The LancetPub Date : 2025-10-09DOI: 10.1016/s0140-6736(25)02058-6
{"title":"Department of Error","authors":"","doi":"10.1016/s0140-6736(25)02058-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)02058-6","url":null,"abstract":"<em>Rossignol P, Zannad F, Massy Z, et al. Spironolactone in patients on chronic haemodialysis at high risk of adverse cardiovascular outcomes (ALCHEMIST): a multicentre, double-blind, randomised, placebo-controlled trial and updated meta-analysis.</em> Lancet <em>2025; <strong>406:</strong> 705–18</em>—In this Article, the spelling of author Delphine Maucort-Boulch's name was incorrect. This correction has been made to the online version as of Oct 9, 2025.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"590 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-08DOI: 10.1016/s0140-6736(25)01820-3
Masako Horino, Sanaa Al Najjar, Amro Tabaza, Haya Alkhammash, Reham Jaffal, Jiaxin Chen, Ghada Al-Jadba, Keith P West, Akihiro Seita
{"title":"Assessment of malnutrition in preschool-aged children by mid-upper arm circumference in the Gaza Strip (January, 2024–August, 2025): a longitudinal, cross-sectional, surveillance study","authors":"Masako Horino, Sanaa Al Najjar, Amro Tabaza, Haya Alkhammash, Reham Jaffal, Jiaxin Chen, Ghada Al-Jadba, Keith P West, Akihiro Seita","doi":"10.1016/s0140-6736(25)01820-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01820-3","url":null,"abstract":"<h3>Background</h3>Since October, 2023, Palestinian children in the Gaza Strip have suffered war-induced displacement, food insecurity, malnutrition, and elevated risks of famine and mortality. In this study, we aimed to document the extent of, and patterns in, wasting malnutrition in children aged 6–59 months across the Gaza Strip between January, 2024, and August, 2025.<h3>Methods</h3>This longitudinal, cross-sectional, surveillance study was conducted across a total of 16 UN Relief and Works Agency for Palestine Refugees in the Near East health centres and 78 medical points established within school shelters and tent encampments across the five governorates of Gaza. Children aged 6–59 months were screened for wasting malnutrition by mid-upper arm circumference (MUAC) measurement. Children with a MUAC of less than 125 mm were enrolled into therapeutic feeding regimens. MUAC Z scores were derived from published WHO age-specific and sex-specific arm circumferential growth curves. Monthly prevalence of acute wasting (MUAC Z scores less than –2) and severe wasting (MUAC Z scores less than –3) were described by age, sex, type of screening facility, and governorate.<h3>Findings</h3>Between Jan 1, 2024, and Aug 15, 2025, 265 974 measurements were obtained from 219 783 uniquely identified children, with two-thirds of children screened in Khan Younis and Middle Governorates. The monthly prevalence of acute wasting ranged from 5% (34 of 722 children) to 7% (794 of 10 907) between January and June, 2024. After approximately 4 months of severe aid restrictions between September, 2024, and mid-January, 2025, the prevalence of wasting increased from 8·8% (1601 of 18 225 children) to 14·3% (1661 of 11 619), with the highest prevalence observed in Rafah (32·2%; 95 of 295) and among children aged 24–59 months (21·0%; 1366 of 6518). After a 6-week ceasefire, marked by a substantial increase in the number of aid trucks entering through territory borders, by March, 2025, the prevalence of wasting had declined to 5·5% (831 of 15 165). However, after an 11-week blockade from March to May, 2025, and continued severely restricted entry of food, water, medicines, fuel, and other essentials thereafter, by early August, 2025, 15·8% (1213 of 7668) of screened children were acutely wasted, including 3·7% (280 of 7668) severely wasted, equating to more than 54 600 children in need of therapeutic care.<h3>Interpretation</h3>After nearly 2 years of war and severe restrictions in humanitarian aid, tens of thousands of preschool-aged children in the Gaza Strip are suffering from preventable acute malnutrition and facing an increased risk of mortality.<h3>Funding</h3>UN Relief and Works Agency for Palestine Refugees in the Near East.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-08DOI: 10.1016/s0140-6736(25)02002-1
Zulfiqar A Bhutta, Jessica Fanzo, Paul H Wise
{"title":"Documenting atrocity: child malnutrition in Gaza","authors":"Zulfiqar A Bhutta, Jessica Fanzo, Paul H Wise","doi":"10.1016/s0140-6736(25)02002-1","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)02002-1","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-07DOI: 10.1016/s0140-6736(25)02012-4
Philip J Landrigan, Sarah Dunlop, Joacim Rocklöv, Hervé Raps, Thomas C Chiles, Christos Symeonides, Costas A Velis, Martin Wagner, David A Wirth
{"title":"The global plastics treaty: much needed, but still not there","authors":"Philip J Landrigan, Sarah Dunlop, Joacim Rocklöv, Hervé Raps, Thomas C Chiles, Christos Symeonides, Costas A Velis, Martin Wagner, David A Wirth","doi":"10.1016/s0140-6736(25)02012-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)02012-4","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-07DOI: 10.1016/s0140-6736(25)01873-2
Gaurav Nepal, Tirtha Man Shrestha, Sunital Lamsal
{"title":"Police brutality against children and hospitals in Nepal","authors":"Gaurav Nepal, Tirtha Man Shrestha, Sunital Lamsal","doi":"10.1016/s0140-6736(25)01873-2","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01873-2","url":null,"abstract":"On Sept 8, 2025, widespread protests erupted across Nepal, driven largely by Generation Z youth, particularly school-aged children, expressing frustration over persistent political instability, systemic corruption, and the recent ban on social media.<span><span><sup>1</sup></span></span> Many protesters wore school uniforms, believing that their status as students would provide protection.<span><span><sup>2</sup></span></span> Nepalese police responded with disproportionate and indiscriminate force, including shootings with live ammunition to the head and chest.<span><span><sup>1</sup></span></span> Tragically, the death of a student aged 12 years was confirmed by Nepal's Ministry of Health and Population, and at least 19 young students are reported to have died during the protests in a single day.<span><span>1</span></span>, <span><span>3</span></span>","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-04DOI: 10.1016/s0140-6736(25)01639-3
Ioannis Gallos, Caitlin R Williams, Malcolm J Price, Aurelio Tobias, Adam Devall, John Allotey, Fernando Althabe, Jenny A Cresswell, Jill Durocher, A Metin Gülmezoglu, Christian Haslinger, Rodolfo C Pacagnella, Loïc Sentilhes, Soha Sobhy, Idnan Yunas, Jonathan J Deeks, Arri Coomarasamy, Olufemi T Oladapo
{"title":"Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis","authors":"Ioannis Gallos, Caitlin R Williams, Malcolm J Price, Aurelio Tobias, Adam Devall, John Allotey, Fernando Althabe, Jenny A Cresswell, Jill Durocher, A Metin Gülmezoglu, Christian Haslinger, Rodolfo C Pacagnella, Loïc Sentilhes, Soha Sobhy, Idnan Yunas, Jonathan J Deeks, Arri Coomarasamy, Olufemi T Oladapo","doi":"10.1016/s0140-6736(25)01639-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01639-3","url":null,"abstract":"<h3>Background</h3>Postpartum haemorrhage (excessive bleeding after birth) is a leading cause of maternal mortality and morbidity worldwide. However, there is no global consensus on which clinical markers best define excessive bleeding or reliably predict adverse maternal outcomes. The aim of this study was to assess the prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity.<h3>Methods</h3>In this individual participant data meta-analysis, eligible datasets were identified through a global call for data issued by WHO and systematic searches of PubMed, MEDLINE, Embase, the Cochrane Library, and WHO trial registries (from database inception to Nov 6, 2024). Studies were eligible if they included at least 200 participants with objectively measured blood loss or other clinical markers of haemodynamic instability, and reported at least one clinical outcome of interest. Individual participant data were requested for all eligible studies. For each dataset, we computed the prognostic accuracy of each clinical marker to predict a composite outcome of maternal mortality or severe morbidity (blood transfusion, surgical interventions, or admission to intensive care unit). Five clinical markers were assessed: measured blood loss, pulse rate, systolic blood pressure, diastolic blood pressure, and shock index. Results were meta-analysed through two-level mixed-effects logistic regression models, with a bivariate normal model used to generate summary accuracy estimates. Clinical marker and threshold selections were informed by a WHO expert consensus process, which placed emphasis on maximising prognostic sensitivity (preferably >80%) over prognostic specificity (preferably ≥50%). This meta-analysis was registered on PROSPERO (CRD420251034918).<h3>Findings</h3>We identified 33 potentially eligible datasets and successfully obtained and analysed full data for 12 datasets, comprising 312 151 women. At the conventional threshold of 500 mL, measured blood loss had a summary prognostic sensitivity of 75·7% (95% CI 60·3–86·4) and specificity of 81·4% (95% CI 70·7–88·8) for predicting the composite outcome. The preferred sensitivity threshold was reached at 300 mL (83·9% [95% CI 72·8–91·1]), although at the expense of reduced specificity (54·8% [95% CI 38·0–70·5]). Prognostic performance improved with a decision rule that combined the use of either blood loss thresholds less than 500 mL (≥300 mL to ≥450 mL) and any abnormal haemodynamic sign (pulse rate >100 beats per min, systolic blood pressure <100 mm Hg, diastolic blood pressure <60 mm Hg, or shock index >1·0) or 500 mL or more of blood loss, with sensitivities ranging from 86·9% to 87·9% and specificities from 66·6% to 76·1%.<h3>Interpretation</h3>Measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleed","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-04DOI: 10.1016/s0140-6736(25)01909-9
Willem M Otte
{"title":"The use of IPD meta-analysis in maternal health prognostics","authors":"Willem M Otte","doi":"10.1016/s0140-6736(25)01909-9","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01909-9","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The LancetPub Date : 2025-10-03DOI: 10.1016/s0140-6736(25)01432-1
David J Lewis, Mats Jerkeman, Lexy Sorrell, David Wright, Ingrid Glimelius, Christian B Poulsen, Annika Pasanen, Andrew Rawstron, Karin F Wader, Nick Morley, Catherine Burton, Andrew J Davies, Ingemar Lagerlöf, Surita Dalal, Ruth De Tute, Chris McNamara, Nicola Crosbie, Helle Erbs Toldbod, Jeanette Sanders, Victoria Allgar, Marjukka Pollari
{"title":"Ibrutinib and rituximab versus immunochemotherapy in patients with previously untreated mantle cell lymphoma (ENRICH): a randomised, open-label, phase 2/3 superiority trial","authors":"David J Lewis, Mats Jerkeman, Lexy Sorrell, David Wright, Ingrid Glimelius, Christian B Poulsen, Annika Pasanen, Andrew Rawstron, Karin F Wader, Nick Morley, Catherine Burton, Andrew J Davies, Ingemar Lagerlöf, Surita Dalal, Ruth De Tute, Chris McNamara, Nicola Crosbie, Helle Erbs Toldbod, Jeanette Sanders, Victoria Allgar, Marjukka Pollari","doi":"10.1016/s0140-6736(25)01432-1","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01432-1","url":null,"abstract":"<h3>Background</h3>Ibrutinib, a Bruton tyrosine kinase inhibitor, prolongs progression-free survival when added to immunochemotherapy as first line treatment. The ENRICH trial compared the chemotherapy-free combination of ibrutinib and the anti-CD20 antibody rituximab (ibrutinib–rituximab) with standard immunochemotherapy (R-CHOP [rituximab–cyclophosphamide, doxorubicin, vincristine, and prednisolone] or bendamustine–rituximab) in patients 60 years and older with untreated mantle-cell lymphoma.<h3>Methods</h3>This randomised, open-label, phase 2/3 superiority trial was performed at 66 sites in the UK, Sweden, Norway, Finland, and Denmark. Patients 60 years and older with untreated mantle-cell lymphoma (Ann–Arbor stage II–IV disease, an Eastern Cooperative Oncology Group performance-status score of 0–2) were randomly assigned to receive either rituximab plus immunochemotherapy or ibrutinib–rituximab in a 1:1 ratio, stratified by investigator choice of immunochemotherapy. Patients randomly allocated to the ibrutinib–rituximab (intervention) group received 560 mg oral ibrutinib daily in combination with six to eight cycles of 375 mg/m<sup>2</sup> intravenous rituximab on day 1 of each cycle in the matched schedule of the pre-randomisation choice of immunochemotherapy (every 21 days for R-CHOP or every 28 days for rituximab–bendamustine). R-CHOP comprised 750 mg/m<sup>2</sup> of cyclophosphamide, 50 mg/m<sup>2</sup> of doxorubicin, and 1·4 mg/m<sup>2</sup> vincristine on day 1 of each 21-day cycle, with 100 mg prednisolone on days 1–5 of each cycle. Rituximab–bendamustine comprised 90 mg/m<sup>2</sup> of bendamustine on days 1 and 2 of each cycle, in combination with 375 mg/m<sup>2</sup> rituximab on day 1 of each cycle. All responding patients in both groups at the end of induction received maintenance rituximab administered every 8 weeks for 2 years, and patients allocated to the intervention group continued ibrutinib until disease progression or unacceptable toxicity. The primary outcome was investigator-assessed progression-free survival, stratified by immunochemotherapy choice and analysed in the intention-to-treat population. The trial was registered with EudraCT (2015–000832–13) and is closed for recruitment.<h3>Findings</h3>Between Feb 15, 2016, and June 30, 2021, 397 patients were randomly allocated to immunochemotherapy (control) or ibrutinib–rituximab (intervention). Of the 397, 107 (27%) were pre-allocated to the immunochemotherapy choice of R-CHOP and 290 (73%) were pre-allocated to rituximab–bendamustine. In total, 198 were allocated to the control group (53 to R-CHOP and 145 to bendamustine–rituximab) and 199 were allocated to intervention. The median age was 74 years (IQR 70–77) for the intervention group and 74 years (70–78) in the control group. 296 patients (75%) were male and 101 patients (25%) were female; ethnicity data were not collected. At a median follow-up of 47·9 months, the median progression-free survival of ibrutinib–ri","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145216173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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