[The Health-Seeking Experience of Patients With Sjögren's Syndrome].

BACKGROUND: The multiple symptoms of Sjögren's syndrome lead patients affected by this disease to seek medical advice from different medical disciplines and specialists. Diagnoses are often made many years after initial onset, resulting in mental and physical exhaustion and misunderstandings. PURPOSE: This study was designed to explore the health-seeking experiences of patients with Sjögren's syndrome. METHODS: Qualitative research methods and purposive sampling were used. Fourteen patients with Sjögren's syndrome were interviewed by the first author, and the collected data were analyzed using content analysis. RESULTS: Four themes were revealed from the data, including: (1) distressing symptoms; (2) difficulty in diagnosis; (3) concerns about drug side effects; and (4) facing the disease. The participants initially sought medical attention when they began experiencing early onset symptoms that caused discomfort or annoyance. Their doctors' failure to provide proper diagnoses during the long health-seeking process caused a great deal of suffering to the participants. Although related medications should be taken for life, the participants reported taking lower-than-prescribed dosages out of fear of side-effects. The participants explored their process of coping with the disease, which began with denial and ended with acceptance. By learning from their health-seeking process, participants realized that they needed to take proper care of themselves, adapt to life with their disease, and control related symptoms. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: To facilitate the early diagnosis of Sjögren's syndrome, healthcare professionals should improve their awareness of this condition and refer patients with related symptoms to rheumatologists and immunologists. Effective early diagnosis and treatment can help these patients reduce the time and effort involved in unproductive doctor's visits, allowing them to better continue as productive members of society and to maintain a good quality of life.

The pathogenesis hypothesis and research progress of CLIPPERS: A literature review.

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is still a rare autoimmune disease in the world. In recent years, there are more and more reports about the clinical manifestations of CLIPPERS, but the specific etiology and pathogenesis are not clear. In this paper, by collating the literature reported in recent years, in the reported effective treatment cases, we found the current hypothesis about the pathogenesis of CLIPPERS. Three pathogenesis hypotheses: organ-specific autoimmunity; virus infection affects autoimmunity; and helper T lymphocyte 17 mediates autoimmunity. Although it is hypothetical, it is expected to further clarify the pathogenesis, evolution characteristics, and treatment of CLIPPERS, so as to provide a reference for further understanding of the disease. In the future, more observations and studies are needed to further verify the feasibility of the hypothesis. This article expands on atypical clinical manifestations and summarizes treatment options. Hope to provide a reference for clinical diagnosis and treatment of CLIPPERS.

Theoretical study on photocatalytic performance of ZnO/C2N heterostructure towards high efficiency water splitting.

The construction of van der Waals heterostructures offers effective boosting of the photocatalytic performance of two-dimensional materials. In this study, which uses the first-principles method, the electronic and absorptive properties of an emerging ZnO/C2N heterostructure are systematically explored to determine the structure's photocatalytic potential. The results demonstrate that ZnO and C2N form a type-II band alignment heterostructure with a reduced band gap, and hence superior absorption in the visible region. Furthermore, the band edge positions of a ZnO/C2N heterostructure meet the requirements for spontaneous water splitting. The ZnO/C2N heterostructure is known to possess considerably improved carrier mobility, which is advantageous in the separation and migration of carriers. The Gibbs free energy calculation confirms the high catalytic activity of the ZnO/C2N heterostructure for water-splitting reactions. All the aforementioned properties, including band gap, band edge positions, and optical absorption, can be directly tuned using biaxial lateral strain. A suitable band gap, decent band edge positions, high catalytic activity, and superior carrier mobility thus identify a ZnO/C2N heterostructure as a prominent potential photocatalyst for water splitting.

Role of TRPV1 in respiratory disease and association with traditional Chinese medicine: A literature review.

Transient receptor potential vanilloid type 1 (TRPV1), involved in multiple pathophysiological processes including inflammation, is a thermally activated, non-selective cation channel. It has been identified that TRPV1 is highly involved in some common respiratory diseases including allergic rhinitis, asthma, chronic obstructive pulmonary disease, and pulmonary infection by participating in neurogenic and immunogenic inflammation, sensitization, and oxidative stress. In recent years, the hypothesis of transient receptor potential (TRP) has been introduced in studies on the theory of five flavors and four properties of Chinese medicinal. However, the hypothesis is undetermined due to the multi-component and multi-target characteristics of Chinese medicinal. This study describes the relations between TRPV1 and four types of respiratory diseases based on the literature in recent five years. In the meantime, the therapeutic effect of Chinese medicinal by intervening TRPV1 was reviewed, in an attempt to provide certain evidence for future studies on the medicinal property-effect relationship, mechanism of drug action, the syndrome differentiation in traditional Chinese medicine (TCM) for respiratory diseases and to help for new drug development.

Design of mesoporous Ni-Co hydroxides nanosheets stabilized by BO2- for pseudocapacitors with superior performance.

The investigation of high-efficiency electrodes is essential for the energy conversion/storage devices. In this work, mesoporous two-dimensional Ni-Co hydroxide nanosheets stabilized by BO2- (denoted as (NixCoy)(OH)2/Co(BO2)2) are prepared via a facile and cost-effective procedure to circumvent the shortage of nickel hydroxide, viz. poor conductivity and fast phase transition. The (NixCoy)(OH)2/Co(BO2)2 materials have high specific surface area and plenty of exposed active sites. As electrode, the optimized (Ni0.5Co0.5)(OH)2/Co(BO2)2 delivers a remarkable specific capacity of 2257 F g-1 at 1 A g-1 with superior rate capability (2071 F g-1 at 20 A g-1). Moreover, the asymmetric supercapacitors assembled by (Ni0.5Co0.5)(OH)2/Co(BO2)2 and active carbon provides high energy density (56.5 Wh kg-1 at 0.8 kW kg-1) and excellent cyclic stability (maintaining 98% of initial capacity over 10 000 cycles), demonstrating the promising potential of (Ni0.5Co0.5)(OH)2/Co(BO2)2 in practical applications.

[Highlights of the Chinese guideline on sublingual immunotherapy for allergic rhinitis and asthma（English edition）].

The Chinese guideline on sublingual immunotherapy（SLIT） for allergic rhinitis and asthma（English edition） has been developed by a panel of experts on behalf of the Chinese Society of Allergy, and published in December 2019. The guideline is herein organized to outline the critical items, including the epidemiology of allergic rhinitis and asthma, clinical application and mechanisms of SLIT, standardized procedure, indications and contraindications, therapeutic process, and future perspective, to guide and improve the clinical practice of SLIT.

Comparison of efficacy and long-term survival of laparoscopic radical nephrectomy with partial nephrectomy in the treatment of patients with early renal cell carcinoma Running title: laparoscopic radical nephrectomy.

PURPOSE: To compare the efficacy and long-term survival of laparoscopic radical nephrectomy (LRN) with laparoscopic partial nephrectomy (LPN) in the treatment of patients with early renal cell carcinoma (RCC). METHODS: A retrospective analysis was performed on the medical records of 146 patients, aged 40-60 years, with T1bN0M0 RCC admitted to Chongqing Three Gorges Central Hospital. The patients were divided into a study group (n=62) treated with LPN and a control group (n=84) treated with LRN according to surgical methods. The renal function, one month after operation and surgery-related indicators and the incidence of postoperative complications were analyzed. RESULTS: One month after operation GFR was significantly higher in the study group than in the control group (p<0.05), which was lower than that before operation in the two groups (p<0.05). CONCLUSION: The short- and long-term efficacy of LPN is similar to that of LRN in the treatment of T1bN0M0 RCC, but LPN better preserves the renal function, which has a potential value in reducing cardiovascular events.

An Efficient Attribute-Based Access Control (ABAC) Policy Retrieval Method Based on Attribute and Value Levels in Multimedia Networks.

Internet of Multimedia Things (IoMT) brings convenient and intelligent services while also bringing huge challenges to multimedia data security and privacy. Access control is used to protect the confidentiality and integrity of restricted resources. Attribute-Based Access Control (ABAC) implements fine-grained control of resources in an open heterogeneous IoMT environment. However, due to numerous users and policies in ABAC, access control policy evaluation is inefficient, which affects the quality of multimedia application services in the Internet of Things (IoT). This paper proposed an efficient policy retrieval method to improve the performance of access control policy evaluation in multimedia networks. First, retrieve policies that satisfy the request at the attribute level by computing based on the binary identifier. Then, at the attribute value level, the depth index was introduced to reconstruct the policy decision tree, thereby improving policy retrieval efficiency. This study carried out simulation experiments in terms of the different number of policies and different policy complexity situation. The results showed that the proposed method was three to five times more efficient in access control policy evaluation and had stronger scalability.

Changes in hepatitis B virus surface antibody titer and risk of hepatitis B reactivation in HBsAg-negative/HBcAb-positive patients undergoing biologic therapy for rheumatic diseases: a prospective cohort study.

BACKGROUND: Our aim was to investigate dynamic changes in hepatitis B virus (HBV) surface antibody (HBsAb) titer and the associated risk of HBV reactivation and clinical course in patients with HBV surface antigen negative/core antibody positive (HBsAg-/HBcAb+) serostatus during antirheumatic therapy with biologic agents. METHODS: In a prospective study from January 2013 to June 2017, we monitored the HBV serostatus of HBsAg-/HBcAb+ patients undergoing biologic therapy for rheumatic diseases. From HBsAb titers at baseline and subsequent time points, we calculated the person-years (PY) contributed by patients with different HBsAb levels: < 10 mIU/mL (negative); 10-100 mIU/mL (low); and > 100 mIU/mL (high). We analyzed the incidence of detectable HBV DNA and HBV reactivation in each group, and documented the clinical courses of patients. RESULTS: Among 380 participants, 83 (21.8%) had baseline HBsAb < 10 mIU/mL, 156 (41.1%) HBsAb 10-100 mIU/mL, and 141 (37.1%) HBsAb > 100 mIU/mL. Total PY at study end were 169.3 PY from the HBsAb-negative group, 362.7 PY from the low-titer group, and 285.8 PY from the high-titer group. Seventeen patients had detectable HBV DNA, with respective incidence rates in negative, low- and high-titer groups of 4.7/100 PY, 2.5/100 PY, and 0/100 PY. Two HBsAb-negative patients subsequently developed HBV reactivation, an incidence of 1.2/100 PY. CONCLUSIONS: The risk of HBV reactivation varied with HBsAb titer, which changed during biologic therapy. Neither HBV DNA nor reactivation were detected in patients with HBsAb > 100 mIU/mL, whereas HBV DNA without reactivation occurred periodically in patients with HBsAb 10-100 mIU/mL; HBsAb-negative serostatus was associated with a risk of HBV reactivation.

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia

Summary Objective: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. Method: Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Results: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). Conclusion: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

OBJECTIVE: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. METHOD: Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. RESULTS: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). CONCLUSION: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

Frequency of Lost to Follow-Up and Associated Factors for Patients with Rheumatic Diseases.

OBJECTIVE: To determine the frequency of lost to follow-up (LTFU) in the setting of usual care for outpatients with rheumatic diseases including RA, SLE, AS, and Ps/PsA, to explore the associated demographic factors, and to investigate the reasons for being LTFU from the original medical care. METHODS: Patients registered between May 2011 and January 2014 at the rheumatology outpatient department of a medical center were included. Those who did not attend their scheduled appointment were defined as LTFU. Univariate and multivariate logistic regression were used to analyze the factors for being LTFU. RESULTS: A total of 781 patients were enrolled, including 406 patients with RA, 174 with SLE, 136 with AS, and 65 with Ps/PsA. The frequency of LTFU was 23.9%, 25.9%, 35.3%, and 35.4%, respectively. The frequency of LTFU was significantly different between the four rheumatic diseases (p = 0.028). In multivariate logistic regression analysis, an older age increased being LTFU in the patients with RA (OR 1.02; 95% CI 1.00-1.04; p = 0.033), but reduced being LTFU in those with Ps/PsA (OR 0.96; 95% CI 0.92-0.99; p = 0.021). Female patients with SLE and Ps/PsA were more likely to be LTFU, although this did not reach statistical significance (p = 0.056 and 0.071, respectively). The most common reason for being LTFU was moving to other district hospitals from the original medical center due to convenience for the patients with RA and SLE, and stopping medication due to minimal symptoms for the patients with AS and Ps/PsA. CONCLUSIONS: The frequency of LTFU in patients with rheumatic diseases is high. Associated demographic factors included older age in RA, female gender in SLE and Ps/PsA, and younger age in Ps/PsA, with various reasons for being LTFU. Recognizing these associated factors and reasons for being LTFU may help to improve the attendance of patients and the quality of medical care.