Objective To summarize the anatomic variations of recurrent laryngeal nerve (RLN during thyroid surgery and to investigate the technical key points for identification and preservation of the nerve.Methods Clinical data of 1548 consecutive patients undergoing thyroid operation with intraoperative routine exposure of RLN from June 2010 to June 2012 was retrospectively analyzed.Results In this series,2620 RLNs at risk were clearly exposed and identified during a total of 1548 thyroid operations,wherein complete dissection was performed on 1886 nerves.Injury occurred in 11 of 2620 (0.42％) nerves.Through the analysis of all 2620 RLNs,conditional variations were found in 64 nerves.Of 1886 RLNs that were completely dissected,421 (22.3％)nerves presented with natural variations of six patterns,including morphological branching variation in 126 (6.68％) nerves,course and location variation in 124 (6.57％)nerves,variation in relationship with inferior thyroid artery (ITA)in 36 (1.91％)nerves,variation at the Berry ligament in 112 (5.94％) nerves,variation at the cricothyroid joint in 17 (0.80％) nerves,and 6 (0.32％)cases of non-recurrent laryngeal nerve (nRLN).Conclusions Variations in RLN found during thyroid surgery are of relatively high incidence,complex and diverse,which can be a potential reason of nerve injury due to visual misidentification.Thus,a thorough knowledge of the normal anatomy of RLN and its anatomic variations ensures a safe and effective thyroid surgery.

Objective To establish a comprehensive evaluation indexing system to appraise the implications of prevention and treatment of HIV/AIDS ,and to calculate the weight of each indicator .Methods Based on the idea of performance and input-out-put ,professional consultation ,and Delphi method was determined as the evaluation index system ,analytical hierarchy process (AHP) was used to calculate the weight value for each indicator .Results The evaluation indexing system had been established af-ter three rounds of professional consultation .It contained two 1st class indicators ,six 2nd class indicators and thirty-one in 3rd class indicators .The weight value of each indicator was calculated .Conclusion The evaluation indexing system that has been established and the weight value quantities are of completeness ,practicality ,operability and logic .They have important value for application in the future .

Exosomes are a kind of extracellular vesicles, which contain abundant proteins, RNA, and lipids. They are source-specific and target-specific, and can penetrate the blood-brain barrier and used as biomarkers of diseases and drug carriers. Studies in recent years have shown that exosomes play an important role in the pathophysiology of ischemic stroke. During cerebral ischemia, endothelium-derived exosomes can cause damage to the blood-brain barrier, while exosomes secreted by astrocytes and oligodendrocytes have neuroprotective functions. The exosomes from mesenchymal stem cells can be engineered to promote post-stroke nerve repair and improve neurological deficits. This article reviews the research progress of the correlation between exosomes and ischemic stroke.

OBJECTIVETo investigate the risk factors for metastasis and clinical indications for dissection of lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC).

METHODSA prospective analysis including 283 consecutive patients with PTC who underwent total thyroidectomy with routine central lymph node dissection (CLND) in our hospital from Jan. 2010 to Jan. 2012 was performed. The right paratracheal lymph nodes in the central compartment lymph nodes (CCLN) were divided into the anterior (level VIa) and posterior (level VIb) compartments by recurrent laryngeal nerve (RLN), and were removed respectively. The complications and recurrences were recorded with a follow-up of 3 months to 3 years.

RESULTSCCLN metastases were present in 47.7% (135/283) of the patients, and level VIb metastases were present in 27.2% (77/283) of the patients. The incidence of level VIb metastasis was 20.5% (58/283) in level VIa-positive patients, while 6.7% (19/283) in level VIa-negative patients. Complications of level VIb dissection were found in 4.9% (14/283) of all patients. 2.1% (6/283) of all patients were diagnosed with regional recurrence during the 3-year follow-up. Univariate analysis revealed that level VIb metastasis was significantly associated with tumor size, number, extrathyroidal invasion, clinical nodal stage, level VIa and lateral lymph node metastases. Multivariate analysis revealed that tumor larger than 1 cm, multifocality, extrathyroidal invasion, level VIa and lateral lymph node metastases were independent risk factors for level VIb metastasis.

CONCLUSIONSLymph node posterior to right recurrent laryngeal nerve can be the only site of metastasis from PTC without other cervical compartment involvements. Therefore, routine intraoperative detection of these nodes may be necessary for patients with right PTC, and dissection should be considered when a right-side PTC tumor is larger than 1 cm, multifocality, with extrathyroidal invasion or cervical nodal metastases.

Carcinoma ; pathology ; surgery ; Carcinoma, Papillary ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Prospective Studies ; Recurrent Laryngeal Nerve ; pathology ; Risk Factors ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; Tumor Burden