CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom

BACKGROUND

The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.

METHODS

In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).

RESULTS

Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.

CONCLUSIONS

This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.

Assessing the effects of extreme climate risk on urban ecological resilience in China

The frequent occurrence of extreme weather events has imparted significant pressure on urban ecosystem management. Evaluating the relationship between extreme climate risk (ECR) and urban ecological resilience (UER) is a key issue in achieving the green and sustainable development objectives of cities. This study measures UER in China from 2005 to 2020 using the entropy weight method-TOPSIS method, investigates the relationship between ECR and UER using the dynamic GMM model, and further explores the influencing mechanism. The results suggest that ECR has an inhibiting influence on UER. Additionally, the moderating mechanism investigation demonstrates that environmental regulation can mitigate the threat of ECR to UER to a certain extent, and with the regulation effect based on the government's environmental concern being better than that of the market pollution fee payment. The group test outcomes demonstrate that the discrepancies in regions and marketization lead to certain differences in the relationship between ECR and UER. Additional investigation indicates that ECR has an asymmetric relationship with UER at distinct quantiles. Our findings reflect the subtle associations between ECR and UER as a whole, and will help relevant organizations in formulating more precise and scientific policies to enhance urban ecological resilience.

The nexus among CO2 emission, health expenditure and economic development in the OECD countries: New insights from a cross-sectional ARDL model

To find a way to realize sustainable development, this paper applied a cross-sectional ARDL (CS-ARDL) method to explore the interaction between carbon emissions, economic development, and health care expenditure for OECD countries. Firstly, we conduct a cross-sectional test to check whether the data is confronted with this issue. Secondly, we conduct a panel unit root test and cointegration test to confirm whether the ARDL-based method is suitable for our data. Thirdly, we analyze the results and provide possible explanations. Lastly, we conduct a short-term causality test to detect the connection between different variables. The main conclusion of our study includes: 1) Health care is a necessity in OECD countries. 2) Environmental deterioration places a heavy burden on health care expenditure in OECD countries. 3) Health care expenditure of last year negatively affects health care expenditure. 4) There is a short-run causality relationship from CO2, economic development, and dependency rate of youth to health care expenditure in OECD countries. Related policy proposals are provided according to our analysis of the results.

Preoperative diagnostic value of coronary CT angiography in acute Stanford type A aortic dissection involving the coronary arteries

AIM

To assess the diagnostic value of coronary computed tomography angiography (CCTA) in acute type A aortic dissection (ATAAD) with coronary artery involvement and to evaluate whether CCTA could provide potentially useful information for selecting the surgical method.

MATERIALS AND METHODS

Patients with ATAAD treated from January 2019 to December 2020 were reviewed retrospectively. Involvement of the coronary arteries based on CCTA findings were grouped into three major types and five subtypes. Interobserver and intraobserver diagnostic agreement for five subtypes were determined. The patients were divided into the coronary artery bypass grafting (CABG) and non-CABG groups, and the proportions of the five subtypes between the two groups were compared.

RESULTS

A total of 95 patients were enrolled in this study. Interobserver and intraobserver diagnostic agreement were both substantial in the left and right coronary arteries. Overall, the proportions of the five subtypes of coronary artery involvement were significantly different between the two groups (p<0.001). The proportion of Type A was elevated in the non-CABG group compared with the CABG group (22.6% versus 71.9%); by contrast, the proportions of Type B1 (35.5% versus 14.1%), Type B2 (19.4% versus 10.9%), Type C1 (6.5% versus 0%), and Type C2 (16.1% versus 3.1%) were elevated in the CABG group.

CONCLUSION

CCTA is reliable in evaluating coronary artery involvement by ATAAD. The present retrospective study indicated that CABG may be considered if the intimal flap disrupts the coronary orifice and causes luminal stenosis >50%, particularly Type B, or if an intimal tear occurs in the coronary orifice (Type C), which deserve further validation through prospective studies.

Asymmetric effects of crude oil prices and USD exchange rate on precious metals returns：Evidence from pre and during COVID-19 outbreak

Trading in commodities such as precious metals and crude oil is vital to the economy. Frequent exchange rate fluctuations have led to constant changes in commodity prices since 2000. Using quantile regression, this paper examines the impact of oil prices and the US dollar exchange rate on gold, silver, platinum, and palladium from January 1, 2013 to 5 May 2023. Oil prices positively affect precious metals returns, and positive and negative oil price shocks are asymmetric. Exchange rate movements negatively affect precious metal returns. In addition, gaps in the existing literature are filled by analyzing the effects of oil prices and the exchange rate on precious metals before and during COVID-19. This paper provides substantial evidence for revising the impact of the crisis.

[Research progress of transcriptomics and proteomics in schizophrenia]

Schizophrenia is a severe psychiatric disorder with an unclear etiology and various clinical manifestations. The diagnosis and consequent treatment of schizophrenia mainly rely on clinical symptoms. Multiple risk sites associated with schizophrenia have been identified, yet objective indicators have not been found to facilitate clinical diagnosis and treatment of schizophrenia. The development of omics technology provides different perspectives on the etiology of schizophrenia and make the early identification, diagnosis and treatment of the disorder possible. This article summarizes the prevalence of schizophrenia, reviews the research results and shortcomings of transcriptomics and proteomics, as well as the latest achievements and prospects of multi-omics, aiming to reveal the use of omics in SZ, provide more comprehensive biological evidence to reveal the complex pathogenesis of schizophrenia and provide a theoretical basis for the early identification, accurate diagnosis, disease progression control, and prognosis improvement of schizophrenia.

Partial Stereotactic Ablative Radiotherapy in Bulky Urinary Tract Malignancy: An Update Clinical Outcomes and Dosimetric Analysis

PURPOSE/OBJECTIVE(S)

Patients with bulky urinary tract malignancy have poor prognosis. Stereotactic ablative radiotherapy (SABR) needs careful consideration in abdominopelvic bulky tumors because of dose constraints on the OARs. We reported updated clinical outcomes to evaluate the safety and efficacy of partial stereotactic ablative radiotherapy(P-SABR) in bulky urinary tract malignancy. The study also aims to investigate the feasibility of P-SABR in dose and biologic effective dose (BED) escalation inside the tumors with equivalent toxicity.

MATERIALS/METHODS

A total of 26 patients with urinary tract malignancy underwent P-SABR radiotherapy from January 2013 to September 2018 were retrospectively analyzed in this study. All the patients were in inoperable locally advanced or metastatic stage with tumor diameter > 4.0 cm. The P-SABR plan consisted of the SABR for gross tumor volume boost (GTVb) and following conventionally fractionated radiotherapy for planning target volume (PTV). The first SABR plan to GTVb was delivered in 15-32Gy/3-5f. The second conventionally fractionated radiotherapy plan to PTV was delivered in 40.0-58.08Gy/15-26f. The total P-SABR plan met the OARs constraints. Local control and overall survival were estimated. Acute and late toxicity were evaluated according to RTOG criteria. Paired conventionally fractionated radiotherapy (CFRT) plans were re-designed for all patients, with the same OARs dose constraints and total dose of PTV margin. Dosimetric and BED parameters were compared in P-SABR and paired CFRT plans.

RESULTS

Median age of the patients was 66.5 years (range, 46-90 years). The tumor treated by P-SABR had a median diameter of 8.4 cm (4.1-19.5 cm) and a median volume of 99.2 cc (23.9-631.8 cc). Median follow-up time was 19.1 months. The local control at 1 and 2 years were 83.2%, 77.3%, respectively. The overall survival at 1 and 2 years were 72.2% ,45.5%, respectively. 6 cases have no local recurrence after 36 months. 4 cases remained alive after 60 months. Local symptoms improved in 15/16 cases after P-SABR. Multivariate analysis showed tumor diameter (≥8cm vs. <8cm) was the independent factor affecting local control and overall survival (P=0.033, P=0.016). No patient was observed radiotherapy directly induced ≥grade 3 toxicity. Compared with the paired CFRT plans, the P-SABR plans had no significant difference in most OAR dose parameters, except for the small intestine/colon V15, V45 with an increase of 14.6 cc, 3.4 cc. However, P-SABR plans increased the dose of PTV Dmean, Dmax by 8.7Gy, 14.4Gy (P < 0.001), respectively. In addition, the dose and BED of GTVb had a significant escalation of 15.8Gy and 30.2Gy (P<0.001) respectively in P-SABR plans.

CONCLUSION

We had reported P-SABR is well-tolerated in bulky urinary tract malignancy in previous study. Updated outcomes showed P-SABR may have long-term local control in these people. Compared with traditional CFRT plans, P-SABR plans escalated the dose and BED inside bulky tumors with equivalent toxicity.

Identification and Validation of a Ferroptosis Prognostic Model for Prostate Cancer Patients through Screening the TCGA and scRNA-seq Datasets

PURPOSE/OBJECTIVE(S)

Ferroptosis is currently a common mode of programmed cell death, and the induction of ferroptosis is a new strategy and idea for current tumor therapy. Therefore, the signaling pathways and genes regulated by ferroptosis are significant markers for current malignant tumor therapy. To construct a prognostic model for predicting the survival prognosis of prostate cancer (PCa) based on the molecules and markers related to ferroptosis, we combined with differentially expressed genes (DEGs) in PCa patients, and further analyze the correlation between this risk score and immune cell infiltration. Finally, to validate the expression of risk genes and analyze the expression and localization of risk genes in using the datasets of single cell RNA-sequencing (scRNA-seq).

MATERIALS/METHODS

Firstly, we screened the DEGs in PCa patients by the expression profiles of TCGA database. Meanwhile, we collected the information of ferroptosis regulatory genes from FerrDb, and these two parts were intersected. Then the impact of genes on the survival and prognosis of PCa patients was confirmed and selected by LASSO regression, further screening of molecules and fitting the risk format. And the efficacy of the model was evaluated by ROC curves. The immune cell infiltration of PCa tissues was predicted using TIMER. Last, the scRNA-seq of PCa (GSM5155455, GSM3735993) were carried to reveal the expression of risk molecules in different cell types. Besides, the expression of risk molecules was validated using PCa cell lines.

RESULTS

We found a total of 259 DEGs associated with ferroptosis in PCa tissues. After LASSO regression, we screened DRD5, LINC00336, ACSF2, RRM2, NOX1, GDF15, ALB, MIOX, and NOX4 as variables to establish a prognostic model, and the specific risk scores was calculated following this format: Risk score = (-1.9465)*DRD5+(-1.6806)*LINC00336+(0.3045)*ACSF2+(0.4747)*RRM2+(-0.2815)*NOX1+(-0.1871)* GDF15+(0.1846)*ALB+(0.2676)*MIOX+(0.1648)*NOX4 (lambda.min = 0.0032), with a 10-yr AUC value of 0.751 (95% CI, 0.549-0.953). Furthermore, we discovered the higher the scores, the fewer CD8+ T cells infiltrated as predicting, showing a negative relationship. By testing the gene sets of scRNA-seq forPCa, we discovered that RRM2, GDF15, ALB, and MIOX were mainly expressed in tumor cells, T cells, B cells and neutrophils of PCa tissues, and not in endothelial cells. Finally, we detected differences in protein expression of RRM2, GDF15, and MIOX in PCa cell lines compared to normal prostate cancer epithelium by WB.

CONCLUSION

We constructed a novel prognostic model for PCa based on ferroptosis-related genes, which showed better predictive validity. And we analyzed the cellular expression of risk genes by scRNA-seq, which will be explored future in relation to prostate cancer radiotherapy.

Safety and Efficacy of Radiotherapy Combined with Chemotherapy for Recurrent Metastatic Renal Pelvic and Ureteral Carcinoma

PURPOSE/OBJECTIVE(S)

To retrospectively investigate the safety and efficacy of radiotherapy combined with systemic chemotherapy for recurrent metastatic renal pelvic and ureteral carcinoma.

MATERIALS/METHODS

A total of 109 patients were enrolled in this study, including 44 patients in the Radio-chemotherapy group and 65 patients in the Chemotherapy group. Propensity score matching (PSM) was used to balance the clinical baseline characteristics of the two groups by 1:1 matching. Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS) before and after matching. Prognostic factors were analyzed by Cox proportional risk model. Treatment-related adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0.

RESULTS

The median follow-up time was 14.5 months. Multivariate analysis showed that radiotherapy was a good independent prognostic factor for OS in patients with recurrent metastatic renal pelvic and ureteral carcinoma (HR: 0.327, 95% CI: 0.157∼0.680, P = 0.003). After matching, there were 40 patients in the Radio-chemotherapy group and 40 patients in the Chemotherapy group, and the median PFS and median OS in the Radio-chemotherapy group were better than those in the Chemotherapy group (PFS: 10.4 months vs. 6.7 months, P = 0.035; OS: 43.5 months vs. 18.8 months, P<0.001). The 1-year OS and 2-year OS of the Radio-chemotherapy group were higher than those of the Chemotherapy group (1-year OS: 88.1% vs. 70.4%; 2-year OS: 81.1% vs. 39.3%). In addition, in the Radio-chemotherapy group, patients treated with radiotherapy before first-line chemotherapy failure had longer PFS than those treated with radiotherapy after chemotherapy failure (median PFS: 15.7 months vs. 6 months, P = 0.003). There was no significant difference in the incidence of grade 3∼4 toxicities between the Radio-chemotherapy group and the Chemotherapy group (52.3% vs. 50.8%, P = 0.878).

CONCLUSION

For patients with advanced renal pelvic and ureteral carcinoma, adding radiotherapy on the basis of systemic chemotherapy is well tolerable and expected to bring long-term survival benefits to patients, and the benefits of early interventional radiotherapy may be more obvious.

Radiotherapy Resistance in Prostate Cancer Cells: AKR1C3 Inhibition of Ubiquitinated Degradation of Nrf2 through Interaction with KEAP1

PURPOSE/OBJECTIVE(S)

Radiotherapy is the most fundamental treatment for prostate cancer (PCa), and although radiotherapy for overall PCa patients is effective, poor prognosis and resistance to multiple treatments regimes in some highly malignant PCa, such as those with high Gleason Scores (GS) (≥9), are important bottlenecks limiting the improvement of treatment outcomes for clinical. AKR1C3 is a key PCa resistance gene that our team identified previously, but the induction of the specific mechanism of radiotherapy resistance has not been fully revealed and understand.

MATERIALS/METHODS

To analyze the correlation between its expression level and clinical radiotherapy, we used the gene expression profiles data of PCa patients in TCGA database. We generated a stepwise increase of radiotherapy dose to established PCa radiotherapy resistant cell lines and detect the AKR1C3 expression level. In addition, to explore the molecular mechanism of AKR1C3 induced prostate cancer radiation tolerance through functional enrichment analysis. Then, to treat cells with cycloheximide and the protein stability of the Nrf2 was detected. Last, the protein ubiquitination level was assayed by co-immunoprecipitation (co-IP) after treatment with MG132. Finally, protein-protein interactions were identified using co-IP to mine possible binding molecules.

RESULTS

By analyzing the expression profiles data of PCa patients in the TCGA database, we found that in the population of PCa patients treated with radiotherapy, all patients with high AKR1C3 expression died after radiotherapy, suggesting that high AKR1C3 expression may be a biomarker of resistance to radiation. Accordingly, AKR1C3 expression levels showed a positive correlation with GS score, which may be a symbol for patients with highly malignant PCa. A PCa radiotherapy resistant cell line was constructed by a stepwise increase of ionizing radiation (IR) dose, and the total IR dose of radiotherapy was 84Gy, which reached the dose of radical radiotherapy for prostate cancer. The expression of AKR1C3 was further detected by RT-qPCR and WB, and it was found that the expression of AKR1C3 was significantly up-regulated in the resistant cell line, accompanied by milder DNA damage. What's more, by GSEA functional enrichment analysis, we discovered that AKR1C3 overexpression might be related with intracellular oxidative stress damage. After CHX treatment, the protein stability of Nrf2 was significantly enhanced in AKR1C3 overexpression groups than control groups. And the administration of MG132 showed the same results, indicating that the ubiquitinated degradation of Nrf2 was inhibited in AKR1C3 overexpression groups. Further by co-IP, we found that Nrf2 was less ubiquitinated in the cytoplasm after AKR1C3 overexpression, and AKR1C3 could bind Keap1.

CONCLUSION

In sum, we found that AKR1C3 can bind with Keap1 leading to reduced ubiquitination level of Nrf2, causing upregulation of Nrf2 expression and providing new insights into PCa radiotherapy resistance.

Climate risk and financial systems: A nonlinear network connectedness analysis

To deeply analyze and understand the macro-financial impact of climate change, this paper investigates the effect of climate risk on systemic financial risks by employing a network approach. The results demonstrate that climate risk not only affects a single financial market but also induces risk co-movement, which aggravates potential systemic financial risks. Specifically, the system-wide connectedness across the financial system respectively increased by 2.52% and 1.76% after the withdrawal of the US from the Kyoto Protocol and the Copenhagen UN Climate Change Conference. The bond and stock markets are the primary transmitters of climate shocks, while the forex and commodity markets appear to be more sensitive to climate-related information. In addition, the vulnerability of financial asset price fluctuations to climate risk changes substantially over time. Quantile regressions reveal the positive impact of climate risk on total connectedness across the financial system. This study provides novel insight into how the financial system responds to climate-related information and how systemic risk dynamics materialize.

Facilitate or Inhibit: Corporate Environmental Performance and Financing Costs

The proposed carbon peak and carbon neutralization goals have ushered China into an era of emissions reduction and a climate-oriented economy. With the proposed double carbon goal, China has formulated many environmental protection and green credit policies. This paper aims to assess the impact of corporate environmental performance (CEP) on financing costs, using a panel dataset of companies in China's heavily polluting industries from 2010 to 2019. We employed fixed-effect models, moderating-effect models, and panel quantile regression (PQR) to analyze the impact, underlying mechanisms, and asymmetric features of CEP on financing costs. Our results indicate that CEP has an inhibitory effect on financing costs, with political connections strengthening this effect and GEA weakening it. Moreover, the impact exhibits asymmetry at different levels of financing costs, wherein lower financing costs see a greater weakening effect from CEP. Improved CEP helps to optimize the financing performance of companies and reduce financing costs. Therefore, policy makers and regulatory authorities should work to unblock financing channels for companies, encourage environmental investment, and remain flexible in implementing environmental policies.

Modelling extreme risks for green bond and clean energy

Value at Risk and Expected Shortfall are two traditional tools used to measure extreme risk in financial markets. However, there is little research on measuring extreme risk in emerging markets such as green bonds and clean energy. This paper uses both semi-parametric models with simultaneous excitation functions and traditional models to estimate extreme risk in SP500 Green Bond (GB) and Global Clean Energy (GCE), selecting Expected Shortfall (ES) and Value at Risk (VaR) as the indices of extreme risk. Then, the paper uses a breakpoint scan of the predictions of the different types of models. The results find that the green bond market was relatively stable while the global clean energy market experienced sharp fluctuations after the COVID-19 pandemic outbreak. Representative models in GCE have at least two breakpoints, but those for GB have no breakpoints. The GARCH model with normal innovations performs the best among all target models, and the GARCH-FZ model fits the best among all semi-parametric candidates. Our research could help governments, companies, and investors with risk management and improve model accuracy and mechanisms for measuring extreme risks.

Does digital finance promote the "quantity" and "quality" of green innovation? A dynamic spatial Durbin econometric analysis

Based on the panel data of 284 prefecture-level cities in China, this paper uses the dynamic spatial Durbin model to explore the impact of digital finance on green innovation from the dimensions of "quantity" and "quality." The results show that digital finance has a positive impact on both the quality and quantity of green innovation in local cities, but the development of digital finance in neighboring cities has a negative impact on the quantity and quality of green innovation in local cities, and the impact on the quality of green innovation is greater than that on the quantity of green innovation. And after a series of robustness tests, it was shown that the above conclusions are robust. In addition, digital finance can have a positive impact on green innovation mainly through industrial structure upgrading and informatization level. Heterogeneity analysis shows that the breadth of coverage and the degree of digitization are significantly related to green innovation, and digital finance has a more significant positive impact in eastern cities than in mid-western cities.

[The correlations between influenza and meteorological factors in 15 cities of northern China, 2008-2020]

Objective: To understand the influence of meteorological factors on the morbidity of influenza in northern cities of China and explore the differences in the influence of meteorological factors on the morbidity of influenza in 15 cities. Methods: The monthly reported morbidity of influenza and monthly meteorological data from 2008 to 2020 were collected in 15 provincial capital cities, including Xi 'an, Lanzhou, Xining, Yinchuan and Urumqi (5 northwestern cities), Beijing, Tianjin, Shijiazhuang, Taiyuan, Hohhot, Ji'nan, Zhengzhou (7 northern cities), Shenyang, Changchun and Harbin (3 northeastern cities). The panel data regression model was applied to conduct quantitative analyze on the influence of meteorological factors on influenza morbidity. Results: The univariate and multivariate panel regression analysis showed that after controlling the population density and other meteorological factors, for each 5 ℃ drop of monthly average temperature, the morbidity change percentage (MCP) of influenza was 11.35%, 34.04% and 25.04% in the 3 northeastern cities, 7 northern cities and 5 northwestern cities, respectively, and the best lag period months was 1, 0 and 1 month; When the monthly average relative humidity decreased by 10%, the MCP was 15.84% in 3 cities in northeastern China and 14.80% in 7 cities in northern China respectively, and the best lag period months was 2 and 1 months respectively; The MCP of 5 cities in northwestern China was 4.50% for each 10 mm reduction of monthly accumulated precipitation, and the best lag period months was 1 month; The MCPs of 3 cities in northeastern China and 5 cities in northwestern China were 4.19% and 5.97% respectively when the accumulated sunshine duration of each month decreased by 10 hours, the best lag period months was 1 month. Conclusions: In northern cities of China from 2008 to 2020, the temperature, relative humidity, precipitation and sunshine duration all had negatively impact on the morbidity of influenza, and temperature and relative humidity were the main sensitive meteorological factors. Temperature had a strong direct impact on the morbidity of influenza in 7 cities in northern China, and relative humidity had a strong lag effect on the morbidity of influenza in 3 cities in northeastern China. The duration of sunshine in 5 cities in northwestern China had a greater impact on the morbidity of influenza compared with 3 cities in northeastern China.

The safety of human embryos following long-term cryopreservation ( >6 years) on vitrification

BACKGROUND

Vitrification of embryos has become the basic means of assisted reproductive technology (ART) therapy in recent years. Concerns have also been raised about the safety of vitrification and the effect of cryopreservation time. Most of the previous studies were on the data within 6 years of cryopreservation.

OBJECTIVE

In this study, we aimed to evaluate the impact of long-term cryopreservation (>6 years) on pregnancy and neonatal outcomes.

MATERIALS AND METHODS

This research was a single-center, retrospective analysis, including 426 frozen-thawed embryo transfer (FET) cycles. Patients who participated in IVF-FET cycles between January 2013 to December 2020 were analyzed. Preferentially matched participants were divided into three groups according to storage time: group A (>72 months), group B (0-3 months, propensity score matching [PSM] according to the age of oocyte retrieval), and group C (0-3 months, PSM according to the age of embryo transfer).

RESULTS

Our results revealed that there were no significant differences in human chorionic gonadotropin [HCG] positive rate, clinical pregnancy rate, miscarriage rate, live birth rate, and neonatal outcomes when the embryo storage duration >72 months. But the proportion of high birth weight was higher in group A (>72 months) when matched according to age at embryo transfer.

CONCLUSION

The results of our study showed that long-term cryopreservation had no effect on the pregnancy and neonatal outcomes of vitrification. The results offer evidence for the safety of using long-term cryopreservation embryos after vitrification. DOI: 10.54680/fr23310110612.

The role of the COVID-19 pandemic in time-frequency connectedness between oil market shocks and green bond markets: Evidence from the wavelet-based quantile approaches

This study contributes to the existing literature on the relationship between oil market shocks and the green bond market by investigating the impact of the COVID-19 pandemic on their dynamic correlation. We first decompose the oil market shocks into components using a time-frequency framework. Then, we combine wavelet decomposition and quantile coherence and causality methods to discuss changes during the COVID-19 era. We observe positive effects of both supply-driven and demand-driven oil shocks on the green bond market at most quantile levels. However, supply-driven oil price changes play a major role. The results also indicate that long-term changes have a greater impact than short-term changes on the connection between oil and green bond markets. Nevertheless, the COVID-19 pandemic changed the nature of the causal relationship, as we observed no relationship under extreme market conditions during the pandemic era. We argue that the economic and social impacts of the COVID-19 pandemic have left investors focusing on the short-term substitution between oil and green bond markets.

Analysis of technological innovation on provincial green development levels of logistics industry in China

The transition from traditional logistics to green and low-carbon logistics is crucial and inevitable due to the pressure of climate change and sustainable development in China. Meanwhile, technological innovation is perceived as an important factor affecting the development of the logistics industry. To explore the impacts of technological innovation and other factors and to propose proper policies based on the results, this study utilizes a generalized estimating equations (GEE) regression model to analyze panel data of 30 provinces during 2001-2019. Firstly, the entropy weight method is applied to calculate the green logistics development level based on an index system considering green factors. Secondly, a GEE model which considers the correlation among different observations is used to investigate the impacts of crucial factors on the green logistics development level. Moreover, regional heterogeneity is also analyzed in this paper by comparing the regression results of the Eastern region, Central region, and Western region. Based on the above analysis, several conclusions are drawn: (1) In terms of the average green logistics development levels, the Eastern region ranks 1st, the Central region ranks 2nd, and the Western region ranks 3rd. (2) GEE regression model is proved effective in our sample. (3) For the full sample, technological innovation, trade openness, and logistics infrastructure positively affect the green logistics development level; while, government regulation and energy intensity negatively influence the green logistics development level. (4) Regional heterogeneity is confirmed in our sample. Related policy recommendations are proposed based on our regional regression results. Take the Eastern region as an example, the local governments in the Eastern region should upgrade the manufacturing industry, reduce government financial investment in the transportation sector, and enhance environmental control expenditure in the transportation sector.

How does digital finance affect industrial structure upgrading? Evidence from Chinese prefecture-level cities

Digital finance is playing an increasingly prominent role in economic development. This paper examines the impact of digital finance on industrial structure upgrading based on panel data from 289 Chinese prefecture-level cities from 2011 to 2020. The paper adopts fixed effects, mediating effects, and spatial econometric models and the findings are as follows. First, digital finance development significantly boosts industrial structure upgrading in Chinese cities. The evidence remains valid after various robustness tests. Second, digital finance and industrial structure upgrading exhibit positive spatial spillover effects. Third, digital finance indirectly affects industrial structure upgrading through innovation, entrepreneurship and the structure of household consumption channels. Fourth, the influence of digital finance is more significant in cities with more developed economies, less financialization and lower income inequality. Finally, among the sub-indicators of digital finance, the breadth of coverage plays the most significant role, inspiring policymakers and financial institutions to speed up the digitization infrastructure in backward areas.

Is hepatic resection always a better choice than radiofrequency ablation for solitary hepatocellular carcinoma regardless of age and tumor size?

In this study, we aimed to compare survival outcomes after receiving radiofrequency ablation (RFA) and hepatic resection (HR) for solitary hepatocellular carcinoma (HCC) with stratification by tumor size and age. A retrospective cohort was obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Patients were grouped by tumor size (0-2, 2-5, and > 5 cm) and age (>65 and ≤65). Overall survival (OS) and disease-specific survival (DSS) were assessed. For patients >65 with tumors measuring 0-2 and 2-5 cm, the HR group had better OS and DSS compared with the RFA group. For patients >65 with tumors > 5 cm, OS and DSS did not differ significantly between the RFA and HR groups (p = 0.262 and p = 0.129, respectively). For patients ≤65, the HR group had better OS and DSS compared with the RFA group regardless of tumor size. For patients with resectable solitary HCC, regardless of age, HR is the better choice not only for tumors ≤ 2 cm, but also for tumors 2-5 cm. For resectable solitary HCC with tumors ＞5 cm, HR is the better choice for patients ≤65 but for patients >65, the issue of treatment choice needs to be further studied.

Pollution prevention strategies of SMEs in a green supply chain finance under external government intervention

Small- and medium-sized enterprises (SMEs) are an important force in the promotion of economic development. However, SMEs in the supply chain are often severely punished by the government for polluting the environment through their production processes. Therefore, it is crucial to solve the environmental pollution problem of SMEs. To compensate for the "common knowledge" assumption of participants in traditional game theory, this study constructs an evolutionary game model of a green supply chain composed of SMEs, core enterprises, and commercial banks. The strategic decisions of the supply chain members are analyzed in relation to external interventions of the government. Subsequently, the impact of government incentives and penalties on these strategic choices is considered. The results show that government incentives can promote SMEs' choice to use pollution control strategies, and government penalties can reduce the risk of an SME defaulting, thus promoting the healthy development of a green supply chain finance system. Furthermore, increasing the new income of SMEs, raising the guarantee rate of core enterprises, and reducing the cost of green loans reviewed by banks and the guarantee cost of core enterprises can effectively promote the equilibrium of the tripartite evolutionary game. These findings indicate that the game model introduced here can effectively solve the environmental pollution problems of SMEs and promote the healthy development of a green supply chain finance system.

Can China's carbon trading policy improve the profitability of polluting firms: a retest of Porter's hypothesis

The future trends and development trajectory of China's carbon emissions trading scheme (ETS), one of the key policy instruments for curbing peak carbon emissions and achieving carbon neutrality, have drawn a lot of interest. However, the Porter hypothesis (PH) and its validity boundary have not been explored sufficiently. We use micro-firm data from 2010 to 2019 to investigate whether the triple-difference (DDD) method could reveal the weak PH on the policy viewing ETS as a quasi-natural experiment in this work. Meanwhile, we use the panel threshold model and the moderated mediation effect model to assess the scientific border of the PH on the ETS. The findings show that by verifying the weak PH, the ETS may greatly enhance investment and foster the inventiveness of heavy-polluting industries (HPE). In contrast, the strong PH on the ETS has unstable validity and has non-linear characteristics. In particular, the ETS shows a U-shaped link between innovation and profitability by first decreasing and then increasing HPE's profitability through R&D. The cost of R&D and compliance costs being combined negatively impacts HPE's profitability. Further analysis shows that ETS will have different effects on the profitability of HPE due to R&D level and the threshold change of the compliance cost. This paper will offer some insightful points of view for the implementation of carbon market mechanisms in developing nations like China.

Selection of outsourcing logistics providers in the context of low-carbon strategies

As more attention is given to climate change and sustainable development in China, enterprises start to care about carbon emissions related to their supply chains. One important issue faced by an enterprise is to select a logistics provider who can provide a high-quality service with low carbon levels. To solve this issue, this paper proposes a selection criterion from the perspective of low carbon levels based on previous studies. The selection criterion consists of comprehensive strength, financial status, market competitiveness, development potential and low carbon level. Next, this paper applies a combined method of information entropy and grey correlation vlsekriterijumska optimizacija i kompromisno resenje (VIKOR) model to evaluate the proposed selection criterion. Subsequently, this paper took company S and its four logistics providers as a case study to check the applicability of our proposed selection method and to illustrate how to use it. Sensitivity analysis and comparative analysis are also conducted. Related managerial insights are also proposed based on the evaluation results. One finding of this paper is to establish a decision-making framework to evaluate logistics suppliers under the new background of 'emission peak and carbon neutrality'.

The local-neighborhood effects of low-carbon city pilots program on PM2.5 in China: A spatial difference-in-differences analysis

Using the balanced panel of 260 cities in China from 2005 to 2018, this study explores the local-neighborhood effects of the low-carbon city pilots (LCCPs) program on PM_2.5 concentration by utilizing the spatial difference-in-differences (SDID) method. The results show that the LCCPs program can not only reduce the local PM_2.5 concentration but also effectively alleviate the smog pollution in neighboring cities. The reduction effect of LCCPs on PM_2.5 in local cities is more significant in central and western areas, second-tier and above cities and resource-based cities. Nevertheless, the spillover effect on neighboring cities is more significant in central and western areas, third-tier and below and non-resource-based cities. In addition, the impact of policy is mainly through green innovation, while the intermediary role of industrial structure upgrading is not significant. These findings can provide useful policy inspiration for scientifically implementing air pollution prevention and control actions and winning the battle to defend the blue sky.

A nomogram for predicting overall survival in patients with type II endometrial carcinoma: a retrospective analysis and multicenter validation study

OBJECTIVE

Type II endometrial cancer (EC) is associated with high risk of metastasis and poor prognosis. We aimed to develop a nomogram for predicting survival probability in patients with type II EC.

PATIENTS AND METHODS

Data from a total of 4,117 patients with confirmed type II EC were pulled from the Surveillance, Epidemiology, and End Results (SEER) database, and were randomly divided into a training set and an internal verification set. A nomogram was constructed based on the training set. The concordance index (C-index), area under the ROC curve, and calibration plots were used to evaluate the identification and calibration of the nomogram. The SEER internal validation set and the Chinese multicenter data set (74 patients) were used to verify discriminations and corrections of the model.

RESULTS

Multivariate analysis indicated that age, marital status, tumor size, T stage, N stage, M stage, surgery, radiotherapy, and chemotherapy were independent factors affecting the prognosis of type II EC patients (p<0.001). The corresponding nomogram has showed excellent calibration and discrimination (C-index [95% CI], 0.752 [0.738-0.766]). The model was verified in the internal verification set (0.760 [0.739-0.781]) and the Chinese multicenter set (0.784 [0.607-0.961]). In addition, the AUC further confirmed the accuracy of the nomogram in predicting survival. The calibration curve of OS within 5 years confirmed good calibration of the nomogram.

CONCLUSIONS

This model and the corresponding risk classification system may provide useful tools for clinicians to evaluate the long-term prognosis of patients and carry out personalized clinical evaluation.

Association between Household Solid Fuel Use and Sarcopenia Risk among Middle-Aged and Older Adults in China: A Nationwide Population-Based Cohort Study

BACKGROUNDS

Household solid fuel have been associated with changes of handgrip strength, and exposure to ambient air pollution might be one risk factor of sarcopenia. However, the prospective association between household solid fuel use and sarcopenia remains limited.

METHODS

A total of 11,924 participants (5,723 men (48%) and 6,201 women (52%) with the average age was 59.17 ± 9.57 years) from the China Health and Retirement Longitudinal Study 2011 were included in cross-sectional analyses. 7,507 participants at baseline were included in longitudinal analyses and were followed up in 2015. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria.

RESULTS

In cross-sectional analyses, the participants who used solid fuel for cooking and heating had higher prevalence of sarcopenia than those who used clean fuel. During the follow-up, 302 (4.02%) participants experienced sarcopenia. In the longitudinal analysis, after multivariable adjustment of age, sex and other risk factors, individuals who used solid fuel for cooking had an elevated risk of new-onset sarcopenia, with corresponding odds ratio of 1.32 (95% confidence interval, 1.03-1.71). Consistently, individuals reported solid fuels use for heating were associated with 20% (odds ratio=1.20, 95% confidence interval: 1.01-1.56) increased risk of sarcopenia. In addition, a self-reported switch from clean to solid fuel for cooking appeared to have an increased sarcopenia risk (odds ratio=1.20, 95% confidence interval: 1.02-1.43).

CONCLUSION

Using household solid fuel for cooking and heating was associated with increased risk of sarcopenia prevalence and incidence.

Dynamics of the sheltering role of Bitcoin against crude oil market crash with varying severity of the COVID-19: A comparison with gold

This paper studies evolution of the asymmetric sheltering role of Bitcoin compared to gold against oil-related uncertainties with varying severity of the COVID-19 pandemic. Using a varying-coefficient quantile approach, we find a safe haven role of Bitcoin, and it becomes gradually stronger when the pandemic intensifies. The relationship between gold and oil markets is shown to vary with changing severity of the pandemic. We find that gold acts as an increasingly weakened diversifier as the pandemic intensifies until a level, above which its diversification gains would dissipate then. In normal market conditions, both Bitcoin and gold perform as weak hedges for oil portfolios. Our findings demonstrate that interpretation of the sheltering role of Bitcoin and gold against oil market downturns would be biased unless the role dynamics in different market conditions and pandemic severity are considered. Additional analyses reassure robustness of our findings.

Market implied volatility and natural disasters: international evidence

Using daily data, we provide fresh international evidence that an occurrence of natural disaster is accompanied by an increase in the market implied volatility of the main equity index in the same country contemporaneously and in the future. The relation between market implied volatility and natural disaster is a short-run relationship, mainly driven by the subsample of countries with a low frequency of disaster or with developed financial markets. Our analysis shows that in contrast to ex post volatility measures, implied volatility can reflect more climate physical risk information, which provides insight for multinational equity investment in coping with environmental physical risk. Our findings provide insight for multinational equity investment in coping with climate physical risk.

Exploring the bidirectional causality between green markets and economic policy: evidence from the time-varying Granger test

The vigorous development of green markets and the effective mitigation of economic policy fluctuations are current hotspots that intrigue our interest in exploring the causal relationships between green market returns and economic policy uncertainty (EPU). Green bonds, corporate environmental responsibility, green technology investment, and the carbon trading market are our research objects to comprehensively understand the interaction among them, from both macro and micro perspectives. Considering the importance of temporal heterogeneity and spillover direction in causation, we employ the time-varying Granger causality method to obtain bidirectional real-time identification. We find that green market returns exhibit a time-varying bidirectional causality with EPU over most of the sample period. In contrast, green markets are more a risk spillover than a recipient. Notably, this causality is vulnerable to exogenous financial risks, especially structural changes caused by the COVID-19 pandemic. Overall, this paper provides insights into the deep-seated causes of price fluctuations, volatile market uncertainty, and the interaction mechanism between them, as well as implications for market participants and policymakers.

TOP2A inhibition reverses drug resistance of hepatocellular carcinoma to regorafenib

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death attributed to high frequency of metastasis and multiple drug resistance. We aim to examine the underlying molecular mechanism and to seek potential strategies to reverse primary/acquired resistance to regorafenib. Topoisomerase IIα (TOP2A) is critical for tumorigenesis and carcinogenesis. Clinically, high-TOP2A expression was correlated to shorter overall survival (OS) of patients, but its role in drug resistance of HCC remains unknown. Here, we screened the expression profiling of TOP2A in HCC and identified TOP2A as an upregulated gene involved in the resistance to regorafenib. Sustained exposure of HCC cells to regorafenib could upregulate the expression of TOP2A. Silencing TOP2A enhanced HCC cells' sensitivity to regorafenib. TOP2A inhibition by doxorubicin or epirubicin synergized with regorafenib to suppress the growth of sorafenib-resistant HCC tumors that possessed the sorafenib-resistant features both in vitro and in vivo. Thus, targeting TOP2A may be a promising therapeutic strategy to alleviate resistance to regorafenib and thus improving the efficacy of HCC treatment.

Can China's carbon emissions trading scheme achieve a double dividend?

To ensure the realization of carbon neutrality and emission peak, the Chinese government promulgated the pilot policy for an emissions trading scheme (ETS) in 2011 and gradually expanded the range of the pilot program. However, it has not been systematically studied whether this policy can achieve double dividend and its transmission mechanism. Based on the Porter hypothesis, this paper explores the impacts of an ETS on macro emission reduction and microeconomic performance, verifies the influence of an ETS on double dividend, and analyzes its transmission mechanism using a difference in difference (DID) model and mediation model. The results indicate that an ETS can reduce CO₂ emissions and remarkably improve the economic performance of the enterprises in the areas it is enacted. A double dividend has been realized, which verifies Porter's hypothesis. The mechanism test shows that from the macro perspective, the emission reduction effect of an ETS is mainly achieved by adjusting the energy structure and through local government regulations. In contrast, the mediation effect on the industrial structure is not apparent. From a micro perspective, an ETS mainly affects the economic situation of enterprises through cash flow and technological innovation. Moreover, the transmission effect of enterprises' low-carbon behavior is not apparent. Heterogeneity analysis shows that compared with Midwestern China, an ETS could reduce emissions by adjusting the energy structure in Eastern China. Also, compared with state-owned or large enterprises, an ETS helps improve the economic performance of small or non-state-owned enterprises through technological innovation. This paper provides empirical evidence from macro- and microperspective for evaluating an ETS, conducive to improving the top-level framework of China's future carbon market operation.

Tumor microenvironment and its clinicopathological and prognostic associations in surgically resected cutaneous angiosarcoma

PURPOSE

Cutaneous angiosarcoma (CAS) is a rare but typically aggressive malignant vascular neoplasm of the skin. Tumor microenvironment (TME) of CAS and its associations with baseline clinicopathological features and patient outcomes are very important, especially when considering the recent advances in understanding of the tumor biology.

METHODS/PATIENTS

We retrospectively reviewed medical records of patients who underwent surgical resection for CAS at a tertiary Hospital. The pretreated specimens were evaluated by immunohistochemistry for programmed cell death protein 1 (PD-1) and its ligand (PD-L1), densities of tumor infiltrative lymphocytes (TILs) (CD3+, CD4+, CD8+, CD45RO+, FoxP3+), as well as c-MYC and Ki-67 expressions. Overall survival (OS) was estimated by Kaplan-Meier method and compared with Log-rank test.

RESULTS

A total of 21 CAS patients were identified. Median age was 67 (ranges: 20-81) years, 14 (66.7%) were male, and over 50% had lesions of scalp. Histopathological examination showed a predominantly spindle cell type (57.1%). All patients underwent surgery, 16 (76.2%) were treated further. PD-L1 was positively stained (> 1%) in tumor cells (42.9%) and TILs (23.8%). PD-1 expression (> 1%) was identified in TILs of 11 (52.4%) cases. PD-1/PD-L1 expressions were significantly associated with the higher densities of CD3+, CD4+, CD8+, CD45RO+, and Foxp3+ TILs, but not with patient characteristics or c-MYC or Ki-67 expression. Median OS was 18.5 months (95% CI 6.0-35.9), although no prognostic significance was observed with respect to any clinicopathological features.

CONCLUSION

We characterized TME and its clinical and prognostic association in CAS. PD-1/PD-L1 expressions were significantly associated with TILs subtypes but not with OS.

Gold or Bitcoin, which is the safe haven during the COVID-19 pandemic?

This study compares the dynamic spillover effects of gold and Bitcoin prices on the oil and stock market during the COVID-19 pandemic via time-varying parameter vector autoregression. Both time-varying and time-point results indicate that gold is a safe haven for oil and stock markets during the COVID-19 pandemic. However, unlike gold, Bitcoin's response is the opposite, rejecting the safe haven property. Further analysis shows that the safe-haven effects of gold on the stock market become stronger when the pandemic critically spreads.

Finger touching combined X-ray-guided percutaneous nephrolithotomy in 640 cases: an 8-years' experience

OBJECTIVE

We aimed to evaluate the safety and efficacy of finger touching combined X-ray-guided percutaneous nephrolithotomy, and the feasibility of avoiding damage in medical staff caused by X-ray.

PATIENTS AND METHODS

From January 2013 to December 2020, 640 cases of percutaneous nephrolithotomy were performed through the 18-24-F channel. Among those cases, 22 (3.4%) cases were double-sided kidney stones surgeries, 294 (45.8%) cases were on the right side and 324 (50.5%) cases were on the left side. The targeted renal calyceal puncture was carried out under the combined guidance of the doctor's finger and X-ray. We assessed the X-ray exposure time of patients and doctors, average number of punctures, postoperative hospitalization, calculus removal rates, and complications.

RESULTS

The average number of punctures was 2.8 ± 1.4. Average X-ray exposure time during procedure: 2.8 s (range: 2-8 s). Average surgical time: 106.5 ± 49.4 min. Postoperative hospitalization: 6.8 ± 4.2 d. Average reduced hemoglobin level: 5.9 g/day. Stone-free rate 4 weeks after surgeries: 95.6%. Patients with upper ureteral calculi: 395 cases (61.72%). The calculus residual rate of patients with staghorn renal calculi or multiple renal calculi complementary treatments was 82.9%, including 0 patients who received shock wave lithotripsy, 2 cases of repeated percutaneous nephrolithotomy (PCNL), and 18 cases of ureteroscopy. Postoperative placement of renal drainage tube occurred in 52 cases. As for complications, no perirenal infection occurred, two severe bleeding complication cases occurred, and one case of colon perforation occurred.

CONCLUSIONS

Finger touching combined X-ray-guided percutaneous nephrolithotomy in patients with renal calculus is safe and can accurately guide the puncture without radiation hazards. The placement of a renal drainage tube was beneficial to reduce renal effusion, hematocele, and infections.

Assessing the impact of digital financial inclusion on PM2.5 concentration: evidence from China

Digital finance as a new technology-driven business model shortens the distance between borrowers and lenders. Economic research finds that digital finance promotes economic efficiency by reducing transaction costs, information asymmetry, and inequality. Digital finance is an energy-intensive industry; therefore, increased efficiency in the industry should yield environmental benefits. We examine the externality of digital finance on air pollution. By analyzing data on digital financial inclusion and fine particulate matter concentration in China, we demonstrate using a dynamic panel data model that the development of digital finance damages the environment. However, after incorporating a threshold effect into a kink model, we determine that digital finance reduces pollution when its development exceeds a certain level. The results suggest that a high level of digital finance development not only increases economic growth but also improves air quality; this result provides novel insight into the relationship between economic growth and the environment.

Exploring the real contribution of socioeconomic variation to urban PM2.5 pollution: New evidence from spatial heteroscedasticity

Making cities safe, resilient and sustainable is one of the United Nations Sustainable Development Goals (SDGs). Health risk, productivity loss and climate change caused by air pollution obstacles the present urban sustainable development, especially people living in middle-and low-income countries areas are most affected. The spatial models (such as SAR and SEM) are often considered to examine the driven factors and the spatial spillover effect of PM_2.5 concentrations. Given that these spatial models assume spatially dependent second-order moments of the dependent variable without considering the possible autoregressive conditional heteroscedasticity. This present study empirically examines the heterogeneous effects of economic development, secondary industry, FDI, population density, number of buses and urbanization on PM_2.5 concentrations in 269 Chinese cities using the SAR, spARCH and SARspARCH, respectively. This newly proposed Spatial ARCH model is the first attempt to be applied to environmental research. The empirical results indicate that an increasing spatial correlation with PM_2.5 concentration was observed among 269 cities during 2004-2016, and the most influential cities in high-high clustering are mainly located in North China. Furthermore, except for population density, the effects of other factors are heterogeneous on the time scale. Among those socioeconomic factors, population density shows the largest contribution to urban PM_2.5 pollution, the effects of secondary industry, GDP and FDI may be overestimated in the absence of spatial neighbouring effects in mean or variance. The comparative analysis could provide new enlightenments for a deeper understanding of the socioeconomic impact on PM_2.5 pollution.

OP18 Efficacy and safety of filgotinib for the treatment of perianal fistulizing Crohn’s Disease: Results from the phase 2 DIVERGENCE 2 study

Background

Treatment of perianal fistulizing Crohn’s disease (PFCD) is a major unmet need. Filgotinib (FIL) is a once-daily, oral, preferential Janus kinase 1 inhibitor in development for the treatment of inflammatory bowel diseases. The efficacy and safety of FIL for the treatment of PFCD was evaluated in the phase 2, double-blind, randomized, placebo (PBO)-controlled DIVERGENCE 2 study (NCT03077412).

Methods

Patients (18–75 years old) with PFCD (documented diagnosis of CD for at least 3 months and 1–3 external openings [EOs] with drainage [spontaneous or on compression] for ≥ 4 weeks before screening) previously treated with antibiotics, immunomodulators and/or tumour necrosis factor inhibitors (TNFi) were randomized (2:2:1) to receive FIL 200 mg, FIL 100 mg or PBO once daily for up to 24 weeks. Active luminal CD was permitted providing that the Crohn’s Disease Activity Index score was ≤ 300 at screening. The primary endpoint was combined fistula response (reduction of ≥ 1 from baseline in the number of draining EOs determined by investigator assessment and no fluid collections > 1 cm on centrally read pelvic magnetic resonance imaging [MRI]) at Week 24. Combined fistula remission (closure of all draining EOs present at baseline and no fluid collections > 1 cm) at Week 24 was a key secondary endpoint. The study was not powered for statistical comparisons and was prematurely terminated owing to low recruitment rates during the COVID-19 pandemic.

Results

Baseline characteristics were broadly similar across the treatment groups (Table 1). Overall, 91.2% of patients had complex perianal fistulae and TNFi treatment had previously failed in 64.9% of patients. A lower proportion of patients randomized to receive FIL 200 mg discontinued the study compared with those who received PBO (Table 2). The proportion of patients who achieved a combined fistula response at Week 24 was numerically higher in the FIL 200 mg group (47.1%; 90% confidence interval [CI]: 26.0–68.9) than in the PBO group (25.0%; 90% CI: 7.2–52.7) (Figure 1), with similar results observed for combined fistula remission (FIL 200 mg [47.1%; CI: 26.0–68.9] versus PBO [16.7%; CI: 3.0–43.8]) (Figure 2). Treatment-emergent severe adverse events were highest in the FIL 200 mg group (Table 2). Adverse event rates were otherwise similar across treatment groups.

Conclusion

In this phase 2 study, numerically higher fistula response and remission rates were observed after 24 weeks of treatment with FIL 200 mg versus PBO in patients with active PFCD and a history of multiple medical treatment failures. FIL was well tolerated overall. Further studies of FIL for the treatment of PFCD are warranted.

Crude oil price uncertainty and corporate carbon emissions

Low-carbon transformation has become a key priority in China, as demonstrated in the implementation of the Carbon Peak, Carbon Neutralization policy, leading to increasing concern of environmental performance at the corporate level. This paper measures the carbon emission of 1,089 Chinese companies through the EIO-LCA-based approach. Then we examine the impacts of international crude oil price fluctuations and the corporate development level on carbon emissions of individual companies. Our results indicate that an increase in international crude oil price uncertainty could inhibit the company's carbon emission. In parallel, we find that there might exist an environmental Kuznets curve (EKC) inverted U-shaped correlation between the company's development level and its environmental performance. However, some exceptions to corporate carbon performance may emerge, resulting from specific corporate characteristics such as the state-owned nature and whether the firm is listed on the stock exchange. Our results could help companies optimize their internal carbon emission structure during the low-carbon transition process and contribute to effective policy regulations towards the target of carbon reduction.

Antimicrobial and anti-dust mite efficacy of Cinnamomum camphora chvar. Borneol essential oil using pilot-plant neutral cellulase-assisted steam distillation

Cinnamomum camphora chvar. Borneol essential oil (BEO) was efficiently extracted by using pilot-plant neutral cellulase-assisted steam distillation (NCSD). Borneol, β-cadinene and α-caryophyllene were identified as major components. Bacillus subtilis was the most sensitive bacteria to BEO with the lowest minimal inhibition concentration (MIC) and minimal bactericial concentration (MBC) at 1·75 and 3·50 mg ml^-1 , respectively. Antimicrobial activity of the BEO was also reasonably high against Salmonella typhimurium, Escherichia coli and Staphylococcus aureus, but not sensitive against two fungi, i.e. Aspergillus niger and Penicillium aurantiogriseum. Changes in permeability and integrity of cell membrane, damage of cell wall and further leakage out of metabolites and ions were determined as bactericidal mechanisms of BEO against the two gram-positive bacteria. The BEO showed a reasonably high repelling activity of dust mite, which achieved higher than 95% repelling dust mite activity after the treatment of BEO solution at 0·50 mg ml^-1 . When the concentration of BEO was higher than 0·50 mg ml^-1 , it was B-grade miticide with miticidal activity higher than 95%. Miticidal procedures were characterized as excitation, contraction, relaxation and lastly leading to the death of dust mite. It is speculated that the BEO would cause dehydration and death of dust mite as neuromuscular toxicity.

Prevalence, predictors, and clinical prognosis of macrophage infiltrates in patients with ST-segment elevation myocardial infarction caused by plaque erosion as assessed by OCT

Background

Autopsy series showed that one of most common plaque phenotypes underlying coronary thrombi was plaque erosion. Identification of erosion may permit a less invasive management. Chronic inflammation is a common process in atherosclerosis. The severity of plaque inflammation can be assessed by optical coherence tomography (OCT) defined macrophages density. The impact of macrophage infiltrates (MØI) in ST-segment elevation myocardial infarction (STEMI) patients caused by plaque erosion was still unknown.

Purpose

The aim of this study was to evaluate plaque morphology and clinical prognosis associated with MØI as assessed by optical coherence tomography in STEMI patients caused by plaque erosion.

Methods

From October 2014 to December 2017, 1561 STEMI with OCT imaging before percutaneous coronary intervention were enrolled in this study. Finally, 312 STEMI patients caused by plaque erosion were split into two group according to the presence of MØI in culprit eroded plaques.

Results

163 (52.2%) STEMI patients presented plaque erosion with MØI, whereas 149 (47.8%) patients had no evidence of MØI. MØI were more frequency appeared in older patients (p=0.015). The severity and vulnerability of culprit lesions were higher in patients with MØI characterized by more aggressive and vulnerable features. Patients with MØI had worse long-term prognosis, compared with patient without MØI, mainly driven by a higher rate of target lesion revascularization (p=0.046), especially in STEMI patients presented plaque erosion with intensive antiplatelet therapy (p=0.035).

Conclusions

In the present study, we demonstrated that macrophage infiltrates at the site of erode plaques were associated with severity and vulnerability of culprit lesions. The long-term prognosis in patients with MØI were poorer especially in patients without stent implantation.

Funding Acknowledgement

Type of funding sources: None. Study flow chartPredictors of plaque erosion with MØI