Hamamatsu Medical Center

Abstract Uric acid (UA) is traditionally regarded as a metabolic risk marker; however, its dynamic behavior during glucose-lowering therapy remains incompletely understood. We compared UA responses to a modified traditional Japanese diet (MJDD) and the DPP-4 inhibitor alogliptin in patients with early-stage type 2 diabetes mellitus (T2DM). In this prospective observational study, drug-naïve patients received MJDD (n=58) or alogliptin (n=52) monotherapy for 3 months. Changes (Δ) in serum UA were analyzed in relation to glycemic control, insulin resistance, adipose tissue insulin resistance (adipo-IR), and beta-cell function. Both interventions significantly reduced fasting blood glucose and HbA1c while paradoxically increasing serum UA and HOMA-B. Baseline UA was the primary determinant of ΔUA in both cohorts. MJDD significantly reduced body mass index, insulin, free fatty acids, HOMA-R, and adipo-IR, with effects most pronounced in subjects with baseline BMI >25. In contrast, alogliptin selectively reduced adipo-IR in leaner subjects (BMI <25). Across both treatments, ΔUA correlated positively with ΔHOMA-B and inversely with ΔHbA1c. Notably, during MJDD, ΔUA showed a paradoxical negative correlation with ΔBMI and ΔFBG, and a positive correlation with ΔFFA. Patients exhibiting the greatest UA increases demonstrated the most marked improvements in beta-cell function and, with MJDD, the greatest weight loss. These findings indicate that MJDD and alogliptin exert distinct metabolic effects in early T2DM, yet both link rising UA to enhanced beta-cell function, suggesting that UA may serve as a dynamic pharmacometabolic biomarker reflecting therapy-specific metabolic adaptation rather than metabolic deterioration.

BackgroundNudge strategies are well-established in behavioral economics as effective approaches for promoting desirable behaviors. However, the potential benefits of integrating nudge-based strategies into pharmacist-led patient education have not yet been demonstrated. Here, we present a study protocol for an interventional trial to address this issue.MethodsThe PHARM-NUDGE study is a multicenter, randomized, parallel-group, single-blind, controlled trial prospectively designed to evaluate whether nudge-based pharmacist-led education can promote patients’ preventive behaviors against skin toxicities associated with cancer chemotherapy. The key inclusion criteria are as follows: (1) patients who are men or women and aged 18 years or older and (2) patients scheduled to receive a chemotherapy regimen containing capecitabine, liposomal doxorubicin, lenvatinib, cetuximab, or panitumumab in outpatient chemotherapy units or during hospitalization. The enrolled patients are randomly assigned in a 2:1 ratio to the nudge-based education or standard education groups. Pharmacists responsible for patient education utilize special educational tools that incorporate nudge strategies and provide skincare education to patients assigned to the nudge-based education group. Patients assigned to the standard education group receive skincare education with equivalent content but without nudges. The primary endpoint is the proportion of patients in each group who achieve four or more of the five predefined behavioral criteria.ConclusionsThe PHARM-NUDGE study is the first randomized controlled trial to evaluate the potential benefits of integrating nudge strategies into pharmacist-led skincare education for patients undergoing cancer chemotherapy with a high risk of skin toxicity, with patient enrollment initiated on October 15, 2025. Completion of the trial and acquisition of the final results are eagerly anticipated.Trial registrationThis trial was registeredwith the Japan Registry of Clinical Trials (clinical trial number: jRCT1040250089, registration date: September 3, 2025).Supplementary InformationThe online version contains supplementary material available at 10.1186/s40780-026-00556-4.

Concurrent chemoradiotherapy (CCRT) is the standard treatment for unresectable stage III non-small-cell lung cancer (NSCLC). Completion of CCRT affects subsequent therapy and impacts overall survival. The aim of this study was to develop a model for predicting completion of CCRT and thus guide individualized treatment strategies. We conducted a pooled analysis of data from the Japan Lung Cancer Society-Integrated Database, which includes data from eight randomized phase II/III trials of CCRT for unresectable stage III NSCLC in Japan. Clinical factors associated with CCRT completion were identified through multivariable logistic regression analysis and used to develop a scoring model. The scoring model includes neutrophil count ≥4500/μL = two points, C-reactive protein concentration <1.00 mg/dL = two points, cisplatin-based therapy = one point, and PaO 2 ≥83.0 mmHg = one point for a total of six points (NCCP score). NCCP score categories were defined as low (0–3) or high (4–6). Completion rates of CCRT were 39.7% (95% CI = 34.1–45.5%) in the low and 63.9% (95% CI = 56.6–70.7%) in the high NCCP score groups (p < 0.001). High NCCP scores were also significantly associated with better objective response rate, disease control rate, progression-free survival, time-to-treatment failure, and overall survival) ( p <0.001, 0.003, 0.003, <0.001, and <0.001, respectively). The NCCP score, composed of neutrophil count, use of cisplatin, CRP concentration, and PaO 2 , predicts completion of CCRT and may contribute to optimizing CCRT treatment as a supplementary risk stratification in patients with stage III NSCLC.

Differences of sex development (DSD) are congenital conditions in which chromosomal, gonadal, and anatomical sex characteristics are discordant with typical male or female development. These clinical practice guidelines provide evidence-based recommendations for the diagnosis and management of individuals with DSD across the lifespan. The guidelines were developed by a multidisciplinary committee of specialists representing pediatric endocrinology, adult endocrinology, urology, gynecology, psychiatry, and psychology. The committee employed a systematic review of the literature and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of evidence. Key areas addressed include the initial management of infants with atypical genitalia, diagnostic approaches, hormonal treatment, surgical interventions, gonadal tumor risk assessment, fertility preservation, and the transition from pediatric to adult care. The guidelines integrate international best practices with Japan's unique sociocultural, healthcare, and legal contexts for optimal DSD management and aim to improve clinical care for individuals with DSD while acknowledging the limited high-quality evidence in many aspects of DSD management.

Background and study aimsOlympus’s new endoscopic system, EVIS X1, features five-LED illumination and a novel complementary metal-oxide-semiconductor (CMOS) image sensor distinct from conventional charge-coupled devices (CCDs), potentially improving colorectal adenoma detection rates (ADRs). This study compared ADR and related indicators between the EVIS X1 system and the conventional EVIS LUCERA ELITE, a xenon-light system.Patients and methodsOf 4,915 colonoscopies performed between September 2020 and April 2023, 814 EVIS X1 and 953 LUCERA cases met inclusion criteria. After propensity score matching to balance baseline characteristics, 660 patients per group were analyzed. Outcomes included ADR, polyp detection rate (PDR), adenomas per colonoscopy (APC), and polyps per colonoscopy (PPC). Subgroup analysis assessed the impact of CMOS-equipped scopes within the X1 group.ResultsADR was slightly higher in the X1 group (36.1%) than the LUCERA group (32.1%), although not statistically significant (P= 0.147). APC (0.77 vs. 0.61,P= 0.034) and PPC (0.95 vs. 0.75,P= 0.023) were significantly higher with X1. Within the X1 group, scopes with CMOS sensors achieved a significantly higher ADR (41.9%) compared with those without. Mean size of polyps detected was smaller with CMOS than with CCD scopes. Multivariate analysis identified age > 60 years, male sex, positive fecal occult blood test, and use of the X1 system with CMOS scopes as independent predictors of higher ADR.ConclusionsThe EVIS X1 system may have the potential to improve adenoma detection, particularly when used with CMOS sensor-equipped scopes. These findings suggest potential benefits for colorectal cancer screening, although further large-scale studies are warranted for validation.

We used the sodium-glucose cotransporter 2 inhibitor, luseogliflozin in two patients with diabetes mellitus with Child-Pugh classification B cirrhosis and cirrhotic ascites. In each case, luseogliflozin was safely used for over three years and was also considered effective in reducing ascites. In one of the patients in particular, when luseogliflozin was discontinued and switched to insulin treatment before colorectal cancer surgery, ascites accumulation was observed within two weeks, which subsequently decreased rapidly when luseogliflozin was restarted. In this case, the effect of luseogliflozin on ascites was evident by the clear increase and decrease in ascites over a short period of time, as evaluated using body weight, abdominal circumference and CT scan, without changing her other diuretic medication. Although sodium-glucose cotransporter 2 inhibitors need to be used with caution, they might be an option for the treatment of diabetes in patients with cirrhosis. Luseogliflozin, a sodium-glucose cotransporter 2 inhibitor, is effective for glycemic control and safe in patients with cirrhosis. Luseogliflozin administration reduced ascites in patients with diabetes mellitus. Caution is warranted, as discontinuation of sodium-glucose cotransporter 2 inhibitors might lead to an increase in ascites.