Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis.

INTRODUCTION: Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted a network meta-analysis to assess the comparative impact of different exercise training modalities on glycemic control, cardiovascular risk factors, and weight loss in patients with T2DM. METHODS: We searched five electronic databases to identify randomized controlled trials (RCTs) that compared the differences between different exercise training modalities for patients with T2DM. The risk of bias in the included RCTs was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate mean difference the ratio of the mean and absolute risk differences. Data were analyzed using R-3.4.0. RESULTS: A total of 37 studies with 2208 patients with T2DM were included in our study. Both supervised aerobic and supervised resistance exercises showed a significant reduction in HbA1c compared to no exercise (0.30% lower, 0.30% lower, respectively), however, there was a less reduction when compared to combined exercise (0.17% higher, 0.23% higher). Supervised aerobic also presented more significant improvement than no exercise in fasting plasma glucose (9.38 mg/dl lower), total cholesterol (20.24 mg/dl lower), triacylglycerol (19.34 mg/dl lower), and low-density lipoprotein cholesterol (11.88 mg/dl lower). Supervised resistance showed more benefit than no exercise in improving systolic blood pressure (3.90 mmHg lower]) and total cholesterol (22.08 mg/dl lower]. In addition, supervised aerobic exercise was more powerful in improving HbA1c and weight loss than unsupervised aerobic (HbA1c: 0.60% lower; weight loss: 5.02 kg lower) and unsupervised resistance (HbA1c: 0.53% lower) exercises. CONCLUSION: Compared with either supervised aerobic or supervised resistance exercise alone, combined exercise showed more pronounced improvement in HbA1c levels; however, there was a less marked improvement in some cardiovascular risk factors. In terms of weight loss, there were no significant differences among the combined, supervised aerobic, and supervised resistance exercises. TRIAL REGISTRATION: Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .

[Clustering Analysis of Hydatid Disease in Gansu Province].

The prevalence of hydatid disease in human population and livestock, and the positive rate of echinococcal antigen in canine feces were analyzed with sample clustering method, according to the survey on hydatid disease in 72 counties in Gansu province in the database of the National Survey on Prevalence of Echinococcosis in 2012. The prevalence of hydatid disease in huma and livestock, and the positive rate of echinococcal antigen in canine feces were 0-1.59%, 0-15.22%, and 0-16.87% respectively. Clustering analysis revealed four types of prevalence in the 72 counties. The first type existed only in Dunhuang city, with the three indicators being 0.27%, 15.22% and 16.87%; the second in four counties, with the three indicators being 0.43%, 6.57% and 1.83%; the third in 22 counties, with the three indicators being 0.22%, 1.15% and 1035%; and the fourth in 45 counties, with the three indicators being 0.16%, 0.58% and 1.69%.

[A Retrospective Analysis on the Prevalence of Visceral Leishmaniasis in Gansu Province during 2005-2014].

OBJECTIVE: To review the prevalence of visceral leishmaniasis in Gansu Province during 2005-2014. METHODS: The data of visceral leishmaniasis cases in Gansu Province during 2005-2014 were collected and descriptive statistical analysis was performed. RESULTS: During 2005-2014, 1,260 cases of visceral leishmaniasis were reported in Gansu Province. The incidence showed a trend of annual increase from 2005 (90 cases, 7.14%) onwards, peaked in 2011 (168 cases, 13.33%), and decreased afterwards. In 2014, 85 cases (6.75%) were reported. Most of the cases were from the Longnan region and some areas in Gannan Tibetan Autonomous Prefecture. Specifically, the case number was highest in Wudu District of the Longnan region (506/1,260, 40.16%), followed by Wenxian County (302/1,260, 23.97%) and Zhouqu County (202/1,260, 16.03%). In total, the cases had a male-to-female ratio of 1.46:1, and concentrated in age group of 0-5 years (665/1,260, 52.78%), showing a trend of decrease with age increase. In addition, visceral leishmaniasis occured throughout the year, with a higher cumulative incidence from March to June [10.48% (132/1,260), 13.33% (168/1,260), 12.86% (162/1,260) and 11.67% (147/1,260), respectively]. CONCLUSION: From 2005 to 2014, the Longnan region and some areas of Gannan Prefecture are the major endemic areas of visceral leishmaniasis, with more cases in children under 5 and higher incidence from March to June.

Could clinical pathways improve the quality of care in patients with gastrointestinal cancer? A meta-analysis.

This meta-analysis was performed to assess the implementation effects of clinical pathways in patients with gastrointestinal cancer. A comprehensive search was conducted in the Cochrane Library, PubMed, EMBASE, Web of Science and Chinese Biomedical Literature Database (from inception to May 2014). Selection of studies, assessing risk of bias and extracting data were performed by two reviewers independently. Outcomes were analyzed by fixed-effects and random-effects model meta-analysis and reported as mean difference (MD), standardized mean difference (SMD) and odds ratio (OR) with 95% confidence intervals (CI). The Jadad methodological approach was used to assess the quality of included studies and the meta-analysis was conducted with RevMan 5.1 software. Nine citations (eight trials) involving 642 patients were included. The aggregate results showed that a shorter average length of stay [MD = -4.0; 95% CI (-5.1, -2.8); P < 0.00001] was observed with the clinical pathways as compared with the usual care. A reduction in inpatient expenditure [SMD = -1.5; 95% CI (-2.3, -0.7); P = 0.0001] was also associated with clinical pathways, along with higher patient satisfaction [OR = 4.9; 95% CI (2.2, 10.6); P < 0.0001]. Clinical pathways could improve the quality of care in patients with gastrointestinal cancer, as evidenced by a significant reduction in average length of stay, a decrease in inpatient expenditure and an improvement in patient satisfaction. Therefore, indicators and mechanisms within clinical pathways should be a focus in the future.