Sanko University

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/GIP receptor agonists are highly effective agents for the treatment of type 2 diabetes and obesity. However, gastrointestinal (GI) adverse events remain the most common limitations to long-term therapy. Methods: A narrative review with a structured literature search was conducted using PubMed, Embase, and Cochrane Library databases from inception to March 2025. Randomized controlled trials, observational studies, meta-analyses, and pharmacovigilance reports evaluating GI adverse effects of GLP-1-based therapies were included. Results: Nausea, vomiting, diarrhea, and constipation were the most frequently reported GI adverse events, generally dose-dependent and transient. Delayed gastric emptying, gastroparesis-like symptoms, intestinal obstruction, biliary disease, and pancreatic safety concerns were variably reported, with heterogeneous and sometimes conflicting evidence across studies. Conclusion: GLP-1-based therapies are associated with predictable GI adverse effects, most of which are mild to moderate and manageable. Serious complications appear rare, but evidence remains inconsistent. Individualized risk assessment, patient education, and careful dose titration are essential for optimizing long-term tolerability.

The human microbiome is increasingly recognized as a key determinant of health and disease, yet methodological variability continues to limit reproducibility and clinical translation of findings. This review synthesizes current approaches in microbiome research, critically evaluating each step from sampling to sequencing and downstream bioinformatics. Pre-analytical factors such as sample type, collection method, preservation, and storage conditions profoundly affect microbial community profiles and remain a major source of bias. Nucleic acid extraction protocols and quality assessment strategies are discussed with emphasis on optimized lysis techniques, contamination controls, and DNA yield evaluation. Advances in sequencing technologies are highlighted, including 16S rRNA amplicon sequencing, shotgun metagenomics, third-generation long-read platforms, and emerging single-cell and minimal-input methods, each with specific advantages and limitations in taxonomic and functional resolution. Bioinformatics pipelines for taxonomic profiling, variant detection, phylogenetic inference, and functional annotation are compared, with attention to widely used reference databases such as RefSeq, GTDB, and SILVA. Integrative multi-omics approaches, including metatranscriptomics, metabolomics, and genome-scale metabolic modeling, are presented as powerful tools for linking microbial community structure to host physiology and disease mechanisms. Despite these advances, the lack of standardized workflows across pre-analytical, sequencing, and computational steps continues to hinder inter-study comparability and biomarker validation. This review aims to provide a methodological framework that highlights both strengths and limitations of current technologies while underlining the need for harmonized protocols to ensure reproducibility and accelerate the translation of microbiome research into clinical practice.

Background/Objectives: Systemic inflammation, nutritional status, and immune competence have emerged as important prognostic determinants in metastatic renal cell carcinoma (mRCC). The C-reactive protein-albumin-lymphocyte (CALLY) index integrates these parameters into a single composite biomarker, yet its utility in mRCC remains insufficiently explored. This study aimed to evaluate the prognostic significance of the CALLY index in mRCC and its associations with clinicopathological features and survival outcomes. Methods: A total of 68 patients with mRCC treated between 2017 and 2024 were retrospectively analyzed. All patients received first-line VEGF-TKI therapy, and 73.5% subsequently received second-line treatment, predominantly nivolumab. The CALLY index was calculated as (albumin × lymphocyte count)/(CRP × 104), and patients were stratified using the median cut-off (0.16). Survival outcomes were assessed with Kaplan-Meier and Cox regression analyses. Discriminative performance was evaluated using Harrell's C-index and time-dependent ROC curves at 6, 12, and 24 months. Results: Low CALLY (≤0.16) was significantly associated with shorter PFS (4 vs. 8 months, p < 0.001) and OS (9 vs. 26 months, p < 0.001). In multivariate analysis, the CALLY index independently predicted both PFS (HR = 1.91, p = 0.045) and OS (HR = 2.89, p = 0.005). Time-dependent ROC analysis demonstrated increasing discriminative strength for PFS (AUC: 0.70 → 0.95) and modest decline for OS over time (AUC: 0.83 → 0.72). CALLY also showed strong associations with IMDC risk classification and peritoneal metastasis. Conclusions: The CALLY index is a simple, cost-effective, and objective prognostic biomarker that may independently predict progression and survival in mRCC. Its complementary value to the IMDC model supports its integration into routine risk stratification and real-world clinical decision-making.

Objective This study aimed to determine the explanatory role of nutrition knowledge and food preference on sustainable and healthy eating behaviors in adults, and to examine differences according to sociodemographic variables. Methods This cross-sectional and descriptive study was conducted with 231 adults aged 18–65 years who applied to a university hospital wellness center. Data were collected using a sociodemographic questionnaire, the Adult Nutrition Knowledge and Attitude Assessment Scale and the Sustainable Healthy Eating Behaviors Scale. Chi-square test, independent samples t-test, Mann-Whitney U test, Spearman correlation analysis, and hierarchical linear regression analysis were used for statistical analyses. Results Of the participants, 53.7% were female with a mean age of 26.70 ± 7.14 years. SHEBS scores increased significantly as nutrition knowledge levels improved (p = 0.002). Hierarchical regression analysis showed that adding food preference to the model increased its explanatory power (Adjusted R²=0.129, p < 0.001). Women scored significantly higher than men in food preference (p = 0.001), seasonal food consumption (p = 0.011), and reduced meat consumption (p = 0.030) subscales. The local/organic food subscale showed a positive effect on nutrition knowledge (β = 0.245), while the local food subscale showed a negative effect on both nutrition knowledge (β=-0.182) and food preference (β=-0.160). Conclusion Nutrition knowledge and food preference were significantly associated with sustainable and healthy eating behaviors. These findings suggest that intervention programs promoting sustainable nutrition may benefit from incorporating attitude- and value-based approaches alongside knowledge transfer.

BACKGROUND:Assessing hallux (big toe) pulling force after stroke is important for rehabilitation. The Enhanced Paper Grip Test (EPGT) is a simple method to measure this force. OBJECTIVE:This cross-sectional observational study aimed to determine the reliability and validity of the EPGT in individuals post-stroke. METHODS:Forty-four patients with ischemic stroke, aged 18 to 65 years (mean time since stroke 11.94 ± 6.31 months), participated in this study. The EPGT was applied in two sessions one week apart by two physiotherapists. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients [ICC (3,1)]. Convergent validity was assessed by correlating EPGT scores with the modified mini-BESTest and ankle muscle strength measurements. RESULTS:The EPGT demonstrated excellent intra-rater reliability (ICC = 0.927-0.990) and inter-rater reliability (ICC = 0.953-0.992). EPGT scores were strongly correlated with the modified mini-BESTest scores, with higher correlations on the affected side (ρ = 0.927, p < 0.001) than the non-affected side (ρ = 0.639, p < 0.001). Significant positive correlations were also observed between EPGT scores and ankle muscle strength, particularly on the affected side (ankle plantar flexors: ρ = ;0.826, p < 0.001; ankle dorsiflexors: ρ = 0.846, p < 0.001), while moderate-to-weak correlations were found on the non-affected side (APF: ρ = 0.435, p = 0.01; ADF: ρ = 0.353, p = 0.04). CONCLUSION:The EPGT is a valid and reliable tool for assessing hallux (big toe) pulling force post-stroke and can be quickly applied in clinical settings. TRIAL REGISTRATION:ClinicalTrials.gov (NCT07181005).