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2421. Geospatial mapping to estimate timely access to surgical care in nine low-income and middle-income countries.
作者: Nakul P Raykar.;Alexis N Bowder.;Charles Liu.;Martha Vega.;Jong H Kim.;Gloria Boye.;Sarah L M Greenberg.;Johanna N Riesel.;Rowan D Gillies.;John G Meara.;Nobhojit Roy.
来源: Lancet. 2015年385 Suppl 2卷S16页
The Lancet Commission on Global Surgery calls for universal access to safe, affordable, and timely surgical care. Two requisite components of timely access are (1) the ability to reach a surgical provider in a given timeframe, and (2) the ability to receive appropriately prompt care from that provider. We chose a threshold of 2 h in view of its relevance in time-to-death in post-partum haemorrhage. Here, we use geospatial mapping to enumerate the percentage of a nation's population living within 2 h of a surgeon and the surgeon-to-population ratio for each provider.
2422. A qualitative study exploring contextual challenges to surgical care provision in 21 LMICs.
作者: Nakul P Raykar.;Rachel R Yorlets.;Charles Liu.;Sarah L M Greenberg.;Meera Kotagal.;Roberta Goldman.;Nobhojit Roy.;John G Meara.;Rowan D Gillies.
来源: Lancet. 2015年385 Suppl 2卷Suppl 2期S15页
Billions of people worldwide are without access to safe, affordable, and timely surgical care. The Lancet Commission on Global Surgery (LCoGS) conducted a qualitative study to understand the contextual challenges to surgical care provision in low-income and middle-income countries (LMICs), and how providers overcome them.
2423. Projections to achieve minimum surgical rate threshold: an observational study.
作者: Tarsicio Uribe-Leitz.;Micaela M Esquivel.;George Molina.;Stuart R Lipsitz.;Stéphane Verguet.;John Rose.;Stephen W Bickler.;Atul A Gawande.;Alex B Haynes.;Thomas G Weiser.
来源: Lancet. 2015年385 Suppl 2卷S14页
Recent work has indicated an increase in surgical services, especially in resource poor settings. However, the rate of growth is poorly understood and likely insufficient to meet public health needs. We previously identified a range of 4344 to 5028 operations per 100 000 population annually to be related to desirable health outcomes. From this and other evidence, the Lancet Commission on Global Surgery recommends a minimum rate of 5000 operations per 100 000 population. We evaluate rates of growth in surgery and estimate the time it will take to reach this minimum surgical rate threshold.
2424. How much surgery is enough? Aligning surgical delivery with best-performing health systems.
Surgical delivery varies 150-fold across countries. However, no direct correlation exists between surgical delivery and health outcomes, making it difficult to pinpoint a goal for surgical scale-up. We attempted to determine the amount of surgery that would be delivered worldwide, if the world aligned itself with countries providing the best health outcomes.
2425. Proposed minimum rates of surgery to support desirable health outcomes: an observational study based on four strategies.
作者: Micaela M Esquivel.;George Molina.;Tarsicio Uribe-Leitz.;Stuart R Lipsitz.;John Rose.;Stephen W Bickler.;Atul A Gawande.;Alex B Haynes.;Thomas G Weiser.
来源: Lancet. 2015年385 Suppl 2卷S12页
The global volume of surgery in 2012 is estimated at 312·9 million operations per year, but rates of surgery vary substantially. Maternal health advocates proposed minimum caesarean delivery rates for benchmarking and to improve perinatal outcomes; however, this has not been done for surgery because the association between rates of surgical care provision as a whole and population health outcomes have not been well described. We use available data to estimate minimum rates of surgery that are associated with important health indicators.
2426. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes.
作者: Thomas G Weiser.;Alex B Haynes.;George Molina.;Stuart R Lipsitz.;Micaela M Esquivel.;Tarsicio Uribe-Leitz.;Rui Fu.;Tej Azad.;Tiffany E Chao.;William R Berry.;Atul A Gawande.
来源: Lancet. 2015年385 Suppl 2卷S11页
It was previously estimated that 234·2 million operations were performed worldwide in 2004. The association between surgical rates and population health outcomes is not clear. We re-estimated global surgical volume to track changes over time and assess rates associated with healthy populations.
2427. Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis.
作者: Tracy Jackson.;Sarah Thomas.;Victoria Stabile.;Xue Han.;Matthew Shotwell.;Kelly McQueen.
来源: Lancet. 2015年385 Suppl 2卷S10页
The global burden of chronic pain and disability could be related to unmet surgical needs. This systematic review and meta-analysis aims to characterise existing data regarding the prevalence and associations of chronic pain in low-income and middle-income countries; this is essential to allow better assessment of its relationship to pre-operative and post-operative pain as emergency and essential surgical services are expanded.
2428. Surgical care needs of low-resource populations: an estimate of the prevalence of surgically treatable conditions and avoidable deaths in 48 countries.
作者: Shailvi Gupta.;Reinou S Groen.;Patrick Kyamanywa.;Emmanuel A Ameh.;Mohamed Labib.;Damian L Clarke.;Peter Donkor.;Miliard Derbew.;Rachid Sani.;Thaim B Kamara.;Sunil Shrestha.;Benedict C Nwomeh.;Sherry M Wren.;Raymond R Price.;Adam L Kushner.
来源: Lancet. 2015年385 Suppl 2卷S1页
Surgical care needs in low-resource countries are increasingly recognised as an important aspect of global health, yet data for the size of the problem are insufficient. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a population-based cluster survey previously used in Nepal, Rwanda, and Sierra Leone.
2429. Eczema and indoor environment: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 2.
作者: Teresa Tsakok.;G Weinmayr.;A Jaensch.;D P Strachan.;H C Williams.;C Flohr.; .
来源: Lancet. 2015年385 Suppl 1卷S99页
Numerous studies have reported a positive association between damp housing conditions and asthma, but little is known about indoor environmental exposures in relation to childhood eczema. We aimed to specifically investigate the effect of indoor mould and dampness on eczema risk in the International Study of Asthma and Allergies in Childhood (ISAAC).
2430. Effect of methotrexate on JAK/STAT pathway activation in myeloproliferative neoplasms.
作者: Sally Thomas.;Katherine Fisher.;John Snowden.;Sarah Danson.;Stephen Brown.;Martin Zeidler.
来源: Lancet. 2015年385 Suppl 1卷S98页
The myeloproliferative neoplasms are a group of haematological malignancies characterised by pathological activation of the JAK/STAT (Janus kinase and signal transducer and activator of transcription) intracellular signalling pathway. 50-95% of patients have an acquired mutation (JAK2V617F) causing constitutive activation of JAK2. Our aim was to find new treatments for myeloproliferative neoplasms by identifying compounds that suppress JAK/STAT pathway activation.
2431. Role of interleukin 33/ST2 axis in the immune-mediated pathogenesis of age-related macular degeneration.
作者: Sofia Theodoropoulou.;David A Copland.;Jian Liu.;Andrew D Dick.
来源: Lancet. 2015年385 Suppl 1卷S97页
Age-related macular degeneration is a leading cause of irreversible blindness. Altered immune responses drive degeneration, in response to oxidative stress and hypoxia-induced regulation of metabolism. We tested the hypothesis that toll-like receptor activation of retinal pigment epithelium and cellular metabolic switch upregulate interleukin 33, which acts through its receptor ST2 to activate both choroidal stromal fibroblasts and mast cells. By such mechanisms, the fibrosis and insidious degeneration, which we observe clinically, is accentuated.
2432. Unsupervised overnight closed loop insulin delivery during free living: analysis of randomised cross-over home studies in adults and adolescents with type 1 diabetes.
作者: Hood Thabit.;Daniela Elleri.;Lalantha Leelarathna.;Janet Allen.;Alexandra Lubina-Solomon.;Marietta Stadler.;Emma Walkinshaw.;Ahmed Iqbal.;Pratik Choudhary.;Malgorzata Wilinska.;Katharine Barnard.;Simon Heller.;Stephanie Amiel.;Mark Evans.;David Dunger.;Roman Hovorka.
来源: Lancet. 2015年385 Suppl 1卷S96页
The closed-loop system (artificial pancreas) delivers insulin in a glucose-responsive manner by the use of a control algorithm that automatically directs insulin delivery, based on real-time sensor glucose concentrations. Results from hospital-based studies have shown improved overnight glucose control and reduced risk of hypoglycaemia in type 1 diabetes. We aimed to assess whether unsupervised closed-loop systems can provide a realistic treatment option in patients with type 1 diabetes.
2433. Proteomic analysis to identify biomarkers in the primary tumour that predict response to neoadjuvant chemotherapy in liver metastases.
作者: Paul Sutton.;Jonathan Evans.;Robert Jones.;Hassan Malik.;Dale Vimalachandran.;Daniel Palmer.;Chris Goldring.;Neil Kitteringham.
来源: Lancet. 2015年385 Suppl 1卷S95页
Colorectal cancer is the fourth commonest cancer in the UK, and the second commonest cause of cancer-related death. A knowledge of the biological phenotype of colorectal liver metastases would be invaluable to inform clinical decision making; however, deriving this information from the metastatic lesions is not feasible until after resection. We aimed to use proteomic analysis to identify biomarkers in the primary tumour that predict response to neoadjuvant chemotherapy in liver metastases.
2434. Quantitative assessment of the cell surface proteome to identify novel therapeutic targets in cholangiocarcinoma.
作者: Barney Stephenson.;Neil Shimwell.;Elizabeth Humphreys.;Douglas Ward.;David Adams.;Ashley Martin.;Simon Afford.
来源: Lancet. 2015年385 Suppl 1卷S94页
Cholangiocarcinoma has a high mortality and morbidity. Median survival is less than 6 months. Surgical resection is appropriate in certain circumstances. Because distal cholangiocarcinoma is difficult to distinguish from pancreatic cancers, patients might not receive optimum therapy. Proteomics is the study of complex cellular proteins using mass spectrometry. The aim of this study was to determine the constituent proteins on the cell surface of a model of cholangiocarcinoma.
2435. The changing demographics of inpatient hospice death: population-based, cross-sectional study in England, 1993-2012.
作者: Katherine Sleeman.;Joanna Davies.;Julia Verne.;Wei Gao.;Irene Higginson.
来源: Lancet. 2015年385 Suppl 1卷S93页
The provision of good quality and equitable end-of-life care is high on the public and political agenda. Hospice is second only to home in terms of preference for place of death and scores higher than any other setting for quality of care. However, hospices have been criticised for inequality of access with respect to age, diagnosis, and socioeconomic status. We aimed to describe the demographic characteristics associated with hospice death in England, and assessed how these characteristics have changed over time.
2436. Role of a neurokinin B receptor antagonist in the regulation of ovarian function in healthy women.
Patients with loss-of-function mutation in neurokinin B (NKB) and its receptor show hypogonadotropic hypogonadism characterised by failure to progress through puberty, indicating the involvement of this newly described hypothalamic peptide in human reproduction. However the role of NKB in regulating ovarian function in adult women is unknown. We tested the hypothesis that a NKB antagonist would decrease gonadotropin secretion and inhibit folliculogenesis in healthy women.
2437. Evaluation of carotid plaque inflammation in patients with active rheumatoid arthritis using (18)F-fluorodeoxyglucose PET-CT and MRI: a pilot study.
作者: Sarah Skeoch.;Heather Williams.;Penny Cristinacce.;Paul Hockings.;Jacqueline James.;Yvonne Alexander.;John Waterton.;Ian Bruce.
来源: Lancet. 2015年385 Suppl 1卷S91页
Rheumatoid arthritis is associated with a 50% increased risk in cardiovascular mortality. Inflammation is thought to accelerate atherosclerosis and might also lead to an inflammatory rupture-prone plaque phenotype. We tested the hypothesis that patients with active rheumatoid arthritis also have carotid plaque inflammation and that plaque inflammation correlates with clinical and serological markers of inflammation.
2438. A presurgical window-of-opportunity study of metformin in obesity-driven endometrial cancer.
作者: Vanitha Sivalingam.;Rhona McVey.;Kyle Gilmour.;Saad Ali.;Chris Roberts.;Andrew Renehan.;Henry Kitchener.;Emma Crosbie.
来源: Lancet. 2015年385 Suppl 1卷S90页
Metformin use is associated with reduced cancer risk in several observational studies of patients with type 2 diabetes. Results from preclinical studies in endometrial cancer show that metformin reduces cellular proliferation by inhibition of the PI3K-AKT-mTOR pathway. We tested the hypothesis that metformin would reduce cellular proliferation in vivo in atypical endometrial hyperplasia and endometrial endometrioid adenocarcinoma.
2439. Effect of UBE2L3 genotype on regulation of the linear ubiquitin chain assembly complex in systemic lupus erythematosus.
作者: Myles Lewis.;Simon Vyse.;Adrian Shields.;Sebastian Boeltz.;Patrick Gordon.;Timothy Spector.;Paul Lehner.;Henning Walczak.;Timothy Vyse.
来源: Lancet. 2015年385 Suppl 1卷S9页
A single risk haplotype across UBE2L3 is strongly associated with systemic lupus erythematosus (SLE) and many other autoimmune diseases. UBE2L3 is an E2 ubiquitin-conjugating enzyme with specificity for RING-in-between-RING E3 ligases, including HOIL-1 and HOIP, components of the linear ubiquitin chain assembly complex (LUBAC), which has a pivotal role in inflammation, through crucial regulation of NF-κB. We aimed to determine whether UBE2L3 regulates LUBAC-mediated activation of NF-κB, and determine the effect of UBE2L3 genotype on NF-κB activation and B-cell differentiation.
2440. The roles of DEAD box helicases in the life cycle of HIV-1.
作者: Nyarie Sithole.;Claire Williams.;Aisling Vaughan.;Andrew Lever.
来源: Lancet. 2015年385 Suppl 1卷S89页
HIV/AIDS is the largest global public health problem; about 76 million people have been infected with HIV and 36 million people have already died. Existing antiviral treatment is successful but requires lifelong adherence and mostly targets viral factors. The virus mutates and evades both drugs and the human immune response. Cellular factors are potential therapeutic targets against HIV because the virus must conserve domains that interact with these cellular factors. Unlike many viruses HIV does not encode any helicases but it has been shown to use cellular DDX3. We screened the family of DEAD box helicases to seek other members as possible drug targets.
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