Critical illness triggers dramatic and complex changes throughout the endocrine and metabolic systems. Whether endocrine and nutritional interventions can improve outcomes in critically ill patients has been controversial. As effects are distinct in acute versus chronic critical illness, the timing of interventions can be crucial. This four-part Series in The Lancet Diabetes & Endocrinology explores several aspects of endocrine and metabolic dysfunction in critically ill patients, summarises the latest research on endocrine and nutritional interventions during critical illness, and provides guidance for clinical care of these high-risk patients.
Many approaches are available for breast cancer screening and profiling, and this Lancet Series on Breast Cancer focuses on the evidence behind the differing approaches. The first Series article examines the sensitivity of MRI for screening of patients with known or suspected genetic mutation results. Implications for surgical treatment selection, long-term outcomes, recurrence rates, and chemotherapy response are assessed. The second paper in the Series discusses the development of a molecular classification system and prognostic multigene classifiers for breast cancer. Breast cancer is now perceived as a heterogeneous group of diseases characterised by distinct molecular aberrations, and this article examines results of gene expression profiling studies, and focuses on the conceptual effect and potential clinical use of the molecular classification of breast cancer.
The introduction of targeted therapies has profoundly changed the course of some subtypes of breast cancer—but many challenges remain. The Lancet’s 2016 Series on breast cancer discusses the most recent advances in the three most common breast cancer subtypes. The first pair of papers focus on the treatment of advanced oestrogen-receptor-positive and HER2-positive breast cancers, while the third describes how an improved understanding of molecular alterations in the heterogeneous and hard-to-treat triple-negative breast cancer may lead to more refined and more effective therapy.
The obesity epidemic is a worldwide public health problem; around one third of the global population are overweight or obese. Excess adiposity has direct physiological consequences, including impaired mobility, sleep apnoea, increased bone load, and psychological distress. However, it is the cardiometabolic consequences of obesity - such as type 2 diabetes, cardiovascular and renal disease, and retinopathy - that constitute the major burden of the disease. Although diet and lifestyle interventions have been shown to be effective in trials, they have been less successful at a population level. The most effective treatment for obesity is bariatric surgery, which might also have effects beyond merely reducing excess weight. In this Series of articles from The Lancet Diabetes & Endocrinology, the effects of bariatric surgery on end-organ health are discussed, with detailed information about the mechanisms behind the physiological changes that occur after bariatric surgery presented. Additionally, the safety of such surgery is touched upon and the pathophysiology of bone loss, a major adverse consequence of bariatric surgery, is explored in detail. The Series concludes with a review of existing guidelines governing the use of bariatric surgery and calls for changes to recommendations on the basis of the latest evidence.
Autoimmune rheumatic diseases, including rheumatoid arthritis, scleroderma, and systemic vasculitides, are debilitating, painful conditions that are rare but cause substantial morbidity and mortality in patients, and disproportionately affect women. In The Lancet, we publish a Clinical Series of three papers on these diseases. The Series points to many promising avenues and developments in detection and management of these diseases, which, if seized by clinicians and researchers, should accelerate this reduction further. Indeed, as Goldblatt and O'Neill write: "Rheumatology is entering an exciting time."
You must be logged in to post a comment.