医学最新文献

In the forty years since the publication of the Warnock Report, the fertility field has changed dramatically-in part due to the growing influence of finance capital. This article examines how private equity (PE) and venture capital (VC) investments are reshaping the organisation, practice and future of assisted reproduction. While Warnock anticipated sufficient provision of IVF through the NHS, contemporary IVF has become one of the most privatised and financialised areas of medicine. PE-backed acquisitions introduce short-term return-on-investment logics centred on scaling up, cost-cutting and revenue expansion-all of which have implications for pricing, labour, clinical practice, research and training. Meanwhile, VC investments in fertility start-ups embed reproductive innovation within Silicon Valley's cultures of disruptive innovation and speculative futures. From AI-driven embryo selection and DIY fertility apps to stem-cell based innovations and automated embryology, the approximation between the tech and fertility industries increasingly frames reproduction as a process to be engineered, optimised and platformised. Together, the financial forces of PE and VC reshape power relations in assisted reproduction and reconfigure the future direction of reproductive medicine within their logics of valuation. Revisiting Warnock in this context highlights the need for regulatory frameworks that address not only the ethics of fertility treatments, but the consequences of the expanding financial infrastructures that now underpin the fertility sector.

Messenger RNA (mRNA) has emerged as a powerful tool for protein expression in clinical settings, yet its potential as a platform for biologics manufacturing remains underexplored. Here, we evaluate transient mRNA transfection in Chinese hamster ovary (CHO) cells as a rapid and versatile system for protein production. Using reporter mRNAs, we optimize transfection efficiency and benchmark performance against industry-standard plasmid transfection and stable cell line methods. We demonstrate that co-transfection of heavy and light chain mRNAs enables the efficient synthesis, assembly and secretion of the monoclonal antibody bevacizumab with high fidelity. Compared to conventional approaches, mRNA transfection drives rapid and predictable protein expression, reducing cell incubation times and enabling sequential or conditional expression. These features highlight mRNA as a flexible and efficient platform for transient expression, providing a foundation for accelerating the development and manufacturing of biologics.

Rare monogenic diseases are increasingly identified in children with chronic kidney disease. We describe a consanguineous preterm male infant with a clinical picture of advanced kidney dysfunction and severe renal salt-wasting, highly suggestive of prenatal onset Bartter syndrome. Patient's follow-up was characterized by severe polyuria; episodes of hyponatremia, hypokalemia, and hypochloremia; and metabolic alkalosis and hyperuricemia. We found a homozygous pathogenic variant in the TFCP2L1 gene, a transcription factor required for normal kidney development, that regulates acid-base and salt-water homeostasis. To our knowledge, there is only one published case of a child with TFCP2L1 gene pathogenic variants with a similar phenotype. This report adds evidence to TFCP2L1 as a cause of monogenic kidney disorders. Rare kidney dysplasias may manifest as phenocopies of primary tubulopathies. Genetic diagnosis plays a major role and should be carefully considered in patients with refractory course to standard treatment to facilitate management and family counselling.

Background: Parental stress in pediatric chronic illness is well known; however, there is a dearth of literature describing parental stress in pediatric chronic kidney disease (CKD). This pilot study evaluated parenting stress in mild to moderate pediatric CKD relative to caregivers of healthy, typically developing children.

Methods: The study included 38 children, ages 6 to 12 years, and their parents (CKD Group = 10, Typical Group = 28). Pediatric CKD participants had mild to moderate kidney dysfunction for at least 3 months. Parents completed the Parenting Stress Index (PSI-3) as a measure of their current stress.

Results: Serial linear regressions revealed no significant group differences on the Child, Parent, Total Stress, or Life Stress domains; however, exploratory analyses revealed significant parental stress on the subscales of Mood and Acceptability, as well as concerns about their own Competence and Health. Compared to the control group, parents of patients with CKD also reported significantly high levels of stress on Adaptability (50% versus 21.4%), Mood (60% versus 25%), and Acceptability (50% versus 10.7%).

Conclusions: While overall levels of parenting stress were not unduly elevated in group comparisons, increased stress levels with respect to their child's mood, acceptability, and their own personal health were noted. The proportion of CKD parent ratings reaching significantly high stress levels also was uniformly high, particularly in Adaptability, Mood, Acceptability, (parental) Competence, and Total Stress. These pilot results should guide future studies exploring parent/family factors and potential interventions for reducing parenting stress and related burdens in the clinical care of children with CKD.

Background: Pediatric hypertension is a growing health concern, with prolonged exposure to high blood pressure potentially causing electrical instability and increasing arrhythmia risk. The index of cardiac electrophysiological balance (iCEB), calculated as QT interval divided by QRS duration, is a potential non-invasive marker for arrhythmogenesis. This study aimed to evaluate iCEB and corrected iCEB (iCEBc) in hypertensive children and investigate their relationship with arrhythmic risk.

Methods: This cross-sectional study included 81 children with primary hypertension and 36 age- and sex-matched healthy controls. Office blood pressure, 24-h ambulatory blood pressure monitoring (ABPM), standard echocardiography, and 12-lead electrocardiograms (ECGs) were obtained. QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, iCEB, and iCEBc were calculated. Echocardiographic measurements and laboratory parameters were also evaluated.

Results: The mean age of the hypertensive group was 13.8 ± 3 years, with 60.5% males. Most (64.2%) demonstrated a non-dipping BP pattern. Echocardiography showed preserved ejection fraction (72.7 ± 5.4%) and shortening fraction (42 ± 5.1%), with left ventricular hypertrophy (LVH) observed in 8.6% of cases. ECG analysis revealed significantly prolonged QTc interval (416.8 ± 30.2 ms vs. 401.8 ± 23.4 ms; p = 0.008), iCEB (3.92 vs. 3.44; p = 0.02), and iCEBc (4.58 vs. 4.09; p = 0.001) values in hypertensive patients compared to controls. No significant differences were observed in Tp-e, Tp-e/QT, or Tp-e/QTc.

Conclusion: Children with hypertension exhibit subclinical alterations in cardiac electrophysiology, including significantly elevated iCEB and iCEBc values, which may indicate electrical instability and a higher arrhythmia risk. These indices may serve as practical, non-invasive tools for early detection of subclinical electrophysiological changes in pediatric hypertension.

Introduction: Pneumococcal disease leads to high morbidity and mortality, particularly in older adults and immunocompromised individuals. Many pneumococcal conjugated vaccines (PCVs) have become available. However, the immunogenicity, efficacy, and effectiveness data of these vaccines in older adults and immunocompromised individuals are limited.

Areas covered: This review aims to critically examine the immune responses, immune correlations, efficacy, real-world effectiveness, and cost-effectiveness of pneumococcal conjugated vaccines (PCVs) in older adults and immunocompromised individuals.

Expert opinion: A single dose of 20-valent or 21-valent PCV is recommended for older adults and immunocompromised individuals. Immune correlates of protection vary by serotype and race. An IgG level of 0.35 µg/mL is associated with protection, though this threshold is serotype-dependent. Opsonophagocytic assays, with a threshold of 1:8, remain the most reliable functional correlate of protection against invasive pneumococcal disease. Standardized immunological assays are essential for evaluating immune responses. High-valent PCVs have shown noninferior immunogenicity compared to PCV13, though geometric mean fold rises (GMFRs) for shared serotypes are slightly lower. Real-world effectiveness data are still needed, particularly in regions with differing serotype prevalence. Serotype surveillance is crucial when introducing PCV programs. Due to the high cost of higher-valent PCVs, many countries continue using PCV13 or PCV15 followed by PPSV23 for high-risk groups.