Hamamatsu University

Summary Early walnut powder introduction in high‐risk infants may suppress walnut sensitisation without safety concerns. This randomised non‐inferiority trial compares introduction at 6–8 months versus 12–14 months of age.

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.

Tumor budding (TB) in colorectal cancer (CRC) has been associated with poor prognosis. TB has been considered a form of epithelial–mesenchymal transition (EMT). Additional discovery of proteins involved in TB can help suppress the aggressiveness of CRC. This study focused on examining whether S100A10, which has been implicated in TB and EMT, qualifies as a biomarker for TB. Formalin-fixed, paraffin-embedded tissue sections from 339 low-grade adenocarcinomas were used. TB was assessed using the recommended hotspot method. Immunohistochemical analysis focused on S100A10 expression on both the tumor buds at the hotspot and tumor glands (TGs), which serve as the direct background for TB, with the stroma-facing membrane (SFM) being the target for the evaluation. Among the 339 patients analyzed, 190 (56.0%) were confirmed to have TB. S100A10 positivity in the tumor buds was detected in 153 patients (80.5%) and was significantly correlated with high-grade TB and high S100A10 positivity in background TGs. S100A10 positivity in background TGs was significantly correlated with high-grade TB, node metastasis, and poor pStage. S100A10 positivity in TGs was often observed in the portions having an irregular border with the stroma, especially ones protruding toward the stroma. In CRC, S100A10 expression at the SFMs of the TGs likely promotes TB from its earliest stage and remains active during TB. The increase in the number of S100A10-expressing tumor cells was associated with poor biological behavior in CRC. Overall, our findings suggest that S100A10 could be a potential biomarker for TB of CRC.

Painting and drawing are symbolic representations that visually transform natural scenes into line and colour. These visual expressions change through cultural transmission—the process by which artworks are reproduced and modified across individuals or communities. While structured patterns have been observed in transmitted language and music, it remains unclear whether similar structuring occurs in colour use for visual representations. This study investigates the emergence of structured colour expression in painting through cultural transmission. We conducted a transmission chain experiment using colouring books. Participants viewed and memorised a coloured page, then reproduced the colour patterns from memory. Their reproduction was used as the stimulus for the next participant. Two colouring books were used, each with five initial colourings. Each transmission chain involved ten iterations, with 100 participants total (five chains per book). In the final generation, participants used fewer and more consistent colours for recognizable objects compared to the initial random-like patterns. This indicates a structuring of colour use over time. However, familiar colour choices (e.g. green for leaves) emerged in only some chains, showing partial influence of prior object-colour knowledge. Our findings suggest that, like language and music, colour use in visual art becomes structured through cultural transmission. While not all chains developed familiar colouring, the overall simplification and regularity of colour patterns highlight the role of shared knowledge and perceptual expectations in shaping visual cultural evolution.

Cushing's disease (CD) is a rare but serious endocrine disorder caused by excessive cortisol secretion due to adrenocorticotropic hormone-secreting pituitary tumors. Despite recent developments in diagnostic criteria and treatment options, CD remains associated with substantial comorbidities and mortality. Early and accurate diagnosis is thus essential. Both the Korean Endocrine Society (KES) and Japan Endocrine Society (JES) guidelines are intended to standardize diagnostic approaches to CD, and they share common principles; however, notable differences exist, particularly in biochemical testing thresholds and imaging recommendations. This consensus statement integrates clinical evidence and expert practice from both the KES and JES to establish harmonized recommendations for biochemical evaluation, imaging, and differential testing. This unified framework is intended to enhance diagnostic precision and improve clinical outcomes across East Asian populations.

Patients with chronic kidney disease (CKD) who develop sepsis experience worse prognoses; however, the impact of CKD on the incidence of sepsis has not been systematically investigated. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Medical Literature Analysis and Retrieval System Online, Web of Science, the Cochrane Register of Controlled Trials, and ClinicalTrials.gov was performed for literature published prior to May 22, 2025, comparing the onset of sepsis in patients with or without CKD. The risk of bias was determined using the Risk of Bias in Nonrandomized Studies of Interventions tool. This study was registered with the International Prospective Register of Systematic Reviews (CRD42023465075). A total of 14 studies met the inclusion criteria for the systematic review. Of these, 5 examined community-acquired sepsis, 2 focused on intensive care unit-acquired sepsis, and the rest investigated surgery-acquired sepsis. Most studies enrolled populations aged over 65 years; 2 assessed age-related sepsis risk. One study evaluated sepsis occurrence in patients with end-stage CKD, while 3 studies stratified this association by estimated glomerular filtration rate (eGFR). Nearly all studies demonstrated an increased risk of sepsis among patients with CKD, with the risk progressively increasing as eGFR declined. Additionally, 2 studies reported that CKD elevated the risk of sepsis regardless of age, and all included studies indicated a low risk of bias. We indicate that patients with CKD may have a higher risk of developing sepsis than individuals without CKD.