1.Kaixuan Jiedu Compatibility Alleviates Skin Lesions and Inflammatory Reactions in Psoriasis-like Mice
Ningxin ZHANG ; Jiaqi LI ; Xinqian LIU ; Tianbo ZHANG ; Meiqi SUN ; Mingjing LI ; Bin YANG ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):79-88
ObjectiveTo investigate the efficacy and safety of Kaixuan Jiedu compatibility and the decomposed prescriptions in the treatment of psoriasis. MethodsThirty Balb/c mice were randomly grouped as follows (n=6): normal, model, Kaixuan Jiedu (KXJD, 15.21 g·kg-1), Kaixuan (KX, 3.08 g·kg-1), and Jiedu (JD, 12.13 g·kg-1). Except the normal group, the rest groups were modeled for psoriasis-like skin lesions by topical application of imiquimod, and samples were collected after 7 days of continuous intervention. Mice were photographed at the lesion site during modeling and before sampling and the psoriasis area and severity index (PASI) was calculated. Hematoxylin-eosin (HE) staining was used to observe pathological changes in the lesions and measure the epidermal thickness. Mice were photographed and observed for the tortuous dilation of dermal capillaries. The expression of vascular endothelial growth factor (VEGF), platelet-endothelial cell adhesion molecule (CD31), proliferating cell nuclear antigen (Ki67), and cytokeratin 10 (CK10) in the epidermal tissue was detected by immunohistochemistry. Immunofluorescence assay was employed to determine the expression of Claudin-1 and Occludin. Real-time PCR was employed to determine the mRNA levels of interleukin-17A (IL-17A) and interleukin-23 (IL-23). The spleen and thymus were photographed and weighed, and the spleen and thymus indices were calculated. The safety of the treatment was assessed by automatic biochemistry testing of the serum, liver, and kidney functions and by HE staining of the liver, kidney and spleen. ResultsCompared with that of the normal group, the skin of the model group showed erythema, infiltration, and typical psoriasis-like changes, tortuous dilation of dermal capillaries, hyperkeratosis in epidermal cells, acanthosis, massive lymphocytic infiltration in the dermis, impaired barrier function, increased expression of VEGF, CD31, Ki67, and CK10 (P<0.01), reduced expression of Claudin-1 and Occludin (P<0.01) in the epidermis, and up-regulated mRNA levels of IL-17A and IL-23 (P<0.01). In addition, the mice in the model group showed spleen enlargement, thymus atrophy, increased spleen index, and decreased thymus index (P<0.01). Compared with the model group, KXJD and JD reduced psoriasis-like skin lesions, inhibited the tortuous dilation of dermal capillaries, reduced the expression of VEGF, CD31, Ki67, and CK10 (P<0.01), increased the expression of claudin-1 (P<0.01), and down-regulated the mRNA levels of inflammatory factors (P<0.01). Moreover, the KXJD group outperformed the JD group. The JD group showed no significant difference from the model group regarding the spleen index, thymus index, and Occludin expression. The psoriasis indicators in the KX group were not significantly different from those in the model group. ConclusionKXJD and JD can reduce the symptoms of local skin lesions of psoriasis, which is manifested as different inhibition degrees of the proliferation and differentiation of keratin-forming cells, tortuous dilation of dermal capillaries, and inflammatory reactions, as well as the protection of the skin barrier. Moreover, KXJD outperformed JD. KX alone did not significantly reduce psoriasis lesions in mice. KXJD and the decomposed prescriptions are safe and effective, causing no obvious liver and kidney injuries.
2.Kaixuan Jiedu Compatibility Alleviates Skin Lesions and Inflammatory Reactions in Psoriasis-like Mice
Ningxin ZHANG ; Jiaqi LI ; Xinqian LIU ; Tianbo ZHANG ; Meiqi SUN ; Mingjing LI ; Bin YANG ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):79-88
ObjectiveTo investigate the efficacy and safety of Kaixuan Jiedu compatibility and the decomposed prescriptions in the treatment of psoriasis. MethodsThirty Balb/c mice were randomly grouped as follows (n=6): normal, model, Kaixuan Jiedu (KXJD, 15.21 g·kg-1), Kaixuan (KX, 3.08 g·kg-1), and Jiedu (JD, 12.13 g·kg-1). Except the normal group, the rest groups were modeled for psoriasis-like skin lesions by topical application of imiquimod, and samples were collected after 7 days of continuous intervention. Mice were photographed at the lesion site during modeling and before sampling and the psoriasis area and severity index (PASI) was calculated. Hematoxylin-eosin (HE) staining was used to observe pathological changes in the lesions and measure the epidermal thickness. Mice were photographed and observed for the tortuous dilation of dermal capillaries. The expression of vascular endothelial growth factor (VEGF), platelet-endothelial cell adhesion molecule (CD31), proliferating cell nuclear antigen (Ki67), and cytokeratin 10 (CK10) in the epidermal tissue was detected by immunohistochemistry. Immunofluorescence assay was employed to determine the expression of Claudin-1 and Occludin. Real-time PCR was employed to determine the mRNA levels of interleukin-17A (IL-17A) and interleukin-23 (IL-23). The spleen and thymus were photographed and weighed, and the spleen and thymus indices were calculated. The safety of the treatment was assessed by automatic biochemistry testing of the serum, liver, and kidney functions and by HE staining of the liver, kidney and spleen. ResultsCompared with that of the normal group, the skin of the model group showed erythema, infiltration, and typical psoriasis-like changes, tortuous dilation of dermal capillaries, hyperkeratosis in epidermal cells, acanthosis, massive lymphocytic infiltration in the dermis, impaired barrier function, increased expression of VEGF, CD31, Ki67, and CK10 (P<0.01), reduced expression of Claudin-1 and Occludin (P<0.01) in the epidermis, and up-regulated mRNA levels of IL-17A and IL-23 (P<0.01). In addition, the mice in the model group showed spleen enlargement, thymus atrophy, increased spleen index, and decreased thymus index (P<0.01). Compared with the model group, KXJD and JD reduced psoriasis-like skin lesions, inhibited the tortuous dilation of dermal capillaries, reduced the expression of VEGF, CD31, Ki67, and CK10 (P<0.01), increased the expression of claudin-1 (P<0.01), and down-regulated the mRNA levels of inflammatory factors (P<0.01). Moreover, the KXJD group outperformed the JD group. The JD group showed no significant difference from the model group regarding the spleen index, thymus index, and Occludin expression. The psoriasis indicators in the KX group were not significantly different from those in the model group. ConclusionKXJD and JD can reduce the symptoms of local skin lesions of psoriasis, which is manifested as different inhibition degrees of the proliferation and differentiation of keratin-forming cells, tortuous dilation of dermal capillaries, and inflammatory reactions, as well as the protection of the skin barrier. Moreover, KXJD outperformed JD. KX alone did not significantly reduce psoriasis lesions in mice. KXJD and the decomposed prescriptions are safe and effective, causing no obvious liver and kidney injuries.
3.Development and application of a novel fumigation moxibustion device.
Xin WU ; Xuetao ZHANG ; Fang GAO ; Jiaojiao ZHANG ; Shengbing WU ; Nenggui XU ; Meiqi ZHOU
Chinese Acupuncture & Moxibustion 2025;45(5):713-716
A novel fumigation moxibustion device has been designed to enable adjustable and controllable moxa smoke temperature, maintaining a relatively stable fumigation temperature while improving the utilization efficiency of moxa smoke. The device consists of five main components: a temperature control chamber, fumigation outlet, temperature measurement module, moxa smoke filtration chamber, and elastic band. It is compact, refined, and easy to operate. The device allows users to set the desired fumigation temperature according to therapeutic needs and simultaneously filters and eliminates residual moxa smoke after treatment. This design addresses the challenges of traditional fumigation moxibustion therapy, including unstable moxa smoke temperature, difficulty in regulation, low utilization efficiency, and high dependence on manual operation. It contributes to the promotion and application of fumigation moxibustion therapy and supports the establishment of a standardized moxibustion system.
Moxibustion/methods*
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Humans
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Equipment Design
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Fumigation
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Temperature
4.Electroacupuncture improves myocardial injury in rats with acute myocardial ischemia by inhibiting HPA axis hyperactivity via modulating hippocampal glutamatergic system.
Kun WANG ; Haiyan ZUO ; Jiaojiao ZHANG ; Xin WU ; Wenhui WANG ; Shengbing WU ; Meiqi ZHOU
Journal of Southern Medical University 2025;45(8):1599-1607
OBJECTIVES:
To clarify the role of hippocampal glutamate system in regulating HPA axis in mediating the effect of electroacupuncture (EA) at the heart meridian for improving myocardial injury in rats with acute myocardial ischemia (AMI).
METHODS:
Male SD rats were randomized into sham-operated group, AMI group, EA group, and L-glutamic acid+EA group (n=9). Rat models of AMI were established by left descending coronary artery ligation, and EA was applied at the "Shenmen-Tongli" segment; the rats in L-glutamic acid+EA group were subjected to microinjection of L-glutamic acid into the bilateral hippocampus prior to AMI modeling and EA treatment. Cardiac functions of the rats were evaluated using echocardiography, and ECG and heart rate variation (HRV) were analyzed using PowerLab and LabChart. Pathological changes in the myocardial tissue was examined using HE staining, and serum levels of myocardial enzymes were detected with ELISA. Myocardial expressions of TH and GAP43 were detected with immunohistochemistry, and colocalization of VGLUT1, VGLUT2 and c-fos were observed using immunofluorescence staining; the expressions of VGLUT1, VGLUT2, NMDAR1 and NMDAR2B were detected using Western blotting.
RESULTS:
The rat models of AMI showed significantly decreased LVEF and LVFS and increased serum levels of myocardial enzymes in positive correlation with the HPA axis. Numerous TH- and GAP43-positive cells were observed in the hippocampus, where the expressions of NE and E, neurons colabeled with VGLUT1, VGLUT2 and c-fos, and expressions of VGLUT1, VGLUT2, NMDAR1, NMDAR2B and Glu increased significantly. All these changes were significantly improved by interventions with EA as compared with those in AMI and L-Glutamate+EA groups.
CONCLUSIONS
In rats with AMI, EA at the heart meridian can regulate excessive glutamate release in the hippocampus, thereby inhibiting HPA axis hyperactivity and reducing sympathetic nerve activity to protect the myocardial tissue.
Animals
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Electroacupuncture
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Male
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Rats, Sprague-Dawley
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Hippocampus/metabolism*
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Rats
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Glutamic Acid/metabolism*
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Myocardial Ischemia/physiopathology*
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Hypothalamo-Hypophyseal System/physiopathology*
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Pituitary-Adrenal System/physiopathology*
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Receptors, N-Methyl-D-Aspartate/metabolism*
5.A network meta-analysis on the efficacy and mechanism of traditional Chinese medicine combined with mesalazine in the treatment of ulcerative colitis
Fan ZHANG ; Xuan ZHOU ; Hongmin ZHUO ; Yan CHEN ; Baoping REN ; Meiqi ZHONG ; Meiyan ZENG ; Houpan SONG
Chongqing Medicine 2025;54(6):1408-1418
Objective To evaluate the efficacy and safety of six kinds of commonly used traditional Chi-nese medicine combined with mesalazine in the treatment of ulcerative colitis(UC)based on frequency statis-tical network meta-analysis.Methods Randomized controlled trials(RCT)of oral Chinese medicine for the treatment of UC were searched from the establishment of the database to June 2024 of PubMed,CNKI,Wan-fang,VIP,Sinomed and other databases.The quality of the included literatures was evaluated by Cochrane bias risk assessment tool,and the data were statistically analyzed by Stata MP17.0 software.Results A total of 24 RCTs involving 1 939 patients were included,involving 6 kinds of traditional Chinese medicine and Chinese pa-tent medicine,including 4 macro and micro outcome indicators.In terms of improving the total clinical effec-tive rate,Shaoyao decoction,Gancao Xiexin decoction,Huangqin decoction granule,Baitouweng decoction,Kangfuxin liquid,Shenlingbaizhu powder+mesalazine were all superior to using mesalazine alone,and Kang-fuxin liquid+mesalazine had the best effect(P<0.05).In terms of down-regulation of interleukin(IL)-6 expression in colonic mucosa,Shaoyao decoction,Gancao Xiexin Decoction,Huangqin Decoction granules,Pul-satilla decoction,Kangfuxin Liquid+mesalazine were better than using mesalazine alone,and Pulsatilla De-coction+mesalazine had the best effect on reducing IL-6(P<0.05).In terms of down-regulation of colonic mucosal tumor necrosis factor(TNF)-α expression,Shaoyao decoction,Gancao Xiexin decoction,Huangqin decoction granule,Baitouweng decoction,Shenlingbaizhu decoction+mesalazine was better than using me-salazine alone,and Gancao Xiexin decoction+mesalazine had the best effect(P<0.05).In terms of down-regulation of IL-10 expression in colonic mucosa,Pulsatilla decoction+mesalazine was better than mesalazine alone(P<0.05).Conclusion Traditional Chinese medicine combined with mesalazine could alleviate the clin-ical symptoms of UC patients,improve inflammatory factor indicators,eliminate inflammation,and show a better treatment effect for UC than mesalazine used alone.
6.Morphological study on projections of tyrosine hydroxylase positive neurons in locus coeruleus to paraventricular nucleus of the thalamus in mice
Pengxin ZHANG ; Hui ZHU ; Fei PENG ; Peiyuan LYU ; Huijie FENG ; Meiqi XUE ; Yijia XUE ; Yulin DONG
Chinese Journal of Neuroanatomy 2024;40(4):405-412
Objective:To observe the projections from tyrosine hydroxylase(TH)positive neurons in locus coerule-us(LC)to tachykinin-1(TAC1)neurons in paraventricular nucleus of the thalamus(PVT),and morphologically determine whether they are involved in transmission and modulation of nociceptive information.Methods:TAC1-ires-Cre mice were hybridized with Rosa26:CAG-LSL-tdTomato(Ai9)mice.And spared nerve injury(SNI)induced neu-ropathic pain model was established with TAC1-ires-Cre::Ai9 mice to observe the colocalization of TAC1 and Fos and the close appositions between TAC1/FOS double-labeled neurons and TH positive axonal terminals.The distribution of the TH positive neurons and FG retrogradely labeled neurons were observed in the LC after Fluorogold(FG)was injec-ted into the PVT.Finally,the coexistences of TH positive neurons and RV labeled neurons in the LC were observed after injection of RV-mediated retrograde tracing system.Results:TAC1 positive neurons were shown with red fluores-cence in TAC1-ires-Cre::Ai9 mice.TAC1/FOS double-labeled neurons were found in the PVT of the SNI model.Some TAC1/FOS double labeled neurons made close appositions with TH positive axonal terminals.FG retrogradely labeled neurons were observed in the LC after FG injected into the PVT,and some of the FG labeled neurons coexisted with TH positive neurons.Using RV retrograde transsynaptic tracing virus,the results showed that presynaptic neurons of TAC1 positive neurons in the PVT were found in the LC,and most of the presynaptic neurons were TH positive neu-rons.Conclusion:TH positive neurons in the LC project to TAC1 positive neurons of the PVT,forming LCTH+-PVTTAC1+neural circuit,which were activated by nociceptive information.It demonstrates that this pathway plays a role in pain transmission or regulation.
7.Mechanism study of ATOX1 promoting biological behavior of hepatocellular carcinoma cells through JAK2/STAT3 pathway
Jiajia MA ; Yaping ZHANG ; Bin YANG ; Meiqi ZHAO ; Lu JIANG ; Xiaoyu HUANG ; Luchang FAN ; Fengmei WANG
Tianjin Medical Journal 2024;52(9):907-912
Objective To investigate the clinical significance of the expression of antioxidant 1 copper chaperone protein(ATOX1)in hepatocellular carcinoma(HCC)and its relationship with tumor proliferation,migration and invasion.Methods The expression of ATOX1 mRNA in HCC cancer tissue and normal liver tissue was analyzed using the Human Genome Atlas database.Immunohistochemical experiment was used to detect the expression of ATOX1 in 15 cases of HCC cancer tissue and adjacent tissue.Human HCC cell lines Hep3B and HepG2 were divided into the control group(NC),the ATOX1 knockdown group 1(si-ATOX1#1)and the ATOX1 knockdown group 2(si-ATOX1#2).The effects of ATOX1 knockdown on the malignant biological behavior of HCC cells were observed through CCK-8 cell proliferation experiment,scratch experiment and Transwell invasion experiments.A nude mouse xenograft tumor model was constructed to analyze the effect of ATOX1 knockdown on the quality and volume of transplanted tumors.Western blot assay was used to detect the relationship between ATOX1 and JAK2/STAT3 pathway protein expression.Results Bioinformatics analysis showed that expression of ATOX1 mRNA in HCC cancer tissue was higher than that in adjacent normal tissue(P<0.05).The immunohistochemical staining results showed that the positive rate of ATOX1 protein was higher in HCC cancer tissue than that in adjacent tissue(93.33%vs.13.33%,P<0.01).In vitro experimental results showed that siRNA knockdown of ATOX1 protein expression in Hep3B and HepG2 cells significantly reduced the proliferation,migration and invasion abilities of cancer cells(P<0.05).In vivo experiments in mice showed that the volume and weight of subcutaneous xenograft tumors were significantly smaller in the sh-ATOX1 group than those in the sh-con group(P<0.05).The expression levels of JAK2/STAT3 pathway-related proteins p-JAK2,p-STAT3,CyclinD1 and MMP2 were significantly lower in the subcutaneous transplanted tumor tissue of the sh-ATOX1 group than that of the sh-con group(P<0.05).Conclusion ATOX1 can promote the proliferation,migration and invasion of HCC through JAK2/STAT3 pathway,which can potentially become a potential tumor marker and therapeutic target.
8.Role and mechanisms of disulfiram in improving cardiac function and re-ducing myocardial inflammation in HFpEF rats based on NLRP3/cas-pase-1/GSDMD signaling pathway
Xuanyang SHEN ; Weidong LI ; Xiaolu JIANG ; Meiqi ZHANG ; Wentao TAN ; Yuan SHEN ; Hongfu WEN
Chinese Journal of Pathophysiology 2024;40(10):1891-1897
AIM:To investigate the role and possible mechanisms of disulfiram(DSF)in a rat model of heart failure with preserved ejection fraction(HFpEF)induced by high-fat diet(HFD)and nitric oxide blocker Nω-nitro-L-argi-nine methyl ester(L-NAME).METHODS:The HFpEF rat model was constructed using HFD and L-NAME.Sprague-Dawley rats were randomly divided into 3 groups:control group(fed with a normal diet and water),HFpEF group(fed with HFD and drinking water containing 0.5 g/L L-NAME),and DSF+HFpEF group(treated with DSF in addition to HFD and L-NAME).After 5 weeks,cardiac function of the rats was examined using echocardiography and exercise test.Myo-cardial pathological changes were detected using hematoxylin-eosin and wheat germ agglutinin staining,the degree of car-diac fibrosis was assessed using Masson staining,and apoptosis levels were observed using TUNEL staining.Western blot was performed to detect the expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),cleaved caspase-1,gasdermin D N-terminal fragment(GSDMD-N)in the myocardium,and serum level of N-terminal pro-brain natriuretic peptide(NT-proBNP),and interleukin(IL)-1β and IL-18 in the myocardium were detected by ELISA.RESULTS:Compared with control group,the rats in HFpEF group showed increased body weight,systolic blood pres-sure,diastolic blood pressure,E/E′ ratio,left ventricular anterior wall thickness at diastole and serum NT-proBNP level(P<0.05),and decreased E/A ratio and absolute value of global longitudinal strain(GLS;P<0.05).In contrast,the rats in DSF+HFpEF group showed decreased body weight,E/E′ ratio,diastolic blood pressure and serum NT-proBNP level(P<0.05),and increased E/A ratio and absolute value of GLS(P<0.05),with no significant changes in systolic blood pressure,left ventricular posterior wall thickness at diastole and left ventricular ejection fraction(P>0.05).The rats in HFpEF group had increased myocardial fibrosis area,cardiomyocyte cross-sectional area,and apoptotic rate compared with control group(P<0.05),while these indexes were reduced in DSF+HFpEF group(P<0.05).The results of Western blot and ELISA showed that the levels of NLRP3,cleaved caspase-1,GSDMD-N,IL-1β and IL-18 were increased in the myocardium of rats in HFpEF group compared with control group(P<0.05),but decreased in DSF+HFpEF group com-pared with HFpEF group(P<0.05).CONCLUSION:Disulfiram improves cardiac function and attenuates myocardial remodeling in HFpEF rats.The mechanism may be related to the modulation of NLRP3/caspase-1/GSDMD signaling path-way and the reduction of myocardial inflammatory response.
9.The diagnostic evaluation value of multidetector CT,CT cholangiography and CT angiography pre-postreatment for advanced hilar cholangiocarcinoma
Ping LIANG ; Jinhua CAI ; Gengrui CHEN ; Lin DENG ; Xiaoyun YAN ; Guangren HUANG ; Meiqi LIANG ; Yan ZHANG ; Zhongkui HUANG
Journal of Practical Radiology 2024;40(9):1459-1462
Objective To explore the application value of multidetector computed tomography(MDCT),computed tomography cholangiography(CTC)and computed tomography angiography(CTA)reconstruction technology in the diagnosis and classification and the evaluation of the efficacy of biliary drainage in advanced hilar cholangiocarcinoma(HCCA).Methods A total of 44 patients of inoperable advanced HCCA were collected.Conventional CT plain scan and enhanced multi-phase scan were performed before treat-ment.Minimum intensity projection(MinIP)combined with curve planar reformation(CPR)was used to perform CTC.CTA of the portal vein,hepatic artery and hepatic vein were performed by maximum intensity projection(MIP),volume rendering(VR)or CPR,respectively.CT was reexamined after biliary drainage treatment.The study included the comparison between reconstruction technology of CTC and CTA and conventional CT scanning technology,CTC in the classification and diagnosis of HCCA,CTA in the evaluation of vascular invasion,and the evaluation of the effect of jaundice drainage by biliary imaging before and after biliary drain-age treatment.Results All HCCA cases obtained clear location diagnosis,including 39 cases of Bismuth-Corlette type Ⅳ and 5 cases of type Ⅲ.There were 40 cases of hepatic vascular involvement,including 15 cases of bilateral portal vein invasion by tumor,12 cases of portal vein constriction,8 cases of portal vein tumor thrombosis,4 cases of bilateral hepatic arteries involvement,and 1 case of hepatic vein involvement.CTC and CTA could better display a full view of the bile duct and blood vessel than conventional CT scanning ima-ges,and provided more accurate analysis of tumor classification and degree of vascular invasion.Before treatment,CT showed severe dila-tion of bile duct in 21 cases and moderate dilation in 20 cases,severe dilation of the intrahepatic bile duct in the left lobe but mild dilation of the intrahepatic bile duct in the right lobe in 3 cases.After drainage treatment,the contraction rate of intrahepatic bile duct dilation was<25%in 4 cases,25%to 49%in 13 cases,50%to 74%in 18 cases,and ≥75%in 9 cases.The bile duct contraction rate was positively correlated with the decrease in total bilirubin(TBIL).Conclusion MDCT,CTC and CT A reconstruction technology can well complete the diagnosis of advanced HCCA,Bismuth-Corlette typing,and vascular evaluation.Observing the contraction rate of the intrahepatic bile duct after biliary drainage treatment can evaluate the efficacy of jaundice drainage.
10.Factors influencing patient involvement in decision-making for initial administration of insulin in patients with Type II diabetes:a Meta integration of qualitative study
Jingyuan ZHANG ; Dan YANG ; Yiyi YIN ; Meiqi MENG ; Sihan CHEN ; Yufang HAO
Modern Clinical Nursing 2024;23(8):71-80
Objective To summarise and analyse the qualitative studies on the factors that influence patient involvement in decision-making for the initial administration of insulin for the patients with Type II diabetes,from the perspectives of patients and healthcare staff in order to provide a reference to promote patient involvement in decision-making.Methods Systematic searches were conducted across databases,such as CINAHL,Cochrane Library,EMBASE,PubMed,Web of Science,PsycINFO,China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,and SinoMed,for qualitative studies on the factors that affect patient involvement in initial insulin decision-making for the patients with Type II diabetes.The search was limited to articles from the inception of the databases to 30th September,2023.Quality of the included studies was assessed using the Joanna Briggs Institute(JBI)evidence-based healthcare centre for qualitative research quality assessment tool.The results were integrated using a synthesising integration method.Results A total of 19 articles were included,yielding 20 study results,which were categorised into 7 themes of patient decision-making related values,patient role preferences in decision-making,condition of patient,the role of healthcare staff in patient participation in decision-making,professional quality of healthcare staff,relationship between patient and healthcare staff,and the support from a medical institution.The data were ultimately integrated into 4 overarching themes of patient personal factors,healthcare staff factors,patient-staff interaction factors and medical institution factors.Conclusion The involvement of the patients with Type II diabetes in the decision-making for the initial administration of insulin is influenced by patients themselves,healthcare staff and medical institutions.It requires efforts of multiple parties:not only with the patients actively participate in decision-making,but also with the healthcare staff and institutions who provide effective decision supports.

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