Zimbabwe has successfully reached the UNAIDS 95-95-95 HIV testing, treatment, and viral suppression targets; however, gaps remain particularly among the growing population of artisanal and small-scale miners, who are highly vulnerable to HIV. Sex work, gender-based violence, and sexual harassment, which are all risk factors for HIV infection, are common in artisanal and small-scale miners’ communities in Zimbabwe.1 More than 50% of artisanal and small-scale miners engaging in extramarital sex reported not using condoms.

I spent most of my 2010 wedding day in the emergency ward of my local hospital. Instead of exchanging vows, I was desperately trying to convince the doctors there not to call elder protective services regarding the woman who was about to become my mother-in-law. She had been preparing for the marriage of her youngest son for weeks. Between cooking for more than 200 guests, pressing all the wedding finery, and trying to educate the American bride who would be joining her family on Vietnamese traditions, she kept telling us she was “so tired”.

Since the first successful combined liver–kidney transplantation reported in The Lancet in 1984,1 this procedure has evolved into a preferred treatment for patients with end-stage liver disease and end-stage kidney disease. Since the Model for End-stage Liver Disease scoring system was introduced for organ allocation candidates on the waitlist in 2002, the number of combined liver–kidney transplantations has increased rapidly worldwide. Nevertheless, donor supply has lagged far behind demand. Combined liver–kidney transplantation strategies have evolved in terms of organ allocation, surgical techniques, immunosuppressive therapies, donor selection, indications and contraindications, and prevention of infection and recurrent diseases.

2025 marks the centenary of the Locarno Treaties—a series of treaties between European countries after World War 1, negotiated in October, 1925, in Locarno, Switzerland, and signed in London in December, 1925. These agreements ushered in a period of hopeful optimism and peace for European security: the so-called Spirit of Locarno. Relations were re-established between European neighbours and Germany was accepted into the League of Nations. The Nobel Peace Prize was awarded to the three main architects of the treaties.

Jairath V, Acosta Felquer ML, Jaihyun Cho R. IL-23 inhibition for chronic inflammatory disease. Lancet 2024; 404: 1679–92—In this Therapeutics paper, the name IL-23A in the abstract should have been IL-23. Also, the model of TYK2 activation shown in the figure is incorrect. TYK2 activates via IL-12Rβ1, not IL-23R. These corrections were made to the online version as of December 19, 2024.

The medical knowledge of Renaissance artists, honed through the study of classical texts and direct anatomical exploration (including autopsies and early scientific observations), played a surprisingly crucial role in advancing the understanding of human anatomy and, by extension, neurology.1 Artists, such as the Flemish painter Quentin Matsys, provided detailed depictions of the human form, often including conditions that are recognisable today as pathologies.

Most people with functioning ovaries will eventually go through menopause. However, the research priorities for those with lived experience of menopause and their health-care providers is not known.1 A James Lind Alliance Priority Setting Partnership is a powerful process to establish shared priorities for future research.2 This established method has already identified key priority questions across more than 100 health conditions since 2004. However, menopause has been recognised as an important gap.

A huge criminal investigation is under way following accusations that fraud and substandard care have resulted in the deaths of several babies. Kaya Genc reports from Istanbul.

In this issue of The Lancet we feature 30 photographs selected from the many interesting images that were entered for this year's Highlights photography competition. The winning images offer different insights and perspectives on health stories from a range of countries, including Cambodia, India, Japan, Kenya, Lesotho, Nepal, the UK, and Ukraine.

Published in 1984, the Warnock Report gave the embryo a “special status”, enabling medical research. As science and society develops, there are new challenges. Jacqui Thornton reports.

For the 2024 Wakley Prize Essay we invited submissions on any clinical topic of importance to health and particularly encouraged entries that reflect on the act of caring in medicine.1 In the call for submissions we noted how “Medicine is a caring profession. But not everyone who goes through the health-care system feels cared for” and asked for essays that reflect on how caring can be prioritised in clinical encounters. We were impressed by the engaging, thought-provoking essays that we received and thank everyone who entered the competition.

A 17-year-old child with fibrolamellar hepatocellular carcinoma presented for treatment of recurrence in the right hilum and bilateral lungs discovered during routine surveillance imaging; he had reported no symptoms.The patient was first diagnosed at 13 years of age, when he presented with right upper quadrant pain; he underwent an extreme liver resection, and received multiple cycles of chemotherapy to achieve his first remission. Over the next 3 years, he sustained relapses to his peritoneum and brain, warranting further chemotherapy, surgery, and radiotherapy.

Imagine stepping outside and each breath feels like a hazard—this situation is the grim reality for millions living in Lahore, Pakistan. The average air quality index (AQI) in Lahore from Oct 17 to Nov 16, 2024, ranged from unhealthy to hazardous (AQI 180 to AQI 1110). Lahore was the world's most polluted city in the world on Nov 14, 2024,1 with an unprecedented AQI peaking at 2061 (recorded near the Center for Economic Research in Pakistan office in Lahore, between 2200 h and 2300 h), far exceeding safe limits.

A report from October, 2024,1 on sex normalisation surgeries for intersex children in Serbia exposed an urgent human rights crisis. Serbian doctors claim that these procedures prevent trauma, but extensive evidence2 shows that non-consensual sex normalisation surgeries are traumatic and medically unnecessary. A systematic review2 found that these interventions rely on outdated theories rather than scientific proof. The notion that early surgery prevents psychological harm is entirely unsubstantiated.

Morris MJ, Castellano D, Herrmann K, et al. 177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial. Lancet 2024; 404: 1227–39—Appendix 1 of this Article has been corrected as of December 19, 2024.

We read with interest the Offline piece on xenotransplantation published in The Lancet.1 As a research group that has made substantial preclinical contributions to the field of genetically modified pig-to-baboon liver xenotransplantation,2 we find the Offline piece to be both encouraging and timely. It underscores the progress made in this evolving field, which has become an important part of organ transplantation research over the past few years. However, we would like to contribute some reflections on the points raised.

We read Jessamy Bagenal's Comment about physician associates with concern and offer a crucial perspective prioritising patient safety and transparency.1 Research by the Royal College of General Practitioners found that 81% of respondents considered negative effects on patient safety a challenge of physician associate use in primary care.2 A British Medical Association (BMA) survey revealed that 15 819 (87%) of 18 182 doctors felt that the way physician associates work was always or sometimes a risk to patient safety.

We found the Comment by Jessamy Bagenal to be an insightful exploration of the role of physician associates in the UK health-care system.1 Since its publication, the UK's political landscape has shifted with the election of the Labour Government, bringing substantial reforms aimed at addressing the disillusionment among doctors. A 2024 study highlighted that only 36% of foundation trainees pursued specialty training after the COVID-19 pandemic. They cited challenges associated with increasing pressure, burnout, and a general feeling of disillusionment with medicine.

In the Comment by Jessamy Bagenal on the roles of physician associates and doctors in the UK, professional protectionism is cited as a factor in opposing the appointment of physician associates.1 However, there are legitimate concerns2 that physician associates with 2 years of training are not safe substitutes for qualified doctors with a minimum of 5 years of undergraduate training in primary or secondary care. These 5 years and the subsequent postgraduate training are key to the clinical pattern recognition needed for diagnosis.

Jessamy Bagenal's argument in support of p-hysician associates in primary care1 overlooks the effect of such competence expansion of non-general practitioners on general practitioner workloads and, ultimately, general practitioner burnout. Burnout among general practitioners has long been recognised,2 is increasing in prevalence,3 and has implications for both clinician wellbeing and patient safety.4 Substantial and continuously increasing general practitioner workloads are a major driver of this burnout,5 and competence expansion of non-general practitioners has often been proffered as a potential solution.

Andersen BK, Sejr-Hansen M, Maillard L, et al. Quantitative flow ratio versus fractional flow reserve for coronary revascularisation guidance (FAVOR III Europe): a multicentre, randomised, non-inferiority trial. Lancet 2024; 404: 1835–46—In this Article, author Eric Van Belle's name should have been written as E Van Belle in the affiliations section. This correction has been made to the online version December 19, 2024.

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding.

The 65th World Health Assembly in 2012 established six global nutrition targets (GNTs) related to birthweight, exclusive breastfeeding, child growth (stunting, wasting and overweight), and anaemia in women of reproductive age as key indicators of maternal and child health.1 Therefore, evaluations of progress towards achieving these targets, and their forward projections are of great interest to governments, public health policy makers, scientists, and clinical practitioners. Although some other bodies have reported on progress towards these targets,2 the recent analysis by the Global Nutrition Target Collaborators, as part of the Global Burden of Disease Study (GBD),3 is a comprehensive effort to provide changes in the prevalence of GNT indicators and their attributable burden at a regional, national, and global level from 2012 to 2021, with projections to 2050 in 204 countries and territories, using GBD 2021 data.

From preventing the spread of malaria in the USA during the early 1950s1 to protecting the public from avian influenza, the US Centers for Disease Control and Prevention (CDC) has worked for almost 80 years to take care of the US public's health. However, health threats are ever present and ever changing, and CDC has changed over the past 4 years to stay ahead of them. After the COVID-19 pandemic, in which the clarity of the agency's guidance and timeliness of its communications were questioned, CDC listened, learned lessons, and took action—to be more effective, more responsive, and more transparent.

Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. The diagnosis is based on the presence of typical symptoms and multiple morphological manifestations of the pancreas, including pancreatic duct stones and strictures, parenchymal calcifications, and pseudocysts. Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care.