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[Editorial] Social media, screen time, and young people's mental health

Sa, 16/02/2019 - 00:00
The death by suicide in 2017 of a 14-year-old British girl has in the past month led to a highly charged debate about social media's negative effects on children's and young people's mental health. The concern is the ease with which explicit images of self-harm can be accessed on Instagram and other platforms. Discussions have included the possibility of government-led regulations and legislation, such as privacy law.

[Editorial] Russia's burgeoning HIV epidemic

Sa, 16/02/2019 - 00:00
While some countries in western Europe celebrate relative successes in the treatment and control of HIV, a burgeoning epidemic in the eastern part of the region poses a continued threat to progress.

[Editorial] From wonder and fear: make epilepsy a global health priority

Sa, 16/02/2019 - 00:00
In the heart of London, the British Museum holds a Babylonian script with what is believed to be the oldest descriptions of epilepsy. On this clay tablet (626–539 BCE), ancient scholars also described supernatural associations of specific seizure types with demons and evil gods, and how the treatment of this sacred disease was largely spiritual. For millennia, people with epilepsy were feared and treated as outcasts. Not until the 19th century did the concept of epilepsy as a brain disorder begin to disentangle aetiology and treatment from the mystical world.

[Comment] Survival of total hip replacements

Sa, 16/02/2019 - 00:00
Although total hip replacement is a successful procedure for many, there is potential for post-operative complications, such as bleeding, wound dehiscence, infection, and dislocation, among others.1–4 Although most complications can be prevented or medically managed, the ultimate effects of these complications can compromise the prosthesis, resulting in early implant failure.5 However, not all early component failures are directly attributable to post-operative complications. As Jonathan Evans and colleagues6 report in The Lancet, given enough time in situ, all implants will eventually fail.

[Comment] Neurodevelopment after general anaesthesia in infants

Sa, 16/02/2019 - 00:00
Concerns about anaesthesia-related neurological injury in young children have been increasing among parents, health-care providers, and regulatory organisations. These concerns were first prompted by animal studies that showed accelerated apoptosis and neuronal death after exposure to general anaesthetic drugs.1 Most commonly used general anaesthetic drugs have since been found to cause pervasive adverse neurological effects in vitro and in immature animals, including non-human primates.2 This issue gained widespread prominence in 2017, when the US Food and Drug Administration issued a safety communication stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”.

[Comment] Improving survival in molecularly selected glioblastoma

Sa, 16/02/2019 - 00:00
Clinical investigation of novel treatments for glioblastoma has been met with repeated setbacks over the past two decades. Modest, but clinically meaningful, improvement in survival has only been shown for temozolomide1 and tumour-treating fields,2 whereas many randomised trials assessing drugs targeted to vascular endothelial growth factor,3,4 integrins,5 and epidermal growth factor receptor (EGFR),6 showed that such drugs failed to prolong patient survival.

[Comment] Offline: AMR—the end of modern medicine?

Sa, 16/02/2019 - 00:00
“I am proud of what the European Union has done on AMR” (antimicrobial resistance), proclaimed Sally Davies, England's Chief Medical Officer (CMO), with a mischievous glint in her eye. She is usually more cautious. Acutely aware that the power she wields within government depends on the trust of ministers, Sally steers carefully around potential political minefields. But last week, speaking at our joint LSHTM–Lancet Global Health Lab, she seemed surprisingly unconstrained. The reason became clear on Friday.

[World Report] USA sets goal to end the HIV epidemic in a decade

Sa, 16/02/2019 - 00:00
The unexpected announcement in the State of the Union address could set the start of a realistic agenda to end HIV/AIDS in the USA, provided funds are secured. Susan Jaffe reports.

[World Report] Nigeria's unending war with Lassa fever

Sa, 16/02/2019 - 00:00
50 years after its discovery, Lassa Fever is still going strong in Nigeria. Research suggests light on the horizon, but, for now, the country still faces devastating epidemics. Paul Adepoju reports.

[Perspectives] Digitising the way to better sleep health

Sa, 16/02/2019 - 00:00
We don't expect a smartphone to help us sleep. Screens and connectivity are typically seen as a distraction from sleep. Yet emerging digital technologies are in development that could paradoxically help promote sleep health and aid in the diagnosis of sleep disorders.

[Obituary] Bertrand Coiffier

Sa, 16/02/2019 - 00:00
Leader in lymphoma research. Born in Le Puy-en-Velay, France, on March 26, 1947, he died of lung cancer in Lyon, France, on Jan 2, 2019, aged 71 years.

[Correspondence] Improving foundations for future global health practitioners

Sa, 16/02/2019 - 00:00
Global health, an area of study that focuses on improving the health of the global population and addressing the inequalities in health care worldwide,1 has been gaining momentum in the UK, and substantial efforts are being made to ensure it remains a priority in education and clinical training. Health-care professionals are increasingly pursuing global health interests, which has inevitably encouraged medical students to do the same.

[Correspondence] Tomorrow (and surgery) never dies

Sa, 16/02/2019 - 00:00
The results of the RAZOR trial (June 23, 2018, p 2525)1 demonstrated that robot-assisted radical cystectomy is a safe and efficacious procedure in comparison with the open approach. The medical community needs to consider some historical issues to better understand the real value of the revolution of the robotic surgery in this field.

[Correspondence] Robot-assisted versus open cystectomy in the RAZOR trial

Sa, 16/02/2019 - 00:00
Occam's RAZOR—is the simplest conclusion the correct one?

[Correspondence] Robot-assisted versus open cystectomy in the RAZOR trial

Sa, 16/02/2019 - 00:00
We read with interest the Article by Parekh and colleagues,1 who report non-inferior 24-month progression-free survival following robot-assisted versus open radical cystectomy. Previous investigations questioned the role of robot-assisted radical cystectomy for two main reasons: high costs and risk of early cancer dissemination due to spillage.2,3 Although cost-effectiveness analysis has not been carried out, this prospective, randomised trial clearly demonstrated the same early cancer recurrences after either treatment method.

[Correspondence] Robot-assisted versus open cystectomy in the RAZOR trial – Authors' reply

Sa, 16/02/2019 - 00:00
We read with great interest the comments from Larcher and colleagues and Khetrapal and colleagues and appreciate their interest.

[Articles] How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

Sa, 16/02/2019 - 00:00
Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

[Articles] How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

Sa, 16/02/2019 - 00:00
Our pooled registry data, which we believe to be more accurate than the case series data, shows that approximately 82% of TKRs last 25 years and 70% of UKRs last 25 years. These findings will be of use to patients and health-care providers; further information is required to predict exactly how long specific knee replacements will last.

[Articles] Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Sa, 16/02/2019 - 00:00
Slightly less than 1 h of general anaesthesia in early infancy does not alter neurodevelopmental outcome at age 5 years compared with awake-regional anaesthesia in a predominantly male study population.

[Articles] Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA–09): a randomised, open-label, phase 3 trial

Sa, 16/02/2019 - 00:00
Our results suggest that lomustine-temozolomide chemotherapy might improve survival compared with temozolomide standard therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. The findings should be interpreted with caution, owing to the small size of the trial.