Objective:To understand the responsiveness of community health service institutions in Henan Province. Methods:This research collected information through questionnaire investigations. The object of the investigations is key informants familiar with community health service institutions. Various dimensions of responsiveness within Henan province community health service institutions are determined through a multiple-input pecking order graph. The fuzzy comprehen-sive evaluation method is used to evaluate the level of responsiveness. Responsiveness inequality index is used to measure the distribution of reactions. Results:A total of 431 valid key informants were surveyed. The various dimensions of the questionnaire of Cronbach alpha coefficient was greater than 0. 623;the total scale of the Cronbach alpha coefficient was 0. 850;the correlation coefficient of each dimension of test-retest reliability were greater than 0. 907. The levels of responsive-ness and distribution index were 8. 33 and 0. 2744, respectively;each dimension by order of importance:timely attention>dignity>infrastructure>communication>confidentiality >social support >selective >autonomy. Approximately 50% of key informants considered that vulnerable groups in community health service institutions were sometimes or often treated unfairly. Conclusion:Key informants considered the responsiveness level of overall higher community health service institu-tions in Henan Province was high, and the distribution of responsiveness was relative equilibrium. However, there is a large shortage of infrastructure, privacy protection, doctor-patient communication, etc.

Objective To investigate the effect and safety of self-made blenderized diet used for nutritional support treatment in the ICU critically ill patients with diabetes. Methods 74 ICU critically ill patients with diabetes were randomly divided into two groups:study group and control group. The self-made blenderized diet were given to the patients in study group and enteral nutrition to the patients in control group for nutritional support treatment for four weeks. Then glucose metabolism, various nutrition indicators and gastrointestinal dysfunction were observed in these two groups. Results The fasting blood glucose and fructosamine levels were decreased significantly,while the nutritional indicators was significantly higher after treatment than at baseline in all patients. There was no significant difference in the levels of fasting blood glucose, postprandial glucose, fructosamine and nutritional indicators between two groups after treatment,so were the incidence of the hypoglycemia and gastrointestinal complications. Conclusion The self-made blenderized diet was a good enteral nutrition support therapy for ICU critically ill patients with diabetes which had a considerable effect, but more cheaper,and practical compared to the enteral nutrition emulsions.

Objective To evaluate the effect and clinical value of open surgery combined ultrasound-guided Mammotome in the treatment of multiple breast lumps. Methods Four hundred and forty-four patients in our hospital from Jan. 2006 to Jun. 2008 were divided into 3 groups, who underwent classical open surgery, ultrasound-guided Mammotome operation, or combined therapy respectively and followed by post-operation visits reguarly. The operation effects were compared between the 3 groups. Results Compared with the classical open surgery, combined therapy had no difference in time of procedure and procedural bleeding, but had lower incidence of local skin, better incision condition and higher satisfaction of patients. Compared with ultrasound-guided Mammotome operation, combined therapy took less time in procedure, and in the same time had less procedural bleeding, lower post-operation complication and higher patients satisfaction. Conclusions Combined therapy has high complete removal rate, low post-operation complication as well as cosmetic effect. It has special advantages over the other two kinds of surgery, so it has wide clinical application.

Objective To summarize and explore the clinical value of Mammotome technology in the diagnosis and treatment of breast neoplasms. Methods Nine hundred and eighty-seven breast neoplasms of 710patients were biopsied and excised with the aid of ultrasound-guided Mammotome system. The malignant neoplasms,according to the histological report,were radically removed during the operation without delay. All patients enrolled into the study were followed up closely on the complcations and satisfaction degree. Results All the operations except one were successful and got the sufficient specimen to perform the pathological examination,the biopsy achievement rate was 99. 8% . Both the sensitivity and specificity of the diagnosis were 100% in 16 breast tumors. Complete resection rate was 99%. The incision length was about 3 mm,showing good cosmetic outcome. Complcations were mild,mainly composed of haematoma and ecchymosis. The patients' general satisfactory rate was 93%. Conclusions This technique can help achieve biopsy of breast neplasm and excision of benign lesions at the same time with cosmetic result Further attention should be paid to reduce the lesion residue and hemorrhagic complications.

ObjectiveTo study the morphology, normal values and lateral asymmetry of Chinese calcarine sulcus on MRI. Methods High-resolution and transverse MRI were obtained from 40 female volunteers. Brainvisa software was used to reconstruct the calcarine sulcus and measure its average length, depth and width automatically. Results The posterior branch of calcarine sulcus showed six types in the median sagittal plane: bifurcation(32.50%), single peak(25.00%), flat (16.25%), S-shaped (15.00%), double peak(7.50%) and other shape (3.75%); its location had three types: inferior(72.50%), middle(21.25%)and superior(6.25%). The depth of left calcarine sulcus was (15.24±2.67)mm, and the right one was (16.97±3.25)mm, which revealed great statistical significance (P＜0.000 1). The width of left calcarine sulcus was (3.14±0.91)mm, and it was (3.19± 0.83)mm in the right side. The bottom length of calcarine sulcus: the left was (86.47±16.85)mm, the right was (83.62±17.10)mm. The top length of calcarine sulcus: the left was (70.52±12.40)mm, the right was (64.90±15.17)mm. There were not statistical significance in width, bottom length and top length between left and right calcarine sulci. More than half of the end part of calcarine sulci turned to the lateral surface of cerebral hemisphere.Totally 63 cases (78.75%) were found with prominent calcar avis. Conclusion Significant difference of depth between left and right calcarine sulcus of female was found. Three-dimensional reconstruction is an effective method to study the anatomy of calcarine sulcus.

Objective To establish the background information of physiological parameters for germ?free ( GF ) Taihu piglets. Methods In this study we selected 25 days old GF Taihu piglets and 4 conventional ( CV) littermates, the male and female ratio was 1∶3, to measure the normal clinical values of hematology and serum biochemistry, immunoglobu?lin concentration and main organ coefficients. The analysis of relative growths of main organ weight to body weight was con?ducted in the Taihu GF and CV pigs by allometric scaling model. Results (1) Twelve hematological parameters and 8 blood biochemical parameters in the GF piglets were significantly lower than those in CV pigs (P<0?05). (2) The aver?age body weight, IgM concentration of GF pigs and CV pigs had significant difference ( P <0?05 ) , and no mesenteric lymph nodes were found in the GF pigs. (3) The gut weight had the largest allometric association with body weight in the GF pigs, while spleen weight has the largest allometric association with body weight in the CV pigs. Both the weight of heart and stomach in CV and GF pigs had a negative allometric association with body weight (allometric coefficient b<1), respectively. Conclusions Different microbe control grades affect the body weight, hematology and serum biochemistry, expression of immunoglobulin and development of main organs in laboratory pigs.

Objective To evaluate the effect of ultrasound-guided vacuum-assisted minimal invasive resection(Mammotome procedure)of breast lumps through the retromammary space. Methods Seven hundred and eighty-seven patients in Obstetrics and Gynecology Hospital Affiliated to Fudan University from Jan. 2011 to May 2012 were underwent ultrasound-guided Mammotome operation through the retromammary space (retromammary space group,385 cases),or adjacent the lumps,and followed by post-operation visits regularly (Mammotome operation adjacent the lumps group,402 cases). The operation effects were compared between the two groups. Results All cases were followed up for 12 months. The period of Mmmotome operation through the retromam mary space and the rate of resection were(48 ± 6)min and(52 ± 4)min,99. 48%(383 / 385), 99. 25%(399 / 402),perspectively,in group of Mammotome operation through the retromammary space and Mammotome operation adjacent lumpsand. There was no significant difference between the two groups( P> 0. 05). The amount of procedural bleeding,the incidence of ecchymosis,local hematoma and the number of incision in group of Mammotome operation through the retromammary space were(8 ± 3)ml,2. 34%(9 / 385), 0. 52%(2 / 385),(1. 3 ± 0. 6)respectively,which were significantly lower than those in Mammotome operation adjacent the lumps group((14 ± 6)ml,8. 71%(35 / 402),2. 74%(11 / 402),(2. 4 ± 0. 3)respectively). There were statistical difference between two groups( P = 0. 003,P < 0. 001,P = 0. 001,P = 0. 006). The rate of satisfaction in group of Mammotome operation through the retro-mammary space was 98. 70%(380 / 385),which is significantly higher than in group of Mammotome operation adjacent the lumps(89. 30%(359 / 402),P< 0. 01). Conclusion The therapy approach of ultrasound-guided Mammotome operation through the retromammary space has lower hemorrhagic complication,as well as the better effect with special advantages. Therefore it has prospective clinical application.

Objective:To develop a guiding manual of family doctor contracting service for the disabled with Delphi method.Methods:From November 2017 to July 2018, a research group was formed and a survey on the status of family doctor service for disables was conducted in Beijing and other places. After the preliminary outline was formulated, 15 experts from the fields of general practice and rehabilitation for the disabled were invited and 4 rounds of expert consultation were conducted, finally the Guiding Manual of Family Doctor Contracting Service for the Disabled was developed. Results:The authority coefficient of experts was 0.870, and 13, 13, 15 and 15 questionnaires were collected from 15 experts in 4 rounds of consultation, respectively. The W value of Kendall harmony coefficient of the fourth round of expert consultation was 0.394 (χ 2=319.501, P<0.01) and accuracy was 0.234 (χ 2=189.189, P<0.01). After adding and deleting terms by the suggestion and scores of experts, the final draft of the manual is formed, including 5 first-level terms, 15 second-level terms, 18 third-level terms and 17 fourth-level terms. Conclusion:The Guiding Manual of Family Doctor Contracting Service for the Disabled has been developed with Delphi method. Its reliability, validity and practicability need to been further studied.

Objective:To investigate the feasibility of contracted nursing services for disabled persons.Methods:A qualitative study on the feasibility of contracted nursing services for disabled persons was conducted from August 2020 to October 2020 with the phenomenological method. Community nurses were selected with the purpose of sampling method from Yuetan and Baizhifang Community Health Service Centers in Beijing Xicheng District for semi-constructed interviews, and 12 community nurses were finally interviewed according to the principle of information saturation. The research team took field notes, audio recordings and transcriptions of the interviews, coded to refine the themes, and fed back with the respondents to confirm the accuracy of the themes.Results:All the interviewed nurses thought that the contents of basic medical and public health required by the Guidance manual of contracted services of family doctors for disabled persons (the manual) including basic documentation, appointments, pre-diagnosis and post-diagnosis services, home care, rehabilitation nursing guidance, referral services and extended nursing services for the disabled and their families could be completed. All interviewees said that the manual had a guiding role in contracted services for disabled persons. Eight interviewed nurses believed that the manual involved referral services and rehabilitation care, but the technical guidance content did not meet the actual work needs and it should be supplemented and improved; 9 interviewees pointed out that there was a lack of communication with various types of disabled people in service practice, especially for those with vision, hearing, mental disabilities and disabled children; 7 interviewees said that it the free home care for the disabled was not sustainable. Conclusion:The contracted nursing services for disabled persons are feasible and the manual has a guiding role for the practice,and some contents need to be added in the manual to further improve service capacity for disabled people.

Objective:To investigate the status quo of communication between contracted family doctor team and the disabled.Methods:Using convenience sampling, family doctor team members of 80 community health centers (CHCs) in Beijing were selected to participate in a questionnaire survey from April to June 2022. The questionnaire included the basic information of team members, the choice of communication methods and targets, the acquisition of communication knowledge and skills and so on.Results:A total of 365 team members participated in the survey. The most common type of disability was physical disability (78.08%,285/365). All participants met communication obstacles with disabled people in contracted health service, and hearing and speech disabilities were the most common (70.14%, 256/365). Only 13.42% (49/365) chose to directly communicate with the disabled themselves; 84.93% (310/365) used "increase the volume and slow down" method when communicating with the disabled, and 38.63% (141/365) chose "write and convey multiple messages at the same time". Most of participants (84.38%, 308/365) indicated the need for professional training in communication with persons with disabilities.Conclusion:There are communication obstacles between family doctor team members and the disabled during contracted services. More relevant professional training are urgently needed for contracted family doctor team to improve the abilities to communicate with the disabled.