Background: We assessed the prevalence of complications from percutaneous ethanol injection (PEI) for benign and cystic thyroid nodules (CTNs) and their management. Methods: We conducted a systematic review with meta-analysis of data from published observational studies on PEI of CTNs. We also included unpublished retrospectively collected data on complications after PEI from all consecutive patients with cytologically benign CTNs who underwent PEI at the Unit of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli (Naples, Italy) between June 1, 2021, and March 31, 2024. A random effects meta-analysis was performed on the prevalence rate data. Pooled prevalence data were presented with confidence intervals (CIs). The I ² statistic index was used to quantify the heterogeneity. The details of the complications and the management were qualitatively described. Results: The literature search yielded 1189 studies, of which 48 studies were included in the systematic review and meta-analysis, in addition to our institutional experience (3670 CTNs in total). The overall quality of each included study was judged as fair. The prevalence of “Overall” complications of PEI was 32% ([CI 25–40%], I ² 92.7%, 967 of 3195 thyroid nodules [TNs]). The prevalence of “Minor” complications of PEI was 32% ([CI 25–40%], I ² 92.7%, 952 of 3195 TNs). The prevalence of “Major” complications of PEI was 2% ([CI 1–2%], I ² 0%, 22 of 3670 TNs). Sensitivity analyses did not modify the results. The pooled prevalence rate of local pain was 21% (CI [16–27] I ² 90.3). Local pain was typically transient and mild, sometimes moderate, and requiring analgesics for few days. The pooled prevalence rate of dysphonia was 1% (CI [1–2], I ² 0). Dysphonia was transient and could last from several hours to 12 months after PEI. Conclusions: Complications of PEI for benign and CTNs are relatively common, but most are minor and usually transient, not requiring treatment. Dysphonia was a major complication, but it was uncommon and transient. PEI for CTNs could be considered a generally safe technique.

Circulating levels of endothelial progenitor cells (EPCs) involved in endothelial homeostasis are often reduced in people with type 1 diabetes (T1D). The Glycemia Risk Index (GRI) quantifies the quality of glucose control by assessing both hypo- and hyperglycemia risk. We aim to investigate the association between the GRI and circulating EPC levels in people with T1D. This cross-sectional study included 132 adults with T1D, on intensive insulin therapy. We calculated GRI from 14 days continuous glucose monitoring-derived metrics and quantified EPCs count by flow cytometry, stratifying results by GRI zones, ranging from A (lowest risk) to E (highest risk). Higher GRI scores were significantly associated with poorer metabolic parameters. Circulating levels of CD34⁺, CD133⁺, KDR⁺, and CD34⁺KDR⁺ cells were lower in participants with a worse GRI compared to adults with a better GRI. Linear regression analyses showed a negative association between GRI and CD34⁺ (β = −1.079, p = 0.006), CD34⁺CD133⁺ (β = −0.581, p = 0.008), and CD34⁺KDR⁺ (β = −0.147, p = 0.010). No significant association was found between HbA_1c and any EPC phenotype. Adults with T1D and a high GRI level had a lower EPCs count. GRI was significantly associated with certain EPC phenotypes, suggesting its potential role as a biomarker for cardiovascular risk assessment.

The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on peripheral artery disease (PAD) remains uncertain. We assessed the association between GLP-1RA use and major limb events in individuals with type 2 diabetes (T2D) and PAD. We performed a literature search from inception to 31 March 2026 for randomized controlled trials and cohort studies comparing GLP-1RA use versus placebo, active comparators or non-use on lower limb outcomes in individuals with T2D and PAD. The primary outcome was a composite of major limb events, as defined by the investigators of the original studies included in the meta-analysis. Secondary outcomes included lower extremity amputation (LEA), revascularization, gangrene, major adverse cardiovascular events (MACE) and all-cause mortality. Subgroup analyses, leave-one-out sensitivity analyses, and meta-regression analysis were also performed. Twelve studies (2 RCTs and 10 matched cohort studies) with thirteen arms involving 418,282 participants were included. Treatment with GLP-1RAs was associated with a significantly lower risk of major limb events by 27% (thirteen arms, RR 0.73, 95% CI 0.65-0.82). Reduced risks were also observed for LEA (RR 0.76, 95% CI 0.66-0.87), revascularization (RR 0.81, 95% CI 0.77-0.86), gangrene (RR 0.80, 95% CI 0.77-0.85), MACE (RR 0.76, 95% CI 0.63-0.90) and all-cause mortality (RR 0.67, 95% CI 0.61-0.73). Subgroup and sensitivity analyses did not substantially change point estimates. Among adults with T2D and PAD, treatment with GLP-1RAs was associated with a lower risk of major limb events. There is a need of dedicated studies with standardized limb-specific endpoints to confirm the protective role of GLP-1RAs on limb events in people with T2D and PAD.

Aims: To investigate the independent association between long-term glycemic variability, measured as the coefficient of variation (CV) of HbA1c, and the presence of diabetic retinopathy (DR) in a cohort of adults with diabetes within a systematic eye screening program. Methods: This study screened 379 adults with type 1 and type 2 diabetes. Long-term glycemic variability was calculated as the CV of serial HbA _1c measurements. DR was assessed via dilated fundus photography. The association between HbA _1c CV and DR was analyzed using multivariable logistic regression adjusting for confounders. Results: DR incidence of 12.4%, mostly mild non-proliferative. The median HbA _1c CV was 7.0% (53 mmol/mol). In unadjusted bivariate analysis, the incidence of mild DR was higher in the low- glycemic variability group (CV < 5%) compared to the high- glycemic variability group. However, the multivariable logistic regression analysis revealed that higher HbA _1c CV was independently associated with the presence of DR (β = 0.643, P = 0.042), alongside diabetes duration (P < 0.001) and age (P < 0.001). Conclusions: In conclusion, in a cohort of individuals with both type 1 and type 2 diabetes and a low incidence of DR, long-term glycemic variability, estimated as HbA _1c CV, was independently associated with an increased risk of this complication.

Background: We aimed to identify the main factors influencing the achievement of high efficacy or negative outcomes for ethanol ablation (EA) of cystic thyroid nodules. Methods: We conducted a retrospective cohort study on consecutive patients treated with EA for cytologically benign and symptomatic CTNs at the Vanvitelli University Hospital in Naples (Italy) over a period of four years. Data was analyzed using multivariable logistic regression and Fisher's exact test. All tests were performed at the significant level of 0.05. Results: We included 118 nodules undergoing EA with one year follow-up [median volume 16.2 (7.0–32.8) mL], with important cervical symptomatology [overall visual analogue scale (VAS) score 26.0 (22.0–30.0) and cosmetic score (CS) 4.0 (3.0–4.0)]. At 12 months follow-up (T12), median VRR was 88.9 (77.2–97.6) %, overall VAS score and CS were 0 (0.0–1.5) and 1.0 (1.0–1.0), respectively. The classical EA was the only predictor of VRR > 75% (OR = 3.27; 95% CI 1.01–10.57; p = 0.048). Monolocular aspect was the only predictor (OR = 5.719; 95% CI 1.664–19.652; p = 0.006) of VAS = 0 and CS = 1. Conclusions: EA for CTNs is usually associated with high efficacy and rarely (one out of ten patients) with negative outcomes at one-year follow-up. The classical EA procedure (when the cystic content can be initially aspirated) and the monolocular aspect thyroid nodules seem to be factors that positively influence the high efficacy of EA, regardless of baseline nodule volume, ultrasound composition, number of EA sessions, and total ethanol amount.