Objective To register two breath-hold lung volumes image from one subject with deep expiration and deep inspiration.Methods Three pairs of thoracic high resolution CT serial from three subjects were collected under two breath-hold respiration stages.The lung parenchyma of every serial was segmented using the serial segmentation algorithm.Left and right lungs were stored separately.Expiration and inspiration volume images of single lung were registered.Firstly,affine transformation parameters were found based on the anatomic flag surfaces and expiration image volume was re-sampled with affine transformation.Secondly,"Demons" algorithm was employed to register two image volumes non-rigidly.Results Two lung surfaces and the inner structures have a nice registration.The average volume overlap of two images before registration is 0.7982.After global affine transformation,it improves to 0.8936.After "Demons",it is up to 0.9544.The average descending percentage of root mean square errors is 19.83%(after the global affine transformation) and 49.43%(after the "Demons" non-rigid registration).Conclusion The intra-subject registration between two lung image volumes with large deformations described here has an effective registration result.It offers a good base to analyze the lung respiration function.

Objective To explore the clinical application of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (CPR)in the treatment of critically ill children with cardiac arrest.Methods The clinical data of critically ill children due to cardiac arrest who were treated with ECMO assisted CPR from June 2012 to December 2015 in Affiliated Bayi Children's Hospital,Clinical Medical College in Army General Hospital,Southern Medical University were retrospectively reviewed,and the datas were analyzed by SPSS 20.0 software.Results A total of 17 patients received ECMO assisted CPR treatment,13 cases were male,4 cases were female,aged from 5 hours to 5 years old,the weight ranged from 3 to 16 kg;5 cases survived,and the survival rate 29.41％;12 cases died,the mortality rate 70.59％,of which 5 cases died of hear failure in withdrawal of ECMO,and 7 cases died of complications after withdrawal of ECMO.The age,sex ratio,body weight and other demographic data between 2 groups were not statistically significant (all P ＞ 0.05).There was no significant difference in the primary diseases between 2 groups (P ＞ 0.05).There was no significant difference in CPR time and ECMO support time between 2 groups (t =1.541,0.375,all P ＞ 0.05).Among 11 cases of children with ECMO-related complications,the incidence rate was 64.71％,the incidence of complication in the survival group was significantly less than that in the death group (x2 =8.709,P =0.003).The common complications of ECMO were bleeding,acral necrosis,infection,multiple organ failure,nervous system injury and acute kidney injury.There was no significant difference in the level of lactic acid between the survival group and the death group (P ＞ 0.05) before ECMO support started,but after 24 h of ECMO support,the lactic acid level in the survival group was significantly lower than that in the death group (t =2.896,P =0.014).Conclusions ECMO assisted CPR can improve the survival rate of critically ill children who have cardiac arrest and have no response to the conventional CPR.The serum lactic acid level after 24 h ECMO support has a guiding significance for the prognosis assessment,and ECMO patients' complications are still the most important factor affecting the prognosis of ECMO assisted CPR patients.

Objective Total 21 pulmonary artery sling( PA sling)combined with tracheal stenosis children who received treatment in our hospital were reviewed. The feasibility of treatment strategy including left pulmonary artery( LPA)re-implantation without tracheoplasty was discussed in this study. Methods From April 2009 to November 2015,a total of 21 pediatric patients received surgical treatment due to PA sling with tracheal stenosis. Six patients received LPA re-implantation and trachea intervention simultaneously. The other 15 patients received LPA re-implantation alone to relieve the trachea compression without tracheoplasty. The postoperative strategy including early extubation and CPAP ventilation was employed in PICU. Results A total of 21 PA sling with tracheal stenosis children who underwent surgical treatment in our hospital were recruited. There were 9 females and 12 males. Ages of these children were from 1 months to 10 years old,and body weights were from 2. 9 kg to 25. 0 kg. Five patients needed mechanical ventilation for severe respiratory symptoms preoperatively. Six patients received LPA re-implantation and tracheal interven-tion simultaneously. Among them,3 patients received slide tracheoplasty,and one was discharged after recov-ery. The remaining 3 patients received tracheal stent implantation,but finally died. The survival rate was 16. 7% in these patients. Fifteen patients received LPA re-implantation alone,and slide tracheoplasty was per-formed in 2 patients for extubation failure who finally died of air leakage. The survival rate of 15 patients who received LPA re-implantation alone was 86. 7%. Conclusion The strategy in LPA re-implantation alone to relieve the trachea compression without tracheoplasty and early extubation and CPAP ventilation postoperative may be an ideal treatment for the pediatric patients with PLA sling combined with tracheal stenosis.

Objective To explore the comparative application of phase and diaphragmatic navigation in three-dimensional magnetic resonance cholangiopancreatography(3D-MRCP)thin-layer scanning in elderly patients.Methods A total of 180 elderly patients were scanned by phase and diaphragmatic navigation via Siemens Aera1.5T superconducting MR scanner.The acquired images were reconstructed by 3D reconstruction.The anatomical structure,image quality and disease diagnosis were compared between the phase and diaphragmatic navigation groups.Results In liver of anatomy,the liver of primary bile duct,the superior,middle and inferior extrahepatic bile duct and the gallbladder could be well displayed,and the difference was not statistically significant between the two groups(P＞0.05).The display of pancreatic duct and the liver of secondary bile duct of diaphragmatic navigation was significantly better than those of phase navigation(P＜0.05).In terms of image quality,the excellent rate of diaphragmatic navigation was significantly higher than that of phase navigation,and the difference was statistically significant(P＜0.05).There were no statistically significant differences in the detection rate of pancreatobiliary system diseases,the diagnostic rate of cholelithiasis,common bile duct stones,common bile duct dilatation and pancreatic duct dilatation between the two groups(P＞0.05).Conclusion Diaphragmatic navigation is signifi-cantly better than phase navigation in the display of the anatomical structure of the pancreatic duct,the liver of secondary bile duct,and the excellent rate of image quality.Diaphragmatic navigation is more suitable for thin-layer 3D-MRCP scanning in elderly patients.

Objective:To investigate the current status of sarcopenia and self-management in elderly patients with type 2 diabetes mellitus (T2DM), and to explore the identification of risk factors for sarcopenia by diabetes self-management ability.Methods:Using convenience sampling, 284 elderly patients with T2DM who visited a community health service center in Beijing from March to September 2023 were selected as subjects. The patients were screened for sarcopenia and received related health examinations based on Asian working group for sarcopenia (AWGS) 2019 Consensus. Surveys were conducted using general information questionnaire, the Summary of Diabetes Self-Care Activities measure, and other questionnaires. Patients were divided into groups according to the presence or absence of muscle attenuation (defined as suspected and confirmed sarcopenia).Results:The prevalence of muscle attenuation in the 284 elderly patients with T2DM was 48.9%, and the prevalence of sarcopenia was 15.9%. The proportions of females, patients who are over 70 years old, and patients with a sedentary lifestyle were significantly higher in the group with muscle attenuation compared with the group without muscle attenuation. High-quality protein intake, extremity skeletal muscle mass index, grip strength, and six-meter walking speed were significantly lower in the muscle attenuation group. Binary logistic regression analysis revealed that age, alcohol consumption, a sedentary lifestyle, and high-quality protein intake were influencing factors for sarcopenia in elderly patients with T2DM ( P<0.05). The total self-care scores and subtotals in exercise domains showed significant differences ( P<0.05) between patients with and without muscle attenuation. Univariate analysis indicated significant differences in self-management behaviors among patient groups stratified by grip strengths and 6-meter walk speeds ( P<0.05). Multivariate linear regression analysis showed that grip strength and 6-meter walk speed were influencing factors for exercise management behaviors in elderly patients with T2DM ( P<0.05). Conclusions The prevalence of sarcopenia in elderly patients with T2DM is relatively high, and their level of diabetes self-management is medium to low. Practitioners should pay extra attention to patients who are over 70 years old, with sedentary habits, with low intake of high-quality protein, and females. It's recommended to use grip strength and 6-meter walk speed tests as initial screening tools for sarcopenia in elderly patients with T2DM, in order to identify risks early and implement targeted health management to promote the development of good self-management behaviors among patients.