Objective To explore the value of contrast-enhanced ultrasound(CEUS)in the assessment of diabetic microangiopademia through evaluating microcirculation perfusion of triceps surae muscle by CEUS.Method Totally 51 patients with type 2 diabetes mellitus(T2DM)admitted in our hospital between August 2020 and January 2023 were collected,including 15 pure T2DM patients and 36 T2DM patients complicated with microcirculatory disturbance(T2DM+CM).Each patient's hemoglobin A1c(HbA1c)and homeostatic model assessment for insulin resistance(HOMA-IR)were recorded.After getting enhanced intensity(PI-BI)and regional peak time(TTP-AT)by CEUS,comparative analysis between groups was conducted.Results The levels of HbA1c and HOMA-IR in T2DM+CM group were higher than those in pure T2DM group(P<0.05).TTP-AT in T2DM+CM group were longer than that in pure T2DM group of all muscles musculi gastrocnemii(MG),laterale musculi gastrocnemi(LG),soleus(SOL)and triceps surae muscle's junction region)(P<0.05).The TTP-AT of SOL was longest in both groups,followed by LG,and MG(P<0.05).The PI-BI had no significant difference among MG,LG and SOL in pure T2DM group.The PI-BI of MG was higher than that of SOL in the T2DM+CM group(P<0.05).TTP-AT of triceps surae muscle's junction region had significant positive association with both HbA1c and HOMA-IR(P<0.05).Conclusion The TTP-AT of triceps surae muscle measured by CEUS is a new indicator for evaluating microangiopathopathy in T2DM patients.

Objective To explore the value of shear wave elastography(SWE)in the early assessment of hepatic and renal fibrosis in patients with metabolic associated fatty liver disease(MAFLD).Methods A total of 52 MAFLD patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from July 2023 to May 2024 were selected as MAFLD group,and 40 non-MAFLD patients treated during the same period were served as control group.General information,laboratory data and ultrasound data were collected and compared between two groups.The differences as well as the correlation of the indicators between two groups were compared.The value of SWE in hepatic fibrosis and renal fibrosis in MAFLD patients was assessed.Results Liver function indicators,uric acid and aspartate aminotransferase-to-platelet ratio index(APRI)in MAFLD group were higher than those in control group(P＜0.01);There were no statistically significant differences between two groups in fibrosis 4 index,estimated glomerular filtration rate,serum creatinine and blood urea nitrogen(P＞0.05).The brightness of the liver,liver-kidney ratio,and liver elasticity value were higher in MAFLD group than those in control group(P＜0.05);There was no significant difference in the elasticity value of the right renal cortex between two groups(P＞0.05).Liver elasticity values was positively correlated with alanine aminotransferase(ALT);The liver-kidney ratio was positively correlated with body mass index(BMI),ALT,aspartate aminotransferase,alkaline phosphatase,y-glutamyl transferase and APRI.No significant correlation was found between the right renal cortex elasticity and BMI,estimated glomerular filtration rate,serum creatinine,blood urea nitrogen,or serum uric acid.Conclusion SWE helps in early identification of liver hardness in the MAFLD patients.But the application of SWE in early renal fibrosis in the MAFLD patients needs further evaluation.

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.

Objective To observe the role of abatacept in the treatment of diabetic nephropathy in rats. Methods Type 2 diabetic nephropathy rat model was established, and was randomly divided into abatacept group and non-intervention group, 15 each. 15 normal rats were served as control group ( NC) . The abatacept group was given abatacept for 8 weeks. The control group was set at the same time period. Then the blood biochemical indexes, blood flow parameters of renal main artery, elasticity of renal parenchymal, HE staining of renal parenchymal and ultrastructure of podocytes were all evaluated. The expression of CD31, CD34, podocin, nephrin, and B7-1 in renal parenchyma were detected. Results Compared to the NC group, the fasting blood glucose, creatinine clearance rate, urine albumin excretion rate, and kidney hypertrophy index in the non-intervention and abatacept groups were significantly increased (P<0. 05);creatinine clearance rate, urine albumin excretion rate, and kidney hypertrophy index in the abatacept group were significantly lower compared to the non-intervention group (P<0. 05). There were significant differences in peak systolic velocity, end diastolic velocity, and mean velocity among these 3 groups, and these differences were ranked as non-intervention groupabatacept>control groups (P<0. 05). There were significant differences in the stiffness of kidneys among these three groups, with the differences ranked as non-intervention>abatacept>control groups (P<0. 05). HE staining and transmission electron microscope observation showed that there were obvious changes in the renal parenchyma of rats in the non-intervention group and the abatacept group, and the changes of kidney in the non-intervention group were worse than those in the abatacept group. CD31 and CD34 expression in kidney parenchyma of rats in the abatacept group and non-intervention group were higher than those in the control group, the abatacept group and non-intervention group>the control group (P<0. 05), while no significant differences between the abatacept group and non-intervention group in CD31 and CD34 expression (P>0. 05). There were significant differences in podocin and nephrin expression in kidney parenchyma of rats among these three groups, and these differences were ranked as the control>abatacept>non-intervention groups (P<0. 05). There were significant differences in B7-1 expression in kidney parenchyma of rats among these three groups, and these differences were ranked as the control

Objective To explore the feasibility of endothelial function of dorsal artery of foot in patients with type 2 diabetes(T2DM) by high frequency ultrasound combined with warm bath test.MethodsThirty-five patients with T2DM and thirty normal people were collected,all subjects were examined by high frequency ultrasound.Diameter of brachial artery in baseline and after reactive hyperaemia were detected;Diameter of dorsal artery of foot in baseline and after the foot immersed in 40℃ warm water for 5 minutes were acquired.Flow mediated dilatation of dorsalis pedis artery(FMDDPA) and flow mediated dilatation of brachial artery(FMDBA) were calculated and compared.Multiple stepwise regression analysis was used to examine the correlation between FMDDPA and hemoglobin A1c(HbAlc). Results The FMDDPA and FMDBA were decreased in patients with T2DM (P<0.01).The FMDDPA and FMDBA were correlated significantly(r=0.864,P<0.01).In stepwise regression analysis,HbA1c is the most affecting factor for FMDDPA (R2=0.321,P<0.01).Conclusions Ultrasound combined with warm bath test can be used to detect the change of endothelial function of dorsal artery of foot in patients with T2DM,which have a certain clinical application value in endothelial function of terminal limb artery.

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 .

Objective Three parameters include circumferential strain (CS),circumferential strain rate (CSr) and stiffness parameter (β) were measured to evaluate the elasticity of carotid artery using two-dimensional(2D) strain imaging and evaluate its clinical value in patients with type 2 diabetes mellitus (T2DM).Methods 60 patients with T2DM were collected and divided into carotid intima-midia thickness (CIMT) thickeness group(34 cases,1.0 mm＜CIMT≤1.2 mm) and plaque group(26 case,CIMT＞ 1.2 mm).33 normal people were supplied as control group.The systolic global peak CS and CSr of the carotid artery were obtained from short-axis view of the common carotid artery and the stiffness parameters β was measured using 2D strain imaging.All the parameters were compared among the three groups.Results The CS and CSr were decreased and β was increased in patients with T2DM (P ＜ 0.01),The CS and CSr obtained from the plaque group were less than that of the CIMT thickeness group(P ＜0.05),but the β was higher than that of the CIMT thickeness group (P ＜0.01).The CS and β were correlated significantly with CIMT respectively (r =-0.79,P ＜ 0.01 ; r =0.72,P ＜ 0.01).Conclusions 2D strain imaging is a technique for early assessing the carotid artery elasticity in patients with T2DM,the thicker the CIMT is,the smaller the deformation is and the larger the β is.

Objective To investigate the effects in elasticity of anterior tibial artery in new patients with type 2 diabetes caused by medicines of reducing blood sugar. Methods One hundred patients with type 2 diabetes were involved. The patients were divided into control group(50 cases) and case group(50 cases) according the vascular complications (including macroangiopathy and microangiopathy). Maxmum of circumferential strain(CSmax) of anterior tibial artery was acquired through strain and strain rate imaging. Local blood pressure which included local systolic blood pressure(LSBP) and local diastolic blood pressure (LDBP) of anterior tibial artery was measured at the same time. Strain-blood pressure index(SBPI) of anterior tibial artery was calculated, SBPI = CSmax/[(LSBP - LDBP)/LDBP] × 100%. It took six months for each patient to take medicines of reducing blood sugar. Then SBPI of anterior tibial artery was calculated again. Parameters were compared inter- and intra-groups. Results SBPI of anterior tibial artery after therapy was higher than that before therapy in control group( P<0. 05). There was no significant difference between SBPI of anterior tibial artery before therapy and that after therapy in case group( P >0. 05). SBPI of anterior tibial artery in case group was lower than that in control whatever before and after therapy( P < 0. 05). Conclusions The protection of medicines of reducing blood sugar on elasticity of anterior tibial artery in new diabetic patients without vascular complications was better.

Objective To investigate the changes of the shear wave velocities on thyroid tissues in patients with Graves disease(GD) and its correlation with thyrotropin (TSH).Methods Forty GD patients and 30 health adults who underwent an ultrasound-based acoustic radiation force impulse (ARFI) technique,the shear wave velocity of thyroid tissues was obtained using virtual touch tissue quantification (VTQ) of ARFI technique,and the changes of the shear wave velocities on thyroid tissues with GD patients and its correlation with the serum TSH level were analyzed.Results The shear wave velocities of thyroid tissues in patients with GD was lower than that of normal,thas were significant difference( P ＜0.05),but there were no significant differences among different locations in GD patients( P ＞0.05).The shear wave velocities of thyroid tissues were correlated with the serum TSH level in patients with GD,the correlation coefficient was 0.707.Conclusions The shear wave velocity may be considered as a helpful index in diagnosing GD and indirectly reflect the serum TSH level,provide some reference for therapy of the GD.

Objective To investigate the clinical value of contrast-enhanced three-dimensional ultrasound in assessing neovascularization within carotid soft plaques. Methods Thirty-six cases with 42 soft plaques were examined with contrast-enhanced two dimensional ultrasound and contrast-enhanced three dimensional ultrasound. Soft plaques were divided into four grades according to distribution and shape of contrast media:grade Ⅰ (there was no enhancement in plaque) , grade Ⅱ (plaque was enhanced with sparse spots pattern or enhanced in small range locally), grade Ⅲ (plaque was enhanced with sparse spots and short-line pattern ),grade Ⅳ (plaque was enhanced with line and grid pattern). Results The results of contrast-enhanced two-dimensional ultrasound were as followed: 4.8% grade Ⅰ , 35.7% grade Ⅱ , 52.4% grade Ⅲ and 7.1% grade Ⅳ. The results of contrast-enhanced three-dimensional ultrasound were as followed:9.5% grade Ⅱ , 47.6% grade Ⅲ and 42.9% grade Ⅳ. Conclusions Spatial distribution of neovascularization within carotid soft plaques could be reflected comprehensively by contrast-enhanced three dimensional ultrasound, and it might be a new mothod to investigate spatial structure and microvascular perfusion of soft plaques furtherly.