Lancet Regional Health-Europe最新文献

{"title":"Iran's humanitarian crisis: war, legality, and the erosion of population health","authors":"Karl Blanchet , Sultan Barakat , Bernadette Kumar , Paul Spiegel","doi":"10.1016/j.lanepe.2026.101656","DOIUrl":"10.1016/j.lanepe.2026.101656","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101656"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147650032","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":"Diabetes community calls for quality standards for continuous glucose monitoring devices","authors":"Francesco Giorgino , Tadej Battelino , Stefano Del Prato , Rahab Hashim , Sabine E. Hofer , Sufyan Hussain , Kasia Karpinska , Tom Melvin , Eric Renard , Campbell Hutton , Jannet Svensson , Bart Torbeyns , Petra Wilson , Chantal Mathieu","doi":"10.1016/j.lanepe.2026.101598","DOIUrl":"10.1016/j.lanepe.2026.101598","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101598"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168030","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":"Incidence and spatial variation of Parkinson's disease in the Netherlands (2017–2022): a population-based study","authors":"Mariana Simões ,&nbsp;Susan Peters ,&nbsp;Anke Huss ,&nbsp;Sirwan K.L. Darweesh ,&nbsp;Bastiaan R. Bloem ,&nbsp;Roel Vermeulen","doi":"10.1016/j.lanepe.2025.101565","DOIUrl":"10.1016/j.lanepe.2025.101565","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson's disease (PD) is a growing public health concern with a largely unknown aetiology. Understanding temporal trends, demographic drivers, and regional variations in PD risk is critical for guiding healthcare planning and identifying potential environmental and socioeconomic risk factors. We aimed to investigate the incidence and spatial distribution of PD in the Netherlands from 2017 to 2022, and examined demographic and socioeconomic disparities in PD risk.</div></div><div><h3>Methods</h3><div>We conducted a nationwide, population-based study leveraging complementary strengths of multiple independent administrative health records linked to demographic and socioeconomic data. Incident PD cases were identified using a newly developed algorithm integrating mortality records, hospital data, health insurance claims, and medication prescriptions. We estimated overall and stratified age- and sex-internally standardized PD incidence rates (IRs). Spatial variations in PD risk were assessed using Bayesian hierarchical models to generate smoothed relative risk estimates at a fine-grained neighbourhood level.</div></div><div><h3>Findings</h3><div>Between 2017 and 2022, we identified 22,343 incident PD cases in a population of 19,995,771 individuals (totalling 105,027,472 person-years at risk). Overall standardized IR was relatively stable across the evaluated time at 21.8 (95% confidence interval (CI): 21.6–22.1) per 100,000 person-years at risk. Incidence increased with age (peaking at 75–85 years) and was higher in men than women, in individuals with higher socioeconomic position, and residents of the northern provinces. Spatial analysis revealed significant geographic clustering of PD risk, which did not ecologically align with major environmental indicators such as air pollution, agricultural activity, or urbanization.</div></div><div><h3>Interpretation</h3><div>The multifaceted algorithm offers a robust PD case ascertainment tool that allowed for a comprehensive nationwide assessment of PD incidence. In the Netherlands, this new approach uncovered regional disparities in PD risk that are not readily explained by known environmental indicators, warranting further investigation into potential environmental and socioeconomic determinants.</div></div><div><h3>Funding</h3><div><span>Woelse Waard</span>, <span>Gieskes-Strijbis</span>, and <span>Ministry of Agriculture, Fisheries, Food Security and Nature</span> of the Netherlands.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101565"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367096","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":"Subphenotype- and complication-guided adjunctive fosfomycin versus standard monotherapy in Staphylococcus aureus bacteraemia: pooled analysis of two randomised trials","authors":"Francesc Escrihuela-Vidal ,&nbsp;Julia García Larrauri ,&nbsp;Joaquín López-Contreras ,&nbsp;Gorane Euba ,&nbsp;Andrea Vázquez ,&nbsp;Silvia Gómez-Zorrilla ,&nbsp;Luis Eduardo López-Cortés ,&nbsp;Oriol Gasch ,&nbsp;Eduardo Aparicio-Minguijón ,&nbsp;Rosa Escudero-Sánchez ,&nbsp;María Teresa Pérez-Rodríguez ,&nbsp;Dolors Rodríguez-Pardo ,&nbsp;Alfredo Jover-Sáenz ,&nbsp;Graciano García-Pardo ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;Miquel Pujol ,&nbsp;Jordi Carratalà ,&nbsp;Belén Gutiérrez-Gutiérrez","doi":"10.1016/j.lanepe.2026.101611","DOIUrl":"10.1016/j.lanepe.2026.101611","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Randomised trials of combination therapies for &lt;em&gt;S. aureus&lt;/em&gt; bacteraemia (SAB) have failed to improve clinical outcomes—likely reflecting the lack of risk-targeted patient selection. The FEN-AUREUS classification enables early risk stratification based on clinical subphenotypes. We aimed to validate this framework in a pooled trial cohort and assess whether combining subphenotypes with IDSA-defined complicated SAB could identify patients most likely to benefit from adjunctive fosfomycin.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a post-hoc analysis of individual-level data from two multicentre randomised trials evaluating adjunctive fosfomycin in SAB. Participants were classified according to the FEN-AUREUS framework into phenotypes and risk subphenotypes. Associations between subphenotype, complicated bacteraemia, and 60-day mortality as the primary outcome and 30-day mortality and 8-week treatment success as secondary outcomes were assessed. A DOOR analysis provided an integrated assessment of overall outcomes. This study is registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;NCT07155590&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 369 patients (median age 68 years, IQR 56–78; 262/369 [68·8%] male), high-risk subphenotypes were associated with greater 60-day mortality (23·2% versus 6·6%; risk ratio [RR] 3·49, 95% confidence interval [CI] 1·87–6·52; adjusted hazard ratio [aHR] 3·38, 1·69–6·78), regardless of complication status. Combining risk subphenotypes with the IDSA classification showed heterogeneity in response to adjunctive fosfomycin. In patients with low-risk and uncomplicated SAB (n = 107), 60-day mortality was low with both monotherapy and adjunctive fosfomycin (2·1% versus 3·4%; risk difference [RD] −1·3% [95% CI −7·4 to 4·8]; p = 0·68), and treatment success at week 8 exceeded 89%. In the intermediate strata, 60-day mortality was 18·8% with monotherapy versus 7·4% (RD 11·3% [95% CI −5·4 to 28·1]; p = 0·20) with adjunctive fosfomycin in low-risk/complicated SAB (n = 59), and 15·0% versus 22·8% (RD −7·8% [95% CI −19·9 to 4·3]; p = 0·21) in high-risk/uncomplicated SAB (n = 159); week-8 treatment success was 78·1% versus 88·9% and 61·3% versus 54·4%, respectively. By contrast, in high-risk, complicated SAB (n = 44), adjunctive fosfomycin was associated with higher treatment success (25·8% versus 69·2%; RD −43·4% [−72·9 to −14·0]; p = 0·007) and a non-significant reduction in 60-day mortality (45·2% versus 23·1%). DOOR analysis suggested a more favourable overall outcome profile with adjunctive therapy in this subgroup.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Integrating early risk subphenotyping with IDSA complication criteria may enable more precise identification of SAB patients who may benefit from intensified therapy, while supporting monotherapy in those at lowest risk. This stratified approach provides","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101611"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367181","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":"Anterior cruciate ligament reconstruction combined with anterolateral ligament reconstruction using hamstring autograft versus anterior cruciate ligament reconstruction using bone–patellar tendon–bone autograft: a randomised controlled trial with 5-year follow-up","authors":"Bertrand Sonnery-Cottet ,&nbsp;Alessandro Carrozzo ,&nbsp;Hervé Poilvache ,&nbsp;Jean-Marie Fayard ,&nbsp;Benjamin Freychet ,&nbsp;Mathieu Thaunat ,&nbsp;Thais Dutra Vieira ,&nbsp;Adnan Saithna","doi":"10.1016/j.lanepe.2025.101561","DOIUrl":"10.1016/j.lanepe.2025.101561","url":null,"abstract":"<div><h3>Background</h3><div>Anterior Cruciate Ligament (ACL) rupture is common knee injury. Although ACL reconstruction (ACLR) is standard, graft failure rates remain high in young active patients. This study investigated whether combining ACLR with anterolateral ligament (ALL) reconstruction (ALLR) reduces grafts failure compared with ACLR.</div></div><div><h3>Methods</h3><div>In this prospective, single-centre, randomised controlled trial conducted at the Santy Orthopedic Center in Lyon, France, patients aged 18–35 years with symptomatic ACL rupture were randomly allocated (1:1) to ACL + ALL reconstruction using hamstring tendon autograft (ACLR + ALLR) or ACLR with bone-patellar tendon-bone autograft (ACLR). Randomisation was performed with a block size of four using telematic software by an independent study coordinator, with concealed allocation. Surgeons were informed of the assigned procedure on the morning of surgery. Outcome assessors were not blinded. The primary outcome was graft failure at 5 years, assessed clinically and by magnetic resonance imaging (MRI) by an independent sports medicine physicians not involved in the index surgery. Efficacy analyses were performed on the Full Analysis Set in accordance with the intention-to-treat principle, while safety analyses were conducted on the Safety Set. Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, ID <span><span>NCT03740022</span><svg><path></path></svg></span>. The trial has been completed.</div></div><div><h3>Findings</h3><div>Between November 11, 2016, and January 20, 2020, 593 patients were randomized (297 assigned to ACLR + ALLR and 296 to ACLR). The mean age was 25.0 years (SD 4.5); 447 (75%) participants were male and 146 (25%) female. Of these 593 patients, 556 (94%) completed a mean 5-year follow-up. Graft failure occurred in 12/283 (4.2%) with ACLR + ALLR versus 28/273 (10.3%) with ACLR (p = 0.006; adjusted odds ratio 2.54 [95% CI 1.27; 5.36]—p = 0.008). The number needed to treat was 17 overall, and 9 in patients younger than 25 years.</div></div><div><h3>Interpretation</h3><div>In our study of young, active adults with ACL rupture, who are considered high-risk for graft failure, combining ACL reconstruction with anterolateral ligament reconstruction (ACLR + ALLR) significantly decreased graft failure compared with ACLR. These results suggest that ACLR + ALLR might be beneficial for young or highly active individuals and provide a basis for future research to refine patient selection, evaluate long-term outcomes beyond five years, and explore benefits in other subgroups of patients with ACL injuries.</div></div><div><h3>Funding</h3><div><span>GCS Ramsay Santé pour l'Enseignement et la Recherche</span> funds the scientific activity at the Santy center.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101561"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841222","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":"30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studies","authors":"","doi":"10.1016/j.lanepe.2025.101566","DOIUrl":"10.1016/j.lanepe.2025.101566","url":null,"abstract":"<div><h3>Background</h3><div>Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems.</div></div><div><h3>Methods</h3><div>This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score.</div></div><div><h3>Findings</h3><div>A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality.</div></div><div><h3>Interpretation</h3><div>Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research</span>, United Kingdom.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101566"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077833","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":"Breast cancer incidence, by stage at diagnosis, and mortality in 21 European countries in the era of mammography screening: an international population-based study","authors":"Rafael Cardoso ,&nbsp;Idris Ola ,&nbsp;Lina Jansen ,&nbsp;Monika Hackl ,&nbsp;Petra Ihle ,&nbsp;Julie Francart ,&nbsp;Nancy Van Damme ,&nbsp;Zdravka Valerianova ,&nbsp;Trayan Atanasov ,&nbsp;Ondřej Májek ,&nbsp;Ondřej Ngo ,&nbsp;Kaire Innos ,&nbsp;Margit Mägi ,&nbsp;Sandrine Dabakuyo Yonli ,&nbsp;Anne-Sophie Woronoff ,&nbsp;Brigitte Tretarre ,&nbsp;Florence Poncet ,&nbsp;Alexander Katalinic ,&nbsp;Paul M. Walsh ,&nbsp;Ieva Vincerževskienė ,&nbsp;Hermann Brenner","doi":"10.1016/j.lanepe.2025.101574","DOIUrl":"10.1016/j.lanepe.2025.101574","url":null,"abstract":"<div><h3>Background</h3><div>Mammography screening programmes have been widely implemented across European countries over the past 40 years with the main aim to detect breast cancer earlier and thereby reduce breast cancer mortality. This study aimed to analyse and compare changes over time in breast cancer incidence, by stage at diagnosis, and breast cancer mortality across countries in relation to the timing of screening implementation and age at diagnosis.</div></div><div><h3>Methods</h3><div>In this population-based study conducted in 21 European countries, data from cancer registries covering over 3 million female patients diagnosed with breast cancer, along with data from national statistical offices from 1978 to 2019 were analysed. Annual age-standardised breast cancer incidence rates (by stage and age at diagnosis) and age-standardised breast cancer mortality rates were calculated. Average annual percent changes (AAPCs) in these metrics within 10 years before and 10 years after screening implementation were estimated.</div></div><div><h3>Findings</h3><div>Overall, breast cancer incidence rates increased over the study period, with the largest increases observed in the first two decades (1978–1987 and 1988–1997), and AAPCs of up to 4.55 (95% confidence interval, CI, 2.56–6.57). In contrast, breast cancer mortality rates decreased most predominantly in the last two decades (1998–2007 and 2008–2018/19), with AAPCs down to −5.40 (95% CI, −9.70 to −0.89). The largest increases in incidence were seen for in situ and stage I cancers (AAPCs ranging from non-significant to 12.03 (95% CI, 7.40–16.86) following screening implementation). Incidence of stage IV cancer declined or remained stable in most countries, with AAPCs down to −6.16 (95% CI, −8.28 to −4.00) after screening introduction. These trends were particularly pronounced among age groups targeted by screening (mostly 50–69 years). Breast cancer mortality rates declined by up to 3 percent annually after screening initiation (lowest AAPC estimate −3.29 (95% CI, −6.26 to −0.23); yet, AAPCs as low as −2.54 (95% CI, −3.15 to −1.93) were also observed before introduction of screening programmes in countries where implementation occurred later, in the 2000s.</div></div><div><h3>Interpretation</h3><div>This study suggests that mammography screening has influenced trends in breast cancer incidence and mortality in European countries. The results point to the contribution of mammography screening, alongside advances in diagnostics and treatment, to the observed reductions in breast cancer mortality.</div></div><div><h3>Funding</h3><div>There was no funding source for this study.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101574"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885243","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":"Efficacy of anakinra in reducing progression to organ dysfunction in patients with pneumonia (INSPIRE): a randomised, double-blind, placebo-controlled, phase IIa trial","authors":"Georgios Tavoulareas ,&nbsp;Olga Kontakou-Zoniou ,&nbsp;Nikolaos Antonakos ,&nbsp;Elisavet Tasouli ,&nbsp;George Adamis ,&nbsp;Nikolaos Kakavoulis ,&nbsp;Evangelos Michelakis ,&nbsp;Ilias Skopelitis ,&nbsp;Konstantina Dakou ,&nbsp;Christos Psarrakis ,&nbsp;Panagiotis Koufargyris ,&nbsp;Myrto Astriti ,&nbsp;Styliani Sympardi ,&nbsp;Evangelos J. Giamarellos-Bourboulis","doi":"10.1016/j.lanepe.2025.101573","DOIUrl":"10.1016/j.lanepe.2025.101573","url":null,"abstract":"<div><h3>Background</h3><div>Early recognition of risk of death in pneumonia and start of precision immunotherapy to improve outcomes is an unmet need. We hypothesized that a precision strategy approach combining early recognition of interleukin (IL)-1 activation coupled with Anakinra treatment may improve pneumonia outcome.</div></div><div><h3>Methods</h3><div>INSPIRE is a prospective, double-blind randomized placebo-controlled trial which recruited hospitalized adults with community-acquired or hospital-acquired pneumonia, with qSOFA (quick sequential organ failure assessment) equal to 1 and plasma presepsin (soluble CD14) more than 350 pg/ml. Patients were 1:1 randomised to standard-of-care medication plus either subcutaneous placebo or subcutaneous Anakinra 100 mg once daily for 10 days. The primary endpoint was progression into organ dysfunction defined as meeting at least one of the following two conditions; (i) at least 2-point increase of the baseline SOFA score by day 7 and/or (ii) death by day 90. This was analyzed in the intention-to-treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2022-002390-28) and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT05785442</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Patients were enrolled between March 2023 and June 2024; 30 patients in the placebo arm and 30 patients in the Anakinra arm were the ITT population. The primary endpoint was met in 50·0% (15 patients) of placebo-treated and in 20·0% (6 patients) of Anakinra-treated patients (difference 30·0% [5·9 to 49%]; p: 0·011). 90-day mortality was 43·3% (13 patients) and 20·0% (6 patients) (difference 23·3% [0 to 43·7%]; p: 0·029). The overall incidence of serious treatment-emergent adverse events (TEAEs) in the placebo group was 50% and in the Anakinra group 33·3%. None of the serious TEAEs was judged to be related to treatment assignment. Production of TNFα and ΙFNγ by blood mononuclear cells was decreased.</div></div><div><h3>Interpretation</h3><div>Presepsin-guided Anakinra treatment prevents progression of pneumonia to organ dysfunction and death. The mechanism of benefit is associated with attenuation of cytokine production.</div></div><div><h3>Funding</h3><div><span>Hellenic Institute for the Study of Sepsis</span>; <span>PHC Europe BV</span>; <span>Swedish Orphan Biovitrum AB</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101573"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885245","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":"Long-term effect of discontinuing anticholinesterase treatment on cognitive decline and mortality in Alzheimer's disease in France: a quasi-experiment and target trial emulation study","authors":"Simon Lecerf ,&nbsp;Octave Guinebretiere ,&nbsp;Raphaël Bentegeac ,&nbsp;Victoria Gauthier ,&nbsp;Estelle Aymes ,&nbsp;Chaymae Mekkaoui ,&nbsp;Julien Dumurgier ,&nbsp;Philippe Amouyel ,&nbsp;Stanley Durrleman ,&nbsp;Thomas Nedelec ,&nbsp;Thibaud Lebouvier","doi":"10.1016/j.lanepe.2026.101607","DOIUrl":"10.1016/j.lanepe.2026.101607","url":null,"abstract":"<div><h3>Background</h3><div>In 2018, France withdrew reimbursement for cholinesterase inhibitors (ChEIs) in Alzheimer's disease, citing modest efficacy, lack of long-term benefit, and safety concerns. This policy shift provided a unique opportunity to assess ChEI effectiveness in real-world settings, by evaluating, among patients treated with ChEI between 01/08/2017 and 01/08/2018, the impact of treatment discontinuation on cognitive decline (MMSE score) and survival.</div></div><div><h3>Methods</h3><div>Using the French National Alzheimer's Database (BNA) and Meotis databases, we emulated a pragmatic, intention-to-treat trial comparing patients who discontinued ChEIs after delisting to those who continued treatment, under quasi-experimental conditions. To model cognitive trajectories, we used the inverse probability treatment-weighted (IPTW) cohort and applied mixed-effects models with random intercepts across all follow-up visits. Survival was estimated with a pooled logistic regression including treatment group, follow-up time, and an interaction between treatment and time.</div></div><div><h3>Findings</h3><div>The mean difference in MMSE decline between discontinuers and continuers after one year was 0·97 points (95% CI 0·68–1·27, <em>p</em> &lt; 0·001), reaching 1·81 points (0·91–2·71, <em>p</em> &lt; 0·001), after four years. No significant difference in mortality (RR 1·10, 95% CI [0·95–1·29]) was observed over a five-year period.</div></div><div><h3>Interpretation</h3><div>Our findings confirm and extend prior trials by demonstrating the sustained cognitive benefits of ChEIs in a real-world setting. While acknowledging the limitations associated with its retrospective nature, our study argues for reconsidering the 2018 delisting decision, as ChEIs remain safe and clinically relevant for mild-to-moderate Alzheimer's disease.</div></div><div><h3>Funding</h3><div>This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101607"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188213","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":"Development and validation of the NEOS2 score for prediction of long-term outcomes and improvement after first-line immunotherapy in patients with anti-NMDAR encephalitis: an international cohort study","authors":"Juliette Brenner ,&nbsp;Anna E.M. Bastiaansen ,&nbsp;Mar Guasp ,&nbsp;Sergio Muñiz-Castrillo ,&nbsp;Takahiro Iizuka ,&nbsp;Marienke A.A.M. de Bruijn ,&nbsp;Amaia Muñoz-Lopetegi ,&nbsp;Eugenia Martínez-Hernández ,&nbsp;Géraldine Picard ,&nbsp;Alberto Vogrig ,&nbsp;Mathilde Millot ,&nbsp;Carsten Finke ,&nbsp;Christian Geis ,&nbsp;Jan Lewerenz ,&nbsp;Nico Melzer ,&nbsp;Harald Prüss ,&nbsp;Saskia Räuber ,&nbsp;Marius Ringelstein ,&nbsp;Kevin Rostàsy ,&nbsp;Kurt-Wolfram Sühs ,&nbsp;Maarten J. Titulaer","doi":"10.1016/j.lanepe.2025.101562","DOIUrl":"10.1016/j.lanepe.2025.101562","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Anti-N-methyl-&lt;span&gt;d&lt;/span&gt;-aspartate receptor (anti-NMDAR) encephalitis is a severe disease that primarily affects young people and can improve with adequate treatment. We aimed to refine the anti-NMDAR Encephalitis One-year functional Status (NEOS) score by developing NEOS2, an updated model using readily available data at the time of diagnosis. We assessed the predictive value of the NEOS2-score for (1) improvement following first-line treatment, (2) functional outcome at one-year follow-up, and (3) resumption of school or work within three years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this international (France, Germany, Japan, the Netherlands and Spain) cohort study in patients with a definite anti-NMDAR encephalitis diagnosis (according to the clinical criteria plus antibody testing in CSF), we performed logistic regression analyses to develop and validate multivariable models to predict -based upon variables available at diagnosis- short (ΔmRS two weeks after first-line treatment), middle (modified Rankin Scale [mRS] at one year), and long-term (return to school or work within three years) outcomes. We included clinical variables and biomarkers available at diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;We included 702 patients (mean age 23 years, 95%-CI 2–69; 79% female, 21% male) diagnosed between the discovery of the disease in 2007 and 2022. Most patients (96%; 672/702) had received first-line immunotherapy, and 38% (233/615) showed improvement within two weeks. One year after diagnosis, 80% (517/644) had a favourable functional outcome (mRS≤2). At three years, 73% (203/278) had resumed work/school. In multivariable analysis, higher age (odds ratio [OR] 0·35, 95%-CI 0·29–0·43, p &lt; 0·0001), treatment delay (OR 0·49, 95%-CI 0·41–0·58, p &lt; 0·0001), movement disorders (OR 0·32, 95%-CI 0·24–0·41, p &lt; 0·0001), ICU-requirement (OR 0·34, 95%-CI 0·26–0·44, p &lt; 0·0001) and increased CSF leucocyte count (OR 0·65, 95%-CI 0·60–0·71, p &lt; 0·0001) independently predicted poorer outcomes (NEOS2, accuracy AUC 80%, 95%-CI 75–86%). The same variables, excluding age, were relevant in predicting improvement following first-line immunotherapy (NEOS2-T AUC 81–84%, 95%-CI 77–86%). Return-to-work or -school served as a useful measure of longer-term outcomes, predicted with equal accuracy as one-year functional outcome (NEOS2-W AUC 80%, 95%-CI 75–85%). The NEOS2-score, applied as an ordinal measure, enabled nuanced predictions of outcome probabilities across the score spectrum, ranging from a high (80%; n = 20/25) likelihood of improving after first-line immunotherapy and achieving a good outcome (100%; n = 32/32) to a high risk of first-line treatment failure (97%; n = 77/79) and no return to school/work (94%; n = 15/16).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The NEOS2-score, readily available at diagnosis and easy to apply, can identify patients with either a favourable or poor prognosis, and those who may ","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101562"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749855","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}