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The links among firms’ environmental regulation, innovation process, and sustainable development has been analyzed, but a research gap still remains in terms of environmental commitment and different types of sustainable innovation in firms’ sustainability. Through collecting a dataset of 380 valid respondents from Chinese manufacturing firms, this paper incorporates evironmental regulation, environmental commitment, sustainability exploration innovation, sustainability exploitation innovation, environmental performance, and business performance into a multiple mediating effect model. Our key emperical findings are as follows: (1) Environmental regulation not only cannot affect environmental performance and business performance, but also cannot affect the two types of firm performance through sustainability exploration innovation or sustainability exploitation innovation; (2) The relationship between environmental regulation, environmental performance (or business performance) is subsequently mediated by both environmental commitment and sustainability exploitation innovation; (3) Environmental regulation does not affect environmental performance (or business performance) through environmental commitment and sustainability exploration innovation. These results do, however, support the Porter Hypothesis in terms of revealing a new multiple mediating effect path dominated by environmental commitment and sustainability exploitation innovation. Our findings can provide a better understanding of how environmental commitment and sustainability exploitation innovation play a key effect in helping firms relieve the pressure from environmental regulation, and thus improve their environmental management while keeping their competitive edge.

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Introduction and hypothesisWe report the clinical outcome of surgical repair for rectovaginal fistula (RVF) carried out by one operative team. We also investigate the predictive factors for fistula healing.MethodsA retrospective cohort of 63 patients underwent local surgical repair of RVF during January 2008 and December 2017 by one operative group. The clinical features of the patients were reviewed. The association between fistula closure and diverse clinical parameters, including operative method, fistula location, prior repair, and diverting stoma, was analyzed.ResultsSixty-three consecutive patients underwent 80 local surgical repairs by our surgical team. Forty-five patients eventually healed after an average of 1.22 procedures. The overall success rate per procedure was 71.2%, whereas the closure rate of the first operation was 55.5% (n = 35). The etiology of the fistula did not impact on the success rate of surgical repair. The history of prior repair predicted a lower success rate on both overall procedure (RR = 0.59, 95% CI 0.41–0.85, p = 0.008) and the first repair in our institution (RR = 0.50, 95% CI 0.31–0.80, p = 0.003). There was no difference in closure rate between the stoma group and the non-stoma group. Nevertheless, among the 15 patients who underwent more than one operation in our center, a diverting stoma seemed to be necessary (10 patients healed in the stoma group and none of the patients healed in the non-stoma group, p = 0.02).ConclusionsHistory of prior surgical repair is a risk factor for failure. Diverting stoma did not increase the overall closure rate, but it seemed to be necessary for patients in whom the first operation failed.