Background and aim: Peroxisome proliferator-activated receptor-γ (PPAR-γ) modulating treatment may have cardiovascular benefits in type 2 diabetes mellitus (T2DM) patients after ischemic stroke (IS). However, whether there are additional benefits from intensive PPAR-γ modulating treatments in Asian patients with T2DM and hypertension (HTN) after IS remains unknown.Methods: Between 2001 and 2013, patients admitted due to IS were identified from the National Health Insurance Research Database of Taiwan. Patients with T2DM and HTN using angiotensin receptor blockers were further included. Eligible patients were divided into two groups: (1) pioglitazone and (2) non-pioglitazone oral anti-diabetic agent groups. Propensity score matching (1:2) was used to balance the distribution of baseline characteristics, stroke severity and medications. The primary outcome was recurrent IS. Subgroup analysis for recurrent IS in pioglitazone and/or telmisartan users, the trend of IS risks across different PPAR-γ intensity treatments, and dose-dependent outcomes across different pioglitazone possession ratios were further studied. Statistical significance was set at p < 0.05 and p < 0.1 for clinical outcomes and interaction of subgroup analyses, respectively.Results: There were 3190 and 32,645 patients in the pioglitazone and non-pioglitazone groups. Patients of the pioglitazone group had a lower risk of recurrent IS (subdistribution hazard ratio, 0.91; 95% confidence interval 0.84-0.99). Pioglitazone was also associated with reduced recurrent IS in patients who also used telmisartan (p for interaction = 0.071). A graded correlation was found a borderline significant trend between the intensity of PPAR-γ therapy and following IS (p = 0.076). The dose-dependent outcome also showed that a borderline significant trend that higher pioglitazone possession ratio was associated with a lower risk of recurrent IS (p = 0.068). Conclusions:The current study suggests that the use of pioglitazone in type 2 diabetic and hypertensive IS patients is associated with fewer recurrent IS events in an Asian population. Concurrent telmisartan use or a higher pioglitazone possession ratio may have a trend of increased pleiotropic effects, which could possibly be related to higher PPAR-γ effects. Future studies are warranted to confirm or refute the clinical effects and the possible mechanism of more intensive PPAR-γ-modulating treatments. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

The effects of aqueous solutions on the behavior of rocks are of great concern in many geotechnical applications. Many factors regarding the corrosion process should be considered, including temperature and the solute. In this paper, the evolution of the meso-structure of gypsum from Xishan, Taiyuan, China, with a purity of 95.86 %, is studied under the coupling effect of brine solution (with concentrations of 0, 3.08 and 5.989 mol/L) and temperature (23, 40 and 70°C) using scanning electron microscopy. Results indicate that an aqueous solution can significantly soften gypsum rocks. Unaltered gypsum rock is initially compact in structure and fissures or fractures are less obvious. After being corroded by an aqueous solution, the original compact gypsum is largely damaged in structure and the gypsum's crystal clusters change from jointed connections to separated connections. Moreover, some of the crystal clusters are broken into pieces and layers, or split into small columns. In this study, q is defined as the corrosion damage ratio representing the corroding effect of the aqueous solution on the gypsum rock. The lager the value of q, the more serious the gypsum structure damage. Study results show that with a rising temperature, the corrosion damage ratio q also gradually increases. The corrosion damage ratio q increases with the brine changing from a fresh concentration to a half-saturated concentration. However, when the brine concentration is changed from half-saturated to saturated, the damage ratio q decreases, partly due to halite crystallization of the saturated brine on the gypsum's surface. This study enhances insight into the micro-structure development mechanism of soluble rock under different aqueous solution conditions.

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