Effects of Tai Chi Chuan on Cognitive Function in Adults 60 Years or Older With Type 2 Diabetes and Mild Cognitive Impairment in China: A Randomized Clinical Trial.

Importance: Type 2 diabetes (T2D) is associated with the progression of cognitive dysfunction. Physical activity benefits cognition, but no evidence from randomized clinical trials has shown whether tai chi chuan has better long-term benefits than fitness walking in cognitive function for patients with T2D and mild cognitive impairment (MCI). Objective: To compare the effectiveness of tai chi chuan, a mind-body exercise, for improving cognitive function in older adults with T2D and MCI, with fitness walking. Design, Setting, and Participants: This randomized clinical trial was conducted between June 1, 2020, and February 28, 2022, at 4 sites in China. Participants included 328 adults (aged ≥60 years) with a clinical diagnosis of T2D and MCI. Interventions: Participants were randomized in a 1:1:1 ratio to a tai chi chuan group, a fitness walking group, or a control group. The tai chi chuan group received 24-form simplified tai chi chuan. The fitness walking group received fitness walking training. Both exercise groups took the training for 60 min/session, 3 times/wk, for 24 weeks in a supervised setting. All 3 groups were provided with a 30-minute diabetes self-management education session, once every 4 weeks for 24 weeks. The participants were followed up for 36 weeks. Main Outcomes and Measures: The primary outcome was the global cognitive function measured at 36 weeks by the Montreal Cognitive Assessment (MoCA). Secondary outcomes included MoCA at 24 weeks and other cognitive subdomain measures and blood metabolic indices at 24 and 36 weeks. Results: A total of 328 participants (mean [SD] age, 67.55 [5.02] years; mean [SD] T2D duration, 10.48 [6.81] years; 167 [50.9%] women) were randomized to the tai chi chuan group (n = 107), fitness walking group (n = 110), or control group (n = 111) and included in the intention-to-treat analysis. At 36 weeks, the tai chi chuan group showed improved MoCA scores compared with the fitness walking group (mean [SD], 24.67 [2.72] vs 23.84 [3.17]; between-group mean difference, 0.84 [95% CI, 0.02-1.66]; P = .046) in the intention-to-treat analysis. The per-protocol analysis data set and subgroup analysis at 36 weeks showed similar results. Based on the generalized linear models, the treatment effects were similar in each group after adjusting for self-reported dietary calories and physical activity. There were 37 nonserious adverse events (tai chi chuan group, 8; fitness walking group, 13; control group, 16) unrelated to the study with no statistically significant difference among the 3 groups (P = .26). Conclusions and Relevance: In this randomized clinical trial including older adults with T2D and MCI, tai chi chuan was more effective than fitness walking in improving global cognitive function. The findings support a long-term benefit, suggesting the potential clinical use of tai chi chuan as an exercise intervention to improve cognitive function for older adults with T2D and MCI. Trial Registration: ClinicalTrials.gov Identifier: NCT04416841.

Hydrological controls on cascade reservoirs regulating phosphorus retention and downriver fluxes.

Many coastal rivers have a system of cascade reservoirs, but the role of these reservoirs in regulating nutrient transport from watershed to coast is still unknown. In this study, phosphorus (P) in surface water and top sediment was investigated along the North Jiulong River (southeast China) under three hydrological conditions (high flow, medium flow and low flow) in 2012-2013, and P dynamics in a cascade reservoir (Xipi Reservoir) were studied on a monthly scale. Results showed that the concentrations of dissolved reactive phosphorus (DRP) consistently decreased longitudinally in the upper river with the lowest values observed in the section of cascade reservoirs, likely due to tributary inputs and in situ uptakes. The decrease was most rapid during base flow when DRP was highest in the free-flowing river section and lowest in cascade reservoirs. Results from monthly monitoring on the Xipi Reservoir showed general downriver decreases in DRP, total particulate phosphorus (TPP) and total phosphorus (TP) in the riverine zone and transition zone. Mass balance results on an annual basis suggest that the Xipi Reservoir (lacustrine zone) was an overall sink for TPP (6 % retention) but somewhat a source of DRP (-0.3 %) with TP retention (1 %). Even scaled up to the whole cascade reservoir system, P retention was low compared with worldwide reservoirs, which we ascribe to the high P loading and short hydraulic residence time. Nevertheless, major processes controlling P retention in coastal rivers with cascade reservoirs varied from sedimentation in the dry-cold season to biotic transformation in the wet-warm season, thereby affecting loading and composition of P from watershed to the coast. This study highlights the hydrological controls on the role of cascade reservoirs in regulating P retention and downriver fluxes in different seasons.

[Treatment of type 2 diabetes mellitus patients of qi-yin deficiency phlegm-stasis inter-obstruction syndrome by jiangtang xiaozhi capsule and pioglitazone tablet: a non-inferiority randomized controlled trial].

UNLABELLED: OBJECTIVE; To evaluate the efficacy and safety of Jiangtang Xiaozhi Capsule (JTXZC) in treating type 2 diabetes mellitus (T2DM) of qi-yin deficiency phlegm-stasis inter-obstruction syndrome (QYDPSIOS), and to observe its effect on inflammatory factors and fibrinolytic factors. METHODS: By adopting a randomization grouping, parallel control, and prospective study, 73 T2DM patients of QYDPSIOS were assigned to two groups by random digit table, the Pioglitazone Tablet group (36 cases, as the control) and the JTXZC group (37 cases). All patients maintained their basic therapies and lifestyle as previous after recruitment. Patients in the JTXZC group took JTXZC, 4 pills each time, three times per day, while those in control group took Pioglitazone Tablet, 15 mg each time, once daily. The therapeutic course for all was 8 weeks. The body weight (BW), the height, body mass index (BMI), waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), and scoring of Chinese medicine (TCM) symptoms were observed. Levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2 h PBG), glycated hemoglobin (HbA1c), tumor necrosis factor alpha (TNF-alpha), nuclear factor kappaB (NF-kappaB), and plasminogen activator inhibitor 1 (PAL-1) were detected. The safety indices such as liver and renal functions and adverse reactions were also observed. RESULTS: Compared with before treatment, BW, BMI, HbA1c, and PBG were obviously lower after 8-week treatment than before treatment in the JTXZC group (P < 0.05). There was no statistical difference in post-treatment BW, BMI, HbA1c, or 2 h PBG between the two groups (P < 0.05). Compared with before treatment, levels of TNF-alpha and PAI-1 were lowered after 8 weeks of treatment in both groups (P < 0.01). The level of NF-kappaB was obviously lowered after 8 weeks of treatment in the control groups (P < 0.05), but it also decreased in the JTXZC group with no statistical difference. The scorings of CM symptoms were somewhat improved after treatment in the two groups (P < 0.01). Besides, better effects were obtained in the JTXZC group (P < 0.05). No severe adverse event occurred in either group during the whole therapeutic course. CONCLUSIONS: JTXZC showed similar therapeutic effect to pioglitazone. Both of them could effectively improve patients' clinical symptoms, the inflammation and fibrinolytic activities in different pathways, with no severe adverse reaction.

[Characteristics of sediment phosphorus in the Jiulong River-Reservoir system and its ecological significance].

Sediment phosphorus (P) content and component ratio from 16 sites along the North Jiulong River-reservoir system were analyzed using the Standard Measurement and Test (SMT) procedure. The spatial pattern and characteristics of sediment P and its ecological significance in the Jiulong River-reservoir system were examined in combination with water measurement and watershed information. Total P content in sediments ranged from 387 to 2092 mg x kg(-1) with an average of 1032 mg x kg(-1). Inorganic phosphorus (IP) dominated P in sediment, accounting for 48%-98% of TP, and Fe/Al-bound phosphorus (Fe/Al-P) took 43%-99% of IP. The spatial pattern of sediment showed that TP and Fe/Al-P were higher in upstream and lower in downstream, corresponding to the spatial variation of surface water P and land-based loads from animal waste, human waste and fertilizer loss. Spatial variation of TP in sediment was controlled by Fe/AI-P along the North Jiulong River. The P-rich sediment with a great release potential due to the high ratio of Fe/ Al-P, the typical spatial pattern, and the lower N/P ratio observed in upstream water (where phytoplankton growth tends to be weakly limited by phosphorus), are likely to explain the fact that algal blooms first appear in the upstream and then spread to downstream reservoirs along the North Jiulong River. Present findings concerning sediment P characteristics indicate an important regulating effect and the ecological significance on the process of algal blooms in the Jiulong River.

[Clinical study of Jiangtang Xiaozhi Capsule in treating type 2 diabetes mellitus patients].

OBJECTIVE: To evaluate the efficacy and safety of Jiangtang Xiaozhi Capsule (JTXZC) in treating type 2 diabetes mellitus (T2DM) patients of qi-yin deficiency and inter-obstruction between phlegm and stasis. METHODS: Adopting prospective, randomized, controlled trial design, 73 T2DM patients of qi-yin deficiency and inter-obstruction between phlegm and stasis syndrome, were randomly assigned to two groups, the pioglitazone tablet group (36 cases) and the JTXZC group (37 cases). The therapeutic course for all was 8 weeks. The body weight, height, body mass index (BMI), waistline (WC), hipline, waist-to-hip ratio (WHR), and scoring for Chinese medicine (CM) symptoms assessment were observed. The fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG), glycated hemoglobin (HbA1c), plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), plasma insulin (FINS) were detected. The HOMA-IR was also calculated. The safety indices such as liver and renal functions, adverse reactions were also observed. RESULTS: The levels of HbA1c were lowered after treatment in the two groups after 8 weeks of treatment, showing statistical difference when compared with before treatment (-0.59% +/- 1.99% and -0.27% +/- 2.73%, P < 0.05). The PBG level also decreased with statistical difference (-1.71 +/- 2.52 mmol/L and -0.72 +/- 4.17 mmol/L, P < 0.05), but there was no statistical difference between the two groups. The body weight, BMI, TG obviously decreased (P < 0.05). The CM symptoms efficacy and CM symptom scoring were significantly reduced in the two groups (P < 0.01). Besides, better effects were shown in the JTXZC group (P < 0.05). No severe adverse event occurred in either group during the therapeutic course. There was no statistical difference in the incidence of adverse events (P > 0.05). CONCLUSIONS: JTXZC showed similar therapeutic effects to pioglitazone. They both could effectively im- prove clinical symptoms with no severe adverse reaction.

[Analysis on associated risk factors and syndrome types in diabetes mellitus type 2 patients complicated with non-alcoholic fatty liver].

OBJECTIVE: To explore the risk factors and the main TCM syndrome types associated with the diabetes mellitus type 2 (DM2) patients complicated with non-alcoholic fatty liver (FL). METHODS: Adopted controlled trial method, the age, stature, body weight, and body mass index (BMI) of 180 DM2 patients were compared with those complicated with or without FL. And some related laboratory indexes, including the age, stature, body weight, BMI, fasting blood glucose (FBG), C-peptide (CP), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), high and low density lipoprotein cholesterol (HDL-C and LDL-C), and 2 h post-prandial CP (2 h CP), were compared as well. Moreover, patients' TCM syndrome types were classified. RESULTS: No significant differences were found between DM2 patients complicated with or without FL in aspects of FBG, HbA1c, TC, LDL-C and age, stature (P > 0.05), but significant difference did show between them in aspects of CP (4.09 +/- 2.40 microg/L vs 2.47 +/- 1.74 microg/L), 2h CP (6.38 +/- 5.46 microg/L vs 4.35 +/- 2.92 microg/L), TG (2.81 +/- 2.33 mmol/L vs 1.93 +/- 1.92 mmol/L), HDL-C (1.07 +/- 0.06 mmol/L vs 1.19 +/- 0.32 mmol/L) as well as in body weight (73.4 +/- 11.7 kg vs 61.4 +/- 10.1 kg) and BMI (26.0 +/- 3.67 vs 22.8 +/- 3.23), respectively (P < 0.05 or P < 0.01). Moreover, phlegm-dampness type was more liable to appear in DM2 patients complicated FL. CONCLUSIONS: Obesity, insulin resistance and lipid metabolism disorder are the chief risk factors in DM2 patients complicated with FL and phlegm-dampness is the chief pathogenesis.