Higher Mortality In Women Research Articles

Long-term PM2.5 exposure before diagnosis is associated with worse outcome in breast cancer.

Increasingly epidemiological evidence supports that environmental factors are associated with breast cancer (BC) outcomes after a BC diagnosis. Although evidence suggests that air pollution exposure is associated with higher mortality in women with BC, studies investigating potential mechanisms have been lacking. We evaluated women with BC (N = 151) attended at the National Cancer Institute-Mexico from 2012 to 2015. We calculated 1-year average exposures to particulate matter < 2.5μm (PM2.5) at home address before diagnosis. We used linear and logistic regression models to determine the associations between PM2.5 exposure and BC aggressiveness (tumor size, molecular phenotype). Average annual PM2.5 exposure of this population was 23.0μg/m3 [standard deviation (SD)]: 1.90μg/m3]. PM2.5 levels were positively correlated with tumor size at diagnosis (r = 0.22; p = 0.007). Multivariable linear models had a similar inference [risk ratio (RR): 1.32; 95% confidence interval (95% CI): 1.04, 1.674]. We did not observe differences in this association by age or menopause status. Further, women with triple-negative BC (TNBC) had significantly higher PM2.5 levels compared with other phenotypes (p = 0.015). Multivariable-adjusted logistic regression models assessing the association between PM2.5 and tumor size had a similar inference (RR 1.41; 95% CI 1.05, 1.89) overall for all ages and also for women who were ≤ 50years old at diagnosis (RR 1.63; 95% CI 1.036, 2.57). Our findings suggest a significant association between long-term PM2.5 exposure and BC aggressiveness based on tumor size and phenotype, as well as a worse outcome.

Enhanced therapeutic efficacy of Listeria-based cancer vaccine with codon-optimized HPV16 E7

ABSTRACT Cervical cancer is a leading cause of high mortality in women in developing countries and has a serious impact on women’s health. Human papilloma virus (HPV) prophylactic vaccines have been produced and may hold promise for reducing the incidence of cervical cancer. However, the limitations of current HPV vaccine strategies make the development of HPV therapeutic vaccines particularly important for the treatment of HPV related lesions. Our previous work has demonstrated that LM4Δhly::E7 was safe and effective in inducing antitumor effect by antigen-specific cellular immune responses and direct killing of tumor cell on a cervical cancer model. In this study, the codon usage effect of a novel Listeria-based cervical cancer vaccine LM4Δhly::E7-1, was evaluated for effects of codon-optimized E7 expression, cellular immune response and therapeutic efficacy in a tumor-bearing murine model. Our data demonstrated that up-regulated expression of E7 was strikingly elevated by codon usage optimization, and thus induced significantly higher Th1-biased immunity, lymphocyte proliferation, and strong specific CTL activity ex-vivo compared with LM4Δhly::E7-treated mice. Furthermore, LM4Δhly::E7-1 enhanced a remarkable therapeutic effect in establishing tumors. Taken together, our results suggest that codon usage optimization is an important consideration in constructing live bacterial-vectored vaccines and is required for promoting effective T cell responses.

Conceptualizing "access" of maternal health services in lower-middle-income countries

A considerable number of women die each year worldwide due to preventable causes during pregnancy and childbirth. The high mortality of women who die from pregnancy-related issues can be attributed to inadequate access of high-quality maternal health services. However, access is a nebulous concept with a compendium of conceptualizations and definitions. In this paper, we discuss the various conceptualizations of access to maternal health services in lower middle-income countries, and compare how issues related to access differ between high- and lower middle-income countries. This discussion informs two priorities that we suggest for researchers conducting health system improvement work in lower middle-income countries: 1) develop a robust understanding of the barriers to access that continue to persist due to cultural, socioeconomic, and political factors, and 2) formulate frameworks and theories specific to lower middle-income countries to guide research.

Sequentially-targeted biomimetic nano drug system for triple-negative breast cancer ablation and lung metastasis inhibition

As a breast cancer subtype with high mortality in women, the efficient treatment of Triple-negative breast cancer (TNBC) is still a challenge due to its unique metastatic mode and poor prognosis. In this study, we developed a biomimetic nanodelivery system (denoted as GTDC@M-R NPs) based on erythrocyte membrane (M)-camouflaged graphene oxide quantum dots (GOQDs, G) for TNBC therapy. The TAT (T) and RGD (R) peptides were used to endow targeting accumulation ability of Gamabufotalin (CS-6, C) and doxorubicin (DOX, D) in tumor tissue. In vitro assay indicated good biocompatibility, prolonged blood circulation time (3-fold longer than GT NPs), and effectively enhanced cell and nucleus targeting capability of this nanosystem. Fluorescence activated cell sorter (FACS) analysis indicated that the combination of DOX and CS-6 induced TNBC cell apoptosis more than 89 % under the ratio of 10:1. In vivo assay indicated that the accumulation of GTDC@M-R NPs in tumor sites increased about 2-fold compared to naked GTDC NPs, which was accompanied by high tumor apoptosis rates through blocking chemotherapy-activated cyclooxygenase-2 (COX-2) and enhancing DOX's anti-tumor activity of chemical drugs (85%). Moreover, comparing with the control, the average number of lung metastatic nodules in tumor-bearing mice reduced 84%, the molecular mechanism of which is related to the down expression of COX-2, matrix metalloproteinase 9 (MMP9) and vascular endothelial growth factor (VEGF). Taken together, our results proved that the developed GTDC@M-R NPs can inhibit the growth and suppress metastasis of TNBC, which broaden our insights into the application of combinational strategy for efficient TNBC therapy. Statement of SignificanceIn this study, we developed a biomimetic nanodelivery system (denoted as GTDC@M-R NPs) based on erythrocyte membrane (M)-camouflaged graphene oxide quantum dots (GOQDs, G) for TNBC therapy. The TAT (T) and RGD (R) peptides were used to endow targeting accumulation ability of Gamabufotalin (CS-6, C) and doxorubicin (DOX, D) in tumor tissue. These GTDC@M-R NPs indicated synergistic chemotherapy against TNBC cells through the precise cell and nuclear targeting, immune escape, and improved DOX sensitivity. A effective inhibition of tumor growth and metastasis was achieved by inhibiting Bcl-2/BAX, COX-2 and VEGF related signal pathways. Our finding suggests that the developed GTDC@M-R NPs present great treating effects in the preclinical models of TNBC, which broaden our insights into the application of combinational strategy for efficient TNBC therapy.

Sevoflurane Inhibits Growth and Metastasis of Cervical Cancer Through Up-Regulating miR-203 by Targeting Tumor Protein Translationally Controlled 1

Background: Cervical cancer is a type of malignancy with high incidence and high mortality in women all over the world. Recent findings revealed the role of sevoflurane in the inhibition of development of various cancer types. This study aimed to explore whether sevoflurane could suppress cells proliferation and metastasis through adjusting miR-203 expression in cervical cancer. Methods: The effects of sevoflurane on HeLa cell viability was assessed using CCK-8 assay. miR-203 level in Hela cells was determined by qRT-PCR. In addition, cells apoptosis, migration and invasion were evaluated using flow cytometry and transwell analysis respectively after sevoflurane treatment or miR-203 expression changes. Bioinformatics software (TargetScan) was used to predict the potential target genes for miR-203 and the prediction was validated using dual-luciferase reporter system. Results: Sevoflurane effectively inhibited cell viability, metastasis and stimulated apoptosis in cervical cancer. miR-203 demonstrated a low expression in cervical cancer tissues and cells and sevoflurane significantly up-regulated miR-203 expression in cervical cancer cells. Upregulation of miR-203 significantly suppressed cell growth and metastasis and induced apoptosis, while down-regulation of miR-203 presented the opposite effects in cervical cancer cells. In addition, the inhibitory effects of sevoflurane were eliminated by down-regulating miR-203 in cervical cancer cells. In addition, TPT1 was confirmed as a target gene for miR-203. Conclusion: Sevoflurane inhibited cervical cancer cells viability and metastasis through up-regulation of miR-203 expression by targeting TPT1.

Mixing of Apples and Oranges in Milk Research: A Cohort Analysis of Non-Fermented Milk Intake and All-Cause Mortality.

Mortality in relation to type of milk intake is unclear. We present mortality rates by intake of non-fermented milk fat content type and examine the degree of bias when other fat content types of non-fermented milk are kept in the reference category. For this purpose, we used a longitudinal cohort consisting of 61,433 women who had been administered food frequency questionnaires in 1987–1990 and in 1997, and analyzed time to death. Non-fermented milk consumption was divided into low ≤0.5%, medium 1.5%, or high fat 3%. For each specific type of milk, the first analysis (A) is restricted to those who consumed less than one serving per day of the other milk subtypes. In the second analysis (B), everyone is retained, i.e., leading to a reference category “contaminated” with other milk consumers. During follow-up, 22,391 women died. Highest (≥3 glasses/day) vs. lowest consumption category of milk (<1 glass/day) with 0.5% fat content was associated with a multivariable hazard ratio (HR) of 1.71 (95%CI 1.57–1.86) in analysis A, whereas the same comparison with a “contaminated” reference category in analysis B provided a HR of 1.34 (95%CI 1.24–1.45), p-value for homogeneity <0.0001. The corresponding HRs for 1.5% fat milk were: 1.82 (95%CI 1.63–2.04) and 1.38 (95%CI 1.25–1.51), and for 3% fat milk 1.95 (95%CI 1.77–2.15) and 1.40 (95%CI 1.29–1.52). HR for ≥3 glasses/day of total milk was 1.95 (95%CI 1.84–2.06). We observe a higher mortality in women with high milk consumption, irrespective of milk fat content. A “contaminated” reference group substantially attenuates the actual estimates.

Hypoxia-induced up-regulation of miR-27a promotes paclitaxel resistance in ovarian cancer.

Ovarian cancer (OC) is a malignant tumor with high mortality in women. Although cancer patients initially respond to paclitaxel chemotherapy following surgery, most patients will relapse after 12–24 months and gradually die from chemotherapy resistance. In OC, cancer cells become resistant to paclitaxel chemotherapy under hypoxic environment. The miR-27a has been identified as an oncogenic molecular in ovarian cancer, prostate cancer, liver cancer etc. In addition, the miR-27a is involved in hypoxia-induced chemoresistance in various cancers. However, the role of miR-27a in hypoxia-induced OC resistance remains unclear. The aim of the present study was to investigate the regulatory mechanism of miR-27a in hypoxia-induced OC resistance. The expression of HIF-1α induced Hypoxia overtly up-regulated. At the same time, hypoxia increased viability of Skov3 cells and decreased cell apoptosis when treated with paclitaxel. The expression of the miR-27a was obviously up-regulated under hypoxia and involved in hypoxia-induced paclitaxel resistance. Follow-up experiments portray that miR-27a improved paclitaxel resistance by restraining the expression of APAF1 in OC. Finally, we further elucidated the important regulatory role of the miR-27a-APAF1 axis in OC through in vivo experiments. According to our knowledge, we first reported the regulation of miR-27a in hypoxia-induced chemoresistance in OC, providing a possible target for chemoresistance treatment of OC.

Gender Differences in Early Mortality after LVAD: An IMACS Analysis

Prior studies have observed higher mortality in women after LVAD; however a paucity of data exists on mediators of observed disparities. We used the International Registry for Mechanically Assisted Circulatory Support (IMACS) database to examine what clinical factors might mediate observed gender differences in mortality after LVAD. We analyzed 15,498 adults (>18 years) who received a CF LVAD from Jan 2013 - Sep 2017 (age: 56.0 ± 13.2 yrs, 20.8% female, 35.9% centrifugal pumps, median follow-up:13.4 [IQR 5.6, 25.9] months). Inverse probability weighted Cox proportional hazards model was used to estimate the association of female gender with all-cause mortality. Covariates included age, BSA, pump type, sodium, BUN, bilirubin, INR, hemoglobin, eGFR, MELD score, modified HeartMate II Risk Score (without center volume), INTERMACS profile, PADP and CI. Restricted cubic spline regression analysis was used to examine hazard ratio (HR) variation with time. Causal mediation analysis was performed to test plausible pre-implant mediators that were significantly different between genders (p<0.05). Women were younger, less likely to have ischemic HF, and more likely to have a centrifugal pump (all p<0.001). Women had higher mortality after LVAD (adjusted HR: 1.38, 95% CI: 1.20 - 1.57, p<0.001). Gender*time interaction was significant (p<0.001), with women experiencing increased mortality during the first 3 months after implant (adj HR: 1.76, 95% CI: 1.42 - 2.19, p<0.001), but not after (adj HR: 1.17, 95% CI: 0.98-1.39, p=0.08). Increased tricuspid regurgitation (TR), and smaller LV end-diastolic diameter (LVEDD) at baseline mediated ∼20.6% of the increased early hazard of death in females; however most of the mechanisms underlying the increased hazard remained unexplained. Women have higher post-LVAD mortality during the first 3 months after implant, that is partly mediated by increased TR and smaller LVEDD at baseline. Further studies are needed to explore additional underlying mechanisms.

Clinical Risk Factors and Angiographic Pattern of Coronary Artery Disease in Young Females

Background: Coronary artery disease (CAD) is associated with the highest mortality in women around the world. The objective of this study was to compare the clinical risk factors and angiographic pattern of coronary artery disease in young versus old age females having CAD.Material and Methods: This cross-sectional study was conducted at the Department of Cardiology, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology Multan, Pakistan from April 2018 to December 2018. All females with diagnosis of angina and consistent ischemic changes on ECG were enrolled in the study. A total of 230 females were included with 123 patients aged &lt;45 years and 107 patients aged &gt;45 years. Comparison of patient characteristics, clinical risk factors and angiographic pattern in young and old age females was done by using SPSS version 21 statistical software.Results: Prevalence of hypertension (P=0.001), dyslipidemia (P=0.06) and diabetes mellitus (P=0.007) was significantly higher in females of older age group (&gt;45 years). Similarly, a larger number of older age females (32; 29.9%) presented with ST-Elevation Myocardial Infarction (STEMI) as compared to young female patients (22; 17.88%) (P=0.03). Regarding angiographic patterns of CAD, there was no difference in the prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) between the groups. Normal angiogram was found in 13 (12.3%) old age females versus 35 (28.8%) young females, respectively (P=0.002).Conclusions: The risk factors profile and clinical presentation of CAD is different in young female patients with CAD. There is an essential need to determine the coronary atherosclerosis factors in young females and these women should be treated more aggressively to prevent adverse cardio-vascular outcomes.Key words: Angiographic Pattern, Coronary Artery Disease, Clinical Pattern, Young Females

Kt/V: achievement, predictors and relationship to mortality in hemodialysis patients in the Gulf Cooperation Council countries: results from DOPPS (2012-18).

BackgroundDialysis adequacy, as measured by single pool Kt/V, is an important parameter for assessing hemodialysis (HD) patients’ health. Guidelines have recommended Kt/V of 1.2 as the minimum dose for thrice-weekly HD. We describe Kt/V achievement, its predictors and its relationship with mortality in the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates).MethodsWe analyzed data (2012–18) from the prospective cohort Dialysis Outcomes and Practice Patterns Study for 1544 GCC patients ≥18 years old and on dialysis >180 days.ResultsThirty-four percent of GCC HD patients had low Kt/V (<1.2) versus 5%–17% in Canada, Europe, Japan and the USA. Across the GCC countries, low Kt/V prevalence ranged from 10% to 54%. In multivariable logistic regression, low Kt/V was more common (P < 0.05) with larger body weight and height, being male, shorter treatment time (TT), lower blood flow rate (BFR), greater comorbidity burden and using HD versus hemodiafiltration. In adjusted Cox models, low Kt/V was strongly related to higher mortality in women [hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.09–3.34] but not in men (HR = 1.16, 95% CI 0.70–1.92). Low BFR (<350 mL/min) and TT (<4 h) were common; 41% of low Kt/V cases were attributable to low BFR or TT (52% for women and 36% for men).ConclusionRelatively large proportions of GCC HD patients have low Kt/V. Increasing BFR to ≥350 mL/min and TT to ≥4 h thrice weekly will reduce low Kt/V prevalence and may improve survival in GCC HD patients—particularly among women.

Coronary Artery Bypass Grafting in Women 50Years or Younger.

BackgroundPrior research has shown higher mortality in women with severe coronary artery disease compared with men, particularly in younger patients. It is unknown if this could be attributable to an adverse risk factor profile.Methods and ResultsIn a population‐based cohort study, we included all adults ≤50 years of age (932 women and 4514 men) who underwent coronary artery bypass grafting from 1995 to 2013 from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) register. Following inverse probability of treatment weighting, we investigated differences between women and men. Women had a higher prevalence of cardiovascular risk factors compared with men. There was no difference in early mortality between women and men (unadjusted: 1.3% versus 0.9%; hazard ratio, 1.42; 95% CI, 0.75–2.70; weighted sample: 1.1% versus 1.0%; hazard ratio, 1.10; 95% CI, 0.52–2.30). During a median follow‐up time of 11.8 years, in the unweighted population, the risk of death was greater in women compared with men (hazard ratio, 1.34; 95% CI, 1.13–1.58). However, in the weighted sample, the risk of death was not significantly different in women compared with men (hazard ratio, 1.02; 95% CI, 0.83–1.26).ConclusionsWomen ≤50 years of age had a higher unadjusted risk of death after coronary artery bypass grafting compared with men, but this was explained by a clustering of cardiovascular risk factors. Female sex per se was not associated with increased mortality or major adverse cardiovascular events. Early mortality was not increased in women compared with men, even though younger women in our study had an increased burden of risk factors known to affect early risk.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.

Comparison of the Effectiveness of Percutaneous Intervention of the Left-Main Coronary Artery With Everolimus-Eluting Stents in Women -Vs- Men

Everolimus-eluting stents are largely used for left main (LM) percutaneous coronary interventions (PCI). Long-term follow-up of patients who underwent LM PCI in a real world clinical setting, in particular women, have been scarcely reported. Consecutive patients who underwent unprotected LM PCI with EES at a single Institution from December 2006 to April 2016 were included. Main outcome assessed was the occurrence of major adverse cardiovascular events (MACE) as a composite of death, myocardial infarction or target lesion revascularization at follow-up. Overall, 589 patients (20.8% women) were included in the present analysis. Women were older, had lower body mass index and more frequently hypertensive compared with men. Main clinical presentation was stable coronary artery disease (CAD); unstable angina was more frequently observed in women compared with men, whereas ST-elevation myocardial infarction was less frequent. After 69.7 ± 28.3 months of follow-up, 47 patients overall experienced MACE (1.43 per 100*patients/year). MACE rate was higher in women compared with male patients, with a rate of 2.49 and 1.17 per 100*patients/year, respectively (p = 0.015). The difference was driven mainly by higher mortality in women (0.89 vs 0.15 per 100*patients/years, p = 0.002). At multivariable Cox regression, female gender was independently associated with an increased risk of MACE at follow-up (hazard ratio 2.21, 95% confidence interval 1.20 to 4.08, p = 0.011). In conclusion, EES can be safely and effectively adopted for LM PCI.

Long noncoding RNA LINC00958 regulates cell sensitivity to radiotherapy through RRM2 by binding to microRNA-5095 in cervical cancer.

Long noncoding RNAs (lncRNAs) have been implicated in the regulation of resistance to radiotherapy in cervical cancer, which is a type of gynecological disease with high mortality in women around the world. Hence, our purpose is to delineate the involvement of LINC00958 in regulating cell sensitivity to radiotherapy in cervical cancer. LINC00958 expression in cervical cancer was assayed, followed by verification of the relationship among LINC00958, microRNA-5095 (miR-5095) and ribonucleotide reductase subunit M2 (RRM2). Hela cells were transduced with up-/downregulation of miR-5095 or RRM2, or LINC00958 silencing, respectively, and then treated with or without a 6 Gy dose of X-ray irradiation. Then the cell proliferation, apoptosis, survival fraction rate, as well as sensitivity to radiotherapy, were assessed. Finally, xenograft tumor in nude mice was established by transplanting Hela cells transfected with sh-LINC00958 and irradiated with 6 Gy of X-ray. High expression of LINC00958 was revealed in The Cancer Genome Atlas and Gene Expression Profiling Interactive Analysis, as well as in radiation-resistant patients, which was associated with lower sensitivity to radiotherapy in cervical cancer. Moreover, cervical cancer patients with higher LINC00958 expression exhibited a shorter overall survival according to Kaplan-Meier analysis. In addition, LINC00958 could regulate the expression of RRM2 by competing for miR-5095. A combination of radiotherapy with LINC00958 silencing, RRM2 downregulation or miR-5095 overexpression was found to inhibit cervical cancer cell proliferation and tumor growth, while promoting cell apoptosis both in vitro and in vivo. Collectively, our results suggest that LINC00958 could regulate RRM2 by competing to miR-5095, which regulates cell sensitivity to radiotherapy in cervical cancer.

Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands.

BackgroundSex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands.MethodsThis registry is a merge of available data on ACS patients in the electronic data capture systems of 11 centres with 24/7 interventional cardiology services. We included patients >18 years undergoing a cardiac catheterisation between 2010–2012. We evaluated sex differences in clinical and procedural characteristics and 1‑year mortality.ResultsA total of 29,265 ACS patients (8,720 women and 20,545 men) were registered. Women were on average 4.5 years older (68.5 vs 63.0 years, p < 0.001) and had a higher prevalence of hypertension (62.7 vs 49.8%, p < 0.001) and insulin-dependent diabetes mellitus (9.6 vs 6.8%, p < 0.001) than men. Women less often presented with ST-elevation myocardial infarction (43.7% vs 47.6%, p < 0.001) and appeared to have less extensive coronary artery disease than men. Women less often underwent coronary angiography by radial access (52.5 vs 55.9%, p < 0.001). One-year mortality was higher in women than in men (7.3% and 5.6%, p < 0.001). More specific, the relationship between sex and mortality was age-dependent and showed higher mortality in women ≤71 years, but lower mortality in older women compared with men (p-interaction <0.001).ConclusionWe found differences in clinical and procedural characteristics and outcome between women and men admitted for ACS, which are in line with other Western countries. The limitations of our registry, based on existing local databases, can be overcome by the use of the prospective Netherlands Heart Registry that is currently in development.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-1271-0) contains supplementary material, which is available to authorized users.

Gender differences on mortality and re-interventions after TEVAR for intact aneurysms of the thoracic aorta.

Thoracic endovascular aortic repair (TEVAR) has been increasingly adopted in the treatment of intact thoracic aorta aneurysms (iTAA), offering a less invasive approach with good effectiveness. Women usually present with smaller aortas, while having greater aneurysm growth rates. How sex can affect mortality and re-interventions after TEVAR for iTAA is the aim of this review. A search was conducted on PubMed databases to identify studies with gender-specific data on outcomes after TEVAR for iTAA. Primary endpoints were 30-day (or in-hospital) and mid-term mortality. Secondary endpoints were 30-day and mid-term secondary interventions. Nine studies were included with a total of 4484 patients (2707 men and 1777 women). Thirty-day mortality ranged from 0% to 6% in female and from 1.1% to 5.3% for male patients. Three studies reported gender-specific mortality one year after TEVAR, ranging from 12% to 15.2% for female and from 8% to 16.8% in male patients. Six studies were found describing gender-related secondary intervention data. Mortality after TEVAR for iTAA seems to be similar between genders. While there was a tendency for higher mortality in women, specially at 30-days, statistically significant differences were reported in only two studies. Re-interventions rates were higher in men in 4 of 6 studies, probably due to increased rates of endoleak in men, but no statically significant difference was found. Further studies with larger female population and longer follow-up are needed to firmly confirm differences among genders.

WOMEN'S OUTCOMES ARE IMPROVING AFTER CONTEMPORARY CORONARY ARTERY BYPASS GRAFT PROCEDURES

Higher mortality in women than in men after isolated coronary artery bypass graft (CABG) procedures has been historically accepted. We have reviewed our continuous series of isolated CABG performed in a single institution providing all coronary interventions in a geographically isolated region,

Comparison of pathologic characteristics of breast cancer in younger and older women.

Background:Breast cancer is the most common invasive cancer with high mortality in women all around the world. The present evidence shows that younger patients have poor survival. Thus, the aim of this study was to compare the pathologic characteristics of breast cancer in women younger than 40 years compared with older.Methods:This is a cross-sectional study which contains 681 patients with a confirmed diagnosis of breast cancer, who referred to Babolsar Shahid Rajaei Hospital as a referral cancer therapeutic center in the North of Iran. The data included age, residence area, occupation, location, histopathologic characteristics of the tumor, TNM classification and staging.Results:The mean age (SD) of patients was 49.7 (11.9) years, of which 19.5% were under 40. Ductal carcinoma was the most common histopathologic type (90.0%) but patients at a younger age had a higher incidence of lobular and other rare carcinoma compared to the older ones (P=0.04). The younger had a greater tumor size (P=0.01), lymphatic node involvement (P=0.04) and higher staging (P=0.004). The younger age was not associated with positive estrogen/progesterone receptors.Conclusion:These findings indicated more aggressive tumor characteristics and serious breast cancer in women less than 40 years compared with older ones.

Higher mortality in women living in high-participation areas of a population-based health check and lifestyle intervention study.

The aim was to study whether the effects of a population-based health check and lifestyle intervention differed according to study participation rate. All persons living in 73 areas of Copenhagen County, Denmark, were included in the Inter99 randomized trial in 1999 (intervention group n = 11,483; control group n = 47,122). All persons in the intervention group were invited for health checks and were offered lifestyle counseling if they were at high risk of ischemic heart disease. Areas were divided into low 35-49%, middle 50-54% and high ≥ 55% health check participation. All persons were followed in registers for 10-year cause-specific mortality. In high-participation areas, there was a significantly higher risk of lifestyle-(HR 1.37 [1.04, 1.79]) and cancer-related deaths (HR 1.47 [1.08, 2.02]) among women in the intervention group than control group. Regarding smoking-related cancer deaths, differences were even more pronounced. Among men, no significant difference in mortality was seen between control and intervention groups. The results of this paper suggest that among women, the health check and lifestyle intervention may increase the risk of lifestyle and cancer-related deaths.

Outcomes Associated With Percutaneous Coronary Intervention in Patients With NASH Cirrhosis: Analysis of the National Inpatient Sample 2004-2014

Introduction: Cardiovascular disease is the leading cause of death in non-alcoholic fatty liver disease, but there is limited data on outcomes for interventions with NASH cirrhosis and cardiac disease. We aim to assess rates and outcomes of percutaneous coronary intervention (PCI) in NASH cirrhosis (NASH+) vs. non-NASH cirrhosis (NASH-). Methods: Demographics, liver disease etiology, and cardiovascular risk factors were extracted from the National Inpatient Sample database, 2004 to 2014. Patients with cirrhosis receiving PCI were included for analysis. Acute coronary syndrome (ACS) was defined as having ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina. Illness severity (Elixhauser index), mortality, hospital cost, and length of stay were also extracted. We calculated chi-square and Mann-Whitney tests for categorical and continuous variables, respectively. Linear and logistic regression was performed to assess associations with mortality in NASH+ and NASH- patients. Results: Of 1,104,723 hospitalizations with cirrhosis, 3,855 patients received PCI, with 752 had ACS. 46.1% were NASH+, and 53.9% NASH-. The rate of PCI in NASH+ patients was nearly double that of NASH- (4.72 vs. 2.43 PCIs per 1,000 patients, p<0.0001). NASH+ patients receiving PCI were more often female, with Medicare insurance, had hypertension, and hospitalized in the Northeast and South. NASH+ patients had significantly lower mortality, decompensated cirrhosis, tobacco use, disease severity, and shorter hospitalization duration. Univariate analysis revealed lower odds of mortality in NASH+ compared to NASH- (OR 0.69, p=0.018), and lower hospital costs and lengths of stay. After multivariable adjustment, this finding became non-significant (OR 1.43, p=0.419), but female gender and Southern region (vs. North) still predicted post-PCI mortality (OR = 7.18, p<0.0001, and OR = 5.10, p = 0.025, respectively). In this model, patients in the lowest income quartile and with coronary artery disease had improved post-PCI survival outcomes (OR 0.16, p=0.008; OR 0.22, p=0.002). Conclusion: More hospitalized patients with NASH cirrhosis receive PCI, compared to non-NASH cirrhosis. NASH cirrhosis is associated with increased mortality with PCI, but this effect disappears with adjustment for cardiac risk factors. Demographic differences are observed, with higher mortality in women, and hospitalizations in the Southern United States.1004_A Figure 1 No Caption available.1004_B Figure 2 No Caption available.

ПОРІВНЯЛЬНА КЛІНІКО-АНАМНЕСТИЧНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ ГОСТРОГО КОРОНАРНОГО СИНДРОМУ БЕЗ ЕЛЕВАЦІЇ СЕГМЕНТА ST У ЖІНОК В ПЕРИ- ТА ПОСТМЕНОПАУЗАЛЬНИЙ ПЕРІОДИ

Упродовж останніх десятиліть увага наукової спільноти у галузі кардіології була зосереджена в основному на групі пацієнтів чоловічої статі, незважаючи на існування істотних гендерних відмінностей при патофізіологічних механізмах розвитку серцево-судинних захворювань на ґрунті атеросклерозу, їх факторів ризику, особливостей клінічного перебігу, характерних агіографічних змін, підходів до лікування, прогнозу та вищої летальності у жінок.Мета дослідження – провести порівняльний аналіз факторів високого серцево-судинного ризику в жінок із ГКСбпST та практично здорових, залежно від ендокринного статусу жіночих статевих гормонів.Матеріали і методи. Обстежено 157 жінок віком від 35 до 72 років (середній вік – (56,54±0,87) року). Першу групу склали 112 жінок, хворих на ГКСбпST , віком від 39 до 72 років (середній вік – (58,52±0,99) року). Групу порівняння (друга група) – 45 практично здорових жінок у віці від 35 до 71 років (середній вік – (52,58±1,58) року). Визначали рівні жіночих статевих гормонів. Вивчали основні фактори високого серцево-судинного ризику. За типом гормонального статусу, жінок першої та другої груп поділили на підгрупи. Підгрупа ІА – 64 хворі жінки 39–72 років (середній вік – (60,77±1,16) року), ІІА – 26 практично здорових жінок 42–71 років (середній вік – (58,64±2,18) року) з гормональними ознаками постменопаузи: рівнем естрадіолу &lt;80 пмоль/л (21,79 пг/мл) та індексом ЛГ/ФСГ&lt;1. ІБ підгрупа – 48 хворих жінок 35–65 років (середній вік – (52,29±1,63) року), ІІБ – 19 практично здорових жінок віком 35–58 років (середній вік – (49,84±1,84) року) з рівнями естрадіолу &gt;80 пмоль/л (21,79 пг/мл) та індексом ЛГ/ФСГ&gt;1.Результати досліджень та їх обговорення. У хворих жінок із постменопаузальним типом гормонального статусу (ІА) достовірно більш поширені такі традиційні фактори серцево-судинного ризику, як АГ (82,81±4,72) %, дисліпідемія, гіперхолестеринемія, гіпертригліцеридемія. Частота гіперхолестеринемії серед них у 1,3 раза достовірно перевищувала таку ж у пацієнток підгрупи ІБ (95,31±2,64) % (ІА) проти (75,00±6,25) % (ІБ)). Середній рівень ХС ЛПВГ у хворих на ГКСбпST ІБ підгрупи достовірно нижчий порівняно з підгрупою жінок ІА (1,04±0,03) Ммоль/л (ІБ) проти (1,16±0,05) Ммоль/л (ІА). Індекс вісцерального ожиріння (ІВО) найвищий у підгрупі ІА (4,74±0,51) од. (ІА) проти (3,75±0,33) од. (ІБ). Цукровий діабет (31,25±5,15) %, тютюнокуріння (54,16±7,19) % та професійно-шкідлива праця (89,58±4,41) % більше поширені у ІБ підгрупі. Серед них виявляли достовірно більшу частку осіб із підвищеними рівнями С-реактивного протеїну (СР П) і достовірно вищі приблизно на 20 % середні його значення порівняно з хворими жінками підгрупи ІА (6,40±0,53) мг/л (ІБ) проти (5,17±0,44) мг/л (ІА).Висновки. Незалежно від гормонального статусу, в жінок, хворих на ГКСбпST є більше поширеними та вираженими основні фактори високого серцево-судинного ризику порівняно зі здоровими особами. Естрогенодефіцит у постменопаузальних жінок із ГКСбпST призводить до вищої поширеності АГ, тяжких порушень ліпідного, жирового обмінів, що збільшує ризик розвитку ГКСбпST . Причиною ГКСбпST у жінок з відносно збереженим гормональним статусом є більше поширення тютюнокуріння та впливу ксенобіотиків унаслідок тривалої професійно-шкідливої праці, цукрового діабету разом із традиційними факторами високого серцево-судинного ризику.