King's College London

Neurofibromatosis 1 (NF1) and attention-deficit hyperactivity disorder (ADHD) are distinct conditions with similarities in developmental course. Research suggests that neurodivergent processes in both conditions begin in the first year, altering infant behaviour and how parents respond, over time reducing social-communicative opportunities for social brain development. This study aimed to investigate parent-infant interactions in both groups relative to typically developing infants (TD) at 10 and 14 months. We hypothesised that the infants with NF1 and infants at elevated likelihood of ADHD (EL-ADHD) would show less attentiveness to their parent and less mutual parent-infant interaction relative to TD controls, that attentiveness-to-parent would be particularly low in infants with NF1, and that liveliness and negative affect would be higher in infants with EL-ADHD. Parents and their infants with NF1, EL-ADHD and TD were videotaped during free play interactions and coded using validated rating scales. The two non-TD groups differed in their interactive patterns from the TD group and each other in ways somewhat consistent with the early behaviours that characterise each group. The NF1 group showed relatively less mutual interactions than the EL-ADHD group, and less parental sensitive responsiveness and parental directiveness than the TD group, while EL-ADHD infants were livelier and showed less negative affect relative to the other groups. Most main effects persisted over time. While longer-term follow-up in larger samples is needed, our findings highlight how children with neurodevelopmental conditions that are not primarily characterised by social communication difficulties may nonetheless come to have distinct social experiences in the first year of life.

A 3‐year‐old axolotl (Ambystoma mexicanum) presented with anorexia, weakness and abdominal swelling due to hydrocoelom. According to the anamnesis, the symptoms had occurred 3 months prior. The radiographic and ultrasonographic examinations revealed that these symptoms resulted from the fluid accumulating in the coelomic cavity. Then, the habitat of the axolotl and the fluid in the coelomic cavity were inspected. Then, the patient's hydrocoelomic fluid was drained and medical treatment was performed. In addition, habitat arrangement and diet were changed. At the follow‐up visit 1 week later, the patient reported a significant decrease in hydrocoelom and a significant increase in appetite and mobility. Laboratory results showed no microbiologic growth in the sample taken from the coelomic cavity. The patient remained healthy during a 1‐year follow‐up. The last follow‐up examination revealed a significant decrease in all of the symptoms. In conclusion, non‐infective hydrocoelom was observed in an axolotl, and medical treatment was performed.

Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, leading to significant health and economic burdens. Pulmonary vein isolation (PVI) is a key treatment strategy, with pulsed field ablation (PFA) emerging as a promising method due to its specificity and reduced collateral damage compared to traditional thermal ablation techniques like radiofrequency ablation (RFA) and cryoablation (CB). Materials and Methods A comprehensive literature search was performed across multiple databases, including PubMed, Embase, and MEDLINE via Ovid, Scopus, Cochrane CENTRAL, and ClinicalTrials.Gov. Studies reporting on the efficacy and safety of PFA in AF treatment were selected and analyzed. Quality assessment of the studies was conducted using the Newcastle–Ottawa Scale. Result Of the 440 articles initially identified, 28 met the inclusion criteria. PVI using PFA demonstrated high success rates, with most studies reporting over 90% success. Durability stands around 65% after 1 year. Mortality was 0.06%–0.32%, while stroke rate was 0.3%–4.4%. There were no reported oesophageal injuries or pulmonary vein stenosis due to the highly selective electroporation‐induced cell death caused by PFA rather than coagulative necrosis, sparing nearby structures. There is a short learning curve for PFA. Conclusion PFA is a highly effective and safe ablation method. It offers an alternative to conventional thermal ablation strategies in the treatment of AF, showing promise to reduce the risk of collateral damage and complications associated with thermal ablation techniques. However, further research is needed to understand its long‐term efficacy and safety fully and to standardize procedural protocols for wider clinical application.

Introduction The new preference-informed allocation (PIA) system introduced for the 2024 UK cohort Foundation Programme (UKFPO) marks a shift away from the traditional meritocratic ‘ranking’ used in previous years. Instead of appointment to Foundation Programme places, PIA is a computer-generated allocation and deanery preferencing system. This change has raised numerous concerns among both students and clinicians. Aims To investigate the opinions of medical students on the new UKFPO PIA system. Methodology An online questionnaire was distributed to medical students graduating in 2024, 2025, or 2026 across the UK. Results In total, 2297 responses were collected and 2288 were included in the study. Overall, 51.6% (n = 1183) of respondents felt the PIA system was unfair, 76.3% (n = 1746) felt they had lost control of their application, and 46.3% (n = 1049) had noticed a negative effect on their physical or mental health. Notably, 48.2% (n = 1094) of students who responded are now considering a career outside the National Health Service (NHS). Conclusions Overall, the PIA system falls short of students’ expectations and has led to record numbers of students considering careers outside the NHS. Further changes to this system are needed and should aim to address fairness and equity while rewarding students for their hard work. According to these data, the PIA system risks further deteriorating workforce morale and attrition rates.

Time to progression is the strongest predictor of outcome in relapsed diffuse large B‐cell lymphoma. Second‐line treatment with chimeric antigen receptor (CAR) T‐cell therapy is recommended for patients with progression within 12 months of first‐line chemoimmunotherapy. In patients with late relapse, platinum‐based chemotherapy followed by high‐dose chemotherapy with autologous stem cell rescue is recommended. In second relapse, CAR T‐cell or CD3xCD20 bispecific antibody therapy is recommended in eligible patients. Other treatment options are available for less fit patients. Specific recommendations are made on diagnostic immunohistochemistry, bendamustine use and bridging to CAR T‐cell therapy. image

Malignant pericardial effusion (MPE) is a progressive fluid accumulation in the pericardial space that can lead to pericardial tamponade. Despite the high recurrence rate associated with pericardiocentesis, it remains the mainstay therapy. Bleomycin has emerged as an intrapericardial sclerosing therapy that may reduce recurrence and improve patients' quality of life. This systematic review aimed to assess the efficacy and safety profile of Bleomycin instillation in patients with MPE. An exhaustive search was conducted in PubMed, Web of Science, Scopus, ProQuest, EBSCO, and ClinicalTrials.gov databases. Eligible studies included MPE patients as participants who were treated with intrapericardial Bleomycin, reporting the patients' outcomes and using English in the full text. Individual studies were assessed for quality using the Newcastle-Ottawa Scales for cohort studies and the Jadad Scale for trial studies. Eight studies were included in this systematic review involving 242 MPE patients treated with Bleomycin. Bleomycin demonstrated lower recurrence rates than other sclerosing agents, with only ≤5% of patients requiring repeated drainage due to recurrence. Bleomycin treatment resulted in 3.5 days less hospitalisation compared to doxycycline. Bleomycin is also safe to use, with reported less severe pain compared to other treatment agents for MPE, such as doxycycline and pericardiocentesis. Bleomycin may benefit patients by reducing recurrence rates and improving patients' quality of life. Moreover, it is safe and has low rates of adverse events following the instillation.

Purpose of review The CKD-EPI equations were updated in 2021 to remove the race variable from eGFR estimation. In the same year, the creatinine-based EKFC equation was published, subsequently supplemented by the cystatin C-based EKFC equation. Recent findings suggest that the prevalence of chronic kidney disease (CKD) can vary depending on the equation, the biomarker, and the population studied. Recent findings Using the CKD-EPI 2021 equation instead of the CKD-EPI 2009 equation results in an increased prevalence of CKD among Black individuals in the U.S. and a decreased prevalence among non-Blacks. The CKD-EPI equations may underestimate the prevalence of CKD in India and in some sub-Saharan African populations. This is corrected by using the EKFC equation and dedicated Q-values. In general, the prevalence of CKD is slightly higher with EKFC than with the CKD-EPI equations. The CKD-EPI cys equation generally leads to a higher CKD prevalence than the CKD-EPIcrea equations. Few epidemiological data are available for EKFC cys . Summary The choice of biomarkers and equations has an impact on the prevalence of CKD, with implications that also depend on the characteristics of the population being studied.

In this article, I consider the turn to narrative theory that swept through the medical humanities in the 1980s and 1990s. My primary goal is to offer what may be the first historical overview of the field in its decisive second phase (the first running roughly from 1960 to 1980). My focus will be on the efforts of scholars to mobilize ‘narrative’ and related terms to develop the medical humanities as a distinctive field of study. My approach will be genealogical, aiming to identify and delineate the various narrative theories that were put to use, and the aims they were intended to serve. The rise of the narrative-based medical humanities coincided with, and drew strength from, two enormously significant developments in the health sciences, broadly construed. The first was the rise of the biopsychosocial model of health and illness. The second was the refounding of medical anthropology along Geertzian lines by a group of social anthropologists based at Harvard. I offer detailed characterizations of four accounts of narrative (social anthropological, cognitive anthropological, psychological, and bioethical) focusing on why the scholars associated with each discipline turned to narrative and what they did with the concept. Collectively these effected a powerful critique of biomedical rationality. In the second half of the article, I summarize the achievement of the narrative-based medical humanities and consider what they have to offer scholars in the field today.

Research Question/Issue Does the interaction of ownership structure and state expropriation risk affect corporate cash holdings? We address this question by assessing whether corporate ownership structure can amplify or mitigate the effect of greater state expropriation risk, captured by country‐level corruption, on cash. Research Findings/Insights Using all publicly listed firms (circa 52,000 firms) from 87 countries over a 20‐year period, we show that the interaction of corruption with ownership structure has a first‐order effect on firms' cash holdings. Greater corruption leads firms to reduce cash holdings to mitigate the risk of expropriation by the state. This effect is stronger for diffuse ownership firms, which are more susceptible to the risk of expropriation by insiders and the state relative to concentrated ownership firms. We also find that compared with concentrated ownership firms, diffuse firms with more cash respond to corruption increases by making larger dividend payouts and investments in illiquid assets, thus sheltering cash from expropriation. Theoretical/Academic Implications We test the “twin agency” theoretical prediction of Stulz, suggesting that the effect of state expropriation on firms is heterogenous across different ownership structures and that greater corruption increases the risk of expropriation more for diffused vis‐à‐vis concentrated ownership firms. We also show that ownership concentration and corruption have a twin effect on corporate cash holdings. Practitioner/Policy Implications We show that ownership structure, corruption, and their interaction are important determinants of corporate cash. Hence, the associated conflicts between controlling and minority investors can shape firms' liquidity management.

Background BMI is widely used as a primary criterion for prioritizing candidates for metabolic surgery. However, it may not fully capture disease severity or mortality risks associated with comorbidities such as type 2 diabetes (T2D) and cardiovascular disease (CVD). This study aimed to assess whether BMI accurately reflects disease burden and risk in patients undergoing metabolic surgery. Methods A retrospective audit included 723 adult candidates for primary metabolic surgery at a tertiary care center between January 2014 and December 2022. Patients undergoing revisional surgeries were excluded. Clinical data, including demographics, comorbidities, and disease severity indicators (e.g., ASA score, Charlson Comorbidity Index [CCI], medication usage, and estimated 10-year survival), were analyzed. Patients were grouped by BMI (< or ≥ 50 kg/m²), T2D, and CVD status for comparison. Results Prevalence rates for T2D, BMI ≥ 50 kg/m², and CVD were 41.6%, 37.3%, and 16.2%, respectively. Patients with BMI ≥ 50 kg/m² were generally younger, had fewer comorbidities, lower CVD prevalence, and better estimated 10-year survival than those with BMI < 50 kg/m². In contrast, patients with T2D and CVD had significantly higher ASA and CCI scores, greater medication usage, and reduced 10-year survival (p < 0.001 for T2D; p < 0.01 for CVD). Conclusion Higher BMI levels do not reflect greater disease burden and mortality risk among candidates for bariatric/metabolic surgery. These findings do not support the use of high BMI-based thresholds (e.g., ≥ 50 kg/m²) as criteria for expedited access. Clinically relevant measures of baseline disease burden should be used to determine the urgency of access to surgical treatment of obesity and T2D.

The incursion of the financial sector into contemporary politics, economies and societies has been noted, yet financialisation remains under-explored in the sociological study of healthcare. Using the case of Maharashtra, India, and a qualitative research approach combining policy documents, witness seminars and in-depth interviews, we offer an account of how financialisation has been facilitated and enacted in this sector. We analyse the restructuring of a healthcare system in favour of corporate chains and calculative logics, with concomitant changes including closure and takeover of smaller hospitals and re-modelling of not-for-profit hospitals along corporate lines. We highlight ways in which such financialisation of healthcare, and its sidelining of health needs, has significance for care processes, professional dynamics, access to care and the parameters of regulatory systems.

Background Binge-eating disorder (BED) is characterized by highly distressing episodes of loss-of-control over-eating. We have examined the use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of people with BED and associated obesity. Such non-invasive brain stimulation (NIBS) techniques are used therapeutically in several psychiatric conditions and there is an associated scientific rationale. Methods Sixty participants were randomly allocated to receive 20 sessions of neuronavigated 10 Hz rTMS administered to the left dorsolateral prefrontal cortex (dlPFC) or sham treatment. Primary outcomes were the frequency of binge eating episodes (BEE) and the ‘urge to eat’ (craving) evaluated at baseline and end-of-treatment (8 weeks post-randomization). Secondary outcomes included body mass index (BMI), hunger, general and specific eating disorder psychopathology. Follow-up analyses were conducted for most outcomes at 16 weeks post-randomization. Multilevel models were used to evaluate group, time, and group-by-time interactions for the association between rTMS exposure and outcomes. Results The real rTMS group (compared with sham treatment), showed a significantly greater decrease in the number of BEE at the end of treatment (Estimated Mean [EM]: 2.41 95% CI: 1.84–3.15 versus EM: 1.45 95% CI: 1.05–1.99, p = 0.02), and at follow-up (EM: 3.79 95% CI: 3–4.78 versus EM: 2.45 95% CI: 1.88–3.17, p = 0.02; group × time interaction analysis p = 0.02). No group differences were found for other comparisons. Conclusion rTMS was associated with reduced BEE during and after treatment: it suggests rTMS is a promising intervention for BED.

Objective To examine the variation in stillbirth rates between different ethnic and socioeconomic groups within each organisational hospital group (health trust). Design National registry study. Setting All health trusts (HT) in National Health Service England. Population All mothers and babies born between April 2015 and March 2017. Methods This observational study examined ethnic and socioeconomic disparities in stillbirth rates for 1 268 367 births in 133 HTs compared to the national average. Outcome Stillbirth at or after 24 gestational weeks. Results The average stillbirth rates ranged from 3.4/1000 births for White women up to 7.1/1000 births for Black women. The rates ranged from 2.9/1000 births for women living in the least deprived areas to 4.7/1000 births for those in the most deprived. The proportions of HTs with stillbirth rates well above the national average (more than 2 standard deviations) for White, Asian and Black women were 0.8%, 21.8% and 38.6%, respectively. When HTs were ranked by stillbirth rate, there were notable variations, with some trusts demonstrating lower than average stillbirth rates for White women while concurrently having higher than average stillbirth rates for Asian and/or Black women. There were no units exhibiting lower than national average stillbirth rates for Asian/Black women while concurrently having higher than average stillbirth rates for White women. Conclusions These findings suggest that access to and delivery of maternity care vary depending on the mother's ethnicity and level of socioeconomic deprivation. Social factors are likely determinants of inequality in stillbirth rather than maternity care alone.

The field of child and adolescent mental health research is currently undergoing important shifts. In line with its mission to support accessible child mental health science for all, JCPP Advances has included 12 studies in its June 2025 issue, eight of which are presented in this editorial. These articles reflect how recent changes are influencing research in the field. These include the adoption of transdiagnostic frameworks to better understand shared mechanisms across diagnostic categories, and the growing use of participatory research to involve children, young people, and families in the design of assessments and interventions. The highlighted papers examine emotion regulation in autism, longitudinal pathways to psychopathology, the role of family dynamics and prosocial behaviours, and the development of accessible, inclusive tools and interventions. Together, they showcase how the field is evolving to become more developmentally informed, inclusive, and responsive to the real‐world needs of young people and their support networks.

The number of people dying with preventable, serious health-related suffering is rapidly increasing, and international calls for the expansion of palliative care services have been made, such as the World Health Assembly Resolution 67.19, which named palliative care as an essential component of Universal Health Coverage. Despite this, only about 14% of all palliative care need globally is met today, and health systems around the world are unprepared to meet the growing need. Palliative care has been shown to improve patient, caregiver and health-system outcomes and reduce costs for many populations and contexts. Geographic, social, cultural and health-literacy related inequities in access to and quality of palliative care services persist. We provide evidence-based recommendations which require immediate, coordinated action to improve progress towards achieving equitable access to high-quality palliative care for all. These include but are not limited to ensuring every country has palliative care codified into national health policy; providing evidence-based, basic palliative care education and training for all non-specialist healthcare workers; empowering and facilitating community action in research and service development; and ensuring that all essential palliative care medicines are available for those who need them. Unless urgent, evidence-based, coordinated action is taken, countries, health systems, and communities will fail to meet the growing palliative care demand, and millions of people around the world will experience preventable suffering.

Background Understanding dose-response relationships is crucial in optimizing clinical outcomes, particularly in complex interventions such as psychotherapy. While dose-response research is common in pharmaceutical contexts, its application in complex interventions remains underexplored. This review examines existing statistical methods for modelling dose-response relationships in complex interventions, focusing on psychotherapy. Methods A systematic literature search following PRISMA guidelines identified studies proposing novel statistical methods or innovative applications of methods for analysing dose-response relationships. The search encompassed various databases, yielding 224 articles. After screening and exclusion, seven studies were eligible for analysis. Data synthesis categorized methods into three groups: multilevel and longitudinal modelling, non-parametric regression, and causal inference with instrumental variables. Additionally, a survey was conducted among clinical researchers to understand their perspectives on dosing decisions in psychotherapy trials. Results Multilevel and longitudinal modelling techniques, although informative, were only applicable to participants with sessional data, limiting causal interpretations. Non-parametric regression methods provided avenues for causal inference but were constrained by assumptions. Causal inference with instrumental variables showed promise in addressing these limitations, particularly in randomised controlled trials, yet still require a priori assumption of the dose-response function. The results of our survey suggested that there is not sufficient information available to clinical researchers to make empirical dosing decisions in psychotherapeutic complex interventions. Conclusions This review highlights the scarcity of robust statistical methods for evaluating dose-response relationships in psychotherapy trials. The dose-response methodology applied to RCTs remains underdeveloped, hindering causal interpretations or requiring strong assumptions. Traditional approaches oversimplify outcomes, highlighting the need for more sophisticated methodologies. Clinical researchers emphasized the necessity for clearer guidelines and enhanced patient involvement in dosing decisions, echoing the broader findings of the review. Future research requires methodological advancements to inform effective decision-making in psychotherapy trials, ultimately optimizing patient care and outcomes.