Joint predictability of physical frailty/pre-frailty and subjective memory complaints on mortality risk among cognitively unimpaired older adults.

The aim of the present study was to investigate how frailty/pre-frailty in combination with subjective memory complaints predicts all-cause mortality in community dwelling cognitively unimpaired older adults. There were 1904 community-dwelling cognitively unimpaired persons aged 65 years or older who participated in the 2013 Taiwan National Health Interview Survey with a 5-year follow-up. Frailty was determined based on the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMC). In this study, 11.9% of participants had both frailty/pre-frailty and SMC. A total of 239 deaths were recorded after 9009.5 person-years of follow-up. After adjustment for other factors, compared with participants who were physically robust with no SMC, participants who reported either SMC alone (HR = 0.88, 95% CI = 0.60-1.27) or were frail/pre-frail alone (HR = 1.32, 95% CI = 0.90-1.92) had no significantly increased mortality risk. However, coexisting frailty/pre-frailty and SMC was associated with a significantly increased hazard ratio for mortality of 1.48 (95% CI = [1.02-2.16]). Our results highlight the high prevalence of co-occurring frailty/pre-frailty and SMC and that this co-occurrence is associated with an increased risk of mortality among cognitively unimpaired older adults.

Skin-Inspired Tactile Sensor on Cellulose Fiber Substrates with Interfacial Microstructure for Health Monitoring and Guitar Posture Feedback.

Skin-inspired flexible tactile sensors, with interfacial microstructure, are developed on cellulose fiber substrates for subtle pressure applications. Our device is made of two cellulose fiber substrates with conductive microscale structures, which emulate the randomly distributed spinosum in between the dermis and epidermis layers of the human skin. The microstructures not only permit a higher stress concentration at the tips but also generate electrical contact points and change contact resistance between the top and bottom substrates when the pressure is applied. Meanwhile, cellulose fibers possessing viscoelastic and biocompatible properties are utilized as substrates to mimic the dermis and epidermis layers of the skin. The electrical contact resistances (ECR) are then measured to quantify the tactile information. The microstructures and the substrate properties are studied to enhance the sensors' sensitivity. A very high sensitivity (14.4 kPa-1) and fast recovery time (approx. 2.5 ms) are achieved in the subtle pressure range (approx. 0-0.05 kPa). The device can detect subtle pressures from the human body due to breathing patterns and voice activity showing its potential for healthcare. Further, the guitar strumming and chord progression of the players with different skill levels are assessed to monitor the muscle strain during guitar playing, showing its potential for posture feedback in playing guitar or another musical instrument.

Risk and Protective Profile of Men Who Have Sex With Men Using Mobile Voluntary HIV Counseling and Testing: Latent Class Analysis.

BACKGROUND: Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored. OBJECTIVE: The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups. METHODS: A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators-multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases-and three protective indicators-experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing. RESULTS: Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19%), highest protection (n=121, 11.89%), and low risk and low protection (n=722, 70.92%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ≥40 years of age (odds ratio [OR] 2.197, 95% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95% CI 2.272-18.482; P<.001), and a CD4 count ≤349/µL (OR 17.50, 95% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95% CI 1.033-6.277; P=.04). CONCLUSIONS: LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ≥40 years old. These results could be applied to tailor HIV prevention and testing programs.

[Post COVID-19 Pandemic Care for HIV Caregivers].

The COVID-19 pandemic that swept the world in 2020 has highlighted the dangers and challenges posed by infectious diseases and encouraged healthcare providers to further re-think the stigma of epidemic and pandemic diseases. HIV infection was reclassified as a chronic disease in Taiwan after highly active antiretroviral therapy was introduced in the country. Because HIV infection is related to behavior, people living with HIV are often affected by a negative social image that is influenced by multiple stereotypes and the general stigma toward AIDS. In Taiwan, this stigma is deeply influenced by Eastern philosophy and Confucian culture, making the context and effect of stigma different from Western countries. The current "U=U" concept of HIV treatment holds that someone under treatment for HIV with an undetectable HIV viral load cannot sexually transmit the virus to others. Therefore, in the post-pandemic era, HIV medical care personnel should apply evidence-based-care thinking. This article describes HIV stigma in the context of Confucianism, U=U as the leading concept of HIV treatment, and the recommended approach to care for HIV healthcare practitioners in the post-COVID-19 era. Reducing HIV stigma will enable Taiwan to achieve the ' Three Zeros' of zero discrimination, zero infection, and zero death advocated by the Joint United Nations Program on HIV/AIDS for ending the AIDS epidemic by 2030.

Flexible Hybrid Electronics Nanofiber Electrodes with Excellent Stretchability and Highly Stable Electrical Conductivity for Smart Clothing.

In this paper, a side-by-side, dual-nozzle electrospinning process was used to prepare a flexible hybrid electronics (FHE) material with excellent stretchable properties. A highly stable electrical conductivity was also imparted to the resulting membrane electrodes using silver nanoparticles (AgNPs) and carbon-based nanomaterials of different structures. The AgNP/carbon-based nanomaterials were coated onto bicomponent polymer nanofibers (composed of polyurethane (PU) and polyvinylidene difluoride (PVDF)) on the nanofiber membrane. The FHE nanofiber electrodes were finally integrated into clothing designed to accurately measure human body sensing signals (e.g., electrocardiography (ECG) and electromyography (EMG) signals). To effectively increase the high electrical conductivity, a polymer-type dispersant (polyisobutylene-b-poly(oxyethylene)-b-polyisobutylene, a triblock copolymer) was used to effectively and stably disperse AgNPs with different particle sizes and carbon-based nanomaterials with different geometric dimensions (e.g., zero-dimensional carbon black, one-dimensional carbon nanotubes, and two-dimensional graphene) through non-covalent adsorption. Moreover, the bicomponent PVDF-PU nanofibers were immersed in a mixed dispersant of AgNPs and carbon-based nanomaterials at low concentrations, and thermal post-treatment was conducted to improve the electrical conductivity. The AgNP/graphene oxide (GO) nanofiber electrode exhibited a continuous phase with a stable material microstructure after 5000 repetitions of 50% tension-tension fatigue testing. The waveform pattern obtained from the proposed AgNP/GO nanofiber electrode was compared with those of traditional ECG and EMG electrodes. The nanofiber web electrode treated with organic/inorganic mixed dispersants and verified via tests of its electrical and fatigue properties was found to be suitable for long-term ECG and EMG monitoring, and it has excellent potential in wearable smart sensors.

Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality?

OBJECTIVES: The main aim of this study was to examine how physical activity in combination with physical frailty and cognitive impairment affects risk of mortality in older adults. STUDY DESIGN: A national sample of community-dwelling Taiwanese aged 65 years or older (n=2678) was followed for 5 years. MAIN OUTCOME MEASURES: Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. The Mini-Mental State Examination was used to assess cognitive impairment. Information on self-reported physical activity was collected at baseline. The study cohort was followed until the date of death or the end of the study period (31 December 2018). Deaths were confirmed by the computerized data files of the National Register of Deaths. RESULTS: A total of 417 deaths were recorded after 12415.2 person-years of follow-up. After adjustment for other factors, compared with active participants who were physically robust with normal cognition, inactive participants who were with either frail/pre-frail or cognitively impaired had hazard ratios for mortality of 2.65 (95% CI=[1.88-3.74]) and 3.09 (95% CI=[2.08-4.59]), respectively. Inactive participants with coexisting frailty/pre-frailty and cognitive impairment had the highest hazard ratio for mortality of 3.85 (95% CI=[2.73-5.45]). Being active was associated with a mortality reduction of 31%, 38%, and 42% in physically robust participants with normal cognition, those who were frail/pre-frail only, and those with cognitive impairment only, respectively. CONCLUSIONS: Having a physically active life style has beneficial effects on survival in older persons with either frailty/pre-frailty or cognitive impairment.

Combined effects of frailty status and cognitive impairment on health-related quality of life among community dwelling older adults.

OBJECTIVES: The aim of the present study was to investigate the combined association of frailty/pre-frailty and cognitive impairment with health related quality of life (HRQOL) among community dwelling older adults. METHODS: Data came from a cross-sectional study of community-dwelling older adults aged 65 years or older, who participated in the 2013 National Health Interview Survey in Taiwan. Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. The Mini-Mental State Examination was used to assess cognitive function. HRQOL was measured using the European Quality of Life-5 Dimensions questionnaire (EQ-5D) that assesses three levels of functioning for the dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Poisson regression models were performed to estimate prevalence ratios (PR) and 95 % Confidence Intervals (95 % CI) for health problems in all EQ-5D domains. RESULTS: In this study, 11.0 % of participants aged 65 years and older had co-occurring frailty/pre-frailty and cognitive impairment. After adjustment for other factors, compared with participants who were physically robust with normal cognition, participants with co-occurring frailty/pre-frailty and cognitive impairment had PRs of 10.38 (95 % CI 7.56-14.26), 9.66 (95 % CI 6.03-15.48), 9.37 (95 % CI 6.92-12.68), 3.04 (95 % CI 2.53-3.64), and 5.63 (95 % CI 3.83-8.28) for reporting problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, respectively. CONCLUSIONS: There is a high prevalence of co-occurrence of frailty/pre-frailty and cognitive impairment in older adults, and this co-occurrence was strongly associated with self-reported health problems across all EQ-5D domains.

The mediating effects of leisure engagement on relationships between caregiving stress and subjective wellbeing among family caregivers of persons with cognitive impairment: A cross-sectional study.

Family caregivers of persons with cognitive impairment experience changes in reductions in leisure engagement, which can decrease their subjective wellbeing (leisure satisfaction, negative affect and positive affect). We recruited 100 dyads of patients with cognitive impairment and family caregivers by convenience sampling from outpatient memory clinics and daycare centers in northern Taiwan. Hierarchical regression analysis tested the mediating effects of leisure engagement on the relationship between caregiving stress and subjective wellbeing. Results indicated that the restorative experience of event/tourism activities (ß = 0.23, p < .05) significantly mediated between caregiving stress and leisure satisfaction. In addition, the only significant mediator between caregiving stress and negative affect was leisure barriers (ß = 0.21, p < .05). Both of the regression models explained 27% of the variance. Future development of leisure interventions should focus on reducing leisure barriers and providing event and tourism activities to the dyads. (146 words).

A Highly Selective and Sensitive Fluorescent Chemosensor for Detecting Al3+ Ion in Aqueous Solution and Plant Systems.

The solubilized form of aluminum, Al3+, is present under acid soil conditions and toxic to both animals and plants. Detecting and quantifying Al3+ is vital for both chemistry and biology. A new Schiff-based fluorescent turn-on sensor (probe L) for the selective detection of the Al3+ ion was synthesized by coupling 2-hydroxy-1-naphthaldehyde and 2-aminoisoindoline-1,3-dione, and the structure was characterized by nuclear magnetic resonance spectra. The probe L exhibited an excellent selective and sensitive response to the Al3+ ion over other metal ions in DMSO-H2O (1:9 v/v). Fluorescence quantification revealed that probe L was promising for the detection and accumulation of Al3+. Treating rice seedlings with Al3+ at 25⁻200 µM inhibited their growth. Al3+ treatment produced reactive oxygen species in rice roots. Practical applications of the fluorescent probe for the quantification of Al3+ in water samples and rice seedlings are demonstrated. Detecting the Al3+ ion with the probe L is easy and a potential alternative to existing analytical methods. The method can be used for detecting the Al3+ content of aqueous solution and plant systems. The novel fluorescent probe L has good potential for monitoring Al3+ content in the environment and biological systems.

Effects of Al Addition on Microstructures and Mechanical Properties of CoCrFeMnNiAlx High Entropy Alloy Films.

CoCrFeMnNiAlx (x = 0, 0.07, 0.3, 0.6, 1.0, 1.3) high-entropy alloy films (HEAFs) were processed by co-sputtering of CoCrFeMnNi alloy and Al targets. The effects of Al content on the microstructures and mechanical properties of HEAFs were studied. The XRD results indicated that the crystalline structure changed from the single face-centered cubic (FCC) phase for x = 0 and 0.07 to duplex FCC + body-centered cubic (BCC) phases for x = 0.3 and 0.6, and eventually, to a single BCC phase for x = 1.0 and 1.3, which agreed with the corresponding selected-area electron diffraction patterns. Also, nanotwins were observed in the FCC phase. Mechanical properties of films were studied using nanoindentation and micropillar compression tests. The hardness increased from 5.71 GPa at x = 0 to 8.74 GPa at x = 1.3. The compressive yield strength increased from 1.59 GPa to 3.73 GPa; however, the fracture strain decreased from 20.91% (no fracture) to 13.78% with the increasing Al content. Both nanotwins and BCC phase contributed to the strengthening effects for CoCrFeMnNiAlx HEAFs. Also, compared to the bulk CoCrFeMnNiAlx counterpart, the film exhibited much higher hardness and strength because of the much smaller grain size and the presence of nanotwins.

Frailty and health care use among community-dwelling older adults with diabetes: a population-based study.

PURPOSE: The aims of this study were to investigate the prevalence of frailty and its relationship with health care use among community-dwelling older adults with diabetes. METHODS: We analyzed data from a nationally representative sample of people aged 65 years and above (n=3,203) participating in the 2013 National Health Interview Survey in Taiwan. A total of 719 participants had a history of self-reported physician-diagnosed diabetes. The presence of frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. FRAIL scores range from 0 to 5 and are categorized as frail (3-5), pre-frail (1-2), and robust (0). Participants were asked whether they had been hospitalized or had visited an emergency department in the past year. RESULTS: Among community-dwelling older adults with diabetes, 9.4% of participants were frail and 35.3 % were pre-frail. After adjustment for other factors, being frail was significantly associated with hospitalization during the past year (OR =5.31, 95% CI =1.87-15.10), whereas being pre-frail was not associated with hospitalization. Both being pre-frail and frail were significantly associated with emergency department visits during the past year (OR =2.64, 95% CI =1.35-5.17 and OR =4.05, 95% CI =1.31-12.49, respectively) after adjustment for other factors. CONCLUSION: Our results highlight the high prevalence of frailty in community-dwelling older adults with diabetes. Furthermore, being frail is associated with a greater burden of hospitalizations and emergency department visits.

The co-occurrence of depressive symptoms and cognitive impairment and its relationship with self-care behaviors among community dwelling older adults with diabetes.

AIMS: The aims of the present study were to investigate the co-occurrence of depressive symptoms and cognitive impairment in community dwelling older adults with diabetes and its relationship with specific diabetes self-care behaviors. METHODS: We analyzed data from two national samples of older adults (65years or older) with self-reported physician-diagnosed diabetes (N=1034), who participated in the 2005 or 2009 National Health Interview Survey in Taiwan. The Mini-Mental State Examination was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. The study assessed self-care behaviors including medication adherence, exercise, healthy diet, and self-monitoring of blood glucose. RESULTS: In this study, 8.8% of participants with diabetes had both depressive symptoms and cognitive impairment. After adjusting for other factors, participants with both cognitive impairment and depressive symptoms were less likely to exercise (Prevalence Ratios (PR)=0.66; 95% Confidence Intervals (CI)=[0.47-0.91]; P-value=0.011), and have a healthy diet (PR=0.82; 95%CI=[0.70-0.96]; P-value=0.012). CONCLUSIONS: Our results illustrate the high prevalence of combined depressive symptoms and cognitive impairment and that this combination is associated with worse self-care behaviors in older adults with diabetes. These findings highlight the difficulty that some older adults with diabetes may have in maintaining self-care behaviors in the presence of depressed mood and cognitive impairment, particularly in the areas of diet and exercise. The results emphasize the importance of providing more support for these aspects of self-care to such older adults.

Long-term follow-up of papillary and follicular thyroid carcinomas with bone metastasis.

The aims of this study were to investigate papillary and follicular thyroid carcinomas with bone metastasis in various clinical presentations and to determine the prognostic factors after multimodality treatment. A retrospective analysis was performed of 3,120 patients with papillary and follicular thyroid carcinoma. Of these patients, 131 (including 97 women, 71.8%) were diagnosed with bone metastasis and underwent follow-up at the Chang Gung Medical Center. Patients with bone metastasis were categorized into two groups. Group A was comprised of patients who were diagnosed with bone metastasis either before thyroidectomy or within 6 months of the initial thyroidectomy (90 patients, 68.7%). Group B was comprised of patients with bone metastasis who received a diagnosis 6 months post-thyroidectomy in the follow-up period (41 patients, 31.3%). After a mean follow-up period of 8.4 ± 7.0 years, there were 88 deaths (67.2%) attributed to thyroid cancer and 13 patients (9.9%) achieved disease-free status. A multivariate analysis showed that older age, early diagnosis, and brain metastasis were each associated with a poor prognosis. The difference in disease-specific mortality rates between groups A and B was significant (p < 0.0001). In conclusion, papillary and follicular thyroid cancers with bone metastasis have a high rate of mortality. Despite this high mortality, 9.9% patients still had an excellent response to treatment.

Predictors of postoperative falls in the first and second postoperative years among older hip fracture patients.

AIMS AND OBJECTIVES: To explore risk factors for a single fall and multiple falls in the first and second postoperative years among older hip fracture patients. BACKGROUND: Older hip fracture patients have a high probability of falling again after a fall incident. Risk factors for postoperative falls among older hip fracture patients in Taiwan remain to be confirmed. DESIGN: Secondary analysis. METHODS: Data collected from control groups of two clinical trials conducted during 2001-2004 and during 2005-2009 were selected. Overall, 181 older adults who underwent hip fracture surgery were assessed at predischarge and postdischarge. Participant data were collected through home visits. RESULTS: Decline in unaffected limb quadriceps muscle endurance was a crucial predictor of a single fall in the first postoperative year for older hip fracture patients. Advanced age and more severe depressive symptoms were the crucial predictor for multiple falls. Engagement in activities of daily living was the crucial predictor for falls during the first to second postoperative years among older hip fracture patients. CONCLUSION: In Taiwan, postoperative falls that occur within 1-2 years of a hip fracture are associated with a high incidence of single and multiple falls in older people. The crucial predictors of falls in the first and second year after a hip fracture include unaffected limb quadriceps endurance, age, depression status and postdischarge activities of daily livings in older people. RELEVANCE TO CLINICAL PRACTICE: The identified factors associated with subsequent falls within one and two years of a hip fracture should be incorporated into clinical strategies and taught in nursing courses. Early postoperative lower extremity muscular endurance rehabilitation must be provided. Furthermore, as part of the healthcare plan before hospital discharge, it must be ensured that the community where the older adults live has nutritional education, cognitive screening and psychological support.

(4R,6S)-2-Dihydromenisdaurilide is a Butenolide that Efficiently Inhibits Hepatitis C Virus Entry.

Without a vaccine, hepatitis C virus (HCV) remains a significant threat, putting 170-300 million carriers worldwide at risk of cirrhosis and hepatocellular carcinoma. Although the direct-acting antivirals targeting HCV replication have revolutionized the treatment of hepatitis C, several obstacles persist, including resistance development, potential side-effects, and the prohibitive cost that limits their availability. Furthermore, treatment of HCV re-infection in liver transplantation remains a significant challenge. Developing novel antivirals that target viral entry could help expand the scope of HCV therapeutics and treatment strategies. Herein, we report (4R,6S)-2-dihydromenisdaurilide (DHMD), a natural butenolide, as an efficient inhibitor of HCV entry. Specifically, DHMD potently inhibited HCV infection at non-cytotoxic concentration. Examination on the viral life cycle demonstrated that DHMD selectively targeted the early steps of infection while leaving viral replication/translation and assembly/release unaffected. Furthermore, DHMD did not induce an antiviral interferon response. Mechanistic dissection of HCV entry revealed that DHMD could inactivate cell-free virus, abrogate viral attachment, and inhibit viral entry/fusion, with the most pronounced effect observed against the viral adsorption phase as validated using ELISA and confocal microscopy. Due to its potency, DHMD may be of value for further development as an entry inhibitor against HCV, particularly for application in transplant setting.

Prevalence, characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey.

OBJECTIVE: The aim of this study was to investigate the prevalence, characteristics, and acute care utilization of community dwelling disabled older adults with an absence of help for activities of daily living (ADL). METHODS: We analyzed cross-sectional data from a nationally representative sample of people aged 65 years and over (n=2904) participating in the 2009 National Health Interview Survey in Taiwan. Disability was defined as self-reporting a lot of difficulty or complete inability to carry out one or more ADL tasks. Participants with disability were asked whether they received help in the form of personal assistance or assistive devices to complete ADL tasks, with a yes response indicating the presence of help and a no response indicating the absence of help. Hospitalization and emergency department visits was assessed as a dichotomous variable (any or none), respectively. RESULTS: An absence of available help for ADL disability was reported in 16.6% of disabled older adults. Disabled older adults reporting an absence of help were more likely to be female. After adjustment for other factors, compared to older adults without disability, older adults with disability not receiving help for ADL tasks were highly related to hospitalization (OR=4.57; 95%CI=[1.51-13.82]) and emergency department visits (OR=3.52; 95%CI=[1.15-10.76]) during the past year, respectively. CONCLUSIONS: We found that there is high prevalence of absence of help to perform ADL tasks in older adults with disability, and that this absence of help for ADL disability is associated with a greater burden of acute care utilization than those without disability.

Early Viral Entry Assays for the Identification and Evaluation of Antiviral Compounds.

Cell-based systems are useful for discovering antiviral agents. Dissecting the viral life cycle, particularly the early entry stages, allows a mechanistic approach to identify and evaluate antiviral agents that target specific steps of the viral entry. In this report, the methods of examining viral inactivation, viral attachment, and viral entry/fusion as antiviral assays for such purposes are described, using hepatitis C virus as a model. These assays should be useful for discovering novel antagonists/inhibitors to early viral entry and help expand the scope of candidate antiviral agents for further drug development.

Limonium sinense and gallic acid suppress hepatitis C virus infection by blocking early viral entry.

A preventive vaccine against hepatitis C virus (HCV) infection remains unavailable and newly developed drugs against viral replication are complicated by potential drug-resistance and high cost. These issues justify the need to develop alternative antiviral agents and expand the scope of strategies for the treatment of hepatitis C, such as targeting viral entry. In this study, we explore the bioactivity of Limonium sinense (L. sinense) and its purified constituents against HCV life cycle using subgenomic replicon and infectious HCV culture systems. Data indicated that the water extract from the underground part of L. sinense (LS-UW) exhibited potent inhibitory activity against HCV at non-cytotoxic concentrations. LS-UW targeted early HCV infection without affecting viral replication, translation, and cell-to-cell transmission, and blocked viral attachment and post-attachment entry/fusion steps. Bioactivity analysis of major constituents from LS-UW through viral infectivity/entry assays revealed that gallic acid (GA) also inhibits HCV entry. Furthermore, both LS-UW and GA could suppress HCV infection of primary human hepatocytes. Due to their potency and ability to target HCV early viral entry, LS-UW and GA may be of value for further development as prospective antivirals against HCV.

The relationship between healthy lifestyle and hospital utilization among adults with diabetes: results from a national cohort in Taiwan.

The aim of this study was to investigate whether adopting healthy lifestyle habits, such as engaging in leisure time physical activity (LTPA), adopting recommended dietary patterns, and not smoking, are associated with reduced hospitalizations over 1 year among adults with diabetes. We analyzed data from a national sample of people aged 18 years and above with self-reported physician-diagnosed diabetes (n = 664) through linkage to the 2001 National Health Interview Survey in Taiwan and the 2002 National Health Insurance claims data. Multivariate analysis showed that participants reporting greater than 150 min/wk of moderate-intensity activity had a significantly lower chance for hospitalization (odds ratio = 0.52; 95% confidence interval [CI] = 0.27-0.98), fewer admissions (incidence rate ratio [IRR] = 0.58; 95% CI = 0.33-1.00), and fewer hospital bed days (IRR = 0.42; 95% CI = 0.20-0.92) compared with inactive individuals. Diet control and smoking status did not significantly predict hospital use after controlling for other factors. Our findings indicate that increased LTPA results in reduced hospitalization among adults with diabetes.