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Sarcopenia is an age-related clinical complaint characterized by the progressive deterioration of skeletal muscle mass and strength over time. Type 2 diabetes (T2D) is associated with faster and more relevant skeletal muscle impairment. Both conditions influence each other, leading to negative consequences on glycemic control, cardiovascular risk, general health status, risk of falls, frailty, overall quality of life, and mortality. PubMed/Medline, Scopus, Web of Science, and Google Scholar were searched for research articles, scientific reports, observational studies, clinical trials, narrative and systematic reviews, and meta-analyses to review the evidence on the pathophysiology of di-abetes-induced sarcopenia, its relevance in terms of glucose control and diabetes-related outcomes, and diagnostic and therapeutic challenges. The review comprehensively addresses key elements for the clinical definition and diagnostic criteria of sarcopenia, the pathophysiological correlation be-tween T2D, sarcopenia, and related outcomes, a critical review of the role of antihyperglycemic treatment on skeletal muscle health, and perspectives on the role of specific treatment targeting myokine signaling pathways involved in glucose control and the regulation of skeletal muscle metabolism and trophism. Prompt diagnosis and adequate management, including lifestyle inter-vention, health diet programs, micronutrient supplementation, physical exercise, and pharmaco-logical treatment, are needed to prevent or delay skeletal muscle deterioration in T2D.

摘要 背景: 2型糖尿病（T2D）是一种对血管健康产生负面影响的慢性疾病。对慢性并发症、包括微循环的仔细评估是必须的。计算机化甲襞视频毛细血管镜（CNVC）能够准确检查甲襞微血管，但其是否适合用于T2D尚待研究。本文旨在描述T2D患者的甲襞微血管，探讨血糖控制水平以及慢性微血管和大血管并发症对其的影响。 方法: 这是一项针对102名连续且未经筛选的T2D门诊患者的横断面研究，所有患者均接受CNVC检查。使用电子视频毛细血管镜以300倍的放大率进行检查。根据已确定的参数描述毛细血管镜下外观和毛细血管改变。将毛细血管镜参数在血糖控制不佳（HbA1c≥7%）和血糖控制较好（HbA1c<7%）的患者之间以及有慢性并发症和无慢性并发症的患者之间进行比较。慢性并发症根据病史、实验室和仪器数据以及国际勃起功能指数（IIEF‐5）问卷进行推断。 结果: HbA1c≥7%患者的甲襞毛细血管较厚（p=0.019）且更长（p=0.021），与血糖控制较好的患者相比。HbA1c≥7.0%的患者中毛细血管扩张（p=0.017）和微动脉瘤（p=0.045）的发生率高于HbA1c<7.0%。与无ED患者相比，有ED的患者奇异形状毛细血管的发生率较低（p=0.02）。伴有颈动脉狭窄>20%的患者中微动脉瘤的发生率较高（p=0.02）。 结论: 在2型糖尿病患者中观察到相关的甲襞微血管改变，其中大多数与血糖控制不佳、ED和颈动脉狭窄有关。需要进一步调查以认识到CNVC在预测慢性并发症的发生和进展以及监测抗高血糖药物治疗对微循环的有效性中所起的作用。

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by impaired glucose storage and utilization in adipose tissue and skeletal muscle. Type 2 diabetes mellitus (T2DM) is particularly prevalent among individuals with obesity, as excess weight fosters significant health complications, including inflammation and insulin resistance, ultimately contributing to the development of T2DM. It is believed that the crosstalk between adipose tissue, skeletal muscle, and the endocrine pancreas underlies the glucose dysmetabolism associated with excess weight. Extracellular vesicles (EVs) can play a role in mediating intercellular crosstalk and could be involved in the pathogenesis of T2DM and related complications in individuals with obesity. Exosomes/small EVs (sEVs) derived from adipose tissue may contribute to either the progression or management of metabolic syndromes, primarily through their effects on insulin resistance. Hence, the current narrative review was designed to evaluate the effect of adipose-derived sEVs in insulin resistance and its related complications. These sEVs have been isolated from white adipose tissue (WAT), brown adipose tissue (BAT), adipose-derived stem cells (ADSCs), adipose tissue macrophages (ATMs), as well as from plasma and other tissues of obese individuals and animal models. The present review showed that sEVs derived from adipose tissue and/or obese individuals and animal models may contribute significantly to the onset and enhancement of insulin resistance. However, sEVs extracted from ADSCs of healthy adipose tissue could enhance insulin sensitivity via their bioactive components (e.g., microRNAs). Additional complementary studies are required to validate the dual role of adipose-derived sEVs on the amelioration or progression of insulin resistance-related complications.

Dopamine regulates several functions, such as voluntary movements, spatial memory, motivation, sleep, arousal, feeding, immune function, maternal behaviors, and lactation. Less clear is the role of dopamine in the pathophysiology of type 2 diabetes mellitus (T2D) and chronic complications and conditions frequently associated with it. This review summarizes recent evidence on the role of dopamine in regulating insular metabolism and activity, the pathophysiology of traditional chronic complications associated with T2D, the pathophysiological interconnection between T2D and chronic neurological and psychiatric disorders characterized by impaired dopamine activity/metabolism, and therapeutic implications. Reinforcing dopamine signaling is therapeutic in T2D, especially in patients with dopamine-related disorders, such as Parkinson’s and Huntington’s diseases, addictions, and attention-deficit/hyperactivity disorder. On the other hand, although specific trials are probably needed, certain medications approved for T2D (e.g., metformin, pioglitazone, incretin-based therapy, and gliflozins) may have a therapeutic role in such dopamine-related disorders due to anti-inflammatory and anti-oxidative effects, improvement in insulin signaling, neuroinflammation, mitochondrial dysfunction, autophagy, and apoptosis, restoration of striatal dopamine synthesis, and modulation of dopamine signaling associated with reward and hedonic eating. Last, targeting dopamine metabolism could have the potential for diagnostic and therapeutic purposes in chronic diabetes-related complications, such as diabetic retinopathy.

The impact of work engagement and burnout on medical activities, physicians’ performance, and quality of care has gained interest over the last decades. However, the effect of demographics, job-related, and organizational variables on burnout and work engagement in young endocrinologists has not been fully investigated. To assess the impact of demographics, job-related, and organizational variables on burnout and work engagement in young endocrinologists who joined the Italian Association of Clinical Endocrinologists. The levels of burnout and work engagement were assessed by the Maslach Burnout Inventory and the Utrecht Work Engagement Scale, respectively, as a part of an online survey of the “Associazione Medici Endocrinologi” addressed to young members (31–40 years). Eighteen MANOVAs were applied to analyze differences in burnout and work engagement based on demographic, job-related, and organizational factors. We collected responses from 160 young endocrinologists, mainly women (80.6%), aged 31–35 years (33.8%) and 36–40 years (66.2%). Most were in a stable relationship with (40%) or without (45%) children. Most of them worked in hospitals or local healthcare districts (35.6%), as independent contractors (31.9%), or as Ph.D. students or residents (25.6%). Multivariate analyses found no statistically significant differences in burnout and work engagement due to demographics (gender, age, and partnership) and job-related variables (type of job and contract). On the other hand, organizational variables (levels of conflict amongst colleagues, more than expected time spent working, and no involvement in team-building activities) were associated with higher emotional exhaustion, lower dedication, and less vigor. The novelty of the study is that both burnout and work engagement can be affected by organizational variables in early-career Italian endocrinologists, highlighting the need for supporting the healthcare system to overcome this gap.

Background: Osteosarcopenic obesity (OSO) is an emerging syndrome characterized by the coexistence of obesity, sarcopenia, and osteoporosis, primarily affecting aging populations. Nutrition, especially polyphenol-rich foods like extra virgin olive oil (EVOO), may play a preventive or therapeutic role in OSO. This review aims to critically examine evidence from in vitro, in vivo, and human studies on the effects of olive oil polyphenols on OSO-related biological domains. Methods: This systematic review followed PRISMA guidelines. Studies were identified from PubMed and Google Scholar using MeSH terms related to olive oil, polyphenols, and OSO-associated conditions. In vitro and in vivo studies (both in animal and human models) published in the last ten years were included. The study protocol was registered with PROSPERO (CRD420251077836). Results: Fifteen studies were included: eight in vitro, four in vivo on animal models, and three human trials. Phenolic compounds such as hydroxytyrosol, oleuropein, oleocanthal, and oleacein demonstrated antioxidant, anti-inflammatory, anti-adipogenic, and osteo-/myo-protective effects. These compounds modulated key metabolic pathways and gene expression related to adipogenesis, bone metabolism, and muscle integrity. Conclusions: Olive oil polyphenols exhibit promising biological effects on the tissues involved in OSO. Although evidence is mostly preclinical, selected compounds (notably hydroxytyrosol and oleuropein) may serve as adjuncts in nutritional strategies for OSO prevention.

Over the last two years, many countries have enforced confinement to limit both the spread of COVID-19 and the demand for medical care. Confinement has resulted in a disruption of work routines, boredom, depression, and changes in eating habits, among them consumption of coffee and tea. Following six databases, we examined articles tracking consumption of these beverages. Out of 472 articles, including 23 beverage entries, 13 matched our criteria. While no clear trend in coffee consumption during the coronavirus pandemic emerged (7 of 13 studies indicated an increase, accounting for 53.8%), tea consumption clearly increased (70% versus 30%). Considering the global health emergency continuum, more research is needed to better understand the paths underlying food choices and the ways those changes may influence health outcomes, including those related to COVID-19 disease.

Background: The selection of thyroid nodules ≤ 10 mm requiring characterization and treatment should be improved, as extensive detection, cytological assessment, and surgery of small and well‐differentiated thyroid carcinoma are not cost‐effective. Aim: To assess the accuracy of algorithms and ultrasonographic characteristics in selecting actual high‐risk thyroid nodules ≤ 10 mm. Methods: A cross‐sectional study was conducted on 38 of 112 outpatients who attended the University of Bari and underwent echo‐assisted FNA for cytological characterization of thyroid nodules ≤ 10 mm (65 out of 118) and thyroid surgery from January 01 to December 31, 2016. Results: The median age of patients was 49.5 years [16; 69]. Thyroid cytology (SIAPeC‐IAP 2014) was classified as TIR1 (one nodule), TIR2 (15), TIR3A (7), TIR3B (10), TIR4 (8), and TIR5 (24). Thirty‐nine thyroid nodules were diagnosed as well‐differentiated thyroid microcarcinoma. The clinical performance of 4 algorithms widely employed in clinical practice was low (AACE/ACE/AME, 38%; ACR‐TIRADS, 45%; K‐TIRADS, 60%; EU‐TIRADS, 66%). Ultrasonographic features indicating high‐risk nodules were hypoechogenicity ( p = 0.0047), irregular margins ( p = 0.004), and microcalcifications ( p = 0.0019). Multivariable analyses indicated that hypoechogenicity was the main ultrasonographic characteristic associated with high‐risk nodules (OR = 5.48, p = 0.0484). Discussion: Validated algorithms fail to select thyroid nodules ≤ 10 mm for which cytological characterization is needed. Our results are expected to improve the reliability of current algorithms by improving the weight of variables associated with a more consistent risk of thyroid malignancy in nodules ≤ 10 mm.

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of steatotic liver disease and has major implications on cardiovascular safety. Study aims As the precise role linking MASLD to cardiovascular diseases is still unclear, the present study aims to investigate the association between liver steatosis and fibrosis and circulating plasminogen activator inhibitor-1 (PAI-1) levels. Methods Eighty-two patients (41.6 ± 12.4 yrs, 34 men, 41%), naïve to medications, who attended the Nutrition Center for the Research and Care of Obesity and Metabolic Diseases at the National Institute of Gastroenterology “Saverio de Bellis” for weight management, were cross-sectionally evaluated. Demographic, anthropometric, clinic, and laboratory data were collected and analyzed. All patients underwent liver ultrasonographic assessment by FibroScan to diagnose liver steatosis (controlled attenuation parameter or CAP > 275 dBm) and fibrosis (liver stiffness > 8.2 kPa). Results Sixty-one individuals (74.4%) had liver steatosis, and 17 (20.7%) had liver fibrosis. PAI-1 mean levels were 3,261 ± 1,270 pg/mL, mean body mass index (BMI) and waist circumference (WC) values were 36.6 ± 7.1 kg/m 2 and 114.1 ± 16.5 cm, respectively. Mild systolic and diastolic arterial pressure elevation and significantly high values of fasting plasma insulin (19.6 ± 12.6 IU/mL) and homeostatic model assessment of insulin resistance or HOMA-IR (4.8 ± 3.5) were also found. CAP values were correlated with several anthropometric, clinical, and laboratory parameters of insulin resistance. We found a significant association between PAI-1 and CAP (β = 1.605; p  = 0.004), and noteworthily, when PAI-1 increased by 100 units, the expected variation of CAP values was by + 1.6 units ( p  = 0.004). Notably, the association was independent of gender, age, and insulin resistance. Discussion Circulating PAI-1 levels are correlated with liver steatosis and, to a lesser extent, fibrosis in apparently healthy patients with a BMI ≥ 25 kg/m 2 . This is the first study to show these results in patients naïve to medications, using FibroScan assessment. The bidirectional relationship between circulating PAI-1 levels and CAP measurement highlights the relevance of our research from a diagnostic and pathophysiological-prognostic viewpoint. Longitudinal trials are needed to clarify the cause-effect association between MASLD and PAI-1 levels.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly correlated with the severity of obesity, and the extent of liver fibrosis is associated with a higher risk of liver-related complications, cardiovascular events, and overall mortality. Leptin circulating levels are directly correlated with the amount of adipose tissue. Aims: In the present study, we investigated the association between circulating leptin levels and liver steatosis and fibrosis. Methods: Eighty-six patients (41.7 ± 12.6 yrs, 35 men, 41%), naïve to medications, who attended the Nutrition Center for the Research and Care of Obesity and Metabolic Diseases at the National Institute of Gastroenterology “Saverio de Bellis” for weight management, were cross-sectionally evaluated. Demographic, anthropometric, clinical, and laboratory data were collected and analyzed. All patients underwent liver ultrasonographic assessment by FibroScan to diagnose liver steatosis (controlled attenuation parameter, CAP > 275 dBm) and fibrosis (liver stiffness measurement, LSM > 8.2 kPa). Results: Sixty-three individuals (73.3%) had liver steatosis, and 17 (19.8%) had liver fibrosis. The mean leptin levels were 22.3 ± 14.1 ng/mL, while the BMI and waist circumference were 36.7 ± 7.2 kg/m2 and 114.5 ± 16.4 cm, respectively. CAP values exhibited no correlation with leptin (r = 0.09, p = 0.436), while a significant connection was seen between leptin and LSM (β = 0.065; p = 0.038). Specifically, for each unit increase in leptin, LSM values were varied by +0.065 units (p = 0.038). This association was independent of gender, age, insulin resistance, adiponectin, RBP4, and visfatin. This is the first study showing these results by using FibroScan assessment in patients naïve to medications. Conclusions: Circulating leptin concentrations are independently correlated with hepatic fibrosis in individuals with a BMI ≥ 25 kg/m2. These findings indicate a function for leptin in promoting liver fibrosis; however, longitudinal studies are required to elucidate the causal nature of this interaction.