VTK is not only an open-source code but also a powerful toolkit for visualization.According to the requirement of medical image processing and on the basis of visualization and display function of VTK,VC++6.0 is used to design and implement a three-dimensional system which can be integrated into PACS.This system is useful for advancing the post-processing function of PACS.

Objective To present a new algorithm for multidimensional medical image registration from global registration to local registration in sequence. Methods Firstly, the global registration was achieved by the method of affine transformation composed of B-splines,whose knots were the four vertexes of the medical image. Then the knots of the B-splines were increased, and the transformation function was more complex and elastic than ever,which completed the elastic aligning for the detail of the medical image. Results The whole registration algorithm represented the principle aligning from global registration to local registration. Conclusion It is proved by experiments that the presented algorithm can decrease the time of calculation and increase the robustness of registration.

Objective To summarize the experience in surgical treatment of Ebstein anomaly,and evaluate the therapeutic effect.Methods Thirty-five patients of Ebstein anomaly were treated by operation.New York heart association(NYHA)heart function classⅠ?was in 11 cases,classⅡ?was in 14 cases,class III-Ⅳ?was in 10 cases.The cue of echocardiogram about tricuspid valve regurgitation in 24 cases were severe,5 cases were moderate and 6 cases were mild.Two patients accepted tricuspid valve replacement.Thirty-three cases were accepted tricuspid valve repair and right ventricle folded,in which 2 cases accepted Danielson method,and 31 cases accepted Carpentier method,among them,9 cases accepted one and a half ventricular repair.Associated heart anomaly was corrected at the same time.Results One patient died.There were 2 cases with third degree atrioventricular block after tricuspid valve replacement,2 cases with low cardiac output syndrome and 2 cases with atrial fibrillation combined premature ventricular contraction.The heart was lower by chest X-ray and echocardiogram examination,tricuspid valve regurgitation in 22 cases were disappeared,9 cases were mild,3 cases were moderate.All patients were followed up from 1 month to 7years,tricuspid valve regurgitation in 21 cases were disappeared,12 cases were mild,heart function were class Ⅰ-Ⅱ.Because of heart function aggravation,1 patient was operated again 3 years after operation.Condusions Ebstein anomaly is a rare congenital heart disease,Carpentier method tricuspid valve repair can decrease regurgitation obviously and protect right ventricular function.One and a half ventricular repair should be adopted according to the function of tricuspid valve and right ventricle.

By analyzing the questionnaire survey of consciousness of rights protection and status quo of rights and interests among medical staff in three 3rd degree and A grade hospitals located in northwest Hubei province,this paper concludes that medical staff there have a generally strong consciousness of rights,while their rights and interests are not well protected by society and hospitals,especially certain aspects including personal security,occupational health,working hours,legal vacation,and the rights to be involved in hospital management.It is suggested that legal rights and interests of medical staff should be improved through legislation,social support,and the direction function of public opinions.

Objective　To introduce the technique of mitral v alve replacements in beating heart, and review the clinical experience in 234 ca ses of operation. Methods　A total of 234 patients of mitral val ve replacement in beating heart with mild hypothermic extracorporeal circulation (30～32 ℃) were reviewed. Results　 The procedures underwe nt fluently and only 2(0.85%) died early postoperatively. No low cardiac output , arrhythmia and cer ebral embolism complications was found. Conclusion　Results sugg ested that mitral valve replacement in beating heart is a safe and available method and is good in extenuating myocardial and pulmonary i njury from ischemia-reperfusion and deep hypothermia.

Objective　To compare the effects of mild hypothe rmic cardiopulmonary bypass (CPB) and moderate hypothermic cardiopulmonary bypas s in pediatric cardiac surgery. Methods　A total of 118 cas es of less than 3 years of age that had undergone open heart surgery were review ed, in which 46 patients received moderate hypothermic CPB(group 1) and 72 patie nts received mild hypothermic CPB(group 2). The CPB duration, incidence of low c ardiac output and postoperative concentration of CK-MK, etc, were compared with each other betwee n the two groups. Results　Duration of bypass and postoperative mechanical respiratory assistance of group 2 was shorter than that of group 1 ( P<0.05). Transfusion requirements, incidence of low cardiac output syndrome, concentration of CK-ME and percentage of metabolic acidosis were lower in grou p 2 than in group 1 (P<0.05), while the index of oxygenation was higher in g roup 2(P<0.05). Conclusion　The mild hypothermic CPB is saf er and more effective and therefore is superior to moderate hypothermic CPB in p ediatric cardiac surgery.

Objective　To compare the clinical efficiency of intracardiac procedures on traditional cardioplegic arrested-heart and on-pu mp beating-heart for congenital heart disease (CHD) with severe pulmonary hyper tension. Methods　Among all 153 cases, 95 cases underwent operat ions on cardioplegic arrested-heart, while 58 on-pump beating-heart. In arres ted-heart group, 79 cases with ventricular septal defect (VSD), 13 with atria l septal defect (ASD) and 3 with patent ductus arteriosus (PDA) were examined whi le in beating-heart group, 43 cases with VSD, 10 with ASD, and 5 with PDA were examined. Results　There were 12 cases of operative death (12.6%) and 8 of tracheotomy (8.4%) in heart arrested group. No operative death and tracheotomy in beating-heart group. 141 patients were followed up for 3 months to 10 year s with good recovery. There were 2 cases of right heart function failure six yea rs later in arrested-heart group. Conclusion　Results sugges t that on-pump beating-heart technique is superior to traditional cardiopl egic arrested-heart for CHD with severe pulmonary hypertesion. The cause might be t hat on-pump beating-heart intracardiac operation is more effective in cardio pulmon ary protection.

Objective To evaluate the efficiency of emergency surgery to consecutive 258 infants suffering with critical congenital heart diseases (CHD). Methods From January 2006 and February 2009,emergency surgery was performed within 24 h after definite diagnosis on 258 children with critical congenital heart diseases,including 150 males (58.1%) and 108 females (41.9%),with a mean age of (7.5?4.3) months (ranging from 6 d to 11 months),at a mean weight of (5.5?3.3) kg (ranging from 2.1 to 9.5 kg). Complications such as refractory pneumonia,heart failure,repeated episodes of hypoxic spells,kidney dysfunction,liver dysfunction,severe anaemia or growth retardation were found in 233 infants (90.2%). Totally 246 (95.3%) of them were operated on CPB with heart arrested,and 12 (4.7%) with patent ductus arteriosus and operated off pump. Results This group of patients had a stage-one corrective rate of 92.3%,and a total curative rate of 96.9%. In infants operated with heart arrested and with heart beating,the duration of cardiopulmonary bypass was 105.00?38.71 min and (71.89?27.78) min respectively,postoperative ventilation duration was (16.5?9.3) h,intensive care unit (ICU) staying duration was (98.5?33.6) h. After operation,low cardiac output syndrome occourred with a rate of 6.9% and severe complications of major organs with a rate of 12.9%. Of 8 (3.1%) dead infants,7 were diagnosed with complicated CHD. Five died of low cardiac output syndrome,1 of arrhythmia,1 of respiratory failure and 1 of arrhythmic heart. Conclusion Emergency surgical treatment should be performed as soon as definite diagnosis for critical infants with congenital heart disease. Heart failure,respiratory failure,liver dysfunction,severe anaemia and infection are not contraindications to surgical treatment. However,complex anomalies and younger age are considered to be the most risk factors for surgery of infants with CHD.

Objective To study the effect of aerobic exercise and dietary intervention on lipid metabolism in metabolic syndrome rats, and investigate the possible mechanism mediated by peroxisome proliferator-activated receptorα(PPARα). Methods After one-week feed-ing, Sprague-Dawley rats were randomly divided into blank control group (CC group) and model group which were feed in high-fat-and-salt diet for 18 weeks to establish a metabolic syndrome model. Then, the metabolic syndrome rats were randomly divided into model control group (MC), the model high-fat diet group (MHE) and the model general died exercise group (ME). ME and MHE groups were forced to run on a treadmill for twelve weeks at the same time. The weight of perirenal fat, blood free fat acid (FFA), and blood lipid were determined. The expression of PPARαmRNA in myocardium was detected by RT-PCR. Western blotting was applied to detect the protein expression of PPARαin myocardium. Results Compared with CC group, MC group showed significant increase in body weight, perirenal fat weigh, FFA, and blood lipid (P<0.05), and significant decrease in PPARαmRNA and protein expression (P<0.01) in myocardium. Compared with MC group, ME and MHE groups showed significant decrease in body weight, perirenal fat weight, triglyceride (TG), and showed significant in-crease in high-density lipoprotein (HDL), and the expression of PPARαmRNA and protein in myocardium (P<0.05). Compared with MHE group, ME group showed decrease in low-density lipoprotein (LDL) (P<0.05), and increase in the expression of PPARαmRNA and protein (P<0.01). Conclusion Aerobic exercise may activate the expression of PPARα, enhance the utilization of fatty acid, reduce body mass and visceral fat mass, improve the dyslipidemia and then regulate lipid metabolism in metabolic syndrome rats.

A 29-year-old male patient with extranodal NK/T-cell lymphoma,a nasal type lymphoma with involvement of skin as the first symptom,was reported.The patient presented with swelling in the left side of the nose and suffered intermittent fever for 1 month.The fester in the oral mucosa and skin under the left nostril and redness,and the swelling on the orbit of the left eye lasted for 1 week.Physical examination showed that the left side of nose was swelling,and the skin below the left nostril was anabrotic and crusted.There were different ulcers in his jaws and buccal mucosa.Bilateral eyelid was redness and swelling,especially in the left side.Binocular conjunctival was congestive.The diagnosis of extranodal NK/T-cell lymphoma (nasal type) was confirmed by biopsy and immunohistochemistry.