Surgical management of a large retinal cyst in X-linked retinoschisis with internal drainage: Report of an unusual case

Although X-linked retinoschisis is a common retinal degeneration condition, the presence of a large retinal cyst obscuring the visual axis in an infant is a rare presentation. Herein, we describe such a case of a child who presented to us with the diagnosis of retinal detachment in both the eyes. However, following multimodal imaging and electrophysiology, the child was found to have bilateral juvenile retinoschisis with a large retinoschisis cyst involving the visual axis seen intraoperatively in the left eye. A limbal approach followed by lensectomy was used to excise the inner retinal layer of the cyst. The intracystic fluid was then drained and the stretched retinal vessels were endocauterized and severed without causing any iatrogenic outer retinal breaks and retinal detachment. The correct diagnosis and meticulous preoperative planning of the surgical procedure helped us manage this challenging case with a favorable anatomical and functional outcome.     

Pre-pubertal exposure of cytarabine-induced testicular atrophy,impaired spermatogenesis and germ cell DNA damage in SD rats

Context: Cytarabine (Ara-C) is an effective chemotherapeutic drug for the treatment of acute leukaemias. It inhibits the DNA synthesis and repair, thereby causes cytotoxicity in the proliferating cells.

Objective: This study was aimed to investigate the effects of pre-pubertal exposure of Ara-C on testesticular development in juvenile SD rats and their function at puberty.

Materials and methods: Ara-C was injected at the doses of 50, 100 and 200?mg/kg/day from postnatal day (PND) 29–42 (14 days) by intraperitoneal (i.p.) route. Half of the animals were sacrificed on PND 43 and remaining on PND 70. End points of the evaluation included gross pathological examination, histomorphometric analysis, sperm count and sperm head morphology, cell proliferation and DNA damage as well as apoptosis analysis.

Results: Ara-C treatment significantly decreased food and water intake, weight gain, testes and epididymis weight and increased histological alterations in the seminiferous tubule. Furthermore, Ara-C treatment significantly decreased the PCNA-positive cells and sperm count in a dose-dependent manner. Ara-C treatment also increased the DNA damage and apoptosis in testes and sperm as evident from the comet and TUNEL assays results.

Discussion: The present study results clearly indicated that Ara-C treatment impaired spermatogenesis and adversely affects the testicular development and its function in rats by reducing the germ cell proliferation and the inducing DNA damage and apoptosis.     

Suicidal Ideation and its Correlates among Juvenile Delinquents in South Korea

Objectives

This study investigated suicidal ideation and its correlates among juvenile delinquents in South Korea.

Methods

Suicidal ideation, psychological health status, and health-related behaviors were assessed using a self-administered questionnaire in 1682 juvenile offenders aged between 15 and 18 years in 2012.

Results

The prevalence of suicidal ideation in juvenile delinquents was 15.2%. Girls were more likely to report suicidal thoughts than boys (30.3% vs. 12.7%). Suicidal ideation was more common among adolescents who were not living with their family prior to entering detention centers (22.6% vs. 13.2%) than their counterparts. The likelihood of suicidal ideation was significantly associated with problem drinking [odds ratio (OR) = 1.84], psychedelic drug use (OR = 2.04), feeling unhappy (OR = 3.05), feeling sad or depressed (OR = 13.37) after controlling for sociodemographic factors, other health behaviors and perceptions.

Conclusion

The present study provides evidence for an association between suicidal ideation and psychological health and health risk behaviors among juvenile delinquents. It also highlights the importance of mental health and behavioral interventions for this population to prevent suicidality.     

Daily production and metabolic clearance of growth hormone in juvenile diabetes mellitus

Summary Daily production (PR) of human growth hormone (HGH) was calculated in patients with juvenile diabetes and control subjects by determining metabolic clearance rate (MCR) of¹³¹I HGH, at equilibrium, and mean endogenous HGH levels throughout a 24 h day. Half hourly sampling or a constant withdrawal pump were used to obtain an integrated mean endogenous HGH level. MCR (liters/day) was significantly reduced in all diabetic subjects both in absolute terms (96 ± 15 vs 274 ± 37) and relative to surface area (62 ± 8 vs 171 ± 21) (p < 0.01). Mean HGH levels were 8.4 ng/ml in the diabetics and 5.5 ng/ml in age matched controls. Daily HGH PR in the diabetic subjects (339 to 1365 g/day) did not exceed values in the control subjects (1005–1426 g/day). The results indicate that the elevated plasma HGH levels and increased HGH response to stimuli observed in diabetes, reflect reduced metabolic clearance, rather than increased pituitary secretion.     

Prepubertal exposure to low doses of sodium arsenite impairs spermatogenesis and epididymal histophysiology in rats

For the first time, juvenile toxicity of inorganic arsenic (As) was investigated in male rats, focusing on reproductive effects. As is a metalloid naturally occurring in the environment, being the inorganic forms the most toxics. Contaminated drinking water and agricultural products are the main prospectors of intoxication for general population. In the present study, Wistar male rats (21 days old) were distributed into three groups (n = 10/group): control (received vehicle‐filtered drinking water), As1 (received AsNaO₂ at 0.01 mg L^?1) and As2 (received AsNaO₂ at 10 mg L^?1). The animals were euthanized on PND 53. Testicular damages increased in As1 and As2 compared to control (ie, presence of vacuolization, acidophilic cells, and epithelium degeneration). Testicular interstitium of As1 and As2 presented fluid's increase and intense inflammatory infiltration. In the epididymis there was reduction of sperm amount in the lumen, besides epithelium areas presenting cribriform aspect in As1 and As2, exfoliation of cells in the light (in As1) and vacuoles (in As2). In epididymis interstitium, inflammatory infiltrates were observed in initial segment of As1 and As2. AsNaO₂ changed immunolabeling pattern for androgen receptor in epididymis of As2, although serum testosterone levels was statistically comparable to control. Mass spectrometry revealed higher As concentrations in testis and epididymis of As2 compared to As1 and Control. These results indicate compromise of spermatogenesis and epididymal histophysiology in AsNaO₂‐treated animals, possibly impairing sperm quality and fertility in long‐term, even at low levels of exposure. Investigations about the reversibility of reproductive damages are necessary to better understand the mechanisms of As reproductive toxicity.     

托珠单抗治疗12例难治性全身型幼年特发性关节炎的临床疗效

目的：探讨托珠单抗治疗难治性全身型幼年特发性关节炎的临床疗效和不良反应。方法：选取2016年9月至2017年5月湖南省儿童医院肾脏风湿科收治的难治性全身型幼年特发性关节炎患儿12例进行前瞻性自身病例对照研究。入组患儿均给予托珠单抗治疗（每次8 mg/kg或12 mg/kg,每2周静脉滴注1次）,比较治疗前后血白细胞总数（WBC）、红细胞沉降率（ESR）、C反应蛋白（CRP）、血清铁蛋白（SF）、白介素-6（IL-6）水平及激素用量并记录患儿治疗前后症状、体征的变化情况。结果：共入组患儿12例,所有患儿给予托珠单抗前均有中等热度以上发热,在应用托珠单抗24~48 h后体温恢复正常,6例有关节症状的患儿治疗12周后2例症状消失,2例症状好转,2例无明显变化。在治疗前无关节症状的患儿中有2例在治疗第12周出现新的关节症状。4例患儿治疗前有皮疹,在治疗24~48 h后皮疹均消失且未反复出现。与治疗前相比,治疗12周后血白细胞、红细胞沉降率、C反应蛋白、血清铁蛋白均明显下降,激素用量较治疗前明显减少,白介素6水平治疗前后差异无统计学意义。4例患儿出现转氨酶升高,5例患儿出现中性粒细胞水平下降,2例患儿并发上呼吸道感染2次,所有患儿在治疗期间均无过敏及严重感染等严重不良反应出现。结论：托珠单抗治疗难治性全身型幼年特发性关节炎疗效较好,不良反应发生率低,临床应用较安全。