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[Articles] Complete versus culprit lesion-only revascularisation for acute myocardial infarction (Complete Revascularisation Trialists' Collaboration): an individual patient data meta-analysis of randomised trials

In patients presenting with acute myocardial infarction and multivessel disease, complete revascularisation reduced the composite of cardiovascular death or new myocardial infarction as well as cardiovascular death alone compared with a culprit lesion-only PCI strategy. In addition, all-cause death was lower with complete revascularisation. These data provide the strongest and most robust evidence to date that complete revascularisation improves important cardiovascular clinical outcomes.

[Articles] Transcatheter aortic valve implantation with the Trilogy valve for symptomatic native aortic regurgitation (ALIGN-AR): a pivotal, multicentre, single-arm, investigational device exemption study

In patients with symptomatic moderate-to-severe or severe aortic regurgitation considered to be of high surgical risk, TAVI with a dedicated platform met prespecified safety and effectiveness performance goals. We observed substantial reductions in aortic regurgitation, favourable valve haemodynamics and myocardial remodelling, with associated improvements in functional status and quality-of-life gains up to 2 years. These data support TAVI with a purpose-built device as a feasible and effective treatment option for selected patients with native aortic regurgitation who are at high risk for death or complications after surgery.

[Department of Error] Department of Error

Romanello M, Walawender M, Hsu S-C, et al. The 2025 report of the Lancet Countdown on health and climate change: climate change action offers a lifeline. Lancet 2025; 406: 2804–57—The title of this report has been updated to “The 2025 report of the Lancet Countdown on Health and Climate Change: climate change action offers a lifeline”. Pratik Singh's affiliation has been updated to the Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany. In the second sentence in the final paragraph of the growing momentum section, the percentage decrease in health-care-related greenhouse gas emissions has been updated to 16% to match the text in indicator 3.5.

[Correspondence] The importance of patient selection in stroke monitoring research – Authors' reply

By the very nature of having eligibility criteria to define the study population, all randomised controlled trials are complicated by some degree of selection bias. However, Atsushi Shiraishi and colleagues highlight the potential for an extension of this issue in differential selection bias across the randomised groups to have influenced the results in the stepped-wedge cluster-randomised design of the OPTIMISTmain study.1

[Correspondence] The importance of patient selection in stroke monitoring research

As the number of patients with acute ischaemic stroke receiving thrombolysis increases, identifying monitoring protocols that optimise resource use and improve patient outcomes is crucial. The OPTIMISTmain trial1 provides valuable data on the safety and efficacy of low-intensity monitoring after thrombolysis, concluding non-inferiority in safety compared with standard protocols. However, we propose that a potential source of eligibility bias linked to patient recruitment merits closer examination.

[Correspondence] Clinical benefits of selumetinib in adults with neurofibromatosis type 1 – Authors' reply

We acknowledge the observations raised by Suyin Feng and colleagues. KOMET,1 the first global, randomised, placebo-controlled trial represents a landmark achievement demonstrating selumetinib efficacy and safety in adults with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas. The sample size and methodological robustness enabled clear conclusions about the positive effect of selumetinib on volume and pain of plexiform neurofibromas.1

[Correspondence] Clinical benefits of selumetinib in adults with neurofibromatosis type 1

The KOMET study1 is a landmark achievement, being the first randomised, placebo-controlled trial to demonstrate the efficacy of selumetinib in adult patients with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas. However, the interpretation of selumetinib's clinical benefits, particularly in the discussion of the objective response rate (ORR), invites a more cautious and comparative appraisal. Although the trial reports a statistically significant ORR of 20% in the selumetinib group versus 5% in the placebo group by cycle 16 (p=0·011), this result requires further contextualisation.

[Correspondence] Accurate diagnosis of Indigenous child deaths in Ecuadorian Amazonia – Authors' reply

We thank Miguel Angel Garcia-Bereguiain and Solon Alberto Orlando for their thoughtful comments on our Correspondence regarding the leptospirosis outbreak in Taisha, Morona Santiago.1 Their concerns underscore the urgent need to strengthen diagnostic capacity for neglected tropical diseases in Ecuador, especially in remote areas such as Taisha, a community recently affected by a severe public health crisis.

[Correspondence] Accurate diagnosis of Indigenous child deaths in Ecuadorian Amazonia

We read with great interest the Correspondence by Esteban Ortiz-Prado and colleagues.1 We agree with the authors’ ideas of improving the surveillance of leptospirosis, a neglected tropical disease in Ecuador, and also the call to action to guarantee health care for the underserved Indigenous communities in Ecuadorian Amazonia. However, we disclose facts that challenge the official story attributing the deaths of eight Achuar children from the Taisha community to leptospirosis.

[Correspondence] B-cell targeted therapies in acute lymphocytic leukaemia

We read with interest Hagop Kantarjian and colleagues’ Seminar on acute lymphocytic leukaemia (ALL).1 Although the review focuses on the transformative impact of novel B-cell targeted therapies, several important considerations—such as infective adverse effects of bispecific T-cell engager (BiTE) therapy, and chimeric antigen receptor (CAR) T cells directed against B-cell surface antigens, potential use of immunoglobulin replacement therapy, and their wider impact on health-care systems—merit further discussion.

[Correspondence] WHO's category mistake

WHO's new global traditional medicine strategy aims “to advance the contribution of evidence-based traditional, complementary, and integrative medicine to the highest attainable standard of health and wellbeing”, as “traditional medicine is more than a collection of therapies; it represents a worldview in which health is harmony within and between individuals, communities and ecosystems. Restoring this balance is a scientific, rights-based and sustainability imperative.”1

[Correspondence] 45-year follow-up after Grüntzig's coronary angioplasty

In 1978, Andreas Grüntzig published in The Lancet the first report of transluminal dilatation of a coronary artery stenosis, prompting a revolution in cardiovascular medicine.1 We now report the 45-year clinical follow-up of a patient treated by Grüntzig himself, providing a unique historical and human perspective on the durability of this innovation.

[Correspondence] Research in health-care resilience for large-scale conflict

The first duty of any government is to keep its people safe. The Russian military's full-scale invasion of Ukraine has revived the threat of large-scale conflict in Europe, posing an immediate security challenge for the UK. On June 2, 2025, Prime Minister Starmer stated that the UK should move towards war-fighting readiness.1

[Perspectives] Love will tear us apart, again

A new film from director Lynne Ramsay is a rare treat: in a career spanning 25 years, she has made five movies. Her widely admired works eschew standard formulas and are distinctive and challenging. 2017's You Were Never Really Here, found a war veteran confronting his violent past; 2011's We Need to Talk About Kevin examined the aftermath of a high school shooting.

[Perspectives] Is science diplomacy still possible?

In a world of strategic rivalry, fragmented multilateralism, and techno-nationalism, can science diplomacy still serve as a bridge for cooperation? There is an emerging consensus that global health must evolve as the scientific, technological, and geopolitical landscape is transformed. The classic post–Cold War model of science as a universal language is giving way to polycentric, politically constrained, but still vital forms of scientific cooperation. But how exactly should science and diplomacy engage?