Fish consumption in early pregnancy and congenital gastrointestinal tract atresia in the Japan Environment and Children's Study.

Current evidence suggests that the aetiology of congenital gastrointestinal (GI) tract atresia is multifactorial, and not based solely on genetic factors. However, there are no established modifiable risk factors for congenital GI tract atresia. We used data from a Japanese nationwide birth cohort study launched in 2011, and examined whether fish consumption in early pregnancy was associated with congenital GI tract atresia. We analysed data of 89 495 women (mean age at delivery=31·2 years) who delivered singleton live births without chromosomal anomalies. Based on the results of the FFQ, we estimated the daily intake of fish and n-3 PUFA consumption in early pregnancy. We defined a composite outcome (oesophageal atresia, duodenal atresia, jejunoileal atresia and/or anorectal malformation) as congenital GI tract atresia. In this population, median fish intake was 31·9 g/d, and seventy-four cases of congenital GI tract atresia were identified. Fish consumption in early pregnancy was inversely associated with the composite outcome (multivariable-adjusted OR for the high v. low consumption category=0·5, 95 % CI 0·3, 1·0). For all the specific types of atresia, decreased OR were observed in the high consumption category, although not statistically significant. Reduced atresia occurrence was observed even beyond the US Food and Drug Administration's recommended consumption of no more than 340 g/week. Also, n-3 PUFA-rich fish and n-3 PUFA consumptions tended to be inversely associated with atresia. Fish consumption in early pregnancy may be a preventive factor for congenital GI tract atresia.

Prolonged Hypocalcemia Following a Single Dose of Denosumab for Diffuse Bone Metastasis of Gastric Cancer after Total Gastrectomy.

Hypocalcemia is a significant adverse effect of denosumab. We herein report a case of prolonged hypocalcemia in a patient with multiple risk factors for hypocalcemia, including gastrectomy, increased bone turnover, and a poor performance status. Hypocalcemia developed after denosumab treatment for diffuse bone metastasis of gastric cancer, despite oral supplementation with vitamin D and calcium. To avoid serious prolonged hypocalcemia, a thorough assessment of the bone calcium metabolism is required before initiating denosumab treatment.

Therapy-related acute promyelocytic leukemia caused by hormonal therapy and radiation in a patient with recurrent breast cancer.

We report a patient with therapy-related acute promyelocytic leukemia (APL) that may have been caused by regional radiation or hormonal therapy after surgery. A 36-year-old Japanese woman developed right breast cancer and underwent breast-conserving surgery and regional radiation to the right breast without adjuvant systemic therapy because she wished to preserve her fertility. Two years later, she developed multiple bone metastases of breast cancer and received hormonal therapy. During the second line hormonal therapy, she developed APL and received induction and consolidation chemotherapy with all-trans retinoic acid (ATRA) and a combination of anthracycline and cytarabine. After she achieved a complete remission (CR) of the APL, her bone metastases of breast cancer progressed. She received weekly paclitaxel treatments and her bone marrow function recovered. However, 9 months later, her APL relapsed; she achieved a second CR after undergoing ATRA therapy again. This patient is thought to be a rare case of secondary leukemia, since the leukemia might have been caused by hormonal therapy and regional radiation without chemotherapy.

[Effects of quantity of Japanese cedar pollen, air pollution and urbanization on allergic rhinitis morbidity in Ibaraki prefecture].

OBJECTIVES: It has been reported that morbidity from allergic rhinitis in the National Health Insurance records in Ibaraki Prefecture for May correlated with the quantity of Japan cedar pollen scattered in each year. The purpose of the present investigation was to clarify the Japanese cedar pollinosis contribution to morbidity, and also clarifying the influence of air pollution and medical resources on the crisis and symptoms of allergic rhinitis. METHODS: The charts in four otolaryngology facilities were used for analyzing the Japan cedar pollinosis content with reference to the allergic rhinitis during the pollen season. The age-adjusted morbidity of allergic rhinitis was annually compared employing data of National Health Insurance records for medical examinations made in May during the period between 1988 and 1996 in Ibaraki Prefecture. The quantity of Japanese cedar pollen was measured at seven area points in Ibaraki Prefecture during the three-year period from 1994 to 1996, and was compared with the degree of Japan cedar wood occupation in each municipality. Traffic volume according to municipalities in Ibaraki Prefecture was taken as a surrogate indicator of air pollution. The area otolaryngology facilities and doctors were taken as medical resources. Values were thus compared with allergic rhinitis morbidity. RESULTS: Sixty to eighty percent of the allergic rhinitis patients examined in May were found to be suffering from pollinosis. The quantities of Japanese cedar pollen scatter at the seven points in Ibaraki Prefecture varied in concert every year, the quantities correlating well with the area of Japanese cedar woods stands in each municipality in some but not in other years. The morbidity in the records of allergic rhinitis according to municipalities correlated negatively with the proportion of the population occupied in farming (r = -0.38) and with the area of Japanese cedar woods in each municipality (r = -0.40). The traffic volume calculated according to municipalities in Ibaraki Prefecture correlated significantly with the yearly average concentration of nitrogen dioxide (r = 0.63, P < 0.01) and with the morbidity of allergic rhinitis. In places among the northern mountains of the Prefecture, both the morbidity in the records and the distribution of otolaryngology facilities were low. CONCLUSIONS: More than 60% of the morbidity from allergic rhinitis in May appeared in the National Health Insurance records to be associated with Japanese cedar pollinosis. This was confirmed by the correlation between yearly variation in morbidity and that of the quantity of Japanese cedar pollen scatter. As local factors increasing the morbidity of allergic rhinitis in the records, air pollution, urbanization and a greater availability of medical resources were indicated.