Objective:To explore the barriers and facilitators of exercise rehabilitation in patients with atrial fibrillation (AF) after radiofrequency ablation.Methods:From March to August 2022, 285 patients with atrial fibrillation who underwent radiofrequency ablation within three months were recruited from the "Cloud Ward" of the Department of Cardiovascular of the First Affiliated Hospital with Nanjing Medical University by convenience sampling. The Cardiac Rehabilitation Barriers Scale (CRBS) and the Self-efficacy for Exercise Scale (SEE) were used to evaluate the barriers and self-efficacy of patients participating in exercise rehabilitation, respectively. Among them, 22 patients were subjected to semi-structured interviews to extract themes.Results:Among 285 patients with atrial fibrillation, 202 (70.88%) participated in exercise rehabilitation programs. Work/time conflicts, lack of cardiac rehabilitation knowledge, and health/physical function limitations affected the participation of patients in exercise rehabilitation ( P<0.05). Qualitative research extracted three themes that affected the patient's exercise rehabilitation, including capability, opportunity, and motivation. Conclusions:The participation of atrial fibrillation patients in exercise rehabilitation is influenced by multiple factors such as family responsibility, capability, motivation, and opportunity. Medical and nursing staff should comprehensively consider the above factors, develop targeted interventions from all aspects and multiple angles, so as to effectively improve the participation of patients in exercise rehabilitation.

Objective:To explore the application value of magnifying endoscope and flexible spectral imaging colour enhancement(ME-FICE)combined with small ultrasound probe in the diagnosis of early gastric cancer and precancerous lesions.Methods:A total of 80 patients with suspected gastric cancer who admitted to Wuhan Red Cross Hospital from April 2021 to April 2022 were selected,and the ME-FICE was used to distinguish positive and/or negative lesions,and then,small ultrasound probe with high-frequency were used to explore the depth of the infiltration of the lesions.After the examination,biopsy should be performed on the obvious position of lesion under FICE mode.The endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD)or surgical resection were performed on the lesions according to the different intentions of the positive patients.The result of postoperatively pathological examination was the"gold standard"for diagnosis.Kappa consistency test was used to evaluate the consistency of benign and malignant diagnosis,the assessment of infiltration depth under endoscope and the assessment of infiltration depth after surgery between ME-FICE combined with small ultrasound probe and pathological examination.Results:The sensitivity,specificity and accuracy of ME-FICE combined with small ultrasound probe were respectively 90.63%,79.17%and 83.75%for benign and malignant diagnosis,which were at higher levels.The Kappa value of that was 0.887,which had favorable consistency with the result of biopsy for cases.The sensitivity,specificity and accuracy of ME-FICE combined with small ultrasound probe were respectively 66.67%,90.00%and 81.25%for the assessment of infiltration degree,indicating poor sensitivity and higher level of other indicators,with a Kappa value of 0.803,which had favorable consistency with postoperatively pathological results.Conclusion:ME-FICE combined with small ultrasound probe is suitable for the diagnosis of early gastric cancer and precancerous lesions,which can improve the sensitivity and accuracy of disease diagnosis,and more accurately assess the degree of infiltration before surgery,and provide guidance for subsequently surgical selection and treatment.

Objective The combined detection of serum angiopoietin-like protein 8(ANGPTL8)and Vascular cell adhesion molecule-1(VCAM-1)levels was analyzed for the predictive value of cerebral vasospasm(CVS)after intracranial aneurysm embolization.Methods A total of 196 patients who underwent intracranial aneurysm embolization in our hospital from March 2019-March 2022 were selected as the study subjects,99 patients with CVS were in the CVS group,and 97 patients without CVS were in the non CVS group.Serum ANGPTL8 and VCAM-1 levels were detected by ELISA;the correlation between serum ANGPTL8 and VCAM-1 levels was analyzed by Pearson method,Logistic regression was used to analyze the influencing factors of CVS in patients undergoing intracranial aneurysm embolization;ROC curve was used to analyze the serum levels of ANGPTL8 and VCAM-1 to predict the cutoff value of CVS in patients undergoing intracranial aneurysm embolization;four grid table method was used to analyze the predictive value of ANGPTL8,VCAM-1 and their combination on the occurrence of CVS in patients undergoing intracranial aneurysm embolization.Results The differences between CVS and non-CVS groups were statistically significant in hypertension,Hunt-Hess grade,and Glasgow coma(GCS)scores(P＜0.05).The serum ANGPTL8 and VCAM-1 levels in the CVS group were significantly higher than those in the non-CVS group(P＜0.05).There was a positive correlation between serum ANGPTL8 and VCAM-1(r=0.468,P＜0.05).Multivariate analysis showed that high level of ANGPTL8(OR=3.652,95％CI:1.434-9.302),high level of VCAM-1(OR=2.619,95％CI:1.212-5.658),Hunt Hess grade Ⅲ-Ⅳ(OR=1.927,95％CI:1.104-3.362),GCS score of 3-8(OR=2.813,95％CI:1.257-6.295)were independent risk factors for CVS in patients undergoing intracranial aneurysm embolization.The AUC of serum ANGPTL8 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.844,and the cut-off value was 189.233 U/L;the AUC of serum VCAM-1 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.795,and the cutoff value was 17.984 mg/L.The accuracy,sensitivity and specificity of the combined prediction for CVS were 89.81％,93.94％and 85.57％,respectively,which were obviously higher than those of the single prediction.Conclusion The serum levels of ANGPTL8 and VCAM-1 in CVS group are obviously higher than those in non CVS group.The combination of the two has a high predictive value for CVS after intracranial aneurysm embolization.

Objective:To analyze clinicopathological features of thyroid nodules and to assess preoperative diagnostic methods for the nature of nodules.Methods:The clinical and pathological data of 2 132 patients [456 males and 1 676 females with a mean age of (48.7±11.4) year] with thyroid nodules who underwent surgical treatment in our hospital from January 2017 to December 2019 were retrospectively analyzed. Among all patients, 433 nodules had complete fine needle aspiration biopsy cytology (FNAC) and ultrasound results were selected for further assessment. According to preoperative high-resolution ultrasound images, the nodules were classified by Kwak thyroid imaging and reporting data systems (Kwak TI-RADS) and American College of Radiology TI-RADS (ACR TI-RADS). ROC curve was used to assess the diagnostic efficacy of the two ultrasound modes and FNAC.Results:In 2 132 patients with thyroid nodules, 743 were benign and 1 389 were malignant. In all malignant cases 1 119 were females, accounting for 80.56%. In newly diagnosed benign nodules, 67.97% (505/743) were found by examination, and 32.03% (238/743) were self-found. In malignant nodules, 48.67% (676/1 389) were detected by examination, 51.33% (713/1 389) were self-found. The malignant rate of nodule diameter≤1 cm was the lowest in 1 118 patients with complete thyroid ultrasound data. In 628, 722 and 782 patients who underwent surgical treatment in 2017, 2018 and 2019, the proportion of malignant nodules was 56.37% (354/628), 66.48% (480/722) and 70.97% (555/782); the proportion of benign nodules was 43.63% (274/628), 33.52% (242/722) and 29.03% (227/782), respectively. Among all malignant nodules, papillary carcinoma accounted for 95.18% (1 322/1 389), followed by follicular carcinoma 4.32% (60/1 389), myeloid carcinoma 0.43% (60/1 389) and undifferentiated carcinoma 0.07%(1/1 389). Among all benign nodules, the proportion of nodular goiter was the highest (95.56%, 710/743). The proportion of patients undergoing preoperative FNAC in 2017, 2018 and 2019 was 57.96% (364/628), 63.43% (458/722) and 69.44% (543/782), respectively;the coincidence rate of preoperative FNAC and postoperative pathological diagnosis was 46.15% (168/364), 52.18% (239/458) and 62.06% (337/543), respectively. Among 433 nodules with both FNAC and ultrasound data, the areas under the ROC curve(AUC)of FNA, ACR TI-RADS and Kawk TI-RADS were 0.91, 0.74 and 0.59, respectively ( P<0.05). The sensitivity of ACR TI-RADS and Kawk TI-RADS was 84.34%, 37.35% ( P<0.05) and specificity was 56.29% and 79.14% ( P=0.075). Conclusions:The study reveals that from 2017 to 2019, both the number of cases and malignant rate of thyroid nodules shows a rising trend, meanwhile the application rate of preoperative FNAC and its coincidence rate with postoperative pathology shows an increasing trend. FNAC, ACR Ti-RADS and Kawk TI-RADS have certain diagnostic efficacy in differentiating benign and malignant thyroid nodules, and the diagnostic value of FNAC is the highest followed by ACR TI-RADS and Kawk TI-RADS.

OBJECTIVE：To improve the quality standard of M ongolian med icine Artemisia sacrorum ，and to provide scientific basis for comprehensive quality evaluation. METHODS ：The appearance and microscopic characteristics of A. sacrorum were identified；scopoletin，chlorogenic acid ，caffeic acid ，scopoletin and 3，5-dicaffeoylquinic acid were identified quantitatively by TLC；the contents of above 5 components were determined by HPLC. The water content ，total ash and extract were examined. RESULTS：The stem of A. sacrorum was cylindrical ，and its surface was purple or purple-brown or cyan-brown ；the leaves were ovate or oblong-ovate ，fragrant；the flowers were yellow ，head-shaped，subglobose or hemispherical. The powder was green or yellow-green，its pollen grain had three germination ；the parenchymal cell clusters with sharp edges and numerous threaded ducts ， occasionally having marginal pitted ducts ；its wood fibers were in bundles mostly. Results of TLC showed that the spots of the same color were found in the corresponding positions of chromatogram for 5 substance control and samples. The linear range of scopoletin， chlorogenic acid ， caffeic acid ， scopolactone and 3，5-dicaffeoylquinic acid were 85.60-428.00， 10.16-101.60， 10.20-102.00，40.84-408.40 and 40.80-408.00 μg/mL（all r＞0.999 0）. RSDs of precision ，stability，repeatability tests were all less than 3.00％（n＝6）. The average recoveries were 103.07％，99.66％，98.37％，97.78％，98.40％（all RSDs ＜3.00％，n＝6）. The contents of the above-mentioned 5 compounds in 10 batches of samples were 0.36％-1.23％，0.09％-0.51％，0.04％-0.13％， 0.61％ -1.13％ ，0.12％ -1.11％ ，respectively；the average com contents of water ，total ash and water soluble extract were 6.25％，5.86％，26.50％，respectively. CONCLU SIONS：O the basis of the original quality standard of A. sacrorum ， microscopic identification，TLC identification ，content determination and examination items of water ，total ash and extract are added. The method shows good precision ，accuracy and stability ，which can provide reference for more scientific and standardized evaluation of the quality of this medicinal material.

Online medical consulting, acting as the primary type of Internet medical market, has been developing dramatically in the past ten years and begins to take shape. This study collected available information to describe service content status and service provider for online medical consulting websites. The current online medical consulting sites are mainly comprehensive medical consultation websites. The most common consulting provision from is combining graphics and text, which might not meet users' primary demand. The registered physicians are mostly the ones with junior position and work in the eastern and south-central parts of China. Activities of the registered physicians vary across the departments, but with extremely low initiatives.

Objective To investigate the effects of electromagnetic pulse (EMP) on reproductive function of male adult mice.Methods A total of 48 healthy adult male BALB/c mice (8 weeks old) were randomly divided into sham group and EMP group with 24 animals in each group.The mice were wholebody exposed or sham exposed to EMP at 720 kV/m for 100 pulses with 1 Hz repetition rate and 40 ns pulse width.At 1,7,14 and 35 d after EMP exposure,the mice were anesthetized and the sperms were collected from the bilateral epididymal tail.After that,the sperm quality including the number of sperms,the ratio of abnormalities and the survival rate was evaluated.In addition,the morphology of testis was observed by HE staining and the diameter of seminiferous tubules was measured by Image J 1.43 u software.The protein level of stem cell factor (SCF) and glial-derived neurotrophic factor (GDNF) in testis tissue were detected by ELISA and Western blot.Results The sperm quality and the morphology of testis did not change obviously at different times after exposing mice to EMP at 720 kV/m for 100 pulses,compared with sham group (P＞0.05).The diameters of seminiferous tubules at 1,7,14 and 35 d after exposure were (196.85+ 16.65),(196.79+ 14.33),(196.35±22.71) and (198.60±25.88) μm in exposed mice,respectively,while (204.31±27.13),(197.07± 18.11),(194.37±21.45) and (200.59± 19.36) Iμm in sham exposed mice,respectively.There was no significant difference between two groups (P＞0.05).Additionally,the levels of SCF and GDNF in testis tissue between EMP group and sham group had no statistically significant difference (P＞0.05).Conclusion Under this exposure condition,EMP couldn't affect the reproductive function of male adult mice.

Objective To investigate the status quo of hope level as well as the relationship between the hope level and social support in patients with chronic heart failure (CHF). Method A total of 120 CHF patients were surveyed by Herth hope index (HHI) and social support rating scale (SSRS). Results The overall HHI score and SSRS were (30.2±4.2) and (38.4±6.2), respectively. Both were at a medium level. The general score of HHI was positively related to general SSRS (r=0.527, P＜0.01). Conclusions Both of HHI and SSRS of patients with CHF are at moderate level. The patients with higher level of social support have better hope level. Nurses should take pertinent interventions to improve the social support of CHF, helping them to improve their hope and respond to diseases effectively.

ObjectiveTo explore the degree of psychological distress in patients with different personality traits who receive insulin pump treatment to control blood glucose, and analyze the correlation between them. MethodsA total of 175 diabetic patients on insulin pump from January to December of 2018 were selected by convenience sampling. Chinese Version of Eysenck Personality Questionnaire Short Scale (EPQ-RSC) and Kessler＇ Non-specific Psychological Distress Scale (K10) were used to evaluate the patients＇personality features and psychological distress level, and the correlation between them was analyzed by Pearson Correlation analysis. Multivariate linear regression was used to analyze the influencing factors of patients＇psychological distress. ResultsAccording to the results of EPQ-RCS, 43 of 175 patients with insulin pump for blood sugar control were melancholic, 48 were phlegm, 41 were bilious and 43 were sanguineous. The psychological distress score of 175 patients was (25.77±4.52), which was at the level of moderate psychological distress. Among them, 33 patients without psychological distress accounted for 18.86%, 32.57% were mild, 38.29% were moderate and 10.29% were severe. Pearson correlation analysis showed that the degree of psychological distress was negatively correlated with "psychoticism (P)" and "neuroticism (N)" in EPQ-RCS (r=-0.602, -0.562;P＜0.05), but was not correlated with "extroversion (E)" and "concealment (L)"(P＞0.05). Regression analysis showed that the influencing factors of psychological distress in patients with insulin pump treatment included P and N dimension scores, depression, duration of insulin pump wearing and the level of glycosylated hemoglobin. ConclusionsThe patients who use insulin pump to control blood glucose have some degree of psychological distress. The patients with sanguineous temperament have the lightest distress and the patients with melancholic temperament are the most serious. According to different personality traits, medical workers should conduct targeted psychological intervention.

International medical service is becoming much more popular at present with the increased exchanges between countries around the world.This paper mainly analyzes the characteristics and practical measures taken by the international department of some large comprehensive class A tertiary hospitals in regard to customer orientation,service features,facility and environment building,talent team building and foreign communications,management and credentials,and insurance cooperation.It is found out that thecustomers are ambassadors,counselors,foreign workers and their family members,foreigners for business visits or foreign tourists;appointment service,one-stop service and other special service are provided;separate clinical area or room of international elements are installed;they continually enhance foreign exchanges and improve language skills and foreign culture cognitions of team members;they have particular management modes and operate with international standards;they cooperate with international insurance companies.The mode of international medical service is thus concluded on the analysis.