Category: 3. Business

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This study underscores the efficacy of a structured interhospital transfer program in managing patients requiring various levels of cardiac surgical intervention. Key findings reveal distinct patterns in patient characteristics, urgency classifications, and clinical outcomes, similar findings were found in a study from Sanaiha et al. [7]. Emergent patients displayed significantly higher rates of myocardial infarction, preoperative shock, and mechanical ventilation, which correlated with an elevated in-hospital mortality rate of 6.9%, findings consistent with these were reported by Metkus [8]. These results were not surprising, as those criteria are, per se, predictors of in-hospital mortality in the STS Score and the EuroSCORE II [9, 10]. In contrast, urgent and elective patients had lower mortality rates and reduced preoperative risk profiles. At Düsseldorf University Hospital, we operated on an average of 1,650 patients per year. The overall in-hospital mortality rate was 5.2%. Stratified by urgency, the mortality rate was 2.0% for elective cases, 5.2% for urgent cases, and 16% for emergency cases. The markedly high mortality rate among emergency patients can be attributed, among other factors, to the high proportion of in-house resuscitations from other departments within the university hospital, as well as to the frequent admissions following out-of-hospital cardiac arrests, given our role as a major cardiac arrest center. Interestingly, the emergency patient cohort transferred from the Karl-Leisner-Klinikum demonstrated a notably lower in-hospital mortality rate. This discrepancy may be explained by significant differences in patient selection and timing. In particular, the patients referred emergently from external hospitals were usually hemodynamically stabilized prior to transport, and resuscitated patients were typically not transferred unless a return of spontaneous circulation (ROSC) had been achieved and a certain degree of neurological prognosis could be anticipated. Additionally, the Karl-Leisner-Klinikum lacks a dedicated cardiac arrest center, which may have led to a different triage and referral strategy, focusing more on potentially salvageable patients with a better short-term prognosis. Consequently, while the clinical severity of transferred patients was still high, the proportion of high-risk, non-survivable emergencies may have been lower compared to the in-house emergency population at the tertiary center.

The stepwise development of the program allowed for iterative improvements in communication, triage, and transport logistics [11]. Trends across the five-year period demonstrated a gradual shift toward a higher proportion of urgent admissions, reflecting growing confidence and reliance on the transfer protocol by referring clinicians. The stability of emergent case proportions, along with consistent transport durations, indicates that the program successfully maintained efficiency under varying clinical loads. CABG remained the predominant surgical procedure, especially among emergent patients, emphasizing the program’s responsiveness to ischemic heart disease [12, 13]. The relatively short median time to surgery for emergent cases (4 h) reflects a high level of logistical coordination between the hospitals, from transfer initiation to operative readiness, this factor was crucial to consider in the study, as the duration of the operation is a well-known predictor of outcomes [14, 15]. Telemedicine integration represents the next logical evolution for this program. Real-time virtual consultations can facilitate early triage decisions, optimize patient stabilization prior to transfer, and reduce unnecessary referrals, the efficacy of such programs was also demonstrated in Morh et al. study [16]. Standardized digital documentation and dedicated transfer coordination teams may further streamline operations, decrease time to surgery, and improve outcomes.

The findings of this study provide actionable insights into optimizing IHT programs for cardiac surgical patients. The demonstrated ability to transfer emergent patients with a median time-to-surgery of only 4 h confirms that well-structured interfacility logistics can meet the critical time demands of life-threatening cardiac conditions. This supports the broader implementation of time-targeted transfer protocols, particularly for patients at high risk for preoperative shock or myocardial infarction. Furthermore, the observed trend toward increased urgent referrals over time suggests that program transparency and reliability foster greater trust among referring clinicians—a factor that may enhance early identification and mobilization of at-risk patients. The stable proportion of emergent cases, despite rising volumes, highlights the system’s resilience and scalability. These results argue for wider adoption of standardized triage tools and escalation pathways within regional hospital networks. Integration of telemedicine and dedicated transfer coordinators, as proposed, would not only improve clinical decision-making but also reduce time-to-treatment disparities—an especially relevant factor in geographically distributed healthcare systems.

Notably, several measures could further enhance the IHT process:

• Implementing standardized triage criteria across referring centers [17].

• Establishing dedicated IHT coordinators [18].

• Enhancing pre-transfer stabilization protocols [19].

• Incorporating predictive risk stratification tools to assist with surgical prioritization [20].

The Spanish-German engineering company Siemens Gamesa has decided to shelve plans for an offshore wind turbine nacelle factory at the Port of Esbjerg in Denmark.

Siemens Gamesa told offshoreWIND.biz that the Port of Esbjerg remains a key hub for its offshore wind activities and that the company continues to assess potential investment options there.

“Siemens Gamesa has maintained a longstanding presence at the Port of Esbjerg, which is a strategically important location for our offshore wind operations, also in the future. Like in any other place, we continue to evaluate potential investment opportunities,” said the spokesperson.

“ However, given the current market conditions, any such decision will require greater clarity and stability in the industry.”

In 2022, Siemens Gamesa announced that it would be the first tenant to Port of Esbjerg’s new warehouse facility, planned to handle components used in the offshore wind market.

The 35-metre-high hall is capable of accommodating port-related and assembly activities.

Siemens Gamesa will supply SG 14-236 DD turbines to the 1.1 GW Thor offshore wind in Denmark. Wind turbine installation is scheduled to start next year and will be carried out from the Port of Esbjerg.

Last week, another wind turbine manufacturer, Vestas, announced that it would put its plans to open a factory in Poland on hold.

The facility would produce blades for its flagship offshore wind turbine, the V236-15.0 MW.

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This meta-analysis demonstrates that SGLT2 inhibitors confer significant benefit in patients with HFpEF by reducing the composite outcome of cardiovascular death or hospitalization for heart failure. These findings align with major trials such as EMPEROR-Preserved and DELIVER [5, 8]. The reduction in HF hospitalization is particularly meaningful, reflecting an important improvement in morbidity for this complex patient population.

The lack of a statistically significant effect on all-cause mortality, despite a favorable trend, merits careful interpretation. This observation likely reflects the heterogeneity of HFpEF phenotypes and the limited modulation of natriuretic peptides observed in this subgroup, as noted in recent evidence.¹⁷ Even in advanced HFrEF, where stronger mortality signals have been observed, SGLT2 inhibitors may exert their benefits predominantly through metabolic and renal pathways rather than direct hemodynamic effects. This underscores the complexity in translating mechanistic improvements into mortality reductions, particularly in HFpEF [20, 21].

The use of an LVEF > 40% threshold in our inclusion criteria, though broader than the conventional ≥ 50% definition, was deliberately chosen to reflect contemporary trial designs and clinical practice patterns. This approach facilitates methodological consistency with EMPEROR-Preserved and DELIVER [5, 8]. and ensures that our findings are applicable to both HFpEF and the adjacent HFmrEF population; a clinically relevant spectrum where therapeutic options have historically been limited.

Recent meta-analytic data further illuminate the potential role of SGLT2 inhibitors in promoting favorable cardiac remodeling. Fan and Guo demonstrated that SGLT2i therapy significantly reduced left ventricular mass index, left atrial volume index, and E/e′ ratio, while modestly improving LVEF and lowering NT-proBNP levels [22]. Additional studies by Moras et al. and Alcidi et al. reinforce these findings, suggesting improvements in global longitudinal strain, myocardial mechanics, and diastolic function [21, 23]. While these surrogate endpoints do not directly translate into mortality reductions, they provide compelling mechanistic support for the clinical utility of SGLT2 inhibitors [21].

The modest improvement in KCCQ scores observed in our analysis complements the reduction in HF hospitalization risk and highlights the multidimensional benefit profile of SGLT2 inhibitors. The pooled mean difference of approximately + 1.8 points, while small, suggests a consistent effect on patient-reported symptoms and function, reinforcing their therapeutic relevance beyond hard clinical endpoints [2,3,4].

Our findings must be interpreted in the context of several limitations. We did not perform formal subgroup or sensitivity analyses by diabetes status, type of SGLT2 inhibitor, geographic region, or baseline patient characteristics, as stratified data were inconsistently reported across trials. This limitation reflects the inherent constraints of study-level meta-analysis and highlights the need for future patient-level meta-analytic approaches to assess potential treatment effect heterogeneity. Additionally, variability in baseline patient characteristics and trial inclusion criteria may have contributed to moderate statistical heterogeneity observed for the primary composite outcome.

In terms of potential bias, most included trials were methodologically rigorous with adequate randomization and allocation concealment. The principal sources of potential bias included incomplete outcome data from loss to follow-up and lack of blinding of outcome assessors, though these risks were generally low or moderate.

The absence of a significant effect on all-cause mortality contrasts with the substantial mortality reductions observed in large HFrEF trials such as DAPA-HF and EMPEROR-Reduced [4, 5], further underscoring differences in disease biology and therapeutic responsiveness between HF phenotypes. The benefits observed in these HFrEF trials, including reductions in cardiovascular death and HF hospitalization and improvements in KCCQ scores, provide important context for interpreting the more modest-but still clinically meaningful; effects seen in HFpEF [18].

BEIJING – China’s wholesale and retail sectors posted solid growth in the first nine months of 2025, providing sound support for expanding domestic demand in the country, the Commerce Ministry said on Monday.

From January to September, the added value of China’s wholesale and retail trade grew by 5.6 percent from a year earlier to reach 10.5 trillion yuan (about $1.48 trillion), which accounted for 10.3 percent of the country’s gross domestic product, said an official with the ministry, quoting data from the National Bureau of Statistics.

During this period, profits of key commodity markets in the wholesale industry expanded by 8.2 percent year-on-year, while profits of industrial consumer goods markets increased by 17.9 percent year-on-year, the ministry said.

Looking at the retail industry, retail sales of goods reached 32.5 trillion yuan in the first three quarters of 2025, an increase of 4.6 percent year-on-year.

Online retail sales in China’s rural areas registered a 7.7 percent year-on-year increase in the January-September period, while sales of agricultural products via e-commerce platforms grew by 9.6 percent.

China has seen about 126 million new home appliances sold under its consumer goods trade-in program this year, the ministry noted.

The bank, which exited Saudi Arabia in 2014, is now securing a new investment banking license and plans to open offices in Riyadh by early 2026, CEO C.S. Venkatakrishnan said in an interview with Bloomberg TV, where he was attending the Fortune Global Forum and the kingdom’s flagship annual Future Investment Initiative summit. ​Confirming the bank’s re-entry into Saudi Arabia and that the kingdom “will be recognizing” the new regional headquarters in just a couple of days, the kingdom’s Investment Minister Khalid Al-Falih said, “People have seen that the kingdom is a long-term partner. We’re not transactional.”

Venkatakrishnan told Fortune Editor-in-Chief Alyson Shontell that working with trusted partners is important “because you’re making fairly large commitments financially and otherwise, and you need to work with partners whom you can trust and who are there for the long term and who will help you through the teething troubles.”

Barclays joins a growing list of financial giants like Citigroup, Goldman Sachs, and HSBC setting up deeper roots in the Gulf’s largest economy; by contrast JP Morgan is celebrating 90 years of doing business in the region. The move underscores Saudi Arabia’s ambition to transform itself from being a petroleum superpower into a diversified global business and financial hub, and increasingly a strategic nexus from which major businesses can access three different continents with ease.

The wider RHQ program

Saudi Arabia’s nine-year-old economic transformation plan, known as Vision 2030, is 85% complete, Minister Al-Falih said in opening remarks at the Fortune Global Forum. The strategy has already attracted over 675 regional headquarters—well past its original target of 500 by 2030—through generous incentives such as 30-year tax exemptions, tax relief, and streamlined regulatory frameworks.​

The government’s Regional Headquarters Program, launched in 2021 by the Royal Commission for Riyadh City, aims to make the capital the de facto economic center of the Middle East. Multinational players such as PwC, Deloitte, Lenovo, and Siemens Energy have already relocated leadership operations from Dubai and other hubs to Riyadh. Unlike special economic zone offices elsewhere, RHQs in Riyadh are designed to serve as genuine operational bases—not symbolic branches—managing corporate strategy and human capital across the entire Middle East and Africa. Also, Riyadh’s trillion-dollar transformation—anchored by NEOM, the Public Investment Fund (PIF), and megaprojects across tourism, AI, and green energy—represents a lucrative opportunity for capital providers.​​

At a breakout session at the Fortune Global Forum, executives hailed the program as transformative for localization, manufacturing, and innovation. Executives at Lenovo, for example, detailed construction of the region’s largest ICT manufacturing plant in the Saudi desert, while leaders at Siemens Energy spoke of expanding exports across the Middle East through its Riyadh-based regional center.​

In conversation with Diane Brady, Executive Editorial Director, Fortune Live Media, executives from Massimo, Siemens, and Lucid Motors highlighted that their RHQs have allowed them to do things like scale production, export vehicles to Europe, and build AI-driven health and transport systems from within the kingdom.​

Air Liquide announces today that it has entered into an agreement to acquire NovaAir, a leading industrial gas producer and supplier in India, from PAG, an Asia-focused private equity firm. This acquisition represents another investment for the Group in the country and a strategic milestone in its Indian growth story.

Founded in 2019, NovaAir is a full-service industrial gases platform supplying bulk industrial gases, critical specialty gases, and providing onsite services and EPC (Engineering, Procurement and Construction) support to its clients in the key industrial regions of East and South India. The company serves customers in the steel, automotive, fabrication, electronics, photovoltaic and healthcare industries, among others. 

The acquisition of NovaAir which is present in the East and South of India complements Air Liquide’s existing operations in the North and West of the country, bringing a large project portfolio managed by an experienced team. Through this operation, the expanded geographical reach will substantially strengthen Air Liquide’s footprint in the industrial merchant market, allowing it to better serve customers in the growing automotive, metals, electronics and healthcare sectors.

This acquisition follows a series of recent investments in India by Air Liquide, underscoring the Group’s commitment to investing in the long-term growth opportunities of the Indian market. Air Liquide has been present in India since 1992 and has solid ambitions in this country. The Group’s operations in India encompass the supply of industrial and medical gases, engineering and construction services, cryogenic equipment manufacturing, medical systems for healthcare and the development of speciality chemical ingredients.

Emilie Mouren-Renouard, member of Air Liquide’s Executive Committee, notably in charge of supervising activities in India, stated: 

“This acquisition represents a new step in our development in India. It demonstrates our long-term commitment to supporting the country’s industrial and healthcare development. This acquisition will significantly enhance our capacity to serve customers from small and medium enterprises to large industrial players, across a wider geographic footprint. It is another illustration of the growth potential of the Group.”

Watson Farley & Williams (“WFW”) advised Standard Chartered Bank (“Standard Chartered”) and Bank of India, IFSC Banking unit (“BOI”), GIFT City, on the US$215m refinancing of six Boeing B777-300ER aircraft for Air India Limited (“Air India”).

Implementing an innovative structure, the first of its kind in India, this transaction marks the first time a financing for an Indian airline has been structured directly to a borrower in GIFT City, India’s emerging international financial hub, which has not been structured through Ireland.

Lending directly to AI Fleet Services IFSC Limited (“AI Fleet”) – Air India’s GIFT City-based subsidiary – demonstrates significant increase in market confidence and regulatory maturity in India. BOI’s involvement as lender establishes Indian domestic appetite for financing its aircraft and is evidence of the growing role of Indian domestic financial institutions are sure to play in India’s ambitions in aviation. This innovative structure not only streamlines execution but also facilitates Indian domestic participation in a more cost-effective structure.

Standard Chartered is a leading international banking group offering global financial services, whilst BOI is a major public sector bank in India providing a wide range of domestic and international banking solutions.

The cross-border WFW Aviation team that advised Standard Chartered and BOI was led by Singapore Asset and Structured Finance Partner Richard Williams, with outstanding support from Associates May Eng and Rheya Panjwani and Paralegal Lydia Ong. New York law advice was provided by Counsel Maxi Adamski-De Visser and Associate Chloe Sucato.

Richard commented: “The groundbreaking new structure used to complete this transaction sets a precedent for aviation finance for India. Lending directly to AI Fleet with the involvement of BOI represents a strong vote of confidence in Indian aviation and the recently developed regulatory framework in India. Advising on matters of this nature highlights WFW’s market leading footprint in Indian aviation finance.  Our thanks go to Standard Chartered, BOI, Air India and AI Fleet for their confidence in us and the other legal professional advisors, whose collaborative approach was essential in closing this transaction”.

This study retrospectively compared the clinical outcomes of 62 elderly patients with Neer three- or four-part proximal humeral fractures who underwent PHILOS plate fixation, with or without the adjunctive use of a bionic n-HA/PA66 composite for medial support.

Elderly patients who present with Neer three- or four-part proximal humerus fractures frequently exhibit significant comminution and severe osteoporosis, which can substantially complicate fracture reduction and fixation during surgical intervention [23]. A key difficulty in the surgical management of these fractures lies in obtaining precise reduction and strong fixation, with accurate reduction of the humeral head being paramount. Furthermore, the importance of a stable calcar to prevent secondary varus displacement, particularly in distracted varus-type fractures, is well-established [9, 10, 24, 25]. This study presents an innovative application of n-HA/PA66 for medial calcar support. After a one-year follow-up, the n-HA/PA66 group exhibited significantly smaller changes in NSA (3.6° ± 1.6°) and HHH (2.4 mm ± 0.7 mm) compared to the PHILOS group, which showed changes of 9.5° ± 2.0° and 4.1 mm ± 0.6 mm, respectively, indicating superior clinical outcomes. This advantage likely stems from the critical role of optimal reduction and minimized postoperative displacement in achieving favorable shoulder function, as suboptimal HHH and NSA can cause pain and rotator cuff weakness, directly impairing joint function. Consequently, at the final follow-up, patients treated with n-HA/PA66 demonstrated statistically superior functional outcomes, as reflected by their DASH (25.5 ± 5.1 points) and ASES (78.9 ± 8.9 points) scores, compared to the PHILOS group, which had DASH (28.1 ± 4.7 points) and ASES (73.0 ± 10.3 points) scores. However, long-term observations revealed no significant differences in CMS or range of motion between the two groups. This discrepancy may be attributed to the inherent subjectivity of the DASH and ASES scores, which emphasize overall postoperative functional recovery and pain perception. In contrast, the CMS and range-of-motion assessments provide a more objective evaluation of local shoulder function.

Double-plate osteosynthesis, typically employing a lateral locking plate in conjunction with a ventrally placed one-third tubular plate, has emerged as a technique to enhance primary stability and facilitate anatomical reconstruction in humeral head fractures characterized by calcar region destruction, aiming to prevent secondary dislocation [26]. The supplementary steel plate stabilizes the medial column of the humerus, thereby preventing displacement during the reduction process [27]. Theopold et al. [28] published a small case series describing their technique using a lateral locking plate combined with an inverted one-third tubular plate placed in the bicipital groove, with a mean follow-up of 24 months. The average CMS was 80 points, but the incidence of AVN was 14.3%. Mara Warnhoff et al. [29] conducted a retrospective review of 31 patients who underwent double-plate internal fixation, with an average follow-up of 30.9 months. At final follow-up, the mean CMS was 77 points, the ASES score was 76 points, and the NSA was 135° ± 13°. However, the study reported an AVN complication rate of 9.7%. Our results indicate that, at final follow-up, patients with n-HA/PA66 implants demonstrated a CMS of 73.8 ± 8.1 and an NSA of 132.7° ± 13.8°. Humeral head necrosis occurred in one patient (3.7%). Although our findings align with previous studies regarding functional and radiological outcomes, a key consideration is the surgical technique. The use of supplementary plates requires more extensive dissection and exposure, potentially increasing the risk of vascular and nerve bundle injury, as well as humeral head necrosis.

While segmental fibular allograft augmentation, placed endosteally in conjunction with a lateral locking plate, is frequently suggested as a strategy for enhancing medial support in proximal humerus fractures [14], the evidence regarding its efficacy remains somewhat equivocal. Dasari et al. [30] synthesized data from ten observational studies encompassing 802 patients, reporting a 95% rate of improved radiographic outcomes, increased ASES clinical outcome scores, and reduced odds of major complications in patients treated with a PHILOS plate augmented with a fibular allograft compared with those treated with a locking compression plate alone. However, these findings are not universally supported. Lee et al. [31] demonstrated that locking plate fixation combined with a fibular strut allograft yields satisfactory short-term outcomes in terms of humeral head support and maintenance of reduction. However, in their study, the CMS scores of the two groups showed no statistically significant difference (83.5 ± 6.5 and 87.8 ± 5.6), both of which were higher than our results (73.8 ± 8.1 and 70.5 ± 6.8). One possible explanation is that satisfactory therapeutic outcomes in their study were achieved with locking plates alone, making the supportive role of the fibular strut allograft non-additive. Furthermore, a randomized controlled trial [32] concluded that fibular allograft augmentation provided no additional benefit in treating medial column comminuted proximal humeral fractures, either radiographically or functionally. Variations in these study results may be attributed to several factors, including patient age, fracture type, graft- and technique-related variables, and methodological differences in study design and evaluation.

Moreover, some researchers have explored the use of bone cement to augment the stability of the PHILOS plate in proximal humeral fractures, reporting promising clinical outcomes and reduced complication rates [33], but the body of research on this technique remains limited. Furthermore, the potential for cement-related thermal necrosis warrants continued consideration.

Research demonstrates that the mean operative time for two-part proximal humeral fractures typically ranges between 60 and 90 min [25, 34]. In contrast, several studies have reported that the average surgical duration for three- and four-part proximal humeral fractures extends from 110 to 130 min [35, 36]. A primary factor contributing to the prolonged operative time in more complex fractures is the increased difficulty in achieving effective temporary fixation. In the present study, a comparison of operative durations between two fixation techniques revealed that the n-HA/PA66 group experienced an average reduction of 25 min compared to the PHILOS group. Our experience suggests that incorporating n-HA/PA66 to support the humeral head, followed by K-wire insertion through the n-HA/PA66 construct (as shown in Fig. 4B), can enhance the overall stability of temporary fixation. The n-HA/PA66 effectively acts as a bridging scaffold, reducing the need for repeated K-wire insertions and maintaining fracture reduction. The PHILOS combined with the n-HA/PA66 augmentation provides surgeons with a more dependable and efficient solution for treating complex proximal humeral fractures. Extended operative time is associated with an increased risk of complications [28, 32, 35]. Although this study did not find a statistically significant difference in complication rates between the two groups, nor did the use of implants appear to increase the incidence of related complications, these findings may be influenced by the study’s limited sample size and relatively short follow-up duration.

Although n-HA/PA66 is recognized as a bioactive material [15,16,17], current evidence does not demonstrate osseointegration with the host bone. Theoretically, the potential for micromotion persists under extreme conditions. Moreover, as with all implantable devices, managing deep infections remains highly challenging once established. Extended follow-up periods are necessary to substantiate the long-term reliability of this material. It is recommended that quantitative CT analyses be employed to evaluate changes in bone density at the scaffold-bone interface, thereby enabling an objective assessment of the integration process. Furthermore, collaboration with biomechanical research laboratories is essential to systematically investigate n-HA/PA66 scaffolds with diverse geometrical configurations, porosities, and mechanical properties to determine experimental parameters that ensure sufficient load-bearing capacity. Existing research offers valuable frameworks for identifying optimal treatment strategies [37, 38]. Conducting a multicenter, prospective, randomized controlled trial comparing PHILOS combined with n-HA/PA66 scaffolds to PHILOS with autologous iliac crest bone grafts and PHILOS with allograft bone grafts would provide higher-level evidence to inform clinical practice.

Despite the need to acquire a comprehensive dataset encompassing both imaging and functional outcomes, this study is subject to several limitations. First, the retrospective design, which lacks randomization, inherently introduces the potential for selection bias and confounding variables. Second, while considerable effort was made to ensure appropriate patient selection, the statistical power of this single-center study remains relatively modest, potentially hindering the detection of subtle yet meaningful differences between the groups. Furthermore, a larger sample size is necessary to enable robust subgroup analyses. Third, the subjective nature of the DASH score may contribute to the discrepancies observed between it and the more objective CMS. Finally, the relatively short one-year follow-up period necessitates caution in drawing definitive conclusions regarding the long-term efficacy of the investigated treatment approach, suggesting the need for studies with extended follow-up durations.