Lancet

Physician Magda Robalo has dedicated her career to supporting health equity in Africa. At the age of 16 years, she moved from her home in Guinea-Bissau to Portugal, later studying medicine at the Universidade do Porto and then public health and tropical medicine at the Universidade Nova. After graduating, Robalo's plan was to specialise in neurosurgery, until her final residency took her to the Egas Moniz Hospital in Lisbon, which, she says, “from colonial times, was dedicated to infectious tropical diseases.

In May, 2020 a new law in England changed the rules around organ donation, intended to help alleviate the desperate shortage of available organs for people on the transplant list. Max and Keira's Law, or the Organ Donation (Deemed Consent) Act 2019 altered the framework around the choice to donate from an opt-in to an opt-out. It is vital that everyone entering the database as a potential organ donor or recipient is registered as a number rather than a name, and that those waiting for a suitable organ understand that it is not a queue, but a matching service—it is not how long you have been on it that matters, but how critically vulnerable the recipient, and how compatible with the donor organ.

Which landscapes help us recover? For the Instagram generation, detox and rehab may summon images of tropical climates and luxurious minimalism. The Outrun is an antidote. Scotland's Northern Isles, with their unending surge of empty sea and salted wind hitting the rocks, where few trees grow and the flatness of the landscape declares the absence of natural or man-made distraction, are an uncertain and risky terrain for getting better.

Physician, scientist, and discoverer of surfactant. He was born in Auburn, NY, USA, on March 16, 1923 and died on Sept 3, 2024 in Tiburon, CA, USA, aged 101 years.

Global health security has become a focal point following the COVID-19 pandemic. The Pandemic Fund, launched in 2022, aims to provide financial support to low-income and middle-income countries for pandemic prevention, preparedness, and response.

With great interest we read the Article1 by Martin Bendszus and colleagues presenting results of the randomised TENSION trial. With enthusiasm, we acknowledge the important conclusions of the TENSION trial, particularly in the context of the TESLA trial,2 which was published in September, 2024, and we would like to congratulate the authors. In the TENSION trial, the treatment effect of thrombectomy on functional independence was 18·4%, which was similar to the effect shown in the HERMES meta-analysis3 (ie, 19·5%) for patients with predominantly smaller lesion volumes.

The Article authored by Martin Bendszus and colleagues1 has sparked our interest as it provides evidence that patients presenting with acute ischaemic stroke with a large core lesion might attain functional independence and have reduced mortality rates through the administration of endovascular treatment, in contrast to individuals who receive standard medical management. Although we appreciate the authors’ meticulous and comprehensive investigation, we would like to offer some critical observations regarding some assertions made in the study.

We read the Article1 by Martin Bendszus and colleagues with great interest. In this paper, the authors aimed to compare the safety and efficacy of thrombectomy in acute stroke patients with an Alberta Stroke Program Early CT Score (ASPECTS) score of 3–5. The assessment was done with the use of non-contrast CT or MRI, within an extended time window of 12 h, as compared with medical treatment (standard of care) alone. Previous trials have relied on diffusion-weighted imaging-ASPECTS or perfusion CT for ASPECTS scoring, while the TENSION trial utilises non-contrast CT, a more clinically practical approach.

We thank Gabriel Broocks and Andre Kemmling, Hong-Jie Jhou and colleagues, and Zhenzhen Wang and colleagues for their interest in and comments on our Article.1 We agree with Broocks and Kemmling that it might appear contradictory that the observed clinical benefit of thrombectomy in TENSION was not reflected by a significant reduction in infarct volumes at 24 h, although mean infarct volume at 24 h was numerically lower in patients assigned to endovascular thrombectomy (205·8 mL vs 277·7 mL). The same result was observed in the ANGEL-ASPECT trial of thrombectomy for patients with stroke with large infarct.

The Lancet. The fertility industry: profiting from vulnerability. Lancet 2024; 404: 215—The discussion of the private clinics in this Editorial should have said that PGT is more likely to be part of IVF treatment in a private equity-affiliated clinic than elsewhere. The references have been updated to refer to the original study on this issue. These changes have been made to the online version as of Oct 31, 2024..

Lorusso D, Xiang Y, Hasegawa K, et al. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2024; 404: 1321–32—The appendix for this Article has been updated as of Oct 31, 2024.

A 43-year-old man who developed numbness and impaired fine motor skills in his left arm lasting approximately 10 min while chanting during a football match, attended our emergency room. The patient, who was visiting Germany for the UEFA European Football Championship, explained that the problems started at the end of the first half. He said he had been chanting continuously during the game. Despite complete resolution of the symptoms, he was concerned enough to seek help, and at half-time he came to our hospital by ambulance.

Steatotic liver disease is the overarching term for conditions characterised by abnormal lipid accumulation in the liver (liver or hepatic steatosis). Steatotic liver disease encompasses what was previously termed non-alcoholic fatty liver disease (NAFLD), which is now called metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, steatotic liver disease includes alcohol-related liver disease (ALD) and MetALD, the new classification for the overlap between MASLD and ALD, and rare causes of liver steatosis.

Most individuals use medication during pregnancy. However, decision making on antenatal pharmacotherapy presents considerable ethical and scientific challenges. Amid a sociocultural paradigm prioritising the elimination of fetal risks, available evidence and guidance are limited, and current decision making on antenatal drugs mostly proceeds in an ad-hoc and, often, biased manner. This approach might undermine the health of both mother and child. The need for a systematic approach towards antenatal drug decisions is becoming even more pressing with the growing knowledge of pregnancy-induced changes in drug disposition and effects.

Nearly 80 years after the end of the National Socialist (Nazi) regime, its legacies persist with the continued use of anatomical atlases whose precise origins remain unknown.1 Although previous investigations on the history of anatomy during the Nazi era have revealed unsettling evidence concerning the Pernkopf atlas and other publications of knowledge gained from the bodies of Nazi victims in life and death,2 there remains poor insight into the origins of other anatomical atlases of this period.

The global public health burden of depression is extensively documented and is particularly challenging in low-income and middle-income countries (LMICs), where medical resources are scarce and health services need to manage the dual burden of high-prevalence communicable and non-communicable disorders. Creative solutions are needed, and work in the growing field of global mental health, including work on collaborative care and task-sharing, has made important advances in developing these solutions.

Integrated care for people with major depressive disorder and chronic health conditions is effective at reducing depressive symptoms, improving functioning, and reducing the odds of depression, and facilitates expansion of services through existing infrastructure.

Historically, visual assessment-guided revascularisation led to overestimation of stenosis severity, resulting in overtreatment and poorer long-term outcomes.1 With optimisation of stents, procedures, and medical therapy, some consider these prognostic disadvantages a thing of the past.2 However, prevention of overtreatment remains a current topic regardless of prognostic impact due to associated costs, complications, and the focus on minimally invasive medicine. Functional assessment of intermediate stenoses with pressure measurements during invasive coronary angiography (ICA) has therefore been guideline-recommended since 2005.

The results of the FAVOR III Europe trial do not support the use of QFR if FFR is available to guide revascularisation decisions in patients with intermediate coronary stenosis. This finding could have implications for current clinical guidelines recommending QFR for this purpose.

Despite the initial hope inspired by the 2015 Paris Agreement, the world is now dangerously close to breaching its target of limiting global multiyear mean heating to 1·5°C. Annual mean surface temperature reached a record high of 1·45°C above the pre-industrial baseline in 2023, and new temperature highs were recorded throughout 2024. The resulting climatic extremes are increasingly claiming lives and livelihoods worldwide.