Pub Date : 2024-11-18DOI: 10.1016/s0140-6736(24)02439-5
Victor M Aguayo, Pia R Britto
No Abstract
无摘要
{"title":"The first and next 1000 days: a continuum for child development in early life","authors":"Victor M Aguayo, Pia R Britto","doi":"10.1016/s0140-6736(24)02439-5","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02439-5","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"173 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670823","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}
Pub Date : 2024-11-18DOI: 10.1016/s0140-6736(24)01390-4
Milagros Nores, Claudia Vazquez, Emily Gustafsson-Wright, Sarah Osborne, Jorge Cuartas, Mark J Lambiris, Dana C McCoy, Florencia Lopez-Boo, Jere Behrman, Raquel Bernal, Catherine E Draper, Anthony D Okely, Mark S Tremblay, Aisha K Yousafzai, Joan Lombardi, Günther Fink
Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2–5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers. We show that a minimum package of 1 year of ECCE for all children would cost on average less than 0·15% of low-income and middle-income countries' current gross domestic product. The societal cost of not implementing this package at a national and global level (ie, the cost of inaction) is large, with an estimated forgone benefit of 8–19 times the cost of investing in ECCE. We discuss implications of the overall evidence presented in this Series for policy and practice, highlighting the potential of ECCE programming in the next 1000 days as an intervention itself, as well as a platform to deliver developmental screening, growth monitoring, and additional locally required interventions. Providing nurturing care during this period is crucial for maintaining and further boosting children's progress in the first 1000 days, and to allow children to reach optimal developmental trajectories from a socioecological life-course perspective.
{"title":"The cost of not investing in the next 1000 days: implications for policy and practice","authors":"Milagros Nores, Claudia Vazquez, Emily Gustafsson-Wright, Sarah Osborne, Jorge Cuartas, Mark J Lambiris, Dana C McCoy, Florencia Lopez-Boo, Jere Behrman, Raquel Bernal, Catherine E Draper, Anthony D Okely, Mark S Tremblay, Aisha K Yousafzai, Joan Lombardi, Günther Fink","doi":"10.1016/s0140-6736(24)01390-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01390-4","url":null,"abstract":"Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2–5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers. We show that a minimum package of 1 year of ECCE for all children would cost on average less than 0·15% of low-income and middle-income countries' current gross domestic product. The societal cost of not implementing this package at a national and global level (ie, the cost of inaction) is large, with an estimated forgone benefit of 8–19 times the cost of investing in ECCE. We discuss implications of the overall evidence presented in this Series for policy and practice, highlighting the potential of ECCE programming in the next 1000 days as an intervention itself, as well as a platform to deliver developmental screening, growth monitoring, and additional locally required interventions. Providing nurturing care during this period is crucial for maintaining and further boosting children's progress in the first 1000 days, and to allow children to reach optimal developmental trajectories from a socioecological life-course perspective.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670822","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}
Pub Date : 2024-11-14DOI: 10.1016/s0140-6736(24)01548-4
<h3>Background</h3>Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5–24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15–24 years) and adults for all 50 states and Washington, DC.<h3>Methods</h3>In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m<sup>2</sup> to less than 30 kg/m<sup>2</sup> and obesity was defined as a BMI of 30 kg/m<sup>2</sup> or higher, and for individuals younger than 18 years definitions were based on International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.<h3>Findings</h3>In 2021, an estimated 15·1 million (95% UI 13·5–16·8) children and young adolescents (aged 5–14 years), 21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male adolescents (aged 15–24 years), at 52·4% (47·4–57·6), whereas Mississippi had the highest for female adolescents (aged 15–24 years), at 63·0% (57·0–68·5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for males, estimated at 80·6% (78·5–82·6), and in Mississippi for females at 79·9% (77·8–81·8). The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9–197·4) among male adolescents and 185·9% (139·4–237·1) among female adolescents (15–24 years). For adults, the percentage change in prevalence of obesity was 123·6% (112·4–136·4) in males and 99·9% (88·
{"title":"National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990–2021, and forecasts up to 2050","authors":"","doi":"10.1016/s0140-6736(24)01548-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01548-4","url":null,"abstract":"<h3>Background</h3>Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5–24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15–24 years) and adults for all 50 states and Washington, DC.<h3>Methods</h3>In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m<sup>2</sup> to less than 30 kg/m<sup>2</sup> and obesity was defined as a BMI of 30 kg/m<sup>2</sup> or higher, and for individuals younger than 18 years definitions were based on International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.<h3>Findings</h3>In 2021, an estimated 15·1 million (95% UI 13·5–16·8) children and young adolescents (aged 5–14 years), 21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male adolescents (aged 15–24 years), at 52·4% (47·4–57·6), whereas Mississippi had the highest for female adolescents (aged 15–24 years), at 63·0% (57·0–68·5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for males, estimated at 80·6% (78·5–82·6), and in Mississippi for females at 79·9% (77·8–81·8). The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9–197·4) among male adolescents and 185·9% (139·4–237·1) among female adolescents (15–24 years). For adults, the percentage change in prevalence of obesity was 123·6% (112·4–136·4) in males and 99·9% (88·","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637716","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}
Pub Date : 2024-11-14DOI: 10.1016/s0140-6736(24)01774-4
Jeremy S Abramson, Matthew Ku, Mark Hertzberg, Hui-Qiang Huang, Christopher P Fox, Huilai Zhang, Dok Hyun Yoon, Won-Seog Kim, Haifaa Abdulhaq, William Townsend, Charles Herbaux, Jan M Zaucha, Qing-Yuan Zhang, Hung Chang, Yanyan Liu, Chan Yoon Cheah, Herve Ghesquieres, Stephen Simko, Victor Orellana-Noia, Richard Ta, Gareth P Gregory
<h3>Background</h3>Glofitamab monotherapy induces durable remission in patients with relapsed or refractory diffuse large B-cell lymphoma after two or more previous therapies, but has not previously been assessed as a second-line therapy. We investigated the efficacy and safety of glofitamab plus gemcitabine–oxaliplatin (Glofit-GemOx) versus rituximab (R)-GemOx in patients with relapsed or refractory diffuse large B-cell lymphoma.<h3>Methods</h3>The phase 3, randomised, open-label STARGLO trial was done at 62 centres in 13 countries in Asia and Australia, Europe, and North America. We recruited transplant-ineligible patients (aged ≥18 years) with histologically confirmed relapsed or refractory diffuse large B-cell lymphoma after one or more previous therapies. Patients were randomly assigned in permuted blocks (block size of six) via an interactive voice or web response system (2:1; stratified by 1 <em>vs</em> ≥2 previous lines of therapy and relapsed <em>vs</em> refractory status) to Glofit-GemOx (intravenous gemcitabine 1000 mg/m<sup>2</sup> and oxaliplatin 100 mg/m<sup>2</sup> plus glofitamab step-up dosing to 30 mg; for a total of eight cycles, plus four additional cycles of glofitamab monotherapy) or R-GemOx (intravenous gemcitabine 1000 mg/m<sup>2</sup> and oxaliplatin 100 mg/m<sup>2</sup> plus rituximab 375 mg/m<sup>2</sup>; for a total of eight cycles). The trial independent review committee, which evaluated all response-based endpoints, was masked to treatment assignment. The primary endpoint was overall survival. Efficacy analyses were by intention to treat in all randomly assigned patients. We present results from both the primary analysis (cutoff: March 29, 2023) and updated analysis after all patients had completed study therapy (cutoff: Feb 16, 2024). Safety analyses included all patients who received any study treatment. This study 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>NCT04408638</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 ongoing (closed to recruitment).<h3>Findings</h3>From Feb 23, 2021, to March 14, 2023, 274 patients were enrolled and randomly assigned to receive Glofit-GemOx (n=183) or R-GemOx (n=91). 158 (58%) patients were male and 116 (42%) were female; median age was 68 years (IQR 58–74). At the primary analysis after a median follow-up of 11·3 months (95% CI 9·6–12·7), overall survival was significantly improved with Glofit-GemOx versus R-GemOx (median not estimable [NE; 95% CI 13·8 months–NE] <em>vs</em> 9·0 months [7·3–14·4]; hazard ratio [HR] 0·59 [95% CI 0·40–0·89]; p=0·011). At the updated analysis after a medi
背景格洛菲他单抗可诱导既往接受过两种或两种以上疗法的复发或难治性弥漫大B细胞淋巴瘤患者获得持久缓解，但此前尚未将其作为二线疗法进行评估。我们研究了吉非他滨联合吉西他滨-奥沙利铂（Glofit-GemOx）与利妥昔单抗（R）-GemOx在复发或难治性弥漫大B细胞淋巴瘤患者中的疗效和安全性。我们招募了不符合移植条件的患者（年龄≥18岁），他们都是组织学确诊的复发性或难治性弥漫大B细胞淋巴瘤患者，既往接受过一种或多种疗法。1；按既往接受过1种疗法与≥2种疗法，以及复发与难治状态进行分层）分配到Glofit-GemOx（静脉注射吉西他滨1000毫克/平方米和奥沙利铂100毫克/平方米，加上格列菲他单抗，剂量增至30毫克；共8个周期，再加上4个周期的格列菲他单抗单药治疗）或R-GemOx（静脉注射吉西他滨1000毫克/平方米和奥沙利铂100毫克/平方米，加上利妥昔单抗375毫克/平方米；共8个周期）。试验独立审查委员会负责评估所有基于反应的终点，并对治疗分配进行了屏蔽。主要终点是总生存期。疗效分析对所有随机分配的患者进行意向治疗。我们展示了主要分析（截止日期：2023 年 3 月 29 日）和所有患者完成研究治疗后的更新分析（截止日期：2024 年 2 月 16 日）的结果。安全性分析包括所有接受任何研究治疗的患者。研究结果从2021年2月23日至2023年3月14日，274名患者入组并被随机分配接受Glofit-GemOx（约183人）或R-GemOx（约91人）治疗。158名患者（58%）为男性，116名患者（42%）为女性；中位年龄为68岁（IQR 58-74）。在中位随访11-3个月（95% CI 9-6-12-7）后的主要分析中，Glofit-GemOx与R-GemOx相比，总生存率显著提高（中位无法估计[NE；95% CI 13-8个月-NE]vs 9-0个月[7-3-14-4]；危险比[HR]0-59[95% CI 0-40-0-89]；P=0-011）。在中位随访20-7个月（19-9-23-3）后进行的更新分析中，观察到Glofit-GemOx与R-GemOx相比，总生存期持续改善（中位25-5个月[18-3-NE] vs 12-9个月[7-9-18-5]；HR 0-62 [0-43-0-88]）。在安全组中，Glofit-GemOx 组的 180 名（100%）患者和 R-GemOx 组 88 名患者中的 84 名（96%）患者在研究期间至少发生过一次不良事件。在172名接受格列菲坦单抗治疗的患者中，有76人（44%）出现细胞因子释放综合征，且主要为低度。与R-GemOx相比，Glofit-GemOx具有显著的总生存期获益，支持将其用于既往接受过一种或多种疗法后复发或难治的弥漫大B细胞淋巴瘤患者。
{"title":"Glofitamab plus gemcitabine and oxaliplatin (GemOx) versus rituximab-GemOx for relapsed or refractory diffuse large B-cell lymphoma (STARGLO): a global phase 3, randomised, open-label trial","authors":"Jeremy S Abramson, Matthew Ku, Mark Hertzberg, Hui-Qiang Huang, Christopher P Fox, Huilai Zhang, Dok Hyun Yoon, Won-Seog Kim, Haifaa Abdulhaq, William Townsend, Charles Herbaux, Jan M Zaucha, Qing-Yuan Zhang, Hung Chang, Yanyan Liu, Chan Yoon Cheah, Herve Ghesquieres, Stephen Simko, Victor Orellana-Noia, Richard Ta, Gareth P Gregory","doi":"10.1016/s0140-6736(24)01774-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01774-4","url":null,"abstract":"<h3>Background</h3>Glofitamab monotherapy induces durable remission in patients with relapsed or refractory diffuse large B-cell lymphoma after two or more previous therapies, but has not previously been assessed as a second-line therapy. We investigated the efficacy and safety of glofitamab plus gemcitabine–oxaliplatin (Glofit-GemOx) versus rituximab (R)-GemOx in patients with relapsed or refractory diffuse large B-cell lymphoma.<h3>Methods</h3>The phase 3, randomised, open-label STARGLO trial was done at 62 centres in 13 countries in Asia and Australia, Europe, and North America. We recruited transplant-ineligible patients (aged ≥18 years) with histologically confirmed relapsed or refractory diffuse large B-cell lymphoma after one or more previous therapies. Patients were randomly assigned in permuted blocks (block size of six) via an interactive voice or web response system (2:1; stratified by 1 <em>vs</em> ≥2 previous lines of therapy and relapsed <em>vs</em> refractory status) to Glofit-GemOx (intravenous gemcitabine 1000 mg/m<sup>2</sup> and oxaliplatin 100 mg/m<sup>2</sup> plus glofitamab step-up dosing to 30 mg; for a total of eight cycles, plus four additional cycles of glofitamab monotherapy) or R-GemOx (intravenous gemcitabine 1000 mg/m<sup>2</sup> and oxaliplatin 100 mg/m<sup>2</sup> plus rituximab 375 mg/m<sup>2</sup>; for a total of eight cycles). The trial independent review committee, which evaluated all response-based endpoints, was masked to treatment assignment. The primary endpoint was overall survival. Efficacy analyses were by intention to treat in all randomly assigned patients. We present results from both the primary analysis (cutoff: March 29, 2023) and updated analysis after all patients had completed study therapy (cutoff: Feb 16, 2024). Safety analyses included all patients who received any study treatment. This study 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>NCT04408638</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 ongoing (closed to recruitment).<h3>Findings</h3>From Feb 23, 2021, to March 14, 2023, 274 patients were enrolled and randomly assigned to receive Glofit-GemOx (n=183) or R-GemOx (n=91). 158 (58%) patients were male and 116 (42%) were female; median age was 68 years (IQR 58–74). At the primary analysis after a median follow-up of 11·3 months (95% CI 9·6–12·7), overall survival was significantly improved with Glofit-GemOx versus R-GemOx (median not estimable [NE; 95% CI 13·8 months–NE] <em>vs</em> 9·0 months [7·3–14·4]; hazard ratio [HR] 0·59 [95% CI 0·40–0·89]; p=0·011). At the updated analysis after a medi","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637730","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}
Pub Date : 2024-11-14DOI: 10.1016/s0140-6736(24)02478-4
Park S-J, Ahn J-M, Kang D-Y, et al. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. Lancet 2024; 403: 1753–65—In table 2 of this Article, the proportion of patients in the optimal medical therapy group with target-vessel-related myocardial infarction at 4 years should have been 0·9%. This correction has been made to the online version as of Nov 14, 2024.
Park S-J、Ahn J-M、Kang D-Y等：预防性经皮冠状动脉介入治疗与单纯最佳药物治疗治疗易损冠状动脉粥样硬化斑块（PREVENT）：一项多中心、开放标签、随机对照试验。Lancet 2024; 403: 1753-65-在本文表2中，最佳药物治疗组中4年后发生靶血管相关心肌梗死的患者比例应为0-9%。截至2024年11月14日的在线版本已作此更正。
{"title":"Department of Error","authors":"","doi":"10.1016/s0140-6736(24)02478-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02478-4","url":null,"abstract":"<em>Park S-J, Ahn J-M, Kang D-Y, et al. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial</em>. Lancet <em>2024; <strong>403:</strong> 1753–65</em>—In table 2 of this Article, the proportion of patients in the optimal medical therapy group with target-vessel-related myocardial infarction at 4 years should have been 0·9%. This correction has been made to the online version as of Nov 14, 2024.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637729","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}
Pub Date : 2024-11-14DOI: 10.1016/s0140-6736(24)01818-x
Enzo Lüsebrink, Leonhard Binzenhöfer, Marianna Adamo, Roberto Lorusso, Alexandre Mebazaa, David A Morrow, Susanna Price, Jacob C Jentzer, Daniel Brodie, Alain Combes, Holger Thiele
Cardiogenic shock is a complex syndrome defined by systemic hypoperfusion and inadequate cardiac output arising from a wide array of underlying causes. Although the understanding of cardiogenic shock epidemiology, specific subphenotypes, haemodynamics, and cardiogenic shock severity staging has evolved, few therapeutic interventions have shown survival benefit. Results from seminal randomised controlled trials support early revascularisation of the culprit vessel in infarct-related cardiogenic shock and provide evidence of improved survival with the use of temporary circulatory support in selected patients. However, numerous questions remain unanswered, including optimal pharmacotherapy regimens, the role of mechanical circulatory support devices, management of secondary organ dysfunction, and best supportive care. This Review summarises current definitions, pathophysiological principles, and management approaches in cardiogenic shock, and highlights key knowledge gaps to advance individualised shock therapy and the evidence-based ethical use of modern technology and resources in cardiogenic shock.
{"title":"Cardiogenic shock","authors":"Enzo Lüsebrink, Leonhard Binzenhöfer, Marianna Adamo, Roberto Lorusso, Alexandre Mebazaa, David A Morrow, Susanna Price, Jacob C Jentzer, Daniel Brodie, Alain Combes, Holger Thiele","doi":"10.1016/s0140-6736(24)01818-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01818-x","url":null,"abstract":"Cardiogenic shock is a complex syndrome defined by systemic hypoperfusion and inadequate cardiac output arising from a wide array of underlying causes. Although the understanding of cardiogenic shock epidemiology, specific subphenotypes, haemodynamics, and cardiogenic shock severity staging has evolved, few therapeutic interventions have shown survival benefit. Results from seminal randomised controlled trials support early revascularisation of the culprit vessel in infarct-related cardiogenic shock and provide evidence of improved survival with the use of temporary circulatory support in selected patients. However, numerous questions remain unanswered, including optimal pharmacotherapy regimens, the role of mechanical circulatory support devices, management of secondary organ dysfunction, and best supportive care. This Review summarises current definitions, pathophysiological principles, and management approaches in cardiogenic shock, and highlights key knowledge gaps to advance individualised shock therapy and the evidence-based ethical use of modern technology and resources in cardiogenic shock.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637733","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}
Pub Date : 2024-11-14DOI: 10.1016/s0140-6736(24)02472-3
Gabriel Weston
No Abstract
无摘要
{"title":"Rewriting the female body | Elizabeth Comen, All in Her Head: The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today, Harper Wave/HarperCollins (2024), p. 368, US$32·00, ISBN: 9780063293014","authors":"Gabriel Weston","doi":"10.1016/s0140-6736(24)02472-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02472-3","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637862","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}
Pub Date : 2024-11-14DOI: 10.1016/s0140-6736(24)02518-2
No Abstract
无摘要
{"title":"Trump, health, science, and the next 4 years","authors":"","doi":"10.1016/s0140-6736(24)02518-2","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02518-2","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637715","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：