The application value of GeneXpert MTB/RIF Ultra in the detection of special specimens of tuberculosis / 中国热带医学

@#Abstract: Objective To compare the diagnostic efficacy of the upgraded version of the GeneXpert automated fluorescent quantitative PCR system (GeneXpert MTB/RIF Ultra, GeneXpert Ultra) and the original version of the GeneXpert system (GeneXpert MTB/RIF, Xpert), real-time fluorescent quantitative nucleic acid detection (FQ-PCR), real-time fluorescent thermostatic amplification of Mycobacterium tuberculosis RNA (SAT-RNA), real-time fluorescent thermostatic amplification detection of DNA (thermostatic amplification method) and traditional BACTEC MGIT 960 liquid culture (culture method) for special specimens of tuberculosis, in order to analyze its application value in clinical detection. Methods Using prospective research methods, a total of 170 special specimens (including 47 pleural and ascites effusion samples, and 34 24-hour urinary sediment specimens, 49 tissue specimens and 40 fester specimens) were collected i'an Chest Hospital from January to September 2021. GeneXpert Ultra, Xpert, FQ-PCR, SAT-RNA, isothermal amplification, and traditional culture were used for detection. Clinical diagnosis was used as the standard, and sensitivity, specificity, positive predictive value, negative predictive value, coincidence rate, and Kappa value were compared among the methods. Results The sensitivities of GeneXpert Ultra, Xpert, FQ-PCR, SAT-RNA, isothermal amplification, and traditional culture were 65.18% (73/112), 49.11% (55/112), 37.50% (42/112), 19.64% (22/112), 8.04% (9/112), and 22.32% (25/112), respectively. The sensitivity of GeneXpert Ultra was higher than that of the other five methods, and the differences were statistically significant (χ2=66.25, 42.10, 28.89, 13.09, 4.92, 15.18, all P<0.05). GeneXpert Ultra result analysis showed that: 5.48%(4/73) cases had trace, that is, trace Mycobacterium tuberculosis load, 79.45% (58/73) cases were extremely low, 10.96% (8/73) cases were low, 2.74% (2/73) were medium, , and 1.36% (1/73) were high load. In 4 trace samples, the Xpert detection was negative for all. Of the 73 GeneXpert Ultra positive reports, 63 were rifampicin-sensitive, 6 were rifampicin-resistant, and 4 were rifampicin-resistant but of unclear resistance. Of the 55 Xpert positive reports, 45 were rifampicin-sensitive, 2 were rifampicin-resistant, and 8 were rifampicinresistant but of unclear resistance.. Conclusions The new generation of GeneXpert MTB/RIF Ultra has high sensitivity, specificity and drug resistance detection rate, and its advantage is even more apparent in the pathogenic diagnosis of special specimens of tuberculosis. It can be used as one of the preferred methods in samples with low bacterial load.

Application of limiting antigen avidity enzyme immunoassay for estimating HIV-1 incidence in men who have sex with men / 中华流行病学杂志

Objective: To estimate the incidence of HIV-1 infection in men who have sex with men (MSM) in key areas of China through HIV-1 limiting antigen avidity enzyme immunoassay (LAg-Avidity EIA), analyze the deviation from the actual results and identify influencing factors, and provided reference for improving the accuracy of estimation results. Methods: Based on the principle of the cohort randomized study design, 20 cities were selected in China based on population size and the number of HIV-positive MSM. The sample size was estimated to be 700 according to the HIV-1 infection rate in MSM. MSM mobile phone app. was used to establish a detection appointment and questionnaire system, and the baseline cross-sectional survey was conducted from April to November 2019. LAg-Avidity EIA was used to identify the recent infected samples. The incidence of HIV-1 infection was calculated and then adjusted based on the estimation formula designed by WHO. The influencing factors were identified by analyzing the sample collection and detection processes. Results: Among the 10 650 blood samples from the participants, 799 were HIV-positive in initial screening, in which 198 samples (24.78%) missed during confirmation test. Only 621 samples were received by the laboratory. After excluding misreported samples, 520 samples were qualified for testing. A total of 155 samples were eventually determined as recent infection through LAg-Avidity EIA; Based on the estimation formula , the incidence of HIV-1 infection in MSM in 20 cities was 4.06% (95%CI:3.27%-4.85%), it increased to 5.53% (95%CI: 4.45%-6.60%)after the adjusting for sample missing rate. When the sample missing rate and misreporting rate were both adjusted, the incidence of HIV-1 infection in the MSM increased to 5.66% (95%CI:4.67%-6.65%). The actual incidence of HIV-1 infection in MSM in the 20 cities might be between 4.06% and 5.66%. Conclusions: Sample missing and misreporting might cause the deviation of the estimation of HIV-1 infection incidence. It is important to ensure the sample source and the quality of sample collection and detection to reduce the deviation in the estimation of HIV-1 infection incidence.

Incidence, risk factors and prognosis of acute kidney injury early after lung transplantation / 中华器官移植杂志

Objective:To explore the incidence, risk factors and outcome of acute kidney injury (AKI) early after lung transplantation (LT).Methods:Clinical data were retrospectively reviewed for 167 LT patients. AKI was defined according to the criteria of Kidney Disease Improving Global Outcomes (KDIGO) guideline within the first 7 days post-LT. AKI incidence was calculated. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented with the Kaplan-Meier curve.Results:The incidence of AKI early post-LT was 65.9%. Gender (male), preoperative higher serum creatinine (sCr), lower glomerular filtration rate (eGFR), extracorporeal membrane oxygenation (ECMO), mechanical ventilation (MV), intraoperative or postoperative hypotension, cardiovascular events, postoperative septic shock, multiple organ failure, ECMO support ≥2 days and reintubation were risk factors for AKI early post-LT ( P<0.05). Postoperative AKI was correlated with prolonged MV and/or ECMO as well as ICU stay and higher short/long-term mortality post-LT. Conclusions:The incidence of AKI early post-LT is high and affects the prognosis of LT patients. Greater attention should be paid to early prevention of AKI to reduce its incidence and improve its prognosis.

Observation of the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis and its regulating effect on patients' serum interleukin-17/ interleukin-4 / 中国医师进修杂志

Objective:To explore the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis (AS) and its regulation of serum interleukin (IL)-17/IL-4.Methods:A total of 117 patients with AS in the First Hospital of Baoding from July 2016 to June 2019 were selected as prospective research subjects, and they were simply randomized into three groups, with 39 cases in each group. The control group A was treated with methotrexate, the control group B was treated with methylprednisolone, and the observation group was treated with methotrexate combined with methylprednisolone. The chi-square test was used to compare the clinical efficacy and the incidence of adverse reactions in the three groups. F-test was used to compare the thoracolumbar spine mobility, Bath AS disease activity index (BASDAI), Bath AS function index (BASFI) scores, the levels of serum high mobility protein 1 (HMGB1), matrix metalloproteinase-3 (MMP-3), interleukin (IL)-4, IL-17, and IL-17/IL-4 before and after the treatment of the three groups. Results:The total effective rate of treatment in the observation group was better than that in the control groups A and B :92.31%(36/39) vs. 74.36%(29/39) and 69.23%(27/39), P<0.05. After the course of treatment, the BASDAI and BASFI scores in the observation group were lower than those in the control group A and B, and the thoracolumbar spine mobility were higher than those in the control group A and B: (3.36 ± 1.03) scores vs. (4.62 ± 1.19), (4.98 ± 1.25) scores; (3.70 ± 0.89) scores vs. (4.36 ± 0.96), (4.64 ± 0.95) scores; (4.96 ± 1.17) cm vs. (4.18 ± 1.02), (3.98 ± 1.15) cm, (5.93 ± 1.32) cm vs.(5.02 ± 1.15), (4.92 ± 1.25)cm, P<0.05. After the course of treatment, serum HMGB1, MMP-3, IL-17, IL-17/IL-4 in the observation group were lower than those in the control group A and B: (20.25 ± 6.41) μg/L vs. (27.81 ± 7.63), (29.26 ± 7.31) μg/L; (4.83 ± 1.06) μg/L vs. (9.26 ± 1.25), (9.71 ± 1.28) μg/L; (13.41 ± 5.06)ng/L vs.(17.62 ± 5.61), (19.06 ± 6.14) ng/L; 0.51 ± 0.27 vs. 0.92 ± 0.41, 1.04 ± 0.45, P<0.05; and IL-4 was higher than that in the control groups A and B: (26.15 ± 4.94) ng/L vs. (19.16 ± 5.14), (18.32 ± 5.26) ng/L, P<0.05. There was no significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:The combination of methylprednisolone and methotrexate in the treatment of AS can significantly reduce serum HMGB1 and MMP-3 levels, regulate serum IL-17/IL-4 and further improve the therapeutic effect, and it has high safety.

Acute kidney injury following adult lung transplantation / 中华医学杂志(英文版)

BACKGROUND@#Acute kidney injury (AKI) is a common and serious complication following lung transplantation (LTx), and it is associated with high mortality and morbidity. This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.@*METHODS@#This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019. The outcomes were AKI incidence, risk factors, mortality, and kidney recovery. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented using the Kaplan-Meier curves.@*RESULTS@#AKI occurred in 137 of the 191 patients (71.7%), with transient AKI in 43 (22.5%) and persistent AKI in 94 (49.2%). AKI stage 1 occurred in 27/191 (14.1%), stage 2 in 46/191 (24.1%), and stage 3 in 64/191 (33.5%) of the AKI patients. Renal replacement therapy (RRT) was administered to 35/191 (18.3%) of the patients. Male sex, older age, mechanical ventilation (MV), severe hypotension, septic shock, multiple organ dysfunction (MODS), prolonged extracorporeal membrane oxygenation (ECMO), reintubation, and nephrotoxic agents were associated with AKI (P < 0.050). Persistent AKI was independently associated with pre-operative pulmonary hypertension, severe hypotension, post-operative MODS, and nephrotoxic agents. Severe hypotension, septic shock, MODS, reintubation, prolonged MV, and ECMO during or after LTx were related to severe AKI (stage 3) (P < 0.050). Patients with persistent and severe AKI had a significantly longer duration of MV, longer duration in the intensive care unit (ICU), worse downstream kidney function, and reduced survival (P < 0.050).@*CONCLUSIONS@#AKI is common after LTx, but the pathogenic mechanism of AKI is complicated, and prerenal causes are important. Persistent and severe AKI were associated with poor short- and long-term kidney function and reduced survival in LTx patients.

Evaluation, maintenance and procurement analysis of 128 lung donors from Beijing / 中华器官移植杂志

Objective:To assess the potentials for lung donation among 128 donors (deceased citizens) in 2017 from Beijing.Methods:Gender, age, blood type, duration of ventilation, oxygenation index (PaO 2/FiO 2), chest film and bronchoscopy were analyzed. Results:A total of 5135 deceased Chinese citizens were available for donation in 2017. The rate of donation per million population (PMP) was 3.71. And 463 donors from Beijing were recorded in 2017 and the rate of PMP was 21.05. In 2017, 299 lung transplantations were performed with an average rate of donor lung utility at 5.82%. Among 128 cases assessed for potential lung donors in Beijing, 72 were successfully procured with a percentage of lung utilization of 15.55%. There were 110 males (85.94%) and 18 females (14.06%) with an average age of (39.61±10.67) years. Mechanical ventilation duration was (7.59±2.93) days. The oxygenation rate (PaO 2/FiO 2) was (397.38±105.01) mmHg, (450±67.79) mmHg in procurement group and (338.89±116.15) mmHg in non-procurement group ( P=0.020). The median level of procalcitonin (PCT) was 0.195 ng/ml in procurement group versus 0.349 ng/ml in giving-up group ( P=0.042). Conclusions:Oxygenation rate and PCT level are the independent risk factors for reaching a procurement decision of donor lung. The actual PMP and lung procurement rate in Beijing were both higher than average domestic level (15.55% vs. 5.82%, P=0.000) because of excellent cooperation between Organ Procurement Organization (OPO) and lung transplantation centers. The evaluation of donor lungs and lung maintenance protocols from Beijing should be popularized nationwide.

Clinical Effect of Acupoint Application Therapy of Modified Wuzhuyu Binglang Tang on Chronic Non-atrophic Gastritis / 中国实验方剂学杂志

Objective: To observe the effect of acupoint application therapy of modified Wuzhuyu Binglang Tang on chronic non-atrophic gastritis (CNAG) and the mechanism of action. Method: Two hundred and seventeen patients were randomly divided into control group (107 cases) and observation group (110 cases) by random number table. Both groups' patients got Omeprazole enteric-coated tablets half an hour before meals, 20 mg/time, 2 times/day, bismuth potassium citrate tablets half an hour before meals, 2 tablets/time, 2 times/day, amoxicillin capsules after meals, 1.0 g/time, 2 times/day, two dimensional furazolidone tablets after meals, 1 tablet/time, 2 times/day, mosapride citrate tablets, 5 mg/time, 3 times/day. The treatment lasted for 2 weeks. Patients in observation group got acupoint application of modified Wuzhuyu Binglang Tang at Zhongwan, Weiyu, Geyu, Shenyu and Piyu for 6 h/day, 1 time/day. And the patients in control group got model drug at the same acupoints. Before and after treatment, epigastric fullness and epigastric pain were scored. Levels of motilin, gastrin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and prostaglandin E2 (PGE2) were detected. In 1-month follow-up visit, Hp and adverse reaction were detected under gastroscope. Result: The clinical effect in observation group under gastroscope was better than that in control group (Z=2.015, PZ=2.663, PPχ2=5.002, P2 was higher than that in control group (PConclusion: The acupoint application therapy of modified Wuzhuyu Binglang Tang can relieve the clinical symptoms, promote the negative conversion rate of Hp, improve the clinical effect, regulate gastrointestinal hormones, inhibiting release of inflammatory factors, protect gastric mucosa, and improve gastrointestinal function, with safety in clinic use.

Relationship Between Plasma suPAR Level and Acute Coronary Syndrome With its Influencing Factors / 中国循环杂志

Objective: To explore the relationship between plasma level of soluble urokinase plasminogen activator receptor (suPAR) and the severity of acute coronary syndrome (ACS) with its influence factors. Methods: A total of 321 consecutive patients with chest pain admitted in our hospital from 2015-03 to 2016-09 were studied. According to clinical presentation, laboratory test and coronary angiography (CAG), the patients were divided into 2 groups: ACS group, n=228 and Control group, the patients with normal coronary artery, n=93. Plasma levels of suPAR and high sensitive C reaction protein (hs-CRP) were measured by ELISA and compared between 2 groups. Results: The levels of plasma suPAR in ACS patients were significantly higher than those in the control group (OR= 0.104, 95％ CI: 0.048-0.223, P<0.01). In ACS group, the plasma suPAR level gradually increased with the increase of Gensini score, The sensitivity and specificity of the levels of suPAR were determined by ROC curve. The values of ACS were predicted to be 1.8 μg / L, the sensitivity was 0.732 and the specificity was 0.710. Multiple linear regression analysis showed that smoking, Gensini score and uric acid were the main factors affecting plasma suPAR levels. Conclusion: Elevated plasma suPAR level has been related to the severity of coronary stenosis in ACS patients, such relationship is superior to hs-CRP; suPAR might be worked as a new biomarker for predicting coronary stenosis and risk stratification in ACS patients.

Relationship Between Plasma suPAR Level and Acute Coronary Syndrome With its Influencing Factors / 中国循环杂志

Objective: To explore the relationship between plasma level of soluble urokinase plasminogen activator receptor (suPAR) and the severity of acute coronary syndrome (ACS) with its influence factors. Methods: A total of 321 consecutive patients with chest pain admitted in our hospital from 2015-03 to 2016-09 were studied. According to clinical presentation, laboratory test and coronary angiography (CAG), the patients were divided into 2 groups: ACS group, n=228 and Control group, the patients with normal coronary artery, n=93. Plasma levels of suPAR and high sensitive C reaction protein (hs-CRP) were measured by ELISA and compared between 2 groups. Results: The levels of plasma suPAR in ACS patients were significantly higher than those in the control group (OR= 0.104, 95％ CI: 0.048-0.223, P<0.01). In ACS group, the plasma suPAR level gradually increased with the increase of Gensini score, The sensitivity and specificity of the levels of suPAR were determined by ROC curve. The values of ACS were predicted to be 1.8 μg / L, the sensitivity was 0.732 and the specificity was 0.710. Multiple linear regression analysis showed that smoking, Gensini score and uric acid were the main factors affecting plasma suPAR levels. Conclusion: Elevated plasma suPAR level has been related to the severity of coronary stenosis in ACS patients, such relationship is superior to hs-CRP; suPAR might be worked as a new biomarker for predicting coronary stenosis and risk stratification in ACS patients.

Comparison of the outcomes of modified and traditional panretinal photocoagulation for the treatment of diabetic retinopathy / 眼科新进展

Objective To compare the efficacy and safety of modified panretinal photocoagulation (MPRP) and traditional panretinal photocoagulation (PRP) for diabetic retinopathy (DR).Methods The clinical case-control methods were used.A total of 53 patients (106 eyes) who were confirmed as severe nonproliferative diabetic retinopathy (NPDR) or mild proliferative diabetic retinopathy (PDR) after fundus fluorescein angiography (FFA) between October 2013 to January 2017 were enrolled in this study,and the two eyes of each patients were in the same degree of DR,with the 53 right eyes undergoing MPRP (treatment group) and the 53 left eyes receiving PRP (control group).Various including visual acuity,intraocular pressure,mydriatic fundus photography and optical coherence tomography (OCT) findings were observed at 1 day,1 week,1 month,3 months and 6 months after laser treatment,and FFA examination was performed 3 months and 6 months after laser treatment for the comparison of the efficacy and safety in the two groups,Results There was no statistically significant difference in the best-corrected visual between the two groups after treatment (all P ＞ 0.05),but the average visual acuity of the treatment group was higher than that in the control group.The retinal nonperfusion area and new blood vessels disappeared in 39 eyes (73.6％) in the treatment group,and the effective rate was 91％,while the area and new blood vessels disappeared in 29 eyes (54.7％) in the control group,and the effective rate was 75％.There were significant differences in the retinal nonperfusion disappearance and the effective rate of the two groups (both P ＜0.05).Conelusion MPRP is an effective and safe technique in the treatment of diabetic retinopathy,which is superior to traditional PRP.

Protective effect of Zhenrenyangzang decoction on intestinal mucosal bar-rier function in ulcerative colitis rats / 中国病理生理杂志

AIM:To investigate the protective effect of Zhenrenyangzang decoction (ZRYZ) on the intestinal mucosal barrier function and the expression of tight junction proteins,zonula occludens-1 (ZO-1) and occludin,in the co-lon of rats with trinitrobenzenesulfonic acid (TNBS)-induced ulcerative colitis in order to explore the possible mechanism involved. METHODS:Male Wistar rats were randomly divided into normal group, model group, salazosulfapyridine (SASP) positive control group,high-dose ZRYZ(ZRYZ-H) group and low-dose ZRYZ(ZRYZ-L) group. Except the nor-mal group,the rats in other groups were given the TNBS/50% ethanol mixed solution by enema to make the ulcerative coli-tis model. The rats in positive control group were given SASP suspension liquid. The rats in ZRYZ-H group and ZRYZ-L group were orally administered with ZRYZ at doses of 30.4 g/kg and 15.2 g/kg, respectively, while the rats in normal group and model group were orally administered with saline. All the drugs were administered to the rats for consecutive 21 d. Disease activity index (DAI) was investigated during the drug treatment, and colon samples were collected after drug administration for evaluating morphological damage score. Intestinal mucosal permeability was measured by detection of lac-tulose/mannitol (L/M) in urine. Colonic myeloperoxidase(MPO) activity and goblet cell number,serum diamine oxidase (DAO) and D-lactic acid (D-LA) levels, and the colonic expression of ZO-1 and occludin were also measured. RE-SULTS:Compared with normal group,DAI,morphological damage score,L/M value,colonic MPO activity as well as se-rum D-LA and DAO levels in model group significantly increased(P<0.05),while goblet cell number as well as the ex-pression levels of ZO-1 and occludin in model group were significantly reduced(P<0.05). Compared with model group, DAI,morphological damage score,L/M value,colonic MPO activity as well as serum DAO and D-LA levels in ZRYZ-H group and ZRYZ-L group were reduced significantly(P<0.05),while goblet cell number as well as the expression of ZO-1 and occludin in ZRYZ-H group and ZRYZ-L group increased significantly(P<0.05). CONCLUSION:ZRYZ protects the intestinal mucosal barrier function in ulcerative colitis rats by reducing intestinal mucosal permeability,and its mecha-nisms may be related to increasing the expression of ZO-1 and occludin.

Study on the Orthogonal Optimization of Acupuncture, Tuina and Ultrasonic Treatments for Upper Limb Motor Dysfunction after Cerebral Infarction / 上海针灸杂志

Objective To develop a optimized rehabilitation protocol for acupuncture, Tuina and ultrasonic treatments of upper limb motor dysfunction after cerebral infarction.Methods An orthogonal design with three factors (acupuncture as factor A, Tuina as factor B and ultrasound as factor C) and two levels was used. Eighty cerebral infarction patients with upper limb motor dysfunction were randomly allocated to eight groups, 10 cases each. The National Institute of Health Stroke Scale (NIHSS) score and the simplified Fugl-Meyer Assessment (FMA) score for upper limb motor function were recorded after four weeks of treatment. Results There were no statistically significant pre-treatment differences in the NIHSS score and the FMA score for the upper limb between the groups (P>0.05). For an improvement in NIHSS, factors A and B were both significant (bothP0.05). Factors A, B and C were all significant for an improvement in the FMA score for the upper limb (P<0.05,P<0.01,P<0.05). A2B1C1 was the optimal protocol.Conclusions A combination of bilateral acupuncture, Tuina and ultrasound is an optimized protocol for treating upper limb motor dysfunction after cerebral infarction. It can effectively reduce upper limb motor dysfunction.

Treatment of knee osteoarthritis with acupuncture and moxibustion: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the difference of the efficacy on knee osteoarthritis (KOA) between the combined therapy of acupuncture and moxibustion and western medication, and explore the better therapeutic method for KOA.</p><p><b>METHODS</b>One hundred and sixty patients were divided into a combined therapy group and a western medication group, 80 cases in each one according to the visit sequence, with the random number table adopted. In the combined therapy group, the main points were selected from the local painful sites, combined with the acupoints based on the syndrome differentiation and distal acupoints on the affected meridians. The lifting, thrusting or rotating technique was used and the reinforcing or reducing manipulation was applied according to the syndrome differentiation. "Duanci" or "Shuci" needling technique was used specially at the extra points and Ashi points. The needling sensation relied on the patients' tolerance. After acupuncture, the heat-sensitive moxibustion with pure moxa stick was applied over the local painful sites around knee joint and Shenshu (BL 23) to detect the heat-sensitized points. Acupuncture and moxibustion were given once every day. The treatment of 5 days made 1 session. There were 2 days at the interval between two sessions. In the western medication group, glucosamine sulfate capsules were prescribed for oral administration, 2 capsules each time, three times a day. Additionally, the joint cavity injection was combined. On the first day, sodium hyaluronate 25 mg and triamcinolone acetonide acetate 50 mg were injected. Afterwards, on the 8th, 15th, 22nd and 29th days, sodium hyaluronate injection 25 mg was used only. The treatment was for 5 weeks totally in the two groups. The efficacy was analyzed statistically in 5 weeks. The follow-up visit was conducted in 3 months and 6 months after 5 weeks treatment, respectively. The Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) were adopted to assess the recovery of joint function.</p><p><b>RESULTS</b>The efficacy in 5 weeks of treatment was different significantly between the two groups (P < 0.05). The efficacy in the western medication group was better than that in the combined therapy group. The difference in the safety assessment was remarkable (P < 0.01). The result in the combined therapy group was superior remarkably to the western medication group. In 3-month follow-up visit after treatment, the knee joint function was not different obviously between the two groups (P > 0.05). In 6-month followup visit after treatment, the knee joint function was different obviously between the two groups (P < 0.01). The result in the combined therapy group was better remarkably than that in the western medication group.</p><p><b>CONCLUSION</b>The combined therapy of acupuncture and moxibustion achieves the safe and effective therapeutic effect with less adverse reactions in the treatment of KOA. The immediate effect in the combined therapy group is not so obvious as compared with the western medication, but the long-term efficacy is remarkably superior to western medication.</p>

Therapeutic Observation on Treatment of Infantile Diarrhea with Tuina on Differentiation of Acupoints / 针灸推拿医学（英文版）

Infantile diarrhea was divided into four types of wind cold,damp heat,food injury and spleen deficiency on differentiation of symptoms and signs.The techniques of tonifying the spleen,clearing Dachang(large intestine),rubbing the abdomen and pressing Zhixie (stopping diarrhea) point,Zusanli (ST 36) and Changqiang (GV 1) as well as pinching the spine were chosen to treat this disease with a satisfactory result.

On the Freedom of Learning of College Students in the Background of Higher Education Popularization / 中华医学教育探索杂志

Freedom of learning is quite rational and reasonable in higher education due to the essential nature of higher education, the mental and physiological conditions of college students and the great significance of itself. Under the background of the current situation of higher education popularization, the problem of learning freedom is beginning to be more serious. The author thinks that breakthroughs should be achieved from both the ideological and institutional aspects and there always exists a contradiction between the free choice of the students and the regulations of the university or the society. So in this sense, the freedom of learning of college students is a kind of limited freedom.

On the Fear of Mistakes and Failures and the Creative Development of College Student / 中华医学教育探索杂志

The “fear of mistakes and failures” is the psychological state of being scared by the potential mistakes and failures,and therefore dare not to try and explore.This kind of fear is extremely harmful to the creative development of college students.The college students' “fear of mistakes and failures” can be caused by a lot of social issues.The paper is intended to analyze this kind of psychological phenomenon and then put forward the countermeasures to get rid of it.