Phenonium intermediates are almost universally invoked to account for 1,2-aryl migration processes in reactions that exploit in situ-generated hypervalent iodine(III) leaving groups. Here, we demonstrate that such transformations can instead proceed through a previously unrecognized 1,2-C/I(III) dyotropic rearrangement, which represents a fundamentally different mechanistic manifold in iodine(III) chemistry. Treatment of ethyl 2-alkyl-2-aryl-3-iodopropanoates with Selectfluor and Py·9HF enables migratory aryl fluorination across a C(sp3)─C(sp3) bond, installing fluorine regioselectively at the ester Cα position. The same dyotropic logic extends to migratory acyloxy arylation and alkoxy arylation reactions using hypervalent iodine reagents in combination with carboxylic acids or alcohols, respectively, and proceeds with inversion of absolute configuration at the Cα stereocenter. Although a phenonium intermediate is well-established for many systems, this study demonstrates that a dyotropic rearrangement pathway can be energetically favored, offering a distinct rationale for the observed reaction outcome.
In industrial yeast fermentations, population-level viability assays routinely report healthy cultures even as aged, metabolically compromised mother-cell subpopulations go undetected. Replicative age contributes to this hidden heterogeneity, but its link to a cell's metabolic competence has been difficult to measure simultaneously in the same cell by high-throughput flow cytometry. Here, we introduce a dual-parameter flow cytometry workflow combining bud-scar labeling with a recombinant His6-SUMO-mCherry-chitin-binding domain fusion protein (~610 nm emission) and 5(6)-carboxyfluorescein diacetate (CFDA)-based viability detection (~525 nm), providing spectral orthogonality without computational autofluorescence correction. We applied it to four industrially relevant yeasts: Saccharomyces pastorianus W-34/70, S. cerevisiae var. diastaticus BE-134, S. cerevisiae var. chevalieri LA-01, and Komagataella phaffii X33. In S. pastorianus, viability declined monotonically from 88 % in daughter cells to 5 % in the oldest resolved mother-cell class; longitudinal monitoring over 96 h captured a progressive widening of this gradient masked at the population level. Among S. cerevisiae variants, age-dependent gradients were weaker and strain-specific, while in K. phaffii reliable discrimination required exponential growth. Replicative age is thus a strain-dependent predictor of metabolic competence rather than a universally conserved one, and the workflow offers brewers and bioprocess developers a practical tool for age-resolved fermentation monitoring and pitching-yeast assessment.
How individuals explain their partner's behavior is a key cognitive process in romantic relationships. These "relationship attributions" have been consistently linked with relationship quality, but most evidence comes from Western, individualistic contexts. The cultural psychology literature suggests that attributional processes are shaped by broader cognitive and social norms, raising questions about their universality in close relationships. In a pre-registered, cross-cultural design, individuals in romantic relationships from Spain, Taiwan, Turkey, and the United States (N = 2,347) reported on causal and responsibility attributions and relationship satisfaction. We tested country-level differences in levels of attributions and whether the association between attributions and satisfaction was moderated by country. Mean levels of causal and responsibility attributions differed significantly: Taiwanese participants reported the highest levels, followed by Turkey, the U.S., and Spain. Higher levels of causal and responsibility attributions were associated with lower satisfaction in all countries, but the strength of this association varied: it was strongest in Turkey and the U.S., moderate in Spain, and weakest in Taiwan. Relationship attributions are thus culturally patterned in both degree and function. These findings underscore the importance of integrating cultural context into theories of relationship cognition and caution against assuming the universality of attribution-satisfaction links.
This series of Fact Finders presents a brief summary of the evidence and outlines recommendations regarding the injection of preservative-containing steroid formulations in the epidural space and the practice of swabbing newly opened vial tops before drawing up injectate. The evidence in support of the following facts is presented: (1) No adverse events have been documented from the administration of preservative-containing steroids into the epidural space; however, neurological injuries have been reported following intrathecal injection of these preservatives. (2) Swabbing newly opened vial tops before drawing up an injectate has been a standard procedure in healthcare settings. However, the evidence supporting its efficacy is mixed. While a recent study has found no significant benefit, guidelines from the American Society of Anesthesiologists (ASA), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) still recommend this practice. (3) Greater than 60% isopropyl alcohol is not universally effective against all pathogens.
Arbuscular mycorrhizal symbiosis (AMS) is a universal mutualism in natural ecosystems, governed by a complex transcriptional network. Although ethylene response factors (ERFs) are implicated in regulating AMS, their underlying molecular mechanisms remain poorly understood. This study aims to investigate the molecular mechanism by which ethylene response factor 15 (SlERF15) regulates AMS and phosphate uptake in tomato (Solanum lycopersicum). We used tomato loss‑of‑function mutants (erf15#1 and erf15#3), liquid chromatography-tandem mass spectrometry (LC-MS/MS), RT-qPCR, electrophoretic mobility shift assay, yeast one-hybrid assay, and dual-luciferase assays to unveil the molecular basis of SlERF15-mediated AMS and phosphate uptake in tomato. SlERF15 expression was significantly up-regulated in tomato roots during the initial stage of AMS. Mutants lacking the SlERF15 gene exhibited a substantial reduction in arbuscular mycorrhizal fungi (AMF) colonization, phosphate uptake, and plant growth. Strigolactones (SLs) and abscisic acid (ABA), which serve as positive regulators of AMS establishment, showed reduced accumulation in the mycorrhizal roots of SlERF15 mutants. Mechanistically, SlERF15 acts as a transcription factor that directly binds and activates the promoters of carotenoid cleavage dioxygenases 7 (SlCCD7), carotenoid cleavage dioxygenases 8 (SlCCD8), and 9-cis-epoxy carotenoid dioxygenase (SlNCED1), key genes for SLs and ABA biosynthesis. Moreover, ABA positively regulated the expression of SlERF15 and SLs biosynthesis genes, forming a feedback loop. Our findings demonstrate that SlERF15 functions as a key regulator involved in SLs and ABA signaling to promote AMS in tomato, offering novel insights into the complex phytohormonal regulation network fine-tuning in plant-mycorrhizal fungi interactions.
The application of single-atom catalysts (SACs) based on partially filled 3d orbital metals (e.g., Fe, Co, Cu) in Fenton-like systems faces a fundamental activity-stability trade-off caused by metal leaching and irreversible deactivation during redox cycles. Here we report a coordination-symmetry-breaking strategy that activates inert zinc single atoms via atomic coordination distortion and nanofluidic confinement. Asymmetric Zn-Nx sites integrated within carbon nitride nanochannels form a membrane reactor that couples molecular sieving with oxidation catalysis. The synergy between asymmetric coordination and nanoconfinement creates an efficient electron pathway, enabling direct electron transfer from pollutants to peracetic acid (PAA) through metastable complexes, circumventing radical pathways. This coordination asymmetry induces localized charge polarization, lowering the activation barrier for PAA and resulting in exceptional kinetics (0.09 ms-1) under nanoconfinement, negligible Zn leaching (<0.1 ppm), and strong resilience in complex water conditions. The system achieves industry-leading cost efficiency (0.11 USD/m3) over 100 h operation, outperforming conventional Co SAC. This work establishes a universal design principle integrating atomic symmetry control with nanofluidics to transform inert metals into highly efficient and stable catalytic membranes for sustainable water purification.
Infants born very preterm (<30 weeks' gestational age) are at increased risk of long-term developmental challenges. Monitoring health and development after discharge home is an essential aspect of neonatal follow-up care; however, there is limited understanding of how parents and carers experience this care with their child or how their own needs are addressed. This study aimed to understand and evaluate parents' experiences of neonatal developmental follow-up. Participants were recruited purposively from three diverse National Health Service providers in England. Semi-structured qualitative interviews were conducted, and data were generated and analysed using a Constructivist Grounded Theory approach. Data collection and analysis occurred concurrently, supported by memoing, reflexivity and peer debriefing. Initial and focused coding led to the iterative development of categories. Between January 2023 and October 2024, 24 interviews were conducted with parents of infants born before 30 weeks of gestation. Three categories were generated from the data analysis: parent support needs, disintegrated care and healthcare professional (HCP) experience and behaviours. Parents highlighted that their psychological support needs were unmet during their child's neonatal developmental follow-up, and they found navigating healthcare services after discharge home challenging. Changes to care priorities are required, emphasising the development of integrated systems across service providers and geographical areas, and training for universal healthcare providers.
T. vaginalis, the most common non-viral sexually transmitted infection among women, is associated with multiple adverse health outcomes. Screening asymptomatic women is not recommended except among HIV-infected women. We aimed to evaluate the cost-effectiveness of T. vaginalis testing and screening strategies among asymptomatic and symptomatic women, respectively, in U.S. primary care settings. We developed a decision tree model to evaluate 11 testing/screening strategies (using combinations of wet mount microscopy, rapid antigen testing, and T. vaginalis nucleic acid amplification testing [NAAT]) for a hypothetical cohort of 8,000 women aged 15-59 years presenting to U.S. primary care clinics in 2023. We estimated the risk, societal economic burden, and quality-adjusted life year (QALY) losses for trichomonas sequelae-preterm birth, low birthweight, premature rupture of membranes, HIV infection, and cervical cancer-over the cohort's lifetime. Adding T. vaginalis NAAT to wet mount for symptomatic women provided 0.3 additional QALYs at an incremental cost of $24,785 (ICER: $83,097/QALY). Adding NAAT to rapid antigen testing for symptomatic women yielded 0.1 additional QALYs at an incremental cost of $35,628 (ICER: $324,617/QALY). Screening asymptomatic women with NAAT cost $403,541/QALY. Incorporating NAAT into current testing practices for symptomatic women improved health outcomes but increased costs. At a willingness-to-pay threshold of $100,000/QALY, adding NAAT to wet mount for symptomatic women was cost-effective whereas adding NAAT to rapid antigen testing was not. Universal NAAT screening among asymptomatic women was also not cost-effective, suggesting that broader screening strategies may require substantially higher willingness-to-pay thresholds to be economically justified.
Gastric cancer (GC) remains a major clinical challenge, with most patients exhibiting primary resistance to anti-programmed cell death protein-1 (anti-PD-1) immunotherapy and a lack of effective predictive biomarkers. Most advanced GC presents as immune-excluded "cold" tumors that respond poorly to immune checkpoint blockade. Traditional Chinese medicine (TCM) "Yong (abscess)" syndrome and the "treating GC as Yong" theory are widely applied in clinical practice, yet lack clear molecular and immunological mechanisms. Here, by translating these clinical observations into modern biological terms, we present an original, testable hypothesis proposing the "Yong" syndrome-cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) axis as the central molecular bridge connecting TCM syndrome subtypes, GC histological subtypes, and TME reprogramming. We hypothesize that heat-clearing and blood-activating TCM monomers activate cGAS-STING in a subtype-selective manner to convert "cold" tumors to "hot" immunogenic phenotypes, directly addressing the critical clinical dilemmas of primary anti-PD-1 resistance and insufficient biomarkers in GC immunotherapy. This hypothesis translates universal cGAS-STING mechanisms into a clinically actionable, syndrome-based precision strategy for GC.
Diabetes-related foot ulceration (DFU) is a serious complication, serving as a leading cause of amputation, disability, hospitalisation and a significant contributor to healthcare costs. Deficiencies in vitamin C and other micronutrients are common in DFU. Emerging evidence suggests vitamin C supplementation may enhance wound healing; however, high-quality randomised controlled trials are lacking. Therefore, the aim of this study is to investigate the efficacy of oral vitamin C supplementation (1 g/day) for 8 weeks on wound healing in people with DFU. This is a multi-site, parallel group, randomised, placebo-controlled, double-blind trial. Eighty adults with DFU will be recruited and randomly assigned to either placebo or vitamin C supplementation (500 mg twice daily). Ulcer measurements will be obtained at baseline, 2, 4, 6 and 8 weeks with all other measures collected at baseline and 8 weeks. The primary outcome measure is the percentage reduction in ulcer size (ulcer volume in mm3) at 8 weeks, compared to baseline. Secondary outcomes are changes in plasma vitamin C, time to 50% ulcer healing, time to complete ulcer healing, rate of healing of ulcers and adverse events. Exploratory outcomes include changes to glycaemic status, blood lipids, blood pressure, peripheral arterial perfusion, mental health and well-being, scurvy signs and symptoms and oxidative stress. The findings from this research will provide high-quality evidence on the efficacy of vitamin C for wound healing in people with DFU and help to inform clinical practice regarding vitamin C supplementation alongside current standard care to aid in the healing of DFUs. Australian and New Zealand Clinical Trials Registry (ACTRN12624000675527). Universal Trial Number (UTN) U1111-1308-1050.
3D-printed permanent resin-based materials have recognized as practical options for permanent restorations because of their mechanical properties, aesthetic performance, and ability to work with digital workflows. There is a lack of studies on identifying the appropriate surface pretreatments to improve repairability of 3D-printed permanent resin. Accordingly, this study assessed how different surface pretreatment conditions impact the repairability of 3D printed permanent resin utilized for definitive restorations. Sixty cylindrical specimens from 3D-printed permanent resin (10 mm × 3 mm) were categorized according to their surface pretreatments into five groups after being subjected to 5000 thermocycles. The groups were as follows: Control (C), with no surface pretreatment; Diamond Bur (DB), in which the surfaces were roughened using a diamond bur; Sandblasting (SB), in which the surfaces were treated with airborne particle abrasion; Diamond Bur + Scotchbond Universal Adhesive (DB + SBU), in which diamond bur surface roughening was followed by the application of adhesive; and Sandblasting + Scotchbond Universal Adhesive (SB + SBU), in which airborne particle abrasion was followed by the application of adhesive. Onto the prepared CAD/CAM surfaces, a nanohybrid repair resin composite was packed. Subsequently, SBS and the mode of failure were conducted. Data were statistically analyzed using one-way analysis of variance, followed by Tukey's post hoc multiple comparison test at a p < 0.05. The SB + SBU group had the highest mean repair SBS value (17.45 ± 2.78), whereas the C group demonstrated the lowest SBS value (10.32 ± 2.56). The DB + SBU group exhibited a significantly higher SBS (p < 0.001) in comparison to the control group. No statistically significant difference was observed between the DB and SB groups. Adhesive failure were predominantly observed in the control group. Cohesive failures were observed in the SB + SBU and DB + SBU groups, while mixed failures were observed in all groups except control groups. Within limitations of this study, roughening with diamond bur can effectively improve repair bond strength of 3D-printed permanent resin without a determinable effect of air particle abrasion. Additionally, applying a bonding agent after mechanical surface roughening improve the repairability of the 3D printed resin utilized for permanent restoration.
In Taiwan's post-COVID-19 context, universal National Health Insurance (NHI) and broad provider choice may contribute to information asymmetries that influence how older adults seek and navigate care. This cross-sectional study examined the associations among social network support (SNS), intergenerational relationships (IRs), healthcare-seeking behavior attitudes (HSBA), and quality of life (QoL) in community-dwelling older adults in northern Taiwan. A total of 150 participants (mean age = 73.5 ± 5.9 years) completed a newly developed and validated HSBA scale, a validated SNS instrument culturally adapted for older adults, a culturally adapted and validated IR measure, and a Taiwan-specific QoL measure. Analyses included descriptive statistics, Pearson correlations, prespecified subgroup comparisons, and multivariable linear regression analyses (two-tailed α = .05). All variables were positively correlated. QoL showed the strongest association with SNS (r = 0.64, p < .001), followed by IRs (r = 0.51) and HSBA (r = 0.29). In the multivariable models, regular exercise independently predicted higher HSBA, SNS, and QoL, whereas stronger IRs were associated with having more grandchildren and receiving daily telephone contact from non-cohabiting children. Among community-dwelling older adults in northern Taiwan, SNS was the strongest correlate of QoL. The findings support the inclusion of social connectedness, exercise participation, and intergenerational contact in routine gerontological nursing assessment. Because this study used a cross-sectional design, no causal or intervention-related interpretations can be made.
People recently treated for tuberculosis (TB) (TB survivors) face substantial risk of recurrence. The optimal implementation and expected impact of active case-finding are uncertain. We developed an individual-level stochastic simulation model of TB recurrence among recently treated people in India, informed by empirical data on the cumulative incidence and timing of TB recurrence, the extent and durations of symptoms and bacteriological positivity and screening-related costs. We modelled post-treatment symptom screening at quarterly or semiannual intervals, with or without universal near-point-of-care bacteriological testing at the first screening encounter. We estimated months of symptomatic TB and of potentially infectious (bacteriologically positive, regardless of symptom status) TB averted over a 2-year period after treatment, along with corresponding screening programme costs, estimated as medians and 95% uncertainty ranges across simulations. Symptomatic TB recurred within 2 years post-treatment in 10% (8%-12%) of recent TB survivors and undiagnosed prevalence peaked in month 2 (1-3). Symptom screening 6, 12 and 18 months post-treatment (as per Indian guidelines) averted 16% (8%-32%) of symptomatic and 8% (5%-17%) of infectious time. An 'early' screening schedule (3, 6 and 9 months post-treatment) increased case detection and health impact (26% (15%-43%) of symptomatic and 16% (9%-27%) of infectious time averted). Adding 'universal bacteriologic testing' at the 3-month encounter doubled the impact on transmission potential (34% (21%-55%) of symptomatic and 37% (22%-62%) of infectious time averted). In this context, 'early' symptom screening cost $190 ($100-$350) per case detected, and adding universal bacteriological testing cost an additional $520 ($240-$1070) per case incrementally detected by the screening programme. Screening for recurrent TB in high-risk settings such as India could reduce morbidity and time spent with potentially infectious TB. Concentrating screening within the first year has greatest yield. Symptom-based screening is most affordable, but testing for asymptomatic recurrence could further reduce transmission potential.
Universal school-based mental health programs for adolescents intend to promote wellbeing, but some evidence suggest that they may also cause harm. This scoping review aimed to map the state of knowledge on potential harms associated with these programs from the recent literature. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, four databases were searched for peer-reviewed studies published between 2019 and 2024. Articles were included if they evaluated a universal school-based mental health program for adolescents (13-18 years) and reported at least one quantitative outcome measure. Potential harms identified were classified into five harm types based on the observed data. Results showed that, of the 58 included studies, 29% (17 of 58) reported at least one type of potential harm. Statistically significant change in the overall sample was examined in all studies, with 16% (nine of 58) showing deterioration in at least one outcome. Statistically significant change by subgroup (e.g., age, gender, and baseline mental health) was examined in 21 studies, with 29% (six of 21) of these showing deterioration in at least one subgroup. Additional harms were identified through clinically meaningful deterioration, qualitative participant feedback, and safety protocols. Our findings confirm that universal school-based mental health programs can be associated with potential harms. Implications for research and practice are discussed.
Allogeneic hematopoietic cell transplantation is undergoing rapid transformation, propelled by a wave of practice-changing studies that are reshaping how donors are selected, how graft-versus-host disease (GVHD) is prevented, and how post-transplant relapse is managed. Here we review the major advances of the past several years, focusing on practice-changing studies from 2024 to 2026, and the questions they raise. The adoption of post-transplant cyclophosphamide (PTCy) as a near-universal GVHD prophylaxis backbone has diminished the long-standing primacy of human leukocyte antigen matching, enabling comparable outcomes with mismatched unrelated (MMUD) and haploidentical donors and expanding access for patients of non-European ancestry; contemporary guidelines now endorse concurrent donor searches and prioritization of younger donors. Building on the BMT CTN 1703 trial, PTCy-based prophylaxis has become a standard across conditioning intensities and donor types, while correlative studies illuminate both its mechanism and its trade-offs. Complementary strategies, including frontline and prophylactic ruxolitinib, adoptive regulatory T-cell (Treg) therapy, and the precision-engineered Orca-T graft, are broadening the prophylaxis repertoire and beginning to separate GVHD control from the loss of immune competence and graft-versus-leukemia activity. For FLT3-ITD AML, the MORPHO trial and subsequent analyses have established measurable residual disease-directed gilteritinib maintenance, advancing a molecularly individualized approach to relapse prevention. Together, these developments mark a decisive shift from a uniform transplant paradigm toward biomarker-guided, precision-based care, and they define the priorities for the next generation of clinical trials.
Recent studies reveal striking representational alignment between artificial neural networks (ANNs) and biological brains, leading to proposals that all sufficiently capable systems converge on universal representations of reality. We argue that this claim of Universality is premature. We introduce the Umwelt Representation Hypothesis, which proposes that alignment arises not from convergence toward a single global optimum but from overlap in the ecological constraints under which systems develop. We review empirical evidence showing that representational differences between species, individuals, and ANNs are systematic and adaptive, which is difficult to reconcile with Universality. Finally, we reframe ANN model comparison as a method for mapping clusters of alignment in the ecological constraint space rather than as a search for a single optimal world model.
The present study addresses the limited recognition modes and poor universality of conventional cyclodextrin-based chiral stationary phases (CSPs) by proposing a rational design strategy based on "functional group synergy" concept. Following this strategy, sulfobutylether-(hydroxypropyl-β-cyclodextrin), hereafter referred to as SBE-(HP-β-CD), was successfully synthesized and, for the first time, chemically bonded to silica matrix to fabricate a SBE-(HP-β-CD) CSP. Comprehensive evaluation demonstrated that this CSP exhibits superior chiral selectivity, higher column efficiency, and shorter retention times for a diverse set of 33 chiral analytes (including basic, acidic, and neutral compounds). Its overall separation performance was significantly better than that of single-functionalized reference CSPs (HP-β-CD CSP and SBE-β-CD CSP). Multimodal mechanism studies-integrating 1H NMR and thermodynamic analysis-provided direct evidence for a synergistic recognition effect arising from mixed functional groups. Furthermore, the CSP demonstrated excellent performance and good reproducibility in practical analysis of commercial antifungal ketoconazole ointment. This work not only presents a high-performance chiral stationary phase but also establishes a new paradigm for constructing multifunctional synergistic separation materials through rational molecular design.
To evaluate the effect of different surface pretreatment protocols on the repair bond strength and integrity of resin composite to three different resin matrix ceramics (RMCs). Three RMCs - Cerasmart (CS), Grandio blocs (GB) and Katana Avencia (KA) - were subjected to one of three mechanical surface treatments: polishing, diamond bur roughening, or sandblasting. These were randomly assigned to four conditioning groups: 10-MDP and silane-containing adhesive (Clearfil Universal Bond Quick), 10-MDP-based adhesive (G-Premio Bond), 9% buffered hydrofluoric acid (HF) plus silane, and a 10-MDP and silane-free adhesive (Heliobond). A nanohybrid composite (Reflectys) was applied as the repair material. Specimens were sectioned into sticks and subjected to micro-tensile bond strength (µTBS) testing using a universal testing machine. The surface treatments were compared by one-way ANOVA and post-hoc tests for different cases of the variables µTBS and surface roughness. For CS, the combination of sandblasting and 10-MDP plus silane-containing adhesive yielded the highest µTBS (46.42 ± 3.12 MPa), with no significant difference observed between polishing and bur roughening. Similarly, GB showed significantly higher µTBS when sandblasted and treated with 10-MDP plus silane adhesive (42.01 ± 5.06 MPa). However, for KA, the most effective protocol was the combination of sandblasting and 9% buffered HF with silane (48.31 ± 8.46 MPa). Repair bond strength is highly dependent on the specific RMC used. No single universal mechanical surface treatment or conditioning protocol was found to be optimal across all materials. Clinicians should utilise individualised repair protocols - specifically 10-MDP and silane-containing adhesives for CS and GB, and HF and silane for KA - to achieve maximum repair bond strength. When repairing RMC restorations chairside, clinicians should identify the specific material brand, whenever possible, as the chemical composition of the RMC dictates whether a universal adhesive or a traditional HF and silane protocol will provide the most durable immediate repair.
Sudden cardiac arrest (SCA) in women remains understudied, often leading to generalised approaches. We aimed to identify sex-specific differences in the clinical profile, risk factors, and causes of SCA to guide targeted interventions. This prospective population-based study (ReCaPTa) analysed out-of-hospital cardiac arrests in a region of Spain (2014-2017). Data were triangulated from Emergency Medical Services, hospital records, and forensic autopsies. SCA was defined as an unexpected cardiac arrest, with a presumed cardiac cause, occurring within 1 h of symptom onset or seen to be alive and well within the last 24 h. Of 639 SCA cases, 191 (29.9%) were women. Compared with men, women were older (74 vs 66 years, p < 0.001), had more morning SCA and had a higher prevalence of previous psychiatric disorders (15.6% vs 9.0%, p = 0.03) and alcohol abuse (25.4% vs 16.1%, p = 0.01). Toxicological analysis showed significantly higher antidepressant positivity in women (11.3% vs 1.8%, p = 0.004). Women had fewer shockable rhythms (21% vs 36%, p = 0.01), fewer resuscitation attempts, and lower survival rates (4.2% vs 9.9%, p = 0.01). While acute coronary disease was the leading cause in women (20.0%), they exhibited a distinct non-ischaemic profile: pulmonary embolism (PE) was more frequent than in men (13.3% vs 3.0%, p < 0.001) and was universally fatal (0% survival). Compared with men, women with SCA exhibited a disproportionately higher burden of PE and a greater involvement of psychotropic drugs and toxic substances.