The term "a green hospital", meaning "a safe, dependable and harmless hospital", epitomizes the harmony between the hospital's intrinsic quality and extrinsic surroundings. Thus, the construction of a green hospital possesses rich connotations, viz. powerful guarantee, of medical safety, dependable guarantee of quality, delivery of civilized services and harmonious doctor-patient relationship, and comfortable and humanized surroundings for medical care. It is imperative to formulate comprehensive assessment standards for green hospitals or incorporate such standards into the conditions for hospital appraisal so as to render the idea of green hospital a target of hospital development.

[Objective] To investigate the surgical treatments and outcomes of chordomas in the mobile spine.[Methods]A series of 15 cases of chordomas arising from the mobile spine which received surgical treatments were retrospectively reviewed.According to the WBB(Weinstein-Boriani-Biagini)surgical staging system,the tumours mainly occupied the vertebral body areas,ic,4 to 9 radiating zones in 7 cases,expanded outside to 4 or 9 radiating zone in 4 cases,both to 4 and 9 radiating zones in 4 cases.Thirteen of them affected A to D layers,the other 2 affected A to C layers.One vertebra was involved in 9 cases,two vertebrae were involved in 5 cases and 3 vertebrae in 1 case.Vertebrectomies or sagittal resections were performed in 10 cases and total spondylectomies in 5 cases.Four patients underwent posterior approach operations and 3 patients underwent anterior approach operations for spinal reconstruction and stabilization.Eight patients received combined anterior and posterior operations for spinal reconstruction and stabilization.Tricortical autogenions bone grafts,some in titanium mesh,were used for reconstruction in 9 patients.While mesh and bone cement were uesd in 6 patients.Local radiation therapies were performed in all patients after surgeries.[Results]Clinical symptoms and neurologic deficits were relived in all the patients.Fusion of the bone grafts was got in all the 9 cases.The follow-up was 14 to 123 months,average 56.2 months.Local-recurrence could be observed in 7 cases and 4 cases died.No metastasis was seen in this series.[Conclusion]Eearly diagnosis and treatment have great effects on the prognosis of the chordoma arising in mobile spine.Total spondylectomy with postoperative radiation therapy can decline the local-recurrent rate.

Objective To retrospectively study the character, surgical interventions of chordomas in the cervical spine. Methods All the clinical data of 8 cases of chordoma arising in the cervical spine which under went surgical treatment in our department from 1989 to 2006 were retrospectively reviewed, which including 5 males and 3 females. The patients ranged from 34 to 72 years at diagnosis, with an average age of 53.8 years. Surgical interventions were defined according to WBB criteria. 3 patients underwent subtotal centrum or total centrum resection, 2 patients underwent sagital resection and 2 patients received subtotal or total spondylectomy. Extracapsular excision was performed in a intradural invasion case. Autogenic iliac blocks were used as bone graft in 5 cases and titanium mesh with bone cement filling-in for anterior pedestal in 2 cases for reconstructing the stability of spine. Radiation therapy was given as an adjuvant treatment after surgery. Results Symptom of nerve root irritation disappeared or relieved prominently and the patients suffering spinal cord compression symptom got well recovery with at least 1 or 2 levels after operation. The typical “Physaliphorous cell” could be found in the oncologic examination in all those cases. Follow-up average 43.5 months, ranged from 3 to 120 months. All the internal fixation got well fusion and the rate of fusion for the bone graft was 100%. There were 4 cases in which the postoperative local recurrence of the tumor can be seen, with one patient dead of complications of high paralysis, but no local recurrence was observed in the cases which received total spondylectomy. No evidence of distant metastasis was observed in 7 cases for our series except the special intradural case which had the operation history for “sacral chordoma” before. So we consider it as a intradural metastasis case of the primary sacral chordoma. Conclusion Chordomas are rarely seen in the cervical spine and the typical clinical manifestation is rare in pristine cases. So we should think highly of the CT and MR examination for diagnosis. Total spondylectomy with postoperative radiation therapy could lower the rate of local recurrence.

AIM: To investigate the effects of TGF-?_1 and signal protein Smad3 on rat cardiac myocyte hypertrophy.METHODS: The total protein was analyzed by flow cytometry and the ANF mRNA expression was measured by RT-PCR to judge the hypertrophy of cultured neonatal cardiac myocytes.Smad3 mRNA expression in cardiac myocytes was measured by RT-PCR,and the protein expression of Smad3 was analyzed by Western blotting.RESULTS: TGF-?_1 significantly increased the total protein in cardiac myocytes and promoted ANF mRNA expression,compared with control group.In cultured neonatal myocytes,AS-ODN of Smad3 inhibited myocyte hypertrophy induced by TGF-?_1.Smad3 mRNA and protein expression increased at 15 min after incubated with TGF-?_1,reached the peak at 1 h,and declined at 4 h.CONCLUSION: TGF-?_1 and signal protein Smad3 may participate in the progress of rat cardiac myocyte hypertrophy.

Objective To summarize our clinical experience and results of Stanford type B dissection,and analyzed the risk factors of reoperation.Methods From February 2009 to December 2011,81 patients (54 male and 27 female) of Stanford type B aortic dissection underwent surgical procedure in Beijing Anzhen Hospital The mean age was 19 -77 years,averaged (41.6±11.7)years.Associated with hypeftension in 48 cases,Marfan syndrome in 15 case,aortic root aneurysm in 7cases,dilation of aortic sinus and ascending aorta each in one,coarctation of the aorta in 1 case.Reoperation was done in 22cases and 4 of 22 needed the third operation.The risk factors of reoperation were analyzed with Logistic regression analysis.Results Sun (s) procedure was operated on 16 cases,concomitant procedures included Bentall in 7 cases,David in 1,replacement of the ascending aorta in 2 cases,CABG in 1 case.The thoracoabdominal aortic replacement in 31 cases,the descending thoracic aortic replacement in 9 cases,the stented elephant trunk procedure in 24 cases.Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases,aortic valve replacement and ascending aortic plasty in 3 cases,left subclavian artery reconstruction in 2 cases,double valve replacement in 1 cases,and the bypass from ascending aorta to descending aorta each in one,repair of internal leakage in 1 case.2 patients underwent thoracoabdominal aorta replacement died after surgery due to multiple organ failure caused by postoperative bleeding.The hospital mortality was 2.5％(2/81 cases).Complications occurred in 6 patients (6/81 cases,7.4.％ ),including diastinal bleeding requiring reoperation in 3 cases,respiratory insufficiency and hoarseness each in one,postoperative esophageal fistula needed reoperation and jejunal fistulization in I case.No paraplegia or stroke occurred postoperatively.Logistic regression analysis shows Marfan syndrome is the risk factor of reoperation.Conclusion The surgery on Stanford B aortic dissection can achieve satisfactory clinical results and Marfan syndrome is the risk factor of reoperation.The mid- and long-term results need the further follow-up.

Objective To discuss the timing and procedures of reoperations on the residual aortic dissection after initial ascending aortic operations on Stanford type A aortic dissection.Methods From March 2009 to November 2011,16 consecutive patients(13 males,3 females) underwent reoperations on the residual aortic dissection.The mean age was 44 years(23-61 years),8 cases was associated with Marfan syndrome.The right axillary artery or femoral artery cannulation was used for cardiopulmonary bypass,cerebral protection was achieved by unilateral antegrade brain perfusion and nasopharyngeal temperature was dropped to 20℃-25℃.The Sun's procedure (total arch replacement with stented elephant trunk implantation) was performed in all patients,concomitant procedure include aortic root replacement (Bentall procedune) in 3 patients,aortic root replacement and coronary artery bypass grafting (Bentall + CABG) in 1 patient,the coronary artery anastomotic leakage repair in 1 patient,mitral valve replacement (MVR) in 1 patient.Results The interval between two operations averaged(66 ±40)months.The means of cardiopulmonary bypass,cross clamp and selective cerebral perfusion times were(193 ± 49)minutes,(90 ±28) minutes and(22 ± 10) minutes,respectively.The mean time to tracheal extubation was(17 ± 10) hours.All patients survived from the operation.One patient suffered from temporary left lower limb paralysis and recovered after treatment during follow-up.Computed tomography angiography (CTA)of aorta was performed on each patient before discharged from the hospital:descending aortic true lumen was significantly expanded,thrombosis of false lumen was found near stent graft.The average follow-up time was 17 (3-42) months,one patient died of aortic rupture 3 months later,one patient underwent total thoracoabdominal aorta replacement 6 months later,one patient with descending thoracic aortic dilatation combined with endometrial tear underwent thoracic endovascular aortic repair.Conclusion Reoperation should be performed as the following condition:the annual growth rate of residual aortic diameter exceeds 0.5 cm/year,the maximal aortic diameter exceeds 5 cm.The Sun's procedure (total arch replacement with the elephant trunk implantation) is safe and effective in the treatment of residual aortic dissection,low mortality and complications was achieved by it,the mid-and long-term results need the further follow-up.

Objective To summarize our clinical experience and results of intraoperative stented elephant trunk technique on Stanford type B dissection.Methods From March 2009 to December 2011,24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique in Beijing AnZhen Hospital.Of these patients,20 were male and 4 female,with a mean age of (50.6 ± 9.8) years,(36-77 years).Associated with hypertension in 20 cases,aortic root aneurysm in 1 case,aortic insufficiency in 2 cases,mitral insufficiency in 1 case,coarctation of the aorta in 1 case; 14 cases had a history of smoking.The postoperative internal fistula after descending thoracic aortic stent-graft occurred in 4 cases.Results 24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique.Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases,aortic valve replacement and ascending aortic plasty in 3 cases,left subclavian artery reconstruction in 2 cases,double valve replacement in 1 cases,the bypass from ascending aorta to descending aorta each in one.The times of cardiopulmonary bypass and selective cerebral perfusion averaged (163.1 ±48.6) min and (29.1 ± 12.4) min,respectively.There was no in-hospital mortality.Complications occurred in 2 patients (2/24,8.3％),including respiratory insufficiency and mediastinal bleeding requiring reoperation,each in one.No paraplegia or stroke occurred postoperatively.Follow-up was available in 23 patients (23/24,95.8％).During the follow-up,type Ⅰ endoleak occurred in 2 patient and needed surgical repair.One patient underwent endovascular aortic repair due to pseudoaneurysm of the distal end of the stent.The complete thrombosis ratio of the false lumen was 86.4％ (20/24).Conclusion The intraoperative stented elephant trunk technique was safe and feasible for Stanford type B aortic dissection with insufficient anchored zone or the left subclavian.artery involvement,a low rate of morbidity and mortality were achieved.The long-term results need the further follow-up.

This study was aimed to evaluate the clinical effect and safety of Chinese medicine treatment of lumbar disc herniation with qi-tonifying, stasis-resolving and kidney-tonifying method. The randomized con-trolled trial (RCT) was applied in the study to evaluate the clinical effect of qi-tonifying, stasis-resolving and kidney-tonifying method in the treatment of lumbar disc herniation . A total of 122 lumbar disc herniation pa-tients were randomly divided into the treatment group ( n = 61 ) and the control group ( n = 61 ) . Chinese medicine treatment with the qi-tonifying, stasis-resolving and kidney-tonifying method was applied in the treatment group . And Celecoxib and Methycobal were orally administered in the control group . Then , the VAS scores, JOA scores, Oswestry disability index (ODI) were recorded and analyzed pre-treatment, four weeks af-ter treatment and the twelfth week of follow-up in order to evaluate the clinical effect . Adverse reactions were also observed and recorded at the same time to give a comprehensive evaluation on its safety . The results showed that there were no significant differences between the treatment group and control group in the baseline data before treatment . Hence , data from two groups were comparable . Compared with pre-treatment , the VAS scores and ODI scores were obviously reduced in both groups after four-week treatment . The JOA scores were increased obviously ( P < 0 . 05 ) . There were no statistical differences on ODI scores and JOA scores between two groups . The VAS scores of the treatment group were obviously higher than the control group ( P < 0 . 05 ) . In the twelfth week of follow-up , the VAS scores , ODI scores and JOA scores had increasing tendency in
both groups . There were no statistical differences between two groups . There were no statistical differences on the total effective rate between two groups . In the treatment group , four patients received surgery , four cases lost to follow-up , and four cases with mild adverse event . In the control group , six patients received surgery , three cases lost to follow-up , and two cases with mild adverse event . It was concluded that the RCT of Chi-nese medicine treatment of lumbar disc herniation with q i-tonifying , stasis-resolving and kidney-tonifying method received same clinical effect as the combination of Celecoxib and Methycobal . The Chinese medicine treatment can effectively relieve pain degree of lumbar disc herniation , improve function of the lumbar vertebrae and improve the daily life and social activity ability of patients. The short-term follow-up effects were con-firmed . However , the long-term efficacy still requires further study .

Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass ＞ 5 mm,spinal stenosis ＞50％),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the arachnoid was reserved in order to reduce dural damage.Dural defects were repaired by suturing or covering with muscle.After surgery,patients were confined to bed rest to allow for drainage or puncture.Results All 15 patients were followed up for 12 to 18months (average,14.8 months).After operation,10 patients recovered fully without CSFL.Five patients developed CSFL,including 4 cases of spinal dural mater injury that healed within 4-6 days with bed rest and pressure dressing,and 1 case of cerebrospinal fluid pseudocyst that disappeared within 3 weeks with repeat puncture and aspiration treatment.No cases required secondary operations or shunt placement.All cases exhibited good neurological improvement.Conclusion During anterior surgical treatment for severe cervical OPLL,CSFL can be effectively prevented through eareful analysis of preoperative CT images,meticulous operative technique,reasonable handling of the ossified mass and positive repair of dural damage.Moreover,postoperative bed rest and drainage are effective to treat CSFL.

This study sought to assess the effect of Ginsenoside Rg1 on streptozocin-induced diabetic nephropathy in rats and to unveil the underlying mechanism. Diabetic nephropathy (DN) was induced by intraperitoneal injection of streptozocin (STZ). Eight weeks after drug administration, the rats from each group were sacrificed. Serum creatine (Scr) and 24 hours urine protein, cross reaction protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured at the end of the study. The histological changes of renal interstitial tissues were observed by periodic acid-Schiff staining (PAS). Immunohistochemical method was used to examine the expression levels of ectodermal dysplasia (ED-1). The mRNA of transforming growth factor-beta1 (TGF-beta1) was measured by real-time PCR (RT-PCR), and the protein expression of TGF-beta1 was surveyed by Enzyme-Linked Immunosorbent Assay (ELISA). The renal pathological changes in DN rats given ginsenoside Rg1 treatment were ameliorated, and the expression levels of 24 h urine protein, serum creatinine, CRP, TNF-alpha, ED-1 and TGF-beta1 were significantly lower than those in the diabetic nephropathy group (P < 0.05). So, we reach a conclusion that, in the experiment, Ginsenoside Rg1 obviously reduced TGF-beta1 expression and the already-mentioned inflammatory reaction factors in the renal tissues and improved the renal pathological changes in DN rats.
Animals ; Diabetes Mellitus, Experimental ; complications ; Diabetic Nephropathies ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Ginsenosides ; therapeutic use ; Male ; Phytotherapy ; RNA, Messenger ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; genetics ; metabolism