Healthcare

• CSI Medical Service represents the top 50 largest and most-liquid stocks involved in medical devices, medical care, medical informatization, and other medical theme from the Shanghai, Shenzhen, and Beijing Exchanges.
• In this insight, we take a look at the potential ADDs and DELs for the semiannual index rebal event in December 2026.
• We expect up to 5 ADDs/DELs and we estimate one-way flows of approximately US$271mn.

• We screen the Hong Kong-listed mainland stocks ahead of the HSCEI August 2026 review.
• The screen produces one ADD and one DELETE, and the DELETE fires only if the ADD lands.
• We note that the committee skipped the same ADD candidate last review but re-iterate our call.

• The market responded negatively to Artrya’s 4Q26 cash flows today, closing down -16%.
• While there was some frustration in the delay in realising cash from Tanner and the other foundation partners, the response was overblown and represents a buying opportunity.
• Real-time payment authorisation caused Tanner delay: Today’s frustration stems from the longer-than-expected time to see revenue materialise from AYA’s foundation partners (coupled with further SCF delays).

• Thanks to last year’s salesforce streamline and additional indictions/NRDL inclusions, China in-market sales was up 32% YoY to US$94m, driven by Elunate (+41% YoY) and Sulanda (+45% YoY) in 1H26
• Fruzaqla in-market sales was up 14% YoY to US$185m in 1H26, driven by ex-US (+c.70% YoY). Profitability maintained with net profit of US$16m in 1H26. Strong cash position at US$1.4bn
• 2026 revenue guidance maintained; 2H26 key catalysts: 1) global phase 3 readout SAFFRON (Savolitinib in 2L MET EGRF NSCLC), 2) R&D day, 3) potential BD on ATTC. See more inside

Key points (machine generated)

• Miahelsa Holdings reported a 4.3% revenue increase to 24,850 million yen and a 28.6% rise in operating profit to 824 million yen for the fiscal year ending March 2026.
• The company operates 45 pharmacy stores, 78 daycare and after-school facilities, and 61 nursing care facilities as of March 2026.
• Childcare support is identified as a key growth driver for the company’s future expansion.

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• Meet the CEO. Jared Kelly has been CEO of Oncolytics since June 2025.
• He is a transactional lawyer by training who previously served as head of legal and corporate strategy at Ambrx Biopharma, where he played a central role in the company’s $2-billion sale to Johnson & Johnson, and subsequently advised a number of public and private drug development companies.
• Before moving into biotech operating roles, he spent roughly a dozen years as a transactional lawyer advising biotech companies and strategic acquirers on IPOs, public company M&A, buyouts, and licensing deals, at firms including Lowenstein Sandler LLP and Kirkland & Ellis LLP.

• PharmAla hit a commercial inflection in 3QFY26. 
• Revenue of C$513,232 was up 3.8x Y/Y and nine-month revenue roughly tripled to C$1,000,256.
• Gross profit rose ~170% in the quarter to C$338,545 from C$125,549. 

• SNES looks to accelerate expansion of its B2B business via a professional sales organization focused on 8 key verticals where it believes its products offer differentiated value.
• Focus on large-scale B2B opportunities strengthen its opportunity to penetrate these target verticals sectors & grow its subscriber base and recurring revenue.
• SNES expects growing recurring revenues to demonstrate proof of concept of the effectiveness and stickiness of its brands, while concurrently it aims to lower cash burn.

• North American Growth Engine: The company’s revenue trajectory is heavily reliant on its North American operations, specifically the robust sales performance of key products Orgovyx (prostate cancer) and Gemtesa (overactive bladder). These products are central to the company’s near-term growth and strategy to offset upcoming revenue losses.
• Profitability Under Pressure from R&D Investment: While structural reforms have led to a significant V-shaped recovery in profitability from the lows of FY24, future earnings are expected to be constrained. The company is channeling resources into its R&D pipeline, particularly in oncology, leading to higher expenses that will weigh on core operating profit despite projected revenue growth.
• Navigating a Critical Transition: Sumitomo Pharma is at a pivotal juncture, managing the loss of exclusivity for major past earners like Latuda while banking on its pipeline to deliver the next generation of blockbusters. The success of late-stage assets, such as Enzomenib in oncology, is critical for sustaining long-term growth and establishing the company as a “Global Specialized Player”in its focus areas of oncology and neurology.

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• Phase 3-ready lead asset positions Braveheart among later-stage biotech IPOs, with BHB-1893 targeting obstructive and non-obstructive HCM.
• Fidelity’s proposed $75 million anchor investment and a blue-chip healthcare investor base provide meaningful validation ahead of the offering.
• Clinical data suggest BHB-1893 may offer safety and dosing advantages over existing therapies, though pivotal Phase 3 studies remain the key catalyst.

• Apnimed, Inc. is a late-stage clinical pharmaceutical company focused on novel oral therapies for sleep-related breathing diseases. Its sole clinical product candidate, Oxnimbi, is an investigational fixed-dose neuromuscular modulator for.
• NDA for Oxnimbi was submitted to the FDA in April 2026 and accepted in July 2026. Oxnimbi met its primary endpoint in Phase 3 trials.
• As of March 31, 2026, cash and cash equivalents were $46,886, with an accumulated deficit of $329,625. There is substantial doubt about the ability to continue as a going concern.

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• Legacy Liabilities Isolation via CVRs: The pivot from Qualigen Therapeutics to AIxCrypto Holdings (AIXC) isolated high-risk oncology liabilities, primarily QN-302, using a Contingent Value Right (CVR) structure. While this protected the public shell for the Web3 pivot, the actual biotech operations remain in a costly limbo with no path to monetization.
• The FFAI Related-Party Circularity: The commercial EAI (Embodied AI) and RWA (Real World Asset) platforms are currently pre-revenue. The relationship with Faraday Future (FFAI) is highly circular; the $250,000 advance approved on July 19, 2026, is fundamentally a backdoor financing mechanism restricted to a related-party sponsorship, rather than a commercially arms-length software advance.
• Highly Dilutive ELOC Capital Structure: The $50.0 million equity line of credit (ELOC) with Gold King Arthur Holding Limited—registered on Form S-1 on July 27, 2026—features toxic financing terms including a purchase price at 93% of the lowest three-day VWAP and a 3.0% draw fee. If fully executed, it will cause 73.10% dilution to the current 20,234,993 shares outstanding, serving as an on-demand cash machine for a cash-strapped parent company.

• AIxCrypto Holdings, Inc. is a technology infrastructure company focused on AI and blockchain-based programmable systems. It develops software platforms for real-world asset tokenization and Embodied AI deployment.
• The company closed a $41 million PIPE financing in September 2025 and approved a $250,000 advance to FFAI in July 2026.
• EAI and RWA platforms are in early commercialization stages and have not generated material revenue to date.

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• Manipal Health Enterprises operates 49 hospitals with 13,037 licensed beds across 14 states, generating nearly ₹11,000 crore in revenue via aggressive acquisitions and brownfield expansion opportunities.;
• Leading in CONGO-R specialties, Manipal boasts high ARPOB (₹66,145) and low ALOS (2.8 days), backed by lean opex, high EBITDA per employee, and strong institutional governance.
• Priced at ₹560–590 (FY26 EV/EBITDA 30.5x), the IPO offers limited listing gains. Long-term upside hinges on brownfield bed operationalization, doctor retention, and navigating Metro overcapacity.

• Quest Diagnostics reported second quarter 2026 results characterized by robust top-line growth and improved profitability driven by increased demand across multiple customer channels, including physicians, hospitals, and consumers.
• The company generated consolidated revenues of $3.04 billion, reflecting a 10.2% year-over-year increase, with organic revenue growth also at 10%.
• This growth was fueled by higher volume, particularly from collaborations with Corewell Health and Fresenius Medical Care, which contributed significantly to volume expansion.

• The ATTOBODY platform’s technical edge lies in its spatially optimized, biparatopic VHH architecture, which routinely achieves picomolar binding affinity without the chain-mispairing issues common to traditional bispecific IgG platforms. However, while its tunable half-life through Fc-fusion is structurally sound, real-world translation remains a risk due to potential steric hindrance or accelerated target-mediated drug disposition (TMDD) in highly inflamed skin.
• ATTO-1310’s clinical timeline faces tight execution risks despite promising Phase 1b data where 65% of pooled patients achieved the itch responder definition at Week 4. The planned Phase 2 trial in 1H27 will encounter intense recruitment competition from incumbents like Sanofi’s Dupixent and Galderma’s Nemluvio, both of which are aggressively expanding into chronic pruritus of unknown origin (CPUO). De-risking Phase 2 will require clear, multi-modal biomarker readouts, specifically correlating serum IL-31 ligand suppression with pruritus visual analogue scales to prove a differentiated mechanism of action.
• The Alamar Biosciences licensing agreement significantly dilutes Attovia’s long-term upside through a massive 22,562,123-share equity slice and downstream obligations, including up to $4.3M in clinical and regulatory milestones per product and tiered, low single-digit royalties. Structurally, the license is non-exclusive regarding Alamar’s operational know-how, which poses a subtle but distinct intellectual property boundary that could complicate independent manufacturing scale-up and restrict long-term asset valuation.

• Tenet Healthcare reported second quarter 2026 net operating revenues of $5.6 billion and consolidated adjusted EBITDA of $1.304 billion, achieving a 23.2% adjusted EBITDA margin that represented a 16.3% increase compared to the prior year.
• Adjusted diluted earnings per share rose 52% year-over-year to $6.12, supported by strong performance in its two main operating segments: United Surgical Partners International (USPI) and hospitals.
• USPI delivered adjusted EBITDA of $542 million in the quarter, representing 9% growth over Q2 2025 and achieving 25% of its full-year 2026 EBITDA guidance.

• Hanmi Pharm (128940 KS) reported 2Q26 result, with operating profit surging 117% YoY to KRW131B, driven by upfront revenue received from global outlicensing deal with Lilly for sonefeglutide.
• Reacting to 2Q26 result, Hanmi Pharm shares nosedived. Muted core business, weakness in China subsidiary, and expected increase in operating expenses raise concern over the near-term growth prospect.
• The company has reached to an inflection point, where it is ready to reap the benefit of innovation prowess. Its GLP-1-based drug candidate Efpeglenatide aims for commercialization within the year.

• HCA Healthcare’s financial results for the second quarter of 2026 demonstrate a 11% growth in diluted earnings per share both quarterly and year-to-date, despite notable headwinds primarily stemming from unfavorable shifts in payer mix.
• The expiration of enhanced premium tax credits led to a significant decline—approximately 15%—in admissions covered through health insurance exchanges, with a majority of those patients becoming uninsured rather than transitioning to alternative coverage.
• This shift created an estimated $400 million adverse impact on adjusted EBITDA in the quarter, with certain divisions disproportionately affected.

• Universal Health Services reported second quarter 2026 results reflecting both operational progress and some challenges amid a dynamic healthcare environment.
• The company saw a rebound in Acute Care volumes with same-facility adjusted admissions rising 2.9% year-over-year, contributing to 8.2% same-facility segment EBITDA growth.
• Behavioral Health volumes grew modestly, with a 1.4% increase in same-facility adjusted patient days and 9.0% segment EBITDA growth.

• Manipal Health Enterprises  (MHEL) is looking to raise up to US$960m in its upcoming India IPO.
• MHEL operates a pan‑India network of multispecialty hospitals delivering a range of care services, from outpatient services to complex tertiary and quaternary interventions.
• We have looked at the past performance in our previous note. In this note, we talk about the RHP updates and valuations.

• Apnimed is expected to list on the Nasdaq under the ticker APMD, offering 10.0 million shares at a price range of $14.00 to $16.00 per share, targeting approximately $150 million in gross proceeds.
• The company is a late-stage biopharmaceutical developer focused on AD109, an investigational oral therapy for obstructive sleep apnea (OSA), a large and underserved market traditionally treated with CPAP devices.
• The company recently received FDA acceptance of its New Drug Application (NDA) for AD109, with a PDUFA action date of February 28, 2027, representing a significant regulatory milestone.

• Apnimed (NASDAQ: APMD) is seeking to raise $150 million through the sale of 10.0 million shares priced between $14.00 and $16.00, implying a midpoint offering price of $15.00 per share.
• At the midpoint, the company would command an estimated fully diluted market capitalization of approximately $570 million based on approximately 38.0 million shares outstanding after the offering. 
• The IPO is being led by BofA Securities, Evercore ISI, Cantor, and LifeSci Capital, with trading expected to begin Friday, July 31.

• Agenus is a clinical-stage immuno-oncology company with a focused pipeline centered on its lead combination therapy, botensilimab (BOT) and balstilimab (BAL), targeting difficult-to-treat cancers.
• The company’s value is heavily dependent on the clinical and regulatory success of the BOT/BAL program, with a pivotal Phase 3 trial in metastatic colorectal cancer underway.
• Recent strategic partnerships and a sharpened focus on the BOT/BAL program have improved the company’s financial position, though it remains a high-risk, high-reward investment proposition typical of the biotechnology sector.

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• Butterfly Network is a disruptive force in the medical imaging market with its proprietary ‘Ultrasound-on-Chip™’ technology, which enables a portable, single-probe, whole-body ultrasound system at a lower cost than traditional equipment.
• The company is in a high-growth phase, evidenced by strong revenue increases and a strategic focus on expanding its software and AI ecosystem; however, it has a history of significant net losses and cash burn, with profitability remaining a future goal.
• Facing a competitive landscape of established medical device giants and other innovators, Butterfly’s success hinges on its ability to drive widespread adoption, scale its enterprise-level software solutions, and effectively manage its path to profitability.

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• Coherus is undergoing a significant strategic transformation, divesting its biosimilar portfolio to become a pure-play, revenue-generating oncology company focused on innovative immuno-oncology (I-O) therapies.
• The company’s future is now centered on its sole commercial product, LOQTORZI® (toripalimab-tpzi), a next-generation PD-1 inhibitor, and its mid-stage I-O pipeline candidates, casdozokitug and tagmokitug.
• Recent divestitures of its biosimilar assets, including UDENYCA®, have significantly strengthened the balance sheet, providing capital to pay down debt and fund the focused oncology strategy through key clinical milestones in 2026.

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• This is going to be a mostly Claude written article as I am extremely busy today, but I think this needs to get out immediately and this is too long for a note.
• Also not a large position for me, but it is about to have a huge inflection point (up or down).
• Forgive any errors as I am literally writing this over lunch and feel free to correct me in the comments.

• Aadi Bioscience is a commercial-stage biopharmaceutical company centered on its sole approved product, FYARRO (nab-sirolimus), for a rare cancer, making it highly dependent on this single asset.
• The company’s primary value driver is the potential label expansion of FYARRO into other cancers with mTOR pathway alterations, though the pivotal PRECISION1 trial for a tumor-agnostic indication was halted in August 2024 due to lack of efficacy.
• Aadi faces significant financial pressure, characterized by a high cash burn rate, consistent net losses, and a recent strategic pivot involving the sale of FYARRO and a shift to preclinical antibody-drug conjugates (ADCs).

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• Late-Stage biotech seeks $140 million–$160 million to fund Oxnimbi’s regulatory review and potential commercial launch following positive Phase 3 trial results.
• Oxnimbi targets obstructive sleep apnea, a market affecting an estimated 80 million U.S. adults, with the potential to become the first approved oral therapy.
• Investor demand will be closely watched as Apnimed follows recent biotech IPO strength, though sleep medicine has historically drawn less enthusiasm than other therapeutic areas.

• Chugai Pharmaceutical (4519 JP) reported a rise of 15% YoY in revenue to ¥663.3B. Mainstay alongside new products help maintain growth momentum in both domestic and overseas market.
• 2026 guidance reiterated. Revenue expected to increase 7% YoY. Core profit numbers expected to increase by 7.5% YoY each. Achieved almost 43-46% of their 2026 headline guidance numbers.
• Although Chugai is still hugely dependent on Hemlibra export, new launches are slowly gaining momentum. Moreover, new breakthrough products like orforglipron will help provide some traction to the growth momentum.

• Short covering dominated the week of July 20.
• Korea-linked ETFs saw dramatic SI drops, while biotech and borrow markets told a more bearish story.
• A handful of names bucked the trend – shorts added exposure in clinical-stage biotech and niche fixed income plays.

• Royalty Pharma plc has expanded its development-stage portfolio by acquiring part of Neurimmune’s royalty interest in AstraZeneca’s cliramitug, committing up to $425 million for a 3% to 4% royalty on worldwide net sales.
• The structure includes $125 million upfront, another $125 million scheduled for the first quarter of 2027, and $175 million tied to clinical and regulatory milestones.
• Cliramitug is a Phase 3, first-in-class antibody designed to remove transthyretin amyloid fibrils from the hearts of patients with ATTR cardiomyopathy, rather than only slowing further protein accumulation.

Key points (machine generated)

• Start Line (477A) is a leading Japanese company providing comprehensive employment support services for individuals with disabilities.
• The company utilizes scientifically grounded vocational rehabilitation techniques called ‘support power’ and has diversified its services beyond single-service models.
• As of April 1, 2026, Start Line supports 373 client companies, showcasing its significant industry impact.

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• Surgery Partners has taken a significant step in its portfolio-optimisation strategy by agreeing to sell its ownership interests in Mountain View Hospital and Idaho Falls Community Hospital to Intermountain Health.
• The transaction values the two Idaho Falls facilities at approximately $1.15 billion, with roughly $795 million of consideration expected to go to Surgery Partners before debt, working-capital, transaction-cost and other closing adjustments.
• Intermountain is acquiring Surgery Partners’ interests rather than the entire company, while physician ownership in Mountain View Hospital will remain unchanged.

• President Donald Trump’s proposed 100% tariff on imported generic drugs delivered an immediate shock to Teva Pharmaceutical Industries, sending its shares down nearly 4% as investors considered the consequences for one of the world’s largest generic-medicine manufacturers.
• The concern is understandable: generic drugs operate on thin margins, and sharply higher import costs could be difficult to absorb without increasing prices or relocating production.
• Yet Wall Street’s response has been notably less pessimistic.

• Thermo Fisher Scientific reported its second quarter of 2026 with notable financial and operational performance across its diverse business segments.
• The company achieved a 10% increase in revenue to $11.99 billion, led by 5% organic growth, 5% contribution from recent acquisitions, and a minor foreign exchange tailwind.
• Adjusted operating income expanded by 15% to $2.73 billion, supported by a 90 basis point increase in adjusted operating margin to 22.8%.

• PrimeGenX Therapeutics Co., Ltd. is a biotech company founded in 2016, specializing in locally-delivered targeted therapies for immune-inflammation diseases.
• The pipeline includes 4 proprietary drug candidates and 5 generic drug candidates, with PG-011 targeting atopic dermatitis and allergic rhinitis.
• Cash and cash equivalents were RMB127,682 thousand as of April 30, 2026, with net liabilities of RMB(7,191) thousand.

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• Manipal Health will launch its India IPO on July 29. The IPO consists of fresh issue of INR80B (~$829M) and OFS of up to 22M shares aggregating to INR13B.
• The IPO price band is set at INR560 to INR590 per share. The IPO subscription will close on July 31, with expected listing on August 5.
• Manipal Health proposes to utilize the net proceeds mainly for repayment/ prepayment of certain outstanding borrowings. As of May 31, 2026, the company had outstanding borrowings of INR112B.

• Founded in 2007, Guangzhou Novaken Pharm is a clinical-stage pharmaceutical company developing modified new drugs using alternative formulations and drug-delivery technologies.
• DHMP is the first dissolving microneedle drug patch approved for clinical trials in China and the only one to Phase II.
• Net current liabilities were (RMB573,269) as at May 31, 2026, with a current ratio of 0.2.

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• M&A-driven top-line growth is masking severe operational cash drag and negative unit economics. While consolidated revenue grew 23% year-over-year to $2.02 million in Q1 2026, Adjusted EBITDA deteriorated to $(1.26) million, driven by rising clinic-level operating costs and heavy corporate overhead.
• The commercial thesis for INVOcell remains fundamentally flawed due to conflicting economic incentives for physicians and embryologists. High-complexity IVF laboratories depend on profitable add-ons like ICSI and PGT-A. Bypassing the lab with intravaginal culture (IVC) decimates clinic margins because there is no dedicated, highly-reimbursed CPT code for IVC.
• Recent liquidity improvements are temporary, and the newly signed $15 million Alumni Capital equity line is highly dilutive. Although warrant exercises lifted cash to $4.9 million as of March 31, 2026, the structural cash burn from operations—exceeding $5.3 million annually—means the company will heavily rely on the discount-priced stock sale program, delaying any lifting of the going concern qualification.

• Pure Health stands as the largest integrated healthcare network in the UAE, with a rapidly expanding international footprint in the US, UK, and Europe, strategically shifting its revenue base to mitigate domestic pressures.
• Financial performance shows robust top-line growth, driven by international acquisitions; however, the company faces headwinds in its domestic UAE Care segment, with declining revenues and margin compression.
• The company’s strategy is heavily focused on margin-accretive international expansion, aiming for 50% of revenue from outside the UAE, alongside leveraging technology and data to advance preventative care and the science of longevity.

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• Jaguar Health develops novel plant-derived prescription drugs for human GI diseases and non-prescription GI products for animals. This prospectus registers shares for resale by a selling stockholder.
• Jaguar Health received $16.0 million non-dilutive capital in January 2026 from Future Pak, with potential for $20 million in milestone payments. Crofelemer received Orphan Drug Designation for MVID.
• The company holds global unencumbered rights for crofelemer, an FDA-approved drug. Future stock resales and issuances may cause market price decline.

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• Critical Funding Cliff: Guangzhou Novaken Pharm is facing a severe liquidity crisis. As of May 31, 2026, the company had just 102.6 million RMB in cash against 573.3 million RMB in net current liabilities. At its current burn rate, it has a runway of roughly 8 months, making the HKEX IPO refiling on July 24, 2026 an absolute necessity for survival.
• Clinical & Operational Mismatch: While the Dexmedetomidine Hydrochloride Microneedle Patch (DHMP) has cleared Phase IIa pediatric trials as of June 2026, its real-world commercial viability is highly questionable. In busy Chinese public hospitals, where operating room turnover is strictly optimized, the patch’s 15-to-30 minute absorption timeline is a logistical dealbreaker compared to immediate intravenous (IV) injection.
• Unsolved Scale-Up and COGS Bottlenecks: Soluble microneedles cannot be manufactured using traditional high-speed transdermal machinery. Precision micro-molding, tip-loading consistency, and the lack of a standardized, non-destructive sterilization method (as aseptic manufacturing remains prohibitively expensive) keep unit costs extremely high, leaving the product highly vulnerable to pricing pressures in China’s centralized procurement system.

• Pumecitinib (PG-011) Gel’s competitive edge in China’s crowded atopic dermatitis market relies heavily on its unique gel formulation over standard creams and ointments, offering superior cosmetic elegance and rapid absorption for facial use, though it faces intense competition from established giants Hengrui and China Medical System (CMS).
• The commercialization partnerships signed with Simcere Pharmaceutical in Q2 2026 for both the gel and nasal spray formulations of Pumecitinib were a survival necessity rather than a strategic choice; PrimeGenX’s depleted cash reserves made building an in-house sales force impossible, trading long-term margin upside for near-term risk mitigation.
• With only RMB 127.68 million in cash as of April 30, 2026, and a net liability position of RMB 7.2 million, PrimeGenX is operating on a razor-thin cash runway of roughly seven months, making the success of their newly refiled HKEX IPO on July 24, 2026, a make-or-break event for the company’s survival.

• Deleveraging vs. Operational Performance: The proposed ₹5,552.76 crore debt repayment from the IPO proceeds is a balance-sheet reset that will make Manipal virtually net-debt free, but it should not be conflated with operational efficiency. Real margin expansion must come from scaling up the pro forma ARPOB of ₹66,144.59 toward peer leaders through high-acuity CONGO-R clinical integration across recently acquired networks.
• Acquisition Integration and Bed Headroom: Manipal’s rapid expansion to 13,037 licensed beds hides a massive operational delta, with only 6,878 operational beds in FY26. The primary value-creation lever is not greenfield capex, but the optimization of the 6,159 unutilized licensed beds and overcoming the post-acquisition clinical integration bottlenecks of AMRI, Medica Synergie, and Sahyadri.
• Severe Talent Cost Pressures: Doctor professional fees consume a substantial 22.72% of revenue, with aggressive competitor poaching driving specialist salary inflation of up to 12%. To protect its mid-term EBITDA margins, Manipal relies heavily on captive talent pipelines, such as its 343 DNB seats, and a transition away from minimum-guarantee doctor compensation models.

• Future Pak Deal Milestones are Not Low-Hanging Fruit: While the U.S. licensing agreement with Future Pak provided $19.0 million in upfront non-dilutive capital by Q1 2026, the remaining $20 million in milestones is tied to highly demanding cumulative commercial sales thresholds for Mytesi and full FDA approval of Canalevia-CA1 in canine chemotherapy-induced diarrhea (CID), making cash inflows from this source highly improbable in the near term.
• Crofelemer for MVID Offers Solid Clinical Signal but Negligible Market Volume: Liquid oral crofelemer demonstrated impressive efficacy in pediatric intestinal failure, showing up to a 48% reduction in parenteral support (PS) requirements at ESPGHAN 2026. However, Microvillous Inclusion Disease (MVID) is an ultra-rare congenital disorder with a global addressable patient pool of only a few hundred infants, limiting its commercial value to ultra-orphan pricing leverage rather than volume.
• Unrelenting Dilution and Debt Restructuring Signal Severe Going-Concern Risk: Despite out-licensing Mytesi’s commercial cost base to reduce SG&A, Jaguar remains structurally unprofitable with a $7.02 million net loss in Q1 2026 and $33.15 million in total debt. The newly established $40 million equity line of credit (ELOC) with C/M Capital Master Fund, LP, involving the registration of 41,000,000 shares for resale, represents massive impending dilution that will heavily depress share price post the 1-for-35 reverse stock split.

• INVO Fertility, Inc. is a healthcare services and technology company focused on the fertility marketplace, expanding access to assisted reproductive technology (ART) care.
• Proprietary INVOcell® device enables in vivo fertilization and early embryo development, demonstrating equivalent pregnancy success and live birth rates as IVF.
• Auditors’ reports for December 31, 2025 and 2024 contain an explanatory paragraph relating to the ability to continue as a going concern.

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• Medpace Holdings, Inc. reported financial results for the second quarter of 2026, highlighting revenue growth, improving net bookings, and ongoing shifts in clinical trial composition and backlog management.
• Revenue for the quarter reached $707.3 million, representing a 17.2% increase year-over-year, while year-to-date revenue totaled $1.41 billion, up 21.7%.
• EBITDA rose 17.6% to $153.4 million in the quarter with a margin largely stable at 21.7%, and net income increased by 34.5% to $121.4 million, supported by a lower effective tax rate and higher interest income.

• The apparent 2024 profit crash to 26.4 million RMB was primarily an accounting artifact rather than an operational failure, driven by a massive 72.1 million RMB non-cash share-based compensation charge following the withdrawal of their A-share IPO. On an adjusted basis, profitability grew steadily from 97.5 million RMB in 2023 to 152.0 million RMB in 2025.
• Shengsheng’s industry-leading 36.94% gross margin is structurally anchored by its vertically integrated manufacturing of proprietary cold-chain materials (vacuum insulated panels and phase change materials). This buffer shields them from traditional third-party logistics margin erosion, though domestic pricing pressures are rising as clinical sponsors demand multi-vendor setups to reduce dependency.
• The company’s “global leader” marketing narrative is severely mismatched with its actual international commercial footprint, with US operations yielding only 19.4 million RMB in 2025. Upstream financing constraints among domestic biotechs have also begun deteriorating Shengsheng’s balance sheet, pushing trade receivables to 226 million RMB and extending collection times to 106 days.

• On Harmoni squamous NSCLC, SMMT expects FPS data in “backend of 2026” and believes interim OS data in 1H27 (with follow-up of low 20s months) to be “key focal point”
• On Harmoni-3 (2L EGFRm NSCLC post TKI), SMMT provided updated OS analysis (showing consistent HR of 0.76 for Asian and western patients). FDA PDUFA date on 14 November
• See inside for additional SMMT takeaways (on Ivonescimab’s competitions and commercial preparation) and catalyst table on ivonescimab

• Mitesco’s transition from healthcare clinics (“The Good Clinic”) to AI-powered sales automation (Vero’s “Robo Agent”) and edge computing (Centcore’s “TC/DC”) is an operational pivot born out of financial distress, rather than a natural strategic expansion.
• The recently announced up to $30 million equity line of credit with C/M Capital Partners is structurally restrictive and highly dilutive, providing minimal near-term liquidity due to Mitesco’s sub-$2 million market capitalization and daily volume constraints.
• Outstanding legacy liabilities of $19.49 million, including $3.45 million in legal settlements, combined with severe internal control weaknesses and chronic SEC filing delays, pose a high risk of involuntary restructuring or insolvency.

• Mitesco, Inc. is a holding company providing products, services, and technology through Centcore, LLC and Vero Technology Ventures, LLC.
• Centcore, LLC offers data center services, while Vero Technology Ventures develops AI-based software like “Robo Agent” for real estate, expected Q3 FY2026.
• Cash and cash equivalents were $7,000 as of June 30, 2026. Substantial doubt exists about the Company’s ability to continue as a going concern.

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Key points (machine generated)

• Nagai Reiben reported a 0.7% decrease in sales to 13,267 million yen for Q3 FY ending August 2026.
• Operating profit declined by 3.5% to 2,813 million yen, with ordinary profit down 1.2% to 2,958 million yen.
• A 12.3% increase in operating profit is expected for the full fiscal year due to a price increase and delayed projects.

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• Repligen Corporation has agreed to acquire BioLife Solutions (NASDAQ:BLFS) for approximately $1.5 billion, combining cash and stock in a transaction designed to strengthen Repligen’s position in cell therapy manufacturing.
• BioLife shareholders would receive $11.25 in cash and 0.1442 Repligen shares for each BioLife share, implying consideration of $31 per share.
• The proposed acquisition follows a strong operating period for Repligen, which reported 11% organic revenue growth in the first quarter of 2026 and preliminary second-quarter organic growth of approximately 13%.

• Scribe priced above expectations, upsized its IPO, and opened 66.7% higher, highlighting exceptional institutional demand.
• The deal wasmore than 10x oversubscribed, supported by strategic investments from Eli Lilly and Sanofi.
• Although Phase 1 data is not expected until 2027, strong long-term holders should help preserve much of the IPO premium.

• Shanghai Shengsheng Pharmaceutical Cold Chain Technology is a leading integrated temperature-control supply chain service provider in China for the pharmaceutical and life science industry, with a core focus on clinical.
• Shanghai Shengsheng is the largest temperature-control supply chain service provider in China for the pharmaceutical and life science industry in 2025. Revenue increased from RMB614.2 million in 2023 to RMB727.6.
• Revenue was RMB727,574 in 2025, with a gross profit margin of 36.9% in the same year. Adjusted net profit was RMB151,984 in 2025.

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• Cosmos is a vertically integrated healthcare group with a portfolio that spans pharmaceutical and nutraceutical brands, pharmaceutical distribution, proprietary and contract manufacturing as well as an emerging set of technology- and services-oriented assets.
• Cosmos Health has announced record revenues, expanded business and impressive share buyback numbers and investors should start to pay attention.

• Boston Scientific is a leading global medical technology company with a diversified portfolio of minimally invasive devices across high-growth specialties, positioning it to benefit from long-term demographic trends such as an aging population.
• The company has demonstrated a strong track record of revenue and earnings growth, driven by both organic innovation and strategic acquisitions. However, it faces near-term headwinds, reflected in a downward revision of its full-year 2026 organic revenue growth guidance.
• Future performance will be contingent on successful integration of acquisitions, continued R&D investment to maintain a competitive product pipeline, and navigating a complex regulatory and competitive landscape.

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• Mitesco, Inc. is a holding company providing products, services, and technology through Centcore, LLC and Vero Technology Ventures, LLC.
• Centcore, LLC offers data center services, while Vero Technology Ventures develops AI-based software like “Robo Agent” for real estate, expected Q3 FY2026.
• Cash and cash equivalents were $7,000 as of June 30, 2026. Substantial doubt exists about the Company’s ability to continue as a going concern.

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• Samsung Biologics (207940 KS) reported 2Q26 revenue and operating profit of KRW1.3T (+30% YoY) and KRW586B (+23% YoY), driven by stable operations across Plants 1–4 and favorable Fx.
• The company is on track to meet the upper end of FY guidance range, driven by stable operation of Rockville facility, progressive ramp-up of Plant 5, and favorable Fx.
• Samsung Biologics announced all-cash public tender offer to acquire PolyPeptide, a leading global CDMO specializing in peptide-based API, for CHF1.5B. The transaction is expected to be completed this year.

• Eli Lilly has spent the past several years turning Zepbound and Mounjaro into the centerpieces of a rapidly expanding weight-loss and diabetes franchise.
• Now, that momentum is being challenged in federal court.
• Novo Nordisk alleges that Lilly’s advertising misleads consumers by presenting its medicines as outperforming Wegovy and Ozempic, while Lilly maintains that its campaigns accurately reflect direct scientific evidence.

• Agape ATP Corporation is a Nevada corporation engaged in the Health and Wellness Industry, supplying products and advisory services in the Malaysian market. The company is offering units of common.
• Agape ATP Corporation acquired Agape Superior Living Sdn Bhd, securing an established network marketing sales channel in Malaysia for 15 years.
• There is substantial doubt about the Company’s ability to continue as a going concern for the next twelve months.

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• Medpace is a high-growth, high-margin Contract Research Organization (CRO) that provides full-service clinical trial management, primarily for small to mid-sized biotechnology and pharmaceutical companies.
• The company’s key differentiator is its integrated, ‘high-science’ operational model, which combines therapeutic expertise with end-to-end control over the clinical trial process, including in-house labs and imaging. This approach resonates with clients who require deep scientific support and reliable execution for complex trials.
• While Medpace has a strong track record of organic growth and profitability, recent concerns have emerged regarding a declining book-to-bill ratio, signaling a potential slowdown in new business wins and increased cancellations. This, combined with a premium valuation relative to peers, presents a key risk for investors.

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• Tempus AI has moved to deepen its position in precision oncology through a definitive agreement to acquire Personalis, its existing partner in molecular residual disease testing.
• Announced on July 20, 2026, the transaction values the remaining Personalis equity at $16.25 per share and implies an enterprise value of roughly $1.5 billion, net of Tempus’ existing stake.
• The consideration is structured primarily as stock, although Tempus may elect to fund up to half in cash, with closing expected in late 2026 or early 2027, subject to shareholder and regulatory approvals.

• Opaque Capital Structure and Going-Concern Risk: Despite a nominal asset base of $24.91 million, Agape ATP is in severe financial distress with only $220,779 in cash against an accumulated deficit of $12.13 million. Virtually all of the company’s current assets ($24.12 million) are tied up in an unallocated, illiquid investment deposit with Bi Cheng Investment Management, raising massive red flags about capital recoverability and solvency.
• MLM Segment in Structural Decline: The core network marketing business (Agape Superior Living) is deteriorating, with management aggressively cutting MLM expenses by 53.5% in a desperate pivot. The network suffers from extreme distributor concentration and high churn, meaning the departure of a few key multi-level marketing leaders in Malaysia could instantly trigger a complete collapse of their remaining sales pipeline.
• Renewable Energy Pivot is Executionally Unfeasible: The company’s highly publicized green energy ventures—including a 300 MWp solar farm in Sabah and 50 EV charging stations—are viewed as paper-only press releases designed to pump speculative retail interest. With near-zero cash and no technical track record, the company cannot meet the strict capital and compliance hurdles set by Malaysian regulators like the Sustainable Energy Development Authority (SEDA).

• The “SaaS” label is marketing; the reality is a low-margin, high-touch services business. While pure software segments boast gross margins above 70%, CareCloud’s consolidated GAAP gross margins hover in the 33% to 35% range. The structural drag comes from high-touch implementation, manual legacy data cleanups, and the intensive operational labor required to run Revenue Cycle Management (RCM), despite aggressive offshoring to Pakistan.
• Customer churn is structurally high and driven by consolidation, not product failure. Churn in their core target market—independent practices with 1 to 10 providers—is structurally high at 12% to 14% annually. As independent practices are acquired by larger health systems or private equity-backed groups, they are systematically migrated off CareCloud to enterprise platforms like Epic or Athenahealth.
• The M&A-driven growth engine has run out of fuel. CareCloud’s historical strategy of buying distressed RCM books of business at 0.3x to 0.5x revenue and cutting costs via offshore migration is no longer viable. High debt service costs on their credit facilities, combined with a lack of organic cross-sell conversion (which remains below 8%), has forced the company into a defensive restructuring posture.

• Telix has continued to outperform operationally in 2026, but future upside is increasingly dependent on pipeline execution, regulatory approvals and therapeutic progress PSMA imaging continues to gain market share Higher R&D spending accelerates pipeline development Regulatory catalysts could drive the next re-rating

• On July 22, 2026, Arrowhead Pharmaceuticals, Inc. (ARWR) announced positive results for the SHASTA-3 and SHASTA-4 trials of plozasiran in patients with severe hypertriglyceridemia (sHTG).
• The results shared by the company included a 79% and 81% median triglyceride reduction from baseline in SHASTA-3 and SHASTA-4, respectively.
• In addition, Arrowhead reported a statistically significant reduction in acute pancreatitis (AP) events versus placebo, including a 100% event reduction in high-risk patients (TG > 880 mg/dL and a history of AP).

• Strategic backing includes a $7.5 million private placement from Sanofi affiliates and an anchor investment indication from Eli Lilly.
• Scribe is developing next-generation CRISPR therapies targeting large cardiovascular markets, with initial Phase 1 data expected in 1H 2027.
• Although early-stage and small in size, strong institutional sponsorship and industry validation support an optimistic view on the offering.

• Near-term debt obligation reduced, strengthening the balance sheet.
• On July 15, 2026, Seneca Partners filed a Schedule 13D confirming that its affiliated V-Co Investors converted $1.1 million of convertible debt into equity as part of a $1.6-million financing, reducing near-term debt obligations and simplifying Vivos’ capital structure while reinforcing support from an existing anchor investor.
• The Streeterville secured note remains outstanding, with up to $4.5 million conditionally convertible into equity under the extended exchange agreement.

• On the 17th July 2026 , JBM (Healthcare) (2161 HK), a consumer healthcare company, announced the spin-off of 100%-held JPJ, the group’s branded PCM products and Chinese medicine clinic services.
• Listing is slated for the HKEx, market conditions permitting. An application proof has been lodged. JBM intends to hold at least 50% of JPJ post listing.
• My calcs suggest JBM is fairly valued here – before assigning any holdco discount post spin-off. FWIW, JBM was itself spun-off from Jacobson Pharma (2633 HK) in February 2021.

• The Proposed Spin-Off of JPJ (TCM) Limited Lacks Commercial Substance: Creating a three-tier listed structure (Jacobson Pharma to JBM Healthcare to JPJ) serves as financial engineering rather than operating synergy. It will exacerbate holding company discounts across the group and severely restrict JBM’s post-transaction equity liquidity, leaving JBM as an hollowed-out holding company.
• Clinic Acquisitions Dilute JPJ’s High-Margin Heritage Profile: JPJ’s historical strength lies in its dominant 9.2% market share in the Hong Kong Proprietary Chinese Medicine (PCM) space, backed by high-margin legacy brands like Po Chai Pills. However, its recent downstream expansion into lower-margin, labor-and-rent-intensive clinic chains (Kenford and King Pui) compresses consolidated margins and threatens the return-on-capital profile.
• Severe Corporate Governance and Transfer Pricing Risks Exist: High ownership concentration under Derek Sum, combined with rapid connected transactions—such as selling a stake in Li Chung Shing Tong in November 2024 at HK$460 per share and buying it back in June 2026 at HK$600 per share—indicates value leakage from minority shareholders of JBM to the parent. JPJ’s massive HK$506.8 million net current liabilities as of March 31, 2026, highlights major intercompany restructuring risks.

• ImmVira, a China-based clinical-stage biotech company, is seeking a Hong Kong Chapter 18A listing. Citigroup and CICC are the joint sponsors.
• In our previous note, we looked at the company’s core product MVR-T3011, including its mechanism and clinical data, as well as its management and investor backing.
• In this note, we look at developments in the company’s assets and the competitive setting.

• Bumrungrad Hospital (BH TB) shares advanced 27% over the last one year, while its larger peer Bangkok Dusit Medical Services (BDMS TB) shares fell 8% over the same period.
• Financial performance of these two companies justifies their respective share price movements. BH maintained its financial performance superiority to BDMS in recent times.
• Share price movement is not expected to change direction soon. BH shares are trading at EV/EBITDA of 12.6x, higher than BDMS (11.4x). Higher growth and superior profitability justify premium valuation.

• High Tide is the largest cannabis retailer in Canada operating 228 stores across Alberta, Ontario, Saskatchewan, BC, and Manitoba.
• Beyond traditional physical cannabis stores in Canada (Canna Cabana), the company markets Cannabidiol (CBD) and consumption accessories online across Canada, U.S., U.K. and Europe.
• More recently, HITI closed the acquisition of a 51% ownership stake in Remexian Pharma GmbH, a leading low-cost medical cannabis importer and wholesaler in Germany, which is a high-growth market.

• We remain bullish (as of our 4/21/26 Compass) on the S&P 500 (SPX), Nasdaq 100 (QQQ), and Russell 2000 (IWM).
• With that said, we have expressed our concern over the past two weeks in our reports, particularly as it relates to a prolonged consolidation for QQQ/Technology (XLK).
• We continue to believe a consolidation/continuation of the short-term downtrends is likely through mid-to-late-August amid ongoing choppy price action for semiconductors (SOXX), memory (DRAM), and optical equipment/photonics (EUV) names.