Volume 12 · Issue 03 · 2026

The global increase in obesity, type 2 diabetes mellitus (T2DM), and metabolic dysfunction-associated steatotic liver disease (MASLD) has led to a higher use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among patients undergoing gastrointestinal endoscopy. Although GLP-1RAs provide significant metabolic, cardiovascular, and hepatic benefits, their tendency to slow gastric emptying has raised concerns about retained gastric contents (RGC), procedural complications, and a greater risk of pulmonary aspiration during sedation or anesthesia. This review offers a translational narrative synthesis of mechanistic, physiological, and clinical evidence connecting GLP-1RA therapy to changes in gastric motility and peri-endoscopic outcomes. Data from pharmacological studies, scintigraphic evaluations, large observational cohorts, and international consensus statements are combined to guide physiology-based procedural decisions. Evidence consistently indicates that GLP-1RA exposure is associated with a higher incidence of RGC and more frequent procedural disruptions during upper gastrointestinal endoscopy. However, it remains uncertain whether RGC leads to clinically significant aspiration. Consistent with this, real-world data reveal no increase in aspiration pneumonia among GLP-1RA users undergoing colonoscopy, with reported aspiration rates of approximately 0.01%-0.05%. Likewise, during upper gastrointestinal endoscopy, only a small absolute rise in aspiration-related events has been observed, involving fewer than 0.3% of procedures. Current guidelines favor continuing GLP-1RA therapy alongside dietary modification, structured risk assessment, selective gastric point-of-care ultrasound (POCUS), and multidisciplinary communication, rather than routine cessation. Emerging prospective evidence indicates that implementing a preprocedural clear liquid diet, with individualized timing of weekly agents, may reduce the risk of clinically significant RGC, complementing existing dietary preparation strategies.

Background: Colorectal cancer (CRC) is one of the most commonly occurring cancers all over the world. Because of the high metastasis rate, the 5-year survival rate of metastatic CRC is only around 10%. CRC cells trigger the remodeling of the tumor microenvironment (TME), so decoding the TME between metastatic and primary sites becomes crucial. Methods: Single-cell sequencing and analysis were performed on 36 samples from four anatomical locations in nine untreated CRC liver metastasis patients. Cells from primary and metastatic sites were compared, and TMEs were validated. Genes from primary and metastatic sites were compared using a nonparametric test. Results: Eleven major cell types were identified, and high heterogeneity of cell distribution among different locations was observed. We revealed several new features in liver metastatic tumors, including CXCL13 + CD4 T cells and regulatory CD4 T cells enriched, exhausted CD8 + T cells (Tex) increased, SPP1+ tumor macrophage increased, IGFBP7+ cancer-associated fibroblasts in the metastatic TME, and the relative activation of the linoleic acid metabolism pathway. Besides, tumor cells contributed to four distinct biological modules, encompassing apoptosis, epithelial-mesenchymal transition, the cell cycle, and immune processes. Conclusion: Our study contributes new features for the microenvironment of colon cancer and liver metastasis, which may provide unique insights for novel biomarkers and potential treatment strategies.

Background: Cardiovascular disease (CVD) is the leading cause of mortality, posing a major challenge to its rapidly aging demographic. Early identification of individuals at high risk for future cardiovascular events is paramount for implementing timely preventative strategies. However, comprehensive population-level estimates using validated assessment tools remain limited in this setting. This study was to ascertain the prevalence and determinants of persons at high risk of experiencing any cardiovascular event within the next 10 years among older adults in India. Methods: We analyzed data from the Longitudinal Aging Study in India Wave-1 (2017-2018), including 64,266 participants aged 40-74 years. We used the World Health Organization CVD Risk Chart 2019 version, a nonlaboratory-based risk assessment model, to stratify cardiovascular risk based on age, sex, smoking status, systolic blood pressure, and body mass index. Results: Weighted prevalence of high CVD risk (≥ 20%) was 2.67% (95% confidence interval [CI]: 2.44, 2.91), while intermediate risk (10% to < 20%) was 28.41% (95% CI: 27.60, 29.25). Overall, 31.08% had ≥ 10% risk. In the diabetes and hypertension (HTN) subgroups, high risk (≥ 20%) was 3.53% and 4.36%, respectively. Adjusted analysis showed significantly higher odds of high risk among alcohol users, individuals with prior HTN, and widowed/separated participants. Conversely, college education and current employment were associated with significantly lower odds. Conclusions: Over 3 in 100 Indian adults aged ≥ 40 years with diabetes or HTN face a ≥ 20% 10-year CVD risk, highlighting an urgent need for targeted primary care interventions. Prioritizing alcohol cessation, aggressive blood pressure management, and glycemic control through universal standard care coverage is essential to mitigate this burden.

Background: Metabolic syndrome (MetS) is a chronic disorder that poses a major threat to global health. Exosomes have emerged as promising biomarkers for diagnosing and monitoring chronic diseases. However, stage-specific alterations in the exosomal metabolome during MetS development remain poorly understood. This study aimed to characterize the plasma exosomal metabolome and explore candidate exosomal biomarkers in individuals with MetS. Methods: This study included 20 patients with MetS, 23 individuals with pre-MetS, and 45 healthy controls. Plasma exosomes were isolated and analyzed using untargeted liquid chromatography-mass spectrometry-based metabolomics. Differential metabolites were defined by a dual-threshold, that is, p < 0.05 from t-test and variable importance in projection > 1 from partial least squares discriminant analysis, with fold change indicating their expression changes. Further, we employed machine learning algorithms to predict MetS status. Results: We identified 27 differential metabolites between the pre-MetS and control groups, mainly enriched in histidine metabolism and the tricarboxylic acid cycle. Of these, 12 metabolites were upregulated, and 15 were downregulated, with 1-methylhistidine and isocitrate playing central regulatory roles. Comparison between the MetS and control groups revealed 45 differentially expressed metabolites, mainly enriched in thiamine metabolism, including 13 upregulated and 32 downregulated. In the pre-MetS group, cladribine showed the highest area under the curve (AUC) (0.743, p < 0.05), whereas 3-methylxanthine yielded the largest AUC (0.714, p < 0.05) in the MetS group. Conclusion: Our study characterized stage-dependent alterations in the plasma exosome-derived metabolome in MetS and suggests that exosomal metabolomics may provide complementary molecular information on early MetS metabolic perturbations.

Background: Stroke is a leading cause of long-term disability that impairs physical function and health-related quality of life (HRQoL). Rehabilitation during and after hospitalization is essential for promoting neurological recovery and functional independence. This study aims to investigate (1) changes in physical function, balance, and HRQoL from hospital admission to completion of rehabilitation after stroke; (2) associations between rehabilitation amount and changes in physical function and balance; and (3) patient outcomes after rehabilitation compared with those of the general population. Methods: Patients with stroke scheduled for rehabilitation were enrolled in this cohort study. Outcomes assessed at admission, discharge, and the beginning and end of outpatient rehabilitation included the 30-s Chair Stand Test (30sCST) and Berg Balance Scale (BBS). EQ-5D-5L data were collected at admission and after rehabilitation. Rehabilitation hours were recorded and included in the analyses. Results: A total of 121 patients were included (age 72 ± 10 years; 35.5% female). Performance on the 30sCST and BBS and EQ-5D-5L visual analog scale scores improved throughout the study (30sCST: 1.63 [0.96; 2.30]-10.76 [9.47; 12.04] repetitions; p < 0.001). The EQ-5D-5L index remained unchanged. The number of rehabilitation sessions was not associated with changes in 30sCST or BBS scores. After rehabilitation, patients continued to have lower 30sCST performance and EQ-5D-5L scores than the general population (30sCST: 11.9 [10.7; 13.2] vs. 16.9 [16.1; 17.7] repetitions, respectively; p < 0.001). Conclusions: Physical function, balance, and HRQoL improved during inpatient and outpatient rehabilitation. However, rehabilitation sessions were not associated with improvements in physical function or balance. Compared with the general population, patients continued to have reduced physical function and HRQoL after rehabilitation, suggesting a need for continued self-managed rehabilitation.

Background: Obstructive sleep apnea (OSA) is one of the most common sleep disorders. Intermittent nocturnal hypoxia and sleep fragmentation in OSA may be among the main mechanisms triggering cognitive impairment and neurodegeneration. The study was to identify the relationships among plasma total tau (t-tau) levels, Mini-Mental State Examination (MMSE) scores, and sleep parameters in middle-aged men with severe OSA. Methods: Twenty-three men (mean age, 52.3 ± 2.2 years) with severe OSA were included. Nineteen age-matched men without OSA served as controls. All participants underwent overnight polysomnography (PSG). Global cognition was assessed using the MMSE. Plasma t-tau levels were measured by enzyme immunoassay. Pearson correlation analysis was used to assess the relationships among plasma t-tau levels, MMSE scores, and PSG data. Results: Plasma t-tau levels were significantly negatively correlated with non-rapid eye movement sleep stage 3 (N3) duration and mean oxygen saturation (SaO2) and positively correlated with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and arousal index (AI). MMSE scores were negatively correlated with AHI, ODI, and AI. Conclusion: Reduced deep sleep duration, nocturnal intermittent hypoxia, and sleep fragmentation were associated with a greater t-tau burden and lower MMSE performance in severe OSA.

Chronic diseases are the leading causes of morbidity and mortality worldwide and impose a substantial and long-lasting burden on individuals, families, communities, and healthcare systems. In Australia, more than 47% of the population had at least one chronic condition in 2018, and the prevalence rose sharply with age: approximately 80% of adults aged 65 and over lived with one or more chronic diseases. These conditions are complex and driven by multiple factors, with modifiable behavioral risks such as poor diet, physical inactivity, tobacco use, and harmful alcohol consumption playing a major role. Although notable progress has been made since the implementation of the National Strategic Framework for Chronic Conditions 8 years ago, the overall burden of chronic diseases persists at a significant level. This ongoing burden highlights the need for more targeted evidence-based public health interventions that address these modifiable risk factors to reduce the prevalence of chronic diseases and improve population health outcomes.