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Background There is ongoing uncertainty about the association between thyroid nodule size and likelihood of malignancy. Researchers are divided, some proposing that risk is increased with nodule size while others claim the opposite. Numerous studies have been completed but there is at present no agreed consensus. Furthermore, the diagnostic accuracy of fine needle aspiration (FNA), the standard test for investigating thyroid nodules is disputed. Reported ranges of false negatives range from 2 to 20%. Aims The overall aims of this study were to investigate the relationship between thyroid nodule size and malignancy and to examine the association between FNA results and malignancy rates in small and large nodules. Design Systematic review and meta-analysis of observational studies examining the association between malignancy and thyroid nodule size. Methods A systematic review was completed using search words ‘thyroid, nodule and size’ in PubMed database. Criteria for inclusion were retrospective or prospective studies with nodule size and final pathology and/or FNA results that had a primary focus on adult populations. Results In total 17 studies were deemed eligible for inclusion. 16 studies were included in the first meta-analysis looking at the relationship between nodule size and malignancy rates. Overall, nodules over 4 cm were associated with a lower incidence of malignancy, 15% compared with 37%. A Random effects model meta-analysis was undertaken, which also indicated a trend towards a lower risk of malignancy in nodules over 4 cm, with a risk difference of 0.1 (95% CI − 0.01, 0.21). However, there was significant heterogeneity with an I 2  of 99%, therefore caution has to be exercised when interpreting the results. 11 studies were included in the second meta- analysis, examining the impact of nodule size on the association between FNA results and malignancy. The meta-analysis showed that there was no statistically difference between the false negative rates of nodules less than or greater than 4 cm. Conclusion While there is a trend towards larger nodule being less likely to indicate malignancy, thyroid nodule size does not appear to have a significant influence on the accuracy of FNA in predicting cancer. Thyroid nodule size alone should not influence the decision to refer for further tests or surgery as it is an unreliable predictor of malignancy in isolation. However, taken in conjunction with clinical and radiological findings it may be a useful adjunct to guiding treatment.

Background Peri-operative inflammation has been extensively highlighted in cancer patients as detrimental. Treatment strategies to improve survival for cancer patients through targeting peri-operative inflammation have yet to be devised. Methods We conducted a multi-centre, randomised controlled clinical trial using Taurolidine in non-metastatic colon cancer patients. Patients were randomly assigned to receive Taurolidine or a placebo. The primary endpoint for the study was the mean difference in day 1 IL-6 levels. Secondary clinical endpoints included rates of post-operative infections and tumor recurrence. Results A total of 293 patients were screened for trial inclusion. Sixty patients were randomised. Twenty-eight patients were randomised to placebo and 32 patients to Taurolidine. IL-6 levels were equivalent on day 1 post-operatively in both groups. However, IL-6 levels were significantly attenuated over the 7 day study period in the Taurolidine group compared to placebo ( p  = 0.04). In addition, IL-6 levels were significantly lower at day 7 in the Taurolidine group (p = 0.04). There were 2 recurrences in the placebo group at 2 years and 1 in the Taurolidine group. The median time to recurrence was 19 months in the Placebo group and 38 months in the Taurolidine group ( p  = 0.27). Surgical site infection was reduced in the Taurolidine treated group ( p  = 0.09). Conclusion Peri-operative use of Taurolidine significantly attenuated circulating IL-6 levels in the initial 7 day post-operative period in a safe manner. Future studies are required to establish the impact of IL-6 attenuation on survival outcomes in colon cancer. Trial registration The trial was registered with EudraCT (year = 2008, registration number =  005570–12 ) and ISRCTN (year = 2008, registration number =  77,829,558 ).

ABSTRACT Background Focused exploration (FE) and bilateral parathyroid exploration (BE) are the standard surgical options for patients with primary hyperparathyroidism. However, the relative risk of recurrence, persistence, overall failure, reoperation, and any complications associated with either surgical approach is unclear. This study compared the outcomes and complication rates after FE and BE for patients with primary hyperparathyroidism. Methods PubMed and Embase were searched for studies comparing these outcomes between FE and BE. A meta-analysis was performed using RevMan 5.3 software. Published data were pooled using the DerSimonian random-effect model, and results were presented as odds ratio (OR) or mean difference with 95% confidence interval (CI). Results A total of 12,743 patients from 19 studies were included in this meta-analysis. In comparison with BE, the FE arm had comparable rates of recurrence (OR 1.08; 95% CI 0.59–2.00; p  = 0.80; n  = 9 studies), persistence (OR 0.89; 95% CI 0.58–1.35; p  = 0.58; n  = 13), overall failure (OR 0.88; 95% CI 0.58–1.34; p  = 0.56; n  = 13), and reoperation (OR 1.05; 95% CI 0.25–4.32; p  = 0.95, n  = 4). The operative time was significantly shorter (mean difference = −39.86; 95% CI −53.05 to −26.84; p  < 0.01, n  = 9), with a lower overall complication rate in the FE arm (OR  0.35; 95% CI 0.15–0.84; p  = 0.02; n  = 12). The latter was attributed predominantly to a lower risk of transient hypocalcemia (OR  0.36; 95% CI 0.14–0.90; p  = 0.03; n  = 9). There was a significant heterogeneity among these studies for all outcomes except for disease recurrence. Conclusions Compared with BE, FE has similar recurrence, persistence, and reoperation rates but significantly lower overall complication rates and shorter operative time.

ObjectiveThis study aimed to determine the awareness, otological symptoms and prevalence of external auditory canal exostoses in Irish cold-water athletes.MethodAn online and in person cross-sectional survey was undertaken with Irish cold-water athletes to explore athletes' awareness, known prevalence of external auditory canal exostoses and attitudes towards preventive measures.ResultsOf the 926 participants surveyed, 67.5 per cent were aware of external auditory canal exostoses. Triathletes reported the lowest awareness (39.9 per cent) among water athletes. A total of 9.7 per cent (n = 90) had previously been diagnosed with external auditory canal exostoses and 46.7 per cent (n = 42) were non-surfers. Ear symptoms were reported in 76 per cent of athletes. Otoscopic examinations showed that 23.7 per cent had external auditory canal exostoses, 3.6 per cent of whom were aware of their diagnosis.ConclusionThe majority of Irish surfing athletes are aware of external auditory canal exostoses. There is less awareness with regard to Ireland's newly emerging sports such as open water swimming and triathlons. Over 90 per cent of athletes surveyed had no idea they had external auditory canal exostoses, which highlights the need to increase public awareness.

Adjuvant therapeutic options are limited for triple negative breast cancer (TNBC). Thus, we evaluated the cytotoxic effects of the newly synthesized antineoplastic agent 1,4,5-Oxathiazinane-4,4-dioxide (OTD) on TNBC cells as a potential cancer therapeutic strategy. TNBC primary BT-20 and metastatic MDA-MB-231 cell lines were treated with increasing concentrations of OTD for various time periods to assess cell viability. Cell necrosis, apoptosis, necroptosis, autophagy, and ROS generation were evaluated using assay kits or specific inhibitors. Treatment with OTD resulted in a dose- and time-dependent cell death of TNBC BT-20 and MDA-MB-231 cells. OTD also dose-dependently arrested TNBC cell proliferation. Notably, treatment with OTD induced both necrosis and apoptosis of TNBC cells, while the pan-caspase inhibitor Z-VAD-FMK partially attenuated OTD-induced cell death. Importantly, abrogated OTD-induced cell death was observed in the presence of the ROS scavenger N-acetylcysteine (NAC), whereas enhanced OTD-induced cell death was observed after the addition of the glutathione synthesis inhibitor BSO, indicating OTD-induced killing of TNBC cells via a reactive oxygen species-dependent mechanism. OTD is strongly cytotoxic to both primary and metastatic TNBC cells, possibly by inducing multiple cell death pathways.