Lancet

Oesophageal cancer is the seventh leading cause of cancer mortality worldwide. Two major pathological subtypes exist: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Epidemiological studies in the last decade have shown a gradual increase in the incidence of oesophageal adenocarcinoma worldwide. The prognosis of oesophageal cancer has greatly improved due to breakthroughs in screening, surgical procedures, and novel treatment modalities. The success achieved with combined modality therapies, including surgery, chemotherapy, and radiotherapy, to treat locally advanced oesophageal cancer is particularly notable.

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.

In 2013, the WHO set global targets aimed at alleviating some of the of the burden of non-communicable diseases (NCDs), including one to halt the rise in diabetes prevalence by 2025.1 In The Lancet, the NCD Risk Factor Collaboration (NCD-RisC)2 show that the world is far from reaching that target, despite previous studies showing how action on shared risk factors could have been effective.3 This longitudinal modelling study presents a comprehensive account of the evolution of diabetes prevalence and treatment worldwide over the last three decades using the largest compilation of diabetes survey data to date.

In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

Reducing the risk of metastatic relapse in patients with resectable soft tissue sarcomas is crucial for improving outcomes, because metastasis is the primary cause of mortality in this population. Approximately 40% of patients with localised soft tissue sarcomas develop distant metastases, leading to poor long-term survival. Although chemotherapy has traditionally been used in this setting, its role remains contentious due to inconsistent benefits in overall survival.1,2

Addition of pembrolizumab to preoperative radiotherapy and surgery improves disease-free survival for patients with stage III undifferentiated pleomorphic sarcoma and pleomorphic or dedifferentiated liposarcoma of the extremity, which establishes a promising new treatment option for these patients.

20 years ago, the Ministerial Summit on Health Research1 in Mexico led to a World Health Assembly Resolution in 20052 challenging WHO, its member states, and other stakeholders to promote health research globally, especially in low-income and middle-income countries (LMICs). The Resolution highlighted a lack of transparency of clinical trials, poor use of evidence in policy making, and neglect of health systems research as three key barriers for which priority actions were urgently needed.

Over 14 years of Conservative Government in the UK—characterised by policies of austerity and deep cuts to public services—healthy life expectancy dropped, mental health worsened, and public satisfaction with the National Health Service (NHS) fell from 70% in 2010 to 24% in 2023. In September, 2024, 7·7 million people were on the waiting list for hospital treatment (>10% of the population), up from just over 2 million in 2010. UK spending on health stands at 21% below the median of 14 EU countries.

Mpox and its causative pathogen, monkeypox virus, represent a growing international public health concern following a global outbreak of monkeypox virus clade II in 2022–231 and regional outbreaks of monkeypox virus clade I centred in DR Congo beginning in late 2023.2 Epidemiological analysis of monkeypox virus, including genomic epidemiology, is crucial to understanding the expansion of the virus within and outside its historically endemic range due to increased spillover from a zoonotic host, increased human-to-human transmission, or both, and any changes in virulence.

Dr Sivakumar was a successful Consultant Psychiatrist in Maidstone, UK. He had emigrated from Sri Lanka in 1977 and was, in his words, “one of the lucky ones”. Why lucky? Because, having received a “decent English education” in his home country, Dr Sivakumar's journey through medicine as a South Asian doctor in the UK was “comfortable”. This outcome had not necessarily been his expectation. He arrived from Sri Lanka armed with letters attesting to his excellent English language skills. He did not need them.

Revolutionary new HIV drugs are being made available in 120 low-income countries, but many important populations are being left out. Sophie Cousins reports.

A contested election with allegations of vote rigging could be damaging to health NGOs in the country. Sharmila Devi reports.

Marina Romanello is the Executive Director of the Lancet Countdown: Tracking Progress on Health and Climate Change, an independent and multidisciplinary research collaboration headquartered at the Institute for Global Health, University College London, UK.

Picture the scene: an asylum for women in Claresholm, AB, Canada, in the summer of 1933. Southern Alberta was in the grip of the Great Depression, but this town was also in the midst of the Dust Bowl, so-called because the parched topsoil was easily whipped by the wind into filthy clouds that blocked out the sky. Yet at the asylum, water was still being prioritised for a specific therapeutic purpose. Three women were placed in a tub and wrapped up head to toe in saturated blankets. They stayed in these watery cocoons for 3 hours.

Leader in melanoma research and immunotherapy. Born in New York, NY, USA, on May 8, 1952, he died there of pancreatic cancer on Aug 18, 2024, aged 72 years.

The ongoing conflict in Sudan has substantially exacerbated the crisis of gender-based violence, including sexual violence, directed against women and girls, revealing crucial gaps in health services and support systems.1 Although the increase in violence against women and girls is alarming, examining additional dimensions enables a more comprehensive understanding of the crisis.

The PROTECT trial, reported by Brad H Rovin and colleagues,1 showed superior efficacy of sparsentan, a dual endothelin A and angiotensin receptor antagonist, over irbesartan in reducing urinary albumin-to-creatinine ratio and decline in estimated glomerular filtration rate in IgA nephropathy. The ZENITH-CKD trial reported similar kidney protective potential of the selective endothelin A receptor antagonist zibotentan combined with dapagliflozin, in which a marked decrease in haematocrit was noted.

Dion Groothof and colleagues have suggested that the anaemia observed in some volunteers in the PROTECT trial1 was due to endothelin A receptor antagonism increasing renal medullary blood flow and oxygenation with resultant suppressed erythropoietin secretion. Although this possibility cannot be entirely excluded, it is unlikely to contribute substantially to endothelin A receptor antagonist-induced anaemia. Every endothelin receptor antagonist, whether targeting endothelin A or both endothelin A and B receptors, can induce fluid retention,2 including zibotentan in the ZENITH-CKD trial (the 1·5 mg zibotentan dose regimen significantly increased extracellular fluid volume).

Christopher W Ryan and colleagues1 reported that adjuvant everolimus after surgery did not improve recurrence-free survival versus placebo among patients with renal cell carcinoma at high risk of recurrence, and the result did not support the adjuvant use of everolimus for these patients. Curiously, although the median follow-up time was up to 76 months, the survival data were not mature. The median recurrence-free survival was not reached in either group. Moreover, despite a large proportion of patients at very high risk being included (55%), there was a large number of dropout cases in both treatment groups.

We thank Yao-Ning Feng and colleagues for their Correspondence in response to our publication of the EVEREST trial.1 Although recurrence rates in both the everolimus and placebo groups were low, the groups were evaluated on the same schedule. EVEREST included participants with a broad range of recurrence risk as well as both clear and non-clear cell tumours, which probably contributed to the lower than anticipated recurrence rate. Notably, among the subset of patients with a very high risk disease and clear cell histology, an estimated 5-year recurrence-free survival rate of 50% was seen in the placebo group, which is similar to that reported in adjuvant trials that limited enrolment to patients at high risk.