The sequel to Death Stranding is shaping up to be just as strange as the original. At its State of Play showcase today, Sony showed off a new trailer for the game that… starts out with a particularly disturbing bit of surgery. The lengthy clip features a whole bunch of new locations outside of the US, as well as the return of a villain who has been given a Joker-esque makeover. And yes, the baby makes an appearance — along with a new, talking doll.

The sequel also has an official title now: Death Stranding 2: On the Beach. It’s due to launch in 2025. Here’s the premise:

Embark on an inspiring mission of human connection beyond the UCA. Sam — with companions by his side — sets out on a new journey to save humanity from extinction. Join them as they traverse a world beset by otherworldly enemies, obstacles and a haunting question: should we have connected?