Regular Aspirin Use Curbs Risk of Liver and Ovarian Cancer

Two new studies have found that regular long-term aspirin use may lower the risk of certain cancers, adding to the growing evidence that aspirin may play a role as a chemopreventive agent.

In the first study, a pooled analysis of two prospective US cohort studies, found that aspirin use was associated with a dose-dependent reduction in the risk of epatocellular cancer (HCC), an effect that was not observed with nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs).

The second study analyzed NSAID use and ovarian cancer diagnosis using data from two large prospective cohorts and found that regular aspirin users had a lower risk of ovarian cancer. Conversely, an increased risk of ovarian cancer was observed with long-term high-quantity use of other analgesics, particularly nonaspirin NSAIDs.

In an accompanying editorial, Victoria L. Seewaldt, MD, from the City of Hope Comprehensive Cancer Center, Duarte, California, states that these two studies “have the power to start to change clinical practice.”

“Both ovarian cancer and HCC are deadly cancers in need of new prevention strategies,” she writes. “The findings from these two studies provide important information that can guide chemoprevention.”

The two articles and editorial were published online October 4 in JAMA Oncology.

Finding the Connection

A growing number of studies have attempted to tease out the relationship between aspirin use and its possible use for chemoprevention.

Last year, for example, a large observational study found that regular aspirin use was associated with both a reduced relative risk for death from any cause and also death from cancer.

Also in 2017, a study showed that regular use of NSAIDs in long-term survivors of colorectal cancer was significantly associated with improved overall survival, although this benefit was limited to patients with KRAS wild-type tumors.

A third recent study also found that regular aspirin use was associated with a 46% reduced relative risk for pancreatic cancer.

“Several decades of research provide strong evidence that the anti-inflammatory properties of aspirin may reduce cancer risk, particularly for colorectal cancer,” writes Seewaldt in her editorial. “In 2015, given the strength of the association between aspirin use and colorectal cancer risk reduction, the US Preventive Services Task Force (USPSTF) recommended that in individuals aged between 50 and 69 years with specific cardiovascular risk profiles, colorectal cancer prevention be included in the rationale for regular aspirin prophylaxis.”

However, she emphasized that despite the USPSTF recommendations, there are still many unanswered questions regarding the use of aspirin as a means of lowering the risk of colorectal cancer. These include the dose and timing of aspirin chemoprevention and the molecular mechanisms underlying aspirin’s chemoprevention effects.

Seewaldt says the most important unanswered question is “the ability of aspirin to prevent other malignant neoplasms.”

The findings of these two new studies may help answer that last question. The articles provide “key evidence that supports the ability of regular aspirin use to prevent ovarian cancer and HCC, respectively,” she says. “The findings from these two studies provide important information that can guide chemoprevention.”

Reducing HCC Risk

In the first study, Tracey G. Simon, MD, from Massachusetts General Hospital in Boston, and colleagues, assessed the potential benefits of aspirin use for the primary prevention of HCC using data from the Nurses’ Health Study and Health Professionals Follow-up Study, with a total cohort of 133,371 healthcare professionals (87,507 women and 45,864 men). Regular use was defined as standard dose (325 mg) aspirin tablets taken at least two or more times per week.

After more than 26 years of follow-up, the authors found that regular aspirin use was associated with a significant 49% reduced risk of developing HCC.

The HCC incidence rate among regular aspirin users was 2.1 cases/100,000 person-years, while it was 5.2 cases/100,000 person-years for non-users (P < .001). This benefit appeared to be both dose- and duration-dependent and was evident with aspirin use of 5 years or more, at a dose of 1.5 or more standard tablets per week.

Adjusting for regular use of nonaspirin NSAIDs (≥ 2 tablets/week) had no effects on the results, and the benefit from aspirin in relation to HCC was consistent across all prespecified groups (all P > .05).

As for nonaspirin NSAIDs, a reduction in HCC risk was not observed with regular versus nonregular use, and there was also no association between increasing duration of NSAID use and HCC risk (HR for ≥ 10 years of use vs nonuse, 1.06; P for linear trend = .20 among users).

“Our findings add to the growing literature suggesting that the chemopreventive effects of aspirin may extend beyond colorectal cancer,” the authors conclude.

Risk Reduction in Ovarian Cancer

The second study evaluated whether regular aspirin or nonaspirin NSAID use could lower the risk of  ovarian cancer. Led by Mollie E. Barnard, ScD, from the Chan School of Public Health at Harvard University, Boston, Massachusetts, the authors evaluated the use of aspirin or nonaspirin NSAIDS with the risk of ovarian cancer.

Their data came from two prospective cohorts: 93,664 women in the Nurses’ Health Study followed from 1980 to 2014 and 111,834 women in the Nurses’ Health Study II followed from 1989 to 2015.

The timing, duration, frequency, and number of tablets used were evaluated for each type of analgesic (aspirin, low-dose aspirin, nonaspirin NSAIDs, and acetaminophen) and data were updated every 2 to 4 years. A total of 1054 cases of incident epithelial ovarian cancer occurred in the total combined cohort.

There were no significant associations observed between aspirin use and ovarian cancer risk when current versus nonusers were compared, regardless of dose (HR, 0.99; 95% CI, 0.83 – 1.19). But when the authors evaluated low dose and standard dose separately, there was an inverse association for low-dose aspirin (HR, 0.77; 95% CI, 0.61 – 0.96), but none for standard-dose aspirin (HR, 1.17; 95% CI, 0.92 – 1.49).

Overall, this extrapolated to a 23% lower risk of ovarian cancer among current low-dose aspirin users compared with nonusers.

There was a positive association for longer duration of use with standard-dose aspirin (≥ 5 years vs < 1 year) (HR, 1.77; 95% CI, 1.13 – 2.77; P = .004 for trend) and for 2500 or more tablet-days of standard-dose aspirin compared with no regular use (HR, 1.58; 95% CI, 1.00 – 2.48; P = .02 for trend).

In contrast, current use of nonaspirin NSAIDs was positively associated with an increased risk of ovarian cancer compared with nonuse (HR, 1.19; 95% CI, 1.00 – 1.41), with significant positive trends for duration of use (P = .02 for trend) and cumulative average tablets per week (P = .03 for trend).

These data translated into a 19% higher relative risk of ovarian cancer among regular NSAID uses compared with nonusers.

The HCC study was supported by grants from the Nurses’ Health Study, Health Professionals Follow-up Study, and National Institutes of Health. The ovarian cancer study was supported by the National Institutes of Health. A co-author of the HCC study previously served as a consultant for Bayer Pharma AG on work unrelated to the study. No other disclosures were reported. Seewaldt is supported by grants from the National Cancer Institute and Prevent Cancer Foundation.

JAMA Oncol. Published online October 4, 2018. Study 1, Study 2, Editorial

https://www.medscape.com/viewarticle/902974#vp_1

MediciNova Gets Orphan Drug Tag for Glioblastoma Med

MediciNova, Inc., a biopharmaceutical company traded on the NASDAQ Global Market (NASDAQ:MNOV) and the JASDAQ Market of the Tokyo Stock Exchange (Code Number:4875), today announced that the U.S. Food and Drug Administration (FDA) has granted orphan-drug designation to MN-166 (ibudilast) as adjunctive therapy to temozolomide  for the treatment of glioblastoma (GBM).

Yuichi Iwaki, MD, PhD, President and Chief Executive Officer of MediciNova, Inc., commented, “We are very pleased that the FDA has granted orphan-drug designation for MN-166 as adjunctive therapy to temozolomide for the treatment of GBM, a rare cancer with a high recurrence rate and poor prognosis.”

https://globenewswire.com/news-release/2018/10/04/1617208/0/en/MediciNova-Announces-FDA-Grants-Orphan-Drug-Designation-to-MN-166-ibudilast-for-Glioblastoma.html

In Philly building trades, construction workers help colleagues battle addiction

Last year, as a construction apprentice learning to install insulation and remove asbestos, Michael Rossi injured his knee. After telling his coworkers he would be out for a few weeks for surgery, one man pulled him aside.

“He said, ‘You’re an apprentice, you need the money, why not go to a doctor and get something and mask the pain,’” Rossi recalled. “And I had to tell him, that’s not really an option for me. I was coming up on five years of sobriety. I’d struggled with painkillers. The last thing I wanted to do was get a script for them.”

Rossi had just gotten a lesson in a hidden reality of the construction industry: In these physically demanding workplaces, painkillers are still a common way to get through the day, even as the opioid crisis has spiraled and workers have attended funeral after funeral. Workplace data on addiction is sparse, but recent research has indicated that construction workers are at higher risk for fatal overdoses — particularly heroin overdoses.

Rossi couldn’t stop thinking about the conversation. At home, recovering from surgery, he called the president of his union. “I’d already seen a lot of guys in the trades who ended up dying or getting thrown out of the apprenticeship program,” he said. “And so I asked him what we were doing about the opioids.”

These days, Rossi is a peer advocate, one of a few dozen construction workers in Philadelphia’s building trades who double as recovery aides on job sites around the city. They watch for coworkers who might be showing the signs of a substance use disorder and encourage them to seek treatment. Or they help colleagues in recovery stay sober on the job site.

“I never thought I’d be breaking my anonymity,” said Rossi, who participates in a 12-step recovery program. “But I feel compelled to now.”

The peer advocates are all volunteers, trained by the Allied Trades Assistance Program, the building trades’ program that refers members and their families to substance-use treatment. ATAP has been around for 30 years, but its peer advocates program is just a year old, spearheaded by executive director Ken Serviss.

Advocates say they work to dispel the stigma against addiction on the job site by being as open as they can about their lives, hoping that coworkers will come forward.

“If you’re working in the room with me, you know what I had for breakfast, I’m going to tell you about my kids, and I’m going to tell you about my peer advocacy,” said Ed O’Toole, a plumber. “I tell the general contractor on the job, if there’s anyone struggling, let me know, before they lose their job.”

JESSICA GRIFFIN / STAFF PHOTOGRAPHER

Ed O’Toole on a job site: “I tell the general contractor on the job, if there’s anyone struggling, let me know, before they lose their job.”

Serviss is hoping to expand the peer advocate program by applying for federal grants, recruiting more members and training advocates to dispense Narcan, the overdose-reversing spray, on job sites.

Advocates, who meet every month at ATAP’s headquarters in the Far Northeast, are split between older union members, who largely have dealt with alcoholism, and a younger group more familiar with painkillers and heroin addiction.

One advocate was homeless for 15 years before entering recovery and getting a job as a laborer; another, sober for decades, is now trying to help his son through an opioid addiction as he counsels coworkers on job sites.

Others came to the program after losing coworkers to overdoses: “We had a young man on one job, and he was messing with heroin, and they fired him, and within a year he was dead,” said John “Mac” McFadden, a painter. “I’m just not quiet about being sober anymore. Now that I’m a peer I make sure everyone knows who I was and what I’m about. We’ve got ATAP stickers on the damn hard hats now.”

The nature of the industry, Serviss said, presents unique challenges for construction workers entering recovery. A tradition of drinking and substance use among some in the trades can make it difficult for newly sober workers to feel comfortable with people they used to party with after work. “Work hard, play hard,” said Michael Pollack, a laborer in recovery from heroin addiction, “except then you start playing at work.”

Stigma against medication-assisted treatment, considered the gold standard for treating opioid addiction, is even stronger in an industry where drug testing is frequent and employers are worried about liability.

The treatment medications methadone and suboxone, both shown to help produce far more lasting recovery than abstinence alone, are themselves opioids, but used at doses that stave off cravings without producing a high. Still, Serviss said, if they are found on a drug test, it’s grounds for getting kicked off a job site. Some of his advocates who got sober in abstinence-only programs are wary of opioid-based treatments, thinking they could be misused. “When I’m up on a swing,” a painter said at a recent meeting, “I don’t want no one on suboxone next to me.”

“Do we work on changing some of those policies to help people, or do we continue down the same road?” Serviss asked. “The stigma around [medication-assisted treatment] is the most difficult component. To change that mindset is very difficult.”

Still, he said, as the opioid crisis has deepened, he sees union leadership paying closer attention. At union meetings, he said, leaders are pointing out peer advocates, encouraging their workers to reach out to them, speaking about the building trades’ options for substance abuse treatments.

“I think we’re having a lot more success in penetrating our leadership,” he said, “because everyone’s going to a funeral.”

http://www2.philly.com/philly/health/addiction/in-philadelphias-building-trades-construction-workers-are-helping-their-colleagues-battle-addiction-20181003.html

LeMaitre Vascular Announces Preliminary Q3 2018 Results

LeMaitre Vascular, Inc. (Nasdaq:LMAT), a provider of vascular devices, implants and services, announced today Q3 2018 preliminary unaudited results, provided Q4 2018 and updated full year 2018 guidance, and announced a $0.07/share dividend.

Q3 2018 Preliminary Results

• Sales of $24.2mm vs. $24.8mm in Q3 2017 (-3% reported, +1% organic)
• Gross margin of 71.4% vs. 70.8%
• Operating income of $4.6mm vs. $5.1mm, (-9%)
• Operating margin of 19% versus 20%
• Net income of $4.3mm vs. $5.0mm, (-14%)
• Earnings of $0.21 per diluted share vs. $0.25, (-15%)
• EBITDA of $5.5mm vs. $6.0mm, (-8%)
• XenoSure sales of $5.7mm vs. $5.4mm (+6% reported, +7% organic)

On an organic basis, sales in the Americas were up 2% in Q3 2018 vs. Q3 2017, flat in Europe and down 5% in Asia-Pac Rim. Product growth in the quarter was driven by XenoSure and carotid shunts.  The decline in reported sales was due in part to the April 2018 divestiture of the Reddick general surgery product lines, as well as the other factors described below.

Operating expenses increased 1% in Q3 2018 to $12.6mm. At quarter’s end the Company employed 106 sales reps, a 19% increase vs. 89 at September 30, 2017.  The Company recently hired a Vice President of Asia-Pac Rim, opened an Asia-Pac Rim sales office in Singapore and received Australian XenoSure approval.

Cash on hand at September 30, 2018 was $45.6mm, up $3.7mm from June 30, 2018 excluding the $11.0mm acquisition payment for Applied Medical’s clot management business.

George W. LeMaitre, Chairman and CEO, said, “Q3 was a frustrating and humbling quarter, and my often-stated 10/20 aspiration for our business is now incongruous with our 2018 results.  As a 16% shareholder, I know we need to do much better.  We owe our shareholders higher organic sales growth and growing profits.”

Acquisition of Clot Management Business from Applied Medical

On September 20, 2018, the Company acquired the clot management business of Applied Medical for $14.2mm; $11.0mm was paid at closing and $3.2mm will be paid in two post-closing installments.  The acquired business includes Syntel embolectomy and thrombectomy catheters, Python over-the-wire embolectomy catheters, Latis graft cleaning catheters, and irrigation catheters.  Sales of the acquired business during the latest 12-month period were $3.4mm.

The Company expects the acquired business to add $0.5mm to $0.6mm in Q4 2018 sales and to have no impact on Q4 2018 operating income due to short-term channel transition costs.  Following the acquisition, the Company believes it is now the second largest provider of embolectomy catheters worldwide. The acquired catheters feature latex-free balloons, complementing LeMaitre’s latex balloon catheters.

Quarterly Dividend

On October 4, 2018, the Company’s Board of Directors approved a quarterly dividend of $0.07/share of common stock. The dividend will be paid December 6, 2018 to shareholders of record on November 20, 2018.

Q3 2018 Results Versus Prior Guidance

The following items contributed to the $1.8mm difference between the Company’s Q3 2018 preliminary sales results and the midpoint of the Company’s July 26, 2018 guidance:

Item	Actual Sales Versus Expected	Comment
Allografts	($0.7mm)	WW allograft sales were down 5% in Q3 following record sales in Q2.  The Company lost some inherited customers in its transition to a direct-to-hospital model from agents/distributors; tissue supply also constrained sales.
Valvulotomes	($0.5mm)	WW valvulotome sales were down 3% in Q3 following record sales in Q2.  Q3 sales were weak in direct European markets.
Export	($0.4mm)	WW export sales to distributors were down 36% in Q3. Weakening currencies, economies and/or ordering patterns resulting in reduced orders from Turkey, Korea, Saudi Arabia, Russia, Greece, etc.
China Product Return	($0.1mm)	Rationalizing China distribution channel
Hurricane Florence	($0.1mm)	–
Stronger USD Since Guidance	($0.1mm)	–

Q4 2018 and 2018 Business Outlook

	Previous Guidance (7/26/2018)		Current Guidance
Q4 2018 Sales	NA		$25.6mm – $26.4mm (Midpoint: -1% reported, +1% organic)
Q4 2018 Gross Margin	NA		70.3%
Q4 2018 Operating Income	NA		$4.8mm – $5.4mm (Midpoint: -20%)
Q4 2018 Earnings Per Share	NA		$0.18 – $0.20 (Midpoint: -12%)
2018 Sales	$105.3mm – $107.9mm (Midpoint: +6% reported, +7% organic)		$102.8mm – $103.6mm (Midpoint: +2% reported, +3% organic)
2018 Gross Margin	71.3%		70.7%
2018 Operating Income	$27.6mm – $29.4mm (Midpoint: +35%)		$25.8mm – $26.4mm (Midpoint: +24%)
2018 Earnings Per Share	$1.04 – $1.11 (Midpoint: +25%)		$1.01 – $1.03 (Midpoint: +19%)

Conference Call

Management will conduct a conference call tomorrow, October 5, 2018 at 8:00am ET to review the Company’s financial results and discuss its business outlook for the remainder of the year. The conference call will be broadcast live over the Internet. Individuals who are interested in listening to the webcast should log on to the Company’s website at www.lemaitre.com/investor. The conference call may also be accessed by dialing 844-239-5284 (+1 512-961-6497) for international callers), using passcode 8692409. For individuals unable to join the live conference call, a replay will be available on the Company’s website.

https://www.marketscreener.com/LEMAITRE-VASCULAR-INC-35329/news/LeMaitre-Vascular-Announces-Preliminary-Q3-2018-Results-27371532/

CVS Touts Consumer Benefits of $69B Deal As Small Pharmacies Urge Rejection

Aetna Inc. and CVS Health Corp. asked Connecticut regulators Thursday to approve their $69 billion merger with pledges to reshape health care as a grassroots service that puts consumers first.

The acquisition of Aetna by CVS would represent a new direction in the changing health care industry. CVS began with storefront pharmacies and developed into a pharmacy benefits manager. For Aetna, it could be a major step toward a digital business using its store of data and playing a critical role in personalized health.

“Health care, like politics, is local,” Tom Moriarty, executive vice president and general counsel of CVS, told an Insurance Department panel at a public hearing.

CVS already has a broad presence in Connecticut, he said, and its acquisition of Aetnais a “natural extension of our commitment to put consumers at the center of their health care,” he said.

Karen Lynch, president of Aetna, said the tie-up with CVS is the “next and most important step to put consumers at the center of their care.”

However, two Georgia State University economists who filed an analysis of the deal with the Insurance Department said they cannot determine the ultimate consumer impact of the deal.

“We cannot predict with a high level of confidence how the proposed merger would affect prices or the quality of care in the relevant markets,” economists William Custerand Robert Klein said.

As a result, they said they cannot predict with “a high level of confidence whether the proposed merger would increase, decrease, or have no effect on consumer welfare.”

Nathan Tinker, chief executive officer of the Connecticut Pharmaceutical Association, said the combination of the two giant companies will drive small drug stores out of business, depriving consumers of choice and failing to push down costs.

The CVS acquisition of Aetna is “tantamount to letting the fox into the hen house,” he said.

CVS told Connecticut insurance regulators Wednesday it will keep Aetna in Hartford for at least 10 years as part of its $69 billion acquisition of the health insurer.

In addition, the number of employees at Aetna and its Connecticut subsidiaries will remain about 5,300 for at least four years after the deal closes.

Insurance Commissioner Katharine Wade said in an interview before the hearing that the agreement is “part of the process.”

“It’s pretty standard to get commitments,” she said.

The four-year jobs pledge is standard, but the 10-year commitment required some negotiation, Wade said, without elaborating.

Carolyn Castel, a spokeswoman for CVS, said in an email that a “substantial number of states” have approved the deal, but she would not say how many or which states.

Some states prefer to wait for a decision by the Department of Justice before making their approval final, she said. As a result, CVS expects that states will approve the deal after federal officials act, she said.

John Perra, chairman of the Aetna Retirees Association, said in a letter to state regulators that the group is concerned the proposed acquisition “may again imperil retiree benefits.”

In an interview published in the New York TimesSept. 21, Aetna Chief Executive Officer Mark Bertolini said he did not know the answer to a question about whether Aetna’s culture will “survive after the sale to CVS.”

“When we were getting near signing the merger agreement, they wanted to change our benefits immediately. I said, ‘No. You can do whatever you want to the executives, everybody is going to do really well. But not the front line employees,'” Bertolini said.

“So I don’t know,” he said.

Perra told regulators it is “quite worrisome” to retirees that Bertolini does not know what may happen to benefits though CVS talked in merger negotiations about change to Aetna benefits.

CVS said in January it will keep Aetna in Hartford, where it has been headquartered since 1853.

Shareholders of Aetna and CVS approved the deal in March.

https://www.marketscreener.com/AETNA-11549/news/Aetna-CVS-Tout-Consumer-Benefits-of-69-Billion-Deal-As-Small-Pharmacies-Urge-Rejection-27370799/

Massachusetts nurse staffing mandate could cost nearly $950M annually

• Implementing the Massachusetts nurse-to-patient staffing ratio ballot question could cost the state $676 million to $949 million a year if the law is passed, according to a new study from the Massachusetts Healthy Policy Commission.
• If enacted, the law would force hospitals in the state to hire as many as 2,286 to 3,101 additional full-time nurses to be in compliance. Hospitals that don’t comply would be fined $25,000 per violation.
• Proponents of mandated nurse staffing ratios argue that such laws are investments in patient and worker safety that pay out with better health outcomes. The commission found that Massachusetts’ mandate could reduce adverse events and length of stay for patients, resulting in potential savings of up to $47 million.

The hospital industry has been successfully railing against mandated nurse staffing ratio legislation for years. Hospital groups have poured money into anti-mandate studies and lobbying efforts, often threatening the closure of hospitals as a last resort, as Massachusetts Health & Hospital Association did last year.

For opponents of nurse-to-patient ratio mandates, such as the American Hospital Association and the American Organization of Nursing Executives (AONE), the argument is that mandatory ratios would create unmanageable hiring costs, resulting in higher costs of care for patients.

Opponents of the mandate also cite the looming nurse shortage, but proponents of the mandate, coalitions largely composed of nursing unions, point to California as a model. When the state passed its mandate in 2004, applications for nursing licenses there reportedly increased by more than 60%, with vacancies for RNs reducing 69% by 2008.

There are other ways to address nurse staffing, such as holding hospitals responsible for setting ratios within their own facilities and forcing them to publicly disclose staffing data, but proponents of the ratio mandate say those methods are proven to be ineffective. Currently, 14 states have laws that address nurse staffing in some way, with California being the only state to have a ratio mandate.

The Massachusetts study does not bode well for advocates in other states, such as Pennsylvania, where nurses have been visiting with legislators and their mid-term opponents in hopes of corralling support for staffing ratio bills in the state House and Senate. Pennsylvania nurses have even gotten a nod of approval for staffing ratios from Governor Tom Wolf.

“Hospitals are focused on how many dollars they’ll spend at the end of the year. How can you put a price on patient safety and patient mortality?” Sharon Mitchell, a nurse and safe staffing advocate in Pennsylvania, told Healthcare Dive. “To me, in the long-term, having adequate nursing staff on the floor, having a safe patient limit, there’s no price to put on that. That’s what nurses are standing for.”

Those who favor a staffing mandate do so out of fear of the real risks that short-staffed and overworked nurses pose to patient safety, health outcomes and workforce retention in hospitals. Kronos Incorporated polling shows that 90% of nurses are considering leaving their hospital for another job, and recent research has shown that patient-heavy staffing ratios are costing patients their lives, especially in intensive care units.

Massachusetts passed a ratio mandate solely for ICUs in 2014 in a compromise between the Massachusetts Health & Hospital Association and the Massachusetts Nurses Association. This time, the decision will be completely up to Massachusetts voters.

https://www.healthcaredive.com/news/massachusetts-nurse-staffing-mandate-could-cost-nearly-950m-annually/538818/

Musk tweet oversight goes into effect 90 days after settlement, Recode reports

Recode’s Teddy Schleifer reported via Twitter after Tesla CEO Elon Musk called the SEC the “Shortseller Enrichment Commission” in a tweet: “The agreement for oversight of Elon’s tweets does not take effect for 90 days from the settlement date, per source. So he still has ~80 days to tweet whatever he wants.” Shares of Tesla are down 2%, or $5.32, to $276.51 in after-hours trading.
https://thefly.com/landingPageNews.php?id=2800077