Male circumcision for HIV prevention in young men in Kisumu, Kenya : a randomised controlled trial. Commentary

Rationale: Extracellular matrix (ECM) is a dynamic tissue that contributes to organ integrity and function, and its regulation of cell phenotype is a major aspect of cell biology. However, standard in vitro culture approaches are of unclear physiologic relevance because they do not mimic the compositional, architectural, or distensible nature of a living organ. In the lung, fibroblasts exist in ECM-rich interstitial spaces and are key effectors of lung fibrogenesis.Objectives: To better address how ECM influences fibroblast phenotype in a disease-specific manner, we developed a culture system using acellular human normal and fibrotic lungs.Methods: Decellularization was achieved using treatment with detergents, salts, and DNase. The resultant matrices can be sectioned as uniform slices within which cells were cultured.Measurements and Main Results: We report that the decellularization process effectively removes cellular and nuclear material while retaining native dimensionality and stiffness of lung tiss...

/pdf/acellular-normal-and-fibrotic-human-lung-matrices-as-a-2z9563pfzp.pdf

Acellular Normal and Fibrotic Human Lung Matrices as a Culture System for In Vitro Investigation

Mouse pulmonary dose- and time course-responses induced by exposure to multi-walled carbon nanotubes.

Safety and efficacy data on many medicines used in children are surprisingly scarce. As a result children are sometimes given ineffective medicines or medicines with unknown harmful side effects. Better and more relevant clinical trials in children are needed to increase our knowledge of the effects of medicines and to prevent the delayed or non-use of beneficial therapies. Clinical trials provide reliable evidence of treatment effects by rigorous controlled testing of interventions on human subjects. Paediatric trials are more challenging to conduct than trials in adults because of the paucity of funding, uniqueness of children and particular ethical concerns. Although current regulations and initiatives are improving the scope, quantity and quality of trials in children, there are still deficiencies that need to be addressed to accelerate radically equitable access to evidence-based therapies in children.

https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bcp.12305

Clinical trials in children

/pdf/guidelines-on-paediatric-urology-5b1q1v671w.pdf

Guidelines on paediatric urology

Early Hypospadias Surgery May Lead to a Better Long-Term Psychosexual Outcome

The ethics of clinical research is based on several well-known guidelines and documents. The guidelines vary between countries, but the principles of respect for persons, beneficence, and justice are constant. These principles are reflected in requirements to obtain free and informed consent, to minimize risk or harm, and to not overly burden or disadvantage particular populations. For research to be ethical, it must also be of such a standard, and be conducted in such a manner that it will generate knew and useful knowledge. Children have limited capacity for understanding and may be more open to coercion. Therefore, they are regarded as a particularly vulnerable population, and specific clauses regarding children are incorporated into many guidelines. A key concept in these clauses is the degree of risk acceptable for children involved in research. While it is generally agreed that children require particular attention because of their vulnerability, there is also increasing concern that children in general should not be disadvantaged by lack of knowledge due to reduced research activity. Finally, an increasingly active area of research in children involves genetics and biobanking. Research in these areas raises new and challenging ethical issues.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1460-9592.2009.03117.x

Michael O'Brien

Papers

Early Hypospadias Surgery May Lead to a Better Long-Term Psychosexual Outcome

Ethics and medical research in children

Long-term urethral function measured by uroflowmetry after hypospadias surgery: comparison with an age matched control.

A novel device to assess hip strength: Concurrent validity and normative values in male athletes

Two-stage graft urethroplasty for proximal and complicated hypospadias in children: A retrospective study