Background Vascular ultrasound is a commonly used tool to predict the existence and severity of coronary artery disease (CAD) by detecting the atherosclerosis of peripheral arteries. However, most studies on atherosclerosis are based on the general population, and the predictive efficacy of carotid or femoral ultrasound in type 2 Diabetes mellitus (T2DM) and its correlation with CAD severity are less elucidated. This study aimed to compare the predictive value of carotid or femoral artery ultrasound for CAD in T2DM patients free from known CAD, and to assess the relationship with the severity of coronary artery stenosis. Methods Cross-sectional study in adults with a T2DM duration of at least 5 years and without established CAD. All participants underwent carotid and femoral ultrasound and underwent coronary angiography for the first time. The carotid plaque score (CPS) was calculated by the sum of the maximum thickness of plaques on three segments of the carotid arteries on both sides. The Gensini score was used to assess the severity of coronary stenosis, and patients were divided into no or mild group, moderate group and severe group according to the tertile of the score. Results Multiple regression analysis showed that carotid plaque score, femoral plaque and smoking were independently and positively correlated with CAD. Carotid plaque score yielded the highest area under the curve for detecting significant coronary disease (AUC = 0.7323). In contrast, the area under the curve of femoral artery plaque and carotid intima-media thickness was lower than 0.7, which was at a lower prediction level. In the no or mild, moderate and severe groups, the CPS value gradually increased, and the difference between the groups was statistically significant (p < 0.05). The positive rate of femoral artery plaque in patients with moderate and severe CAD was significantly higher than that in the no or mild group (p < 0.0001). Conclusion In patients with long T2DM duration, carotid plaque score has a higher ability to predict the occurrence and severity of CAD. However, femoral artery plaque has special value in predicting moderate to severe coronary artery disease in patients with long-term T2DM.

BACKGROUND: Accumulating evidence shows that the increase in blood viscosity (BV) is an independent risk factor for atherosclerosis and its related diseases, but as far as we know, there are few studies on the relationship between blood viscosity and carotid plaque severity. Therefore, we aimed to investigate the relationship between blood viscosity and the presence of carotid plaques, and further explore its relationship with the severity of carotid plaques. METHODS: We retrospectively analyzed the data of consecutive subjects in the physical examination center of the Affiliated Hospital of Ningbo University Medical College from January 2022 to May 2022. The parameters of blood viscosity include the whole blood viscosity (WBV) at high, middle, and low shear rate, plasma viscosity (PV), hematocrit (HCT), rigidity “k”, rigidity index (RI), aggregation index (AI) and electrophoresis rate (ER), and standardized BV calculated by Quemada’s equation were included in the study. Carotid plaque score (CPS) was used to measure the severity of carotid artery disease, and participants were divided into mild, moderate, and severe groups according to the quartile of the score. Independent samples t-test and one-way ANOVA were used to compare normally distributed continuous variables between two or more independent groups, respectively. Binary logistic regression was used to evaluate the risk factors of carotid plaque. RESULTS: 314 men were enrolled in the study, of which 165 participants were diagnosed with Carotid artery plaque (CAP) (66.9%). Compared with the CAP- group, the WBV and PV of the CAP+group decreased, but the difference only existed in the PV (p = 0.001). However, standardized BV values (HCT set at 0.45) were higher in the CAP+group than in the CAP- group (3.8643±0.35431vs 3.9542±0.64871, p = 0.188). Regarding the rigidity and aggregation of RBC, the parameters including rigidity “k”, RI, AI and ER increased in the CAP+group compared with the CAP- group. The difference was statistically significant in k and ER (p = 0.04, p = 0.009). To assess the severity of carotid plaque, we divided the participants into mild, moderate, and severe groups by using the tertile of CPS value. The mild group was defined as CPS≤0.5 (n = 108), the moderate group as 0.5 <  CPS≤1.7 (n = 105), and the severe group as CPS >  1.7 (n = 101). It was found that WBV and PV decreased with the increase of plaque severity, but the difference among the three groups was significant in PV (F = 8.073, p <  0.0001). In addition, with the severity of plaque from mild to severe, standardized BV gradually increased, which were 3.8611±0.34845, 3.8757±0.36637, 3.9007±0.38353 respectively. The difference between the groups was close to statistically significant (F = 2.438, p = 0.089). The values of parameters describing erythrocyte aggregation and rigidity increased among the mild, moderate, and severe groups. The difference was statistically significant in RBC rigidity “k” and ER of RBC (F = 3.863, p = 0.022; F = 5.897, p = 0.003, respectively). CONCLUSION: Increased blood viscosity is a risk factor for carotid plaque, but its increase may be hidden by decreased hematocrit. Therefore, it is necessary to comprehensively analyze various parameters of blood viscosity, such as the standardized BV calculated by Quemada’s equation, which may provide more useful reference value.

The objective of this study is to explore the prognostic factors of double primary cancer patients with lung cancer as the first primary cancer (FPC). The Surveillance, Epidemiology, and End Results (SEER) database is a database established by the National Institutes of Research for cancer registration purposes, which collects relatively complete demographic characteristics and clinical data for assessing the epidemiological characteristics of cancer worldwide. Clinical data on patients with a clear histopathological diagnosis of double primary with lung cancer as the FPC were identified and collected from the SEER database from 2010 to 2015. Survival curves were plotted by Kaplan–Meier survival analysis. Independent prognostic factors of patients were analyzed by COX proportional risk model. Clinical data were collected from a total of 9306 patients, including 6516 patients in the modeling group and 2790 patients in the validation group. When we retrieved that the FPC was lung cancer, we found that the most common site of the second primary cancer was located in the respiratory system (54.0%). In addition, the most common site of first primary lung cancer in patients with double primary cancer was the right upper lobe (33.3%). A total of 14 independent prognostic factors were included, and the constructed survival nomogram had high accuracy and clinical applicability. The nomogram established in this study can help to raise awareness of clinical workers and the importance of such diseases, and guide the treatment and follow-up strategies.