2010 Feb 27 - Dilated cardiomyopathy

John Lynn Jefferies MD a, Prof Jeffrey A Towbin MD b. The Lancet, Volume 375, Issue 9716, Pages 752 - 762, 27 February 2010
Dilated cardiomyopathy is characterised by left ventricular dilation that is associated with systolic dysfunction. Diastolic dysfunction and impaired right ventricular function can develop.

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2010 Feb 27 - Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial

Prof Hans Erik Bøtker MD a , Rajesh Kharbanda MD d, Michael R Schmidt MD a, Morten Bøttcher MD a, Anne K Kaltoft MD a, Christian J Terkelsen MD a, Kim Munk MD a, Niels H Andersen MD a, Troels M Hansen MD e, Sven Trautner MD f, Jens Flensted Lassen MD a, Evald Høj Christiansen MD a, Lars R Krusell MD a, Steen D Kristensen MD a, Leif Thuesen MD a, Søren S Nielsen MD b, Michael Rehling MD b, Prof Henrik Toft Sørensen MD c, Prof Andrew N Redington MD g, Prof Torsten T Nielsen MD a. The Lancet, Volume 375, Issue 9716, Pages 727 - 734, 27 February 2010
Background
Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty. We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infarction, and done before primary percutaneous coronary intervention, increases myocardial salvage.

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2010 Mar - Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data

Diederik van de Beek MD a, Jeremy J Farrar FRCP d e h , Jan de Gans MD a, Nguyen Thi Hoang Mai MD d, Elizabeth M Molyneux FRCPCH f, Heikki Peltola MD g, Tim E Peto FRCP j, Irmeli Roine MD k, Mathew Scarborough MD f i, Constance Schultsz MD b e, Guy E Thwaites MRCP l, Phung Quoc Tuan MD d e, AH Zwinderman PhD c. The Lancet Neurology, Volume 9, Issue 3, Pages 254 - 263, March 2010

Background
Dexamethasone improves outcome for some patients with bacterial meningitis, but not others. We aimed to identify which patients are most likely to benefit from dexamethasone treatment.

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2010 Feb 20 - Biological, clinical, and ethical advances of placebo effects

Dr Damien G Finniss MSc [Med] a , Ted J Kaptchuk b, Franklin Miller PhD c, Prof Fabrizio Benedetti MD d. The Lancet, Volume 375, Issue 9715, Pages 686 - 695, 20 February 2010

For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings.

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2010 Feb 17 - Lancet Comment: Dialysis dose in acute kidney injury and chronic dialysis

Andrew Davenport a, Ken Farrington b. The Lancet, Early Online Publication, 17 February 2010doi:10.1016/S0140-6736(09)62062-6Cite or Link Using DOI
The major function of the kidneys is to remove metabolic waste products. Patients with acute kidney injury, especially in the context of multiple-organ failure, are often highly catabolic, and hence have increased production of such waste products. This fact led to the idea that survival of such patients might be improved by increased removal of these toxins by renal replacement therapy. Two multicentre randomised trials that were designed to investigate the effect of dose of renal replacement t ...

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2010 Feb 13 - Lancet Correspondence: Ventilatory support versus ECMO for severe adult respiratory failure

Lancet, Feb 13, 2010, Volume 375, Number 9714, Pages 549 - 551
Thilo Busch, Sven Laudi, Udo Kaisers: Giles Peek and colleagues (Oct 17, p 1351)1 report an improved outcome in patients with severe acute respiratory failure who were treated in one centre according to a management protocol based on extracorporeal membrane oxygenation (ECMO) when compared with conventional therapy in less specialised hospitals. .....
Jayant S Jainandunsing, Farouq Ismael: Giles Peek and colleagues1 describe the beneficial effects of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome. ....
Thomas Bein, Bernhard Graf, Steffen Weber-Carstens: We congratulate Giles Peek and co-workers1 for successfully doing a study of the effect on survival of extracorporeal membrane oxygenation (ECMO) in patients with severe lung failure. .....
Andrew Jones, Nicholas Barrett, Damon Scales, Richard Beale: We congratulate the authors of the CESAR study1 on their considerable achievement. ....

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2010 Feb - Lancet Seminar: Pulmonary Embolism in Pregnancy

Dr Ghada Bourjeily MD a , Michael Paidas MD c, Hanan Khalil MD b, Prof Karen Rosene-Montella MD a, Marc Rodger MD d. The Lancet, Volume 375, Issue 9713, Pages 500 - 512, 6 February 2010
Pulmonary embolism (PE) is the leading cause of maternal mortality in the developed world. Mortality from PE in pregnancy might be related to challenges in targeting the right population for prevention, ensuring that diagnosis is suspected and adequately investigated, and initiating timely and best possible treatment of this disease.

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2010 Feb - Review: Role of acute infection in triggering acute coronary syndromes

Vicente F Corrales-Medina MD a, Mohammad Madjid MD b e f, Prof Daniel M Musher MD b c d The Lancet Infectious Diseases, Volume 10, Issue 2, Pages 83 - 92, February 2010
Acute coronary syndromes are a leading cause of morbidity and mortality worldwide. The mechanisms underlying the triggering of these events are diverse and include increased coronary and systemic inflammatory activity, dominant prothrombotic conditions, increased biomechanical stress on coronary arteries, variations in the coronary arterial tone, disturbed haemodynamic homoeostasis, and altered myocardial metabolic balance.

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2010 Jan 29 - A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial

Dr Thomas Strøm MD a , Prof Torben Martinussen PhD b, Prof Palle Toft DMSc a. The Lancet, Early Online Publication, 29 January 2010
Background
Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation. We aimed to establish whether duration of mechanical ventilation could be reduced with a protocol of no sedation versus daily interruption of sedation.

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2010 Jan 23 - Lancet Comment: Will procalcitonin reduce antibiotic use in intensive care?

Marin H Kollef. The Lancet, Early Online Publication, 23 January 2010
The Lancet today, Lila Bouadma and colleagues 1 report the results of the PRORATA trial. These investigators assessed the effect of a procalcitonin-guided algorithm on the duration of antimicrobial therapy in critically ill patients. The main findings were that patients in the procalcitonin group had significantly more antibiotic-free days than did those in the control group, who were managed according to present practices. Mortality, relapsing infection, and days free of mechanical ventilation d ...

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2010 Jan 23 - Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial

Lila Bouadma MD a, Charles-Edouard Luyt MD e, Florence Tubach MD b, Christophe Cracco MD f, Antonio Alvarez MD g, Carole Schwebel MD h, Frédérique Schortgen MD i, Sigismond Lasocki MD c, Prof Benoît Veber MD j, Monique Dehoux MD d, Maguy Bernard MD k, Blandine Pasquet MS b, Prof Bernard Régnier MD a, Prof Christian Brun-Buisson MD i, Prof Jean Chastre MD e *, Prof Michel Wolff MD a *, for the PRORATA trial group† The Lancet, Early Online Publication, 23 January 2010
Background
Reduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units. We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting.

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2010 Jan 23 - Clinical Picture: Impaled head

Martin Missmann MD a, Thomas Tauscher MD b, Siegfried Jank MD a, Frank Kloss MD a, Prof Robert Gassner MD a The Lancet, Volume 375, Issue 9711, Page 317, 23 January 2010
Although case reports of trauma describe single events only, they can contain very useful scientific information for applied surgery. The portrait of Gregor Baci from the collection of Archduke Ferdinand II of Austria (figure A) provokes the question: is the legend that Baci survived a piercing injury with a lance only a myth, or does medical fact indicate that such severe impalement of the head and neck can be survived?

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2010 Jan 16 - Lancet Viewpoint: Adjustment of dosing of antimicrobial agents for bodyweight in adults

Dr Matthew E Falagas MD a b c , Drosos E Karageorgopoulos MD a. The Lancet, Volume 375, Issue 9710, Pages 248 - 251, 16 January 2010
Advances in molecular biology have given rise to the disciplines of pharmacogenomics and pharmacoproteomics and have created the appealing possibility of individual patient-tailored drug therapy. 1

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2010 Jan 14 - Lancet Comment: Ticagrelor in ACS: redefining a new standard of care?

Gregg W Stone. The Lancet, Early Online Publication, 14 January 2010
Tremendous progress has been achieved over the past decade in the treatment of acute coronary syndromes (ST-segment elevation myocardial infarction [STEMI ] , non-STEMI [NSTEMI ] , and unstable angina). 

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2010 Jan 14 - Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study

Dr Christopher P Cannon MD a , Prof Robert A Harrington MD b, Stefan James MD c, Diego Ardissino MD d, Prof Richard C Becker MD b, Håkan Emanuelsson MD e, Steen Husted MD g, Prof Hugo Katus MD h, Prof Matyas Keltai MD i, Nardev S Khurmi MD f, Frederic Kontny MD j, Prof Basil S Lewis MD k, Prof Philippe Gabriel Steg MD l, Robert F Storey MD m, Daniel Wojdyla MSc b, Prof Lars Wallentin MD c, for the PLATelet inhibition and patient Outcomes (PLATO) investigators. The Lancet, Early Online Publication, 14 January 2010

Figure. Structure of Ticagrelor
Background
Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients.

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2010 Jan 2 - Lancet Viewpoint: The Global Snake Bite Initiative: an antidote for snake bite

David Williams BSc a b , José María Gutiérrez PhD c, Robert Harrison PhD d, Prof David A Warrell FMedSci a e, Julian White MD f, Kenneth D Winkel PhD a, Prof Ponnampalam Gopalakrishnakone DSc g, on behalf of the Global Snake Bite Initiative Working GroupInternational Society on Toxinology. The Lancet, Volume 375, Issue 9708, Pages 89 - 91, 2 January 2010
Clinicians have for a long time witnessed the tragedy of injury, disability, and death from snake bite that is a daily occurrence in many parts of Africa, Asia, and Latin America. To many people living in these regions, including some of the world's poorest communities, snake bite is an ever present occupational risk and environmental hazard, an additional penalty of poverty. Like malaria, dengue, tuberculosis, and parasitic diseases, the risk of snake bite is always present. Unlike many of thes ...

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2010 Jan 2: Lancet Seminar: Snake bite

Prof David A Warrell FMedSci. The Lancet, Volume 375, Issue 9708, Pages 77 - 88, 2 January 2010

Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. Its public health importance has been largely ignored by medical science. Snake venoms are rich in protein and peptide toxins that have specificity for a wide range of tissue receptors, making them clinically challenging and scientifically fascinating, especially for drug design.

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2010 Jan - Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum β-lactamase producing, Enterobacteriaceae infections: a systematic review

Dr Matthew E Falagas DSc a b c , Antonia C Kastoris MD a, Anastasios M Kapaskelis MD a b, Drosos E Karageorgopoulos MD a. The Lancet Infectious Diseases, Volume 10, Issue 1, Pages 43 - 50, January 2010
Rising rates of resistance to antimicrobial drugs among Enterobacteriaceae limit the choice of reliably active forms of these drugs. We evaluated the evidence on fosfomycin as a treatment option for infections caused by members of the family Enterobacteriaceae with advanced resistance to antimicrobial drugs, including producers of extended-spectrum β-lactamase (ESBL).

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2009 Dec 17 - Lancet Comment: Incentives for organ donation: Israel's novel approach

Linda Wright a b d, Diego S Silva c d. The Lancet, Early Online Publication, 17 December 2009
In view of the global shortage of transplantable organs, 1 does an individual's willingness to accept an organ transplant create a responsibility to agree to organ donation? In The Lancet today, Jacob Lavee and colleagues 2 describe an Israeli initiative which aims to increase rates of organ donation, which are presently low, 3 and address the challenge of free riders (ie, people who are willing to take but not to give) by bestowing privileges on individuals who are willing to donate in preference to th ...

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2009 Dec 17 - Lancet Comment: New Israeli law about organ transplantation

The Lancet, Early Online Publication, 17 December 2009
Paolo Bruzzone aIn The Lancet today, Jacob Lavee and colleagues 1 describe a new law recently approved by Israel's Parliament. The law will become effective in January, 2010, and will grant donor-card holders priority in organ allocation, with the aim of increasing the number of organ donations and reducing the length of transplantation waiting lists.

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