The Effects of Using a Low-Cost and Easily Accessible Exercise Toolkit Incorporated to the Governmental Health Program on Community-Dwelling Older Adults: A Quasi-Experimental Study.

The Community Care Station (CCS) service was initiated by the Taiwanese government as a part of its elderly social services programs. This study aimed to investigate the effects of using an inexpensive exercise toolkit, containing a stick, theraband, sandbag and a small ball, led by a physical therapist among community-dwelling older adults participating in CCS. A total of 90 participants (aged 77.0 ± 6.8 years) were recruited and divided into an intervention group (n = 45) and a comparison group (n = 45). The intervention group regularly participated in a health promotion program with the exercise toolkit for approximately 90 min per twice-weekly session for 3 months, and the comparison group maintained their usual CCS activity program. Both groups were assessed before and after the 3-month intervention period. Outcome measures included the Short Physical Performance Battery (SPPB), one-leg stance, functional reach (FR), Timed Up and Go (TUG), and 10 m walk tests; 83 participants completed the study. No significant between-group differences were found at baseline in general characteristics or outcome variables. After 3 months, the intervention group showed the significant group x time interaction effects in SPPB, one-leg stance, FR, TUG and 10 m walk tests compared to the comparison group (p < 0.05).; A structured group-based health promotion program using a low-cost exercise toolkit could be effective in improving the physical performances, balance, and walking ability of community-dwelling older adults receiving CCS program services. Furthermore, the comparison group maintained most of their physical performances, even showing significant progress on FR.

Reversible Charge-Polarity Control for Multioperation-Mode Transistors Based on van der Waals Heterostructures.

Van der Waals (vdW) heterostructures-in which layered materials are purposely selected to assemble with each other-allow unusual properties and different phenomena to be combined and multifunctional electronics to be created, opening a new chapter for the spread of internet-of-things applications. Here, an O2 -ultrasensitive MoTe2 material and an O2 -insensitive SnS2 material are integrated to form a vdW heterostructure, allowing the realization of charge-polarity control for multioperation-mode transistors through a simple and effective rapid thermal annealing strategy under dry-air and vacuum conditions. The charge-polarity control (i.e., doping and de-doping processes), which arises owing to the interaction between O2 adsorption/desorption and tellurium defects at the MoTe2 surface, means that the MoTe2 /SnS2 heterostructure transistors can reversibly change between unipolar, ambipolar, and anti-ambipolar transfer characteristics. Based on the dynamic control of the charge-polarity properties, an inverter, output polarity controllable amplifier, p-n diode, and ternary-state logics (NMIN and NMAX gates) are demonstrated, which inspire the development of reversibly multifunctional devices and indicates the potential of 2D materials.

Facile and Reversible Carrier-Type Manipulation of Layered MoTe2 Toward Long-Term Stable Electronics.

Flexible manipulation of the carrier transport behaviors in two-dimensional materials determines their values of practical application in logic circuits. Here, we demonstrated the carrier-type manipulation in field-effect transistors (FETs) containing α-phase molybdenum ditelluride (MoTe2) by a rapid thermal annealing (RTA) process in dry air for hole-dominated and electron-beam (EB) treatment for electron-dominated FETs. EB treatment induced a distinct shift of the transfer curve by around 135 V compared with that of the FET-processed RTA treatment, indicating that the carrier density of the EB-treated FET was enhanced by about 1 order of magnitude. X-ray photoelectron spectroscopy analysis revealed that the atomic ratio of Te decreased from 66.4 to 60.8% in the MoTe2 channel after EB treatment. The Fermi level is pinned near the new energy level resulting from the Te vacancies produced by the EB process, leading to the electron-dominant effect of the MoTe2 FET. The electron-dominated MoTe2 FET showed excellent stability for more than 700 days. Thus, we not only realized the reversible modulation of carrier-type in layered MoTe2 FETs but also demonstrated MoTe2 channels with desirable performance, including long-term stability.

Oxidation-boosted charge trapping in ultra-sensitive van der Waals materials for artificial synaptic features.

Exploitation of the oxidation behaviour in an environmentally sensitive semiconductor is significant to modulate its electronic properties and develop unique applications. Here, we demonstrate a native oxidation-inspired InSe field-effect transistor as an artificial synapse in device level that benefits from the boosted charge trapping under ambient conditions. A thin InOx layer is confirmed under the InSe channel, which can serve as an effective charge trapping layer for information storage. The dynamic characteristic measurement is further performed to reveal the corresponding uniform charge trapping and releasing process, which coincides with its surface-effect-governed carrier fluctuations. As a result, the oxide-decorated InSe device exhibits nonvolatile memory characteristics with flexible programming/erasing operations. Furthermore, an InSe-based artificial synapse is implemented to emulate the essential synaptic functions. The pattern recognition capability of the designed artificial neural network is believed to provide an excellent paradigm for ultra-sensitive van der Waals materials to develop electric-modulated neuromorphic computation architectures.

Probing Charge Transport Difference in Parallel and Vertical Layered Electronics with Thin Graphite Source/Drain Contacts.

In the present study, we aim to help improve the design of van der Waals stacking, i.e., vertical 2D electronics, by probing charge transport differences in both parallel and vertical conducting channels of layered molybdenum disulfide (MoS2), with thin graphite acting as source and drain electrodes. To avoid systematic errors and variable contact contributions to the MoS2 channel, parallel and vertical electronics are all fabricated and measured on the same conducting material. Large differences in the on/off current ratio, mobility, and charge fluctuations, between parallel and vertical electronics are evident in electrical performance as well as in charge transport mechanisms. Further insights are drawn from a well-constrained analysis of both temperature-dependent current-voltage characteristics and low-frequency (LF) current fluctuations. This work offers significant insight into the fundamental understanding of charge transport and the development of future layered-materials-based integration technology.

Oxygen-Sensitive Layered MoTe2 Channels for Environmental Detection.

The oxygen (O2)-dependent resistance change of multilayered molybdenum ditelluride (MoTe2) channels was characterized. A variation of the channel resistance could reproducibly determine relative O2 content (denoted as the O2 index). We found that Joule heating in a layered MoTe2 field-effect transistor caused the O2 index to decrease drastically from 100 to 12.1% in back gate modulation. Furthermore, Joule heating caused effective O2 desorption from the MoTe2 surface and repeatable O2 detection by multilayered MoTe2 channels was realized. This work not only explored the influence of O2 on the electrical properties of multilayered MoTe2 channels but also revealed that MoTe2 channels are promising for sensing O2 in an environmental condition.

A Triode Device with a Gate Controllable Schottky Barrier: Germanium Nanowire Transistors and Their Applications.

Electrical contacts often dominate charge transport properties at the nanoscale because of considerable differences in nanoelectronic device interfaces arising from unique geometric and electrostatic features. Transistors with a tunable Schottky barrier between the metal and semiconductor interface might simplify circuit design. Here, germanium nanowire (Ge NW) transistors with Cu3 Ge as source/drain contacts formed by both buffered oxide etching treatments and rapid thermal annealing are reported. The transistors based on this Cu3 Ge/Ge/Cu3 Ge heterostructure show ambipolar transistor behavior with a large on/off current ratio of more than 105 and 103 for the hole and electron regimes at room temperature, respectively. Investigations of temperature-dependent transport properties and low-frequency current fluctuations reveal that the tunable effective Schottky barriers of the Ge NW transistors accounted for the ambipolar behaviors. It is further shown that this ambipolarity can be used to realize binary-signal and data-storage functions, which greatly simplify circuit design compared with conventional technologies.

Association between diuretic use and the risk of vertebral fracture after stroke: a population-based retrospective cohort study.

BACKGROUND: Stroke is a major risk factor for osteoporosis and fractures. No study has evaluated the association between diuretic use and risk of vertebral fracture in stroke patients, although a considerable proportion of stroke patients are prescribed diuretics for hypertension. Our study aimed to investigate whether treatment with thiazides or loop diuretics affects the risk of vertebral fracture after stroke. METHODS: A population-based propensity score-matched retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients with a new diagnosis of stroke between 2000 and 2011 were included. After propensity score matching, 9468 patients were included in the analysis of the effect of thiazides, of who 4734 received thiazides within 2 years after stroke. To analyze the loop diuretic effect, 4728 patients were included, of who 2364 received loop diuretics. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) of vertebral fractures among patients according to thiazide or loop diuretic use within 2 years following stroke. Sensitivity analyses based on the duration of thiazide or loop diuretic use were further conducted. RESULTS: There was no significant difference in vertebral fracture risk between thiazide users and non-users (adjusted HR [aHR] = 1.14, 95% confidence interval [CI] = 0.88-1.47, p = 0.316). Loop diuretic users had a significantly higher vertebral fracture risk than non-users (aHR = 1.45, 95% CI = 1.06-1.98, p = 0.019). However, the sensitivity analysis revealed that short-term thiazide use (exposure duration < 90 days within 2 years after stroke) significantly increased the risk of vertebral fracture versus non-use (aHR = 1.38, 95% CI = 1.02-1.88, p = 0.039). Only short-term loop diuretic users had significantly higher risk of vertebral fracture (aHR = 1.56, 95% CI = 1.11-2.20, p = 0.011). The other two subgroups with longer exposure duration in analyses for both thiazides and loop diuretics revealed no significant effect. CONCLUSIONS: Short-term thiazide or loop diuretic use was associated with an increased risk of vertebral fracture after stroke. Further prospective clinical trials are required to confirm this finding.

Association between benzodiazepine use and risks of chronic-onset poststroke pneumonia: a population-based cohort study.

OBJECTIVES: To investigate the association between benzodiazepine (BZD) use and the risk of chronic-onset poststroke pneumonia. DESIGN: Population-based propensity-matched retrospective cohort study. SETTING: Taiwan's National Health Insurance Research Database. PARTICIPANTS: Patients newly diagnosed with stroke between 2000 and 2012 were identified and, after propensity score matching, 7516 patients were enrolled. Among these, 3758 patients received BZDs after stroke while 3758 did not. OUTCOME MEASURES: HRs for developing pneumonia over 1 month after stroke according to BZD use were assessed using Cox proportional hazards regression models. Analyses according to cumulative defined daily doses (cDDDs) of BZDs and stratification for age and sex were also performed. RESULTS: During a mean follow-up time of 4.4 years, 1027 patients in the BZD cohort and 478 patients in the non-BZD cohort developed pneumonia over 1 month after stroke. Patients using BZDs after stroke had a higher pneumonia risk than did those not using BZDs (52.2vs32.6 per 1000 person-years, adjusted HR (aHR)=2.21, 95% CI (CI)=1.97 to 2.48, p<0.001). Analyses based on cumulative BZD dose revealed that all BZD user subgroups were associated with a higher risk of pneumonia. The aHRs for patients taking 1-90, 91-365 and >365 cDDDs of BZDs were 2.28 (95% CI=2.01 to 2.58; p<0.001), 2.09 (95% CI=1.77 to 2.47; p<0.001) and 2.08 (95% CI=1.72 to 2.52; p<0.001), respectively. The significant association between BZD use and increased pneumonia risk persisted even after stratifying subgroups by age and sex. CONCLUSIONS: BZD use is associated with an increased risk of chronic-onset poststroke pneumonia.

Atomically thin van der Waals tunnel field-effect transistors and its potential for applications.

Power dissipation is a crucial problem as the packing density of transistors increases in modern integrated circuits. Tunnel field-effect transistors (TFETs), which have high energy filtering provided by band-to-band tunneling (BTBT), have been proposed as an alternative electronics architecture to decrease the energy loss in bias operation and to achieve steep switching at room temperature. Very recently, the BTBT behavior has been demonstrated in van der Waals heterostructures by using unintentionally doped semiconductors. The reason of the BTBT formation is attributed to a significant band bending near the heterointerface, resulting in carrier accumulations. In this work, to investigate charge transport in type-III transistors, we adopted the same band-bending concept to fabricate van der Waals BP/MoS2 heterostructures. Through analyzing the temperature dependence of their electrical properties, we carefully ruled out the contribution of metal-semiconductor contact resistances and improved our understanding of carrier injection in 2D type-III transistors. The BP/MoS2 heterostructures showed both negative differential resistance and 1/f 2 current fluctuations, strongly demonstrating the BTBT operation. Finally, we also designed a TFET based on this heterostructure with an ionic liquid gate, and this TFET demonstrated an subthreshold slope can successfully surmount the thermal limit of 60 mV/decade. This work improves our understanding of charge transport in such layered heterostructures and helps to improve the energy efficiency of next-generation nanoscale electronics.

High Mobilities in Layered InSe Transistors with Indium-Encapsulation-Induced Surface Charge Doping.

Tunability and stability in the electrical properties of 2D semiconductors pave the way for their practical applications in logic devices. A robust layered indium selenide (InSe) field-effect transistor (FET) with superior controlled stability is demonstrated by depositing an indium (In) doping layer. The optimized InSe FETs deliver an unprecedented high electron mobility up to 3700 cm2 V-1 s-1 at room temperature, which can be retained with 60% after 1 month. Further insight into the evolution of the position of the Fermi level and the microscopic device structure with different In thicknesses demonstrates an enhanced electron-doping behavior at the In/InSe interface. Furthermore, the contact resistance is also improved through the In insertion between InSe and Au electrodes, which coincides with the analysis of the low-frequency noise. The carrier fluctuation is attributed to the dominance of the phonon scattering events, which agrees with the observation of the temperature-dependent mobility. Finally, the flexible functionalities of the logic-circuit applications, for instance, inverter and not-and (NAND)/not-or (NOR) gates, are determined with these surface-doping InSe FETs, which establish a paradigm for 2D-based materials to overcome the bottleneck in the development of electronic devices.

Intrinsic Carrier Transport of Phase-Pure Homologous 2D Organolead Halide Hybrid Perovskite Single Crystals.

This work reveals the intrinsic carrier transport behavior of 2D organolead halide perovskites based on phase-pure homologous (n = 1, 2, and 3) Ruddelsden-Popper perovskite (RPP) (BA)2 (MA)n -1 Pbn I3n+1 single crystals. The 2D perovskite field effect transistors with high-quality exfoliated 2D perovskite bulk crystals are fabricated, and characteristic output and transfer curves are measured from individual single-crystal flakes with various n values under different temperatures. Unipolar n-type transport dominated the electrical properties of all these 2D RPP single crystals. The transport behavior of the 2D organolead halide hybrid perovskites exhibits a strong dependence on the n value and the mobility substantially increases as the ratio of the number of inorganic perovskite slabs per organic spacer increases. By extracting the effect of contact resistances, the corrected mobility values for n = 1, 2, and 3 are 2 × 10-3 , 8.3 × 10-2 , and 1.25 cm2 V-1 s-1 at 77 K, respectively. Furthermore, by combining temperature-dependent electrical transport and optical measurements, it is found that the origin of the carrier mobility dependence on the phase transition for 2D organolead halide perovskites is very different from that of their 3D counterparts. Our findings offer insight into fundamental carrier transport behavior of 2D organic-inorganic hybrid perovskites based on phase-pure homologous single crystals.

Exposure to nicotine-derived nitrosamine ketone and arecoline synergistically facilitates tumor aggressiveness via overexpression of epidermal growth factor receptor and its downstream signaling in head and neck squamous cell carcinoma.

Long-term nicotine-derived nitrosamine ketone (NNK) and arecoline exposure promotes carcinogenesis and head and neck squamous cell carcinoma (HNSCC) progression, although most associated data on the two were analyzed individually. The molecular mechanisms underlying tumor progression associated with the synergistic effects of NNK and arecoline remain unclear. We treated SCC-25 and FaDu cells with NNK and arecoline (separately or in combination) for 3 months. Comparative analysis was performed to investigate the mechanism underlying the acquisition of properties related to tumor promotion, including stemness, anti-apoptosis, and resistance to HNSCC therapeutics. Long-term exposure to NNK and arecoline resulted in an increase in cancer stem cell properties, anti-apoptosis, and the resistance to cisplatin in HNSCC. We detected abundant epidermal growth factor receptor (EGFR) expression in HNSCC cells after combined treatment with NNK and arecoline. EGFR was pivotal in inducing tumor promotion and anti-apoptosis in cancer cells by inducing pAKT and NFκB. Combined treatment with NNK and arecoline synergistically facilitated tumor aggressiveness via EGFR-AKT signaling. Targeting EGFR-AKT signaling may be a feasible strategy for treating HNSCC.

Reversible and Precisely Controllable p/n-Type Doping of MoTe2 Transistors through Electrothermal Doping.

Precisely controllable and reversible p/n-type electronic doping of molybdenum ditelluride (MoTe2 ) transistors is achieved by electrothermal doping (E-doping) processes. E-doping includes electrothermal annealing induced by an electric field in a vacuum chamber, which results in electron (n-type) doping and exposure to air, which induces hole (p-type) doping. The doping arises from the interaction between oxygen molecules or water vapor and defects of tellurium at the MoTe2 surface, and allows the accurate manipulation of p/n-type electrical doping of MoTe2 transistors. Because no dopant or special gas is used in the E-doping processes of MoTe2 , E-doping is a simple and efficient method. Moreover, through exact manipulation of p/n-type doping of MoTe2 transistors, quasi-complementary metal oxide semiconductor adaptive logic circuits, such as an inverter, not or gate, and not and gate, are successfully fabricated. The simple method, E-doping, adopted in obtaining p/n-type doping of MoTe2 transistors undoubtedly has provided an approach to create the electronic devices with desired performance.

Multilayer Graphene-WSe2 Heterostructures for WSe2 Transistors.

Two-dimensional (2D) materials are drawing growing attention for next-generation electronics and optoelectronics owing to its atomic thickness and unique physical properties. One of the challenges posed by 2D materials is the large source/drain (S/D) series resistance due to their thinness, which may be resolved by thickening the source and drain regions. Recently explored lateral graphene-MoS21-3 and graphene-WS21,4 heterostructures shed light on resolving the mentioned issues owing to their superior ohmic contact behaviors. However, recently reported field-effect transistors (FETs) based on graphene-TMD heterostructures have only shown n-type characteristics. The lack of p-type transistor limits their applications in complementary metal-oxide semiconductor electronics. In this work, we demonstrate p-type FETs based on graphene-WSe2 lateral heterojunctions grown with the scalable CVD technique. Few-layer WSe2 is overlapped with the multilayer graphene (MLG) at MLG-WSe2 junctions such that the contact resistance is reduced. Importantly, the few-layer WSe2 only forms at the junction region while the channel is still maintained as a WSe2 monolayer for transistor operation. Furthermore, by imposing doping to graphene S/D, 2 orders of magnitude enhancement in Ion/Ioff ratio to ∼108 and the unipolar p-type characteristics are obtained regardless of the work function of the metal in ambient air condition. The MLG is proposed to serve as a 2D version of emerging raised source/drain approach in electronics.

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan's National Health Insurance Research Database.

OBJECTIVES: This study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke. SETTING: A population-based, propensity-matched cohort study was conducted on the basis of Taiwan's National Health Insurance Research Database. PARTICIPANTS: Patients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not. OUTCOME MEASURES: HRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions. RESULTS: Overall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008). CONCLUSIONS: The long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

A New Comprehensive Short-form Health Literacy Survey Tool for Patients in General.

PURPOSE: To validate a conceptual short-form health literacy 12 items questionnaire (HL-SF12) in patient populations. METHODS: A cross-sectional study was conducted via a convenient sample of 403 patients from three departments of a community general hospital in the northern Taiwan. Patients' health literacy was assessed with a validated HL-SF12, derived from the full scale, the European Health Literacy Survey Questionnaire (HLS-EU-Q), as well as a single-item from Chew's Set of Brief Health Literacy Question. A reference population in Northern Taiwan (n=928) via the HLS-EU-Q in 2013-2014 was used as a reference to compare the health literacy between that of the general public and the patients. Data was analyzed by confirmatory factor analysis (CFA), internal consistency analysis, correlation analysis, and linear regression models. RESULTS: Patients' health literacy assessed with the HL-SF12 was shown with high internal consistency (Cronbach α=.87), and moderately correlated with the single-item from Chew's Set of Brief Health Literacy Question, with satisfactory item-scale convergent validity (item-scale correlation ≥ .40), without floor/ceiling effect, and with satisfactory goodness of fit indices of the three-factor construct model for most of the patients. Their health literacy was significantly positively associated with female gender, higher income, and more often watching health-related TV programs. On the other hands, patients were reported with significantly higher healthcare health literacy than the general public, but not in general health literacy, disease prevention health literacy, or health promotion health literacy. CONCLUSION: The comprehensive HL-SF12 was a valid and easy to use tool for assessing patients' health literacy in the hospitals to facilitate healthcare providers in enhancing patients' health literacy and healthcare qualities.

The Effect of Individual and Neighbourhood Socioeconomic Status on Diabetes Mellitus Survival in Working Age Patients in Taiwan.

PURPOSE: Diabetes mellitus (DM) is a global pandemic metabolic disorder. In recent years, the amount of medical resources required for the treatment of diabetes has increased as diabetes rates have gradually risen. The combined effects of individual and neighbourhood socio-economic status (SES) on DM survival rates are still not clear, especially in patients of working age. In this paper, we aim to analyze the combined effects of neighbourhood and individual SES on DM survival rates in patients of working age in Taiwan. METHODS: The study of 23,781 people who were diagnosed with DM by using population-based study between 2002 and 2006. Each sample was followed up for 4 years or as a sensor case. We defined Individual SES and neighbourhood SES by each patient's job category and household income which characterized as advantaged or disadvantaged. Then we compared the survival rates by SES group used Cox proportional hazards model for adjust risk factors. RESULTS: The 4-year overall survival rates of diabetic patients were worst for those with low individual SES who living in advantaged neighbourhoods. After adjustment for patient characteristics, DM patients with high individual SES living in disadvantaged neighbourhoods had the same risk of mortality as those patients with high individual SES living in advantaged neighbourhoods (hazard ratio: 1.11; 95% confidence interval [CI]: 0.81-1.51). The study found that DM patients with low individual SES who live in disadvantaged areas had a greater risk of mortality than those with high SES (odds ratio: 2.57; 95% CI: 2.04-3.24). There were significant differences in survival rates between patients with high individual SES and patients with low individual SES. In contrast, the results did not statistically significant differences in survival rates between advantaged and disadvantaged neighbourhood SES groups. CONCLUSION: DM patients with low individual SES had the worst survival rate, regardless of whether they were living in a high or low SES neighbourhood area. The competitive cause of death, i.e., the fact that complications, rather than DM itself, are often the cause of death, may be the reason for the inverse relationship found between the effects of individual SES and neighbourhood SES on DM survival. We conclude that the socio-economic gradient in survival among DM patients may be the result of differences in access to medical treatment and attributes related to individual SES.

Hepatic circadian-clock system altered by insulin resistance, diabetes and insulin sensitizer in mice.

Circadian rhythms are intrinsic rhythms that are coordinated with the rotation of the Earth and are also generated by a set of circadian-clock genes at the intracellular level. Growing evidence suggests a strong link between circadian rhythms and energy metabolism; however, the fundamental mechanisms remain unclear. In the present study, neonatal streptozotocin (STZ)-treated mice were used to model the molecular and physiological progress from insulin resistance to diabetes. Two-day-old male C57BL/6 mice received a single injection of STZ and were tested for non-obese, hyperglycemic and hyperinsulinemic conditions in the early stage, insulin resistance in the middle stage, and diabetes in the late stage. Gene expression levels of the hepatic circadian-clock system were examined by real-time quantitative PCR. Most of the components of the hepatic circadian-clock gene expression system, such as the mRNAs of Bmal1 (brain and muscle Arnt-like protein-1), Per2 (period 2) and Cry1 (cryptochrome 1), were elevated, and circadian patterns were retained in the early and middle stages of insulin-resistant conditions. The insulin sensitizer, rosiglitazone, returns the physiological and molecular changes associated with the diabetic phenotype to normal levels through peroxisome proliferator-activated receptor γ (PPARγ) rather than PPARα. Early and chronic treatment with rosiglitazone has been shown to be effective to counter the diabetic condition. Over time, this effect acts to attenuate the increased gene expression levels of the hepatic circadian-clock system and delay the severity of diabetic conditions. Together, these results support an essential role for the hepatic circadian-clock system in the coordinated regulation and/or response of metabolic pathways.

C-reactive protein concentration as a significant correlate for metabolic syndrome: a Chinese population-based study.

Increasing evidence suggests that chronic, low-grade inflammation may be a common soil involving the pathogenesis of metabolic syndrome (MetS) and cardiovascular disease. We examined the association between C-reactive protein (CRP) concentration, an extensively studied biomarker of low-grade inflammation, and the MetS in a representative sample of Chinese adults in Taiwan. We performed a cross-sectional analysis of data from 4234 subjects [mean (±SD) age, 47.1 (±18.2) years; 46.4 % males] who participated in a population-based survey on prevalences of hypertension, hyperglycemia, and hyperlipidemia in Taiwan. CRP levels were measured by the immunoturbidimetric CRP-latex high-sensitivity assay. The MetS was defined by an unified criteria set by several major organizations. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated with logistic regression model. Overall, there were 938 subjects with MetS among 4,234 participants, resulting in a prevalence rate of 22.1 %. A significantly progressive increase in the prevalence of MetS across quartiles of CRP was observed (p for trend <0.001). Participants in the second, third, and upper quartiles of CRP had significantly higher risk of having MetS when compared with those in the lowest quartile [adjusted ORs (95 % CIs) were 2.18 (1.62-2.94), 4.39 (3.31-5.81), and 7.11 (5.39-9.38), respectively; p for trend <0.001]. Furthermore, there was a strong stepwise increase in CRP levels as the number of components of the MetS increased. The prevalence of MetS showed a graded increase according to CRP concentrations. The possible utility of CRP concentration as a marker for MetS risk awaits further evaluation in prospective studies.