Diabetic kidney disease（DKD） is a chronic kidney structural and functional disorder caused by diabetes. With the global prevalence of diabetes continuing to rise， DKD has gradually become a major cause of chronic kidney disease and end-stage renal disease（ESRD）， posing a serious threat to patients' quality of life and long-term health outcomes. Studies have shown that apoptosis plays a pivotal role in the development and progression of DKD， with its mechanisms involving abnormal activation of multiple signaling pathways such as Toll-like receptor 4（TLR4）/nuclear transcription factor-κB（NF-κB）/B-cell lymphoma-2（Bcl-2）/cysteinyl aspartate-specific proteinase（Caspase）-3， protein kinase R-like endoplasmic reticulum kinase（PERK）/eukaryotic initiation factor 2α（eIF2α）/activating transcript factor 4（ATF4）/CCAAT enhancer-binding protein homologous protein（CHOP）， phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β）， Janus kinase 2（JAK2）/signal transducer and activator of transcription 3（STAT3）， adenosine monophosphate-activated protein kinase（AMPK）/mammalian target of rapamycin（mTOR） and silent information regulator 1（SIRT1）/tumor suppressor protein 53（p53）， thereby accelerating renal pathological damage in DKD. Extensive evidence-based medical studies have confirmed that traditional Chinese medicine（TCM）， leveraging its unique therapeutic advantages of multi-target， multi-component and multi-pathway approaches， has demonstrated remarkable efficacy and favorable safety profiles in treating DKD. Recent studies have demonstrated that active components of TCM can specifically target and modulate key effectors in apoptotic signaling pathways. Meanwhile， traditional compound formulations exert synergistic effects through multiple approaches such as replenishing deficiency and activating blood circulation， detoxifying and dredging collaterals， tonifying kidney essence， and removing stasis and purging turbidity， thereby comprehensively regulating critical pathological processes including endoplasmic reticulum stress and mitochondrial apoptosis pathways. This combined therapeutic approach of molecular targeting and holistic regulation provides novel strategies for delaying the progression of DKD. Based on this， this paper provides an in-depth analysis of key apoptotic signaling pathways and their regulatory mechanisms， while systematically summarizing recent research advances regarding the therapeutic effects of TCM active components， compound formulations， and proprietary Chinese medicines on DKD through modulation of these pathways， with particular emphasis on their underlying molecular mechanisms. These findings not only elucidate the modern scientific connotation and theoretical basis of TCM in treating DKD but also establish a solid theoretical and practical foundation for promoting the wider clinical application and further research of TCM in the field of DKD treatment.

Objective:To compare the immobilization effect of two different immobilization methods in treatment with CyberKnife for intracranial tumors.Methods:A retrospective analysis was conducted on 48 patients with intracranial tumors who received treatment with CyberKnife in the Department of Radiotherapy at Peking Union Medical College Hospital from June 2023 to July 2024.Based on the different immobilization method,patients were divided into two groups:the Double Shell Positioning System(DSPS)group(n=22)and the Qfix group(n=26).The DSPS group was immobilized using an American full-body integrated positioning frame combined with a carbon fiber bracket and DSPS film,while the Qfix group was immobilized using an Encompass board and Qfix film.All patients were treated with 6 dimensions(6D)-skull tracking technique.During treatment,images were acquired as one times per 60 seconds,which were registered with digitally reconstructed radiograph(DRR)to record and compare the overall relative errors.The data of relative displacement error during treatment was calculated as|dx|=d1-d0,and differences between the two groups were compared.The maximum displacement(|d|=dmax-dmin)was also calculated,and difference in maximum displacement between the two kinds of immobilization methods was analyzed.Results:In the comparison of the overall relative errors between the two kinds of immobilization methods,the median values in the errors of superior-inferior(SI),anterior-posterior(AP),Roll,Pitch,and Yaw directions in the Qfix group were respectively 0.174,0.309,0.150,0.147,and 0.477,which were significantly less than those(0.224,0.316,0.175,0.221,and 0.584)of DSPS group,and the differences were statistically significant(Z=-4.358,-1.698,-2.595,-6.833,-5.371,P<0.05).The difference of the relative displacement errors between two kinds of immobilization methods was not significant(P>0.05),while the median values in all directions were not zero.The comparison of the maximum displacement value between the two kinds of immobilization methods indicated the displacement amounts of Qfix group was less than those of DSPS group on SI,left-right(LR),AP,roll,pitch,and yaw directions,and the differences of them were significant(Z=-3.373,-2.525,-2.488,-3.169,-5.130,-5.166,P<0.05).Conclusion:Both immobilization methods can meet the requirements of clinical treatment.The results of comparison indicate the immobilization effect of Qfix group is best,and the combination of Encompass board and Qfix film is recommended as the immobilization method of CyberKnife-based radiotherapy for intracranial tumors.

Objective:An integrated automatic quality control system(automatic quality control instrument)for high dose rate(HDR)afterloader was independently developed.This system was used to measure the placement accuracy,residence time and activity of the radioactive source,so as to assess the accuracy and stability of this system in quality assurance.Methods:The automatic quality control system was connected to the Flexitron type of HDR afterloader through a connecting tube.Quality assurance(QA)plans with different resident positions,clearances,and times were designed for measurement and verification.The measurement length was 1079-1119 mm,and the measurement time was 2-10 s,and the measurement activity was 14,326-28,653 μGy·m2·h-1.The measurements were repeated once per one week in three months,so as to determine the consistency of the measurement parameters in a longer period of time.The measurement results of the placement accuracy,resident time and activity of radioactive source of the HDR 192Ir radioactive source were analyzed.Results:The plate ionization chamber was used to measure the activity of radioactive source.In three months,the measurement deviation of the activity of radioactive source was 1.17%,and the fitted activity decay curve was consistent with the expected decay curve of radioactive source.The measurement accuracies of the positioning of radioactive source were respectively 0.46,0.18,0.23,0.25,and 0.15 mm when the interval step sizes of resident times were respectively 2,3,5,8,and 10 mm,all of them were<1 mm.The measurement accuracy of time was(4.90±0.04)s when the resident time was 5 s.In the measurement accuracy of different resident times(1,2,3,5 and 10s)of same step size,the deviation of them was less than 0.5s.When the resident time was the shortest,the deviation between the read-out value of the automatic system software of quality control and the actually resident time was(0.09±0.04)s.The measurement accuracy gradually stabilized with the increasing of resident times.Conclusion:The automatic quality control instrument can complete the measurements for the positioning accuracy,the accuracy of resident time and the activity of radioactive source,and achieve rapidly and accurately periodic quality assurance.

Objective:To establish daily quality assurance workflow based on self-developed phantom to ensure MR-linac performance such as beam accuracy, MR image guidance accuracy, and the clinical treatment workflow to enhance the efficiency of daily quality assurance (QA).Methods:The self-developed phantom was made by 3D printer and used in conjunction with Daily QA-MR detector array. After CT-sim scanning, a treatment plan was designed and transmitted to the accelerator, tests were performed such as image guidance accuracy, beam output and beam quality, the differences in daily QA results between the self-developed phantom and standard phantom recommended by the manufacturer were analyzed by using paired t-test. Results:A total of 24 sets results were collected, the image guide accuracy in the X, Y and Z directions between standard and self-made phantom were (0.1±0.4), (-0.14±0.16), (0.07±0.05) mm and (0±0.02), (-0.02±0.02), (0.02±0.01) mm, respectively, and the differences were statistically significant ( P<0.001, =0.001 and <0.001). Daily QA-MR detector array beam measurement results including output, symmetry, beam quality and field size were -0.11%±0.20%, -0.10%±0.19%, -0.01%±0.08%, (0.4±0.1) mm and (0.2±0.1) mm, respectively. The new process saved 25% (approximately 9 min) of the time compared to the standard process. Conclusions:The new daily QA process for MR-linac is performed based on self-developed phantom and Daily QA-MR detector array. The accuracy and sensitivity meet the requirements and can improve the QA efficiency.

Type Ⅳ cardiorenal syndrome(CRS)is a subtype of CRS characterized by cardiac structural damage and/or functional decline secondary to chronic kidney disease.Clinically,it often manifests as fatigue,shortness of breath,edema,oliguria,and difficulty lying flat at night,which align with the TCM pattern of"deficiency of primordial qi and excess of yin-pathogenic fire".Li Dongyuan proposed the theory that"yin-pathogenic fire and primordial qi are opposites",emphasizing the dynamic relationship of"mutual growth and decline"between primordial qi and yin fire.From this perspective,the development and progression of Type Ⅳ CRS are believed to correspond to the fluctuations in the balance of primordial qi and yin-pathogenic fire.Based on this theory,the core pathogenesis of Type Ⅳ CRS is summarized as"imbalance between qi and fire",where"deficiency of primordial qi"is the root cause,often attributed to damage to the heart,spleen,and kidney,while"exuberance of yin-pathogenic fire"represents the pathological manifestation.In clinical practice,the treatment should focus on reinforcing primordial qi and subduing yin-pathogenic fire,with tailored approaches according to the stages of disease progression.In the early stage,when primordial qi lacks a foundation for generation and yin-pathogenic fire begins to emerge,the treatment should aim to consolidate the root of primordial qi and suppress the budding of yin-pathogenic fire.In the middle stage,when primordial qi is insufficiently produced and yin-pathogenic fire becomes predominant,the treatment should focus on nourishing the source of primordial qi and curbing the exuberance of yin-pathogenic fire.In the late stage,when primordial qi becomes dispersed and yin-pathogenic fire is unconstrained,the treatment should prioritize consolidating the foundation of primordial qi and restraining the chaotic movement of yin-pathogenic fire.

Type Ⅳ cardiorenal syndrome(CRS)is a subtype of CRS characterized by cardiac structural damage and/or functional decline secondary to chronic kidney disease.Clinically,it often manifests as fatigue,shortness of breath,edema,oliguria,and difficulty lying flat at night,which align with the TCM pattern of"deficiency of primordial qi and excess of yin-pathogenic fire".Li Dongyuan proposed the theory that"yin-pathogenic fire and primordial qi are opposites",emphasizing the dynamic relationship of"mutual growth and decline"between primordial qi and yin fire.From this perspective,the development and progression of Type Ⅳ CRS are believed to correspond to the fluctuations in the balance of primordial qi and yin-pathogenic fire.Based on this theory,the core pathogenesis of Type Ⅳ CRS is summarized as"imbalance between qi and fire",where"deficiency of primordial qi"is the root cause,often attributed to damage to the heart,spleen,and kidney,while"exuberance of yin-pathogenic fire"represents the pathological manifestation.In clinical practice,the treatment should focus on reinforcing primordial qi and subduing yin-pathogenic fire,with tailored approaches according to the stages of disease progression.In the early stage,when primordial qi lacks a foundation for generation and yin-pathogenic fire begins to emerge,the treatment should aim to consolidate the root of primordial qi and suppress the budding of yin-pathogenic fire.In the middle stage,when primordial qi is insufficiently produced and yin-pathogenic fire becomes predominant,the treatment should focus on nourishing the source of primordial qi and curbing the exuberance of yin-pathogenic fire.In the late stage,when primordial qi becomes dispersed and yin-pathogenic fire is unconstrained,the treatment should prioritize consolidating the foundation of primordial qi and restraining the chaotic movement of yin-pathogenic fire.

Objective:An integrated automatic quality control system(automatic quality control instrument)for high dose rate(HDR)afterloader was independently developed.This system was used to measure the placement accuracy,residence time and activity of the radioactive source,so as to assess the accuracy and stability of this system in quality assurance.Methods:The automatic quality control system was connected to the Flexitron type of HDR afterloader through a connecting tube.Quality assurance(QA)plans with different resident positions,clearances,and times were designed for measurement and verification.The measurement length was 1079-1119 mm,and the measurement time was 2-10 s,and the measurement activity was 14,326-28,653 μGy·m2·h-1.The measurements were repeated once per one week in three months,so as to determine the consistency of the measurement parameters in a longer period of time.The measurement results of the placement accuracy,resident time and activity of radioactive source of the HDR 192Ir radioactive source were analyzed.Results:The plate ionization chamber was used to measure the activity of radioactive source.In three months,the measurement deviation of the activity of radioactive source was 1.17%,and the fitted activity decay curve was consistent with the expected decay curve of radioactive source.The measurement accuracies of the positioning of radioactive source were respectively 0.46,0.18,0.23,0.25,and 0.15 mm when the interval step sizes of resident times were respectively 2,3,5,8,and 10 mm,all of them were<1 mm.The measurement accuracy of time was(4.90±0.04)s when the resident time was 5 s.In the measurement accuracy of different resident times(1,2,3,5 and 10s)of same step size,the deviation of them was less than 0.5s.When the resident time was the shortest,the deviation between the read-out value of the automatic system software of quality control and the actually resident time was(0.09±0.04)s.The measurement accuracy gradually stabilized with the increasing of resident times.Conclusion:The automatic quality control instrument can complete the measurements for the positioning accuracy,the accuracy of resident time and the activity of radioactive source,and achieve rapidly and accurately periodic quality assurance.

Objective:To establish daily quality assurance workflow based on self-developed phantom to ensure MR-linac performance such as beam accuracy, MR image guidance accuracy, and the clinical treatment workflow to enhance the efficiency of daily quality assurance (QA).Methods:The self-developed phantom was made by 3D printer and used in conjunction with Daily QA-MR detector array. After CT-sim scanning, a treatment plan was designed and transmitted to the accelerator, tests were performed such as image guidance accuracy, beam output and beam quality, the differences in daily QA results between the self-developed phantom and standard phantom recommended by the manufacturer were analyzed by using paired t-test. Results:A total of 24 sets results were collected, the image guide accuracy in the X, Y and Z directions between standard and self-made phantom were (0.1±0.4), (-0.14±0.16), (0.07±0.05) mm and (0±0.02), (-0.02±0.02), (0.02±0.01) mm, respectively, and the differences were statistically significant ( P<0.001, =0.001 and <0.001). Daily QA-MR detector array beam measurement results including output, symmetry, beam quality and field size were -0.11%±0.20%, -0.10%±0.19%, -0.01%±0.08%, (0.4±0.1) mm and (0.2±0.1) mm, respectively. The new process saved 25% (approximately 9 min) of the time compared to the standard process. Conclusions:The new daily QA process for MR-linac is performed based on self-developed phantom and Daily QA-MR detector array. The accuracy and sensitivity meet the requirements and can improve the QA efficiency.

Objective:To compare the immobilization effect of two different immobilization methods in treatment with CyberKnife for intracranial tumors.Methods:A retrospective analysis was conducted on 48 patients with intracranial tumors who received treatment with CyberKnife in the Department of Radiotherapy at Peking Union Medical College Hospital from June 2023 to July 2024.Based on the different immobilization method,patients were divided into two groups:the Double Shell Positioning System(DSPS)group(n=22)and the Qfix group(n=26).The DSPS group was immobilized using an American full-body integrated positioning frame combined with a carbon fiber bracket and DSPS film,while the Qfix group was immobilized using an Encompass board and Qfix film.All patients were treated with 6 dimensions(6D)-skull tracking technique.During treatment,images were acquired as one times per 60 seconds,which were registered with digitally reconstructed radiograph(DRR)to record and compare the overall relative errors.The data of relative displacement error during treatment was calculated as|dx|=d1-d0,and differences between the two groups were compared.The maximum displacement(|d|=dmax-dmin)was also calculated,and difference in maximum displacement between the two kinds of immobilization methods was analyzed.Results:In the comparison of the overall relative errors between the two kinds of immobilization methods,the median values in the errors of superior-inferior(SI),anterior-posterior(AP),Roll,Pitch,and Yaw directions in the Qfix group were respectively 0.174,0.309,0.150,0.147,and 0.477,which were significantly less than those(0.224,0.316,0.175,0.221,and 0.584)of DSPS group,and the differences were statistically significant(Z=-4.358,-1.698,-2.595,-6.833,-5.371,P<0.05).The difference of the relative displacement errors between two kinds of immobilization methods was not significant(P>0.05),while the median values in all directions were not zero.The comparison of the maximum displacement value between the two kinds of immobilization methods indicated the displacement amounts of Qfix group was less than those of DSPS group on SI,left-right(LR),AP,roll,pitch,and yaw directions,and the differences of them were significant(Z=-3.373,-2.525,-2.488,-3.169,-5.130,-5.166,P<0.05).Conclusion:Both immobilization methods can meet the requirements of clinical treatment.The results of comparison indicate the immobilization effect of Qfix group is best,and the combination of Encompass board and Qfix film is recommended as the immobilization method of CyberKnife-based radiotherapy for intracranial tumors.

OBJECTIVE To study the effects of Phellodendron amurense polysaccharides （PAP） on improving gouty nephropathy （GN） in rats， and to investigate its mechanism primarily by interfering the p38 mitogen-activated protein kinase （p38 MAPK）/nuclear factor-κB（NF-κB）/tumor necrosis factor-α（TNF-α）. METHODS Sixty rats were randomly divided into normal group （water）， model group （water）， allopurinol group （positive control， 20 mg/kg）， PAP high-dose， medium-dose and low-dose groups （100， 50， 25 mg/kg， by raw material） after being stratified by body weight， with 10 rats in each group. Except for the normal group， the other groups were induced to construct GN model by giving 1 500 mg/kg potassium oxazinate and 100 mg/kg adenine intragastrically for 14 days. After modeling， the rats in each group were given relevant medicine/water intragastrically， once a day， for consecutive 28 days. After the last medication， the levels of biochemical parameters related to renal function [uric acid， creatinine （Cr）， blood urea nitrogen （BUN）， xanthine oxidase （XOD）] were detected in rats， and the histopathological changes in the rat kidney were observed. The protein expressions of monocyte chemoattractant protein-1（MCP-1），TNF-α and interleukin-6（IL-6） as well as the phosphorylation levels of p38 MAPK and NF-κB p65 protein were determined in renal tissue of rats. RESULTS Compared with the normal group， the model group suffered from the dilatation of renal tubules， structural damage to glomeruli， accompanied by inflammatory infiltration and fibrosis； the contents of uric acid， Cr， BUN and XOD， the protein expressions of MCP-1，TNF-α and IL-6 and the phosphorylation levels of p38 MAPK and NF-κB p65 protein were all increased significantly （P＜0.05 or P＜0.01）. Compared with the model group， the pathological symptoms of renal tissue in rats had been improved to varying degrees in different dose groups of PAP； the contents of uric acid， Cr， BUN and XOD， protein expressions of MCP-1， TNF-α and IL-6， the phosphorylation levels of p38 MAPK and NF-κB p65 protein in PAP high-dose and PAP medium-dose groups were all decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS PAP exhibits an anti-GN effect， the mechanism of which may be associated with inhibiting the p38 MAPK/NF-κB/TNF-α signaling pathway.