The anterior portion of the circle of Willis was examined in 106 adult and child brains under 6～40 magnifications. In this study,the proximal portion of the left anterior cerebral artery(A_1 segment) was larger and shorter than that of the right.The hypoplastic A_1 were found in 8.49?1.91%,mostly on the right side.In approximately 50% cases,A_1 were curved in their courses.A_1 passed across the optic nerve or optic chiasma to the longitudinal fissure where they communicated with the opposite ant.cereb,art.by the short anterior communicating artery(AGOA)lying in front of the optic chiasma(56.19?4.74%). In most of the cases,the recurrent artery belonged to one-branch type or two-branch type.It arose from the ant.cereb,art.at the level of the AGOA in 52.53?2.89%, usually coursing anterior to A_1 segment.This artery had many perforating branches (average 4.5)which perforated into the ant.perforated substance.Some of these branches may be traced to the inf.surface of frontal lobe,the olfactory sulcus,Sylvian fissure and suprachiasmatic area. In most cases,the anterior perforating artery belonged to one-branch type or two- branch type too,most frequently arising from the lat.portion of A_1.It was usually divided into perforating branches to the ant.perforated substance.Some of them may be traced to the olfactory tract,olfactory trigone,gyrus rectus,subcallosal gyrus and optic chiasma. The hypothalamic branches mainly arose from the lat.portion of A_1.The average number was 8.6.These branches may be traced to the optic tract,the dorsal surface of the optic chiasma,the ant.perforated substance,subcallosal gyrus and the genu of corpus callosum. The AGOA had many variations.In this study,the normal type was seen in 43.39 ?4.71%.The AGOA frequently gave rise to perforating arteries terminating in the suprachiasmatic area,the dorsal surface of the optic chiasma,lamina terminalis,subcal- losal gyrus,and the septic area.The number of perforating branches ranged from 1～8 (average 4.7).The frequent variations such as double or triple branches were encoun- tered. The third or median ant.cereb,art.arising from the ACOA was found in 17 cases (16.0?3.5%).Most of them were small and short,while only a few were large and coursing upward and backward over the dorsum of corpus callosum,and gave branches to the anteriomedial surface of the hemisphere.

The middle cerebral artery and its branches were examined in 110 adult and child brains under 6-40 magnification. The following results were obtained.The main stem of the left middle cerebral artery was larger and longer than that of the right. The anomalies of the middle cerebral artery occurred less frequently than anomalies of the other major intracranial arteries. In this study, only one case of duplication of the middle cerebral artery was encountered.The patterns of the branching of the middle cerebral artery could be classified into 3 types. Double trunk type was the most common one, occurred in 76.37?2.86％. Single trunk type and triple trunk type occurred in 12.73?2.24％ and 10.90?2.10％ respectively. The latter two types could be further classified into some subtypes.The cortical branches of the middle cerebral artery consisted of frontalis orbitalis, precentralis, centralis, postcentralis, parietalis inferior, temporalis polaris, temporalis anterior, temporalis media, temporalis posterior and gyri angularis arteries. Each of these branches were usually 1～2 in number, and could originate independently or in common trunk with other branches. The average outer diameter of these branches were larger than 1.0 mm, except the temporalis polaris artery.The central branches of the middle cerebral artery consisted of medial perforating arteries and lateral perforating arteries. The medial perforating arteries were short, small, and 2-3 in number. They usually originated from the main stem of the middle cerebral artery at right angle, and then ascended to penetrate the brain through the anterior perforated substance. The lateral perforating arteries were 2～3 in number too, but they were larger than the medial perforating arteries. They originated at an acute angle from the main stem of the middle cerebral artery, or from a point of division of the middle cerebral artery, and from one of the cortical branches of the middle cerebral artery. Immediately after arising from the middle cerebral artery, they always passed medially and upward in a recurrent direction to the parent vessel after which they turned upward and laterally to penetrate the anterior perforating substance.The clinical significances of the middle cerebral artery and its branches were briefly discussed.

The posterior portion of the circle of Willis was examined in 125 adult and child brains under 6～40 magnification. The following results were obtained:The terminal segments of the two internal carotid arteries were mostly equal in size (47.20?4.46%). An average of 2.5 perforating branches commonly arose from this segment distal to the origin of the posterior communicating artery. They penetrated into the anterior perforating substance, optic tract, tuber cinerum and the medial surface of the temporal lobe.The anterior choroid artery was found to originate from the internal carotid artery in 99.20?0.56% of 250 hemispheres. It usually originated laterally to the optic tract, crossed it twice, and then entered into the choroid fissure. Along its course, it sent off branches penetrating into the anterior perforating substance, temporal lobe, optic tract, hypothalamus-tractus furrow, lateral geniculate body and the uncus.The configuration of the posterior communication artery could be grouped into 4 types: straight, curved, looped and plexiform of the posterior portion. The curved type was more common in adults. The PCOA gave rise to an average of 8.1 perforating branches which emerged into tuber cinerum, optic tract, hypothalamustractus opticus furrow, mammillary body, crus cerebri, and the region located between optic tract and crus cerebri laterally, and mammillary body medially. According to the variety of calibres of the PCOA, the Willis' circle could be classified into modern, primitive, transitional and mixed type.The calibre of proximal portion of the posterior cerebral artery was equal in size bilaterally in 57.60?4.4%. There was an average of 3.1 posterior perforating arteries arising from P_1. They entered into the mammillary body, interpeduncular fossa, posterior perforating substance and crus cerebri.The collicular artery and the blood supply of mammillary body were observed and briefly discussed.

The origin, diameter, arrangement pattern, distribution and microvascular architecture of the intracerebral segments(IS) of the central branches of the middle cerebral artery(MCA) were examined and pictured in 27(10 infants, 5 newborns, 12 fetuses) unfixed brains under stereoscopic microscope and scanning electron microscope. 1. The extracerebral segments(ES) of the central branches run toward the anterior perforated substance in S-shaped curves. The IS arise from ES or their collateral branches. They form the fan-shaped appearance in rostromedial and caudolateral state after entering brain. 2. The IS give rise collateral branches in right or acute angles, and they are of two kinds: the longitudinal and the transverse branches. The mean diameter of the IS in original site is 0.21?0.18mm for the medial group; 0.36?1 0.21mm for the lateral group. 3. The medial group mainly distribute in the rostal part of the internal capsule and basal nucleus; the lateral group mainly distribute in the caudal part. 4. Some circular impressions of the precaillary sphincters were observed at the beginning of precapillary arteriole and capillary, converging point of tributary branches of venule. The relationship between the IS of the central branches and the hemodynamics was discussed.

The microangioarchitecture of human thalamus was studied by the ink-gelatin injection, thick section transparency, histochemical staining and methacrylate cast under the stereoscope and scanning electron microscopy. There were some impressions of smooth muscular cells on the arteriole, precapillary arteriole, origin of capillary, larger venule, and converging region of each venula. Some circular impressions presented at the course of capillary regularly and discontinuously, which might be caused by contraction of pericytes of capillary. The microvascular anastomoses were rich and complex. Besides capillary anastomoses of different shape, there were many anastomoses occurred between two arterioles, or between several arterioles. The form of venular anastomoses was similar to arterioles. The anastomosis between arteriole and venule was observed occasionally. The relationship of characteristic of vertical branches of arterioles to thalamic hemorrhage was discussed.

Objective To investigate the level changes of plasma insulin,serum lipids in type 2 diabetes with cholelithiasis.Methods 159 cases of types 2 diabetic patients was studied during recently 3 years in our department of endocrinology,the levels of blood glucose,plasma insulin and insulin sensitivity index(ISI),serum lipids,apolipoproteins(ApoA 1,B) were measured both fasting and post-prandial,and investigated their correlation between type 2 diabetic patients with cholelithiasis(n=103) and without cholelithiasis(n=56).Results Female was predominated in fifty-six diabetic with cholelithiasis,they had higher triglyceride(TG),fasting or post-prandial insulins,ApoA 1,ApoB,the top body weight index and lower ISI than 103 diabetics without cholelithiasis.There were no significant differences in total cholesterol(CH),HDL-Ch,LDL-Ch,blood glucose concentrations between the groups.Conclusions Obesity,insulin resistance and lipids metabolic disturbance might be related to the development of cholelithiasis in type 2 diabetic patients.

Objective To evaluate the influence of L-ornithine-L-aspartate (LOLA) on model for end stage liver disease(MELD) score and liver function of patients with chronic liver failure (CLF). Methods Sixty patients consecutively admitted to our hospital from May, 2002 and November, 2008 were enrolled into the study and randomly divided into low dose group (LD group, LOLA:10 g/d) and high dose group (HD group, LOLA :20 g/d)After treatment of LOLA, the clinical data ( serum NH3 , MELD score and liver function ) were compared between the two groups. Results Compared to serum NH3 level before treatment, serum NH3 decreased ( 62.59 + 27.87 )μmoL/L in the HD group and (49.36 + 27.34 ) μmol/L in the LD group, and both decreasements were statistical significant (Ps ＜ 0. 05 ). Compared to MELD before treatment, MELD score decreased ( 8.38 ± 2. 24 ) and ( 14.57 + 7.68), respectively ( Ps ＜ 0.05 ). Compared to LD group, all indices of liver function in the HD group improved more compared to those of the LD group ( Ps ＜ 0.05 ). Conclusions LOLA could significantly decrease serum NH3 and MELD score and improve liver function in CLF patients.

Objective:To study the effect of changing operator on the detection rate of colorectal polyps during surgery in patients who had been diagnosed with colorectal polyps by electronic colonoscopy for the first time.Methods:From June 2016 to June 2019, the patients who had been diagnosed with colorectal polyps by electronic colonoscopy for the first time, they were performed by electronic colonoscopy for the second time after 3 months by 5 doctors in the No.946 Hospital of PLA who had engaged in endoscopic work longer and been with rich experience. The results of the electronic colonoscopy were recorded and compared.Results:Fived hundred and seventy-six patients were found have colorectal polyps through electronic colonoscopy for the first time. Among them, 423 patients came to the hospital within 3 months and were eligibled for the research. The detection rate of newly detected polyps by the same operator was 22.7%(96/423), after changing the operator, the detection rate became 24.3% (103/423), but there was no significant difference ( P>0.05). The detection rates of newly detected polyps were respectively 20.8% (220/1 059) and 25.9%(294/1 133), the proportion of newly detected polyps with diameter ≤ 5 mm was respectively 73.6%(162/220) and 82.0%(241/294), the ratio of flat polyps to total newly detected polyps was 71.8%(158/220) and 79.9%(235/294), and there were significant differences ( P<0.05). The proportion of polyps in sigmoid colon was respectively 35.0% (77/220) and 39.1%(115/294), and there was no significant difference ( P>0.05). Conclusions:For patients with colorectal polyps detected by electronic colonoscopy, the operator should be changed during surgery, so that more missed polyps can be detected during surgery, especially flat polyps with diameter ≤ 5 mm. The operator should be changed to improve the detection rate and reduce the probability of missed diagnosis.

Objective To study the diagnosis,prophylaxis and treatment of splenic artery steal syndrome (SASS),and to evaluate their clinical outcomes in recipients who underwent orthotopic liver transplantation (OLT).Methods 1 385 consecutive patients who suffered from liver cirrhosis and had undergone OLT in our hospital between Jan,2004 and Dec,2013 were studied.We hypothesized that patients were at risk of SASS when the calibre of the splenic artery (SA) was 1.5 times larger than the common hepatic artery (CHA) together with splenomegaly (318 patients,23.0％).Further surveillance with Doppler ultrasound (DUS) was carried out immediately at CHA reperfusion during operation.When a sluggish peak systolic velocity (PSV) ＜ 30 cm/s or no flow was detected in a patent hepatic artery,prophylactic SA banding (SAB) was considered.127 patients (39.9％) who fulfilled these criteria were recruited to the intervention group to undergo SAB.Eventually,patients who developed SASS were treated with coil-embolization of the SA (SAE),re-anastomosis of the HA to aorta (HTA),ligation of SA (SAL) or splenectomy (SPT),or retransplantation.Results SAB resulted in immediately increase in the mean PSV of the HA from 19.3 ±5.5 cm/s to 45.9 ± 9.1 cm/s (P ＜ 0.05),and resistance index (RI) of the HA rehabilitated to reasonable levels (0.5 ～0.8),without any HA or biliary related complication in all the 127 patients.17 patients in the control group were identified to have SASS (8.9％).5 of these 17 patients required emergency treatment by coil-embolization.Of the remaining 12 patients,11 who developed hepatic artery thrombosis secondary to SASS required to undergo embolectomy or thrombolysis followed by HTA (4 patients),SAL (3 patients),SPT (5 patients).Three of these patients finally required re-OLT.All these patients obtained acceptable results by these salvage strategies,except 2 out of the 12 patients who died from liver failure.Conclusions SASS is an important but it is often and under-diagnosed cause of graft ischemia after OLT.Prophylactic SAB should be introduced to patients at risk of developing SASS in order to obtain satisfactory results.Coil-embolization of SA shortly after diagnosis is an effective salvage intervention to prevent further progression to develop devastating consequences.

Purpose To investigate the clinical characteristics and Oxford classification of IgA nephropathy patients with hyperurice-mia. Methods 151 IgA nephropathy patients confirmed by renal biopsy in 2013 were analyzed retrospectively. The patients were di-vided into the two groups:IgA nephropathy patients with or without hyperuricemia. Morphological changes were evaluated with Oxford classification scoring system and Lee’s grades. A comparative analysis of clinical manifestations and pathological injuries was performed between the two groups. Results Incidence of hyperuricemia in IgA nephropathy patients was 48. 3% and was more common in young men. Hypertension was associated with hyperuricemia. Oxford classification of IgA nephropathy patients with hyperuricemia was pre-dominant M1E0S1T0 and Lee’s grades presented with grade Ⅲ. The outstanding histopathologic features with higher plasma uric acid levels indicated higher tubulointerstitial chronicity, higher glomerular sclerosis ratio, accompanied by a decline in glomerular filtration rate. There was no significant difference of vascular lesions. Conclusions The prevalence of hyperuricemia in IgA nephropathy pa-tients is high. Oxford classification shows IgA nephropathy with hyperuricemia are associated with more severe tubulointerstitial lesions and lower GFR.