Objective To research the levels of thyroid hormone in patients with Sheehan′s syndrome .Methods The difference of thyroid‐stimulating hormone(TSH) or free triiodothyronine(fT3 ) or free thyroxine(fT4 ) levels was compared between 100 pa‐tients with sheehan′s syndrome and 100 cases of female healthy controls included in this study .The difference for TSH or fT3 or fT4 levels was compared between before and after treatment in Sheehan′s syndrome patients .The difference of TSH or fT3 or fT4 levels was compared when time from a large bleeding to disease onset below 1 year ,1‐5 years and over 5 years respectively in Shee‐han′s syndrome patients .Results The difference of TSH or fT3 or fT4 levels between patients with Sheehan′s syndrome and female healthy controls had obvious statistical significance .TSH :1 .60(0 .79 -2 .86)mU/L versus 3 .08(1 .97 -5 .08)mU/L ,fT3 :2 .09 (1 .44-3 .69)pmol/L versus 4 .86(4 .49-5 .40)pmol/L ,fT4 :8 .01(3 .45 -12 .64)pmol/L versus 14 .56(13 .63 -16 .11)pmol/L (P<0 .001 for comparisons respectively) .The difference of TSH or fT3 or fT4 levels between before and after treatment had obvi‐ous statistical significance .TSH :1 .60(0 .79-2 .86)mU/L versus 1 .16(0 .57-2 .11)mU/L ,fT3 :2 .09(1 .44-3 .69)pmol/L versus 3 .27(2 .38-4 .11)pmol/L ,fT4 :8 .01(3 .45 -12 .64)pmol/L versus 14 .32(10 .48 -15 .92)pmol/L(P<0 .05 for comparisons re‐spectively) .Time from a large bleeding to disease onset were below 1 year ,1-5 years and over 5 years ,TSH levels were respective‐ly 2 .85(2 .21-3 .51)、1 .82(1 .24-2 .98) and 1 .52(0 .65-2 .64)mU/L(P<0 .05 for comparisons) .The fT3 levels were respective‐ly 3 .74(2 .24-4 .45) ,2 .54(1 .87-3 .32) and 1 .89(1 .13-3 .11)pmol/L(P<0 .05 for comparisons) .The fT4 levels were respec‐tively 12 .21(10 .45-14 .32) ,8 .52(5 .13-12 .34) and 7 .85(3 .12 -10 .12)pmol/L(P<0 .05 for comparisons) .Conclusion TSH could serve as an identifiable index for sheehan′s syndrome and primary hypothyroidism .The time from a large bleeding to the dis‐ease onset is longer ,the anterior pituitary function is more serious .Thyroid hormone should be monitored regularly in order to pre‐vent the happening of hyperthyroidism during the process of the treatment .For postpartum hemorrhage patients ,thyroid hormone should be early detected and combine with the clinical manifestations .They should early diagnose and timely treat in order to pre‐vent the sheehan′s syndrome and its crisis .

Objective To analyze the value of three-dimensional computed tomography (CT) reconstruction imaging for the diagnosis and treatment of congenital scoliosis. Methods 76 patients with congenital scoliosis were examined with X-ray of total spine and three-dimensional CT reconstruction, and the results were analyzed. Compared with X-ray film, the findings with the CT imaging were classified into three groups: Group Ⅰ, no supplementary useful information was obtained; Group Ⅱ, further confirmation of findings which were unclear or ambiguous on X-ray film, with improved visualization and comprehension of the type of the deformity; Group Ⅲ, substantial new information was obtained. Results Group Ⅰ: 11 (14.5%) patients, without supplementary useful information obtained with three-dimensional CT reconstruction imaging. The patients aged from 2 to 16 years(11.00?10.09 years), and the Cobb angle ranged from 28? to 102?(55.60??21.06?). Group Ⅱ: 49 (64.5%) patients, with confirmatory finding or improved visualization and comprehension of the previously identified deformities obtained with CT imaging. The 49 patients aged from 4 to 28 years (13.53?4.47 years), and the Cobb angle ranged from 20? to 115? (55.41??23.44?). Group Ⅲ: 16 (21%) patients, with substantial new information obtained with CT reconstruction images which was unrecognized with X-ray film. The patients aged from 6 to 16 years (12.88?2.68 years),and the Cobb angle ranged from 37? to 145?(73.19??28.18?). The difference of age of patients between 3 groups was of no significance (P=0.052), but the difference of Cobb angle between 3 groups was significant statistically (P=0.039). Conclusion Three-dimensional and multiplanar reformatted CT imaging allows better visualization and understanding of the deformities of scoliosis, and supplementary useful information may be obtained which was obscure or unrecognized with X-ray film, especially for patients with severe deformities. Its application in clinical practice may contribute to the diagnosis of the type of deformity and the segments involved, as well as the individualized operative planning.

0.05). In Group 2, the mean maximum pull out strength of the GSS screws was 127% of that of the CCD control screws, while the mean maximum pull out strength of the TSRH screws was 64% of that of the CCD control screws. The mean maximum pull out strength of the GSS screws was significantly higher than that of the TSRH screws (P0.05). Conclusion GSS screws offer better anchoring in revision surgery than most of the currently used screws do.

Objective To evaluate the clinical manifestation and operative treatment for the scolio-sis of Marfan syndrome, and analyze its clinical outcomes as well. Methods The retrospective study cov-ered 10 patients including 8 females and 2 males with an average age of 12.9 years (9 to 16 years), who had undergone operations from January 1990 to December 2002. The Cobb's angle in the coronal and sagittal plane, the trunk shift, the apex rotation and shift were evaluated both before and after operation respectively. In the group, there were four cases with family history. Of the 10 cases, the classification of scoliosis was single curve in two cases, double curves in six cases and three curves in two cases. Results All the pa-tients were followed up for a mean time of 15 months, ranged from 4 months to 3 years. The trunk shift changed from the mean distance of 2.17 cm to 1.41 cm. The apex rotation decreased about 1?. The apex shift changed from the mean distance of 4.57 cm to 2.14 cm. The mean Cobb's angle in the coronal plane changed from 88? to 42?. The correction rate was about 46.38% (18.18% to 81.54%). The Cobb's angle on the final follow-up was 46?( 11? to 96?), and the mean lost angle was 4?. The mean Cobb's angle of the thoracic kyphosis was 20?(-10? to 52?) preoperatively and 23?(0? to 35?)postoperatively, and 24?( 0? to 35?) on the final follow-up. The Cobb's angles of the thoracolumbar kyphosis of 5 cases improved from 85? to 10? after operations, and there was no angle loss on the follow-up. Conclusion The three dimensional corrective instrumentation can be used effectively for the correction of the scoliosis of Marfan syndrome. The critical points for the successful operation are the simultaneous correction of the coronal and sagittal plane deformities, prevention of the dural expansion in the lumbar or lumbosacral canal, rigid and multi-segmental internal fixation, extensive and ample bone fusion, and correct external fixation after operation.

Objective To investigate the efficacy of allograft bone in posterior spinal fusion in scoliosis. Methods From March 1995 to March 2000, 60 patients with scoliosis, who underwent posterior spinal instrumentation and fusion using allograft or autograft bone, were evaluated prospectively. All of the patients were randomized into group A (30 cases using only allograft bone) and group B(30 cases using autograft iliac bone).Among the patients in group A, there were 16 with congenital scoliosis, 12 with idiopathic scoliosis, 1 with neurofibromatsis scoliosis and Marfan syndrome respectively. The average age at surgery was 14 years 6 months. the average preoperative major curve was 86.6? with an average number of 8 fused segments (range, 4 to 10 segments). Whereas in group B, there were 15 with congenital scoliosis, 9 with idiopathic scoliosis, 5 with neurofibromtasis scoliosis and 1 with Marfan syndrome. The average age at surgery was 13 years and 8 months. The average preoperative major curve was 77.8? with an average number of 7 fused segments (range, 5 to 10 segments). The mean operative duration, average blood loss, complications and loss of correction between the two groups were analyzed comparatively. Results Each patient had a minimum 2-year follow-up with an average duration of 4 years 5 months. Group A was better than group B by a shorter operative duration, less blood loss. At last follow-up, the major curve measured an average of 44? (range, 31? to 72?) in group A and 41? (range, 24? to 68?) in group B respectively. There were 3 (10%) and 2 (6.7%) pseudoarthrosis occurred in group A and group B respectively. One superficial infection developed in group A. There was no significant difference of the average loss of correction and complication rate between the 2 groups. But there were 6 patients who had donor site pain in group B. Conclusion A satisfactory outcome can be achieved in posterior spinal fusion in scoliosis using allograft bone especially when a large amount of bone graft is needed.

Obiective To evaluate the value of allograft bone for acetab ular and femoral reconstruction in THA revision surgery. Methods A total of 19 p atients underwent reconstruction of acetabular and proximal femoral bone defects from June 1996 to December 2000 were reviewed. Eleven of the patients were men and 8 women with a mean age of 66.5 years and 63.2 years respectively at the t ime of resision surgery. According to AAOS system, the acetabular bone defects w ere classified into type I in 2 hips, type II 10 hips and type III 4 hips, and o n the femoral side, there were type I in 3 hips, type II 11 hips and type III 2 hips respectively. The reconstruction of bone defect of acetabulum included stru ctural allograft in 3 hips, impacted morselized allograft in 3 hips, and metal w ire mesh with morselized allograft in 3 hips. In all 3 of femoral segemental def ects, the reconstructions of the proximal femoral bone defects were done with st ructural allografts. Metalwire mesh with morselized allograft for femoral bone d efects were performed in 2 cases and morselized allogratts alone for femoral bon e defects in 4 cases; both acetabular and femoral bone defects were reconstruct ed with impacted morselized allografts in 6 cases (7 hips), and 4 patients with no bone grafts; Harris score system and radiograph were used for the final eva luation. Results Ninteen patients were followed up for an average period of 46 m onths (ranges, 6 to 68 months), Harris score improved from 42.7 points pre rev ision to 82.7 points at final follow up, the incorporation of allografts bone in 15 patients (16 hips) were noticed radiographically in all but one hip was fo und reabsorption of the structural allograft and radiolucents were found in the other 3 patients. No infection was encountered in this series. Conclusion If th e different types of bone defects were properly identified and suitable allogrft s adopted, reconstruction of bone defects with allografts during the THA revisi on surgery is a useful and reliable method. [

Objective To measure and compare the insertion torque and pullout strength of newly designed general spine system(GSS) screws with those of SOCON and CCD pedicle screws in normal human cadaver vertebrae, and to evaluate the screw purchase of GSS pedicle screws. Methods Twenty seven lumbar vertebral bodies obtained from 6 fresh normal male cadavers were classified into 3 groups randomly, 18 pedicles per group. GSS, SOCON and CCD pedicle screws were implanted into the pedicles of each group respectively. Pedicle screws were inserted with a torque screwdriver. Each screw was extracted axially from the pedicle at a rate of 5 mm/min until failure using a material testing machine(SWD-10, Changchun, China). Force data were recorded and analyzed using a one way ANOVA. P

BACKGROUND: Spinal somatosensory evoked potential(SEP) monitoring is widely used intraoperatively due to the easiness to operate and its reliability.OBJECTIVE: This study was designed to assess the significance of improving SEP signals in intraoperative spinal monitoring on predicting the post-operative spinal function.DESIGN: A non-randomized concurrent controlled study was conducted on selected patients.SETTING: This study was conducted at the Orthopedic Department of Peking Union Medical College Hospital.PARTICIPANTS: Totally 34 patients with cervical spondylosis underwent surgical treatment at the Orthopaedic Department of Peking Union Medical College Hospital were selected from January to October in 2001. Of all the patients, 24 underwent anterior decompression and fusion, 3 single door operation and 7 double door operation. According to the variance of intraoperative SEP, the patients were divided into the improvement group(12 cases)and the non-improvement group(22 cases).METHODS: All the patients' neurologic deficits were assessed according to the Japanese Orthopaedic Association scoring system(JOA score), prior to operation and postoperative week 1, 2, and 4 and month 3, 6. Each patient received the intraoperative spinal SEP monitoring. The variance of SEP signals in amplitude and latency were classified as improvement(an increase in amplitude of 50% or more, or a decrease in latency of 10% or more), decrease(a decrease in amplitude of 50% or more, or an increase in latency of 10% or more), and no improvement.MAIN OUTCOME MEASURES: JOA scores were calculated in two groups in the study at all time points.RESULTS: All the 34 patients entered the statistical analysis procedure. In postoperative week 1 and week 2, the improvement group showed a larger increase in JOA score than the non-improvement group did[improvement group:(14.08±1.44), (14.17±1.11) points; no improvement group:( 12.73 ± 1.42), ( 12.86 ± 1.28)points, P ＜ 0.05]. In postoperative week 4, month 3 and month 6, both groups showed an increase in JOA scores [improvement group: (14.00±1.04), (13.58±1.08), (13.68±1.61)points; no improvement group: (13.82 ± 1.01), (13.41 ± 1.22), (13.41± 1.47)points], but there was no significant difference( P ＞ 0.05).CONCLUSION: Improvement of intraoperative SEP can be used to predict the good early clinical outcomes in surgery for cervical spondylosis.

Objective:To investigate the regulation mechanisms of the bone marrow mesenchymal stem cells on lymphocyte pro -liferation of type I diabetic rats .Methods:The rat bone marrow mesenchymal stem cells were isolated , cultured and identified and the effect on lymphocyte proliferation of type Ⅰdiabetic rat was observed by MTT assay , and analyze the CD 4 +CD25 +regulatory T cell ra-tio, cell cycle and apoptosis of type I diabetes rat by flow cytometric .Results:B and C groups was significantly lower than the absor-bance values of group A,the differences between the data were statistically significant (P<0.05), C group was significantly lower than group B absorbance values, the difference was significant (P<0.05);the CD4 +CD25 +regulatory T cells of B and C groups were sig-nificantly higher than group A, the differences of the data were statistically significant (P<0.05), the CD4 +CD25 +regulatory T cell ratio of C group significantly higher than that group B , the differences were statistically significant (P<0.05);the apoptosis levels of B and C groups were significantly higher than group A , the differences were statistically significant (P<0.05), the apoptosis levels of C group were significantly higher in group B , the differences were statistically significant (P<0.05).Conclusion:Bone marrow mesen-chymal stem cells can significantly inhibit lymphocyte proliferation of type Ⅰdiabetic rats, and it may regulate CD4 +CD25 +regulatory T cells, promote apoptosis, thereby affecting the immune function of T lymphocytes , and play its rejection.

Objective To investigate the association of chest pain patients with primary level in high-sensitivity troponin T (hs-cTnT) level no more than 14 ng/L in the onset of acute myocardial infarction in pa-tients with chest pain. Methods We enrolled 3 096 participants from January 2012 to December 2013 in West China Hospital, Sichuan University. All patients were classified two groups (hs-cTnT > 14 ng/L, hs-cTnT ≤14 ng/L and no ischemia on ECG) according to hs-cTnT levels and ECG. We evaluated the risk of myocardial in-farction and death and negative predictive value in 30 days. Results Thirty-seven patients were diagnosed in having acute myocardial infarction (AMI) and 4 patients were dead in the hs-cTnT > 14 ng/L group in 30 days in the absolute risk 2.35(1.86-2.74) and 0.29(0.12-0.53); 9 patients were diagnosed as having AMI and no patients were dead in the hs-cTnT ≤ 14 ng/L group in 30 days in the absolute risk 0.58 (0.42-0.74). Conclu-sion Chest pain patients whose primary levels no more than 14 ng/L in hs-cTnT with no ischemia on ECG can be ruled out AMI in negative predictive value 99.6%. the levels of hs-cTnT which were dynamic monitored at least 5 h and still no more than 14 ng/L can rule out AMI directly.