Energy transition aims to reduce national greenhouse gas emissions. Policies that promote renewable energy and the electricity market design influence energy transition at a countrywide level. Policy instruments include feed-in tariffs (FITs) and renewable portfolio standards (RPSs) that have been adopted worldwide. FITs and RPSs function by guaranteeing a fixed price and setting a minimum amount of renewable energy. In addition to policies, the electricity market affects the promotion of renewable energy, with which electricity markets are classified into regulated and deregulated markets. Compared to a regulated market, a deregulated market is more likely to provoke competition between suppliers, which is propitious for developing renewable energy. This article covers the following topics: (1) the effects of government policies on energy transition; (2) how different types of electricity markets work and their potential to promote the use of green electricity; and (3) a case study of an electricity market, in which policy instruments were used to encourage green electricity, and efforts paid by the government and citizens towards an energy generation profile of less emission and more renewable electricity.
Introduction: Locally advanced or metastatic pancreatic cancer presents challenges with limited treatment options and poor prognosis. While gemcitabine-based chemotherapy has been used as the first-line therapy, liposomal irinotecan, with its longer half-life and increased area under the concentration-time curve, holds promise as a second-line therapy. This study aimed to provide evidence on the safety and efficacy of liposomal irinotecan as a second-line treatment for locally advanced or metastatic pancreatic cancer. Methods: A systemic literature search was conducted on PubMed, Cochrane Library, EMBASE, and Web of Science databases to identify eligible clinical trials and observational studies focusing on the efficacy of liposomal irinotecan as a second-line treatment for advanced pancreatic cancer. The search encompassed studies published up to May 26th, 2023. A meta-analysis utilizing a bivariate and random-effects model was performed to derive pooled risk ratios (RRs) for essential clinical outcomes, such as overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and the incidence of grade 3 or 4 adverse events. Results: A total of 15 studies, including 1,129 patients of locally advanced or metastatic pancreatic cancers from 3 randomized clinical trials and 12 real-world studies, were subjected to meta-analysis. The utilization of liposomal irinotecan resulted in a significantly improved PFS (pooled mean difference=1.38 months, 95% CI: 0.78-1.99, P< 0.0001), OS (pooled mean difference=2.06 months, 95% CI: 0.48-3.63, P< 0.0001) and ORR (pooled mean difference = 10.96 months, 95% CI: 3.7-32.5, P< 0.0001) compared to other second-line regimens. However, a significantly increased risk of grade 3 or 4 neutropenia (pooled RR=6.86, 95% CI: 2.22-21.24, P=0.0008), diarrhea (pooled RR=3.86, 95% CI: 2.16-6.92, P< 0.0001), hypokalemia (pooled RR=3.3, 95% CI: 1.23-8.89, P=0.020), and vomiting (pooled RR=3.46, 95% CI: 1.50-7.96, P=0.003) were noted. Conclusion: Liposomal irinotecan-based second-line treatments significantly improved PFS, OS and ORR in patients with advanced pancreatic cancer. Further research is necessary to corroborate these findings and ascertain the efficacy of liposomal irinotecan in both primary and subsequent treatment settings.
Abstract Background: In the current literature, studies assessing the role of Helicobacter pylori (HP) infection in psoriasis have reported conflicting data. Therefore, we investigated the association between HP infection and psoriasis using a nationwide population-based longitudinal cohort study. Methods: We identified 41,539 patients with HP infection and 83,078 matched controls between 2000 and 2013 from the Longitudinal Health Insurance Research Database of the National Health Insurance Research Database in Taiwan. Propensity score analysis was used to match age, sex, comorbidities, and medical visits at a ratio of 1:2. Multiple Cox regression analysis was used to estimate the adjusted hazard ratio of psoriasis. Furthermore, sensitivity tests and a stratified analysis were conducted. Results: The incidence rates of psoriasis did not differ significantly between the HP and control cohorts (4.58 vs 4.20 per 100,000 person-months, crude relative risk: 1.092, 95% confidence interval: 0.917–1.302). After multivariate adjustment, no significant difference in psoriasis risk was observed in patients with HP infection (adjusted hazard ratio: 1.081, 95% confidence interval: 0.907–1.288). Risk of psoriasis was significantly higher in men and the elderly, and in those with diabetes, hyperlipidemia, chronic obstructive pulmonary disease, or tuberculosis. Stratified analysis also confirmed that HP infection was not correlated with an increased risk of psoriasis based on follow-up duration, sex, and age. Conclusion: This retrospective population-based longitudinal cohort study, conducted in Taiwan, found no association between HP infection and risk of psoriasis. Further research may be warranted.
The mecA gene, carried by methicillin-resistant Staphylococcus aureus (MRSA), allows the bacterium to promotes bacterial resistance to antibiotics such as methicillin, penicillin, and other penicillin-like antibiotics. Our objectives are to use a bioinformatics tool to analyze the sequence of the mecA gene, which is spread on the SCCmec genetic element, and to investigate the relationship between each mecA gene. From 2008 to 2016, we collected 229 MRSA from bacteremia; we extracted DNA from the MRSA and designed specific primers to target mecA using PCR. The primer used are listed in mec A-1(5’-GGGATCATAGCGTCATTATTC-3’) and mec A-2(5’-AACGATTGTGACACGATAGCC-3’). We determined whether the mecA gene was present by using electrophoresis and then sequenced the MRSA samples in which it was present. The POWER tool was employed to analyze the mecA gene and compile a pedigree chart. Using the sequencing data, we created an MRSA database, and the BLAST findings demonstrated that most of the mecA genes were similar, with over 95% identified. The pedigree chart illustrates that there are four groups of mecA genes, and these groups were found to be not differentiated between the sources of the MRSA, whether from communities or hospital association infections. Our findings indicate that even though there were four groups with ancestors in the pedigree chart, no significant difference was found between MRSA from community- and hospital-associated infections. We plan to collect more MRSA samples for analysis and investigate the differences between MRSA groups and MRSA from various geographical regions. All authors: No reported disclosures.
Abstract Objectives Immune checkpoint inhibitors are associated with adverse cardiovascular events. However, there are no data characterizing cardiovascular events among Asians on immune checkpoint inhibitors. We aim to determine the incidence and risk of cardiac events associated with immune checkpoint inhibitors in an Asian population. Methods We performed a retrospective, propensity score-matched cohort study at two tertiary referral centers in Taiwan. Immune checkpoint inhibitor users were matched with non-immune checkpoint inhibitor users based on predetermined clinical variables. The primary outcome was major adverse cardiovascular events, defined as a composite of myocardial infarction, ischemic stroke, acute peripheral occlusive disease, pulmonary embolism, deep venous thrombosis, heart failure, pericardial disease, myocarditis, cardiac arrhythmias and conduction block. Results Between January 2010 and November 2021, 868 immune checkpoint inhibitor users were matched 1:1 with non-immune checkpoint inhibitor users. Among immune checkpoint inhibitor users, 67 (7.7%) patients developed major adverse cardiovascular events. During a median follow-up period of 188 days, the incidence rate of major adverse cardiovascular events for immune checkpoint inhibitor and non-immune checkpoint inhibitor users was 94.8 and 46.2 per 1000 patient-years, respectively, resulting in an incidence rate ratio of 2.1 [95% confidence interval: 1.5–2.9]. In multivariate Cox proportional hazard models, immune checkpoint inhibitor users had a 60% increased risk for major adverse cardiovascular events [hazard ratio, 1.6 (95% confidence interval: 1.1–2.3)]. Immune checkpoint inhibitors use was independently associated with increased risk of ischemic stroke [hazard ratio, 3.0 (95% confidence interval: 1.0–9.0)] and pulmonary embolism [hazard ratio, 5.5 (95% confidence interval: 1.4–21.3)]. In multivariate logistic regression analysis, age > 65, metastatic disease, hypertension and baseline platelet-to-lymphocyte ratio < 180 were risk factors for major adverse cardiovascular events. Conclusions Among Asians, immune checkpoint inhibitors were associated with an increased risk of major adverse cardiovascular events, particularly ischemic stroke and pulmonary embolism.
Objectives Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce heart failure (HF) in at-risk patients and may possess antitumour effects. We examined the effect of SGLT2i on HF and mortality among patients with cancer and diabetes. Methods This was a retrospective propensity score-matched cohort study involving adult patients with type 2 diabetes mellitus diagnosed with cancer between January 2010 and December 2021. The primary outcomes were hospitalisation for incident HF and all-cause mortality. The secondary outcomes were serious adverse events associated with SGLT2i. Results From a total of 8640 patients, 878 SGLT2i recipients were matched to non-recipients. During a median follow-up of 18.8 months, SGLT2i recipients had a threefold lower rate of hospitalisation for incident HF compared with non-SGLT2i recipients (2.92 vs 8.95 per 1000 patient-years, p=0.018). In Cox regression and competing regression models, SGLT2i were associated with a 72% reduction in the risk of hospitalisation for HF (HR 0.28 (95% CI: 0.11 to 0.77), p=0.013; subdistribution HR 0.32 (95% CI: 0.12 to 0.84), p=0.021). The use of SGLT2i was also associated with a higher overall survival (85.3% vs 63.0% at 2 years, p<0.001). The risk of serious adverse events such as hypoglycaemia and sepsis was similar between the two groups. Conclusions The use of SGLT2i was associated with a lower rate of incident HF and prolonged overall survival in patients with cancer with diabetes mellitus.
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