout, gouty arthropathy, pyogenic arthritis, essential hypertension, coronary atherosclerosis, ischemic heart disease, chronic ischemic heart disease, myocardial infarction, and hypercholesterolemia) that were associated with genetically determined serum urate levels after multiple testing correction (p < 3.35 × 10−4). TreeWAS analysis, examining 10,750 ICD-10 diagnostic terms, identified more sub-phenotypes of cardiovascular and cerebrovascular diseases (e.g., angina pectoris, heart failure, cerebral infarction). MR analysis successfully replicated the association with gout, hypertension, heart diseases, and blood lipid levels but indicated the existence of genetic pleiotropy. Sensitivity analyses support an inference that pleiotropic effects of genetic variants on urate and metabolic traits contribute to the observational associations with CVDs. The main limitations of this study relate to possible bias from pleiotropic effects of the considered genetic variants and possible misclassification of cases for mild disease that did not require hospitalization.

Conclusion

In this study, high serum urate levels were found to be associated with increased risk of different types of cardiac events. The finding of genetic pleiotropy indicates the existence of common upstream pathological elements influencing both urate and metabolic traits, and this may suggest new opportunities and challenges for developing drugs targeting a common mediator that would be beneficial for both the treatment of gout and the prevention of cardiovascular comorbidities.

Moving to Mars – this show will help you become a real Martian

New Scientist - Ve, 18/10/2019 - 18:57
From memorious clothing to wasteless habitats, the reality of living on Mars is brought home at London's Design Museum with genuine optimism

DeepMind AI beats humans at deciphering damaged ancient Greek tablets

New Scientist - Ve, 18/10/2019 - 13:56
An AI was trained on thousands of ancient Greek engravings to fill the gaps where there are missing or damaged words

Use of personalised risk-based screening schedules to optimise workload and sojourn time in screening programmes for diabetic retinopathy: A retrospective cohort study

PLoS Medicine - Gi, 17/10/2019 - 23:00

by Andreas Ochs, Stuart McGurnaghan, Mike W. Black, Graham P. Leese, Sam Philip, Naveed Sattar, Caroline Styles, Sarah H. Wild, Paul M. McKeigue, Helen M. Colhoun, on behalf of the Scottish Diabetes Research Network Epidemiology Group and the Diabetic Retinopathy Screening Collaborative

Background

National guidelines in most countries set screening intervals for diabetic retinopathy (DR) that are insufficiently informed by contemporary incidence rates. This has unspecified implications for interval disease risks (IDs) of referable DR, disparities in ID between groups or individuals, time spent in referable state before screening (sojourn time), and workload. We explored the effect of various screening schedules on these outcomes and developed an open-access interactive policy tool informed by contemporary DR incidence rates.

Methods and findings

Scottish Diabetic Retinopathy Screening Programme data from 1 January 2007 to 31 December 2016 were linked to diabetes registry data. This yielded 128,606 screening examinations in people with type 1 diabetes (T1D) and 1,384,360 examinations in people with type 2 diabetes (T2D). Among those with T1D, 47% of those without and 44% of those with referable DR were female, mean diabetes duration was 21 and 23 years, respectively, and mean age was 26 and 24 years, respectively. Among those with T2D, 44% of those without and 42% of those with referable DR were female, mean diabetes duration was 9 and 14 years, respectively, and mean age was 58 and 52 years, respectively. Individual probability of developing referable DR was estimated using a generalised linear model and was used to calculate the intervals needed to achieve various IDs across prior grade strata, or at the individual level, and the resultant workload and sojourn time. The current policy in Scotland—screening people with no or mild disease annually and moderate disease every 6 months—yielded large differences in ID by prior grade (13.2%, 3.6%, and 0.6% annually for moderate, mild, and no prior DR strata, respectively, in T1D) and diabetes type (2.4% in T1D and 0.6% in T2D overall). Maintaining these overall risks but equalising risk across prior grade strata would require extremely short intervals in those with moderate DR (1–2 months) and very long intervals in those with no prior DR (35–47 months), with little change in workload or average sojourn time. Changing to intervals of 12, 9, and 3 months in T1D and to 24, 9, and 3 months in T2D for no, mild, and moderate DR strata, respectively, would substantially reduce disparity in ID across strata and between diabetes types whilst reducing workload by 26% and increasing sojourn time by 2.3 months. Including clinical risk factor data gave a small but significant increment in prediction of referable DR beyond grade (increase in C-statistic of 0.013 in T1D and 0.016 in T2D, both p < 0.001). However, using this model to derive personalised intervals did not have substantial workload or sojourn time benefits over stratum-specific intervals. The main limitation is that the results are pertinent only to countries that share broadly similar rates of retinal disease and risk factor distributions to Scotland.

Conclusions

Changing current policies could reduce disparities in ID and achieve substantial reductions in workload within the range of IDs likely to be deemed acceptable. Our tool should facilitate more rational policy setting for screening.

Long strand of DNA from Neanderthals found in people from Melanesia

New Scientist - Gi, 17/10/2019 - 20:00
Most humans have small snippets of DNA inherited from ancient hominins like Neanderthals. Now the first study shows some people have long stretches of it

Google gets green light to access five years of NHS patient data

New Scientist - Gi, 17/10/2019 - 18:55
A freedom of information request by New Scientist shows that Taunton and Somerset NHS Foundation Trust will grant Google five years of historical data on patients

SpaceX plans to put more than 40,000 satellites in space

New Scientist - Gi, 17/10/2019 - 17:22
Documents show Elon Musk's firm SpaceX wants to launch another 30,000 satellites – more than triple the total amount humans have ever launched

Early mouse fetuses generated without sperm or eggs for first time

New Scientist - Gi, 17/10/2019 - 17:00
For the first time, artificial mouse embryos have started growing into early fetuses, but we are still a long way off making babies without sperm or eggs

Quiz: How well do you cope with uncertainty?

New Scientist - Gi, 17/10/2019 - 14:56
Complete this questionnaire to find out what your “intolerance of uncertainty” is, and what that means for how you can better cope with life’s limbos

How well do you cope with uncertainty?

New Scientist - Gi, 17/10/2019 - 14:56
Complete this questionnaire to find out what your “intolerance of uncertainty” is, and what that means for how you can better cope with life’s limbos
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