Background Intraoperative nerve monitoring (IONM) is used increasingly in thyroid surgery to prevent recurrent laryngeal nerve (RLN) injury, despite lack of definitive evidence. This study analysed the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to investigate whether IONM reduced the incidence of RLN injury. Methods UKRETS data were extracted on 28 July 2018. Factors related to risk of RLN palsy, such as age, sex, retrosternal goitre, reoperation, use of energy devices, extent of surgery, nodal dissection and IONM, were analysed. Data with missing entries for these risk factors were excluded. Outcomes of patients who had preoperative and postoperative laryngoscopy were analysed. Results RLN palsy occurred in 4.9 per cent of thyroidectomies. The palsy was temporary in 64.6 per cent and persistent in 35.4 per cent of patients. In multivariable analysis, IONM reduced the risk of RLN palsy (odds ratio (OR) 0.63, 95 per cent confidence interval (CI) 0.54 to 0.74, P < 0.001) and persistent nerve palsy (OR 0.47, 0.37 to 0.61, P < 0.001). Outpatient laryngoscopy was also associated with a reduced incidence of RLN palsy (OR 0.50, 0.37 to 0.67, P < 0.001). Bilateral RLN palsy occurred in 0.3 per cent. Reoperation (OR 12.30, 2.90 to 52.10, P = 0.001) and total thyroidectomy (OR 6.52, 1.50 to 27.80; P = 0.010) were significantly associated with bilateral RLN palsy. Conclusion The use of IONM is associated with a decreased risk of RLN injury in thyroidectomy. These results based on analysis of UKRETS data support the routine use of RLN monitoring in thyroid surgery. Based on analysis of United Kingdom Registry of Endocrine and Thyroid Surgery data, recurrent laryngeal nerve (RLN) palsy occurred in 4.9 per cent of thyroidectomies. RLN monitoring reduced the risk of overall RLN palsy (odds ratio (OR) 0.63, 95 per cent CI 0.54 to 0.74; P <0.001) and persistent RLN palsy (OR 0.47, 0.37 to 0.61; P <0.001) in multivariable analysis. These results support the routine use of RLN monitoring in thyroid surgery. IONM reduces RLN

Multiple organs work together to achieve a balance between glucose entry into blood circulation (from the liver, glucose is absorbed through intestinal mucosa after meals) and peripheral tissue glucose uptake (mainly brain and skeletal muscles). Blood glucose is controlled and maintained within a narrow range under normal physiological conditions, which is referred to as glucose homeostasis. Endogenous insulin is secreted when blood glucose levels rise. Its release can be aided by other factors such as amino acids and hormones released from the gut following food consumption, a phenomenon known as the incretin effect. Diabetes mellitus is caused by defects in insulin secretion, insulin action, or both, resulting in chronic hyperglycemia caused by disturbed carbohydrate, fat, and protein metabolism. The current review discusses the role of incretin-based therapies in the management of diabetes mellitus and the maintenance of glucose homeostasis.

In this systematic review, the efficacy and safety of chronomodulated chemotherapy, defined as the delivery of chemotherapy timed according to the human circadian rhythm, were assessed and compared to continuous infusion chemotherapy for patients with advanced colorectal cancer.Electronic English-language studies published until October 2020 were searched. Randomised controlled trials (RCTs) comparing chronomodulated chemotherapy with non-chronomodulated (conventional) chemotherapy for the management of advanced colorectal cancer were included. The main outcomes were the objective response rate (ORR) and system-specific and overall toxicity related to chemotherapy. Electronic databases including Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Review were searched.In total, seven RCTs including 1,137 patients were analysed. Males represented 684 (60%) of the study population. The median age was 60.5 (range = 47.2-64) years. There was no significant difference between chronomodulated and conventional chemotherapy in ORR (risk ratio (RR) = 1.15; 95% confidence interval (CI) = 0.87-1.53). Similarly, there was no significant difference in gastrointestinal toxicity under the random effect model (RR = 1.02; 95% CI = 0.68-1.51). No significant difference was found regarding neurological and skin toxicities (RR = 0.64, 95% CI = 0.32-1.270 and RR = 2.11, 95% CI = 0.33-13.32, respectively). However, patients who received chronomodulated chemotherapy had less haematological toxicity (RR = 0.36, 95% CI = 0.27-0.48).In conclusion, there was no overall difference in ORR or haematologic toxicity between chronomodulated and non-chronomodulated chemotherapy used for patients with advanced colorectal cancer. Chronomodulated chemotherapy can be considered in patients at high risk of haematological toxicities.

Aim: In this systematic review, the efficacy and safety of chronomodulated chemotherapy, defined as delivery of chemotherapy timed according to the human circadian rhythm, were assessed, and compared to continuous infusion chemotherapy for patients with advanced colorectal cancer. Methods: Electronic English language studies published until October 2020 were searched. Randomised Controlled Trials (RCTs) compared chronomodulated chemotherapy with non chronomodulated (Conventional) chemotherapy for management of advanced colorectal cancer were included. Main outcomes were the objective response rate (ORR) and system specific and overall toxicity related to chemotherapy. Electronic database search in Ovid Medline, Ovid Embase, Cochrane CENTRAL and the Cochrane Database of Systematic Review (CDSR). Results: In total, 7 RCTs including 1137 patients were analysed. Males represented 684 (60%) of the study population. The median age was 60.5 (range: 47.2 , 64) years. There is no significant difference between chronomodulated and conventional chemotherapy in ORR ((risk ratio (RR) 1.15; 95%CI [0.87,1.53]). There was no significant difference in gastrointestinal toxicity under the random effect model RR 1.02; CI 95% [0.68 , 1.51]. No significant difference was found regarding neurological and skin toxicities, (RR 0.64 ,95%CI [0.32 ,1.27]) and (RR 2.11, 95%CI [ 0.33, 13.32]), respectively. However, patients who received chronomodulated chemotherapy had fewer haematological toxicity, (RR 0.36, 95%CI [0.27, 0.48]). Conclusion: There was no overall difference in ORR or toxicity but haematologic, between chronomodulated and non chronomodulated chemotherapy used for patients with advanced colorectal cancer. Chronomodulated chemotherapy could be considered in patients at high risk of haematological toxicities.