Ulcerative colitis （UC）， a chronic relapsing inflammatory bowel disease， involves multifaceted pathological mechanisms such as intestinal barrier dysfunction， immune dysregulation， and oxidative stress. Current therapeutic strategies remain limited in efficacy and safety. In recent years， the adenosine monophosphate-activated protein kinase （AMPK） signaling pathway has emerged as a pivotal therapeutic target for UC due to its central role in energy metabolism， inflammatory regulation， and intestinal homeostasis. This article systematically reviewed the mechanisms by which traditional Chinese medicine （TCM） prevented and treated UC through the regulation of the AMPK signaling pathway， with a focus on elucidating AMPK's multidimensional regulatory network in inflammatory signaling crosstalk， alleviating oxidative stress， restoring intestinal immune balance， repairing the intestinal barrier， and modulating gut microbiota. Leveraging its unique advantages of multi-target engagement and low toxicity， TCM demonstrates promising potential in UC treatment and has become a focal area of research. By systematically summarizing and synthesizing the existing literature on TCM-mediated AMPK pathway modulation in UC， this review aims to provide a theoretical foundation for advancing mechanistic research and clinical interventions in UC.

Ulcerative colitis （UC）， a chronic， non-specific inflammatory bowel disease with typical symptoms such as abdominal pain， diarrhea， and bloody stools， demonstrates a high relapse rate and difficulty in curing. Sishenwan， first recorded in Internal Medicine Abstract （Nei Ke Zhai Yao）， are a classic prescription for treating diarrhea caused by deficiency of the spleen and kidney Yang. The core therapeutic principle of Sishenwan is warming and tonifying the spleen and kidney， and astringing the intestine and stopping diarrhea. In recent years， Sishenwan have demonstrated distinct advantages in the clinical treatment of UC. The pathogenesis of UC involves multiple factors， including immune dysregulation and gut microbiota imbalance. Although Western medicine is effective in the short term， its side effects， high relapse rate， and resistance associated with long-term use pose substantial challenges. Sishenwan have shown excellent clinical outcomes in the treatment of UC due to deficiency of the spleen and kidney Yang. Modern clinical studies indicate that Sishenwan， used alone or in combination with Western medicine or other Chinese medicine compound prescriptions， significantly improve the clinical efficacy in treating UC due to deficiency of the spleen and kidney Yang. Sishenwan effectively alleviate core symptoms such as mucus， pus， and blood in stools， and persistent abdominal pain， reduce Mayo scores and the relapse rate， and improve patients' quality of life. Research on the material basis reveals that Sishenwan contain multiple active ingredients such as psoralen， isopsoralen， and evodiamine. Mechanism studies indicate that Sishenwan inhibit the inflammatory cascade reactions by regulating the signal network through multiple targets. Sishenwan regulate cellular immunity and restore intestinal immune homeostasis. At the microecological level， Sishenwan promote the intestinal barrier repair through the "microbiota-metabolism-immunity" axis. The current research still needs to be deepened in aspects such as the mining of specific biomarkers for syndromes and the exploration of the collaborative mechanism of traditional Chinese and Western medicine. In the future， a full-chain system covering syndrome differentiation， targeting， and monitoring needs to be constructed for promoting the paradigm transformation of Sishenwan into precision drugs. This review systematically explains the treatment mechanism of Sishenwan regarding the combination of disease and syndrome and its multi-target regulatory characteristics， providing a theoretical basis and transformation direction for the treatment of UC with integrated traditional Chinese and Western medicine.

Ulcerative colitis （UC）， a chronic， non-specific inflammatory bowel disease with typical symptoms such as abdominal pain， diarrhea， and bloody stools， demonstrates a high relapse rate and difficulty in curing. Sishenwan， first recorded in Internal Medicine Abstract （Nei Ke Zhai Yao）， are a classic prescription for treating diarrhea caused by deficiency of the spleen and kidney Yang. The core therapeutic principle of Sishenwan is warming and tonifying the spleen and kidney， and astringing the intestine and stopping diarrhea. In recent years， Sishenwan have demonstrated distinct advantages in the clinical treatment of UC. The pathogenesis of UC involves multiple factors， including immune dysregulation and gut microbiota imbalance. Although Western medicine is effective in the short term， its side effects， high relapse rate， and resistance associated with long-term use pose substantial challenges. Sishenwan have shown excellent clinical outcomes in the treatment of UC due to deficiency of the spleen and kidney Yang. Modern clinical studies indicate that Sishenwan， used alone or in combination with Western medicine or other Chinese medicine compound prescriptions， significantly improve the clinical efficacy in treating UC due to deficiency of the spleen and kidney Yang. Sishenwan effectively alleviate core symptoms such as mucus， pus， and blood in stools， and persistent abdominal pain， reduce Mayo scores and the relapse rate， and improve patients' quality of life. Research on the material basis reveals that Sishenwan contain multiple active ingredients such as psoralen， isopsoralen， and evodiamine. Mechanism studies indicate that Sishenwan inhibit the inflammatory cascade reactions by regulating the signal network through multiple targets. Sishenwan regulate cellular immunity and restore intestinal immune homeostasis. At the microecological level， Sishenwan promote the intestinal barrier repair through the "microbiota-metabolism-immunity" axis. The current research still needs to be deepened in aspects such as the mining of specific biomarkers for syndromes and the exploration of the collaborative mechanism of traditional Chinese and Western medicine. In the future， a full-chain system covering syndrome differentiation， targeting， and monitoring needs to be constructed for promoting the paradigm transformation of Sishenwan into precision drugs. This review systematically explains the treatment mechanism of Sishenwan regarding the combination of disease and syndrome and its multi-target regulatory characteristics， providing a theoretical basis and transformation direction for the treatment of UC with integrated traditional Chinese and Western medicine.

Objective To observe the therapeutic effect of Suoquan Runchang Prescription for senile mice with constipation and its mechanism of action.Methods Senile Kunming mice were randomly divided into constipation group,Suoquan Runchang Prescription group,ISCK03[stem cell factor(SCF),receptor tyrosine kinase(c-Kit)signaling pathway inhibitor]group,Suoquan Runchang Prescription+ISCK03 group,and normal group,with 12 mice in each group.Except for the normal group,a constipation model was constructed by gavage of 150 mg/kg Compound Diphenoxylate Suspension in all groups of senile Kunming mice.After successful modeling,each group was treated for two weeks.At the end of the intervention,the fecal particles count and fecal water content were detected,the serum levels of interleukin(IL)-1β,IL-6,motilin,gastrin,5-hydroxytryptamine(5-HT),and vasoactive intestinal peptide(VIP)were detected by enzyme-linked immunosorbent assay(ELISA),and the changes in gastric emptying rate and small intestine propulsion rate were determined,the pathologic changes of colonic tissues were detected by hematoxylin-eosin(HE)staining,and protein expressions of SCF and c-Kit in the colonic tissues was detected by Western Blot.Results Compared with the normal group,the disrupted cellular structure,thinner muscle layer,damaged mucosal epithelium were seen in the constipation group,and the fecal particle count,fecal water content,serum motilin,gastrin and 5-HT levels,gastric emptying rate,small intestine propulsion rate,the protein expression levels of SCF and c-Kit in colonic tissues were decreased,and the serum IL-1 β,IL-6 and VIP levels were increased,the differences being statistically significant(P＜0.05).Compared with the constipation group,the colonic tissues damage were improved in Suoquan Runchang Prescription group,the fecal particle count,fecal water content,serum motilin,gastrin and 5-HT levels,gastric emptying rate,small intestine propulsion rate,protein expression levels of SCF and c-Kit in colonic tissues were elevated,the serum IL-1β,IL-6 and VIP levels were decreased,the difference being statistically significant(P＜0.05).The indexes mentioned above in mice of ISCK03 group versus to the results of Suoquan Runchang Prescription group(P＜0.05).Compared with Suoquan Runchang Prescription group,the colonic tissues damage showed aggravated in Suoquan Runchang Prescription+ISCK03 group,and the fecal particle count,fecal water content,serum motilin,gastrin and 5-HT levels,gastric emptying rate,small intestine propulsion rate,protein expression levels of SCF and c-Kit in colonic tissues were decreased,the serum IL-1β,IL-6 and VIP levels were increased,the difference being statistically significant(P＜0.05).Conclusion Suoquan Runchang Prescription can effectively improve constipation in senile mice,and its therapeutic effect maybe related to the up-regulation of SCF,c-Kit expression,thus promoting intestinal peristalsis.

Objective:To analyze human factors in radiotherapy safety incidents and identify their correction for the purpose of mining the latent incident chains.Methods:A total of 60 radiotherapy safety incidents were included in the Radiation Oncology Incident Learning System (ROILS) for cause identification and frequency statistics using the Human Factors Analysis and Classification System (HFACS). Latent class analysis (LCA) was performed for the result to correlate the incident causes.Results:Incidents in the protocol design stage were the most common, accounting for 35%. Adverse organizational climate, inadequate supervision, and personnel factors were the primary causes of incidents at each level of the HFACS, accounting for 4.66%, 15.68%, and 16.20%, respectively. Three latent incident chains were identified through LCA, comprising two originating from organizational climate issues and one from organizational process issues, which were passed down via various human factors or " loopholes"Conclusions:HFACS assists in tracing the human factors at all levels that lead to radiotherapy safety incidents. The high-frequency causes and three latent chains of radiotherapy incidents found in this study can provide a guide for the development of targeted safety and defense measures.

Objective:To investigate the dosimetric effects of complex cardiac-respiratory motion in cardiac stereotactic body radiotherapy (CSBRT).Methods:A cardiac motion phantom was employed to simulate patient-specific cardiac-respiratory motion in 10 cases. The measured doses obtained under the phantom motion state were compared with the calculated doses in radiotherapy treatment planning for clinical patients. Moreover, 18 groups of design-based cardiac-respiratory motion were simulated. The radiation doses under the phantom motion state were measured using radiochromic films and compared with those under the resting state.Results:In the patient-specific cardiac-respiratory motion group, the gamma passing rate (GPR) under the 3%/2 mm standard between the measured and the calculated doses was 90.0% ± 7.0%. The correlation coefficient of the respiratory motion amplitude in the superior-inferior (SI) dimension with the GPR was -0.86 ( P=0.01). In the design-based cardiac-respiratory motion groups, the increase in the amplitude of cardiac-respiratory motion reduced the consistency between the dynamic dose and the static reference dose. Especially, the increase in the respiratory motion amplitude produced the most pronounced effect, reducing the width of the 90% isodose line in the respiratory motion direction, with a mean slope of -1.6. Additionally, the increase in the penumbra corresponds to a mean slope of 1.4. Conclusions:The respiratory motion amplitude serves as a primary factor influencing the dose accuracy of CBSRT. The characteristics and dosimetric effects of cardiac-respiratory motion are patient-specific, thus necessitating the assessment of cardiac-respiratory motion characteristics before CBSRT to individualize the application of motion management techniques for enhanced treatment accuracy.

Objective:To investigate the dosimetric feasibility of cardiac stereotactic body radiotherapy (CSBRT) using volumetric-modulated arc radiotherapy (VMAT)-like technique on the Unity MR-linac.Methods:A retrospective analysis was conducted on 12 refractory arrhythmia patients who underwent CSBRT at West China Hospital, Sichuan University, from April 2021 to December 2022. Four different treatment plans were designed for each patient based on the average phase of 4DCT: VMAT plan based on a linear accelerator, VMAT-like plan with magnetic field based on Unity, VMAT-like plan without magnetic field based on a Unity, and static intensity-modulated radiation therapy (IMRT) plan with 7 beams based on Unity. The VMAT-like plans used static IMRT beams evenly distributed at 30 angles. Evaluation metrics included conformity index (CI), homogeneity index (HI), gradient index (GI), dosimetric parameters of organs at risk (OAR), optimization time, and monitor unit (MU). These metrics among groups were analyzed using the Wilcoxon paired signed-rank test.Results:The CI of the VMAT plan was better than that of the VMAT-like plan with magnetic field (0.84 vs. 0.81, P=0.005). The GI of the VMAT-like plan without magnetic field was significantly lower than that of VMAT-like plan with magnetic field ( P=0.015). The CI and HI of the IMRT plan were both inferior to VMAT-like plan with magnetic field ( P=0.034). The average dose to the heart and lungs in VMAT-like plan with magnetic field was higher than those in the VMAT plan and VMAT-like plan without magnetic field (both P<0.05). The magnetic field significantly increased the dose to the skin, tissue-lung interface, and outside the margins (all P<0.05). The optimization time of the VMAT-like plan with magnetic field was longer than that of the IMRT plan, but it required fewer MUs ( P=0.001). The quality of the IMRT plans was poor and did not meet clinical requirements. Conclusion:The quality of CSBRT plans based on VMAT-like techniques meets clinical requirements, but attention must be paid to the dosimetric effects of the magnetic field.

Objective:To investigate the clinical effects and related mechanism of antibiotic bone cement in treating diabetic foot ulcer (DFU).Methods:A prospective randomized controlled study was conducted. From August 2020 to August 2022, 24 patients with DFU who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. According to the block randomization, the patients were divided into 2 groups, with 12 patients in each group. In antibiotic bone cement group, there were 7 male and 5 female patients, aged (64±8) years, with the ulcer area of (41±21) cm 2. In silver sulfadiazine group, there were 8 male and 4 female patients, aged (62±8) years, with the ulcer area of (38±19) cm 2. Under the condition of ensuring the patency of at least one main inferior genicular artery in each patient, the continuous vacuum sealing drainage was performed for 3-5 days after thorough debridement. Thereafter, the wounds in antibiotic bone cement group were treated with gentamicin-laden bone cement, and the wounds in silver sulfadiazine group were treated with silver sulfadiazine cream for dressing change. After 3 weeks of dressing change, the wound was covered with split-thickness skin graft from the lateral thigh on the affected side. Before debridement and after 3 weeks of dressing change, the blood flow intensities of wound tissue and normal skin tissue in foot were measured using laser Doppler flowmeter, and then, the percentage of relative blood flow intensity of wound and the change rate of blood flow intensity were calculated. After 3 weeks of dressing change, the wound margin tissue was taken, the number of CD31-positive neovascular and the vascular morphology were observed and detected by immunohistochemical staining, the morphology of blood vessels surrounded by CD31 and α-smooth muscle actin (α-SMA) double-positive cells was observed by immunofluorescence staining, the cell proliferation activity was evaluated by immunofluorescence staining (denoted as the ratio of Ki67 positive cells), and the protein expression of vascular endothelial growth factor receptor 2 (VEGFR2) was detected by Western blotting. The skin graft survival was observed 3-5 days after skin grafting, and the wound healing time was recorded. Data were statistically analyzed with independent sample t test and Fisher's exact probability test. Results:The percentages of relative blood flow intensity of wounds of patients before debridement were similar between the two groups ( P>0.05). After 3 weeks of dressing change, the percentage of relative blood flow intensity of wounds and the change rate of blood flow intensity of patients in antibiotic bone cement group were (44.7±2.0)% and (129±12)%, respectively, which were significantly higher than (28.3±1.2)% and (41±8)% in silver sulfadiazine group (with t values of 24.15 and 20.97, respectively, P<0.05). After 3 weeks of dressing change, compared with those in silver sulfadiazine group, the number of CD31-positive neovascular in the wound margin tissue of patients in antibiotic bone cement group was significantly increased ( t=33.81, P<0.05) with larger diameter and more regular arrangement, the vascular wall continuity surrounded by CD31 and α-SMA double-positive cells was better, and the ratio of Ki67 positive cells and protein expression of VEGFR2 were significantly increased (with t values of 40.97 and 47.38, respectively, P<0.05). On post skin grafting day 3-5, all the patients in antibiotic bone cement group and 8 patients in silver sulfadiazine group had good skin graft survival, while 4 patients in silver sulfadiazine group showed spotted/patchy skin graft necrosis, which were cured after corresponding treatment. The wound healing time of patients in antibiotic bone cement group was (47.1±2.9) d, which was significantly shorter than (58.8±2.3) d in silver sulfadiazine group ( t=10.86, P<0.05). Conclusions:Compared with silver sulfadiazine, clinical application of antibiotic bone cement for treating DFU has the characteristics of accelerating wound healing and better reconstruction of local blood flow, which may be closely related to the fact that antibiotic bone cement promoted the local angiogenesis effectively in the wound through enhancing the expression of VEGFR2.

Clinically, beam matching can greatly improve the flexibility and efficiency of treating patients between different medical electron linacs. However, in addition to the regular quality assurance (QA) test of the machine performance of linacs, there is still a lack of comprehensive evaluation of the clinical radiotherapy performance of beam-matched linacs. In this paper, the performance of volumetric modulated arc therapy (VMAT) between three closely matched linacs was evaluated by statistical process control (SPC) technology. It was found that the average and median γ passing rates of the VMAT QA processes of the three linacs had little difference, but the process capability levels were at three different levels. The results show that SPC technology can effectively evaluate the performance of beam matching for medical electron linacs, improve the patient-specific VMAT QA processes, and guide clinical decision-making.
Electrons ; Particle Accelerators ; Quality Assurance, Health Care ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Accurate CT simulation is the key link of precision radiotherapy, and the performance of the localization couch of CT simulator directly affects the accuracy of radiotherapy. With the rapid development of precision radiotherapy, conventional large aperture radiotherapy special CT simulator is difficult to meet the needs of precision radiotherapy localization, so most radiotherapy centers choose high-end diagnostic CT machines equipped with a flat tabletop for radiotherapy localization. In clinical work, the performance testing of the CT simulator localization couch is easy to be ignored. In addition, there are some problems such as insufficient precision in transforming the cradle-shaped couch top of diagnostic CT into a special flat couch top for radiotherapy. This paper provided an in-depth description of the improved design and performance test of the localization couch of the first special GE Revolution CT simulator for radiotherapy introduced by West China Hospital of Sichuan University. After the improvement, all the acceptance tests of the localization couch are in line with the standard, and the performance meets the high-precision radiotherapy localization needs of patients with different body weight in the center.
China ; Computer Simulation ; Humans ; Phantoms, Imaging ; Radiotherapy Planning, Computer-Assisted ; Tomography, X-Ray Computed