Regional differences in infant 25‐Hydroxyvitamin D: Pilot study of the Japan Environment and Children’s Study

Background

In recent years, a resurgence in the number of infants with vitamin D deficiency has been noted. In addition to seasonal differences in exposure to ultraviolet (UV) rays, regional differences in dietary habits and lifestyles may affect susceptibility to vitamin D deficiency. No studies have been conducted, however, on infants in multiple regions of Japan to determine the extent of differences in vitamin D status.

Methods

25‐Hydroxyvitamin D (25OHD) was measured on radioimmunoassay in 126 infants aged 2–4 years, who participated in the Pilot Study of the Japan Environment and Children's Study (JECS) by the Ministry of Environment of Japan. A multiple regression model with 25OHD level as the outcome variable, and season and region as explanatory variables, was generated.

Results

Both region and season during which infants participated in this study significantly affected 25OHD level (P = 0.0087 and <0.0001, respectively; Wald test). Reflecting decreased exposure to UV rays, infants who were examined in winter had lower 25OHD than those examined in summer. Infants from both Fukuoka Prefecture (33°N) and Kumamoto Prefecture (32°N), however, had lower 25OHD than those from Tochigi Prefecture (36°N), contrary to expectations given the extent of UV exposure.

Conclusions

Regional differences in daily habits and/or environmental factors affect 25OHD level in Japanese infants. The JECS is expected to identify those factors to provide guidance on preventing infantile vitamin D deficiency.     

Advanced ERCP techniques for the extraction of complex biliary stones: a single referral center’s 12-year experience

Objectives: Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs.

Methods: A retrospective query for AETs. Primary outcome: Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC).

Results: From 1/00 to 10/12, 349 patients were identified of which 222 (80% had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET’s. Index AETs: POC with EHL/LL (n?=?46/211, 22%), ML (n?=?84/211, 40%), EPLBD with mean balloon size of 11.5?±?1.7?mm (n?=?39/211, 18%) and combination AETs (n?=?42/211, 20%). Stone characteristics: 76% had ≥1 stone, 81% extrahepatic and 32% had strictures. Number of stones (mean 2.5 and range 1–20) did not differ among groups. EPLBD had higher percentage (95%) of extrahepatic stones (p?=?.0003). The ‘Combination’ and ‘POC’ groups had larger stones (mean 17.7?mm ±6.4 and 16.8?mm ±6.1, respectively; p?p?=?.014). Adverse Events: 7/280 (2.5%).

Conclusions: AETs achieved clearance in 99%. EPLBD had higher clearance at index AET likely owing to higher extrahepatic stones. Larger stones, but not number, were associated with increased combination AETs and total ERCPs.     

Uterine cervical edema following cerclage

We present a case of large uterine cervical edema following cerclage during pregnancy.