Female Survival Research Articles

The association between body composition and overall survival in patients with advanced non-small cell lung cancer

Nutritional status is associated with prognosis in a variety of cancers. Studies analyzing the association between the measurements of skeletal muscle and adipose tissue obtained from Computerized Tomography (CT) images at the time of diagnosis of advanced non-small cell lung cancer (NSCLC) and overall survival (OS) are relatively few. Data from 425 patients diagnosed with advanced NSCLC between January 2016 and December 2017 were retrospectively analyzed, with an average follow-up of 15.3 months. To outline the patient’s chest CT plain image at the time of diagnosis,skeletal muscle and subcutaneous fat at the level of both thoracic vertebrae were quantified in terms of mass and quantity by the pectoral muscle index (PMI), pectoral muscle density (PMD), subcutaneous fat index (SFI), subcutaneous fat density (SFD), paravertebral muscle index (PVMI), and paravertebral muscle density (PVMD). The SFI value in the female survival group is significantly lower than that in the death group (P = 0.049), and the PVMI value in the overall survival group is significantly lower than that in the death group (P < 0.001). After adjusting for clinical variables such as gender, smoking status, clinical staging, degree of differentiation, and radiotherapy history, the multivariable Cox regression analysis showed that an increase in SFI significantly improves the overall survival rate of patients (Hazard Ratio [HR] = 1.410, 95% Confidence Interval [CI]: 1.042–1.908, P = 0.026). Conversely, a decrease in PVMD is significantly associated with improved overall survival and prognosis (HR = 0.762, 95% CI: 0.579–0.982, P = 0.048). No association was found between body mass index (BMI) and chest muscle status indicators and overall survival (P > 0.05). CT-measured body composition parameters provide precise prognostic information and are superior to BMI; an increased OS rate in advanced NSCLC is associated with a greater SFI and a lower PVMD.

Survival of Eurasian lynx in the human-dominated landscape of Europe.

Survival and cause-specific mortality rates are vital for evidence-based population forecasting and conservation, particularly for large carnivores, whose populations are often vulnerable to human-caused mortalities. It is therefore important to know the relationship between anthropogenic and natural mortality causes to evaluate whether they are additive or compensatory. Further, the relation between survival and environmental covariates could reveal whether specific landscape characteristics influence demographic performance. We used telemetry data on 681 Eurasian lynx (Lynx lynx), a model apex predator with large spatial requirements, that were tracked across their European distribution. Through time-to-event analyses, we sought to determine the variables associated with differences in their survival. Illegal killing was the main cause of mortality (33.8%), and mortality rates were similar in protected and hunted populations (8.6% and 7.0% per year, respectively). Survival varied greatly across populations (70-95% per year). Across all study sites, higher hunting and anthropogenic mortality rates were partially compensated by lower rates of other mortality causes but not by natural mortality alone. Variation in survival depended on sex (female survival was 1.5 times greater than male survival) and seasonality (highest risk during hunting season and winter), and lower survival rates were correlated with higher human modification of landscapes at both coarse (home range composition) and fine (habitat use within home range) scales. Some variation in survival was driven by unobserved factors, which, given the high rates of human-caused mortalities, including illegal killing, are of foremost concern. Due to the low natural mortality rates in protected and hunted populations, we conclude that anthropogenic causes of mortality are likely close to additive, such that maintaining or increasing refuge habitat with little human disturbance is critical to lynx conservation.

The effect of size on mate selection, fecundity and survival in Culex pipiens mosquitoes

AbstractCulex pipiens L. is a medically important mosquito due to its abundance and ability to transmit West Nile virus. Despite being the focus of many mosquito control strategies, very little is known about its mating behaviour. Several control strategies rely on knowing female mate preferences to ensure their efficacy. Therefore, the purpose of this study was to characterize mate selection based on mate quality. Because larger individuals should have more resources available to be used towards mating behaviour, it was hypothesized that larger mates (males or females) would be of higher value and preferentially mated with compared to smaller ones. By manipulating food availability, males and females were reared to be either large or small adults and were mated with either a large or small mate. Through a series of experiments, the effect of size on mate success and post‐mating responses was assessed via insemination rates, blood feeding, egg laying, fertility and survival. Despite larger females living longer and being more fecund, males did not preferentially mate with larger females, nor did male size influence female survival or fecundity. Because larval rearing environment had an influence on adult morphology and fitness, it should be taken into consideration in mosquito control programmes.

Sex Differences in Melanoma Survival-a GEM study.

Sex differences in melanoma are prominent, with females having a significant survival advantage. However, it is unclear why we see this survival advantage. Here we investigate the relationship between sex, clinicopathologic variables, and melanoma specific survival in 1,753 single primary melanomas from patients in the GEM study. Using Cox proportional hazard models and formal mediation analysis, the effect of sex on survival is explained largely by differences in the clinicopathologic features of tumors at diagnosis. Specifically, we find evidence that 86.5% of the effect of sex on melanoma survival is mediated by differences in age at diagnosis, Breslow thickness, ulceration, mitoses and site (HR 1.85, P < .001). This analysis indicates that the female survival advantage in melanoma is not due primarily to a direct effect of sex (HR 1.19, P = .42) but is largely a result of an indirect effect of sex mediated by clinicopathologic features.

Effects of maternal condition, disease status, and behavior on survival of juvenile bighorn sheep

AbstractNutrition integrates and interacts with a variety of biotic and abiotic factors that modulate performance of large‐herbivore populations. Accordingly, studying patterns of herbivore performance through the lens of nutrition can shed light on the complex mechanisms that drive population dynamics. We studied bighorn sheep (Ovis canadensis) and their habitat and quantified relationships among 1) the foodscape (defined herein as spatiotemporal variation in the quality and availability of forage plants); 2) female behavior (i.e., use of the foodscape and rugged escape terrain), condition (% ingesta‐free body fat), and disease status (infection status and antibody levels); and 3) juvenile survival. We conducted intensive vegetation sampling and used generalized additive modeling to map the foodscapes available to bighorn sheep during summer (May–September) over 2 years in 2 population ranges in Idaho, USA: the East Fork of the Salmon River and the Lost River Range. In each study area, we used global positioning system (GPS) collars and field observations to monitor adult female behavior and lamb survival, quantified nutritional condition and disease status of maternal females in late winter, and used known‐fate survival modeling to test for effects of female traits and behavior on lamb survival. Adjusted R2 values for foodscape models ranged from 0.34 to 0.61. Collared females consistently selected rugged escape terrain in both study areas, but we found little evidence of selection for the foodscape. We did not detect any consistent effects of maternal space‐use behavior on lamb survival. In contrast, nutritional condition of females in late winter had a strong, positive effect on summer lamb survival: lambs born to females in relatively good condition (15% ingesta‐free body fat, ~94% probability of lamb survival) were roughly 4 times more likely to survive the summer months than lambs born to females in poor condition (5% ingesta‐free body fat, ~25% probability of lamb survival). In addition, whereas maternal infection with the pathogen Mycoplasma ovipneumoniae had no discernable effect on juvenile survival, lambs born to females that showed no sign of exposure (antibody) to M. ovipneumoniae (~99% probability of survival) were roughly 3 times more likely to survive the summer than lambs born to females that had mounted a strong immune response (35% probability of survival). Our work adds to a growing body of literature linking nutritional condition to juvenile survival and other key vital rates, and highlights the importance of efforts to better understand the role of nutrition in the context of disease and other factors limiting performance of herbivore populations.

Resource selection and survival of plains sharp‐tailed grouse at a wind energy facility

AbstractAs the demand for wind energy development increases across much of the Great Plains region, there is a need to understand how this type of energy generation may impact wildlife. Due to their extensive range across areas with high wind resources, plains sharp‐tailed grouse (Tympanuchus phasianellus jamesiTympanuchus phasianellus jamesi) represent a valuable species to evaluate how selection and survival are associated with existing wind energy infrastructure. We used spatial and demographic data collected from radio‐marked female sharp‐tailed grouse to evaluate resource selection (nest, brood‐rearing, and breeding season) and survival (nest and female) near existing wind energy infrastructure during the April to August breeding season over a 3‐year period from 2020 to 2022 in northeastern South Dakota, USA. We monitored 119 GPS‐marked females captured at eight leks over the study period. We did not find evidence that females selected nest sites in relation to wind energy infrastructure but found that females with broods and females during the breeding season (April–August) avoided areas near high densities of wind turbines within 1.0 and 5.0 km of their home range, respectively. We found consistent selection for lower lengths of transmission lines across all life stages at the home range scale. We did not detect an effect of wind energy infrastructure on nest or female survival. Based on the results of our study, limiting the siting (the process of selecting the optimal location for a project and the associated features) of wind turbines within 5.0 km of sharp‐tailed grouse breeding habitat may represent an important siting tool to minimize avoidance of otherwise suitable habitats.

Women's Survival Dilemma from the Perspective of Female Writers

With the research on gender issues for a long time, women's studies have become very mature in all aspects. Although the theory is rich, there is still little concrete practical progress. This article focuses on the analysis of the perspective of female writers and looks at the current situation of women's life from their perspective. By perusing a considerable number of literary works, this paper selects four female writers and conducts an analysis of their representative works to elucidate three types of female survival predicaments: the absence of female desires, the absence of a female voice, and the presence of female objectification. By analyzing the works of these female writers, an obvious problem was reflected: the living conditions of women described in their books are still outdated in today's society. Until now, many women's desires have been ignored. Even as a gender that makes up half of the population, many important works lack a female perspective, and the image of women is still objectified, not only in literature and movie works, but also in real life.

Climate Change Impacts Pair-Bond Dynamics in a Long-Lived Monogamous Species.

Climate change can influence populations of monogamous species by affecting pair-bond dynamics. This study examined the impact of climate on widowhood and divorce, and the subsequent effects on individual vital rates and life-history outcomes over 54 years in a snow petrel (Pagodroma nivea) population. We found that environmental conditions can affect pair-bond dynamics both directly and indirectly. Divorce was adaptive, occurring more frequently after breeding failure and leading to improved breeding success. Divorce probabilities also increased under severe climatic conditions, regardless of prior breeding success, supporting the 'Habitat-mediated' mechanisms. Overall, pair-bond disruptions reduced subsequent vital rates and lifetime outcomes. Climate forecasts from an Atmosphere-Ocean General Circulation Model projected increased male widowhood rates due to decreased sea ice negatively affecting female survival, despite considerable uncertainty. These findings highlight the importance of environmentally induced changes in demographic and pair-bond disruption rates as crucial factors shaping demographic responses to climate change.

“Serious Laughter” as a Philosophy of Black Female Survival

“Serious Laughter” as a Philosophy of Black Female Survival

Transgenerational effects of imidacloprid on Sclerodermus alternatusi (Hymenoptera: Bethylidae) based on age-stage, two-sex life table.

Imidacloprid is a widely used insecticide for controlling piercing-sucking pests. However, its impact on nontarget insects must not be ignored. In this study, we assessed the effects of sublethal dose of imidacloprid on Sclerodermus alternatusi (Hymenoptera: Bethylidae), which is an important predator of many pests. The data indicate that imidacloprid at LD10 (0.1468 ng active ingredient per insect) and LD30 (0.2376 ng active ingredient per insect) significantly reduced the longevity and fecundity of the F0 generation of S. alternatusi. However, the adult female longevity of the F1 generation of the LD10 dose group showed a significant increase, and the LD30 dose group showed a nonsignificant increase. The study found that as the imidacloprid dose increased, the intrinsic rate of increase (r) decreased, while the mean generation time (T) increased. The imidacloprid groups also showed a decrease in age-stage specific survival rate (Sxj) and age-specific survival rate (lx). However, the female age-specific survival rate (fx4) showed an increasing and then decreasing trend for all treatments. The study found that imidacloprid had an impact on the longevity of S. alternatusi in the F0 generation and extended the mean generation time (T) in the F1 generation. However, it had negative effects on population growth parameters. These findings can be used as a basis for developing integrated pest management strategies.

Sex differences in myocardial infarction care and outcomes: a longitudinal Scottish National Data-Linkage Study.

We investigate sex disparities in management and outcomes of myocardial infarction (MI) in contemporary practice in Scotland. This was a longitudinal cohort study including all MI admissions aged 45-80 years across Scotland between 2010-2016 and 2:1 age, sex, and general practice-matched general population controls. Participants were followed up until the end of 2021. We analysed in-hospital outcomes (percutaneous coronary intervention, secondary prevention and mortality) using Poisson regressions, adjusting for age, comorbidities, and ST-elevation. We used Royston-Parmar models for long-term outcomes (all-cause and cardiovascular mortality, incident cardiovascular events), adjusting for age, comorbidities, and secondary prevention. Of a total 47 063 MI patients, 15 776 (33.5%) were women. Median (inter-quartile range) age was 66 (57, 73) years. Compared to men, women were older and more comorbid, but were less likely to undergo percutaneous coronary intervention [risk ratio (95% confidence interval) - 0.87 (0.86 - 0.89)] or receive secondary prevention at discharge [0.94 (0.93-0.95)]. No in-hospital mortality difference was observed between sexes [1.06 (0.99-1.13) after adjustment]. Over a median follow-up of 8.2 (6.7, 10.1) years, women had higher crude rates of adverse outcomes. After full adjustment, this translated into a lower risk for women compared to men of all-cause mortality [hazard ratio, 0.92 (0.89-0.95)], cardiovascular mortality [0.82 (0.78-0.87)], and cardiovascular events [0.92 (0.88-0.95)]. The female survival advantage seen in general population controls was attenuated in MI patients. Women were undertreated compared to men after MI. Their survival and outcome benefits may be improved further. Poor outcomes in men despite better receipt of secondary prevention require further attention.

Centenarians in Colombia: a population-based cohort study on the impact of COVID 19

Introduction: This study examines the impact of COVID 19 on the centenarian population in Colombia, highlighting their vulnerability through a detailed demographic analysis. Materials and methods: A retrospective cohort study (March 2020 - December 2022) analysed 1,005 affected centenarians. Descriptive statistics, chi-square tests, and Kaplan Meier survival curves were used. Results: Of these, 65.47% were females; the mortality rate was 37.1%, which was higher in males (45.24%). The average time from symptom onset to recovery was 26.56 days, and the average time to mortality was 14.33 days. The Kaplan Meier curve showed greater survival in females (p=0.0001); the age specific curve showed no significant differences (p=0.084). Centenarians were concentrated in municipalities in special categories 1 and 6. Discussion: This study revealed increased mortality among male centenarians, emphasizing the need for extended follow-up due to the prolonged recovery time.

Variability and correlations among vital rates and their influence on population growth in mule and black‐tailed deer

AbstractTo reverse range‐wide population declines, managers of black‐tailed and mule deer (Odocoileus hemionus) require information on the vital rates and life stages most influential to population growth to target effective management actions. We extracted black‐tailed and mule deer vital rates from a range‐wide literature review and used hierarchical models to summarize vital rates, their variability, and how they correlate with one another. We then used matrix models and life‐stage simulation analysis to determine the individual vital rates that contributed most to annual population growth rate (i.e., lambda). Annual adult female survival explained the greatest amount of variation (62%) in lambda. Annual juvenile survival explained 44% of the variation in lambda, whereas summer or winter juvenile survival by themselves were far less informative. Winter fawn:doe ratios, a metric often collected by management agencies, explained only 10% of the variation in lambda. Given an adult female survival of 0.84, our simulations estimated a lambda of 1.0 (95% credible interval = 0.88–1.14), indicating equal probability that a population would increase or decrease. Simulations further indicated that given adult survival rates &lt;70%, the population would always decline, but as survival increased lambda increased linearly. In contrast, estimates of lambda plateaued when annual juvenile survival reached approximately 0.5, indicating higher survival rates yielded diminishing returns to population stability. Using simulated values within the observed range of vital rate values across the species' geographical distribution, the mean lambda was 0.975 and in 61% of the simulations, lambda was &lt;1. After 20 years, we estimated that this distribution of lambda values would cause populations to decrease in 92% of instances with a mean decrease of 44%. Our results align with observed declines in mule deer populations throughout their range over recent decades and indicate that these trends will continue until management can improve survival of adult females.

Linking proximate drivers and fitness returns of vigilance in a large ungulate

Vigilance allows animals to quickly detect threats from conspecifics and predators to avoid or minimize costly encounters. Time spent vigilant is usually traded‐off against other fitness‐enhancing activities, such that fitness returns are expected when allocation to vigilance increases. We assessed the proximate factors influencing vigilance and investigated whether vigilance correlates with fitness in wild mountain goats. We first studied which extrinsic and intrinsic factors influenced alert duration and frequency using focal observations recorded over 12 years on individually‐marked adult females. We found that females increased vigilance in forested areas compared with open areas and were less vigilant when they were surrounded by conspecific neighbours. Reproductive females were more frequently vigilant and for longer periods compared with females without offspring. Mothers also tended to perform longer alerts when their offspring was &gt; 10 m away than at shorter distances, suggesting that variation in offspring's vulnerability to predation influences mother's vigilance. Thus, predation risk and offspring vulnerability were the main mechanisms driving variation in vigilance. To assess fitness returns, we then used a joint modelling framework to estimate the latent correlations at the individual level among vigilance traits (alert duration, alert frequency, and total time spent vigilant) and fitness components (adult female survival and offspring survival) while accounting for the drivers observed to influence vigilance. Contrary to expectations, we found no evidence that vigilance is associated with fitness returns, with only some traits being at best weakly positively correlated with survival of offspring and adult females. This might arise because vigilance incurs costs that outweighs its potential benefits, or because vigilance metrics are not repeatable due to their high plasticity, challenging the commonly assumed positive relationship between vigilance and fitness.

Impact of metabolic syndrome on cardiovascular, inflammatory and hematological parameters in female mice subjected to severe sepsis

The aim of the study was to evaluate the effect of metabolic syndrome (MetS) on female Swiss mice subjected to severe polymicrobial sepsis induced by cecal ligation and puncture (CLP). MetS was induced in neonatal Swiss mice by subcutaneous injection of monosodium glutamate (MSG) at 4 mg/g body weight from day 1 to day 5 after birth, while animals in the control group (CTL) were treated with equimolar saline solution at the same volume and period. On the 75th day of life, the CLP model was used to induce severe polymicrobial sepsis. For inflammatory parameters, we assessed nitric oxide (NO), determined by the cadmium/Griess technique, and quantified IL-6 and IL1β using the ELISA technique. Glucose levels were measured 24 h before and after CLP using a glucose monitor, and the lipid profile was assessed using commercial kits. Cardiovascular parameters were measured using the CODA platform, and hematological evaluation was determined by standard counting. Unlike male mice, MetS did not alter the survival of females subjected to severe sepsis. Both CTL and MetS CLP groups exhibited hypotension and hypoglycemia, accompanied by leukopenia and increased inflammatory cytokine IL-6. The cytokine IL1β Only increased in MetS CLP group compared to CTL CLP and MetS Sham. It was also observed that MetS attenuated some parameters during sepsis, such as hematological parameters and resistance to NO increase. We can conclude that the obesity paradox theory is not observed in females. Thus, our findings provide new insights for the literature linking MetS and sepsis.

IMMU-41. GBM PLATELET HYPERACTIVITY DRIVES THE IMMUNOSUPPRESSIVE TME IN A SEX-DEPENDENT MANNER

Abstract Cancer-related thrombosis is the second leading cause of death for cancer patients, including those with glioblastoma (GBM), the most common primary malignant brain tumor. Patients with GBM have a 30% risk of venous thromboembolism. Moreover, sex biases are well established in GBM, with men 1.6-fold more likely to develop GBM and exhibiting a poorer prognosis than females. GBM is extremely difficult to treat due to its highly immunosuppressive tumor microenvironment (TME), often infiltrated with suppressive myeloid populations and a reduction in T-cells intratumorally and systemically. Our group has recently demonstrated these sex-biases in survival are due to differences in the immune cell populations making up the TME. Despite these findings, there is limited information as to how a hyper-thrombotic state contribute to the immunosuppressive TME. Additionally, the role that sex biases play in these mechanisms has not been explored. Our previous work demonstrated that thrombin, a major platelet activator through PAR1 and PAR4 receptor signaling, is secreted from cancer stem cells into the tumor microenvironment. We now show that GBM patient have elevated levels of the thrombin-antithrombin complex and have increased PAR4 receptor mediated platelet activation. Similarly, we show that tumor bearing mice have elevated PAR4 receptor mediated platelet activation relative to non-tumor bearing mice. We further demonstrate pharmacologically targeting the thrombin-PAR4 signaling axis in murine GBM models prolongs survival in females but has not affect in males by preventing female platelet hyperactivity and subsequently increasing the number and function of tumor infiltrating CD8+ T-cells. These findings demonstrate how activated platelets interact and regulate immune cell populations in GBM. These results suggest that the hyper-thrombotic state seen in many GBM patients simultaneously contributes to the immunosuppressive TME. In addition, these results identify therapeutic strategies to leverage the platelet hyperactivity seen in GBM by hyperactive thrombin-PAR4 for sex-dependent therapeutic purposes.

No evidence of early life resource pulse effects on age-specific variation in survival, reproduction and body mass of female Siberian flying squirrels.

Understanding the diversity and causes of senescence patterns in the wild remains a challenging task, in particular among fast-living species for which senescence patterns have been poorly studied. Early life environmental conditions can shape senescence by influencing trade-offs between early and late life performance (disposable soma theory) or individual fitness through lifelong positive effects (silver spoon effects). Using a 23-year-long monitoring dataset of two populations of Siberian flying squirrels (Pteromys volans L.) in western Finland, we analysed the occurrence, onset and rate of senescence in female survival, body mass and reproductive performance. We also examined how early life pulsed resources (tree masting during the year of birth) influence age-specific variations in these traits. Our results indicate that survival senescence occurs after sexual maturity from 3 years of age. Females experiencing high resource availability at birth tended to survive better, but the age-specific trend was not affected by early life resource conditions. Maternal body mass declined slightly with age, starting at 4 years, regardless of early resource conditions. Similarly, among reproductive traits, we showed late-onset senescence in both litter size and annual reproductive probability, with no evidence supporting an effect of early life resources on these trends. We found no decline in juvenile body mass or in the juvenile size-number trade-off with maternal age. Our findings suggest that pulsed resources experienced at birth have a limited long-lasting impact on the life-history traits of this fast-living rodent, with no significant effect on senescence patterns.

Interplay of abiotic conditions, density, and body size in shaping demography in a high‐elevation toad population

AbstractIn natural populations, vital rates such as survival and reproduction are influenced by a complex interplay of abiotic conditions (e.g., environment), density dependence, and individual factors (e.g., phenotypic traits). Studies at the extremes of species distributions, particularly high elevations, offer unique insights due to the intensified effects of abiotic stressors, which can amplify both direct and indirect effects on vital rates. In this study, we focus on a high‐elevation population of the common toad (Bufo bufo) located near the upper limit of its elevational range in the Swiss Alps. This setting provides a critical context for examining how extreme abiotic conditions interact with density dependence and individual factors to influence life history traits. Utilizing 28 years of capture–mark–recapture data and individual body size measurements from nearly 2500 toads, we applied in a Bayesian statistical framework a Cormack–Jolly–Seber model for estimating male survival probabilities, and a multistate model for assessing female survival and breeding probabilities, alongside sex‐specific growth curves. Our analysis indicates that survival probabilities are significantly impacted by interactions between abiotic conditions such as the active season length and temperature at emergence from hibernation, density dependence, and individual phenotypic traits such as body size. The breeding patterns of females showed a biennial cycle, with temperature at hibernation emergence influencing the likelihood of skipping breeding events and density affecting the resumption of breeding. These results highlight the role of abiotic conditions and density in shaping physiological and reproductive strategies in a high‐stress ecological niche. Moreover, we uncovered indications of indirect effects, where both abiotic conditions and density potentially affect asymptotic growth and thus survival, mediated through changes in body size. Our findings illustrate the complex dynamics at play in high‐elevation populations and the importance of long‐term, individual‐based data in studying these processes. This study underscores the value of integrating multiple sources of variation to understand population dynamics comprehensively, particularly in understudied, extreme environments where traditional ecological models may not fully capture the nuanced interdependencies of natural systems.

Intra, short and long-term results of mitral VIV for the degenerated surgical mitral prosthesis from italian VIV registry (MIVIV registry)

Abstract Background/Introduction Reoperation of failed bioprosthetic mitral valves is associated with significant morbidity and mortality. Transcatheter mitral valve-in-valve (MViV) replacement was explored early in the development of THVs with transseptal/transfemoral (TS/TF) and transapical (TA) approaches. Purpose This is the first Italian Registry on mitral VIV and it was designed to explore contemporary MViV outcomes with all types of balloon expandable valves. The present study out of the registry aims to asses the &amp;gt;10 years follow-up outcomes in terms of mortality, gender diversity, and perioperative result. Methods Participating centers used standardized definitions to collect clinical information, including patient demographic characteristics, comorbidities, functional status, quality of life indexes, procedural details, and patient outcomes from consecutive MViV cases. Cohort of 265 patients was available for the primary analysis and follow-up too.The patients were grouped by 11 hospitals in Italy performing VIV for degenerated biological mitral prostheses. Results A total of 265 pts underwent mitral VIV due to bioprosthesis degeneration between January 2010 and January 2023. They have been subdivided by transfemoral (TF) with 117 (44%) pts and transapical (TA) with 148 (55,8%) pts. Most of the patients were of female sex (59,2%) and EuroScore II for surgical re-operation was 16.1%. Mixed disease (48%) was more common than mitral regurgitation (29%) and stenosis (22%). 69,8% of the total cohort was in class NYHA III and the mean LVEF was 54%.Otherwise, there were no significant demographic differences between patients undergoing TS and TA. In TF there was more severe PVL (5%)(p-value: 0,001) and much more cases of severe grade of stenosis (54,7%) and regurgitation (57%)(p-value&amp;lt; 0,0001). Considering intraoperative outcomes, technical success has been established in around 97,7% of the total cohort without difference btw groups. Only 3,3% died during hospitalization without difference between groups (P-value=0,735). LVOT obstruction has been seen in 3,4% in the case of TA and 0 for TF. Only 1,5% of the total cohort underwent surgical conversion as well as embolization in only 1,1%. Overall survival from the total cohort was 91,3% at &amp;gt;10 years, Figure 1. Concerning the freedom from cardiac death (CV death) was 96,6% in the total cohort at 13 years. Concerning the difference between access, the general survival is established at 97,4% in TF while 86,3% in TA (p-value =0,050)(Figure 2). Freedom from CV death was 99,1% in TF and 94,5 in TA (p-value=0,209). In gender analysis differentiation, the general survival in females was 98,5% in TF and 85,6% in TA at 13 years (p-value=0,056). Conclusion(s) Transcatheter MViV using a balloon-expandable valve is associated with high technical success, a low complication rate, and a solid long-term benefit in terms of survival. Transseptal access was associated with lower mortality compared with TA access.Figure 1Figure 2

Sex differences in secondary prevention and outcomes post-myocardial infarction in Scotland

Abstract Background Sex differences in outcomes after myocardial infarction (MI) are of increasing interest. Differential receipt of evidence-based treatments may contribute to such disparities. Purpose In this study, we investigate sex differences in the burden of risk factors, in-hospital and long-term treatment and outcomes in contemporary practice in Scotland, by analysing a nationwide sample of consecutive MI admissions. Methods All MI admissions centrally recorded between 2010-2016 by Public Health Scotland were included and followed up until the end of 2021. Poisson regressions analysed in-hospital outcomes (percutaneous coronary intervention (PCI), mortality and post-discharge secondary prevention medication). Models were adjusted for age, co-morbidities and ST-elevation on the electrocardiogram. Royston-Parmar models analysed long-term outcomes (all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE)) and were sequentially adjusted for confounders (age, comorbidities, secondary prevention medications). A 2:1 age and sex-matched general population were included as controls. Results Of a total 47,063 MI patients, 15,776 (33.5%) were women. They were matched with 81,641 controls free of major cardiovascular disease. Median (interquartile range) age was 64 (56-72) years for men and 69 (60-75) years for women. Obesity, hypertension and renal disease were the risk factors more prevalent amongst women, while men had higher rates of previous MI, peripheral vascular disease and atrial fibrillation. Compared to men, women were less likely to undergo PCI (risk ratio (95% confidence interval) – 0.87 (0.86-0.89)) or receive secondary prevention (0.94 (0.93-0.95)), but had similar in-hospital mortality (1.06 (0.99-1.13)), after multi-variable adjustment. Over a median follow-up of 8.4 (6.8-10.2) years, women had higher raw rates of adverse outcomes. However, after full confounder adjustment, this translated into lower risk for women of all cause-mortality 0.92 (0.89-0.95), cardiovascular mortality 0.82 (0.78-0.87) and MACE 0.92 (0.88-0.95) (Figure 1). The female survival advantage was attenuated post-MI in comparison to controls free of significant cardiovascular disease (Figure 2). Conclusions Women and men have different MI risk factor profiles. Women had overall worse crude outcome rates after MI, driven by age and comorbidities. This may have been driven further by undertreatment after MI, including PCI and secondary prevention. Urgent identification of drivers for such disparities in care is warranted in order to improve outcomes and ensure health equity.