Hypervirulent Klebsiella pneumoniae ( hvKP) mainly infects healthy people and causes serious infections, such as liver abscess, meningitis, necrotizing fasciitis, endophthalmitis and severe pneu-monia. Studies have shown that hvKP is more virulent than classic Klebsiella pneumoniae characterized by ex-pressing more capsular polysaccharide and carrying the virulence factors including magA, rmpA and iron ac-quisition molecules. The greater survival and anti-phagocytosis abilities of hvKP strains contribute to the spread and metastasis of hvKP infection. This review describes the virulence factors, colonization and infec-tion of hvKP as well as the host immunity to hvKP.

OBJECTIVE:To optimize the processing technology of honey-fried Polygonum perfoliatum. METHODS:The pro-cessing method of honey-fried P. perfoliatum was optimized by L9(34)orthogonal test with the contents of effective component quer-cetin and water-soluble extract as comprehensive evaluation index,with the amount of honey,moistening time,baking temperature and baking time as investigating factors. RESULTS:The optimal processing technology was as follows as 30% honey,moistening for 120 min,baking for 50 min at 70 ℃. In verification test,the content of quercetin in 3 batches of honey-fried P. perfoliatum was higher than 0.05%,and the content of water-soluble extract was higher than 25%(RSD<2.5%,n=3). CONCLUSIONS:The optimized processing technology is stable and practical,and can provide reference for standardizing the processing technology and quality control of honey-fried P. perfoliatum.

Objective To investigate the efficacy of the combination of improved intramedullary VSD drainage and contained antibiotics bone graft to treat chronic tubular bones osteomyelitis.Methods From March,2011 to December,2013,our department have total of 40 patients with chronic tubular bones osteomyelitis.Twenty cases (group A) treat with one-stage osteomyelitis debridement cortical bone slotted,contained antibiotic bone and autologous bone implants and wound repair.Twenty cases (group B) treat with improved intramedullary VSD drainage 3-5 days temporarily after osteomyelitis debridement cortical bone slotted,then contained antibiotic bone and autologous bone implants and wound repair.A retrospective comparison of two groups of an average residence time of wound drainage postoperative,bone bed bacterial culture positive rate,average healing time,the average time of hospital stay,the average bone healing time,and recurrence rate of osteomyelitis.Statistical analysis with T test was used for above independent parametric.Results The two groups were followed-up for 6-24 months,independent samples t-test was used for two groups in the wound healing time,bone healing time,the drainage tube removal time and the length of hospital stay,in group A bone bed bacteria culture positive rate was 40％,group B was 5％,group A infection relapse has 2 cases,1 case was debridement cured,1 case was amputation,and the recurrence rate of 10％.Group B without infection recurrence,and the recurrence rate of 0％ ; The healing time and hospital stay of intramedullary drainage surgery patients (18.05 ± 2.74 d and 22.65 ± 2.80 d,respectively,in group B) was significantly less than one-stage surgery patients (24.10 ± 8.20 d and 28.10 ± 9.35 d,respectively,in group A),but the bone healing time and the drainage tube removal tine of two groups.There was no significant difference (P ＞ 0.05).Conclusion Contained antibiotic bone and autologous bone implants with wound healing therapy after osteomyelitis debridement cortical bone slotted with improvement VSD intramedullary drainage to treat patient with tubular bones osteomyelitis was more effective,it worthy of clinical spread.

Objective To investigate the clinical efficiency of perforator pedicled propeller flaps for soft-tissue coverage of the lower leg and foot defects.Methods From July 2007 to December 2011,twentyfive cases with soft-tissue defects of the lower leg and foot were cured by using the perforator propeller flaps.The origins of the perforator were 18 cases from peroneal artery,six cases from posterior tibial artery and 1 case from dorsal foot artery.The minimum of the flap scale was 4-9 cm,and the maximum was 10-33 cm.Results All cases were followed-up from 1 to 26 months.All the flap pedicles were smooth with a satisfied appearance.The donor sites were sutured directly in 9 cases and cured with skin-grafting in 16 cases.Three cases suffered from vein congestion,two cases were cured by incisions in the distal parts of the flaps,one flap had necrosis of the distal 1/3 part and was cured by skin-grafting.Conclusion The perforator pedicled propeller flap is a simple,safe and useful flap.It has more advantages than other pedicled flaps for softtissue coverage of the lower leg and foot defects.

Objective To investigate the feasibility of a single-stage operation in the treatment of traumatic osteomyelitis with flap and vancomycin-impreganted artificial bone. Methods Forty-one cases using one single-stage operation in the treatment of traumatic osteomyelitis with flap and vancomycin-impreganted artificial bone were cured, osteomyelitis recurred in 2 cases, and was cured after debridement and vancomycin-impreganted artificial bone plantation again. 1 case occurred nonunion and was cured by autogenous nonvascular iliac bone transplantation. Results All cases were followed from 4 months to 2 years, the average fracture cured time was 5.3 months(3-9 months), and the average wound cured time was 3.7 weeks. The soft tissue defect was cured in one stage, the osteomyelitis of all cases was cured at last. Conclusion It is feasible that one single-stage operation treated the traumatic osteomyelitis with flap and vancomycin-impreganted artificial bone.

BACKGROUND: Tonifying kidney is the main method to treat aging of nervous system, which is characterized by decreasing density of nerve cells,cell aging and deposition of lipofuscin granule in the cytoplasm of nerve cell.OBJECTIVE: To investigate the effect of nourishing kidney and tonifying brain on density and ultrastructural of nerve cell in hippocampal CA1 and CA3 area of aging mouse. DESIGN: Completely randomized and controlled study.SETTING: Institute of Traditional Chinese Medicine of Hunan Province.MATERIALS: The experiment was completed at the Pharmacological Laboratory of Institute of Traditional Chinese Medicine of Hunan Province between September 2000 and November 2003. Totally 30 Kunming mice with 11-month old were selected. Solution of yishen jiannao Ⅰ (zishen prescription) was provided by Agent Laboratory of Institute of Traditional Chinese Medicine of Hunan Province (including 15 g shouwu, 15 g sangshen, 15 g gouqizi, 6 g wuweizi, 30 g danshen, 30 g gegen, 10 g honghua,10 g shichangpu, 10 g yujin, 10 g yuanzhi, 10 g shanzha and scorpion).Scorpion was crushed into power. The rest drugs were decocted with water twice, mixed together and filtered, then the powder of scropion was added.The raw material was 1.0 g/mL.METHODS: Thirty mice were randomly divided into 3 groups with 10 in each group. Mice in control group were given distilled water, those in zishen prescription group were given 20.0 g/kg zishen prescription, and in vitamin E group were given 40.0 mg/kg vitamin E. All mice were perfused with 20 mL/g, once a day for 4 weeks. After 1 hour of the last medication, mice were sacrificed at once at the drugged state. Cranium of mice was sheared and the hippocampal tissue was taken out. Numbers of nerve cells in CA1 and CA3 area were calculated under the microscope to calculate the density of nerve cell.MAIN OUTCOME MEASURES: ① Density of nerve cell in cerebral hippocampus of mice in each group; ② Ultrastructure of nerve cell in cerebral hippocamp us of mice in each group.RESULTS: Totally 30 mice entered the final analysis. ① Density of nerve cell in hippocampal CA1 and CA3 area of brain: Density in zishen prescription group and vitamin E group was higher than that in control group [CA1: (3 707±495), (3 812±281), (257±372) mm-2; CA3:(2 746±262),(2 397±366), (1 992±307) mm-2, t=2.68-8.30, P ＜ 0.05-0.01]. ② Aging of mitochondrion was decreased, deposition of lipofuscin and aging of lysosome in cytoplasm were reduced in zishen prescription group and vitamin E group.CONCLUSION: Granule of nourishing kidney and tonifying brain can defer density decrease of nerve cell and aging of cell in hippocampla area of mice' brain.

Objective:To observe the clinical effect of combining acupuncture, Chinese medicine and rehabilitation training for subacute stroke. Methods:A total of 120 subacute stroke cases were randomly allocated into a treatment group (n=60) and a control group (n=60). Patients in the control group received standard rehabilitation therapy alone, whereas patients in the observation group received additional acupuncture and Chinese medicine. Before treatment, after 30-day and 60-day treatments, and 3 months after treatment, the neurologic deficit severity was evaluated using the National Institute of Health stroke scale (NIHSS); the motor function was evaluated using the Fugl-Meyer assessment scale (FMA); the activities of daily living (ADL) was evaluated using the Barthel index (BI); and the changes of traditional Chinese medicine (TCM) symptoms were evaluated according to TCM symptom scores. Results:After 30-day, 60-day treatments, and 3 months after treatment, the NIHSS, FMA, BI and TCM symptoms scores were statistically different from those before treatment in both groups (allP<0.05); and there were between-group statistical differences at same time points (allP<0.05). Conclusion:Combining acupuncture, Chinese medicine and rehabilitation training can improve neurologic deficit, motor function and ADL in subacute stroke patients and its efficacy is better than rehabilitation therapy alone.

Objective To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke depression.Method Forty-one patients with post-stroke depression were randomized into a treatment group of 22 cases and a control group of 19 cases. In addition to the basic internal medicine treatment, the treatment group received acupuncture plus rehabilitation training, while the control group was intervened by rehabilitation training alone. The Hamilton Depression Scale (HAMD) and National Institutes of Health Stroke Scale (NIHSS) were observed and compared before and after treatment.Result The HAMD and NIHSS scores in the two groups were significantly changed respectively after 4-week and 8-week treatment (P<0.05,P<0.01). Respectively after 4-week and 8-week treatment, the HAMD and NIHSS scores in the treatment group were significantly different from that in the control group (P<0.05,P<0.01).Conclusion Acupuncture plus rehabilitation training is an effective approach in treating post-stroke depression.

Objective To discuss the clinical effect of the phase-one treatment scheme for traumatic osteomyelitis in tibia by combining flap,vancomycin-loaded calcium sulfate and autogenous iliac bone.Methods From January,2009 to July,2014,49 patients which had traumatic osteomyelitis in tibia and met the inclusive criteria were investigated and treated.By taking these patients as treatment group A(34 cases),they were treated by adopting the phase-one treatment scheme of combing tissue flap,vancomycin-loaded calcium sulfate and autogenous iliac bone.Fifteen patients who were treated by using the phase-one treatment scheme,namely,removing the lesion,implanting vancomycin-loaded calcium sulfate and repairing the defect by means of tissue flap,were chosen as control group B.Concerning treatment group A,drainage fluid was collected after operation every day to measure the concentration of vancomycin until drainage tube was removed.All the patients were followed up to study the following indexes:the standing time of drainage tube,the healing time of fracture,infection control rate,bone nonunion rate and other complications.Results All cases were followed up during 17 to 40 months after operation and no amputation was conducted for the affected limb.To repair soft tissue defect,flap and direct suture were adopted for 25 and 9 cases respectively in group A;The results indicated that all flaps survived,the poor healing of flap defect was observed for 2 cases which were healed after dressing change.However,to repair soft tissue defect,all group B cases used flaps;results revealed that distal flap necrosis was found in 2 cases applying neurocutaneous flap,with defect exudation and infection while the 2 cases were cured after debridement and dressing change without performing a second flap operation.In group A,3 cases recurred during 5 months to 2 years after operation;in group B,it was 1;other complications included pintract infection,nonunion,numbness of anterolateral thigh,hematocele in iliac 1 region.In group B,refracture occurred for 2 cases at the original lesion location 18 and 25 months after healing and was cured after plate refixation and the graft of autogenous iliac bone;intraoperative pathology validated no recurrence of osteomyelitis.The standing time of drainage tube was (12.53±4.56) days on average for group A while (17.07±3.87) days for group B;The difference was statistically significant (P＜0.05).The healing time of fracture was (6.20±2.16) months on average for group A while(8.36±2.84) months for group B.The difference was statistically significant(P＜0.05).Conclusion In one stage treatment of localized and diffused traumatic osteomyelitis,the scheme of combining tissue flap,vancomycin-loaded calcium sulfate and autogenous iliac bone effectively shortened the healing time of fracture,increased the healing strength,and reduced the exudation after operation,without increasing infection recurrence rate.The scheme was superior to merely implanting vancomycin-loaded calcium sulfate.

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.