Search Results (1,501)

Specialized, Refined, Unique and Novel (SRUN) listed firms are pivotal to the high-quality development of China’s real economy, and their growth quality underpins the security of industrial and supply chains. This study empirically examines the relationship between R&D investment persistence and growth quality of Chinese A-share SRUN listed firms from 2006 to 2024, with technology conversion efficiency as the mediating variable. R&D investment persistence is measured from the dual dimensions of investment intensity and stability, and firm growth quality is a comprehensive indicator constructed via principal component analysis (PCA) from revenue growth, profitability and risk resilience. Panel data regression models, combined with mechanism, endogeneity, robustness and heterogeneity tests, are adopted for empirical analysis. The results show a significantly positive correlation between R&D investment persistence and SRUN firms’ growth quality, with the regression coefficient of R&D investment persistence on growth quality reaching 0.189 (p < 0.01); both investment intensity and stability exert significant positive effects on all dimensions of growth quality, with their regression coefficients on growth quality being 0.156 and 0.132 (both p < 0.01) respectively. Technology conversion efficiency plays a partial mediating role in this relationship, with the mediating effect ratio of R&D investment persistence on growth quality through technology conversion efficiency at 34.2%, as R&D investment persistence indirectly improves growth quality by enhancing patent output and new product conversion efficiency. Heterogeneity analysis indicates that this positive correlation is more pronounced in high-tech industries, small and medium-sized enterprises (SMEs) and eastern China-based firms, driven by differences in industrial R&D dependence, resource endowments and financing frictions. Though endogeneity is mitigated by instrumental variables, propensity score matching (PSM) and difference-in-differences (DID), strict causal identification is constrained by data availability. This study enriches the theories of R&D investment and firm growth, and provides empirical insights for SRUN firms to optimize their R&D strategies and for the government to formulate targeted support policies, so as to promote the high-quality development of SRUN firms and the transformation of China’s manufacturing industry. Full article

Background: The elderly are vulnerable to chronic diseases and altered lipid metabolism, leading to poor outcomes, including mortality. We investigated the association between Korean Medicine (KM) utilization, blood lipid levels, and health outcomes using the National Health Insurance Service Sample Cohort (NHIS-NSC) database. Methods: This retrospective cohort study included elderly participants who underwent health examinations (2009–2010). Participants were divided into KM and non-KM groups and matched 1:1 using propensity score matching (PSM) for age, sex, income, and comorbidities. Primary outcomes were mortality and disease diagnosis; secondary outcomes included medical spending and utilization. Results: After PSM, 13,044 subjects were analyzed. KM utilization was associated with a significantly lower risk of all-cause mortality (HR 0.93; 95% CI 0.87–1.00; p = 0.048). However, the hypolipidemia subgroup showed no significant differences in all-cause mortality and medical expenses compared to other lipid status subgroups. While the KM group showed a higher incidence of disease diagnosis (HR 1.09; 95% CI 1.04–1.14; p < 0.001), this may reflect increased healthcare engagement and proactive health-seeking behavior. Subgroup analysis revealed that statin users in the KM group had a significantly reduced mortality risk (HR 0.91; 95% CI 0.84–0.99; p = 0.022). Medical expenses and utilization were higher in the KM group. Being underweight or aged over 85 was associated with higher mortality. Conclusions: KM utilization is associated with reduced all-cause mortality after propensity score matching, particularly among statin users. Although KM users had a higher cumulative incidence of disease diagnosis, this potentially reflects increased diagnostic opportunities from prolonged survival. Hypolipidemia, underweight, and late-elderly status remain significant risk factors associated with frailty. KM may support improved survival in the elderly, warranting further prospective studies. Full article

The European Union’s Carbon Border Adjustment Mechanism (CBAM), the world’s first system to impose tariffs on the carbon emissions of imported products, commenced its transition period in October 2023 and is scheduled for full implementation in January 2026. This mechanism exerts a profound impact on the global trade landscape and corporate environmental management practices. Taking the CSI All Share Index constituent companies as a research sample, this paper empirically evaluates the impact of the CBAM transition period on the environmental scores of Chinese export enterprises utilizing the Propensity Score Matching Difference-in-Differences (PSM-DID) method. The results indicate that the CBAM transition period significantly inhibits the short-term environmental performance of regulated enterprises. Mechanism analysis reveals that increased financing constraints serve as a core mediating channel, wherein escalated compliance costs and compressed cash flows crowd out resources for low-carbon investments. Furthermore, heterogeneity analysis demonstrates that the negative impact is more pronounced among state-owned enterprises, firms with lower audit quality, and firms with a higher proportion of female executives. Accordingly, the study recommends establishing targeted green transition financing mechanisms, accelerating domestic carbon market reforms, and strengthening international technical harmonization to build corporate resilience against global climate governance shocks and promote sustainable growth. Full article

Background/Objectives: Plug-based vascular closure devices (Pb-VCDs) are routinely used in 14 and 18 French (F) size for percutaneous vascular access site closure during transfemoral transcatheter aortic valve replacement (TAVR). Recently, larger 18F Pb-VCDs were linked to increased incidence of vascular complications in randomized comparisons. Smaller 14F devices are hypothesized to decrease the incidence of vascular complications, but real-world data on their safety in routine clinical practice is scarce. Methods: We performed a retrospective, propensity score-matched comparison of patients receiving either 14F or 18F Pb-VCDs during TAVR from March 2019 to December 2020. The choice of 14F or 18F Pb-VCD utilization depended on the sheath size during the procedure. No other vascular closure systems (VCDs) were used despite the MANTA (Teleflex Inc.^®, Morrisville, NC, USA) Pb-VCD. The primary endpoints were major and minor vascular complications defined by valve academic research consortium-3 (VARC 3) criteria. Secondary endpoints included VARC-3 bleeding events, length of hospital stay and in-hospital mortality. Results: A total of 183 (14F Pb-VCD) and 110 (18F Pb-VCD) patients were included in 1:1 propensity score matching and resulted in 85 matched patient pairs. The primary endpoint of major and minor vascular complications was balanced between the groups (major: 3.5% (14F Pb-VCD) versus (vs.) 0.0% (18F Pb-VCD), p = 0.25; minor: 12.9% vs. 14.1, p = 1.00). Secondary endpoints of VARC-3 bleeding events (p = 1.00), length of hospital stay (p = 0.34), and in-hospital mortality (p = 1.00) were equally distributed. Conclusions: There is no difference in major and minor VARC-3-defined vascular complications between the 14F and 18F groups in our study. Following this real-world observational analysis, observed rates of vascular complications need to be validated in prospective controlled trials. Full article

Reduced levels of vitamin D are associated with increased incidence and mortality of sepsis. Nonetheless, the effectiveness of vitamin D supplementation in improving sepsis patients’ outcomes continues to be debated. In this research, which was conducted as a retrospective cohort analysis, data obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV 3.0) were used. The focus of the study was on vitamin D3 administration to sepsis patients while in the ICU. The primary outcome measurement was 28-day ICU mortality, with secondary outcomes of mechanical ventilation duration, percentage of patients receiving mechanical ventilation, and ICU stay length. The Kaplan–Meier curve analysis, Cox regression analysis, and subgroup analyses were performed to explore the link between vitamin D3 supplementation and sepsis prognosis. A 1:1 propensity score matching (PSM) approach was used to strengthen the reliability of the results. Before matching, the cohort comprised 28,524 patients, which was reduced to 4,856 after PSM. The analysis revealed that vitamin D3 supplementation was associated with a lower 28-day ICU mortality rate (HR = 0.71, 95% CI: 0.64–0.78, p < 0.001). Kaplan–Meier curve analysis revealed significantly greater survival probabilities in the group receiving vitamin D3 than in the group not receiving vitamin D3 (p < 0.001). Subgroup analysis showed that total cumulative exposure to vitamin D3 was more strongly associated with 28-day ICU mortality (p < 0.001), whereas daily dose and dosing frequency showed no significant association. The results after PSM and subgroup analysis were consistent with those of the original cohort study, further confirming the robustness of the results. Overall, vitamin D3 supplementation is associated with lower 28-day ICU mortality and better outcomes in patients with sepsis. However, given the retrospective observational design, large-scale prospective randomized controlled trials are warranted to validate these observational associations and establish causal effects. Full article

Background and Objactives: Metformin is the most widely prescribed glucose-lowering therapy worldwide and is generally considered safe in patients with chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m². However, very elderly patients are underrepresented in pivotal trials, and evidence on metformin safety in this vulnerable population remains limited. We evaluated the association between metformin use and adverse clinical outcomes in very elderly patients with CKD and type 2 diabetes. Materials and Methods: We conducted a single-center retrospective observational study including 624 very elderly patients (age > 78 years) with CKD, type 2 diabetes mellitus, and eGFR > 30 mL/min/1.73 m². Patients were stratified according to metformin exposure (309 metformin-treated and 315 controls). The primary composite outcome was the first occurrence of intensive care unit (ICU) admission, initiation of renal replacement therapy (RRT), lactic acidosis, or all-cause mortality. A propensity score-matched sensitivity analysis and hierarchical win ratio analysis were also performed to further address potential baseline confounding. Results: Over a median follow-up of 33.7 months, the primary composite outcome occurred more frequently in the metformin group than in controls (18.7% vs. 9.5%; HR 1.75; 95% CI 1.12–2.73; p = 0.013). Metformin use was associated with a higher risk of ICU admission (HR 2.33; 95% CI 1.33–4.08), RRT initiation (HR 1.90; 95% CI 1.14–3.16), and lactic acidosis (HR 3.14; 95% CI 1.75–5.65). All-cause mortality was numerically higher but not statistically significant (HR 1.57; 95% CI 0.89–2.78). In a propensity score-matched analysis including 260 matched pairs, the association between metformin exposure and adverse outcomes remained consistent, and hierarchical win ratio analysis favored the control group (win ratio 2.00; 95% CI 1.24–3.47). Conclusions: In very elderly patients with CKD and type 2 diabetes, metformin use was associated with a higher observed risk of adverse clinical outcomes. These findings support a cautious, individualized risk–benefit assessment when prescribing metformin in this population. Full article

Atmospheric pollutants and CO₂ share common origins in fossil fuel combustion, raising the question of whether fiscal incentives targeting air quality alone can indirectly reduce carbon emissions. This study examines this question by evaluating China’s air quality ecological compensation policy, a provincial-level horizontal fiscal transfer mechanism under which cities are rewarded or penalized according to changes in ambient air quality indicators, without incorporating any explicit carbon-related assessment criteria. Using panel data from 268 prefecture-level cities over 2007–2023 and a multi-period difference-in-differences design, we find that the policy significantly reduces the composite pollution carbon index (β = −0.213, p < 0.01), with the effect confirmed by an alternative weighted-average specification (β = −0.153, p < 0.01) and robust to propensity score matching, one-period lagged regression, exclusion of provincial-level municipalities, and exclusion of the COVID-19 period. A two-step mechanism analysis, adopted to avoid post-treatment bias from “bad controls,” reveals that the policy promotes industrial structure upgrading (β = 0.253, p < 0.01), enhances green technological innovation capacity (β = 0.047, p < 0.10), and reduces energy consumption intensity (β = −0.012, p < 0.01). Heterogeneity analysis based on quartile subsamples shows that the synergistic benefits concentrate in cities with stronger fiscal capacity (β = −0.349, p < 0.01 versus insignificant for low-support cities), higher economic development, and greater urbanization (β = −1.558, p < 0.01 for highly urbanized cities), while the policy effect is statistically insignificant in the least-advantaged subgroups across these three dimensions. In contrast, the green coverage dimension reveals an opposite pattern: the effect is strongest in cities with lower green coverage (β = −0.378, p < 0.05) and insignificant in high-coverage cities, indicating diminishing marginal returns where environmental baselines are already favorable. These findings highlight the need for differentiated compensation standards, including tiered compensation coefficients and targeted fiscal support for resource-constrained regions, to ensure equitable governance outcomes. Full article

The reallocation of production factors, particularly labor, is central to understanding economic development and household welfare. This paper investigates how the transfer of farmland, a fundamental shift in factor endowment, affects rural household financial vulnerability, with a specific focus on the mediating role of labor mobility. While factor market liberalization is theorized to enhance efficiency, the micro-level pathways through which land transactions influence financial resilience remain underexplored. Utilizing a unique household survey dataset from Shaanxi Province, China, and employing ordered Probit model alongside propensity score matching (PSM), the impact of farmland transfer-out on the financial vulnerability of rural households is revealed. The results show that farmland transfer-out significantly reduces household financial vulnerability. Mechanism analysis confirms that this effect operates primarily by releasing surplus agricultural labor and promoting its shift into non-farm employment, thereby expanding both the sectoral and geographic scope of household labor supply. Heterogeneity analysis further reveals that the responsiveness of labor mobility to land transfer is more pronounced among households with older heads, higher human capital, and stronger social networks. However, the ultimate mitigating effect on financial vulnerability is consistent across diverse household types. These findings contribute to the literature on factor market integration and household finance in developing economies and offer direct policy implications for designing land institutions and labor policies that synergistically enhance rural economic resilience. Full article

Background/Objectives: Perioperative blood transfusion (BTF) remains controversial regarding its impact on oncological outcomes in colorectal cancer (CRC). This study aimed to evaluate the association between BTF, transfusion volume, and long-term prognosis in CRC patients undergoing radical resection. Methods: We conducted a retrospective cohort study of 1777 CRC patients who underwent radical surgery at the Fourth Hospital of Hebei Medical University between December 2007 and April 2015. Propensity score matching (PSM) was applied to minimize selection bias between BTF and non-BTF groups. Logistic regression identified factors associated with BTF receipt. Cox proportional hazards models assessed the association between BTF and 5-year overall survival (OS). X-tile analysis determined optimal cut-off values for transfusion volume stratification. Results: Among 1777 patients, 729 (41.02%) received BTF. After PSM, 524 well-matched pairs showed balanced baseline characteristics. Intestinal obstruction was independently associated with BTF requirement (p < 0.001). The BTF group demonstrated significantly inferior 1-, 3-, and 5-year OS compared with non-BTF groups in both overall and PSM cohorts (all p < 0.01). Multivariate Cox analysis identified BTF as an independent adverse prognostic factor (HR = 1.44, 95% CI 1.09–1.89, p = 0.01). X-tile analysis stratified patients into non-BTF, small-volume (≤4 units), and massive-volume (>4 units) groups. Massive-volume transfusion showed the poorest survival outcomes (p < 0.0001) and was independently associated with worse OS (HR = 1.61, 95% CI 1.18–2.20, p = 0.003). Supplementary analyses indicated that no independent association was observed between survival outcomes and either preoperative inflammatory markers or the specific timing and type of transfusion. Conclusions: BTF, particularly when exceeding 4 units, independently predicts inferior long-term survival in CRC patients following radical resection. These findings support the implementation of restrictive transfusion strategies in perioperative CRC management. Given its retrospective observational design, this study shows an association but does not establish causality, and our findings should be interpreted in light of the aforementioned limitations. Full article

Postural sway derived from center-of-pressure (CoP) trajectories is widely used to assess balance and fall risk in older adults, but conventional linear metrics mainly quantify sway magnitude and may overlook temporal organization. Guided by the loss-of-complexity hypothesis, we re-examined associations between fall history and linear and non-linear CoP metrics in an open-access dataset. Quiet-standing trials under eyes-open and eyes-closed conditions were analyzed in adults ≥60 years (fallers n = 19; non-fallers n = 57). To reduce confounding, propensity score matching was performed using age, sex, body mass index, activities of daily living level, illness status, number of medications, disability status, and orthosis/prosthesis use. Linear and non-linear indices, including recurrence quantification analysis, detrended fluctuation analysis, fractal dimension, multiscale entropy, stabilogram diffusion analysis, and sway density measures, were examined. After matching, no CoP metric differed significantly between groups. However, SHAP-based exploratory analysis suggested that non-linear features related to temporal structure and multiscale organization contributed more prominently to model output than conventional magnitude-based metrics. Given the limited sample size, these findings should be interpreted as exploratory and hypothesis-generating. Full article

Background: Neoadjuvant chemoradiotherapy (nCRT) followed by surgery has become the standard treatment for oesophageal cancer. However, data on the outcomes of neoadjuvant immunochemotherapy (nICT) in geriatric patients (≥70 years) who face higher perioperative risks are limited. Objective: This study aimed to compare the perioperative outcomes of nICT versus nCRT in elderly patients with locally advanced oesophageal squamous cell carcinoma (ESCC). Method: This retrospective cohort study included 132 geriatric patients (median age: 72 years) treated with nICT (n = 51) or nCRT (n = 81) followed by esophagectomy at Sichuan Cancer Hospital (2021–2024). Intraoperative outcomes, postoperative pathologic stages, and complications, including pneumonia and anastomotic leakage, were assessed. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were used to adjust for baseline covariate imbalances in the sensitivity analysis. Results: Pathologic ypT0 stage tended to be higher in the nCRT group (p = 0.014), whereas ypN0 was higher in the nICT group (p = 0.035). No significant differences in intraoperative or postoperative outcomes between the two groups, except for pulmonary complications (p > 0.05). Compared with nCRT patients, nICT patients had significantly lower pulmonary complication rates (13.7% vs. 32.1%, p = 0.030), and multivariable analysis confirmed these findings (adjusted OR = 0.26; 95% CI: 0.08–0.85; p = 0.026). Sensitivity analyses showed consistent results. Conclusions: The safety of nICT is comparable to that of nCRT in geriatric ESCC patients, with significantly fewer pulmonary complications. These findings support nICT as a valuable alternative for elderly populations. Full article

Eco-industrial development not only reduces pollutant emissions but also effectively addresses ecological and environmental pressures. Using panel data for 276 Chinese cities from 2006 to 2021, this study employs a Difference-in-Differences model combined with the Propensity Score Matching method to empirically examine the impact of eco-industrial development on air pollution, taking China’s National Eco-Industrial Demonstration Parks as the empirical setting. The analysis further includes robustness tests, heterogeneity analyses, and mechanism examinations focusing on green innovation and green investment. The results show that: (1) the establishment of National Eco-industrial Demonstration Parks significantly reduces PM_2.5 emissions and improves environmental quality in host cities; (2) eco-industrial development mitigates air pollution by promoting green innovation and enhancing green investments; (3) the pollution reduction effect of eco-industrial development is more pronounced in central and western cities, industrial cities, open cities, and regions with lower levels of green development. Full article

Objectives: This study aimed to investigate the impact of TDs on the survival of patients with locally advanced rectal cancer (LARC). Additionally, we propose a novel staging method that combines TDs and lymph node metastases (LNMs) to enhance prognostic accuracy. Methods: Patients with LARC were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database and a Sun Yat-sen University (SYSU) cohort. Propensity score matching (PSM) was utilized to minimize selection bias when evaluating TDs. We quantitatively stratified TDs counts and integrated them with regional LNMs to formulate a novel tumor node metastasis (TNM) staging system. Furthermore, a prognostic nomogram incorporating TDs was constructed and validated to predict survival. Results: Overall, 19,991 patients were included in the SEER database, with 2667 (13.3%) TDs-positive and 17,324 (86.7%) TDs-negative tumors. After PSM, multivariate Cox analysis reveals that TDs are an independent adverse prognostic factor (HR = 1.521, 95% CI: 1.366–1.693, p < 0.001). Patients with high-risk group (TDs > 4) at any TNM stage exhibit OS comparable to or worse than that of stage IIIC disease. For patients staged as T4N2M0, the high-risk group (TDs > 4) demonstrates OS equivalent to stage IV disease. The nomogram achieved C-indices of 0.713 (training cohort, n = 8586) and 0.789 (external validation cohort, n = 304), with AUCs of 0.774 (3-year) and 0.710 (5-year). Conclusions: The presence of TDs is associated with poorer OS, and integrating TDs with LNMs improves the accuracy of TNM staging. The nomogram (C-index = 0.789) provides enhanced prognostic stratification and survival prediction. Full article

Introduction and Objectives: There is limited evidence on the role of glucagon-like peptide-1 receptor agonists in the interplay between cardiovascular disease, chronic kidney disease, and metabolic dysfunction. This work analyzed the efficacy and safety of once-weekly semaglutide in patients with cardiovascular-kidney-metabolic syndrome. Patients and Methods: This observational, real-world study included patients with heart failure, chronic kidney disease, obesity, and type 2 diabetes mellitus treated with once-weekly semaglutide (Sema-CKM Group) and patients not treated with glucagon-like peptide-1 receptor agonists (Control-CKM Group). A 1:1 propensity score matching analysis was performed. The two primary outcomes were heart failure events and major kidney disease events at 24 months. Results: After matching, 302 patients were included in each group. A heart failure event occurred in 63 patients (20.9%) in the Sema-CKM Group and 121 (40.1%) in the Control-CKM Group (OR: 0.80; 95%CI: 0.62–0.98; p < 0.01). The number of major kidney disease events was lower in the Sema-CKM Group than the Control-CKM Group (36 vs. 65; OR: 0.85; 95%CI: 0.72–0.98; p = 0.014). Patients in the Sema-CKM Group were more likely to have an improvement in heart failure health status from baseline to 24 months (OR: 2.80; 95%CI: 1.30–4.30; p < 0.01). Semaglutide also improved glycemic control (glycated hemoglobin −0.7%) and reduced body weight (−9.3 kg). Conclusions: Once-weekly semaglutide was associated with reductions in heart failure events and major kidney disease events in patients with heart failure, chronic kidney disease, obesity, and type 2 diabetes mellitus. Further research on glucagon-like peptide-1 receptor agonists in cardiovascular-kidney-metabolic syndrome is needed. Full article

Background/Objectives: Gastric-type endocervical adenocarcinoma (G-EAC) is a rare, aggressive, and HPV-independent subtype of cervical cancer with a poor prognosis. Due to its rarity, existing literature is often limited by small sample sizes, which hinders the development of evidence-based clinical management strategies. This study aims to evaluate the clinicopathological features, prognostic factors, and responses to postoperative adjuvant therapy in a large cohort of G-EAC patients compared with those with usual endocervical adenocarcinoma (UEA). Methods: We conducted a nested case–control study within a prospectively maintained surgical cohort at a national referral center in China. The study population included 195 pathologically confirmed G-EAC cases and 765 UEA cases. Patients were followed longitudinally with comprehensive clinical and survival data collection. One-to-one propensity score matching (PSM) was performed to balance demographic, clinical, and treatment variables between the groups. Survival outcomes were compared using Kaplan–Meier analysis, and independent prognostic factors were identified via Cox regression. Results: G-EAC patients demonstrated significantly worse survival outcomes than matched UEA patients, with 3-year progression-free survival (PFS) of 66.1% vs. 79.8% (p = 0.014) and 3-year overall survival (OS) of 74.9% vs. 84.6% (p = 0.033). Parametrial involvement and pelvic lymph node metastasis were identified as independent risk factors for both recurrence and death (p < 0.05). Regarding adjuvant treatment, combined radiotherapy and chemotherapy significantly improved survival compared with single-modality treatments (PFS: 65.2% vs. 43.6%; OS: 74.3% vs. 54.5%; p < 0.05); however, G-EAC remained less responsive to these therapies than UEA. Conclusions: G-EAC exhibits more aggressive clinical behavior and poorer survival outcomes compared to UEA. While combined radiotherapy and chemotherapy offer survival benefits, outcomes remain suboptimal. These findings underscore the urgent need for early detection strategies and the development of more effective targeted therapies for this specific subtype. Full article