Objective To observe the efficacy and adverse reaction of NP and GX regimens in the treatment of the anthracycline-and-taxane-resistant advanced breast cancer.Methods Totally 75 patients with advanced breast cancer were divided into two groups,and received NP or GX regimen.NP group (n =40):NVB 25 mg/m2,day 1,day 8,iv.drip; DDP 25 mg/m2,day 1-3,iv.drip.GX group (n =35):GEM 1000 mg/m2 day 1,day 8,iv.drip; XEL 2500 mg/m2,day 1-14,bid po.Every 21 days was a cycle.The efficacy and adverse reaction were evaluated after two cycles.Results The overall response rates in the NP and GX group were 42.5 ％ (17/40) and 40.0 ％ (14/35).The median TTP of two group were 7 and 6.5 months.The MST was 15.8 and 15.0 months in the NP and GX group.The 1-and 2-year survival rates were 60.0 ％,32.5 ％ and 57.1％,31.4 ％.The increase ratio of Karnofsky were 50.0 ％ and 42.9 ％.There were not significant difference between the two groups in terms of their treatment response (P ＞ 0.05).The main adverse reactions in the two group were myelosuppression,gastrointestinal reaction and phlebitis.Hand-foot syndrome in GX was significantly higher than that in NP group,Gastrointestinal reactions in NP was significantly higher than that in GX group (P ＜ 0.05).Conclusion NP and GX regimens are effective for patients with metastatic breast cancer,their adverse reactions are tolerable,so they can be regarded as a ltermate regimens for anthracyclines and taxanes resistant patients with metastatic breast cancer.

Objective To study the effect of Danggui Buxue Tang (DBT) on immunological reconstitution of bone marrow transplantation (BMT) in mice. Methods BALB/c mice were irradiated by 137Cs γ once 8.5 Gy, then the mice were engrafted with bone marrow cells (107 cells/mouse) within 4 hours lethal irradiation. And the mice were fed by DBT every day for 15 days. Flow cytometry technique combined with immunological methods were performed to evaluate immunological reconstitution of BMT mice in 30 and 60 days pest-transplantation. Peripheral blood RBC and WBC were counted, and nucleated cells were assayed in recipient bone marrow. Lymphocyte numbers in thymus and periphery were counted and subpopulations of the two origins were observed respectively. Lymphocyte proliferation induced by Con A and LPS, plaque-forming cell (PFC), delayed type hypersensitivity (DTH) were also examined in 30,60 days in post-transplantation respectively. Results Compared with BMT mice, BMT mice treated with a certain dose of DBT could increase the number of peripheral blood RBC and WBC in the recipients, and also could increase that of nucleated cells significantly. BMT mice treated with DBT could increase lymphocyte numbers in thymus and periphery, and improve thymocyte subpopulations, resulting in enhancement in immune function. Conclusion DBT can enhance the immunological reconstitution of BMT mice.

Objective The study aimed to explore the development direction of congenital heart disease surgery through comparing Europe with Guangdong General Hospital(GDGH) in data of ECHSA Congenital Database.Methods The data between 2009 to 2015 of Europe and GDGH were extracted from ECHSA Congenital Database.The data of Europe and GDGH were compared by basic information,operating difficulty and mortality.Results The results of Europe and GDGH were patient number(71 763 vs 13 119),procedure/patient ratio(126.2％ vs 104.1％),age[(75.91 ± 146.18) months VS(105.80 ± 172.18) months],the proportion of neonate (18.2％ vs 4.4％),Aristotle mean score (7.00 vs 6.67),30 days mortality (2.98％ vs 1.73 ％).The proportion of neonate palliative operation of Europe was more than that of GDGH.In adult group,Europe was more of reoperation and of GDGH was more of primary surgery.Conclusion The surgical treatment of congenital heart disease of GDGH is developing and is close to the mean average of Europe.The proportion of neonate,complex surgery and reoperation is lower than Europe.

Objective: To discuss the surgical treatment and early-mid follow-up results of complete atrioventricular septal defect (CAVSD). Methods: The clinic data of 235 cases of CAVSD underwent surgical treatment at Department of Cardiac Surgery, Guangdong General Hospital from June 2009 to June 2016 was analyzed retrospectively (104 male and 131 female patients). The patients were aged 18 days to 58 years (mid age 8.9 months) at surgery, and 2 cases of newborns (0.9%), 24 cases of 1 to 3 months (10.2%), 56 cases of 4 to 6 months (23.8%), 66 cases of 7 to 12 months (28.1%), 36 cases of 1 to 3 years (15.3%), 37 cases of 4 to 18 years (15.7%), and 14 cases above 18 years (6.0%). There were 129 cases of Rastelli type A (54.89%), 16 cases of type B (6.8%), 25 cases of type C (10.6%) and 65 cases of transitional type (27.7%). The patients were combined with 7 cases of unroofed coronary sinus syndrome, 5 cases of coarctation of aorta, 4 cases of tetralogy of Fallot, 3 cases of double outlet right ventricle, 1 case of transposition of the great arteries, 1 case of multiple ventricular septal defect, 1 case of pulmonary artery sling. The CAVSD correction operations were performed in 199 cases with modified single patch technique (84.7%), 26 cases with two patch technique (11.1%), 10 cases with conventional single patch technique (4.3%), and the corrective surgeries of other anomalies were performed in the meantime. Generalized Estimated Equation was used to statistical analysis of postoperative regurgitation level of mitral valve and tricuspid valve. Results: Followed-up for 1 to 7 years, 18 cases (7.7%) died overall and 15 cases (6.4%) died within 30 days post-operation.The mortality of little infant (operation age ≤3 months) was much highest(26.9%). The mortality of different operation age had significant difference(P=0.007). There was no difference among the mortality with three techniques. Seven cases (3.0%) suffered from the re-operation for severe mitral regurgitation. A total of 217 patients survived more than 1 year after initial surgery, and there were 11 cases (5.1%) with severe mitral regurgitation and 7 cases (3.2%) with severe tricuspid valve regurgitation at 1 year post-operation.The degree of mitral regurgitation after operation decreased at 1 week to 6 months, and slightly higher after 1 year postoperatively.The ratios of severe mitral regurgitation in different operative age group was statistically significant difference(P=0.017), mainly from 3 months group and 1 to 3 years group.The degree of tricuspid regurgitation decreased significantly after operation, and decreased gradually in the follow-up period. The ratio of postoperative residual severe tricuspid regurgitation was the highest in surgical aged >18 years old, less in 3 years group, the lowest in 3 to 18 years group. Conclusions The mortality and the ratio of patients with serious mitral regurgitation were higher in infants less 3 months than elder patients. The infants need more frequently follow-up and medicine treatment after operation. The modified one patch technique is effective for all age groups.

Objective: To analyze the early and midterm results of surgical treatment of interrupted aortic arch (IAA) with double-ventricular procedure. Methods: The data of the 68 cases with the main diagnosis of IAA with biventricular structure from June 2009 to June 2017 at Department of Cardiac Surgery, Guangdong General Hospital was collected, including 46 cases of type A, 22 cases of type B. There was no type C case. Except for 5 cases without patent ductus arteriosus or other intracardiac malformations, the remaining 63 cases were combined with intracardiac deformity. The age of operation was 8 days to 18 years, including 28 cases(41.2%) of newborns, 32 cases(47.1%) within 1 year old, 6 cases(8.8%) from 1 to 15 years old, and 2 cases(2.9%) above 15 years old. Of the 5 patients with no intracardiac malformations, 4 patients were treated with a left-posterior thoracic lateral incision for primary surgical correction with end-to-side anastomosis, and 1 adult patient was treated with a median sternotomy incision to complete the anastomosis with the assist of extracorporeal circulation. Of the 63 patients with intracardiac malformation, 2 underwent reconstruction of the aortic arch via posterolateral left thoracic incision merely; 2 patients underwent staged surgery to correction the IAA and intracardiac malformation; the remaining 59 patients underwent the one-stage procedure of IAA and intracardiac malformation correction with deep hypothermic circulatory arrest and 43 cases of selective cerebral perfusion. A total of 55 cases of end-to-end or end-to-side anastomosis were performed in all aortic arch reconstruction. There were 6 cases of connection the arch to descending aorta with autogenous pulmonary artery conduit, and 1 case with homemade bovine pericardial conduit. And there were 5 cases of anastomosis enlargement with autogenous pulmonary artery patch, and 1 case with left subclavian artery flap patch. There were 1 case performed with D. K.S. operation for the severe hypogenetic aortic valve and ascending aorta, and 1 case with left ventricular double outlet channel operation for the severe subvalvular aortic stenosis. Results: Follow-up to 9 years, 4 deaths (5.9%) related to circulatory system diseases: 3 cases died within 30 days after surgery (1 case was neonatal, 2 cases were 1 to 12 months old); one died 8 months after surgery for low cardiac output syndrome. In the early postoperative period, 11 cases (16.2%) of residual aortic arch obstruction (pressure gradient >30 mmHg) were observed, of which 3 cases were moderate (4.4%); follow-up to 5 years after operation was residual obstruction in 3 cases and moderate in 2 cases. There were 3 cases with aortic valve and subvalvular obstruction (differential pressure >30 mmHg), 3 cases were followed up to 5 years after aortic valve and subvalvular obstruction, and 2 cases were moderate or above. To date, 5 patients have undergone 6 reoperations of the cardiovascular system: 3 cases because of pulmonary artery stenosis, 2 cases because of severe aortic arch stenosis, and 1 case because of aortic subvalvular obstruction. Conclusions One-stage surgical repair of IAA is safe and clinically effective in the neonatal and infant. But some patients still requires reoperation for re-obstruction from subvalvular or aorta arch. For some patients, the choice of aortic arch reconstruction depends on the specific situation.

Objective:To analyze the diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery (AAOCA).Methods:This is a retrospective case series study. From January 2016 to July 2023, 24 cases of high-risk AAOCA underwent surgical treatment in Department of Cardiac Surgery, Guangdong Provincial People's Hospital. There were 18 males and 6 females, operatively aged ( M (IQR)) 13 (26) years (range: 0.3 to 57.0 years). They were confirmed by cardiac ultrasound and cardiac CT, all of which had anomalous coronary running between the aorta and the pulmonary artery. There were 15 cases of the right coronary artery from the left aortic sinus of Valsalva, 6 cases of left coronary artery from the right aortic sinus of Valsalva, 3 cases of the sigle coronary artery. Only 3 patients had no obvious related symptoms (2 cases were complicated with a positive exercise stress test and 1 case with other intracardiac malformations), 21 cases had a history of chest tightness, chest pain, or syncope after exercise. Three patients suffered syncope after exercise and underwent cardiopulmonary resuscitation (2 cases were treated with an extracorporeal membrane oxygenerator (ECMO)). The gap from the first symptom to the diagnosis was 4.0 (11.5) months (range: 0.2 to 84.0 months). The detection rate of coronary artery abnormalities suggested by the first cardiac ultrasound was only 37.5% (9/24). Seven patients were complicated with other cardiac diseases (4 cases with congenital heart defects, 2 cases with coronary atherosclerotic heart disease, 1 case with mitral valve disease). Results:All 24 patients underwent surgical treatment (23 cases underwent abnormal coronary artery unroofing, 1 case underwent coronary artery bypass grafting), and 5 patients underwent other intracardiac malformation correction at the same time. There were no death or surgery related complications in the hospital for 30 days after the operation. A patient with preoperative extracorporeal cardiopulmonary resuscitation was continuously assisted by ECMO after emergency AAOCA correction and had complications such as limb ischemia necrosis and renal dysfunction after the operation. During the follow-up of 2.2 (3.3) years (range: 1 month to 7.2 years), one patient who previously underwent percutaneous transluminal coronary angioplasty with a stent implant experienced significant postoperative symptomatic relief, and the other discharged patients had no related symptoms.Conclusions:The accurate rate of initial diagnosis for high-risk AAOCA is still low, but the risk of cardiovascular accidents is high. For sports-related chest pain and other symptoms, more attention should be paid to the detection of AAOCA, especially for adolescents. Exercise stress testing can be helpful in evaluating the cardiovascular risk of asymptomatic AAOCA. Instant surgical treatment can achieve satisfactory curative effects.

Objective:To analyze the diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery (AAOCA).Methods:This is a retrospective case series study. From January 2016 to July 2023, 24 cases of high-risk AAOCA underwent surgical treatment in Department of Cardiac Surgery, Guangdong Provincial People's Hospital. There were 18 males and 6 females, operatively aged ( M (IQR)) 13 (26) years (range: 0.3 to 57.0 years). They were confirmed by cardiac ultrasound and cardiac CT, all of which had anomalous coronary running between the aorta and the pulmonary artery. There were 15 cases of the right coronary artery from the left aortic sinus of Valsalva, 6 cases of left coronary artery from the right aortic sinus of Valsalva, 3 cases of the sigle coronary artery. Only 3 patients had no obvious related symptoms (2 cases were complicated with a positive exercise stress test and 1 case with other intracardiac malformations), 21 cases had a history of chest tightness, chest pain, or syncope after exercise. Three patients suffered syncope after exercise and underwent cardiopulmonary resuscitation (2 cases were treated with an extracorporeal membrane oxygenerator (ECMO)). The gap from the first symptom to the diagnosis was 4.0 (11.5) months (range: 0.2 to 84.0 months). The detection rate of coronary artery abnormalities suggested by the first cardiac ultrasound was only 37.5% (9/24). Seven patients were complicated with other cardiac diseases (4 cases with congenital heart defects, 2 cases with coronary atherosclerotic heart disease, 1 case with mitral valve disease). Results:All 24 patients underwent surgical treatment (23 cases underwent abnormal coronary artery unroofing, 1 case underwent coronary artery bypass grafting), and 5 patients underwent other intracardiac malformation correction at the same time. There were no death or surgery related complications in the hospital for 30 days after the operation. A patient with preoperative extracorporeal cardiopulmonary resuscitation was continuously assisted by ECMO after emergency AAOCA correction and had complications such as limb ischemia necrosis and renal dysfunction after the operation. During the follow-up of 2.2 (3.3) years (range: 1 month to 7.2 years), one patient who previously underwent percutaneous transluminal coronary angioplasty with a stent implant experienced significant postoperative symptomatic relief, and the other discharged patients had no related symptoms.Conclusions:The accurate rate of initial diagnosis for high-risk AAOCA is still low, but the risk of cardiovascular accidents is high. For sports-related chest pain and other symptoms, more attention should be paid to the detection of AAOCA, especially for adolescents. Exercise stress testing can be helpful in evaluating the cardiovascular risk of asymptomatic AAOCA. Instant surgical treatment can achieve satisfactory curative effects.

Objective To evaluate the value of three-dimensional(3 D) printing technique in the diagnosis and treatment of complex congenital heart disease(CHD).Methods From March 2016 to February 2018,40 patients with complex CHD underwent heart CT scanning.The CT images were imported to Standard Template Library(STL) files after 3D reconstruction and then exported for 3D printing.The 3D printed models were then used for decision making and navigation during surgery.Results Thirty patients were indicated for surgical operation.Three patients underwent single ventricular repair,and biventricular repair were operated on 27 patients.The 3D printed models were quite in accordance with the actual anatomical findings in all the patients.And all the procedures carried on were exactly same as planned based on 3D printed model.Conclusion The 3D printing may help improve the diagnosis and treatment level in complex CHD.

Objective To evaluate the accuracy of 3D models of patients with complex congenital heart disease(CHD) printed by domestic 3D priuters based on cardiac CT data.Methods From April 2018 to June 2018,our hospital used domestic 3D printers to print the hearts of 50 patients with complex CHD.The median age of the patients was 24 months(1 month to 61 years),and the diseases included pulmonary atresia,right ventricular double outlet and transposition of aorta.3 measurement sites(150 in total) were selected for each patient.Pearson correlation coefficient calculation,paired t test and Bland-Altman analysis were performed.Results Pearson correlation coefficient is 0.997.The difference of the measured value of CT-model was tested for normality.P was 0.2 of the D test.The Q-Q graph showed that the data point and the theoretical line were highly overlapped.The mean difference was (-0.07 ± 0.67) mm,P =0.196.In Bland-Altman analysis,the consistency boundary value interval of the difference was(-1.29 mm,1.16 mm) between which there were 143/150(95.33％) points.Conclusion 3D models of patients with complex CHD printed by domestic 3D printers based on cardiac CT data have good accuracy.

As a result of right ventricular outflow tract reconstruction, which is the important and basic step of complex cardiac surgery, the blood flow of right ventricular outflow tract is unobstructed, while pulmonary valve regurgitation and right heart dysfunction could be happened. These problems are often ignored in early days, more and more cases of right heart dysfunction need clinical intervention, which is quite difficult and less effective. How to protect effectively the right ventricular function is the focus. At present main methods to protect the right ventricular function include trying to avoid or reduce length of right ventricular incision, reserving or rebuilding the function of the pulmonary valve, using growth potential material for surgery. The protection of the right ventricular function is a systemic project, it involves many aspects, single measures is difficult to provide complete protection, only the comprehensive use of various protection strategy, can help to improve the long-term prognosis.