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Objective To identify the characteristics of nutritional problems in patients with Parkinsonism who participated in multi-disciplinary team (MDT) and to investigate the correlation between nutritional status and dysphagia in these patients. The predictive value of video fluoroscopic swallowing study (VFSS) and EAT-10 scale for malnutrition was compared. Methods Subjects were patients with Parkinsonism participated in joint MDT consultation project in Peking Union Medical College Hospital from November 2020 to January 2023. Subjective and objective dysphagia were evaluated by EAT-10 scale score and VFSS dysphagia score. Nutritional status of the patients was evaluated by geriatric nutrition risk index (GNRI), albumin, prealbumin, serum folic acid, vitamin B12 and temporal muscle thickness. Results A total of 30 participants met the criteria and were included in the study. The age was 45-82 (66.1±9.0) years old. Six (20%) were at risk of malnutrition shown b a comprehensive nutritional status assessment using GNRI. The areas under receiver operating characteristic(ROC) curves(AUC) of VFSS dysphagia score and EAT-10 score to predict malnutrition were 0.781 (0.568-0.995) and 0.927 (0.827-1.000), respectively. EAT-10 score was correlated with GNRI(r=-0.524, P＜0.01), BMI(r=-0.618, P＜0.001), prealbumin (r=-0.616, P＜0.001). The VFSS dysphagia score was only correlated with BMI (r=-0.446, P＜0.05) and prealbumin(r=-0.387, P＜0.05). Conclusions Patients with Parkinsonism requiring MDT often have multiple micronutrient imbalance. Patients′ subjective perception of dysphagia has a greater impact on their nutritional status than objective assessment of dysphagia.

Background Wrist motor dysfunction is a common sequela at post-stroke, and the wrist has an important role in improving hand practicality. Therefore, improving the range of motion of the wrist can effectively promote the activities of daily life in post-stroke patients. Although repetitive peripheral magnetic stimulations (rPMS) have been shown to have a significant effect on improving the range of motion of the wrist, the therapeutic effect of different stimulation sites still needs to be further explored. Objective To investigate the effect of rPMS on wrist extensor muscle and radial nerve for the motor function of wrist of subacute stroke patients. Methods A total of 60 subacute stroke patients with wrist motor dysfunction admitted to Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine from October 2022 to October 2023 were selected as the study subjects. The included patients were randomly divided into control group (20 cases), muscle stimulation group (20 cases) and nerve stimulation group (20 cases) by simple randomized grouping method using a random number table. Patients in all the three groups received routine rehabilitation training, and those in the muscle stimulation group and nerve stimulation group were additionally managed by rPMS on the wrist extensor muscle and the radial nerve, respectively. Before and after the interventions for 10 times of rPMS, integrated electromyography (iEMG), root mean square (RMS) and median frequency (MF) on the surface of the wrist extensor muscle, the Fugl-Meyer Assessment for upper extremity (FMA-UE), the Action Research Arm Test (ARAT) and the modified Barthel Index (MBI) were measured to assess the upper limb function of the affected side. Results During the intervention period, there were 2 cases of data loss due to voluntary withdrawal or forced termination of the trial, and finally 20 cases were included in the control group, 19 cases in the muscle stimulation group, and 19 cases in the nerve stimulation group. There were no significant differences in iEMG, RMS and MF of wrist extensor muscle among three groups before treatment (P>0.05). After treatment, iEMG, RMS and MF of wrist extensor muscle in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P0.05). After treatment, FMA-UE, ARAT and MBI scores in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P

PurposeThe use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings.MethodsThe study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records.FindingsAll clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period.ConclusionsTo expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.

Objective To evaluate the effect of oral probiotics containing 4 strains of lactobacillus on the vaginal microbiota and adjuvant treatment effect of patients with vaginitis during pregnancy. Methods A total of 395 cases were included, 171 cases in the control group received 7 days of antibiotic treatment, and 224 cases in the combined treatment group. After the combined use of antibiotics and probiotics for 7 days, they continued to take 1 probiotic pill daily for the 28th day. The patients received a vaginal microecological examination and clinical evaluation at study entry and 28 days to compare the vaginal lactobacillus between the two groups. Results There was a statistical difference in the proportion of vaginal lactobacillus and the efficacy of treatment between the two groups of patients (P＜0.05). The effective rates in the combined treatment group and the control group were 90.2% and 86.0% respectively, and the cure rates were 30.4% and 19.3% respectively. Conclusions Oral probiotics containing lactobacillus strains can increase the proportion of vaginal lactobacillus in patients with vaginitis during pregnancy which significantly facilitated the clinical treatment of vaginitis during pregnancy.

Strontium(Sr) is a trace element naturally found in the human skeletal system. In recent years, the potential impact of strontium on bone and cardiovascular health has called significant attention, particularly during pregnancy, when alterations in mineral metabolism may affect the health of both the mother and the fetus. This comprehensive review assesses the current understanding of the role of strontium as a nutritional substance during pregnancy, its effects on maternal health and fetal development, and its potential associations with pregnancy complications such as preeclampsia, gestational hypertension, and lactation-induced osteoporosis. The review also summarizes the possible effects of strontium deficiency, excess, and supplementation, and provides information for developing prenatal nutrition supplementation guideline.

Zinc deficiency during pregnancy is common and has been significantly associated with adverse pregnancy outcomes such as spontaneous preterm birth(PTB), recurrent abortion(RA), low birth weight(LBW), small-for-gestational-age infant(SGA), preeclampsia(PE), and gestational diabetes mellitus(GDM). Unfortunately, there is no specific biomarkers which are sensitive, easy-to-collect and detect available for the clinical evaluation of zinc nutritional status. However, recent studies have identified metallothionein and the ratio of oleic acid to dihydroxymethyl gamma-linolenic acid(LA/DGLA) as potentially candidates of biomarkers.This article focuses on summarizing and discussing the progress of domestic and international researches on zinc deficiency during pregnancy and adverse pregnancy outcomes, potential zinc biomarkers, and zinc deficiency treatments, aiming at providing ideas for perinatal nutritional guidance.

Objective To investigate the effects of comprehensive nutrition management on glycolipid metabolism and pregnancy outcomes in patients with gestational diabetes mellitus(GDM). Methods A total of 121 pregnant women with GDM at 24-28 weeks gestation who were registered in the obstetrics department of 6 sub-central hospitals in China from May 2021 to July 2021 were included in this study and were randomly divided into intervention group(n=74) and control group(n=47). The intervention group received intensive comprehensive nutrition management, including at least 6 outpatient interventions, individualized nutrition management and a half-day standardized outpatient education on gestational diabetes mellitus, continuous dynamic blood glucose monitoring and micro-blood glucose monitoring,and routine check of glycated albumin and urine every 4 weeks. Body weight, body composition and diet and exercise implementation procedures and fetal development as well as complications were recorded. The control group received conventional nutritional guidance. The two groups were compared for difference in blood glucose related indicators at 37 weeks of gestation, weight gain before delivery, some lipid metabolism indicators, pregnancy outcomes, and oral glucose tolerance test(OGTT) at 42 days postpartum. Results Compared with the control group, the level of prenatal fasting blood glucose(P=0.006), intravenous plasma glucose(P=0.009) and blood ketone(P=0.044) in the intervention group was significantly reduced. There was no significant difference in weight gain and weight attainment rate between the two groups. The 2-hour postpartum OGTTs of pregnant women in the intervention group(P=0.006) were significantly lower than those in the control group, and the incidence of preeclampsia and postpartum blood loss were lower than those in the control group but no statistical difference was found. For newborns, the incidence of macrosomia(P=0.042) and planation(P=0.048) in the intervention group was slightly lower than that in the control group, and the results were statistically different. Other adverse pregnancy outcomes were not statistically different between the two groups. Conclusions Intensive comprehensive nutrition management has a positive impact on the control of the blood glucose in pregnant women and improves the maternal and neonatal outcomes of women with GDM.

BackgroundThe COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic.MethodsA literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services.ResultsSoon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints.ConclusionThe COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.

【Objective】Aiming at the problem that BitString can not represent all Bit-Forwarding Routers (BFRs) in large-scale Software Defined Networking (SDN) multicast based on Bit Index Explicit Replication (BIER) due to the limited length, this study designs a Hierarchical Domain (HD)-BIER model and devises its construction algorithm.【Methods】The HD-BIER model is a multi-layer BIER network composed of multiple small-scale Sub Domains (SD), which enables BIER to support a number of devices exceeding the capacity of the BitString representation in large-scale networks. The proposed HD-BIER construction algorithm takes into account the BitString Length (BSL) limitation, link lengths between nodes, and network connectivity. It leverages the concept of community partition algorithms and introduces a modularity function based on node similarity as an evaluation metric for BIER SD partitioning. The construction follows a bottom-up approach to dynamically build the HD-BIER network.【Results】The simulation results show that the HD-BIER construction algorithm can effectively construct HD-BIER networks that exceed the BSL limit in either simple networks or the complex networks with a large number of nodes. Additionally, the resulting HD-BIER model not only ensures normal transmission of multicast service data flows through the gradual encapsulation and decapsulation of BitString layers but also maintains SDN multicast communication performance throughout this process.【Conclusion】The simulation results validate that the proposed HD-BIER model presents an effective multicast service support solution for even larger-scale networks.

Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.