Objective To establish a method for quantitative control of multi-pharmacological components in Kanggan Jiedu capsules,and to evaluate the quality of Kanggan Jiedu capsules by chemometrics and weighted technique for order preference by similarity to an ideal solution(TOPSIS)method.Methods HPLC was performed on an Apollo C18 column with acetonitrile-0.1%formic acid gradient elution as mobile phase.The volume flow rate was 1.0 mL/min,and the detection wavelength was 327,238 and 298 nm.The contents of 3,5-O-dicaffeoylquinic acid,4,5-dicaffeoylquinic acid,gardenoside,geniposide,3'-hydroxy puerarin,puerarin,3'-methoxy puerarin,baicalin,wogonoside,oxypeucedanin,imperatorin,isoimperatorin,pseudoaspidin and tetraalbaspidin ABBA in 15 batches of Kanggan Jiedu capsules were determined by quantitative analysis of multi-components by single marker(QAMS),and then statistical software was used to analyze the difference of 15 batches of samples to find out the main potential markers affecting the quality of Kanggan Jiedu capsules.Results The f value of the 3,5-O-dicaffeoylquinic acid was 0.9119,with 4,5-dicaffeoylquinic acid as the internal reference.The f of the gardenoside,3'-hydroxy puerarin,puerarin and 3'-methoxy puerarin were 1.4941,1.2423,0.9281 and 1.0860,respectively,with geniposide as the internal reference.The f of the baicalin,wogonoside,oxypeucedanin,isoimperatorin,pseudoaspidin and tetraalbaspidin ABBA were 1.4551,0.7414,0.8796,0.6949,1.3248 and 0.8240,respectively,with imperatorin as the internal reference.The f values of each component were robust.There was no significant difference in the content determined by the two methods.The chemometrics method results showed that 15 batches of Kanggan Jiedu capsules could be clustered into three categories,there were certain differences between batches.Baicalin,geniposide,imperatorin,puerarin,3,5-O-dicaffeoylquinic acid and wogonoside were the main potential markers affecting the quality of Kanggan Jiedu capsules.The results of weighted TOPSIS method results showed that the Ci values of 15 batches of samples were between 0.2018 and 0.7346,among which S13 ranked the top with Ci value of 0.7346.Conclusion The established method for quantitative detection of 14 pharmacodynamic components is convenient and accurate.The quality of Kanggan Jiedu capsules can be evaluated by chemometrics and weighted TOPSIS method.

Objective To establish a method for quantitative control of multi-pharmacological components in Kanggan Jiedu capsules,and to evaluate the quality of Kanggan Jiedu capsules by chemometrics and weighted technique for order preference by similarity to an ideal solution(TOPSIS)method.Methods HPLC was performed on an Apollo C18 column with acetonitrile-0.1%formic acid gradient elution as mobile phase.The volume flow rate was 1.0 mL/min,and the detection wavelength was 327,238 and 298 nm.The contents of 3,5-O-dicaffeoylquinic acid,4,5-dicaffeoylquinic acid,gardenoside,geniposide,3'-hydroxy puerarin,puerarin,3'-methoxy puerarin,baicalin,wogonoside,oxypeucedanin,imperatorin,isoimperatorin,pseudoaspidin and tetraalbaspidin ABBA in 15 batches of Kanggan Jiedu capsules were determined by quantitative analysis of multi-components by single marker(QAMS),and then statistical software was used to analyze the difference of 15 batches of samples to find out the main potential markers affecting the quality of Kanggan Jiedu capsules.Results The f value of the 3,5-O-dicaffeoylquinic acid was 0.9119,with 4,5-dicaffeoylquinic acid as the internal reference.The f of the gardenoside,3'-hydroxy puerarin,puerarin and 3'-methoxy puerarin were 1.4941,1.2423,0.9281 and 1.0860,respectively,with geniposide as the internal reference.The f of the baicalin,wogonoside,oxypeucedanin,isoimperatorin,pseudoaspidin and tetraalbaspidin ABBA were 1.4551,0.7414,0.8796,0.6949,1.3248 and 0.8240,respectively,with imperatorin as the internal reference.The f values of each component were robust.There was no significant difference in the content determined by the two methods.The chemometrics method results showed that 15 batches of Kanggan Jiedu capsules could be clustered into three categories,there were certain differences between batches.Baicalin,geniposide,imperatorin,puerarin,3,5-O-dicaffeoylquinic acid and wogonoside were the main potential markers affecting the quality of Kanggan Jiedu capsules.The results of weighted TOPSIS method results showed that the Ci values of 15 batches of samples were between 0.2018 and 0.7346,among which S13 ranked the top with Ci value of 0.7346.Conclusion The established method for quantitative detection of 14 pharmacodynamic components is convenient and accurate.The quality of Kanggan Jiedu capsules can be evaluated by chemometrics and weighted TOPSIS method.

OBJECTIVE To establish a multi-index quantitative detection method,and to evaluate the quality difference of Gleditsia sinensis from different producing areas.METHODS The contents of protocatechuic acid,vanillic acid,isoscopoletin,scoparone,isovitexin,fustin,taxifolin,fisetin,quercetin,kaempferol,echinocystic acid,betulinic acid,β-sitosterol and stigmasterol were detected by high performance liquid chromatography-quantitative analysis of multi-components by single marker(HPLC-QAMS).The chromatographic column was Kromasil C18,the mobile phase was 0.2％phosphoric acid-acetonitrile solution(gradient elution),the detection wavelengths were 254,360,210 nm for different index components,the column temperature was 30 ℃,the flow rate was 1.0 mL/min,and the sample injection volume was 10 μL.The contents of extract and total ash were detected according to the method of Chinese Pharmacopoeia.The quality differences of 30 batches of G.sinensis(No.S1-S30)from different producing areas were evaluated by chemometrics,weighted technique for order preference by similarity to an ideal solution(TOPSIS)analysis and Logistic regression model.RESULTS The linear ranges of 14 components were 1.55-77.50,0.71-35.50,0.28-14.00,0.96-48.00,1.77-88.50,0.09-4.50,4.65-232.50,1.49-74.50,0.37-18.50,1.18-59.00,7.35-367.50,3.58-179.00,0.49-24.50 and 0.21-10.50 μg/mL,respectively(all r＞0.999).The RSDs of precision,stability(24 h)and repeatability were less than 2.00％;the average recoveries were 96.99％-100.13％(all RSDs＜2.00％),and the relative correction factor had good repeatability.The contents of extract and total ash were 4.2％-12.5％and 0.5％-2.3％,respectively.There was no significant difference in the content of 14 components measured by QAMS method and extemal standard method(P＞0.05).The results of chemometrics showed that 30 batches of samples were clustered into 3 categories:S1 to S11 form one category,S12 to S20 form another category,and S21 to S30 constitute the third category.Echinocystic acid,betulinic acid,taxifolin,kaempferol,isovitexin,scoparone and protocatechuic acid may be the differential components affecting the quality of G.sinensis from different producing areas.The analysis results of the weighted TOPSIS method revealed that relative closeness(Jb)for 30 batches of G.sinensis ranged from 0.144 5 to 0.721 8,with S27 achieving the highest value(Jb)of 0.721 8.The analysis results of the Logistic regression model showed that S21-S30 batches of samples were of superior grade,S1-S11 were of intermediate grade,and S12-S20 were of inferior grade.CONCLUSIONS The established HPLC-QAMS method is simple and accurate.The comprehensive evaluation method is objective and comprehensive,and can be used to evaluate the quality difference of G.sinensis from different producing areas.

OBJECTIVE To comprehensively evaluate the quality of Yifei qinghua ointment by multi-component quantitative analysis combined with chemometrics and entropy weight-technique for order preference by similarity to ideal solution （TOPSIS） method. METHODS The contents of lobetyolin， syringin， calycosin 7-O-β-D-glucopyranoside， ononin， astraisoflavan-7-O-β-D- glucoside， isomucronulatol 7-O-glucoside， astragaloside Ⅳ ， deapi-platycoside E， platycoside E， platycodin D3， feretoside， asperulosidic acid， asperuloside， methylophiopogonanone A and methylophiopogonanone B in 14 batches of Yifei qinghua ointment （S1-S14） were determined by high-performance liquid chromatography method. Then， the quality of 14 batches of Yifei qinghua ointment was analyzed by chemometrics （principal component analysis and orthogonal partial least-squares discriminant analysis） and entropy weight TOPSIS method. RESULTS The results of chemometrics showed that 14 batches of Yifei qinghua ointment could be clustered into three categories， S1-S6 as the first category， S7-S10 as the second category， and S11-S14 as the third category. The values of variable importance for projection of calycosin 7-O-β-D-glucopyranoside， ononin， feretoside， astragaloside Ⅳ， astraisoflavan-7-O-β-D-glucoside， lobetyolin， methylophiopogonanone A and platycoside E were higher than 1. The results of the entropy weight TOPSIS method showed that the Euclidean closeness of the optimal solution of 14 batches of Yifei qinghua ointment were between 0.152 9 and 0.736 6， and that of sample S14 was the highest （0.736 6）. CONCLUSIONS Among 14 batches of Yifei qinghua ointment， sample S14 has the best quality， and 8 components such as calycosin 7-O-β-D-glucopyranoside and ononin may be differential markers affecting the quality of Yifei qinghua ointment.

Objective:To investigate the workflow, feasibility and advantages of respiratory navigator-guided stereotactic body radiation therapy (SBRT) of liver malignancies on the magnetic resonance linear accelerator (MR-linac).Methods:Clinical data of 10 patients with liver cancer treated with respiratory navigator-guided SBRT on the MR-linac from September to December 2021 were analyzed retrospectively. All patients underwent CT and MR simulated localization, and plain, enhanced and 4D CT scan, and T 1 3D MR and T 2 3D MR images were collected. The expiratory 4D CT was chosen to design the reference plan. The T 2 3D navigator MR image (end-exhalation) was collected before treatment, the target position was adjusted or the target shape was modified in combination with the real-time monitoring 2D MR image and appropriate online adaptive planning process was selected. Then, the ability of CT, T 2 3D and T 2 3D navigator MR images to display the tumor was evaluated by naked eye. The changes of target volume were calculated. Dosimetric differences between the adaptive and reference plans were compared. The efficacy and adverse reactions of patients were evaluated. Results:In the free breathing state, the T 2 3D navigator MR image was significantly better than T 2 3D MR image to clearly display the tumor and its boundary. The adaptive plans of adapt-to-position (ATP) and adapt-to-shape (ATS) adopted by 10 patients was 37 times and 22 times respectively. The tumor subsided significantly in 3 patients. The average target conformal index (CI) of the adaptive plans was no different from that of the reference plans, but the gradient index (GI) was higher ( P<0.05), especially in the ATS plans. Compared to the reference plans, the normal liver V 5 Gy, V 10 Gy and D mean were almost the same, but the average MU was increased with a significant difference in the ATP adaptive plans ( P<0.05). The average of MU, segments and normal liver D mean and V 10 Gy in the ATS adaptive plans were lower than those in the reference plans, and the liver V 5 Gy was slightly increased. Seven patients were evaluated after 1 month and 3 months. The local control of lesions was promising. Toxicities were mild and no grade 3 or higher toxicities were observed. Conclusion:Respiratory navigator on MR-linac improves the visual clarity of tumors and online MR images, and shows its advantages to guide the adaptive precision radiotherapy of liver tumors, especially in SBRT.

Objective:To study the impact on dose accuracy for the treatment planning by manually assigning accurate electron density for CT image-based tumor tissues and organs at risk.Methods:Twenty cases of retrospective postoperative cervical cancer radiotherapy plans were selected. The body electron density of the corresponding organs was derived from the ICRU 46 report and assigned in the treatment planning system (Monaco5.11, Sweden), including the bladder, rectum, intestine, kidney, spinal cord, femoral head, and ilium. The original plans were double-arc volumetric modulated arc therapy plan (360° VMAT), using Monte Carlo algorithm, the calculation grid was 0.3 cm × 0.3 cm × 0.3 cm, and the minimum subfield width was 0.6 cm. Keep the original plan fluence unchanged and recalculate the dose to generate a new plan. The two-dimensional dose distribution and dose-volume histogram (DVH) were used to compare the differences between the two plans. The difference was compared between the two group plans by using the dosimetry parameters and DVH two dimension curve.Results:For the planning of assigning bulk electron density (Plan RED), the deviation of the patient′s target dose parameters and the original plan (Plan ref) was <2%, and the average deviation of all target regions D2, D98, Dmean was < 0.7%, only 2 of the 180 data were between 2% and 3%. The average deviation of V20, V30, D1 cm 3, Dmean of the bladder, rectum, and small intestine, the original Plan ref was less than 0.6%, and 4 out of 240 data had values > 2%. Plan RED′s average hop count was 0.9% higher than Plan ref, and the total number of subfields remains unchanged. The planned dose generated by manually assigning the electron density in Plan RED was higher than that in Plan ref, but met the clinical requirements. The two-dimensional curves of the DVH diagram for targets and OARs almost completely overlapped, and there was no obvious difference in the dose distribution diagram of the same cross section. The statistical result of all parameters showed that the difference in planned dose parameters between the two groups was not statistically significant( P>0.05). Conclusions:The overall deviation of dose accuracy between Plan RED and Plan ref is <2%, which meets the clinical requirements and provides a reference for realizing MRI-only treatment planning.

Objective: To explore the clinical features, diagnosis and prognosis of renal transplant recipients with NCP. Method: The clinical data of 2 cases of kidney transplant recipients with NCP were retrospectively analyzed. Based onclinical manifestations, blood routine, inflammatory factors, cell immunity, chest CT andtherapeutic effects, the diagnosis and treatment of NCP in kidney transplant recipients (5th edition) were compared to that ofordinary NCP patients. Both recipients developed onset of low andmoderate fever, with no cough or fatigue at the initial stage. Blood routine indicated a normal range of leukocytes,buta significant decrease in lymphocyte counts, increased C-reactive protein (CRP) , and slightly higher procalcitonin (PCT) . The cellular immunity was extremely low, and the chest CT showed multiple patchy ground glass shadows in both lungs. Result: After 1 week of onset, both patients had significant disease progression. The pathogenesis and imaging changes were highly similar tothatreported in ordinary NCP patients.Two patients were givensymptomatic supportive treatment by antiviral agents, stop uses ofimmunosuppression agents, small amount of hormone maintenance, intravenous drip of gamma globulin andrespiratory support toavoid secondary infections. At present, the condition of both patients is obviously improved, and renal function is stable. One of them has recovered and was discharged. Conclusion The clinical manifestations of NCP in renal transplant recipients were generally consistent with that of ordinary NCP patients. Although there is no established method for the treatment of NCP, it is effective by stopping uses of immunosuppressive agents, maintaining small and medium doses of hormones, actively restoring immunity, and providing respiratory support in a timely manner.

Objective:To summarize the diagnosis, treatment and outcome of recurrent focal segmental glomurular sclerosis(FSGS)after kidney transplantation and explore the predictive value of risk grade assessment of peripheral circulating permeability factor for recurrent FSGS.Methods:Retrospective analysis was performed for pathological history, biopsy finding before and after transplantation, blood level of FSGS biomarkers of two patients with recurrent FSGS. Then the relationship was analyzed between the risk grade assessment of peripheral circulating permeability factor and recurrent FSGS.Results:Both patients belonged to primary FSGS with >10g/24h urine protein. The recurrence of FSGS after transplantation was confirmed by renal biopsy. After plasma exchange, rituximab and Tripterygium wilfordii, 24-hour urine protein content declined, general edema subsided significantly and renal function stabilized.Conclusions:After renal transplantation, plasma exchange and rituximab can effectively alleviate the symptoms of recurrent FSGS. And assessing risk level of peripheral circulating permeability factor panel may have value in predicting the recurrent risk of FSGS

Objective:To explore the clinical features, diagnosis and prognosis of renal transplant recipients with COVID-19.Methods:The clinical data were retrospectively analyzed for 2 kidney transplant recipients with COVID-19. Based upon clinical manifestations, blood routine, inflammatory factors, cell immunity, chest computed tomography(CT)and therapeutic efficacies, the diagnosis and treatment of COVID-19 in kidney transplant recipients(Interim Edition V)were compared to that of ordinary COVID-19 patients. Both recipients had an onset of low/moderate fever. There was no initial symptom of cough or fatigue. Blood routine indicated a normal count of leukocytes, a marked lymphocytopenia, elevated C-reactive protein(CRP)and slightly higher procalcitonin(PCT). Cellular immunity was extremely low and chest CT showed multiple patchy ground-glass opacities in both lungs.Results:After 1 week of onset, both patients had a marked disease progression. The pathogenesis and imaging changes were highly similar to those reported for ordinary COVID-19 patients. For preventing secondary infections, both received symptomatic supportive measures of antiviral agents, withdrawing immunosuppressants, tapering of hormone maintenance dose, intravenous drip of gamma globulin and respiratory supports. Currently the conditions of both patients obviously improved and renal function was stable. One case recovered and was discharged.Conclusions:The clinical manifestations of COVID-19 in renal transplant recipients are generally consistent with that of ordinary COVID-19 patients. Although there is no established treatment for COVID-19, withdrawing immunosuppressants, maintaining small and medium doses of hormones, actively restoring immunity and providing respiratory supports in a timely manner are effective.

Objective To compare the neck skin dose between fixed-field dynamic intensity-modulated radiation therapy (dlMRT),volumetric modulated arc therapy (VMAT),and helical tomotherapy (HT) in the treatment of early-stage nasopharyngeal carcinoma.Methods A total of 16 early-stage nasopharyngeal carcinoma patients undergoing radiotherapy were enrolled as subjects.The neck skin was delineated by contraction of the outer edge of neck by 3 mm.Dose planning was made by the traditional method (TP group)and a new method (NP group),in which the neck skin was considered as the organ at risk.Dmean and V5-V70 for the neck skin were recorded.The paired t-test was used to analyze the differences between two plans in each radiotherapy method.An analysis of variance was used to compare the same plan between the three radiotherapy methods.Results The HT group had significantly higher Dmean and V5-V70 for the neck skin than the dIMRT group and the VMAT group (P=0.00,0.00,0.00,0.00,0.00,0.00,0.00,0.02).Using dIMRT,the D and V10-V60 for the neck skin were reduced by 7％,8％,22％,25％,38％,59％,and 85％ in the NP group than in the TP group (P=0.00,0.00,0.00,0.00,0.00,0.00,0.00).Using VMAT,the D and V20-V40 for the neck skin were reduced by 4％,19％,29％,and 34％ in the NP group than in the TP group (P=0.02,0.01,0.02,0.01).Using HT,the V30-V60 for the neck skin were reduced by 20％,29％,50％,and 67％ in the NP group than in the TP group (P=0.00,0.00,0.00,0.00,0.03).Conclusions In the treatment of early-stage nasopharyngeal carcinoma,HT causes a higher radiation dose to the neck skin than dIMRT and VMAT,while dIMRT and VMAT have similar neck skin doses.The neck skin dose can be significantly reduced with the neck skin as the organ at risk.