The Eligibility of Green Bonds as Safe Haven Assets: A Systematic Review

This study follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to examine the existing literature on the connectedness of green bonds with other markets as an attempt to highlight the effectiveness of green bonds in risk management and the benefits associated with incorporating green bonds in investment portfolios. An extensive search of relevant research papers to the scope of the review led to the identification of 31 articles published by February 2022. Our analysis traces the evolution of studies on green bonds' interactions with other markets, the methodologies and data frequencies used for cross-market relations analysis, and the role of green bonds in portfolio risk management (diversifier, hedge, and safe-haven) in normal and extreme market conditions. The study reports several interesting findings. First, green bonds can be a strategic safe-haven avenue for investors in stocks, dirty energy stocks, and the foreign exchange market in the US and China in extreme market downturns. Second, green bonds demonstrated hedging properties against spillovers from Bitcoin, forex, soft commodities, and CO2 emission allowance. Third, the role of green bonds in the markets of natural gas, industrial metals, and crude oil is limited to a portfolio diversifier in different investment horizons. Fourth, green bonds had no diversification or hedge benefits for investors in conventional bonds. Fifth, the interrelationships between green bonds and most markets' understudy were influenced by macroeconomic and global factors such as the COVID-19 pandemic, economic policy uncertainty, OVX, and VIX. Our review of the literature also facilitated identification of future research topics. The outcome of the review offers insightful information to investors in green bonds in risk management and assets allocation. Policy makers can benefit from this review in effective policy legislation for the advancement of the green bonds market and acceleration of a smooth transition to a net zero emission economy.

Predictors of Ovarian Preservation after Ovarian Torsion: A Retrospective Chart Review

Background: Ovarian torsion is a gynecologic emergency that requires surgical intervention to avoid functional loss of the ovary. Our objective was to determine predictors of ovarian preservation in the setting of torsion, primarily time from initial presentation to surgery. Method(s): We conducted a retrospective cohort study of women aged 12-40 who presented to the Emergency Department (ED) at a single institution between 2008 and 2021 and had surgical confirmation of torsion. Cases were identified using diagnosis codes for ovarian torsion, and we performed chart review to confirm inclusion criteria. We compared ovarian preservation by time to surgery after ED presentation. Covariates included age, parity, sonographic doppler flow, presence of ovarian mass, intraoperative attempt at detorsion, intraoperative concern for necrosis, and night or weekend presentation. We considered the potential effect of COVID-19 pandemic on time to surgery. We assessed predictive factors for ovarian preservation based on preoperative sonographic findings and patient characteristics using multivariable logistic regression. Institutional IRB approved a waiver of consent. Result(s): We identified 60 surgical cases of confirmed ovarian torsion, of which 25 underwent oophorectomy (42%). The median time from initial presentation in ED to surgery was 8.6 hours (IQR: 5.9-12.9;8.3 hours in preserved versus 8.7 in removed;p=0.68). When time to surgery was < 4 hours (n=6), the ovary was preserved in 83% of cases, compared to 56% when time to surgery was >=4 hours (n=54;p=0.39). When time to surgery was < 8 hours (n=28), 61% had ovarian preservation compared to 56% at >=8 hours (n=32;p=0.73) (Figure). The COVID-19 pandemic was not associated with a longer time to surgery (n=7). Ovarian preservation was significantly more likely with present doppler flow on sonographic exam (60% vs 27%;p=0.02). Preservation was less likely with necrosis suspected intraoperatively (20% vs 84%;p< 0.01). Detorsion was attempted in 64% of cases, resulting in preservation of 35% of necrotic-appearing ovaries. 76% of cases underwent oophorectomy based on intraoperative concern for necrosis;however, only 48% of ovarian specimens had necrosis confirmed on pathology. Age, parity and night or weekend ED admission were not associated with ovarian preservation. Conclusion(s): Predictors with the greatest likelihood of ovarian preservation after torsion include surgical goal time of < 4 hours after ED presentation, present doppler flow on sonographic exam, and attempt at detorsion intraoperatively despite necrotic appearance. Intraoperative methods to confirm ovarian viability would reassure surgeons. The surgical decision for oophorectomy may be based on factors unrelated to functional loss of the ovary. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1375800-1-ANY(2).docxCopyright © 2023

Especially in adversity, we need fresh thinking

While offering secondary care at home may suit some, and could reduce costs, it is clear that virtual wards need adequate staffing, and careful planning and evaluation, and cannot fully replace traditional hospital wards. A summary of research from NIHR tracks the uptake of mastectomy and bilateral salpingo-oophorectomy among healthy women who carry BRCA1 or BRCA2 genes and are at high risk of cancer (doi:10.1136/bmj.o258).3 Although most women opted to proceed with surgery, others did not, suggesting that more work is needed to understand their reasons and to examine alternative strategies. Claire Johnston and colleagues use available evidence on infectivity and covid-19 to help doctors share pragmatic and straightforward advice with patients and the public (doi:10.1136/bmj-2020-061402).4 Their work comes at a time when covid is re-exerting its pressure on health systems, with rising case numbers having an impact on hospital beds and staffing levels (doi:10.1136/bmj.o1638).5 In such a climate, complaints about clinical care, delays, overcrowding, staffing, and supply problems are likely to rise.

Tissue-Specific Differences in Myocardial and Coronary Vascular ACE2 and TMPRSS2 mRNA Levels are Dependent Upon Sex, Comorbidities, PressureOverload, and Pig Species

SARS-COV-2, or COVID-19, is a respiratory virus infecting over 86 million people worldwide. In addition to respiratory infections, SARS-COV-2 has been shown to include cardiovascular (CV) complications, including myocarditis and acute coronary syndrome. Risk of severe complications from SARS-COV-2 in individuals with existing CV and metabolic disease has been shown to be increased. Evidence indicates SARS-COV-2 enters tissues via the angiotensin-converting enzyme 2 (ACE2) receptor and that the virus is primed and activated by transmembrane protease, serine 2 (TMPRSS2). The goal of this study was to determine ACE2 and TMPRSS2 mRNA levels in pre-clinical swine models of heart failure (HF). We hypothesized sex, pressure-overload, and comorbidities would increase ACE2 and TMPRSS2 mRNA levels. A retrospective analysis was conducted in previously completed studies in our lab including: 1) Female, intact Ossabaw swine that were either lean control or western diet-fed aortic-banded (N=4-5/group);2) Female Yucatan mini-swine subject to ovariectomy and/or aortic banding (N=5-8/group);and 3) Sedentary and exercise trained male, intact Yucatan mini-swine that were aortic banded. ACE2 and TMPRSS2 mRNA levels were evaluated in the left ventricle (LV), right ventricle (RV), and coronary vasculature using qRT-PCR. Linear regression analysis was used to determine differences between the following variables: pig species, sex hormones, aortic banding, comorbidities, exercise training, and tissue. Data was log-transformed to meet linear regression assumptions. ACE2 and TMPRSS2 mRNA levels were significantly influenced by sex, comorbidity, and tissue type. TMPRSS2 mRNA levels were also influenced by species and disease status. Specifically, ACE2 mRNA levels decreased 57.1% in the LV and increased 169.9% in the RV of males compared to coronary vessels in intact females. TMPRSS2 mRNA levels increased in the LV and RV of males (1,218.6% and 5,479.8%, respectively) compared to coronary vessels in intact females. ACE2 and TMPRSS2 mRNA levels increased 344% and 453.4%, respectively, in the LV of Ossabaw swine fed a Western Diet compared to coronary vessels from Yucatan and Ossabaw swine without comorbidities. Species differences indicated TMPRSS2 mRNA levels increased 449.2% in the RV and 498.6% in the LV in Yucatan mini-swine compared to coronary vessels in Ossabaw swine. A 107.3% increase in TMPRSS2 mRNA level was observed in male swine without HF compared to female intact swine with HF highlighting the importance of sex and disease state. Exercise training did not impact ACE2 or TMPRSS2 mRNA levels irrespective of tissue. In conclusion, these results suggest differences in RV, LV and coronary mRNA levels of ACE2 and TMPRSS2 are dependent upon sex and comorbidities. TMPRSS2 levels are additionally influenced by pig species and pressureoverload. These results provide insight into how ACE2 and TMPRSS2 mRNA levels may influence the cardiovascular involvement of SARS-COV-2 infection in an experimental setting of pre-clinical HF incorporating different swine species, sex, and comorbidities.

Treatment of vaginal atrophy using fractional microablative CO2 laser in post-menopausal women with breast cancer on aromatase inhibitors: A pilot study

Aims: Vaginal atrophy (VA) in post-menopausal women with breast cancer (BC) is common and often exacerbated by endocrine therapies. Fractional CO2 intra-vaginal laser is a non-hormonal therapy designed to treat VA by improving microcirculation and collagen formation. We evaluated the feasibility of CO2 laser in women with BC on aromatase inhibitors (AI). Methods : In this single-arm pilot study, post-menopausal BC patients receiving adjuvant AI with symptomatic VA had 3 laser treatments scheduled 4 weeks apart. Clinician assessment, vaginal cytology, biopsy and questionnaires were undertaken at baseline and 12-weeks post treatment. The primary endpoint was improvement in the Urogenital Atrophy Questionnaire (UAQ) and Vaginal Health Index Scores (VHIS). Secondary end points were improvement in epithelial cytology and vaginal atrophy by central review and the Female Sexual Function Index (FSFI). Results : Between May 2017 and July 2020, 33 patients were enrolled. Slow recruitment and COVID-19 restrictions lead to premature study closure. Participants: median age 52 years (range 32-76), bilateral oophorectomy (n = 15, 45%), prior chemotherapy (n = 24, 73%) and bilateral mastectomy (n = 9, 27%). 27 patients completed all 3 pre-planned treatments and post-treatment assessment (T1 n = 30;T2 n = 30;T3 n = 28;post-Rx n = 27) and were eligible for final analysis. patient-reported vaginal dryness (100 vs 48%), irritation/itch (56 vs 19%), pain (63 vs 11%) and dyspareunia (89 vs 78%) all reduced in frequency at 12-weeks post treatment. VHIS score improved by a median of 5-points, predominantly due to an increase in epithelial integrity score. Reported vaginal dryness for most/all the time on UAQ reduced from n = 21/27 (78% to n = 8/27 (30%). No clinically meaningful improvement in sexual function domains was detected on UAQ and FSFI questionnaires. Cytology and histological findings will be presented. Conclusions : Pilot work suggests CO2 laser may be a feasible non-hormonal option for management of vaginal dryness and clinician-assessed VA, with little impact on sexual dysfunction.

Male bias in ACE2 basic science research: missed opportunity for discovery in the time of COVID-19.

Throughout the world, including the United States, men have worse outcomes from COVID-19 than women. SARS-CoV-2, the causative virus of the COVID-19 pandemic, uses angiotensin-converting enzyme 2 (ACE2) to gain cellular entry. ACE2 is a member of the renin-angiotensin system (RAS) and plays an important role in counteracting the harmful effects mediated by the angiotensin type 1 receptor. Therefore, we conducted Ovid MEDLINE and Embase database searches of basic science studies investigating the impact of the biological variable of sex on ACE2 expression and regulation from 2000, the year ACE2 was discovered, through December 31, 2020. Out of 2,131 publications, we identified 853 original research articles on ACE2 conducted in primary cells, tissues, and/or whole mammals excluding humans. The majority (68.7%) of these studies that cited the sex of the animal were conducted in males, while 11.2% were conducted solely in females; 9.26% compared ACE2 between the sexes, while 10.8% did not report the sex of the animals used. General findings are that sex differences are tissue-specific and when present, are dependent upon gonadal state. Renal, cardiac, and adipose ACE2 is increased in both sexes under experimental conditions that model co-morbidities associated with worse COVID-19 outcomes including hypertension, obesity, and renal and cardiovascular diseases; however, ACE2 protein was generally higher in the males. Studies in Ace2 knockout mice indicate ACE2 plays a greater role in protecting the female from developing hypertension than the male. Studying the biological variable of sex in ACE2 research provides an opportunity for discovery in conditions involving RAS dysfunction and will shed light on sex differences in COVID-19 severity.