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.

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 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.

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 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 effect of staging treatment for diabetic leg ulcer by vacuum sealing drainage surgery (VSD) combined with perforator flap.Methods From Aug.2013 to Aug.2015,21 patients (in glycemic stability) with diabetic leg ulcer received the sustained VSD suction after a thorough debridement at the first phase and used perforator flap to repair the wound at second phase.Results After a thorough debridement and the sustained VSD suction,all the wounds were repaired with perforator flaps at the second phase.Postoperative flaps of 19 cases survived completely.Postoperative flaps of 2 cases appeared 1/4-1/5 area necrosis of distal flap and healed well after clear debridement.All patients were followed up in glycemic stability and all the flaps survived well without complications such as osteomyelitis and soft tissue infection.Conclusion Based on glycemic stability,VSD combined perforator flap in treatment of diabetic leg ulcers can control the infection and wound closure,which is worthy of clinical application and promotion.

This study was aimed to select the best preparation form of medicinal in camellia cake,based on the optimal antithrombotic agents in oil tea camellia defatted cake to establish the foundation of research.The content of effective index component of the oil tea camellia defatted cake preparation was detected by HPLC-PDA.The quality of medicinal preparation from oil tea camellia defatted cake was characterized based on the content,relative quantity,relative ratio of content,yield rate and antithrombotic effect.The results showed that the effect of antithrombotic of three medicinal preparations from oil tea camellia defatted cake was listed in the following descending order of enrichment,ethanol extract,and water extract.The enrichment was the best preparation form of medicinal in oil tea camellia defatted cake preparation with the highest content of effective index components,the lowest extract rate and the lowest dosage.But it had the best effect of antithrombotic.It was concluded that the significant improvement of efficacy was due to the increase of the content of the components in the preparation and the rationality of the proportion.At the same time,analysis of component quality based on basic composition of drug system through the consideration of effective components of type and quantity,composition and other quality factors can further guide the preparation of drugs.

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.