Pub Date : 2025-02-27DOI: 10.1016/s0140-6736(24)02851-4
Holger Thiele, Jacob Eifer Møller, Jose P S Henriques, Uwe Zeymer, Christian Hassager
No Abstract
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Pub Date : 2025-02-27DOI: 10.1016/s0140-6736(24)02139-1
Pratima Chowdary, Manuel Carcao, Gili Kenet, Steven W Pipe
Haemophilia A and B are congenital X-linked bleeding disorders resulting from deficiencies in clotting factors VIII (haemophilia A) and IX (haemophilia B). Patients with severe deficiency, defined as having less than 1% of normal plasma factor activivity, often have spontaneous bleeding within the first few years of life. Those with moderate and mild deficiencies typically present with post-traumatic or post-surgical bleeding later in life. A high index of suspicion and measurement of factor activity in plasma facilitates early diagnosis. In the 21st century, therapeutic advances and comprehensive care have substantially improved both mortality and morbidity associated with these conditions. Management strategies for haemophilia include on-demand treatment for bleeding episodes and all surgeries and regular treatment (ie, prophylaxis) aimed at reducing bleeds, morbidity, and mortality, thereby enhancing quality of life. Treatment options include factor replacement therapy, non-replacement therapies that increase thrombin generation, and gene therapies that facilitate in vivo clotting factor synthesis. The therapies differ in their use for prophylaxis and on-demand treatment, the mode and frequency of administration, duration of treatment effect, degree of haemostatic protection, and side-effects. Monitoring the effectiveness of these prophylactic therapies involves assessing annual bleeding rates and joint damage. Personalised management strategies, which align treatment with individual goals (eg, playing competitive sports), initiated at diagnosis and maintained throughout the lifespan, are crucial for optimal outcomes. These strategies are facilitated by a multidisciplinary team and supported by clinician-led education for both clinicians and patients.
{"title":"Haemophilia","authors":"Pratima Chowdary, Manuel Carcao, Gili Kenet, Steven W Pipe","doi":"10.1016/s0140-6736(24)02139-1","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02139-1","url":null,"abstract":"Haemophilia A and B are congenital X-linked bleeding disorders resulting from deficiencies in clotting factors VIII (haemophilia A) and IX (haemophilia B). Patients with severe deficiency, defined as having less than 1% of normal plasma factor activivity, often have spontaneous bleeding within the first few years of life. Those with moderate and mild deficiencies typically present with post-traumatic or post-surgical bleeding later in life. A high index of suspicion and measurement of factor activity in plasma facilitates early diagnosis. In the 21st century, therapeutic advances and comprehensive care have substantially improved both mortality and morbidity associated with these conditions. Management strategies for haemophilia include on-demand treatment for bleeding episodes and all surgeries and regular treatment (ie, prophylaxis) aimed at reducing bleeds, morbidity, and mortality, thereby enhancing quality of life. Treatment options include factor replacement therapy, non-replacement therapies that increase thrombin generation, and gene therapies that facilitate in vivo clotting factor synthesis. The therapies differ in their use for prophylaxis and on-demand treatment, the mode and frequency of administration, duration of treatment effect, degree of haemostatic protection, and side-effects. Monitoring the effectiveness of these prophylactic therapies involves assessing annual bleeding rates and joint damage. Personalised management strategies, which align treatment with individual goals (eg, playing competitive sports), initiated at diagnosis and maintained throughout the lifespan, are crucial for optimal outcomes. These strategies are facilitated by a multidisciplinary team and supported by clinician-led education for both clinicians and patients.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"35 8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518181","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 : 2025-02-27DOI: 10.1016/s0140-6736(24)02811-3
<h3>Background</h3>The WHO Global Oral Health Action Plan has set an overarching global target of achieving a 10% reduction in the prevalence of oral conditions by 2030. Robust and up-to-date information on the global burden of oral conditions is paramount to monitor progress towards this target. The aim of this systematic data analysis was to produce global, WHO region, and country-level estimates of the prevalence of, and disability-adjusted life-years (DALYs) attributed to, untreated caries, severe periodontitis, edentulism, other oral disorders, lip and oral cavity cancer, and orofacial clefts from 1990 to 2021.<h3>Methods</h3>This report is based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Input data were extracted from epidemiological surveys, population-based registries, and vital statistics. Data were modelled with DisMod-MR 2.1, a Bayesian meta-regression modelling tool, to ensure consistency between prevalence, incidence, remission, and mortality estimates for oral conditions. DALYs were estimated as the aggregation of the years of life lost (YLLs) due to premature mortality and years lived with disability (YLDs). YLDs were calculated by multiplying prevalence estimates, the severity of the oral condition's sequelae (disability weight) and duration of the sequelae. Although all oral conditions lead to YLDs, only lip and oral cavity cancer and orofacial clefts lead to YLLs as well. 95% uncertainty intervals (UIs) were generated for every metric with the 25th and 975th ordered 1000 draw values of the posterior distribution.<h3>Findings</h3>The combined global age-standardised prevalence of the main oral conditions (untreated caries, severe periodontitis, edentulism, and other oral disorders) was 45 900 (95% UI 42 300 to 49 800) per 100 000 population in 2021, with 3·69 billion (3·40 to 4·00) people affected globally. Untreated dental caries of permanent teeth and severe periodontitis were the most common oral conditions, with a global age-standardised prevalence of 27 500 (24 000 to 32 000) per 100 000 population and 12 500 (10 500 to 14 500) per 100 000 population, respectively. Edentulism, severe periodontitis, and lip and oral cavity cancer caused the highest burden as demonstrated by their counts of DALYs and age-standardised DALY rates. Existing trends for 1990–2021 reveal relatively small changes (upward or downward) in prevalence and burden. Increasing counts of prevalent cases and DALYs were noted for all oral conditions but untreated caries of deciduous teeth (no percentage change in prevalence or DALYs) and orofacial clefts (–68·3% [–79·3 to –46·5] decrease in DALYs). There were decreases in both age-standardised prevalence and DALY rate for untreated caries of permanent teeth and edentulism, no change in both for untreated caries of deciduous teeth and severe periodontitis, an increase in the prevalence but no change in the DALY rate for lip and oral cavity cancer, and no change in the prevale
{"title":"Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/s0140-6736(24)02811-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02811-3","url":null,"abstract":"<h3>Background</h3>The WHO Global Oral Health Action Plan has set an overarching global target of achieving a 10% reduction in the prevalence of oral conditions by 2030. Robust and up-to-date information on the global burden of oral conditions is paramount to monitor progress towards this target. The aim of this systematic data analysis was to produce global, WHO region, and country-level estimates of the prevalence of, and disability-adjusted life-years (DALYs) attributed to, untreated caries, severe periodontitis, edentulism, other oral disorders, lip and oral cavity cancer, and orofacial clefts from 1990 to 2021.<h3>Methods</h3>This report is based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Input data were extracted from epidemiological surveys, population-based registries, and vital statistics. Data were modelled with DisMod-MR 2.1, a Bayesian meta-regression modelling tool, to ensure consistency between prevalence, incidence, remission, and mortality estimates for oral conditions. DALYs were estimated as the aggregation of the years of life lost (YLLs) due to premature mortality and years lived with disability (YLDs). YLDs were calculated by multiplying prevalence estimates, the severity of the oral condition's sequelae (disability weight) and duration of the sequelae. Although all oral conditions lead to YLDs, only lip and oral cavity cancer and orofacial clefts lead to YLLs as well. 95% uncertainty intervals (UIs) were generated for every metric with the 25th and 975th ordered 1000 draw values of the posterior distribution.<h3>Findings</h3>The combined global age-standardised prevalence of the main oral conditions (untreated caries, severe periodontitis, edentulism, and other oral disorders) was 45 900 (95% UI 42 300 to 49 800) per 100 000 population in 2021, with 3·69 billion (3·40 to 4·00) people affected globally. Untreated dental caries of permanent teeth and severe periodontitis were the most common oral conditions, with a global age-standardised prevalence of 27 500 (24 000 to 32 000) per 100 000 population and 12 500 (10 500 to 14 500) per 100 000 population, respectively. Edentulism, severe periodontitis, and lip and oral cavity cancer caused the highest burden as demonstrated by their counts of DALYs and age-standardised DALY rates. Existing trends for 1990–2021 reveal relatively small changes (upward or downward) in prevalence and burden. Increasing counts of prevalent cases and DALYs were noted for all oral conditions but untreated caries of deciduous teeth (no percentage change in prevalence or DALYs) and orofacial clefts (–68·3% [–79·3 to –46·5] decrease in DALYs). There were decreases in both age-standardised prevalence and DALY rate for untreated caries of permanent teeth and edentulism, no change in both for untreated caries of deciduous teeth and severe periodontitis, an increase in the prevalence but no change in the DALY rate for lip and oral cavity cancer, and no change in the prevale","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517791","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 : 2025-02-27DOI: 10.1016/s0140-6736(25)00039-x
Daniel J Baker, Bruce L Levine, Carl H June
Section snippets
Contributors
DJB led the conceptualisation and writing of the original draft. All authors provided comments and edits of subsequent drafts. All authors approved the final manuscript and had final responsibility for the decision to submit for publication.
Declaration of interests
BLL is an inventor on patents or has patent applications licensed to Novartis Institutes of Biomedical Research and Kite Pharma and receives licence revenue from such licences; is a scientific founder of Tmunity Therapeutics and Capstan Therapeutics; and is a member of the scientific advisory boards of Avectas, Capstan Therapeutics, Cellula Therapeutics, Immuneel Therapeutics, Immusoft, In8bio, Kite Gilead, Ori Biotech, Oxford Biomedica, ThermoFisher Pharma Services, and UTC Therapeutics. CHJ
Acknowledgments
This work was supported by the Centurion Foundation Innovation Fund (1P01CA214278, R01CA226983) and the Parker Institute for Cancer Immunotherapy. The funders had no role in the writing of the manuscript or the decision to submit for publication.
{"title":"Assessing the oncogenic risk: the long-term safety of autologous chimeric antigen receptor T cells","authors":"Daniel J Baker, Bruce L Levine, Carl H June","doi":"10.1016/s0140-6736(25)00039-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)00039-x","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Contributors</h2>DJB led the conceptualisation and writing of the original draft. All authors provided comments and edits of subsequent drafts. All authors approved the final manuscript and had final responsibility for the decision to submit for publication.</section></section><section><section><h2>Declaration of interests</h2>BLL is an inventor on patents or has patent applications licensed to Novartis Institutes of Biomedical Research and Kite Pharma and receives licence revenue from such licences; is a scientific founder of Tmunity Therapeutics and Capstan Therapeutics; and is a member of the scientific advisory boards of Avectas, Capstan Therapeutics, Cellula Therapeutics, Immuneel Therapeutics, Immusoft, In8bio, Kite Gilead, Ori Biotech, Oxford Biomedica, ThermoFisher Pharma Services, and UTC Therapeutics. CHJ</section></section><section><section><h2>Acknowledgments</h2>This work was supported by the Centurion Foundation Innovation Fund (1P01CA214278, R01CA226983) and the Parker Institute for Cancer Immunotherapy. The funders had no role in the writing of the manuscript or the decision to submit for publication.</section></section>","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518182","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 : 2025-02-27DOI: 10.1016/s0140-6736(25)00399-x
Talha Burki
No Abstract
无摘要
{"title":"The medicine of…film and television","authors":"Talha Burki","doi":"10.1016/s0140-6736(25)00399-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(25)00399-x","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517796","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 : 2025-02-27DOI: 10.1016/s0140-6736(24)02843-5
Nazir I Lone, John A Masterson, Swagata Tripathy
No Abstract
{"title":"Understanding the scale of critical illness in Africa and the need for universal access to emergency and critical care","authors":"Nazir I Lone, John A Masterson, Swagata Tripathy","doi":"10.1016/s0140-6736(24)02843-5","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02843-5","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"85 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517794","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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