Factors Influencing Disabled Stroke Survivors' Quality of Life in Rural China: Based on the Structural Characteristics and Psychometric Properties of the SF-36 Assessment.

Many stroke survivors' quality of life is impaired. Few studies of factors influencing their quality of life have been based on the factors tested by the short form 36 instrument. This study did so with 308 physically disabled stroke survivors in rural China. Principal components analysis was applied to refine the dimension structure of the short form 36 assessment, followed by backward multiple linear regression analysis to determine the independent factors influencing quality of life. The structure revealed differed from the generic structure in showing that the mental health and vitality dimensions are not unidimensional. Subjects who reported access to the outdoors as convenient demonstrated better quality of life in all dimensions. Those who exercised regularly achieved better social functioning and negative mental health scores. Other factors influencing a better quality of life in terms of physical functioning were younger age and not being married. Being older and better educated predicted better role-emotion scores. Being female correlated with better social functioning scores, while men scored better on bodily pain. Being less educated predicted higher negative mental health, while being less disabled predicted better physical and social functioning. The results suggest that the SF-36's dimension structure should be re-evaluated before using it to assess stroke survivors.

Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis in an Elderly Patient With Primary Sjögren's Syndrome.

Neurological manifestations of primary Sjögren's syndrome (SS) are diverse involving the peripheral and central nervous system. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, as the most prevalent autoimmune encephalitis, was rarely reported to be complicated with primary SS. Herein, we present an elderly patient with a 15-year history of primary SS presenting with progressive cognitive dysfunction due to anti-NMDAR encephalitis that was once misdiagnosed as primary degenerative dementia. Early recognition of anti-NMDAR encephalitis and initiation of treatment with steroids and immunosuppressant gained a favorable outcome. Our findings enhance the awareness that autoimmune encephalitis should be taken into account in the patients with primary SS presenting with progressive cognitive impairment.

Risk factors for cerebral infarction in Takayasu arteritis: a single-centre case-control study.

OBJECTIVES: We aimed to investigate the clinical features of Takayasu arteritis with cerebral infarction, and the risk factors for cerebral infarction. METHODS: The study analysed 122 consecutive patients with Takayasu arteritis retrospectively. The clinical characteristics of Takayasu arteritis patients with and without cerebral infarction were compared. Binary logistic regression analysis was performed to determine risk factors for cerebral infarction in Takayasu arteritis patients. RESULTS: Cerebral infarction was present in 42 (34.4%) of 122 patients with Takayasu arteritis. There were 33 patients with ischaemic stroke and 11 with asymptomatic lacunar infarction, including two patients with both types of infarction. The cerebral infarction group had a significantly higher proportion of males, higher prevalence of blurred vision, and higher Indian Takayasu Clinical Activity Score (ITAS) 2010 than the non-cerebral infarction group. Binary logistic regression analysis indicated that hyperlipidaemia [odds ratio (OR) 5.549, P=0.021], ITAS 2010 (OR 1.123, P= 0.023), number of involved arteries (OR 1.307, P=0.018), and middle cerebral artery (MCA) involvement (OR 4.013, P=0.029) were significantly associated with cerebral infarction in patients with Takayasu arteritis. Receiver operating characteristic curves indicated fair performance of the ITAS 2010 (>6) and number of involved arteries (> 7) for distinguishing Takayasu arteritis patients at risk of cerebral infarction from those without such risk. CONCLUSION: Hyperlipidaemia, higher ITAS 2010, larger number of involved arteries, and MCA involvement are independent risk factors for cerebral infarction in Takayasu arteritis patients.

Myasthenia Gravis Coexisting With Primary Sjögren's Syndrome: Report of Three Cases and Literature Review.

Objective: The coexistence of myasthenia gravis (MG) and primary Sjögren's syndrome (pSS) is rarely reported. This study aims to describe the clinical features, treatment and outcome of MG coexisting with pSS. Materials and Methods: Herein we reported three cases with the two coexisting diseases, and also searched the PubMed, Medline databases, and China Wanfang databases for the relevant case reports written in English, Chinese, or Japanese with detailed data. Results: We reviewed a total of 17 patients with both diseases. Fifteen patients were female. The median age at onset was 48 years (range 28-78 years). MG was the initial disease in nine of 17 cases. The median interval between the onsets of the two diseases was 30 months (range 7 months to 20 years). The symptoms of MG included fatigable ptosis (64.7%), bulbar symptoms (58.8%), muscle fatigability (64.7%), diplopia (64.7%), dyspnea (23.5%), and facial paralysis (5.9%). Anti-acetylcholine receptor antibody was positive in 70.6% patients. All the patients had sicca symptoms. Manifestations of pSS also included swollen exocrine glands (23.5%), joint pain (23.5%), hair loss (11.8%), leukopenia (11.8%), recurrent oral ulcers (5.9%), Raynaud phenomenon (5.9%), and fever (5.9%). ANA positivity was present in 70.6% patients, anti-SSA positivity in 47.1%, and double positivity of anti-SSA and anti-SSB in 17.6%. There were 12 patients (70.6%) with two autoimmune diseases (pSS and MG), and five patients with more than two autoimmune diseases. Cholinesterase inhibitors were the most commonly prescribed drugs (82.4%). Seven patients received thymectomy and one patient improved after the operation. Two patients were given intravenous methylprednisolone pulse therapy, and four patients oral steroids combined with immunosuppressants initially. Intravenous immunoglobulin and plasma exchange were used in two patients, respectively, for the respiratory failure. All the patients improved following treatment except one patient who died of MG crisis due to medication withdrawal. Conclusion: The coexistence of SS with MG is quite rare. The onset of MG may occur before or after the diagnosis of SS. Co-morbidity with MG does not seem to adversely affect the course of SS. Thus, controlling the progress of MG is the critical aspect of treatment.

Risk factors for cognitive impairment in older people with diabetes: a community-based study.

AIM: The aim of this study was to investigate the risk factors for cognitive impairment in older people with diabetes. METHODS: This cross-sectional study included 2626 community-dwelling participants with diabetes aged ⩾55 years, living in Beijing, China. The participants were screened for risk factors, including smoking, obesity, hypertension, stroke, coronary heart disease, dyslipidemia, depression, apolipoprotein E (APOE) genotype, and low physical activity. Cognitive function was assessed with the scholarship-adjusted Mini-Mental State Examination (MMSE): MMSE ⩽17 for iliterate participants; MMSE ⩽20 for primary school graduates (⩾6 years of education); and MMSE ⩽24 for junior school graduates or above (⩾9 years of education). RESULTS: The prevalence of cognitive impairment in older people with diabetes was 9.90%. Multiple logistic regression analysis demonstrated that stroke [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.20-2.43], less than 0.5 h exercise per day (OR = 1.89, 95% CI = 1.37-2.61), and depression (OR = 1.64, 95% CI = 1.06-2.54), but not smoking, obesity, hypertension, dyslipidemia, and coronary heart disease, were independent risks for cognitive impairment in older people with diabetes. In addition, being married (OR = 0.66, 95% CI = 0.47-0.93) and urban living (OR = 0.33, 95% CI = 0.22-0.48) could decrease the risk of cognitive impairment. CONCLUSIONS: Stroke, depression, and less than 0.5 h exercise per day were independent risks for cognitive impairment in older people with diabetes, whereas being married and urban living were protective.

Different risk factors for cognitive impairment among community-dwelling elderly, with impaired fasting glucose or diabetes.

AIM: The aim of this study was to investigate whether elderly people with impaired fasting glucose (IFG) or diabetes mellitus (DM) share the common risk factors for cognitive impairment as compared to normal blood glucose population. METHODS: This cross-sectional study assessed 10,039 community-dwelling participants aged ≥ 55 years in Beijing, China. According to the glycemic status, subjects were classified into three groups: normal fasting plasma glucose (NG, n=6399), impaired fasting glucose (IFG, n=873) and DM (n=2626). The Mini-Mental State Examination (MMSE) was applied to evaluate the cognitive function status of the study population. Potential demographic, clinical, and genetic risk factors for cognitive impairment were collected and compared across the three groups. Multivariate logistic regression model was performed to explore the risk factors associated with cognitive impairment. RESULTS: Education-modified MMSE scores in the participants with NG, IFG, and DM were 26.91±3.94, 26.67±4.00, and 26.58±4.11, respectively (P=0.0008). In the age- and sex-adjusted comparisons, the MMSE scores in subjects with DM and IFG were significantly lower than that in subjects with normal glucose (P=0.01 and P=0.02, respectively). The logistic regression analysis showed that risk factors only in the NG population were older age, female, apoEε4 carrier, normal or lower uric acid (UA) levels. Hypertension was an independent risk factor only in IFG group, and the history of stroke and depression were the risk factors associated with cognitive impairment only in the DM group. CONCLUSION: Subjects with DM or IFG had a lower performance on the MMSE test compared with subjects who had normal blood glucose. The elderly with diabetes and IFG have some different risk factors for cognitive impairment as compared to those with normal blood glucose.

Waist circumference is a better predictor of risk for frailty than BMI in the community-dwelling elderly in Beijing.

AIM: Obesity is found to be associated with frailty. Body mass index (BMI) and waist circumference (WC) are the commonly used measures for obesity, the former is more closely related to general obesity and body weight; the latter can more accurately reflect abdominal obesity and is more closely associated with metabolic disorders. In this study, we intend to study the relationship between frailty, BMI and WC among older people. METHODS: Data were derived from the Beijing Longitudinal Study on Aging II Cohort, which included 6320 people 65 years or older from three urban districts in Beijing. A Frailty Index derived from 33 items was developed according to Rockwood's cumulative deficits method. A Frailty Index ≥ 0.25 was used as the cut-off criteria. BMI was classified as underweight, normal, overweight, or obese (< 18.5, 18.5-< 24.0, 24.0-27.9, ≥ 28.0 kg/m2, respectively). High WC was defined as WC ≥ 85 cm in men and ≥ 80 cm in women. RESULTS: People with a larger BMI (≥ 28.0 kg/m2, 22.6%) or a larger WC (18.5%) were more likely to be frail. People with normal BMI and overweight people do not suffer from higher prevalence for frailty. In comparison with individuals with normal BMI (18.5-< 24.0 kg/m2) and normal WC (< 85 cm in men, <80 cm in women), the risk of frailty was higher among individuals who have normal BMI and large WC (odds ratio 1.68; 95% CI 1.33-2.12), have overweight and large WC (odds ratio 1.58; 95% CI 1.23-1.96), or have obesity and large WC (odds ratio 2.28; 95% CI 1.79-2.89). In people with normal WC, only those who are underweight have a higher risk for frailty (odds ratio 1.65, 95% CI 1.08-2.52). In comparison with BMI, the relation of WC with the risk for frailty was much closer. CONCLUSIONS: Abdominal obesity is more closely associated with incidence of frailty than general obesity in the elderly. Older adults with large waist circumference are more likely to be frail. Frailty in the elderly might be more closely related to metabolic disorders. WC might be a better measurement to detect frailty than BMI, given its relationship with metabolic disorders.

Temperature-dependent development and reproduction of rice leaffolder, Marasmia exigua (Lepidoptera: Pyralidae).

Marasmia exigua (Butler) (Lepidoptera: Pyralidae) is one of the major rice leaffolders negatively affecting the rice production in the world. The growth and development of M. exigua was studied at seven constant temperatures (10, 15, 20, 25, 27, 30 and 35°C). The results showed that M. exigua eggs failed to hatch at 10°C and the larvae could not complete development at 15 and 35°C. The developmental times of each stage, survival rates of pre-adult, adult longevity, fecundities and oviposition days of M. exigua at 20, 25, 27 and 30°C were investigated using age-stage, two-sex life table. The total pre-adult development time decreased with the increase in temperature decreasing from 61.58 days at 20°C to 28.94 days at 30°C. The highest survival rate was observed at 25°C (73%). Male adult longevities were generally longer than that of females, except at 30°C. The highest mean fecundity, age-stage specific fecundity and age-specific fecundity peak values were all observed at 27°C. The maximum intrinsic rate of increase r and finite rate of increase λ were observed at 27°C, while the maximum net reproduction rate R0 was observed at 25°C. The longest mean generation time occurred at 20°C and the shortest at 27°C. These results provide better understanding on the development, reproduction and dynamic of M. exigua populations, their distribution, and might be utilized to forecast and manage M. exigua outbreaks in China.