Mechanistic and Functional Studies on the Microbial Induction of Wolfiporia cocos Liquid Fermentation Products.

Liquid fermentation is an efficient culture for obtaining polysaccharides from edible mushrooms. In this study, the polysaccharide content and biomass were examined by introducing microorganisms into the Wolfiporia cocos fermentation system. Three edible mushroom co-fermentation systems were established, among which the Wolfiporia cocos-Ganoderma lucidum co-fermentation system significantly increased the mycelial biomass of the system by 57.71% compared to Wolfiporia cocos alone and 91.22% compared to Ganoderma lucidum alone, and the intracellular polysaccharide content was significantly increased. Physiological activities of polysaccharides showed that mycelial polysaccharides in the Wolfiporia cocos-Ganoderma lucidum system had stronger anti-tumor cell value-adding and anti-tumor cell migration activities compared with Wolfiporia cocos and Ganoderma lucidum fermentation alone. The transcriptomic study of Wolfiporia cocos mycelium induced by exogenous substances suggested that the exogenous substances could enhance the intracellular polysaccharide content of Wolfiporia cocos through the upregulation of the expression of α-glycosyltransferase encoded by ALG10 and the downregulation of α-glycosidases encoded by MAN1B in the glycolytic metabolism of Wolfiporia cocos. This study provides a new direction for the transformation of polysaccharides from Wolfiporia cocos and Ganoderma lucidum into functional foods and new product development, and provides an experimental basis.

Temperature dependence mechanism of high-temperature oxidation of transition metal silicide MoSi2.

Transition metal silicides represented by MoSi2have excellent oxidation resistance and are widely used as high-temperature anti-oxidation coatings in hot end components of power equipment. However, the mechanism of temperature-dependent growth of MoSi2oxidation products has not been revealed. Therefore, this study investigated the formation characteristics of oxide film and silicide-poor compound on MoSi2at temperatures of 1000 °C-1550 °C through high-temperature oxidation experiments, combined with microscopic Raman spectroscopy, scanning electron microscope, and x-ray diffraction (XRD) characterizations. The result showed that MoSi2underwent high-temperature selective oxidation reactions at 1000 °C-1200 °C, forming MoO2and SiO2oxide film on the substrate. As the oxidation temperature increased to 1550 °C, after 100 h of oxidation, along with the disappearance of MoO2and the phase transformation of SiO2, a continuous Mo5Si3layer with a thickness of approximately 47µm was formed at the SiO2-MoSi2interface. Thermodynamics and kinetic calculations further revealed the mechanism of temperature-dependent growth of oxidation products (MoO2and Mo5Si3) during high-temperature oxidation process of MoSi2. As the temperature increased, the diffusion flux ratio of O and Si decreased, leading to a decrease in oxygen concentration at the interface and promoting the growth of the Mo5Si3layer. Its thickness is an important indicator for evaluating the oxidation resistance of MoSi2coatings during service. This study provides experimental and mechanistic insights into the temperature-dependent growth behavior of Mo5Si3during the high-temperature oxidation of MoSi2coating, and provides guidance for predicting the service life and improving the oxidation resistance of silicide coatings.

Design of composite puncture blood collection system and research on puncture force.

Venous blood collection testing is one of the most commonly used medical diagnostic methods. Compared with conventional venous blood collection, robotic collection can reduce needle-stick injuries, medical staff workload, and infection risk; allow doctor-patient isolation; and improve collection reliability. Existing venous blood collection robots use rigid puncture needles, which can easily puncture the lower wall of blood vessels, causing vessel damage and collection failure. This paper proposes a bionic blood collection strategy based on a composite puncture needle that mimics the structure and function of mosquito mouthparts. A bionic composite puncture needle insertion system with puncture-force sensing was designed, and venipuncture forces were simulated and mathematically modelled. A prototype insertion system was built and used in an experiment, which demonstrated effective composite puncture blood collection and explored the factors influencing puncture force. Puncture force decreases with increased puncture speed and angle and with a decreased needle diameter. This provides a basis for optimising the parameters of blood collection robots.

The Applications and Mechanisms of Superoxide Dismutase in Medicine, Food, and Cosmetics.

Superoxide dismutase (SOD) is a class of enzymes that restrict the biological oxidant cluster enzyme system in the body, which can effectively respond to cellular oxidative stress, lipid metabolism, inflammation, and oxidation. Published studies have shown that SOD enzymes (SODs) could maintain a dynamic balance between the production and scavenging of biological oxidants in the body and prevent the toxic effects of free radicals, and have been shown to be effective in anti-tumor, anti-radiation, and anti-aging studies. This research summarizes the types, biological functions, and regulatory mechanisms of SODs, as well as their applications in medicine, food production, and cosmetic production. SODs have proven to be a useful tool in fighting disease, and mimetics and conjugates that report SODs have been developed successively to improve the effectiveness of SODs. There are still obstacles to solving the membrane permeability of SODs and the persistence of enzyme action, which is still a hot spot and difficulty in mining the effect of SODs and promoting their application in the future.

2,3-Seco and 3-nor guaianolides fromAchillea alpina with antidiabetic activity.

In this study, we presented the isolation and characterization of eight novel seco-guaianolide sesquiterpenoids (1-8) and two known guaianolide derivatives (9 and 10), from the aerial part of Achillea alpina L.. Compounds 1-3 were identified as guaianolides bearing an oxygen insertion at the 2, 3 position, while compounds 4-8 belonged to a group of special 3-nor guaianolide sesquiterpenoids. The structural elucidation of 1-8, including their absolute configurations, were accomplished by a combination of spectroscopic data analysis and quantum electronic circular dichroism (ECD) calculations. To evaluate the potential antidiabetic activity of compounds 1-10, we investigated their effects on glucose consumption in palmitic acid (PA)-mediated HepG2-insulin resistance (IR) cells. Among the tested compounds, compound 7 demonstrated the most pronounced ability to reverse IR. Moreover, a mechanistic investigation revealed that compound 7 exerted its antidiabetic effect by reducing the production of the pro-inflammatory cytokine IL-1ß, which was achieved through the suppression of the NLRP3 pathway.

Comparative evaluation of the volume of occlusal adjustment of repositioning occlusal devices designed by using an average value digital articulator and the jaw movement analyzer.

STATEMENT OF PROBLEM: The volume of occlusal adjustment of digital occlusal devices designed with different digital occlusal articulators is unknown. PURPOSE: The purpose of this clinical study was to evaluate and compare the clinical efficacy and volume of occlusal adjustment of digital occlusal devices designed by using an average value digital articulator and the jaw movement analyzer (JMA). MATERIAL AND METHODS: Thirty participants were randomly divided into 2 groups, an Average value group and a JMA group, with 15 participants in each group. The centric relation position of the participants was determined by an experienced investigator with the aid of a leaf gauge. An intraoral scanner (TRIOS 3) was used to obtain digital scans of the maxillary and mandibular dentition and the maxillomandibular relationship record in the centric relation position. Personalized articulator parameters of participants in the JMA group were obtained by using a JMA (JMAnalyser). Different articulator parameters were used to fabricate an occlusal device in a denture design software program (exocad DentalCAD). The surface of the occlusal device was coated with a dental optical spray and then scanned by using a laboratory scanner (Kavo LS3). The process was repeated after the occlusal device was adjusted. The files of the 2 scans were imported into a reverse engineering software program, and the root mean square (RMS) values were obtained by best-fit alignment and 3-dimensional comparison. The Shapiro-Wilk normality test and homogeneity of variance test were performed, and t tests were used to evaluate differences in the RMS values between the groups (α=.05). RESULTS: The experimental data were generally normally distributed (P>.05). No statistically significant difference was found between the RMS values of the Average and the JMA groups (P>.05). CONCLUSIONS: No significant difference in the volume of occlusal adjustment was found when using occlusal devices made by using the digital average articulator or the JMA, suggesting that either method can be used to program articulators for the fabrication of occlusal devices.

Observation on the ice crystal formation process of large yellow croaker (Pseudosciaena crocea) and the effect of multiple cryoprotectants pre-soaking treatments on frozen quality.

By observing the formation behavior of ice crystals, the quality of food products under different freezing conditions can be intuitively judged. In this paper, large yellow croaker was taken as the research object, and a novel cryomicroscopic system was developed to directly observe the structure of ice crystals during the freezing process. The cryoprotective effects of 4% sucrose +4% sorbitol (SU + SO), 4% xylo-oligosaccharide (XO), 4% xylo-oligosaccharide + 0.3% tetrasodium pyrophosphate (XO + TSPP) and 0.2% antifreeze protein (AFP) at different freezing temperatures were investigated. And the evaluation indicators, such as cell deformation degree, equivalent diameters, roundness, elongation and fractal dimension were introduced to quantify the damage of ice crystals to muscle tissues and fibers. The results indicate that reducing the freezing temperature and adding cryoprotectants can improve the quality of large yellow croaker. AFP has the best cryoprotective effect, with a reduction in cell deformation degree of 54.78% and 67.83% compared to the Control group at -5 °C and -20 °C, respectively. SU + SO and XO have the equivalent antifreeze effect, which is slightly inferior to XO + TSPP. In addition, physical parameters of large yellow croaker samples were measured to verify the influence of ice crystal structure on product quality. Therefore, direct observation of the ice crystal formation process and evaluation of ice crystal structure can accurately reflect the quality of frozen products, which is of great significance for the development of refrigeration and preservation technology.

Fermented Chinese Herbal Medicine Promoted Growth Performance, Intestinal Health, and Regulated Bacterial Microbiota of Weaned Piglets.

To investigate the effects of fermented Chinese herbal medicine on growth performance, diarrhea rate, nutrient digestibility, and intestinal health of weaned piglets, and to provide the theoretical basis for applying fermented Chinese herbal medicines to weaned piglet production, a total of 162 weaned and castrated piglets at 25 days of age (Duroc × Landrace × Yorkshire, half male and half female) with an initial body weight of 7.77 ± 0.03 kg were randomly divided into the following three groups according to the principle of similar body weight: basal diet (CON) group, basal diet + 3 kg/t fermented Chinese herbal medicine (LFHM) group, and basal diet + 5 g/kg fermented Chinese herbal medicine (HFHM) group. Each group underwent six replicates and there were nine piglets in each replicate. The experiment lasted 24 days, i.e., 3 days for preliminary feeding, and 21 days for the experiment. From Day 1 of the experiment, the piglets were observed and recorded for diarrhea each day. As compared with the CON group, the results indicated: Following the addition of fermented Chinese herbal medicine, the piglets in the LFHM and HFHM groups increased final weight (FW); average daily feed intake (ADFI); average daily gain (ADG) (p < 0.01); apparent digestibility of crude protein (CP) (p < 0.05); as well as chymotrypsin, α-amylase, and lipase activities (p < 0.01). In addition, α-amylase activity in the LFHM group was higher than that in the HFHM group (p < 0.05); chymotrypsin activity in the LFHM group was lower than that in the HFHM group (p < 0.05); as compared with the CON group, the LFHM and the HFHM increased villus height (VH) and crypt depth (CD) in piglet jejunum; isovaleric acid concentration with the HFHM was higher than those with the CON and the LFHM (p < 0.05), but butyrate concentration with the HFFM was lower than those with the CON and the LFHM (p < 0.05). The high-throughput 16S rRNA sequencing of intestinal microbiota results showed that the LFHM and the HFHM affected the microbial α diversity index in weaned piglet colon (p < 0.01). In conclusion, fermented Chinese herbs can improve the growth performance of weaned piglets by promoting the secretion of intestinal digestive enzymes, changing intestinal microbial diversity, regulating the contents of intestinal short chain fatty acids (SCFAs), promoting intestinal health, and improving nutrients digestibility.

Recent advances on air heating system of cabin for pure electric vehicles: A review.

Due to the environmental protection and energy shortage, the electric vehicles (EV) is gradually replacing traditional fuel vehicles. EV generally use more energy for air conditioning system, especially EV have almost no waste heat from engine to be discharged to the passenger compartment to achieve thermal comfort in heating condition. The energy consumption of the heating system for EV will decrease the maximum mileage. Therefore, the energy saving technology for heating system is developing and applied for EV. The article introduced the advance of conventional and emerging heating system for the EV. The positive temperature coefficient (PTC) heater is a convenient heating method used in EV, but PTC heater has some defects such as low efficiency. The heat pump (HP) system is gradually replacing PTC. However, HP has various problems to be overcome, such as the heating capacity and efficiency in low temperature environment. In addition, other novel technologies are proposed to reduce the energy consumption. This article reviews the literature of novel heating methods for EV, introduces adsorption air conditioning systems (AAC), fuel combustion (FC), heat storage (HS), waste heat recovery (WHR), thermoelectric effect (TE) and magnetocaloric effect (ME). © 2017 Elsevier Inc. All rights reserved.

Role of brain-gut-muscle axis in human health and energy homeostasis.

The interrelationship between brain, gut and skeletal muscle plays a key role in energy homeostasis of the body, and is becoming a hot topic of research. Intestinal microbial metabolites, such as short-chain fatty acids (SCFAs), bile acids (BAs) and tryptophan metabolites, communicate with the central nervous system (CNS) by binding to their receptors. In fact, there is a cross-talk between the CNS and the gut. The CNS, under the stimulation of pressure, will also affect the stability of the intestinal system, including the local intestinal transport, secretion and permeability of the intestinal system. After the gastrointestinal tract collects information about food absorption, it sends signals to the central system through vagus nerve and other channels to stimulate the secretion of brain-gut peptide and produce feeding behavior, which is also an important part of maintaining energy homeostasis. Skeletal muscle has receptors for SCFAs and BAs. Therefore, intestinal microbiota can participate in skeletal muscle energy metabolism and muscle fiber conversion through their metabolites. Skeletal muscles can also communicate with the gut system during exercise. Under the stimulation of exercise, myokines secreted by skeletal muscle causes the secretion of intestinal hormones, and these hormones can act on the central system and affect food intake. The idea of the brain-gut-muscle axis is gradually being confirmed, and at present it is important for regulating energy homeostasis, which also seems to be relevant to human health. This article focuses on the interaction of intestinal microbiota, central nervous, skeletal muscle energy metabolism, and feeding behavior regulation, which will provide new insight into the diagnostic and treatment strategies for obesity, diabetes, and other metabolic diseases.

24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing.

STUDY OBJECTIVES: To investigate the association of 24-hour urinary potassium excretion with self-reported sleep quality in the general population. METHODS: In this cross-sectional study, a population of patients aged 18 years or older was randomly selected from Xinjiang, China in 2019, 24-hour urine samples collected, and Pittsburgh Sleep Quality Index (PSQI) questionnaires assessed. Participants were divided into 2 groups (upper and lower median of 24-hour urinary potassium excretion). Poor sleep quality was defined as PSQI global score ≥ 6. Associations between 24-hour urinary potassium excretion and [24.8 mmol/L] sleep quality were assessed by multiple logistic regression analysis in total participants and those stratified by sex. RESULTS: In total, 24-hour urine samples were collected from 1,147 participants, of whom data for those with complete urine samples and PSQI data were analyzed (n = 727; mean age = 48.7 years; percentage of women = 62%). Compared with the upper median group for 24-hour urinary potassium excretion, the lower median group showed a significantly higher PSQI global score (6 vs 5, P = .011), and prevalence of poor sleep quality (51.7% vs 42.2%, P = .011). In a fully-adjusted model of multivariate logistic regression, the lower median group showed 1.50-fold increased odds for presence of poor sleep quality (95% confidence interval: 1.01-2.24, P = .045). Sex-specific analyses translated these results to women, but not to men. CONCLUSIONS: These results suggest that low potassium intake, indicated by lower potassium excretion, is associated with poor sleep quality in the general population, especially among women. Therefore, additional research is necessary to clarify the effect of increasing potassium intake to improve sleep quality. CITATION: Li M, Heizhati M, Wang L, et al. 24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing. J Clin Sleep Med. 2022;18(11):2589-2596.

The Effect of Dietary Leucine Supplementation on Antioxidant Capacity and Meat Quality of Finishing Pigs under Heat Stress.

This study examined the effects of dietary leucine supplements on antioxidant capacity and meat quality in growing-finishing pigs. A total of 24 crossbred (Duroc × Landrace × Yorkshire) pigs with an average initial weight of 68.33 ± 0.97 kg were randomly allotted to three treatment groups. All pigs were exposed to constant heat stress. Each group of pigs was fed a basal diet, or a diet supplemented with increasing levels of leucine (0.25% or 0.50%). The results showed that leucine intake could improve average daily gain and reduce feed/gain of finishing pigs under heat stress (p < 0.05). The supplementation of leucine could improve the carcass slant length (p = 0.09), and dramatically increased loin-eye area of the finishing pigs (p < 0.05) but had no significant effect on other carcass traits. Compared with the control group, 0.50% leucine markedly reduced drip loss and shear force of longissimus dorsi muscle, and increased pH value at 24 h after slaughter (p < 0.05). Dietary supplementation of 0.25% leucine increased the contents of inosine monophosphate and intramuscular fat in biceps femoris muscle (p < 0.05). Supplementation of 0.25% or 0.50% leucine significantly stimulated the activities of antioxidant enzymes while reduced the level of MDA in serum, liver and longissimus dorsi muscle (p < 0.05). Compared with the control group, 0.50% leucine supplementation markedly modulated the relative mRNA expression levels of genes related to muscle fiber type and mitochondrial function in longissimus dorsi muscle and the gene relative antioxidant in the liver (p < 0.05). In conclusion, dietary leucine supplementation could improve the growth performance and meat quality of the finishing pigs under heat stress, and the pathway of Keap1-NRF2 and PGC-1α-TFAM might be involved.

Poor sleep quality is negatively associated with low cognitive performance in general population independent of self-reported sleep disordered breathing.

BACKGROUND: Sleep disordered breathing (SDB) plays a significant role in both sleep quality and cognition and whether it has an impact on the relationship between above two factors remains to be clear. The study aimed to explore the association between sleep quality and cognitive performance in general population by considering influence of sleep disordered breathing (SDB). METHODS: In this cross-sectional study, we enrolled subjects aged ≥ 18 years using a multi-stage random sampling method. Cognitive status was assessed using Mini Mental State Examination (MMSE) questionnaire, sleep quality using Pittsburgh Sleep Quality Index (PSQI) and SDB was assessed using No-SAS scale, respectively. Multi-variable logistic regression was applied to examine the association of sleep quality and cognitive performance. Subgroup analyses were performed in different age groups, and in those with and without SDB. RESULTS: Finally, 30,872 participants aged 47.5 ± 13.8 years with 53.5% women were enrolled, of whom 32.4% had poor sleep quality and 18.6% had low cognitive performance. Compared with good sleepers, subjects with poor sleep quality exhibited significantly higher presence of low cognitive performance (23.7% vs 16.2%, P < 0.001). Poor sleepers revealed 1.26 (95%CI: 1.16,1.36), 1.26 (1.08,1.46) and 1.25 (1.14,1.37) fold odds for low cognitive performance in general population and in subjects with and without self-reported SDB respectively. Stratified by age and SDB, the association was observed in young and middle-aged group without SDB (OR = 1.44, 95%CI: 1.30,1.59) and in the elderly group with SDB (OR = 1.30, 95%CI: 1.07,1.58). CONCLUSIONS: Sleep quality is in a negative association with cognitive performance in general population independent of SDB, implying improvement of sleep disturbances is a potential objective of intervention strategies for cognitive protection at population level.

Lower 24-h urinary potassium excretion is negatively associated with excessive daytime sleepiness in the general population.

OBJECTIVES: Uncertainty remains about the association of potassium (K) intake and sleepiness. Therefore, we aimed to explore the relationship between K excretion using 24-h urine samples and excessive daytime sleepiness (EDS) in the general population. METHODS: In a cross-sectional study, we used multi-stage proportional random sampling to obtain a study sample aged ≥ 18 years from Emin, China between March and June 2019. We collected timed 24-h urine specimens and conducted EDS assessments using the Epworth Sleepiness Scale (ESS) questionnaire. Subjects were divided into two groups by the median of 24-h urinary potassium (24-h UK). EDS was defined as ESS score ≥ 10. Multi-variable linear regression was used to examine the association between the 24-h UK and the odds of prevalent EDS. We performed a sensitivity analysis by excluding subjects under anti-hypertensive treatment and those with sleep disordered breathing by the NoSAS scale. RESULTS: A total of 470 participants with complete 24-h urine samples and ESS data (62% women, mean age 49.6 years, mean ESS score of 9.0 ± 5.2) were enrolled. The mean ESS score was significantly lower in the upper half of 24-h UK group than in the lower half (9.5 ± 5.3 vs 8.5 ± 5.1, P = 0.044), and accordingly, prevalent EDS was significantly greater in the lower half than in the higher half (49% vs 40%, P = 0.039). In further improving the propensity matching score, the results remained consistent with the overall results. In multiple linear regression, 24-h UK was negatively correlated with ESS score (ß = - 0.180 (- 0.276, - 0.085), < 0.001). Sensitivity analysis demonstrated augmented results in those without anti-hypertensive treatment. CONCLUSION: Lower potassium intake, as suggested by lower UK excretion, may be implicated in the presence of EDS in the general population.

Secondhand smoke is associated with poor sleep quality in self-reported never-smokers of Northwest China: a cross-sectional study.

OBJECTIVE: To investigate the relationship between secondhand smoke (SHS) exposure and sleep quality in never-smokers of Northwest China. METHODS: Never-smoking adults (≥ 15 years) from Xinjiang, Northwest China, were included in this cross-sectional survey between April and October 2019. SHS exposure in never-smokers was estimated using a structured questionnaire. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI), with PSQI score > 5 classified as poor sleep quality. Association of SHS exposure and frequency and duration of SHS exposure with poor sleep quality were analyzed by using a multivariate logistic regression after adjusting for potential confounding factors, including stratification by sex. RESULTS: The mean age of participants was 48.0 years, and 77% were females. Of 21,198 never-smokers, 13% (n = 2703) reported SHS exposure and 35% (n = 7390) reported poor sleep quality. In multivariate logistic regression analysis, a significant association was observed between SHS exposure and poor sleep quality (adjusted odds ratio (OR), 1.36; 95% confidence interval (CI) 1.24-1.48). Subgroup analysis showed a negative association of SHS exposure with sleep quality in both sexes. However, a significant dose-response relationship of frequency and duration of SHS exposure per week with poor sleep quality was observed only in females. Consistent results were also observed in the aged ≥ 18 years. CONCLUSION: Exposure to SHS is associated with poor sleep quality in never-smoking adults of Northwest China. A dose-response relationship between SHS exposure and poor sleep quality is found in women. Avoiding SHS exposure may have beneficial effects on sleep quality, especially for females.

Prevalence and Associated Factors of Kidney Dysfunction in Patients with Hypertension and/or Diabetes Mellitus from a Primary Care Population in Northwest China.

PURPOSE: The burden of kidney dysfunction (KD) is rapidly increasing in developing countries due to an ongoing epidemic of hypertension and diabetes. We aimed to evaluate the prevalence and associated factors of KD among population with hypertension and/or diabetes from primary care setting. METHODS: This study was part of a cross-sectional study conducted in Northwest China, which aimed to investigate the epidemiological status of hypertension and other chronic noninfectious diseases. Subjects aged ≥18 years old with hypertension and/or diabetes were included in this study. KD was defined as estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73m2. Least absolute shrinkage and selection operator and multivariable logistic regression were used to identify factors associated with KD. Sensitivity analysis was performed by comparing the results of different estimated equations for GFR. RESULTS: A total of 8899 participants with hypertension and/or diabetes were included. Prevalence of KD was 8.69% (n=144) among patients with both hypertension and DM, 3.36% (n=198) among patients with only hypertension, and 5.22% (n=70) among patients with only diabetes. Women showed higher prevalent KD than men. Modifiable factors independently associated with KD among patients with hypertension and/or diabetes included physical activity, duration of hypertension or DM, anemia, fasting plasma glucose and triglyceride. Results of different estimated equations showed similar trends of difference in the prevalence of KD among groups. CONCLUSION: KD is common in patients with hypertension and/or DM in Northwest China. More attention should be paid to high-risk patients, especially to those with co-existence of hypertension and DM. Control of blood glucose and triglyceride may further improve KD management in this patient population.

Subjective Poor Sleep Quality is Associated with Higher Blood Pressure and Prevalent Hypertension in General Population Independent of Sleep Disordered Breathing.

OBJECTIVE: To explore the relationship of subjective sleep quality with blood pressure (BP) and hypertension by considering the influence of sleep disordered breathing (SDB) and age in the general population. METHODS: We evaluated sleep quality using the Pittsburgh sleep quality index (PSQI) and SDB using NoSAS score and measured BP in randomly selected adults in China in 2019. Sleep quality is categorized into four groups as very good, fairly good, fairly bad and very bad. SDB is defined as NoSAS score ≥8. Hypertension is defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, and/or use of antihypertensive medicine within previous 2 weeks. Multi-variable linear and logistic regression analyses were used to assess the association of global PSQI score and sleep quality with BP and prevalent hypertension. RESULTS: In the 33,341 participants (53.4% women, median age: 48 years), prevalence of hypertension significantly increased from very good to very bad sleepers in total (34.3 vs 42.6 vs 50.3 vs 58.5%), SDB (61.2 vs 68.3 vs 73.3 vs 75.5%) and non-SDB participants (26.8 vs 33.1 vs 40.1 vs 50.9%). In multiple linear regression, PSQI global score showed significant positive association with BP levels in total, SDB and non-SDB participants, consistent in sensitivity analysis by excluding participants who were taking antihypertensives, and in participants aged <60 years in age-stratified analysis. In multivariable logistic regression, odds ratio for presence of hypertension significantly increased from very good to very bad sleepers in total (1 vs 1.08 vs 1.22 vs 1.48), SDB (1 vs 1.17 vs 1.35 vs 1.28) and non-SDB participants (1 vs 1.05 vs 1.14 vs 1.53), consistent in participants aged <60 years. CONCLUSION: Poor subjective sleep quality is significantly associated with higher BP and prevalent hypertension, independent of SDB in the young- and middle-aged general population, indicating potential of improving sleep quality to lower BP and optimize hypertension management at population level.

Association of Hypertension with Mild Cognitive Impairment in Population from Less-Developed Areas of Multiethnic Northwest China.

BACKGROUND: Relationship between hypertension and mild cognitive impairment (MCI) remains undetermined in population from less-developed regions. We aimed to explore whether hypertension is associated with MCI in this specific population. METHODS: In this cross-sectional study, we enrolled subjects aged ≥18 years using multistage random sampling from Emin, China, in 2019. Participants underwent questionnaires and data collection including mini-mental state examination (MMSE) and blood pressure measurement. RESULTS: Finally, 31,329 subjects were included, with 11,270 hypertensives. Compared with normotensive subjects, hypertensives were characterized by significantly older age (55.19 ± 12.25 vs. 43.26 ± 12.71), more men (52.5% vs. 42.9%), low education attainment (≤primary education: 42.4% vs. 26.3%), more abdominal obesity (39.7% vs. 19.1%), poor sleep quality (39.1% vs. 28.7%), and chronic kidney disease (6.6% vs. 3.4%, p for all <0.001). Prevalence of MCI in hypertensives was significantly higher than that of normotensive subjects (24.3% vs. 15.6%, p < 0.001). Multivariate logistic regression analysis showed in a fully adjusted model that the odds for MCI were significantly increased in hypertensives than in normotensive population (OR = 1.19, 95% CI: 1.09, 1.30, p < 0.001) and independent of all the parameters studied including age, education level, and stroke. In the age-stratified regression model, presence of hypertension significantly increased the odds of MCI by 1.17-fold (95% CI: 1.03, 1.33, p = 0.020) and by 1.22-fold (95% CI: 1.04, 1.44, p = 0.016) in middle-aged and elderly population. Sensitivity analysis of excluding those with stroke history showed that hypertension was still a risk factor for MCI in total, middle-aged, and elderly population. CONCLUSION: Hypertension is in independent negative association with MCI in middle-aged and elderly population from underdeveloped regions.

Barriers to Access to Treatment for Hypertensive Patients in Primary Health Care of Less Developed Northwest China: A Predictive Nomogram.

BACKGROUND: This study aims to evaluate the risk factors associated with untreated hypertension and develop and internally validate untreated risk nomograms in patients with hypertension among primary health care of less developed Northwest China. METHODS: A total of 895 eligible patients with hypertension in primary health care of less developed Northwest China were divided into a training set (n = 626) and a validation set (n = 269). Untreated hypertension was defined as not taking antihypertensive medication during the past two weeks. Using least absolute shrinkage and selection operator (LASSO) regression model, we identified the optimized risk factors of nontreatment, followed by establishment of a prediction nomogram. The discriminative ability, calibration, and clinical usefulness were determined using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision analysis. The results were assessed by internal validation in the validation set. RESULTS: Five independent risk factors were derived from LASSO regression model and entered into the nomogram: age, herdsman, family income per member, altitude of habitation, and comorbidity. The nomogram displayed a robust discrimination with an AUC of 0.859 (95% confidence interval: 0.812-0.906) and good calibration. The nomogram was clinically useful when the intervention was decided at the untreated possibility threshold of 7% to 91% in the decision curve analysis. Results were confirmed by internal validation. CONCLUSIONS: Our nomogram showed favorable predictive accuracy for untreated hypertension in primary health care of less developed Northwest China and might help primary health care assess the risk of nontreatment in patients with hypertension.

Association of Depression with Uncontrolled Hypertension in Primary Care Setting: A Cross-Sectional Study in Less-Developed Northwest China.

BACKGROUND: Hypertensive patients commonly experience comorbid depression, which is closely associated with adverse health outcomes. This study aimed to examine the association between depression and uncontrolled hypertension in primary care setting of Northwest China. METHODS: We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years among primary care setting in Xinjiang, Northwest China, between April and October 2019. Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. We related depression to uncontrolled hypertension, using multiple logistic regression, adjusting for minimally sufficient adjustment set of variables retrieved from a literature-based directed acyclic graphs (DAGs) and optimal adjustment set of variables derived from the least absolute shrinkage and selection operator (LASSO) regression. RESULTS: A total of 1,653 (89.1%) patients had uncontrolled hypertension. The prevalence of depression was 14.5% and 7.4% among patients with uncontrolled and controlled hypertension. Depression was associated with 1.12-fold increased odds of uncontrolled hypertension [odds ratio (OR) 2.12, 95% confidence interval (CI): 1.23-3.65]. The association remained significant even after adjusting for the minimal sufficient adjustment sets and the optimal adjustment set of variables. CONCLUSION: Depression is significantly associated with uncontrolled hypertension in primary care setting of northwest China. The integrated management of depression and hypertension in the setting might be warranted.