In order to reduce intraoperative recurrent laryngeal nerve injury,intraoperative neural monitoring(IONM)is widely used in thyroid-related surgery,especially in reoperations.However,some incidental injuries have also been observed during IONM.This article reported a case suffered skin thermal injury at the site of hypodermic needle electrode placement during IONM in Shanghai International Medical Center.Combining relevant adverse event information and analyzing the causes was essential to understand and prevent potential risks,and prioritize patient safety.

To analyze the reasons why tracheal diverticula is easy to be missed or misdiagnosed in the diagnosis and treatment of thyroid tumors, and to strengthen the understanding of the clinical characteristics of the disease. The reasons of the misdiagnosis and missed diagnosis in similar cases were analyzed, and the anatomy, differential diagnosis, and examination methods by reviewing the relevant literature in the past 20 years were further analyzed. At the same time, a retrospective analysis was carried out on two recent clinical cases of tracheal diverticula discovered during surgery. Tracheal diverticula is easily confused with thyroid tumor and may be misdiagnosed for the following reasons: tracheal diverticula is asymptomatic in most patients; symptomatic tracheal diverticula has similar clinical symptoms to thyroid nodules; lack of character in imaging findings. General surgeons should improve their awareness and vigilance of tracheal diverticula. Neck CT should be listed as a routine examination before thyroid-related surgery.

Objective To identify genes associated with hepatocellular carcinoma (HCC) as candidate diagnostic markers in a genome-wide scale. Methods The gene expression profiles of 40 pairs of HCC tumor tissue and peripheral non-tumorous liver tissue were analyzed by using gene chip technology.The gene chips were fabricated at the National Cancer Institute (NCI). Each gene chip contained 9 180 genes. The fluorescent targets were prepared by a direct labeling approach using two kinds of fluorescences as following: 100 ?g of total RNA from non-cancerous liver tissue was labeled with Cy3-dUTP and 200 ?g of total RNA from HCC was labeled with Cy5-dUTP. The targets were mixed together and hybridized with genes on the gene chips. Unsupervised hierarchical clustering analysis was done by CLUSTER and TREEVIEW software using median centered correlation and complete linkage. Results A total of 10 genes were found up-regulated in over 80% of primary tumors comparing with that of their corresponding non-tumorous liver tissues at a two-fold filter with an unsupervised hierarchical clustering algorithm, including protocadherin-alpha 9, ESTs, Homo sapiens cDNA FLJ, KPNA2, RPS20, SNRPE, CDKN2A, UBD, MDK and ANXA2. Conclusion These genes are supposed to be candidates for the diagnosis of HCC. Further investigation of these genes in a large scale of patients with HCC and patients with non-malignant hepatic diseases will be needed to disclose whether they could be used clinically as novel diagnostic tumor markers for HCC.