The Lancet最新文献_第6页

Health worker lay-offs in east Africa following US aid freeze

The Lancet Pub Date : 2025-02-06 DOI: 10.1016/s0140-6736(25)00234-x

Gilbert Nakweya

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The Lancet Pub Date : 2025-02-06 DOI: 10.1016/s0140-6736(25)00203-x

Sarah Boseley

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Normobaric hyperoxia combined with endovascular treatment for acute ischaemic stroke in China (OPENS-2 trial): a multicentre, randomised, single-blind, sham-controlled trial

The Lancet Pub Date : 2025-02-06 DOI: 10.1016/s0140-6736(24)02809-5

Weili Li, Jing Lan, Ming Wei, Lan Liu, Chengbei Hou, Zhifeng Qi, Chuanhui Li, Liqun Jiao, Qi Yang, Wenhuo Chen, Shuling Liu, Xincan Yue, Qinglin Dong, Haicheng Yuan, Zongen Gao, Xiangbin Wu, Changming Wen, Tong Li, Changchun Jiang, Di Li, Jing Zhou

{"title":"Normobaric hyperoxia combined with endovascular treatment for acute ischaemic stroke in China (OPENS-2 trial): a multicentre, randomised, single-blind, sham-controlled trial","authors":"Weili Li, Jing Lan, Ming Wei, Lan Liu, Chengbei Hou, Zhifeng Qi, Chuanhui Li, Liqun Jiao, Qi Yang, Wenhuo Chen, Shuling Liu, Xincan Yue, Qinglin Dong, Haicheng Yuan, Zongen Gao, Xiangbin Wu, Changming Wen, Tong Li, Changchun Jiang, Di Li, Jing Zhou","doi":"10.1016/s0140-6736(24)02809-5","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02809-5","url":null,"abstract":"<h3>Background</h3>Endovascular treatment improves the recanalisation rate for patients with acute ischaemic stroke; however, even with endovascular treatment, approximately half of patients do not have a favourable functional outcome. We aimed to evaluate the effect of normobaric hyperoxia combined with endovascular treatment on functional outcomes up to 90 days after treatment in patients who had an acute ischaemic stroke with large-vessel occlusion.<h3>Methods</h3>In this multicentre, randomised, single-blind, sham-controlled trial, patients aged 18–80 years presenting within 6 h of acute ischaemic stroke attributed to large-vessel occlusion in anterior circulation, who were candidates for endovascular treatment, were recruited from 26 comprehensive stroke centres in China. Eligible patients were randomly assigned (1:1), with an Interactive Web Response System on the basis of a minimisation process to balance assignment at each participating site both overall and according to age, sex, occlusion location, and use of intravenous thrombolytics, to receive either normobaric hyperoxia combined with endovascular treatment or sham normobaric hyperoxia combined with endovascular treatment. Participants and assessors were blinded to treatment assignment. Normobaric hyperoxia treatment involved inhaling 100% oxygen at a flow rate of 10 L/min through a non-rebreather mask for 4 h, or an inspiratory oxygen fraction (FiO<sub>2</sub>) of 1·0 in participants for whom intubation was necessary. Sham treatment was 100% oxygen delivered at a flow rate of 1 L/min or an FiO<sub>2</sub> of 0·3. The primary outcome was the comparison of the ordinal scores on the modified Rankin Scale (mRS) at 90 days assessed in the intention-to-treat population (including all patients randomly assigned to treatment). Safety was assessed in all patients who received any oxygen therapy. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT04681651</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is now complete.<h3>Findings</h3>Between April 22, 2021, and Feb 5, 2023, 473 patients were screened, of whom 282 were randomly assigned to either normobaric hyperoxia plus endovascular treatment (n=140) or sham normobaric hyperoxia plus endovascular treatment (n=142; intention-to-treat population). The median age was 65 years (IQR 57–71), 75 (27%) of 282 participants were female, 207 (73%) were male, and 282 (100%) of participants were of Chinese Han ethnicity. At 90 days, the median score on the mRS for the normobaric hyperoxia group was 2 (IQR 1–4) and it was 3 (1–4) in the sham normobaric hy","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258060","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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Unit 731 and history-informed professional identity formation

The Lancet Pub Date : 2025-02-06 DOI: 10.1016/s0140-6736(24)02682-5

Zohar Lederman, Lam Hin Lai Ivan, Cheuk Nam Liu, Aaron Hames, Jerry Menikoff

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Exenatide once a week versus placebo as a potential disease-modifying treatment for people with Parkinson's disease in the UK: a phase 3, multicentre, double-blind, parallel-group, randomised, placebo-controlled trial

The Lancet Pub Date : 2025-02-04 DOI: 10.1016/s0140-6736(24)02808-3

Nirosen Vijiaratnam, Christine Girges, Grace Auld, Rachel McComish, Alexa King, Simon S Skene, Steve Hibbert, Alan Wong, Sabina Melander, Rachel Gibson, Helen Matthews, John Dickson, Camille Carroll, Abigail Patrick, Jemma Inches, Monty Silverdale, Bethan Blackledge, Jessica Whiston, Michele Hu, Jessica Welch, Tom Foltynie

{"title":"Exenatide once a week versus placebo as a potential disease-modifying treatment for people with Parkinson's disease in the UK: a phase 3, multicentre, double-blind, parallel-group, randomised, placebo-controlled trial","authors":"Nirosen Vijiaratnam, Christine Girges, Grace Auld, Rachel McComish, Alexa King, Simon S Skene, Steve Hibbert, Alan Wong, Sabina Melander, Rachel Gibson, Helen Matthews, John Dickson, Camille Carroll, Abigail Patrick, Jemma Inches, Monty Silverdale, Bethan Blackledge, Jessica Whiston, Michele Hu, Jessica Welch, Tom Foltynie","doi":"10.1016/s0140-6736(24)02808-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02808-3","url":null,"abstract":"<h3>Background</h3>GLP-1 receptor agonists have neurotrophic properties in in-vitro and in-vivo models of Parkinson's disease and results of epidemiological studies and small randomised trials have suggested possible benefits for risk and progression of Parkinson's disease. We aimed to establish whether the GLP-1 receptor agonist, exenatide, could slow the rate of progression of Parkinson's disease.<h3>Methods</h3>We did a phase 3, multicentre, double-blind, parallel-group, randomised, placebo-controlled trial at six research hospitals in the UK. Participants were aged 25–80 years with a diagnosis of Parkinson's disease, were at Hoehn and Yahr stage 2·5 or less when on dopaminergic treatment, and were on dopaminergic treatment for at least 4 weeks before enrolment. Participants were randomly assigned (1:1) using a <span><span>web-based system</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> with minimisation according to Hoehn and Yahr stage and study site to receive extended-release exenatide 2 mg by subcutaneous pen injection once per week over 96 weeks, or visually identical placebo. All participants and all research team members at study sites were masked to randomisation allocation. The primary outcome was the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score, off dopaminergic medication at 96 weeks, analysed in the intention-to-treat population using a linear mixed modelling approach. This study is registered with ISRCTN (14552789), EudraCT (2018-003028-35), and <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT04232969</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>).<h3>Findings</h3>Between Jan 23, 2020, and April 23, 2022, 215 participants were screened for eligibility, of whom 194 were randomly assigned to exenatide (n=97) or placebo (n=97). 56 (29%) participants were female and 138 (71%) were male. 92 participants in the exenatide group and 96 in the placebo group had at least one follow-up visit and were included in analyses. At 96 weeks, MDS-UPDRS III OFF-medication scores had increased (worsened) by a mean of 5·7 points (SD 11·2) in the exenatide group, and by 4·5 points (SD 11·4) points in the placebo group (adjusted coefficient for the effect of exenatide 0·92 [95% CI –1·56 to 3·39]; p=0·47). Nine (9%) participants in the exenatide group had at least one serious adverse event compared with 11 (11%) in the placebo group.<h3>Interpretatio","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"133 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124334","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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First phase 3 trial of GLP-1 receptor agonist for neurodegeneration

The Lancet Pub Date : 2025-02-04 DOI: 10.1016/s0140-6736(25)00161-8

Lorraine V Kalia

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The RDI–Lancet Commission on Rare Diseases: improving visibility to address health-care disparities for 400 million people

The Lancet Pub Date : 2025-02-03 DOI: 10.1016/s0140-6736(25)00211-9

Kym M Boycott, Roberto Giugliani

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Endometriosis: an Australian perspective on encouraging change

The Lancet Pub Date : 2025-01-30 DOI: 10.1016/s0140-6736(24)02511-x

Haddijatou Hughes