Objective To investigate the diagnostic value of serum MK (Midkine)and total bilirubin (TB)in diabetic retinopathy (DR). Methods A total of 148 patients with type 2 diabetes were divided into three groups:diabetes without retinopathy (NDR group,n = 50),diabetic with non proliferative retinopathy (NPDR group,n = 52 )and diabetic with proliferative retinopathy (PDR group,n = 46 ) according to whether retinal lesions were detected. The diagnostic value of serum MK and TB were investigated. Results Age,gender,body mass index (BMI),FPG,HbA1 c,TG,TC,LDL-C,HDL-C, SBP,DBP were not statistically different among the three groups (P >0.05).Duration,UAlb/Cr,SOD, MDA,AOPP,MK,TB and DB were statistically different among the three groups (P<0.05). Duration, ALB/CR,MDA,AOPP,and MK were higher,SOD,TB,DB were lower in PDR and NPDR group than in NDR group (P<0.05). Duration,UAlb/Cr,MDA,AOPP,and MK were higher,and SOD,TB,DB were lower in PDR group than in NPDR group (P <0.05).Logistic regression analysis showed that duration, ALB/CR,MDA,AOPP,and MK were risk factors (OR =1.36,1.71,1.27,1.65,2.35,P <0.05 )and SOD,TB,DB were protective factors for DR (OR =0.46,0.31,0.46,P <0.05). Diagnosis sensitivity, specificity,positive predictive value,negative predictive value and accuracy of TB combined with MK were higher than TB,MK alone(AUC=0.918,0.735,0.762,P <0.05). Conclusion DR may be associated with increased MK and decreased TB.Diagnostic efficacy of MK combined with TB is better than MK,TB alone.

Objective To explore the differences in clinical features between the latent autoimmune diabetes in adults (LADA) and type 2 diabetes mellitus (T2DM) in the elderly.Methods Clinical features of 41 cases with LADA and 49 cases with T2DM were retrospectively analyzed and compared.Results (1) Body mass index (BMI),fasting and postprandial levels of cpeptide,triglyceride (TG) and serum albumin were lower in LADA patients than in T2DM patients.(2) The levels of fasting and postprandial blood glucose were higher in LADA patients than in T2DM patients.(3) There were no statistically significant differences in the disease course,blood pressure (BP),and the functions of liver and kidney between LADA and T2DM patients.Conclusions As compared with T2DM patients,LADA patients have higher blood glucose level,lower BMI and TG level,and poorer function of islet B cell.But there is no significant difference in the chronic complications between two groups.

Objectlve To investigate the value of basic and contrast-enhanced ultrasound in the diagnosis of superficial cervical lymph nodes.Methods Five hundred and forty-five cases of superficial cervical lymph nodes were sacned by basic ultrasound,in which 52 cases were also scaned by contrast-enhanced ultrasound.All cases were performed ultrasound-guided biopsy.Lymph nodes were divided into benign group and malignant group according to pathology reports.The differences of the two groups were analysed,and statistical analysis was performed.Results Two hundred and thirty cases were benign,315 cases were malignant.S/L(P＜0.01),RI(P＜0.01),vascular pattern(P＜0.01)and contrast enhancement pattern(P＜0.01)between benign and malignant group showed statistical significant differences,while no statistical difference in coefficient correlation of the time-intensity curve between the two groups was found.Conclusions A combination of basic and contrastenhanced ultrasound can significantly enhance the ability to identify malignant lymph nodes from benign lymph nodes.

Objective To explore the feasibility of contrast-enhanced ultrasonograhy (CEUS) in preoperative classification of hepatocellular carcinoma (HCC) microvascular morphology.Methods Totally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline Time-intensity curve (TIC) were drawn using SonoTumor. The tumor size, alpha fetoprotein (AFP), cirrhosis, Child-Pugh classifi cation, tumor differentiation and TNM stage were statistically analyzed. The intratumoralmicrovessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed.Results CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC: 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength (PE), rise time (RT), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-in area under the curve (WiAUC) and mean transit time (MTT) in 28 cases of capillary-like type were (4350.7±2566.0) a.u, (10.7±3.2) s, (717.0±489.9) a.u, (12820.3±8331.6 )a.u, (128 240.8±74 487.1) a.u, (71.9±33.1)s. Those parameters in 14 cases of sinusoid-like type were (2471.6±1107.1) a.u, (16.2±4.2)s, (321.9±171) a.u, (5 561.4±2 938.0) a.u, (86 780.1±47 563.7) a.u, (117.8±69.6)s. And in 52 cases of mixed type they were (3563.2±2343.1) a.u, (14.1±4.8)s, (519.4±403.2) a.u, (9 015.3±6 884.7)a.u, (128 240.8±74 487.1) a.u, (71.9±33.1) s respectively. The CEUS parameters of WiR, WiPI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were signifi cant (WiR: t=3.87, 3.3, bothP=0.05; WiPI: t=2.96, 2.06, bothP=0.05; RT: t=3.19, 2.34, bothP=0.05). The parameter of PE in capillary-like type HCC patients were signifi cantly higher than that in sinusoid-like type HCC patients (t=2.51,P=0.05). And the parameter of PE in capillary-like type HCC patients was higher than mixed HCC patients, but there was no signifi cant difference. The parameters of PE, WiR and WiPI in mixed type HCC patients were higher than that in sinusoid-like type HCC patients, while RT in mixed type HCC patients were lower than that in sinusoid-like type HCC patients, but there were no signifi cant differences. No signifi cant differences of WiAUC and MTT were observed in HCC patients with different microvascular morphology.Conclusions There were signifi cant differences of CEUS parameters in different microvascular morphology types. And CEUS, as a non-invasive method, can be used for preliminary preoperative prediction of microvascular morphology in HCC patients.

The carotid initima-media thickness(CIMT)in 78 cases of type 2 diabetic patients was measured.The level of plasma endogenous secretion receptor for advanced glycation end-products(esRAGE)in patients with normal CIMT was higher than those with chickened CIMT[(0.257 3±0.165 6 vs 0.155 4±0.0701)μg/L,P<0.01].esRAGE was negatively associated with CIMT(r=-0.247,P<0.05).Logistic regression analysis showed that CIMT was negatively associated with esRAGE and hish density lipoprotein cholesterol,but was positively associated with age.

Objective To investigate the association between gallstone and non-alcoholic fatty liver disease (NAFLD)in middle-aged and elderly Chinese. Methods A cross-sectional study was conducted in 8934 Chinese adults from Jiading District, Shanghai. Questionnaire interview, anthropometric measurements, biochemical evaluation, and abdominal ultrasonography were performed in all the participants. Results Compared with participants without gallstone,individuals with gallstone had significantly higher prevalence of NAFLD(28.8% and 42.9%,respectively;P<0.01). Using participants without gallstone as the reference,participants with gallstone were associated with an increased risk of NAFLD after adjustment for multiple covariatesodds ratios(OR)and 95% confidence interval(CI)was 1.39(1.45-1.69). In addition,compared with participants without cholecystectomy, participants with cholecystectomy were associated with an increased risk of NAFLD(OR=1. 44, 95% CI 1. 04-1.99). Conclusion The presence of gallstone and cholecystectomy were positively associated with NAFLD in middle-aged and elderly Chinese.