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Background: Limited data evaluated the outcomes of extracorporeal membrane oxygenation (ECMO) in patients with prosthetic valves. This study aimed to compare the outcomes of ECMO support for postcardiotomy cardiogenic shock in patients with mechanical versus bioprosthetic valves. Methods: This retrospective study included patients with ECMO support for postcardiotomy cardiogenic shock after valve replacement. Patients were grouped into bioprosthetic (n = 49) and mechanical valve (n = 22) groups. Results: There were no differences in ECMO duration, inotropic support, intra-aortic balloon pump (IABP), stroke, duration of ICU, and hospital stay between groups. Postoperative thrombosis occurred in 2 patients with bioprosthetic valves (5.41%) and 2 with mechanical valves (14.29%), p =.30. All patients with thrombosis had central ECMO cannulation, concomitant IABP, and inotropic support during ECMO. All thrombi were related to the mitral valve. Three patients with thrombi had hospital mortality. Survival at 6, 12, and 36 months for bioprosthetic valve patients was 30.88%, 28.55%, and 25.34% and for mechanical valves was 36.36% for all time intervals (Log-rank p =.93). One patient had bioprosthetic aortic valve endocarditis after 1 year. Three patients with bioprosthetic valves had structural valve degeneration after 1, 2, and 5 years. Conclusions: Outcomes of ECMO in patients with prosthetic valves are comparable between bioprosthetic and mechanical valves. Thrombosis might occur in both valve types and was associated with high mortality. ECMO could affect the long-term durability of the bioprosthetic valves. [ABSTRACT FROM AUTHOR]

To ensure firm's survival through impermanent market turbulences, corporations need to secure investors' kindness and empathy to adjust their stock prices. Being environmentally responsible seems to be an appealing quality for that purpose. Our research aims to explore the association between firm greenhouse gas (GHG) emission and its downside tail risk, using panel data comprising the FTSE350 firms during the 2008-2018 period. We found that firms that emit more GHG are likely to be harshly penalized by the shareholders through the higher likelihood of extreme negative stock returns, i.e. tail risk. Intriguingly, the association tends to be evidenced after the Paris Agreement 2015 and for firms operating in industries with high emission intensity. The research provides implications for firms to focus on enhancing their environmental performances for higher market trust, rewards, and generosity, especially during their financial downturns or negative market events. [ABSTRACT FROM AUTHOR]

Background: The optimal venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulation strategy in patients with postcardiotomy cardiogenic shock is still debatable. Studies evaluating the effect of cannulation strategy on long-term survival are scarce. Objectives: We investigated the impact of central versus peripheral cannulation strategy for ECMO insertion on hospital outcomes and survival in postcardiotomy cardiogenic shock patients. Methods: This retrospective study involved 101 patients who had either central or peripheral ECMO due to postcardiotomy shock between June 2009 and December 2020. Study endpoints were limb ischemia, bleeding, blood transfusion, wound infection, and overall survival. Results: Eighty-four patients received central (c) ECMO, and 17 patients had peripheral (p) ECMO. In the group of pECMO, limb ischemia was significantly higher (5 [29.41%] vs 6 [7.14%]; p =.01). Other endpoints were similar in both groups. Thirty-day mortality was nonsignificantly different between both cohorts (cECMO 34 [41.67%] vs pECMO 10 [58.82%]; p =.29). However, overall survival was better with cECMO (Log-rank p =.02). Patients' age [HR: 1.04 (95% CI: 1.02–1.06); p =.001], pECMO [HR: 1.98 (95% CI: 1.11–3.55), p =.002] and presence of infective endocarditis [HR: 3.54 (95% CI: 1.52–8.24), p =.03] were significant predictors of overall mortality. Conclusions: Peripheral ECMO was associated with an increased risk of limb ischemia; however, bleeding, blood transfusion, infection, and 30-day mortality were comparable to central ECMO. Central cannulation was associated with a better 1-year survival rate. Therefore, central cannulation might be the preferred strategy for patients with postcardiotomy cardiogenic shock. [ABSTRACT FROM AUTHOR]

Embracing corporate sustainability has emerged as a crucial strategy for companies to bolster their competitive edge and reputation. This research delves into the connection between environmental, social, and governance practices (ESG) and the cost of debt, as well as the moderating role of financial distress within this connection. By analyzing data from Saudi-listed firms between 2013 and 2021, we discovered that ESG practices have a notable negative impact on borrowing costs. This implies that organizations with increased transparency in their ESG disclosure gain access to external financial resources under more favorable terms. Additionally, we observed that the effect of ESG on the cost of debt is significantly and negatively moderated by the financial distress encountered by a firm. To bolster the credibility of these findings, dynamic generalized method of moments (GMM) models were utilized to address any potential endogeneity concerns, thereby enhancing the strength and resilience of the outcomes. The findings of this paper hold substantial value for investors, lenders, corporate management, and policymakers when considering the implementation and significance of a company's ESG practices. [ABSTRACT FROM AUTHOR]

In recent years, many Real Estate Investment Trusts (REIT) have issued to initial public offerings (IPO) in the Saudi Stock Exchange "Tadawul." Occasionally, trust fund issuers such as REITs may face challenges in selling their shares to the public. One of the challenges related to underpricing is trading the stock on the first day of the market. This study investigates the relationship between REIT characteristics and share underpricing for a sample of REITs that are listed on the Saudi Stock Exchange "Tadawul." The purpose of the study is to focus on one of the challenges that is related to the IPOs of REITs. Using a sample of 17 IPOs of REITs listed on the Saudi Arabian Stock Exchange "Tadawul" for the period between 2016 and 2020, we show significant negative associations between the number of IPO underwriters, number of shares subscribed, and the firms' dividend payouts and REITs' underpricing. The result also shows a significant positive association between the number of subscription days and REITs' underpricing. The research should provide significant implications for regulators and market participants in the light of the public offering and the REIT sector. [ABSTRACT FROM AUTHOR]

Background. The Middle East respiratory syndrome (MERS) coronavirus causes isolated cases and outbreaks of severe respiratory disease. Essential features of the natural history of disease are poorly understood. Methods. We studied 37 adult patients infected with MERS coronavirus for viral load in the lower and upper respiratory tracts (LRT and URT, respectively), blood, stool, and urine. Antibodies and serum neutralizing activities were determined over the course of disease. Results. One hundred ninety-nine LRT samples collected during the 3 weeks following diagnosis yielded virus RNA in 93% of tests. Average (maximum) viral loads were 5 × 106 (6 × 1010) copies/mL. Viral loads ( positive detection frequencies) in 84 URT samples were 1.9 × 104 copies/mL (47.6%). Thirty-three percent of all 108 serum samples tested yielded viral RNA. Only 14.6% of stool and 2.4% of urine samples yielded viral RNA. All seroconversions occurred during the first 2 weeks after diagnosis, which corresponds to the second and third week after symptom onset. Immunoglobulin M detection provided no advantage in sensitivity over immunoglobulin G (IgG) detection. All surviving patients, but only slightly more than half of all fatal cases, produced IgG and neutralizing antibodies. The levels of IgG and neutralizing antibodies were weakly and inversely correlated with LRT viral loads. Presence of antibodies did not lead to the elimination of virus from LRT. Conclusions. The timing and intensity of respiratory viral shedding in patients with MERS closely matches that of those with severe acute respiratory syndrome. Blood viral RNA does not seem to be infectious. Extrapulmonary loci of virus replication seem possible. Neutralizing antibodies do not suffice to clear the infection. [ABSTRACT FROM AUTHOR]