Objective To investigate the factors affecting renal parenchymal elasticity in diabetic patients with hypertension. Methods According to the presence of diabetes and hypertension, 167 patients were divided into three groups: simple diabetes mellitus (DM) group, simple hypertension (HP) group and diabetes mellitus combined with hypertension (DM+ HP) group. Meanwhile, 50 healthy volunteers were selected as control group. The basic clinical data of subjects were collected, routine laboratory tests were detected, and virtual touch quantization (VTQ) was used to measure the left renal shear wave velocity (SWV). Then one-way ANOVA was used to analyze the measurement parameters among the above groups, and the relationship between SWV values and various factors was analyzed by multiple stepwise linear regression analysis. Results For SWV, there was significant difference among 4 groups. The SWV values in group DM+ HP were greater than that in group DM and group HP [(2.62±0.35) m/s vs (2.44±0.32) m/s, (2.62±0.35) m/s vs (2.49±0.27) m/s], the differences were statistically significant (t=-2.854, -2.198, all P<0.05). And all three patient groups had greater values of renal SWV than that of control group [(2.01±0.22) m/s], the differences were statistically significant (t=-7.854, -9.783, -10.787, all P<0.05). Multiple linear regression analysis showed that SWV had linear relationship with duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow resistance index (RI) and uric acid (standard regression coefficient b′=0.488, 0.159, -0.187, 0.151, 0.123, P<0.05, respectively). In details, SWV was positively correlated with duration of diabetes, duration of hypertension, left renal artery blood flow RI and uric acid, while negatively correlated with the left renal parenchymal thickness. Conclusions The main factors related to the elasticity of renal parenchyma were duration of diabetes, duration of hypertension, left renal parenchymal thickness, left renal artery blood flow RI and uric acid, which can be helpful for clinical prevention for renal parenchymal change in diabetic patients with hypertension. Key words: Diabetes mellitus, type 2; Hypertension; Ultrasonography

Fetal hydronephrosis (HY) is a frequent congenital condition, which may be detected by prenatal ultrasound. Society for Fetal Urology (SFU) and anterior-posterior diameter (APD) grading are two major grading systems based on ultrasonography. The present study aimed to assess the predictive value of the SFU and APD grades in patients with fetal HY. A total of 162 patients with 234 kidneys affected by HY were included in the present study. The SFU and APD grades were determined from the ultrasound images at 38 gestational weeks, and a 12-month follow-up was performed after birth. The associations of the SFU and APD grades with the outcome of fetal HY, including HY regression, and post-partum surgery were examined. In the present study, 16 patients with 17 kidneys were diagnosed with pathological HY, and stenosis at the ureteropelvic junction was demonstrated to be a leading cause of pathological HY. Among the 234 kidneys affected by HY, 161 kidneys were scored as SFU grade I, 57 as SFU grade II, 7 as SFU grade III and 9 kidneys as SFU grade IV. According to the APD grading system, 112 kidneys were determined as having low, 104 as having moderate and 18 as having severe HY. The SFU and APD grades were demonstrated to be independently associated with the occurrence of pathological HY by logistic regression analysis with a high diagnostic accuracy to distinguish pathological and physiological HY cases as evidenced by the results of ROC analysis. In addition, univariate and multivariate logistic regression analysis indicated that patients with spontaneous HY regression usually had low SFU and APD grades. Furthermore, the rate of surgery was increased in the group of patients with high SFU or APD grades, and these two systems were identified as independent predictors for the requirement of surgery by Kaplan-Meier analysis. Patients with pathological HY had high SFU and APD grades, and these two grading systems may be used as reliable predictors for the outcome of fetal HY, including HY regression, and post-partum surgery.

Objective To explore the feasibility of the promoting effect of ultrasound targeted microbubble destruction(UTMD) on establishment of type Ⅰ diabetic nephropathy in rats.Methods Forty male SD rats were randomly and equally divided into four groups(n =10):control group(group A),streptozocin group(group B),streptozocin and ultrasound microbubble group(group C) and streptozocin and UTMD group(group D).The fasting blood-glucose (FBG) were tested,the 24 h's urine were collected and the 24 h's urine mieroalbumin(mAlb) were measured and then urinary albumin excretion rate(UAER) were calculated twice a week at fixed time in all groups.When greater than 3-fold increase in UAER compared with controls at the same age and gender,the diabetic nephropathy model in rats was considered to be established successfully,then the change of time and weighed were recorded and rats were killed and collected the blood of left atrial appendage to measure,blood urea nitrogen (BUN),serum creatinine (SCr) and Alanine aminotransferase (ALT).The left kidneys were weighted and then observed glomerular pathological changes under light microscope and detected the expression of CD34 in kidney of rats in each group by immunohistochemical method.Results ①The time of establishing diabetic nephropathy model in group D was obviously shorter than that in group B and C (all P ＜ 0.05).The FBG,the kidney index,UAER,BUN and Scr values in group B,C and D were significantly higher than those in group A(all P ＜0.05),but ALT had no significant change among each groups(all P ＞0.05).②The pathological changes of diabetic nephropathy appeared in rats of group B,C and D;the expression of CD34 in B,C and D groups were raised.Conclusions UTMD can obviously shorten the molding time of type Ⅰ diabetic nephropathy rats,which has feasibility.

目的 探讨超声二维应变成像评价规范化治疗对2型糖尿病患者颈动脉弹性影响的可行性, 为规范化治疗对颈动脉弹性影响提供评价指标.方法 选择2015年6月至2016年5月于温州医科大学附属第二医院门诊新确诊的63例2型糖尿病 (T2DM) 患者为研究对象.根据颈动脉内膜中层厚度 (CIMT) 分为:CIMT增厚组30例 (1.0 mm≤CIMT<1.5 mm) 和CIMT正常组33例 (CIMT<1.0 mm) .对研究对象进行右侧颈总动脉二维短轴图像收缩期峰值圆周应变 (CS) 和应变率 (CSr) 的测量, 给予规范化治疗6个月后重复以上超声检查, 比较两组患者治疗前后CS、CSr的变化率, 并比较两组患者在治疗前后体质指数 (BMI) 、收缩压 (SBP) 、舒张压 (DBP), 空腹血糖 (FPG) 、糖化血红蛋白 (Hb A1C) 、总胆固醇 (TC) 、甘油三酯 (TG) 、高密度脂蛋白胆固醇 (HDL-C) 和低密度脂蛋白胆固醇 (LDL-C) 的变化情况.用SPSS 17.0统计软件包进行t检验.结果 规范化治疗前CIMT增厚组Hb A1C大于CIMT正常组, 差异有统计学意义 (P<0.01);治疗后, Hb A1C在两组间比较差异无统计学意义 (P>0.05) .规范化治疗后, 两组患者FPG、Hb A1C和BMI均低于治疗前, 差异有统计学意义 (P<0.01) .治疗前后, CIMT增厚组的CS和CSr均低于CIMT正常组, CS、CSr的变化率均低于CIMT正常组, 差异均有统计学意义 (P<0.05) .治疗后, 两组患者的CS、CSr均高于本组治疗前, 差异均有统计学意义 (P<0.01) .结论 超声二维应变成像可用来评价规范化治疗对2型糖尿病患者颈动脉应变的影响, 在颈动脉弹性功能的评价上具有一定的临床实用价值.

Objective To investigate the multivariate analysis of renal parenchymal elastic changes in diabetic and the value of virtual touch quantization ( VTQ ) techniques in the diagnosis of diabetic nephropathy . Methods According to urinary albumin excretion rate( UAER) ,72 cases of diabetics were divided into 3 groups:the normal albuminuria group ( UAER<30 mg/24 h) 16 cases ,the trace albuminuria group(30 mg/24 h< UAER< 300 mg/24 h) 30 cases and the mass albuminuria group ( UAER > 300 mg/24 h) 26 cases . And 50 healthy volunteers were selected as the control group . The basic clinical data of subjects were collected ,routine laboratory tests were detected ,and VTQ was used to measure the left renal parenchymal shear wave velocity ( SWV ) ,then the statistical software was applied to analyze these data . Results The left renal parenchymal SWV in the control group ,the normal albuminuria group ,the trace albuminuria group and the mass albuminuria group increased in turn ,respectively ( 2 .01 ± 0 .22 ) m/s , (2 .20 ± 0 .22) m/s ,(2 .51 ± 0 .42) m/s ,(2 .88 ± 0 .32) m/s ,the difference among 4 groups was statistically significant( P <0 .05) . Multiple linear regression analysis showed that SWV ( Y) had linear relationship with duration of diabetes(X1 ) ,left renal parenchymal thickness(X2 ) and serum creatinine(X3 ) ,and the regression equation was Y = 2 .719 + 0 .043 X1 -0 .051 X2 + 0 .002 X3 . In addition ,SWV was positively correlated with the duration of diabetes and serum creatinine ,and negatively correlated with the left renalparenchymal thickness . Conclusions There is correlation between the left renal parenchymal SWV andduration of diabetes ,left renal parenchymal thickness and serum creatinine ,and the left renal parenchymal SWV increases as the renal injury aggravating . VTQ has a certain reference value to judge the degree of early renal damage in diabetics .

患儿男，2d，因“出生后呕吐2d”入院。患儿生后2h即出现非喷射性呕吐，量少，予洗胃后仍日吐7～8次，吃奶差，胎便已解。查体：面色发绀，胸廓稍隆起，腹部未触及明显包块。超声检查：中上腹腔内见一大小约2.1cm×1.7 cm的团状等回声，边界清，彩色多普勒示团块外围血管环绕走行，探头置于团块处作上下滑动时，团块呈“麻花状”（图1，2）。超声诊断：肠旋转不良可能。X线造影显示：胸腔偏右侧可见局限性气体影，注入造影剂后见胃上移，胃贲门位于右下，幽门位于贲门左侧方。X线诊断：提示膈疝，胃扭转（图3）。患儿行剖腹探查术，术中见食管裂孔扩大，整个胃疝入右胸腔内。术中诊断：食管裂孔疝合并胃扭转。