Objective To investigate the effects of different surgical modalities on primary anorectal malignant melanoma. Methods Clinical data of 60 primary anorectal malignant melanoma cases who were admitted between 1965 and 2007 were collected, summarized and analyzed. Multivariate analysis was performed using the COX proportional hazards regression method. Results Tumors located in the rectum in 50 cases, in the anal canal in 10 cases. The overall survival rates were not significantly different between the 23 cases who received tumor resection only and those 30 cases receiving postoperative adjuvant therapy (X2=0. 078, P>0.05). Among these 53 surgical cases of anorectal malignant melanoma, 37underwent abdominoperineal resection, 16 underwent wide local excisions, There was no significant difference of the survival rates between the two groups (X2=1.464,P>0.05). Risk factors analysis revealed that the depth of tumor invasion is a risk factor (P<0.05), the modality of treatment is a protective factor (P<0.05). Conclusions Surgical operation is the principal effective management for anorectal malignant melanoma, Wide local excision is the principal therapeutic choice for localized well-circumferential anorectal malignant melanomas.

Objective To analyze the clinical features of primary splenic lymphoma. Method Clinicopatholngie features of 29 patients with primary splenic lymphoma treated in Cancer Hospital, Chinese Academy of Medical Sciences from November 2000 to August 2008 were analyzed retrospectively. Results In this study 27 cases were confirmed to be non-Hodgkin's lymphoma (NHL), and 2 cases were of Hodgkin's lymphoma (HL). According to Ahmann's staging, 6 cases belonged to stage Ⅰ, 4 was stage Ⅱ, and 19 was stage Ⅲ. Twenty-six patients received spleneetomy, 2 cases did splenectomy plus pancreatic body and tail resection, and 1 case did spleneetomy plus partial gastrectomy. Postoperatively, 19 cases received chemotherapy, and 5 of the 19 patients received rituximab (Mabthera) treatment. One patient received radiotherapy for regional lymph node invasion. The median time of follow-up was 24 months (range, 2 -93 months). The l-year, 3-year and 5-year overall survival rates were 96%, 83% and 73%, respectively. The 1-year, 3-year and 5-year disease-free survival rates were 96%, 51% and 51%, respectively. Conclusions Primary splenic lymphoma is the most common malignant tumor of the spleen. Splenectomy combined with excision of invaded tissues or organs is important therapy for patients with primary splenic lymphoma. Comprehensive treatments including chemotherapy, radiotherapy and biotherapy are recommended after operation.

Objective To observe the effects of respiratory training on pulmonary function in the patients with chronic obstructive pulmonary disease(COPD). Methods A total of 74 patients with COPD were recruited and randomly divided into a treatment group and a control group with 37 subjects in each.The treatment group re-ceived respiratory training including lip-contracting breathing,abdominal breathing and breathing exercises for 6 months in addition to routine medical treatment.The control group received only routine medical treatment.Pulmona-ry function was evaluated before and after treatment. Results After treatment,both groups improved in terms of all the pulmonary function measures,showing increased vital capacity(VC),forced expiratory volume after 1 s(FEVl),peak forced expiratory flow rate(PEFR),as well as forced expiratory flow at 25%of Vcmax(V25),de-creased residual volume and residual volume as a percentage of total lung capacity(RV/TCL).The difference be-tween the two groups was significant with regard to the extent of improvement. Conclusion Respiratory training can improve the pulmonary function of COPD patients.

Objective To assess the feasibility and indications of local resection as an alternative to pancreaticoduedenectomy for the treatment of early stage ampullary cancer. Methods In this study,36 patients with an AJCC.stage pTl ampullary carcinoma were operated on between 1989 and 2009.Among those local resection was performed in 11 cases and pancreaticoduodenectomy in 25 cases.The main outcome measures were pre-and intra-operative diagnosis and staing,postoperative morbidity and mortality,recurrence.free and overall survival.Results Amp-llary cancerat early stageWas difficult to be diagnosed and staged before and during operation.It was at a much lower risk to perform local resection than pancreaticoduodenectomy.Postoperative complications were significantly lower in local resefion group than in pancreaticoduodenectomy group(P=0.031);whereas the postoperative hospital stay(P=0.254),perioperative mortality(P=1.000).disease-free survival(P=0:301)and long-term survival(P=0.289) were not statistically different between.the two groups. Conclusions Since accurate diagnosis and staginging of early ampullary cancer was diit3cult to establish perioperatively.local resection should be indicated forpoor risk pafients or those who refuse pancreaticoduedenectomy.

Sinomenine is an alkaloid found in the climbing plant Sinomenium acutum.Structurally,it belongs to the iso-quinoline derivatives,which have various bioactivities.Clinically,it is used in the treatment for rheumatism,rheumatoid arthri-tis and arrhythmia,etc.Nevertheless,due to the need of large dose,photo and thermal instability,quick metabolism in vivo and highly allergic for some patients,scientists have committed to modify its structure to develop the highly effective and low toxic derivatives.In this paper,the recent advances in structural modification of sinomenine are reviewed.

Objective:To explore the correlation between the level of heart rate deceleration (DC), serum homocysteine(Hcy), the scope and extent of coronary artery lesion in coronary heart disease patients with hypertension.Methods:From January 2019 to October 2019, 103 coronary heart disease patients with hypertension who were diagnosed and hospitalized in cardiovascular department of Binzhou Central Hospital were selected as coronary heart disease(CHD) group, and 52 patients with simple hypertension were selected as control group.The serum Hcy levels of the two groups were measured and analyzed.The DC value and the difference of the two groups were analyzed.The degree of coronary artery lesion was evaluated by the number of coronary artery lesion and Gensini score.The relationship between DC, Hcy and the degree of coronary artery lesion was analyzed.Results:Compared with the control group, the DC value of CHD group was significantly lower [(6.02±1.97)ms vs.(4.97±1.59)ms, t=-3.989, P<0.05], and the serum Hcy level was increased [(11.46±4.38)μmol/L vs.(16.79±6.31)μmol/L, t=4.260, P<0.05]. In the CHD group, the DC values and Gensini scores of the patients with single vessel lesion, double vessel lesions and three vessel lesions were (5.52±1.34)ms, (5.06±1.29)ms, (4.39±1.19)ms, (21.35±17.10)points, (26.93±18.18)points, (49.39±30.14)points, respectively.The DC value of patients with three vessel lesions was lower than that of patients with single vessel lesion( F=7.349, P<0.05), and the Gensini score was higher( F=13.487, P<0.05). There were no statistically significant differences in DC value and Gensini score between patients with three vessel lesions and those with two vessel lesions and those with single vessel lesion( P>0.05). The serum Hcy levels of patients with single, double and three vessel lesions were (14.67±5.97)μmol/L, (15.85±6.29)μmol/L and (16.97±7.13)μmol/L, respectively.The difference among the three groups was statistically significant ( F=12.427, P<0.05). There was a negative correlation between DC and Gensini score( r=-0.310, P<0.05), and a positive correlation between serum Hcy and Gensini score( r=0.369, P<0.05). Conclusion:The DC value and Hcy level in coronary heart disease patients with hypertension are significantly decreased, which are closely related to the degree of coronary artery lesion.

This paper reviewed the literatures of TCM treating diabetes mellitus and pulmonary tuberculosis from two aspects, Chinese patent medicine and TCM decoctions, which showed that TCM therapy can control blood sugar levels, improve clinical symptoms such as cough, expectoration and wheezing, promote pulmonary tuberculosis lesion absorption, cavity closure and sputum vaginal discharge, and improve patients' quality of life.

Objective:To design and synthesize series of rotundic acid derivatives by introducing aromatic ester groups with rotundic acid as the parent nucleus, test their anti-tumor activity in vitro,investigate the structure-activity relationship of rotundic acid derivatives in inhibiting tumor cell proliferation, and obtain the novel rotundic acid derivatives with high anti-tumor activity. Method:Compounds 1-8 were synthesized with rotundic acid as the initial raw material through the 28-etherification,3β and 23di-aromatic esterification eaction. The anti-tumor activities in vitro were evaluated by MTT assay against A375 (human malignant melanoma cells),HeLa (human cervical cancer cells),SPC-A1 (human lung adenocarcinoma cells),and HepG2 (human liver cancer cells). Result:Compounds 2-8 were new compounds. Their structures were identified by melting point (MP),high resolution electrospray ionization tandem mass spectrometry (HR-ESI-MS),¹H nuclear magnetic resonance (¹H-NMR) and ¹³ C nuclear magnetic resonance (¹³ C-NMR). MTT results showed that compounds 3,5 and 8 exhibited significant anti-tumor activity, especially compound 5 was found to have the best inhibition activity on HeLa,A375, HepG2 and SPC-A1 with IC₅₀ values of (5.25±1.08),(5.99±0.88),(3.31±1.89),(5.74±1.78) μmol·L^-1, 1.92,3.22,3.79, 3.72 times of that of rotundic acid,respectively. Conclusion:Compound 5 has significant anti-tumor activity with great significance for further research and development of new anti-tumor medicines.

OBJECTIVE： To establish the method for the rapidly non-destructive quality control of Liuwei dihuang capsule. METHODS： AOTF-NIR spectrometry was adopted. Taking 80 batches of Liuwei dihuang capsule produced by a manufacturer in recent three years as samples， HPLC chromatogram was adopted to determine the contents of loganin， morroniside， paeonol， paeoniflorin and ursolic acid； the content of water was determined according to general principles stated in 2015 edition of Chinese Pharmacopeia （part Ⅰ）. Taking 70 batches of samples as correction set， the partial least square method and the cross-validation algorithm were used to establish the NIR quantitative model of 6 indexes in Liuwei dihuang capsules with the Unscrambler quantitative analysis software. Taking residual 10 batches of samples as validation set， external validation was conducted for the model. RESULTS： The correlation coefficients （R2） of internal and external validation of loganin， morroniside， paeonol， paeoniflorin， the content of water quantitative model were all greater than 0.9； the correction of standand deviation （RMSEC） were 0.372 8， 0.025 4， 0.263 3， 0.288 5， 0.186 7 and 0.037 7； the prediction of standard deviation （RMSEP） were 0.462 2， 0.077 5， 0.472 1， 0.634 9， 0.293 4 and 0.206 9； the external verification showed that mean deviations of preclicted value to actual value were 6.04％， 6.05％， 5.87％， 6.97％， 5.62％ and 4.83％， with the mean deviation less than 10％.CONCLUSIONS：The established method can achieve rapidly non-destructive analysis Liuwei dihuang capsule.

OBJECTIVE： To synthesize and identify rotundic acid esters derivatives， and to evaluate in vitro antitumor activity. METHODS： Using rotundic acid as raw material， rotundic acid esters derivatives were synthesized by 28-esterification， 3β and 23-position hydroxyl group combined with acid anhydride. The structure of rotundic acid esters derivatives were identified by HRMS， 1H-NMR， 13C-NMR and physicochemical properties. The in vitro antitumor activities were evaluated by MTT assay against paclitaxel （positive control）， rotundic acid and rotundic acid esters derivatives with human cervical cancer cells HeLa， human malignant melanoma cells A375， human lung adenocarcinoma cells SPC-A1 and human liver cancer cells HepG2 （take IC50 as an indicator）. RESULTS： Totally 6 kinds of rotundic acid esters derivatives were synthesized， i.e. rotundic acid methyl ester（compound 1）， 3， 23-O-di（acetyl） rotundic acid methyl ester（compound 2）， 3， 23-O-di（propionyl） rotundic acid methyl ester（compound 3）， 3， 23-O-di（butyryl） rotundic acid methyl ester（compound 4）， 3， 23-O-di（phthaloyl） rotundic acid methyl ester（compound 5） and 3， 23-O-di（succinyl） rotundic acid methyl ester（compound 6）. Compared with paclitaxel， the antitumor activity of compound 5 and compound 6 to Hela， A375， HepG2 and SPC-A1 was similar to it， and there was no significant difference between them （P＞0.05）； the IC50 of rotuntic acid and other compounds decreased with statistical significance （P＜0.05）. CONCLUSIONS： In the study， 6 kinds of rotundic acid esters derivatives are synthesized and compound 5 and compound 6 have significant antitumor activity in vitro， which can provide reference for further study.