Purpose To explore the clinicopathological features of cholangitis lenta.Methods The clinical data of 12 patients with cholangitis Lenta were collected,HE staining,his-tochemical staining and immunohistochemistry were used to de-tect the clinicopathological changes in 12 cases of cholangitis lenta,and the relevant literature was reviewed.Results All the 12 patients with cholangitis Lenta had acute history and ab-normal liver function,9 cases(75.0％)had abnormal white blood cell count,11 cases(91.7％)had abdominal infection,8 cases(66.7％)had systemic inflammatory response syndrome(SIRS)and 8 cases(66.7％)were diagnosed as sepsis.The common pathological manifestations included spotty necrosis(100％),piecemeal necrosis(100％),confluent necrosis(75.0％),bridging necrosis(66.7％),hepatocyte and capil-lary cholestasis(75.0％),and mild edema in portal area(33.3％).12 cases showed proliferation of bile ductules around the portal area,inspissated bile in dilated bile ductules and no cholestasis in interlobular bile ducts.12 cases had the basis of primary liver disease.2 patients(16.7％)died after being transferred to another hospital for treatment,and 10 patients(83.3％)survived,which lasted for 7 to 55 months.Conclu-sion Cholangitis Lenta shows unique clinical manifestations and morphological features,it is often accompanied by underly-ing diseases.The pathological manifestation of cholangitis Lenta in liver biopsy suggests that patients may have sepsis and/or ab-dominal infection,and therefore its diagnosis should be com-bined with clinical features,laboratory examination and imaging manifestations.

Dendrobium is one of the valuable Chinese herbs in China,and Dendrobium officinale is the top grade of Dendrobium,which is recorded in many ancient medical texts as having the efficacy of treating diabetes.Modern pharmacological research shows that Dendrobium has the effects of anti-tumor,anti-fatigue,immune regulation,anti-aging,and regulation of glycolipid metabolism.In clinical application,Dendrobium officinale also has the function of balancing glucose and lipid metabolism,improving insulin resistance,promoting insulin secretion,improving the function of islet cells,and has a certain role in the prevention and treatment of diabetic complications.At present,there is a lack of systematic review of the pharmacological mechanism of Dendrobium officinale in the treatment of diabetes.In order to understand the pharmacological action of Dendrobium officinale in the treatment of diabetes more comprehensively,and to provide a reference for further pharmacological research,so that it can be better applied in clinics,this paper reviews the research progress of the pharmacological mechanism of Dendrobium officinale in the treatment of diabetes.

Objective:To evaluate the quality of critical patient handover practice between emergency room and intensive care unit (ICU) nurses, and to provide a basis for structured handover process.Methods:From March to July 2023, a total of 223 pairs of nurses in emergency room and ICU (including EICU) of 5 Class 3 Grade A general hospitals in Suzhou were selected as the research objects by using cross-sectional survey method and convenience sampling method. Self-designed general information questionnaire and Patient Handover Practice Quality Scale were used to investigate the included 223 pairs of nurses in emergency room and ICU on the current situation of handover time and quality.Results:A total of 211 pairs of nurses were included, including 286 females (67.8%) and 136 males (32.2%). The average age of emergency department nurses was (27.31 ± 2.17) years old, and ICU nurses was (26.96 ± 3.04) years old. The total scores of the patient handover practice Quality Scale for nurses in the emergency room and ICU were (45.25 ± 6.26) and (43.55 ± 7.19) points respectively, and the scores of the information transmission dimension were (20.47 ± 5.43) and (17.66 ± 3.45) points. The scores of common understanding dimension were (7.59 ± 2.31) and (8.58 ± 2.46) points. The scores of work atmosphere dimension were (7.93 ± 2.11) and (8.39 ± 2.29) points. The scores of handover situation dimension were (5.33 ± 1.30) and (5.70 ± 1.53) points, and the differences were statistically significant ( t values were - 6.35-4.22, all P<0.05). There were statistically significant differences in the scores of handover practice quality between emergency room nurses and ICU nurses according to specialization, education background, working years and job category ( t values were - 4.91-2.56, all P<0.05). Conclusions:Emergency room nurses and ICU nurses have different requirements and expectations for handover procedures, so it is necessary to build a structured handover practice framework and carry out personalized handover practice training, in order to achieve the consistency of handover content and improve the quality of critical patients handover practice.

Bladder perfusion is one of the main methods for the treatment of bladder cancer. In order to further improve the standardization of bladder cancer bladder perfusion operation for nursing staff, this paper, guided by evidence-based methods, formed the expert consensus on the whole process management of bladder perfusion for bladder cancer through Delphi expert consultation and expert demonstration meeting, and provided guidance for the standardization of clinical nursing practice and management institutionalization of bladder cancer bladder perfusion from seven aspects, namely, perfusion environment, operators, drug allocation, operation process, adverse reactions, health education and continuous nursing.

Objective To analyze the relationships of carotid plaque characteristics and hemorheology with disease classification and severity in elderly patients with ischemic stroke. Methods A total of 240 elderly patients with ischemic stroke were selected as observation group, and were further divided into different groups based on disease classification [complete anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), lacunar infarction (LACI)] and severity of the disease (mild, moderate, and severe); another 60 elderly healthy individuals with physical examinations were selected as control group. The characteristics of carotid artery plaques [carotid intima-media thickness (IMT), number of plaques, maximum length of plaques, and nature of plaques]as well as hemorheology indexes[erythrocyte sedimentation rate (ESR), hematocrit (HCT), plasma fibrinogen (Fib), plasma viscosity, and whole blood viscosity]were measured in all the cases, and the relationships of carotid plaque characteristics and hemorheology with disease classification and severity were analyzed. Results The IMT, the number of plaques, maximum diameter of plaques, ESR, HCT, Fib, plasma viscosity, and whole blood viscosity in the observation group were significantly higher than those in the control group (P < 0.05); the IMT, the number of plaques, and maximum diameter of plaques in the LACI group were significantly lower than those in the TACI, PACI, and POCI groups, while the ratios of stable plaques were significantly higher (P < 0.05); the ESR, HCT, Fib, plasma viscosity, and whole blood viscosity in the LACI group were significantly lower than those in the TACI, PACI, and POCI groups (P < 0.05); the IMT, the number of plaques, and maximum diameter of plaques in the mild group were significantly lower than those in the moderate and severe groups, the ratio of stable plaques was significantly higher than that in the moderate and severe groups, the IMT, the number of plaques, and maximum diameter of plaques in the moderate group were significantly lower than those in the severe group (P < 0.05); the ESR, HCT, Fib, plasma viscosity, and whole blood viscosity in the mild group were significantly lower than those in the moderate and severe groups, and the above indicators in the moderate group were significantly lower than those in the severe group (P < 0.05). Conclusion The characteristics of carotid artery plaques and hemorheology in elderly patients with ischemic stroke are related to the classification and severity of the disease, and the status of carotid artery plaques and hemorheological abnormalities in elderly patients with TACI, PACI, and POCI types of ischemic stroke are more severe than those of patients with LACI type.

ObjectiveTo investigate the effect of Loulianwan on the gut microbiota of db/db mice with type 2 diabetes mellitus （T2DM）. MethodMale db/m+ mice aged 4-5 weeks were assigned to the normal group， and male db/db model mice of the same age were randomly divided into model group， metformin group （0.25 g·kg^-1·d^-1）， and Loulianwan group （13 g·kg^-1·d^-1）， with six mice in each group. Drug intervention lasted five weeks. The body weight， water intake， and fasting blood glucose （FBG） of the mice were recorded every week. After five weeks， the FBG， liver triglyceride （TG）， liver total cholesterol （TC）， glycated serum protein （GSP）， and fasting serum insulin （FINS） were detected， and the insulin resistance index （HOMA-IR） was calculated. The feces in the mouse intestines were collected， and the 16S rRNA sequencing technology was used to detect the structural changes in the fecal gut microbiota of mice in each group. ResultCompared with the normal group， the model group showed increased body weight， water intake， FBG， liver TG， liver TC， GSP， FINS， and HOMA-IR （P<0.01）. Compared with the model group， the Loulianwan group showed reduced water intake， FBG， liver TG， liver TC， GSP， FINS， and HOMA-IR （P<0.01）. The gut microbiota in the Loulian Lills group changed from phylum to genus level. The relative abundance of beneficial bacteria increased and the relative abundance of harmful bacteria decreased. Among them， the abundance of Akkermansia muciniphila， Blautia， Ruminococcus， and Parabacteroides increased （P<0.01）. ConclusionLoulianwan can significantly improve glucose and lipid metabolism in db/db mice with T2DM， and its mechanism may be related to the increase in the abundance of Akkermansia muciniphila， Blautia， Ruminococcus， and Parabacteroides in the intestine.

Type 2 diabetes mellitus （T2DM） is a chronic metabolic disease characterized by insulin resistance， hyperinsulinemia， and disturbance of glucose and lipid metabolism， with elevated blood glucose as the main clinical manifestation. Due to its complex etiology and pathogenesis， there is no effective treatment， which critically threatens human health and places a heavy burden on society and families. Saponins are a class of glycosides with complex structures that have the advantage of a wide range of sources， elevated safety， and low adverse effects. As an essential active ingredient in Chinese medicine， Chinese medicine saponins have a variety of biological activities such as hypoglycemia， hypoglycaemia， anti-inflammation， antioxidation， anti-tumor， and immune modulation. In recent years， numerous studies have shown that Chinese medicine saponins are effective in preventing and treating T2DM. Although there have been numerous studies on the hypoglycemic effects and mechanisms of Chinese medicine saponins， there has been no systematic review of the mechanisms of Chinese medicine saponins in the treatment of T2DM. Therefore， to provide a theoretical basis for an in-depth study of the hypoglycemic effects of Chinese medicine saponins and a scientific basis for the development and clinical application of drugs， this paper systematically summarized the hypoglycemic mechanisms of Chinese medicine saponins， such as improving islet β-cell function， improving insulin resistance， inhibiting glycosidase activity， reducing the inflammatory response， anti-oxidative stress， and regulating intestinal flora， and analyzed the current research problems and development trends.

Objective:To investigate the effect of metformin on the microRNA (miRNA) expression and screen potential target with network pharmacology analysis in patients with type 2 diabetes.Methods:Fifteen patients with new diagnosed type 2 diabetes admitted to our hospital were selected, who received metformin during hospitalization and after discharge. The expression of serum matrix metalloproteinase (MMP)-9, transforming growth factor (TGF)-β1, and myocardial fibrosis related miRNAs were compared before and 6 month after metformin treatment. In addition, gene ontology (GO) and KEGG pathway enrichment analysis were applied to analyze differential expression miRNAs showing statistical significance. Meanwhile, the network figure was established to reflect the target gene messenger RNA (mRNA) corresponding to differentially expressed miRNA.Results:Compared with pre-medication, the serum level of MMP-9 was significantly decreased after treatment ( P<0.05). Besides, the expression of homo sapiens microRNA (hsa-miR)29a-3p, hsa-miR133a-5p, hsa-miR21-5p, hsa-miR30c-5p, and hsa-miR1-3p in patients with type 2 diabetes were dramatically down-regulated by metformin ( P<0.05 or P<0.01). Results of GO analysis and KEGG pathway enrichment analysis showed that differentially expressed miRNAs were mainly concentrated in endoplasmic reticulum lumen, synapse, basement membrane and other cell components. The molecular functions such as Rho GTPase binding and participation in extracellular matrix structural constituent were exerted through biological processes such as collagen catabolic process, regulation of short-term neuronal synaptic plasticity, and axon extension, which were mainly enriched in advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) signaling pathway in diabetic complications, tumor necrosis factor (TNF) signaling pathway, and Wnt signaling pathway, etc. The outcome of miRNA-mRNA network analysis demonstrated that there were 230 target genes mRNAs corresponding to differentially expressed miRNA. Conclusion:Metformin could play its role in the treatment of type 2 diabetes by down regulating the expression of miRNA, participating in the transduction of related cellular signaling pathways, regulating chromatin, nucleic acid binding, and enzyme activities.

Objective:To summarize the etiological characteristics and clinical treatment effects of 17 patients with medication-related osteonecrosis of the jaw (MRONJ).Methods:The clinical data of 17 patients with MRONJ admitted to the Department of Oral and Maxillofacial Surgery, the First People′s Hospital of Jinzhong, Shanxi Province, from July 2016 to December 2019 were retrospectively analyzed, including 9 males and 8 females, aged (63.6±9.6) years old (43-82 years old). Descriptive analysis of the primary disease, onset factors, site of disease, clinical manifestations, treatment methods, and treatment effects was conducted through follow-up for at least 1 year.Results:Among the primary diseases of the 17 cases, 12 were malignant tumors, and 5 were osteoporosis. There were 13 cases with a history of a trigger event (tooth extraction or unsuited removable denture). Six cases occurred in the maxilla, 10 cases occurred in the mandible, and 1 case involved both the upper and lower jaws. For the most common medication used, bisphosphonate was used in 16 cases including 5 cases with concomitant use of angiogenesis-inhibiting drugs. There was 1 case resulted from receptor activator of NF-κB ligand (RANKL) monoclonal antibody application. The duration of medication application was (10.1±3.9) months (3-18 months). All 17 cases were treated surgically. Totally 15 patients healed well after surgical treatment and the other 2 patients, who had poor soft tissue healing after surgery, healed well after a second operation.Conclusions:Tooth extraction might be a major trigger factor for the onset of MRONJ in the mandible. The disease was more possibly occured in the mandible than in the maxilla. Appropriate surgical treatment could achieve a good clinical outcome.

Objective:To summarize the clinical characteristics and laboratory diagnostic methods of infant botulism caused by Clostridium botulinum type B. Methods:Clinical data of 3 infants with type B botulism who were admitted to Children′s Hospital Affiliated to Capital Institute of Pediatrics from May to November 2018 were retrospectively analyzed. Botulinum toxin was detected in fecal samples or fecal enrichment solution of the patients, and Clostridium botulinum was cultured and isolated from fecal samples. Results:The age of onset of the patients (two boys and one girl) was 3, 3 and 8 months old, respectively. Two cases had the onset in May and one case had the onset in November. There were two cases with mixed feeding and one case with breast feeding. One case′s family members engaged in meat processing. All of them were previously healthy. All the children presented with acute flaccid paralysis, cranial nerve involvement and difficult defecation. Two cases had secondary urinary tract infection. Electromyograms of two cases showed that action potential amplitude of the motor nerve were lower than those of their peers. After treatments including intravenous human immunoglobulin, respiratory tract management, urethral catheterization, nasal feeding, etc., three cases recovered completely 2 to 4 months later. Type B botulinum toxin was detected in the fecal diluent of one patient, and the TPGYT enrichment solution and cooked meet medium of the feces of 3 patients, respectively. Clostridium botulinum B was identified from the feces of 3 infants after culture, isolation and purification. Conclusions:Combined with typical clinical manifestations including acute flaccid paralysis, cranial nerve involvement symptoms and difficult defecation examination, infant botulism can be clinically diagnosed. The detection of fecal botulinum toxin and the culture and isolation of Clostridium botulinum are helpful for the diagnosis.