[Diagnostic value of combined detection of different indicators for type 2 diabetes mellitus combined with atherosclerotic disease].

Objective: To investigate the diagnostic value of serum lipoprotein associated phospholipase A2 (Lp-PLA2), amyloid A (SAA) and immunoglobulin E (IgE) in patients with type 2 diabetes (T2DM) mellitus complicated with atherosclerotic disease. Methods: From June to December 2019, 224 patients with T2DM in the Second Hospital of Lanzhou University were selected, including 144 males and 80 females, aged (61±11) years. According to the results of imaging examination, the patients were divided into T2DM with AS group (T2DM-AS group, n=160) and T2DM group (n=64); Healthy subjects in the same period were selected as healthy control group (n=160). Lp-PLA2, IgE, SAA, hs-CRP, TC, TG, HDL-C, LDL-C and Hcy were detected in all patients and healthy controls. The correlation between the above indexes, gender, age and T2DM with AS was analyzed; Multivariate logistic regression was used to analyze the risk factors of T2DM with AS. Results: Compared with the healthy control group, the levels of IgE and Lp-PLA2 in T2DM-AS group and T2DM group were increased, and the levels of SAA in T2DM-AS group were increased (all P<0.05); Compared with T2DM group, the levels of Lp-PLA2, IgE and SAA were increased in T2DM-AS group (all P<0.05). T2DM with AS was positively correlated with age, IgE, Lp-PLA2 and SAA (r=0.468, 0.269, 0.486, 0.418, all P<0.05), and negatively correlated with HDL-C (r=-0.338, P<0.05). Multivariate logistic regression analysis showed that age (OR=0.865, 95%CI: 0.763-0.982, P<0.05), IgE (OR=0.910, 95%CI: 0.840-0.987, P<0.05) and Lp-PLA2 (OR=0.942, 95%CI: 0.910-0.986, P<0.05) were risk factors of T2DM with AS. ROC curve showed that the combined detection of Lp-PLA2, SAA and IgE could improve the diagnostic efficiency of T2DM with AS (AUC=0.895, P<0.05), the sensitivity was 80.0%, and the specificity was 93.7%. Conclusion: The levels of Lp-PLA2, IgE and SAA increase in T2DM patients with AS. The combined detection of Lp-PLA2, SAA and IgE can improve the diagnostic efficiency of T2DM patients with AS.

[Clinical application of computed tomography angiography and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps].

Objective: To explore the application value of computed tomography angiography (CTA) and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps. Methods: From December 2014 to December 2018, 12 patients with high-voltage electrical burns in necks, shoulders, axillas, and upper arms were hospitalized. The size of wounds ranged from 13 cm×10 cm to 32 cm×15 cm after complete debridement. Before tissue flap repair, the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA. The main target vessels and their branches were conducted by three-dimensional reconstruction, and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms, amputation stump bone exposed wounds, and wounds in axillas and the anterior, the latissimus dorsi myocutaneous flap is the first choice for repair, if the thoracodorsal artery and internal and external branches are well developed according to CTA examination. Latissimus dorsi myocutaneous flaps were used in 6 patients with the area of myocutaneous flap ranging from 16 cm×12 cm to 32 cm×17 cm. All the donor sites were covered by split-thickness skin graft of thighs. For large wounds in occiputs, necks, and scapulas, the contralateral lower trapezius myocutaneous flap is the first choice for repair, if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination. For small wounds in necks and scapulas, the ipsilateral lower trapezius myocutaneous flap can be used for repair, if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination. Lower trapezius myocutaneous flaps were used in 4 patients with the area of myocutaneous flap ranging from 18 cm×12 cm to 25 cm×17 cm. The donor site of one patient was sutured directly and the donor site of the other 3 patients was covered by split-thickness skin graft of thighs. For wounds in the posteromedial side of upper arms and the anterior side of axillas, the lateral thoracic skin flaps can be used for repair, if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space, when the blood supply of side chest skin is reliable according to CTA examination. Lateral thoracic skin flaps were used in 2 patients with the area of skin flap ranging from 16 cm×12 cm to 17 cm×14 cm. The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh. Results: During the operation of tissue flap repair in 12 patients, the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation. All the tissue flaps survived after operation. During follow-up of 1 to 24 months, the patients were satisfied with no serious scar contracture affecting the function nor secondary infection or chronic ulcer. Conclusions: CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks, shoulders, axillas, and upper arms. It can be used to observe whether the vessels are embolized or not and the starting position and orientation of blood vessels, which can provide an important reference for the selection of tissue flap transplantion.