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Since the mid-1980s, power sector liberalization has been embraced at different levels in the East Asian countries of China, Japan, South Korea and Taiwan. The dominant rationale underlying power liberalization has been a quest for efficiency improvements, to be achieved by substituting private market activity for public regulations and by opening a country's electricity system to the global economy and management techniques. However, as the power system is increasingly liberalized, the possibility of establishing a local energy system, which has the great potential to restore sustainable environment-society relations, has been diminished. As an alternative to the power liberalization strategy, this paper proposes a restoration of local energy regimes based on the model of an energy commons and a decentralization paradigm. The innovative energy-policy model of the Sustainable Energy Utility, as applied in the case of Seoul, Korea, is explored as a possible option for a local energy strategy for East Asian countries. (Contains 4 figures and 6 notes.)

Background: The objective of this study was to assess the impact of statin use on overall survival (OS) and nasopharyngeal cancer (NPC)-specific survival in patients with advanced NPC who underwent standard concurrent chemoradiotherapy (CCRT)., Patients and Methods: This propensity score matched cohort study used data from the Taiwan Cancer Registry Database and National Health Insurance Research Database to examine the impact of statin use during CCRT on both OS and NPC-specific survival., Results: Statin use during CCRT demonstrated significant and independent prognostic value for both OS and NPC-specific survival. The adjusted hazard ratio for all-cause mortality in the statin group compared with the nonstatin group was 0.48 (95% CI, 0.34-0.68; P<.0001). Similarly, the adjusted hazard ratio for NPC-specific mortality in the statin group compared with the nonstatin group was 0.43 (95% CI, 0.29-0.65; P<.0001). Rosuvastatin, atorvastatin, and lovastatin demonstrated significant efficacy in improving NPC-specific survival outcomes. Moreover, our findings indicate a dose-response relationship, with higher cumulative defined daily doses and greater daily intensity of statin use associated with reduced mortality., Conclusions: This study suggests an association between statin use during the CCRT period for NPC and potential enhancements in both OS and NPC-specific survival. Our findings indicate a possible survival benefit of rosuvastatin, atorvastatin, and lovastatin for patients with NPC undergoing CCRT. The observed dose-response relationship underscores the potential importance of higher statin use in mitigating NPC-specific mortality, but further research is needed to establish a definitive causal relationship.

To analyze the effects of metformin in reducing radiation-induced cardiac toxicity (RICT) risk during adjuvant radiotherapy (RT) after surgery for early-stage breast cancer women. We compare the consecutive occurrence of major heart events (heart failure and coronary artery disease) in women with early-stage breast cancer receiving adjuvant breast RT with metformin and in those receiving RT without metformin. A retrospective national cohort study was conducted using the Taiwan Cancer Registry of 2004-2014. This study included 6,993 women with early-stage breast cancer who received adjuvant breast RT. Metformin users were defined as patients prescribed metformin for >28 days during adjuvant breast RT. An inverse probability of treatment weighting (IPTW) Cox hazards model was used to estimate metformin effects on the occurrence of major heart events. Among women with breast cancer status post-surgery under adjuvant breast RT, 2,062 were prescribed metformin and 4,931 were not prescribed metformin. Cox proportional hazard regression analysis, with adjustment using IPTW, indicated that metformin use during adjuvant breast RT significantly reduces the risk of major heart events (adjusted hazard ratio [aHR], 0.789; 95% confidence interval [CI], 0.645-0.965; P = 0.021). In another negative control exposure, thiazolidinedione use during adjuvant breast RT did not statistically reduce consecutive RICT risk (aHR, 1.106; 95% CI, 0.768-1.594; P = 0.589). Our results suggest that metformin use during adjuvant breast RT was associated with reduced RICT risk in women with early-stage breast cancer., Competing Interests: None.

Background: Primary family caregivers (PFCs) in the intensive care unit (ICU) experienced stress and stress-related symptoms such as sleep disturbances and fatigue. These symptoms may cause physical and mental health problems and affect the quality of care that they provide to their care recipients., Purpose: This study explored the levels of severity of stress, sleep disturbances, and fatigue experienced by PFCs in the ICU in order to understand the associations and to explore the predictors and influencing factors in the period following the first ICU admission of their care recipients., Methods: This descriptive correlational study was based on Lazarus and Folkman's Stress-Coping theory. Four questionnaires including the Impact of Events Scale - Revised, General Sleep Disturbance Scale, Lee's Fatigue Scale, and the Norbeck Social Support Questionnaire were used to measure the psychological stress symptoms and social support received by 72 PFCs. Descriptive statistics and multiple hierarchical regression analysis were utilized for data analysis., Results: The participants suffered from high levels of event stress, poor sleep quality, and fatigue severity. However, they also received generally high levels of social support. Stress perception was found to positively associated with sleep disturbances and fatigue severity. The participants who experienced higher event stress sought additional assistance. The age and perceived event stress of PFCs were significant predictors of sleep disturbances, while perceived event stress was the only significant predictor of fatigue., Conclusions / Implications for Practice: This study provided healthcare professionals with important information to understand the psychological symptoms of PFCs. Future studies should identify the stressors of this caregiver group and explore their psychological symptoms during different hospitalization periods. Further interventions should be developed to help PFCs cope with stress and improve stress-related symptoms such as sleep quality and fatigue severity.

Ethanol metabolism produces harmful compounds that contribute to liver damage and cause an alcohol hangover. The intermediate metabolite acetaldehyde is responsible for alcohol hangover and CYP2E1-induced reactive oxygen species damage liver tissues. In this study, we examined whether ginsenoside-free molecules (GFMs) from steam-dried ginseng berries promote ethanol metabolism and scavenge free radicals by stimulating primary enzymes (alcohol dehydrogenase, aldehyde dehydrogenase, CYP2E1, and catalase) and antioxidant effects using in vitro and in vivo models. The results revealed that GFM effectively scavenged 2,2-diphenyl-1-picrylhydrazyl hydrate radicals and hydroxyl radicals. Notably, GFM significantly enhanced the expression of primary enzymes within 2 h in HepG2 cells. GFM clearly removed the consumed ethanol and significantly reduced the level of acetaldehyde as well as enhancement of primary gene expression in BALB/c mice. Moreover, GFM successfully protected HepG2 cells from ethanol attack. Of the major components identified in GFM, it was believed that linoleic acid was the most active ingredient. Based on these findings, we conclude that GFM holds promise for use as a new candidate for ethanol metabolism and as an antihangover agent., (© 2014 Institute of Food Technologists®)

Acute fulminant myocarditis may present with cardiogenic shock refractory to inotropics and intra-aortic balloon pumping (IABP). Benefit of extracorporeal membrane oxygenation (ECMO) support has been established. The effectiveness of combination with ECMO or IABP and activated protein C (drotrecogin alpha; Xigris) in treatment has yet to be defined. Four patients presented with congestive heart failure 3-4 days after flu-like symptoms. Chest roentgenograms showed cardiomegaly and bilateral pulmonary infiltrates. Two-dimensional echocardiograms demonstrated severe myocardial dysfunction with left ventricular ejection fraction (LVEF), measured between 18.4% to 27% (mean, 19.5%). Three patients having been treated with the combination of ECMO or IABP and activated protein C were weaned. Follow-up LVEF measured were 39.9%, 43%, 53%, and 55%, respectively. However, 1 patient died a month later because of systemic lupus erythematosus and repeated infection. There were no neurologic sequelae in the 3 survivors. Serological test and myocardial biopsy for Parvovirus B19 was positive in 3 of 4 patients. Use of circulatory support and activated protein C is an effective alternative for acute life-threatening myocarditis.

Removal of right atrial hepatic tumor with caval involvement requires control of bleeding, avoidance of tumor embolization, and adequate resection. We reported an octogenarian having hepatocellular carcinoma with caval and right atrial involvements who underwent successful resection using cardiopulmonary bypass and intraoperative transesophageal echocardiography.