The US Food and Drug Administration has reduced requirements for preclinical animal testing, leading to a surge of interest in organoids, tissue chips and in silico testing.

The entire biotechnology and pharmaceutical industry will be thrown into turmoil if judges can second-guess the scientific expertise of the US Food and Drug Administration.

Objective To compare the performance of a newly developed race-free kidney recipient specific glomerular filtration rate (GFR) equation with the three current main equations for measuring GFR in kidney transplant recipients. Design Development and validation study Setting 17 cohorts in Europe, the United States, and Australia (14 transplant centres, three clinical trials). Participants 15 489 adults

Objective To evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals with a SARS-CoV-2 infection. Design Population based, longitudinal cohort. Setting General population of canton of Zurich, Switzerland. Participants 1106 adults with a confirmed SARS-CoV-2 infection who were not vaccinated before infection and 628 adults who did not

Blom AW, Lenguerrand, Strange S, et al. Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial. BMJ 2022;379:e071281. To read the full NIHR Alert, go to:

We all know that feeling when a colleague comes up to you with a grave look on their face and says, “You remember that patient you saw last week with….” On a good day the story might go that you admitted the patient to hospital, it turns out that they had a pulmonary embolism, and now they’re better. And on a bad day? Well, you’d better hope you made some good notes and, better still, followed a validated

When teaching trainees vaginal repair surgery, the legendary Douglas Ellis demonstrated a dissection technique using the scalpel’s tip, not its blade. If they got it right, he said, it would make a scratching noise like that of Mr McGregor’s hoe in The Tale of Peter Rabbit . They would never understand how to do the operation properly, he insisted, without reading and “hearing” the Beatrix Potter classic

This is spinal tuberculosis on a midline T2 weighted sagittal magnetic resonance image of the spine of a woman in her 20s (fig 1). She had experienced intermittent, dull low back pain for two …

Facial ageing reflects ageing in other parts of the body. When high quality photographs of the faces of 2700 middle aged and older participants in a longitudinal study were assessed by a panel without knowledge of their chronological age and medical history, people whose perceived age was lower than their chronological age were less likely to have osteoporosis, chronic obstructive pulmonary disease

Wilkinson highlights “tribalism and toxicity” as contributing to failing maternity services, citing Kirkup’s report attributing failures to poor culture and teamwork.1 Morgan wonders why a health system should be “powered by guilt, endless duty, and sacrifice rather than by safe working conditions, fair pay, and patient centred reorganisation.”2 Wilkinson quotes Kirkup as saying, “If resources are

The tribalism and toxicity in maternity care reported by Wilkinson is all too familiar for many healthcare professionals and, as pointed out by Kirkup, is not isolated …

India made the longstanding practice of child marriage illegal, but this has left female health workers and social activists struggling to convince teens to attend pregnancy check-ups. Aatreyee Dhar reports Fatima (name changed), 16, didn’t set out to marry while she was still in high school. Her religious parents had worried about her being one of the prettiest girls in their village in the Barpeta

A complex picture is emerging, along with urgent priorities for future research Covid-19 cases and deaths have decreased globally,1 yet, the long term consequences of infection, including post-covid-19 condition (often known as long covid), are still being managed. Most people who have covid-19 recover soon after the acute phase of the disease but others experience persistent health problems for months

For too long, societies around the world have tended to see money that is spent on healthcare as simply a cost to be borne, while considering spending on innovation, infrastructure, or education to be investments. But if you don’t see health as an investment, then you do not consider the importance of health when formulating policy, particularly economic policy. Ally Brown points to the short term

The online version of this obituary (doi:10.1136/bmj.p695, published 23 March …

Venous thromboembolism (VTE) is a major cause of both morbidity and mortality in patients with cancer. Venous thromboembolism, which includes both deep vein thrombosis and pulmonary embolism, affects a sizable portion of patients with malignancy and can have potentially life threatening complications. Accurate assessment of risk as well as diagnosis and treatment of this process is paramount to preventing

### BMJ Best Practice takes healthcare professionals quickly and accurately to the latest clinical information, whenever and wherever they need it Our step by step guidance on diagnosis, prognosis, treatment and prevention is updated daily using robust evidence based methodology and expert opinion. We are the only point of care tool to support the management of single conditions and patients with more

What is a GP? I suspect that if you asked a representative sample of people on the street, some might be unsure what the initials stood for, but nearly everyone would know that a GP is a local family doctor, the one they go to first with a health problem. Ideally, they’d associate the idea of a GP with someone familiar, an expert they already know and trust. The recent conference of UK local medical

A new report on the conduct of commercially sponsored clinical trials of new medications has just been published. It contains 27 recommendations. The UK government has welcomed all of them, and has promised to fund five. Important features of such trials that are not mentioned in the report include methods for improving and measuring participant adherence to an intervention and methods for detecting

Pursuing interests or causes outside medicine can help medical students foster a sense of identity and self-worth not defined by academic success, write Florence Wedmore and Charlotte Rose Being a medical student can feel really isolating. You’re passed from team to team like an unwanted birthday present. No one knows your name, and by the time you’ve found the toilets or a good place to store your

Patient groups are essential to understanding the value of medicines, but NICE must improve its disclosure practices for conflicts of interest to ensure credibility and impartiality, write Iva Parvanova, Arianna Gentilini, and colleagues Since its creation, the National Institute for Health and Care Excellence (NICE) has committed to including patient and public perspectives to fully capture the value

Wilkinson’s article1 on Kirkup’s review2 of recurring problems in maternity services highlights the cultural and systemic matters involved. These need to be understood in the context of similar challenges across the NHS, from acute care to mental health services. The Health and Social Care Act 2022 is a clear statement that the fragmentation created by the Health and Social Care Act 2012 …

Islam and Djanov’s use of the past tense to refer to the pandemic is unfortunate.1 The World Health Organization’s recent ending of the Public Health Emergency of International Concern was accompanied by a clear warning that the virus is here to stay and represents a severe ongoing threat. Director General Tedros Ghebreyesus said, “The worst thing any country could do is to use this news …

Inequality’s effect on life expectancy is worse than six covid pandemics and is contributing to excess mortality, heard a conference that aimed to provide possible solutions . Andrew Kersley reports A meeting of medical experts and academics on poverty and the cost-of-living crisis, which took place this May, agreed that the government should urgently reform Universal Credit and begin building safe

A scheme brought from South America to a deprived London estate aims to bridge the gap between the NHS and people who don’t engage with health services. Charles Ebikeme examines its goals, successes, and challenges In a GP surgery in Pimlico, London, Cornelia Junghans-Minton meets with a small group. The subject under discussion is their community: chiefly, residents who need health services but often

Ambitious goals that won’t be delivered without investment The UK is heading towards a general election—expected sometime in 2024—and the Labour party is currently ahead in opinion polls on how the public would vote.12 A lot can change between now and then. But if the party finds itself in government, Labour says its policy agenda will be based on five “missions”—broad goals for improving the economy

Clinical evidence highlights a relationship between the blood and the bone, but the underlying mechanism linking these two tissues is not fully elucidated. Here, we used β-thalassemia as a model of congenital anemia with bone and bone marrow (BM) niche defects. We demonstrate that fibroblast growth factor 23 (FGF23) is increased in patients and mice with β-thalassemia because erythropoietin induces

Progressive fibrosis is a feature of aging and chronic tissue injury in multiple organs, including the kidney and heart. Glioma-associated oncogene 1 expressing (Gli1 + ) cells are a major source of activated fibroblasts in multiple organs, but the links between injury, inflammation, and Gli1 + cell expansion and tissue fibrosis remain incompletely understood. We demonstrated that leukocyte-derived

Oncolytic virus therapy has shown activity against primary melanomas; however, its efficacy in brain metastases remains challenging, mainly because of the delivery and immunosuppressive nature of tumors in the brain. To address this challenge, we first established PTEN-deficient melanoma brain metastasis mouse models and characterized them to be more immunosuppressive compared with primary melanoma

A critical step in preserving protein homeostasis is the recognition, binding, unfolding, and translocation of protein substrates by six AAA-ATPase proteasome subunits (ATPase-associated with various cellular activities) termed PSMC1-6, which are required for degradation of proteins by 26 S proteasomes. Here, we identified 15 de novo missense variants in the PSMC3 gene encoding the AAA-ATPase proteasome

Dysregulation of the interleukin-1 (IL-1) pathway leads to immune diseases that can result in chronic tissue and organ inflammation. Although IL-1 blockade has shown promise in ameliorating these symptoms and improving patients’ quality of life, there is an urgent need for more effective, long-lasting treatments. We developed a lentivirus (LV)–mediated gene transfer strategy using transplanted autologous

Abstract not available

Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have

Activating the PD-1 checkpoint might reset the immune system and reduce disease activity in patients with rheumatoid arthritis, according to a phase 2a trial.

Objective To develop and validate a prognostic model to inform risk stratified decisions on frequency of monitoring blood tests during long term methotrexate treatment. Design Retrospective cohort study. Setting Electronic health records within the UK’s Clinical Practice Research Datalink (CPRD) Gold and CPRD Aurum. Participants Adults (≥18 years) with a diagnosis of an immune mediated inflammatory

### What you need to know More than 600 000 people attend emergency departments annually in England and Wales with a recent head injury.1 High quality early management for people with head injury can prevent death from secondary brain injury. Traumatic brain injury is the major contributor to death and disability resulting from major trauma. The National Institute for Health and Care Excellence (NICE)

The reopening of the Hunterian Museum has resurfaced questions and concerns about the use of human remains as museum specimens and decolonising museum collections, writes Órla O’Donovan The remains of Charles Byrne, known as the “Irish giant,” have become the subject of public discussion once more, reviving debates that continue to haunt medical and scientific museums. Instead of engaging in futile

Around 20 years ago I had a consultation with a cardiologist that I’ve never forgotten, because of a single question he asked me. I’d never seen him before, and he took my history in a fairly standard way, barely looking up from his notes. But when he’d finished he looked me directly in the eye and asked, “Is there anything else important I need to know about you?” My eyes welled up. Without pausing

Prediction model could help identify patients needing more or less frequent monitoring Despite the advent of new disease modifying antirheumatic drugs in the past 20 years, low dose methotrexate remains the first line treatment for inflammatory conditions such as rheumatoid arthritis and psoriatic arthritis. This is because of its long record of efficacy and safety spanning almost four decades.1 Despite

Triple negative breast cancer (TNBC) continues to be the subtype of breast cancer with the highest rates of recurrence and mortality. The lack of expression of targetable proteins such as the estrogen receptor and absence of HER2 amplification have made relying on cytotoxic chemotherapy necessary for decades. In the operable setting, efforts to improve outcomes have focused on escalation of systemic

Moving jobs repeatedly over the course of a year can be stressful. How can we make it less of a challenge for trainees, Abi Rimmer asks Eleanor Morris, academic foundation year 2 doctor, says, “As a foundation doctor, I change rotations every four months. It generates stress and anxiety for me, a lot of which stems from lacking key information. What will my shifts be like? Is there a changing room