The Lancet最新文献

{"title":"A decade later, what have we learned from the Zika epidemic in children with intrauterine exposure?","authors":"Patricia Brasil, Karin Nielsen-Saines, Lusiele Guaraldo, Trevon Fuller, Maria Elisabeth Lopes Moreira","doi":"10.1016/s0140-6736(25)00826-8","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)00826-8","url":null,"abstract":"Since the emergence of the Zika virus epidemic in 2014 and the associated novel sequalae that emerged, much has been learned about the effects of antenatal exposure to Zika virus. Zika virus in pregnancy carries severe teratogenic potential to the fetus, ranging from congenital Zika syndrome to milder neurodevelopmental sequelae. Congenital Zika syndrome is associated with a spectrum of alterations that can affect cognitive, language, and motor development. Among children with congenital Zika syndrome, dysphagia and seizures are common, as are hospitalisations for pneumonia and urinary tract infections; overall, morbidity and mortality are extremely high. Children without congenital Zika syndrome but exposed to Zika virus antenatally are also at risk of developmental disorders. In addition, in utero exposure to Zika virus does not lead to the production of neutralising antibodies. Although the epidemic has subsided, Zika virus remains endemic in many countries and continues to affect families. Maternal associations have been fundamental in advocating for health care for children with congenital Zika syndrome and economic support for families. Gaps in scientific knowledge include the absence of data on long-term outcomes among school-age children. Future research and investments are needed to improve diagnostics, restart the stalled development of Zika virus vaccines, and evaluate antiviral treatments.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565852","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}

{"title":"Reflections on the Lancet Commission on Investing in Health's Global Health 2050 report","authors":"Damian Walker, Justice Nonvignon, Saba Waseem, Dan Schwarz","doi":"10.1016/s0140-6736(25)01089-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01089-x","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"8 1","pages":"28-29"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565807","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}

{"title":"Scientific advances in the assessment, modification, and generation of transplantable organs for patients with end-stage organ diseases","authors":"Ciara M Shaver, Peter P Reese, Adam Griesemer, Andreas Zuckermann, Matthew Bacchetta","doi":"10.1016/s0140-6736(25)00239-9","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)00239-9","url":null,"abstract":"The large deficit in donated organs required to provide transplantation to patients with end-stage organ disease is a global health crisis, exacerbated by regional differences in clinical practice and available resources. This deficit highlights the need for better tools to determine organ suitability for transplantation and to enhance the recovery of potential donor organs which are currently not transplanted due to concerns about organ quality. Novel organ assessment approaches, including epidemiological predictive models, advanced functional biometrics, and refined histological analysis, show potential to better identify donated organs suitable for transplantation. In addition, novel machine perfusion platforms have shown remarkable capacities to preserve and potentially modify injured organs, and a series of xenotransplantation experiments suggest a viable pathway to create a new organ supply. Collectively, these technologies will gradually alleviate the organ shortage and expand access to life-saving transplants.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533857","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}

{"title":"Advancing patient monitoring, diagnostics, and treatment strategies for transplant precision medicine","authors":"Alexandre Loupy, Marta Sablik, Kiran Khush, Peter P Reese","doi":"10.1016/s0140-6736(25)00195-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)00195-3","url":null,"abstract":"Transplant medicine faces substantial challenges, as patients require lifelong immunosuppression to prevent graft rejection. Immunosuppressive regimens to date, while reasonably effective at preventing acute rejection, cause numerous health complications, compromising quality of life and patient survival. A shift towards personalised immunosuppression is needed to improve allograft health, reduce long-term adverse effects, and optimise post-transplant outcomes. This necessity has driven advancements in post-transplant monitoring and diagnostics. Innovative monitoring biomarkers and novel diagnostic modalities have been developed to advance transplant care, with many showing promise for widespread clinical implementation. With advances in artificial intelligence, algorithms have the potential to integrate multidimensional data on the immune system and allograft health, offering a comprehensive view of transplant status. This Series paper highlights the state of post-transplant immunosuppression, monitoring, and diagnostics, emphasising the transformative role of emerging innovations to personalise both allograft and patient care. Their implications could extend to xenotransplantation, further broadening their potential to redefine transplant medicine.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533809","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}

{"title":"Policy innovations to advance equity in solid organ transplantation","authors":"Allison Jaure, Vivekanand Jha, Lisa M McElroy, Elmi Muller, Gabriel C Oniscu, Marina Serper, Tanjala S Purnell, Nicole Scholes-Robertson, Peter P Reese","doi":"10.1016/s0140-6736(25)00712-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)00712-3","url":null,"abstract":"Advances in solid organ transplantation, such as improved organ preservation technologies and novel approaches to immunosuppression management, have the potential to improve outcomes in transplant recipients. However, despite these developments, there are persistent disparities in access to transplantation across, and within, certain countries. Low-income and middle-income countries have particularly low rates of transplantation, as well as less access to new technologies, mainly due to limited infrastructure and resources. Additionally, marginalised groups, especially racially and ethnically minoritised people and individuals from low socioeconomic backgrounds, might be most susceptible to these inequities worldwide. In this Series paper, we focus on how policies can advance equity in the field of transplantation, both within individual health systems and across different countries. We propose policy solutions to make progress towards equity in access to transplantation and better outcomes for all patients with end-stage organ disease who could benefit from transplantation.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533808","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}

{"title":"The ESOT–Lancet Commission on Transplantation: a new vision for global sustainability, innovation, and equity in organ transplantation","authors":"Gabriel C Oniscu, Elmi Muller, Chloe Wilson, Richard Horton","doi":"10.1016/s0140-6736(25)01197-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01197-3","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533859","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}

{"title":"Building a resistance to US assaults on public health","authors":"Alicia Ely Yamin, Emma Joanna Lengle, Gregg Gonsalves","doi":"10.1016/s0140-6736(25)01320-0","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01320-0","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533815","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}

{"title":"Tracking maturity of the enabling environment for clinical trials","authors":"Vasee Moorthy, P J Devereaux, Carren Sui-Lin Teh, Indri Rooslamiati, Ololade D Adeyemi, Saeed Hamid, Ana Zanoletty, Kwasi Nyarko, Wei Zhang, Jeremy Farrar, Ibrahim Abubakar","doi":"10.1016/s0140-6736(25)01279-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01279-6","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520731","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}

{"title":"Metrics for diplomats: is mortality from non-communicable diseases increasing or decreasing?","authors":"Pascal Bovet, Nick Banatvala","doi":"10.1016/s0140-6736(25)01280-2","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01280-2","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520736","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}

{"title":"Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis","authors":"Daniella Medeiros Cavalcanti, Lucas de Oliveira Ferreira de Sales, Andrea Ferreira da Silva, Elisa Landin Basterra, Daiana Pena, Caterina Monti, Gonzalo Barreix, Natanael J Silva, Paula Vaz, Francisco Saute, Gonzalo Fanjul, Quique Bassat, Denise Naniche, James Macinko, Davide Rasella","doi":"10.1016/s0140-6736(25)01186-9","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)01186-9","url":null,"abstract":"<h3>Background</h3>The US Agency for International Development (USAID) is the largest funding agency for humanitarian and development aid worldwide. The aim of this study is to comprehensively evaluate the effect of all USAID funding on adult and child mortality over the past two decades and forecast the future effect of its defunding.<h3>Methods</h3>In this retrospective impact evaluation integrated with forecasting analysis, we used panel data from 133 countries and territories— including all low-income and middle-income countries (LMICs)—with USAID support ranging from none to very high. First, we used fixed-effects multivariable Poisson models with robust SEs adjusted for demographic, socioeconomic, and health-care factors to estimate the impact of USAID funding on all-age and all-cause mortality from 2001 to 2021. Second, we evaluated its effects by age-specific, sex-specific, and cause-specific groups. Third, we did several sensitivity and triangulation analyses. Lastly, we integrated the retrospective evaluation with validated dynamic microsimulation models to estimate effects up to 2030.<h3>Findings</h3>Higher levels of USAID funding—primarily directed toward LMICs, particularly African countries—were associated with a 15% reduction in age-standardised all-cause mortality (risk ratio [RR] 0·85, 95% CI 0·78–0·93) and a 32% reduction in under-five mortality (RR 0·68, 0·57–0·80). This finding indicates that 91 839 663 (95% CI 85 690 135–98 291 626) all-age deaths, including 30 391 980 (26 023 132–35 482 636) in children younger than 5 years, were prevented by USAID funding over the 21-year study period. USAID funding was associated with a 65% reduction (RR 0·35, 0·29-0·42) in mortality from HIV/AIDS (representing 25·5 million deaths), 51% (RR 0·49, 0·39–0·61) from malaria (8·0 million deaths), and 50% (RR 0·50, 0·40–0·62) from neglected tropical diseases (8·9 million deaths). Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal conditions. Forecasting models predicted that the current steep funding cuts could result in more than 14 051 750 (uncertainty interval 8 475 990–19 662 191) additional all-age deaths, including 4 537 157 (3 124 796–5 910 791) in children younger than age 5 years, by 2030.<h3>Interpretation</h3>USAID funding has significantly contributed to the reduction in adult and child mortality across low-income and middle-income countries over the past two decades. Our estimates show that, unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030.<h3>Funding</h3>The Spanish Ministry of Science and Innovation, UK Medical Research Council, and EU Horizon Europe.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520802","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}