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The impact of sex on long term outcomes after PEA for CTEPH remains unclear. We therefore examined phenotypical and genotypical differences between males and females to determine whether sex had an impact on outcomes after PEA. A retrospective study of 401 consecutive patients undergoing PEA at our institution between 08/2005 and 03/2020 was performed. Outcomes included survival, functional class and need for postoperative targeted PH therapy. PEA specimens were analyzed in 3 males and 2 females using single cell RNA sequencing. Females (n=203, 51%) were more likely to have preoperative home oxygen therapy (29.6% vs 11.6%, p<0.01), and to present with segmental and subsegmental disease compared to males (49.2% vs 21.2%, p<0.01). Despite similar preoperative values, females had less improvement in postoperative total pulmonary vascular resistance (final TPR after PEA, 437 Dynes•s•cm−5 vs 324 Dynes•s•cm−5 in males, p<0.01). Survival at 10 years reached 73% in females and 84% in males, but females had worse functional class and higher requirement for PH therapy (Figure). Female sex remained an independent factor affecting the need for targeted PH therapy after PEA in a multivariate analysis (HR 2.03, 95%CI 1.03-3.98, p=0.04). Both sexes expressed TGF-β1 in endothelial cells from the PEA specimen, but the receptor TGFβR1 was predominantly expressed in females (Figure). In our cohort, we found significant differences between males and females undergoing PEA. Although outcomes are excellent for both sexes, females had greater need for targeted PH therapy in the long term. Greater TGFβR1 expression in females PEA specimen suggests biological differences in CTEPH pathology. [ABSTRACT FROM AUTHOR]

Abstract: Background: Upper limb second to fourth digit ratio (2D:4D) has been shown to be dependent on prenatal androgen exposure. A longer relative fourth digit to second digit is indicative of increased intrauterine testosterone exposure prenatally and the converse is also true for oestrogen exposure. The 2D:4D ratio has implications in the sporting, academic, financial and sexual arenas. The purpose of this study was to examine the association between smaller finger length ratios (2D:4D) and boxers fractures, in both men and women, by comparing the 2D:4D ratios in 150 boxers fractures and comparing them to matched controls. Boxers fractures are an injury classically incurred during acts of aggression and we postulated that this cohort of patients would have a smaller 2D:4D ratio in comparison to the normal population mean ratio. Methods: One hundred and fifty radiographs from patients with boxers fractures secondary to aggressive actions were analysed and the 2D:4D ratio was calculated. A further 150 X-rays from patients not involved in aggressive activities were used as a control group and the 2D:4D ratio was calculated in the same manner. We then performed statistical analysis to compare the 2D:4D ratios between our two groups. Results: As predicted, the 2D:4D in males was smaller than females in all of the groups. However, our results showed that those presenting with a boxers fracture due to an aggression related injury had a statistically significant smaller 2D:4D ratio when compared to the normal population. Conclusion: Boxers fractures are injuries that typically occur from an aggressive act. It is well documented that a low 2D:4D ratio is reflective of an increased prenatal exposure to androgens, particularly testosterone. We have shown that boxers fractures are associated with a smaller 2D:4D ratio than the normal population, thus suggesting that persons exposed to high levels of prenatal androgens are more likely to exhibit aggressive tendencies in adulthood. Our results suggest that smaller digit ratios may predict a predisposition to acts of aggression, and as such result in an increased likelihood of sustaining an injury such as a boxers fracture. This relationship seems to be present independently of gender. [Copyright &y& Elsevier]

Highlights: [•] Heightened visuospatial ability is associated with a low 2D:4D ratio. [•] Surgeons are renowned for having good visuospatial ability. [•] Male surgeons have a much lower 2D:4D ratio than control group. [Copyright &y& Elsevier]

Background: Diabetes is associated with an increased risk of cancer. This study aimed to evaluate associations between recently reported type 2 diabetes (T2D) susceptibility genetic variants and cancer risk in a prospective cohort of Chinese patients with T2D. Methods: Seven single nucleotide polymorphisms (SNP) in IGF2BP2, CDKAL1, SLC30A8, CDKN2A/B, HHEX and TCF7L2, all identified from genome-wide association studies of T2D, were genotyped in 5900 T2D patients [age mean±SD=57±13 years, % males=46] without any known cancer at baseline. Associations between new-onset of cancer and SNPs were tested by Cox proportional hazard models with adjustment of conventional risk factors. Results: During the mean follow-up period of 8.5±3.3 years, 429 patients (7.3%) developed cancer. Of the T2D-related SNPs, the G-alleles of HHEX rs7923837 (hazard ratio [HR] (95% C.I.)=1.34 (1.08–1.65); P =6.7×10−3 under dominant model) and TCF7L2 rs290481 (HR (95% C.I.)=1.16 (1.01–1.33); P =0.040 under additive model) were positively associated with cancer risk, while the G-allele of CDKAL1 rs7756992 was inversely associated (HR (95% C.I.)=0.80 (0.65–1.00); P =0.048 under recessive model). The risk alleles of these significant SNPs exhibited combined effect on increasing cancer risk (per-allele HR (95% C.I.)=1.25 (1.12–1.39); P =4.8×10−5). The adjusted cancer risk was 2.41 (95% C.I. 1.23–4.69) for patients with four risk alleles comparing to patients without risk allele. Conclusions: T2D-related variants HHEX rs7923837, TCF7L2 rs290481 and CDKAL1 rs7756992 increased cancer risk in patients with diabetes. Impact: Our findings provide novel insights into the pathogenesis of cancer in diabetes. [ABSTRACT FROM AUTHOR]