The current study illustrated the time variance of turning points in the relationship between carbon emissions and income to resolve heated debate on the different responsibility to climate change with 1950–2010 data of five development diversity countries—three developed countries (Germany, Italy, and Japan) and one developing country (India) and one newly industrialized economy (Taiwan). The article also examines the impact of the crisis on emission. The time-varying patterns in the turning points on environmental Kuznets curves (EKCs) were observed by a rolling regression technique with 1950–2010 data regarding the per capita CO2 emissions caused by fossil fuel combustion and the incomes of the countries. Several empirical findings were revealed from this analysis. Per capita CO2 emissions commonly decreased with varying magnitudes in the five countries over time. The EKC hypothesis regarding the CO2 emissions is affirmed again in this study. The announcement effects associated with the Kyoto Protocol was evidenced. As indicated by the occurring GDP of the turning point, there is a strong reduction trend in the income level of the turning points right before the years of Kyoto Protocol; and this decreasing trend nearly ended as the Kyoto protocol approached its end, except in Germany, where the occurring income of the turning points continued to have a decreasing trend. Although the global financial crisis had its effects in the world, the impacts on carbon dioxide emissions vary across countries.
We aimed to determine the prognostic significance of cardiac dose and hematological immunity parameters in esophageal cancer patients after concurrent chemoradiotherapy (CCRT). During 2010–2015, we identified 101 newly diagnosed esophageal squamous cell cancer patients who had completed definitive CCRT. Patients' clinical, dosimetric, and hematological data, including absolute neutrophil count, absolute lymphocyte count, and neutrophil-to-lymphocyte ratio (NLR), at baseline, during, and post-CCRT were analyzed. Cox proportional hazards were calculated to identify potential risk factors for overall survival (OS). Median OS was 13 months (95% confidence interval [CI]: 10.38–15.63). Univariate analysis revealed that male sex, poor performance status, advanced nodal stage, higher percentage of heart receiving 10 Gy (heart V10), and higher NLR (baseline and follow-up) were significantly associated with worse OS. In multivariate analysis, performance status (ECOG 0 & 1 vs. 2; hazard ratio [HR] 3.12, 95% CI 1.30–7.48), heart V10 (> 84% vs. ≤ 84%; HR 2.24, 95% CI 1.26–3.95), baseline NLR (> 3.56 vs. ≤ 3.56; HR 2.36, 95% CI 1.39–4.00), and follow-up NLR (> 7.4 vs. ≤ 7.4; HR 1.95, 95% CI 1.12–3.41) correlated with worse OS. Volume of low cardiac dose and NLR (baseline and follow-up) were associated with worse patient survival.
Background: Definitive chemoradiation is an essential treatment for non-operative thoracic esophageal cancer. However, it may trigger radiation-induced lymphopenia, impacting survival outcomes. The neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status and survival outcomes. Here, we determined the association of clinical and dosimetric parameters with changes in hematological variables. Methods: We recruited 93 thoracic esophageal squamous-cell cancer patients who have completed definitive concurrent chemoradiotherapy (CCRT) between 2010 and 2015. Clinical, dosimetric, and hematological data, including absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and NLR, were analyzed at baseline and during CCRT. Cox regression model and Kaplan-Meier analyses were used to analyze different survival outcomes. Associations between clinical, hematological, and dosimetric variables were determined using Spearman's rank or Pearson correlation coefficients, and a multivariable logistic regression was used to verify identified correlations. Results: Patients (mean age =58.6 y) were predominantly males (94%), 27% of which were stage II (n=25) and 73% were stage III (n=68), with a median overall survival (OS) of 13 months [95% confidence interval (CI): 10.304-15.696]. Baseline NLR (NLR-b) and highest NLR during CCRT (NLR-h) was significantly correlated with OS, progression-free survival (PFS), disease-specific survival (DSS), and freedom from distant metastasis (FFDM). Dichotomized NLR-b, >3.68 or ≤3.68, was also correlated with survival. Primary esophageal tumor length (Spearman's r=0.324, P=0.011) and baseline body weight (Spearman's r=-0.251, P=0.019) were significantly correlated with NLR-b >3.68. In multivariable logistic regression, primary esophageal tumor length (OR =1.345, P=0.021) was associated with a higher NLR-b. Lung V5 (Pearson r=0.254, P=0.014) and V10 (Pearson r=0.317, P=0.002) were significantly correlated with NLR-h. Lung V5 (Pearson r=0.299, P=0.005) and heart V10 (Pearson r=0.273, P=0.011) were significantly correlated with the decrease in ALC during CCRT.Conclusions: Status of inflammation is correlated with survival outcomes and tumor size, and low-dose thoracic irradiation affects inflammation-immunity dynamics. A novel approach that decreases unnecessary exposures to radiation may further improve survival outcomes in esophageal cancer treated with CCRT.
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