Objective To investigate the effect of a new type of retrograde reperfusion on the intraoperative internal environment and hemodynamics during classic orthotopic liver transplantation (OLT).Methods 20 patients underwent classic OLT using a new type of retrograde reperfusion in our center.Blood sampling was done at different parts or time points including:before blood venting via the portal vein (PV) of the donor liver,5 ml of blood was collected from the superior vena cava (PSVC),inferior vena cava (PIVC) and portal vein (PPV).During retrograde reperfusion through the inferior vena cava (IVC),5 mL of blood was collected when the volume of blood venting reached 5 ml (T1),100 ml (T2),and 200 ml (T3),respectively.The differences of data were compared after the blood samples were analyzed.In addition,the number instances of postreperfusion syndrome (PRS) were recorded.Results All operations were completed successfully,in which PRS occurred in 4 patients (20％).The most notable findings are the significant changes of nearly all data at T1,T2 and T3,including pH value,PvO2,SvO2,BEecf,HCO3-,Lac,K +,and Ca2 +,compared with PIVC (P ＜ 0.05) and a trend toward recovery in all the data.Yet their levels at T3 did not come back to the levels at PIVC (P ＜ 0.05).Besides,for pH value,Lac,K +,HCO3-and BEecf,there were no significant differences between PSVC,PIVC and PPV (P ＞ 0.05).Conclusions During classic OLT,the main factors leading to a disordered internal environment after recirculation stem from venous retum within the donor liver.This new type of retrograde perfusion can eliminate some of the harmful metabolites inside the donor liver in time and to some extent reduce internal environment disorders as well as drastic hemodynamic fluctuations after recirculation.

Objective To explore the anatomical basis,safty and manipuility of the puncture technique through anterolateral cervical approach.Methods Twenty two embalmed cadavers and 50 patients who underwent operation through anterolateral cervical approach were used to observe the cervical anatomical characteristics.During the cadaver dissection and operation,the following information was observed:the movement of the carotid sheath while the visceral sheath was pushed left,the features of interspace between the two sheaths at each cervical level,the movement of the esophagus and the interfascial space in which the esophagus moved while the trachea was pushed medially,and the movement of the carotid sheath while it was pushed medially and laterally.From January 2007 to December 2011,206 patients diagnosed as cervical discogenic pain or cervical vertigo were treated by radiofrequency using puncture technique through anterolateral cervical approach,including 93 males and 113 females,aged from 22 to 71 years (average,48years).A total of 434 discs were involved.Results Both in cadaver dissection and in operation,the following results were observed:there was no natural interspace between the carotid sheath and visceral sheath below the C4 level,as a result,manual separation was needed to create a interspace between the two sheaths for the puncture; the two layers of the prevertebral fascia could be separated easily; keeping the visceral sheath intact,the esophagus moved following the trachea when the latter was pushed medially,and the movement of the visceral sheath relative to the cervical vertebra occurred between the two layers of prevertebral fascia; the carotid sheath was primarily constituted by continuation of the prevertebral fascia,as a result,the movement of the carotid sheath was limited by its own tension and the prevertebral fascia.A total of 434 cases of puncture to cervical disc were performed smoothly with no complications related to the carotid artery,esophagus and cervical disc.Conclusion The puncture technique through anterolateral cervical approach requires a correct,thorough understanding of the anterior cervical anatomy,based on which this technique is safe and feasible.

Objective To observe the change of collagen in osteoarthritis and study the pathogenesis of osteoarthritis.Methods The right hind limb of twenty-four adult New Zealand White rabbits were immobilized with plaster cast in extension position for 10,20,30 and 40 days,respectively.Six animals without immobilization served as control.The articular cartilage of the medial femur condyle was harvested for transmission electron microscopy,in-situ hybridization of collagenⅡ,and immunohistochemistry of collagenⅠ,Ⅱ,Ⅲ.Results Transmission electron microscopy showed articular cartilage was destructed from the fine collagen fiber network of tangential zone.The fine collagen fiber network did not contain chondrocyte.Immunohistochemistry and in-situ hybridization showed that in earlier period of osteoarthritis,the collagen typeⅡand its gene expression firstly increased,then decreased with destruction of ultrastructure,and chondrocytes enhanced type Ⅱ collagen expressing and synthesizing mainly in transition zone and upper deep zone.In articular cartilage of osteoarthritis there was type Ⅲ collagen,instead of typeⅠcollagen.Conclusion In osteoarthritis,articular cartilage degenerated from tangential layer,in which collagen can not be repaired after destruction,this may contribute to the chondral degeneration.