Coffee consumption might be associated with lower potential risk and severity of metabolic syndrome: national health and nutrition examination survey 2003-2018.

BACKGROUND: Metabolic syndrome (MetS) is a clinical syndrome characterized by multiple metabolic disorders and is a serious global health problem. The coffee effect, acting as one of the most prevalent beverages on metabolic syndrome, is debatable. METHODS: We included patients from the National Health and Nutrition Examination Survey 2003-2018 and used a comprehensive evaluation called the MetS z-score to assess the severity of metabolic syndrome. The relationship between coffee, decaffeinated coffee, tea, and MetS z-scores was explored using a weighted linear regression. We also divided the participants into metabolic and non-metabolic syndrome groups according to the NCEP/ATP III criteria for the subgroup analysis. RESULTS: A total of 14,504 participants were included in this study. The results demonstrated that drinking more than three cups of coffee daily was significantly linked to lower MetS z-scores (p < 0.001). Daily coffee consumption was also associated with lower BMI (p = 0.02), systolic blood pressure (p < 0.001), Homeostatic Model Assessment for Insulin Resistance (p < 0.001), and triglycerides (p < 0.001), while it was positively correlated with HDL-C (p = 0.001). Participants who consumed more than three cups of coffee daily had a lower MetS z-score in the MetS (p < 0.001) and non-MetS (p = 0.04) groups. CONCLUSION: This research indicates that coffee consumption is linked to MetS severity. However, decaffeinated coffee and tea intake were unrelated to MetS severity.

Association of the American Heart Association's new "Life's Essential 8" with all-cause mortality in patients with chronic kidney disease: a cohort study from the NHANES 2009-2016.

BACKGROUND: People with chronic kidney disease (CKD) are more likely to die prematurely, and this increased risk of death is primarily attributable to deaths from cardiovascular disease (CVD). We aim to investigate the relationship between Life's Essential 8 (LE8), a newly proposed cardiovascular health (CVH) measurement system, and all-cause mortality of CKD patients among US adults. METHODS: A total of 3,169 CKD patients aged 20 and older from the National Health and Nutritional Examination Survey in 2009-2016 were involved in this study. Participants were divided into low (0-49), moderate (50-79) and high (80-100) CVH groups according to LE8 score (range 0-100). The mortality was ascertained from the National Death Index. Cox proportional hazards regression and restricted cubic spline were used to investigate the relationship. RESULTS: Among the 3,169 CKD patients, the median age was 66.0 (25.0) years and 1,671 (52.7%) were female, and the median follow-up time was 6.00 years. The median LE8 score of the study cohort was 57.5 (19.4). CKD patients with low CVH, health behavior (HB) and health factors (HF) scores presented with higher all-cause mortality (both log-rank P-values < 0.001). After adjusted for multiple confounders, patients in higher CVH group had a lower risk of all-cause mortality, with a HR (95%CI) of 0.32 (0.19-0.55). Similar results were observed in high HB group [HR 0.36 (0.25-0.50)]. The restricted cubic spline showed a significant inverse relationship between LE8, HB and HF scores with CKD all-cause mortality, while the protective effect seemed weaker for HF score. Above results remained robust in the sensitivity analysis. Stronger inverse associations were revealed in middle-aged patients and patients with higher education levels. CONCLUSIONS: LE8 and its subscales scores were inversely associated with all-cause mortality in patients with CKD. Promoting CVH in CKD patients is a potential way to improve their long-term survival rate.

Micro-inflammation related gene signatures are associated with clinical features and immune status of fibromyalgia.

BACKGROUND: Fibromyalgia (FM) is a multifaceted disease. Along with the genetic, environmental and neuro-hormonal factors, inflammation has been assumed to have role in the pathogenesis of FM. The aim of the present study was to explore the differences in clinical features and pathophysiology of FM patients under different inflammatory status. METHODS: The peripheral blood gene expression profile of FM patients in the Gene Expression Omnibus database was downloaded. Differentially expressed inflammatory genes were identified, and two molecular subtypes were constructed according to these genes used unsupervised clustering analysis. The clinical characteristics, immune features and pathways activities were compared further between the two subtypes. Then machine learning was used to perform the feature selection and construct a classification model. RESULTS: The patients with FM were divided into micro-inflammation and non-inflammation subtypes according to 54 differentially expressed inflammatory genes. The micro-inflammation group was characterized by more major depression (p = 0.049), higher BMI (p = 0.021), more active dendritic cells (p = 0.010) and neutrophils. Functional enrichment analysis showed that innate immune response and antibacterial response were significantly enriched in micro-inflammation subtype (p < 0.050). Then 5 hub genes (MMP8, ENPP3, MAP2K3, HGF, YES1) were screened thought three feature selection algorithms, an accurate classifier based on the 5 hub DEIGs and 2 clinical parameters were constructed using support vector machine model. Model scoring indicators such as AUC (0.945), accuracy (0.936), F1 score (0.941), Brier score (0.079) and Hosmer-Lemeshow goodness-of-fit test (χ2 = 4.274, p = 0.832) proved that this SVM-based classifier was highly reliable. CONCLUSION: Micro-inflammation status in FM was significantly associated with the occurrence of depression and activated innate immune response. Our study calls attention to the pathogenesis of different subtypes of FM.

Hyperuricemia and gout increased the risk of long-term mortality in patients with heart failure: insights from the National Health and Nutrition Examination Survey.

BACKGROUND: The prevalence of hyperuricemia, gout, and heart failure (HF) is on the rise, and these conditions often share similar risk factors. The present study aimed to evaluate the relationship among hyperuricemia, gout, HF, and all-cause mortality. METHODS: The data on nonpregnant participants aged ≥ 20 years with or without hyperuricemia, gout, and HF from the National Health and Nutrition Examination Survey 2001-2018 and 2007-2018 were included in this study. The binary logistic regression, Kaplan-Meier curve, Cox proportional-hazards model, and restricted cubic spline analysis were employed to evaluate the relationship among hyperuricemia, gout, HF, and all-cause mortality. RESULTS: Of 204,179,060 and 223,702,171 weighted eligible participants, 40,044,228 (19.6%) and 9,158,600 (4.1%) had hyperuricemia and gout, respectively. Older age, diabetes, stroke, and coronary artery disease were the risk factors for HF among patients with hyperuricemia and gout. The median survival time was 7.00 years and 6.25 years and the 5-year survival rate was 59.9% and 55.9% for patients with HF and hyperuricemia and those with HF and gout, respectively. Patients with hyperuricemia or gout were 2.46 and 2.35 times more likely to have HF and 1.37 and 1.45 times more likely to experience all-cause mortality compared with those who did not exhibit these conditions. The restricted cubic spline showed a nonlinear correlation between uric acid levels and HF and a J-shaped correlation between uric acid levels and all-cause mortality. CONCLUSIONS: Ambulatory patients with hyperuricemia or gout were more likely to have HF compared with those without hyperuricemia or gout. Patients with HF with hyperuricemia or gout were more likely to experience all-cause mortality in the long-term follow-up.

Novel Aspects about "Lifetime" in Upconversion Luminescence.

Recent progress on the temporal response (TR) of lanthanide-doped upconversion luminescence (UCL) has enriched the means of UCL regulation, promoted advanced designs for customized applications such as biological diagnosis, high-capacity optical coding, and dynamic optical anti-counterfeiting, and pushed us to reacquaint the dynamic responses of sensitizer/activator ions in UCL systems. In particular, the lifetime of UCL should be revisited after discovery of novel experimental phenomena and luminescence mechanisms, i. e., it should be understood as the collective TR (in the decay edge) of all the involved ions rather than the reciprocal of the radiative rate of an individual ion. In this Concept, we retraced the latest understanding of the dynamics in UCL with special attention to the relationship between excitation and emission, means of TR regulation, and discussed existing challenges. It is expected to provide some fundamental insights to deepened understanding, further regulation, and frontier applications of TR features of UCL.

Excitation-Controlled Host-Guest Multicolor Luminescence in Lanthanide-Doped Calcium Zirconate for Information Encryption.

Efficient control over lanthanide luminescence by regulating excitations offers a real-time and reversible luminescence-managing strategy, which is of great importance and highly desirable for various applications, including multicolor display and information encryption. Herein, we studied the crystal structure, luminescence properties, and mechanisms of undoped and Tb3+/Eu3+-doped CaZrO3 in detail. The intrinsic purple-blue luminescence from host CaZrO3 and the introduced green/red luminescence from guest dopants Tb3+/Eu3+ were found to have different excitation mechanisms and, therefore, different excitation wavelength ranges. This enables the regulation of luminescent color through controlling the excitation wavelengths of Tb3+/Eu3+-doped CaZrO3. Furthermore, preliminary applications for information encryption with these materials were demonstrated using portable UV lamps of 254 and 302 nm. This study not only promotes the development of multicolor luminescence regulation in fixed-composition materials, but also advances the practical applications of lanthanide luminescent materials in visually readable, high-level anti-counterfeiting and information encryption.

Achieving Multicolor Upconversion Emissions without Changing Compositions.

It is widely recognized that a proper way of adjusting fluorescence color is meaningful for pushing forward upconversion materials to be utilized in anti-counterfeiting, display and solid-state lightning applications. Traditional routes that apply different host materials and/or doping categories to adjust fluorescence color have shown large color region tunability yet have to rely on complex synthesis process accompanied with time and raw material consumption. In this work, in order to get a wide luminous color gamut without depending on reciprocating synthesis, we desinged and provided a high-sensitizer-concentration upconversion crystals, hexagonal NaLuF4:Yb3+/Er3+ (50/2 mol%), whose red-to-green emission intensity ratio can be conveniently tuned from 2.69 to 4.96 by simply modulating excitation power densities. The promoted three-photon-population progress of red emission achieved by using an intensive excitation laser is considered to be responsible for the facile upconversion modulation. The results may provide new ideas for emission color control that based on external parameters in identical host and the greatly amplified excitation power-sensitivity of NaLuF4:Yb3+/Er3+ (50/2 mol%) is highly potential for fluorescence anti-fake and colorful display applications.

Modulating the Rise and Decay Dynamics of Upconversion Luminescence through Controlling Excitations.

Different from organic dye/quantum dot possessing one luminescent center, upconversion luminescence (UCL) is actually a statistic of temporal behaviors of countless individual activators. Our experimental results have shown that the rise and decay dynamics of UCL is directly associated with the relative contribution of sensitizer-to-activator energy transfer and energy migration among sensitizers, which can be physically modulated by simply tuning the excitation laser. Therefore, dynamic UCL with record-wide 20-fold lifetime, ≈70-fold red-to-green intensity ratio, and reversibly definable emission color is easily realized by just modulating the excitation laser. Moreover, this generally applicable strategy only requires a simplest-possible UCL system whereas prevalent material engineering such as complicated composition design, sophisticated core-shell construction, or tedious chemical synthesis, is no longer needed.

NaYF4:Yb/Tm@SiO2-Dox/Cur-CS/OSA nanoparticles with pH and photon responses.

Stimulus-triggered drug delivery systems (DDSs) based on lanthanide-doped upconversion nanoparticles (UCNPs) have attracted significant attention for treating cancers due to their merits of high drug availability, precisely controlled drug release, and low side-effects. However, such DDSs usually exhibit a single stimulus-response, which may limit the efficiency of cancer treatment. To extend response types in a single DDS, we construct NaYF4:Yb/Tm@SiO2-doxorubicin (Dox)/curcumin (Cur)-chitosan (CS)/2-Octen-1-ylsuccinic anhydride (OSA) nanoparticles with core-shell structures. Our method is based on the exploration of the synergistic effect of UCNPs and multiple drugs. In particular, the NaYF4:Yb/Tm is used to convert near-infrared light to visible light, activating Cur photosensitizers to produce singlet oxygen for photodynamic therapy, while CS/OSA responds to a low pH environment to release cancer drugs, including Dox and Cur for chemotherapy through breaking a free carboxyl group. The results show that the UCNPs with a 40 nm diameter, 23 nm thick mesoporous SiO2, and 19/1 mol% Yb3+/Tm3+concentrations could continuously release Dox and Cur at a pH value of 6.5 within 6 h after the excitation of a 980 nm-wavelength CW laser. Our study provides a promising approach for developing efficient DDSs for cancer treatment.

Waveguide-integrated graphene spatial mode filters for on-chip mode-division multiplexing.

On-chip mode-division multiplexing (MDM), as a promising method of scaling communication bandwidth, has attracted tremendous attention due to potential applications in optical interconnects ranging from intra-chip to board-to-board communications. However, the MDM technique usually suffers from signal degradation due to crosstalk between spatial modes in multimode waveguide devices. Here we design waveguide-integrated graphene spatial mode filters for on-chip MDM to overcome this limitation. Specifically, TE1-mode-pass and TE2-mode-pass filters are designed based on different waveguide architectures. For the TE1-mode-pass filters, we have obtained a maximum TE1-to-TE0 modal extinction ratio (ER) of 9.19 dB in a 200-µm-long waveguide. While, for the TE2-mode-pass filters, we have achieved a maximum TE2-to-TE1 modal ER of 5.37 dB and TE2-to-TE0 modal ER of 6.44 dB in a 200-µm-long waveguide. Our study could help improve the signal-to-noise ratio for on-chip MDM optical interconnects.

Spatially confined luminescence process in tip-modified heterogeneous-structured microrods for high-level anti-counterfeiting.

Recent years have witnessed the progress of lanthanide-doped materials from fundamental material synthesis to targeted practical applications such as optical applications in photodetection, anti-counterfeiting, volumetric display, optical communication, as well as biological imaging. The unique compositions and structures of well-designed lanthanide ion-doped materials could expand and strengthen their application performances. Herein, we report dual-mode luminescent crystalline microrods that spatially confine upconversion and downconversion photophysical process within defined regions using the specially designed heterogeneous structure. Through an epitaxial growth procedure, downconversion tips have been conjugated with the parent upconversion microrods in oriented directions. This spatially confined structure can effectively depress the deleterious energy depletion in lanthanide ions homogeneously doped materials, and as a result, the red, green, and blue upconversion intensities have been enhanced by 334, 225, and 22 times, respectively. Moreover, the induced tips hardly disturb the upconversion process of the microrod seeds. Upon 980 nm laser or ultraviolet lamp excitation, tunable emission colors were realized in the single tip-modified microrod, indicating potential applications of these microrods for high-level dual-mode anti-counterfeiting.

Lower Serum Uric Acid Levels May Lower the Incidence of Diabetic Chronic Complications in U.S. Adults Aged 40 and Over.

Previous studies have generally reported the association between serum uric acid (SUA) and diabetic complications, but large-scale research exploring the above association in U.S. adults with diabetes is limited. To explore the association between SUA and chronic complications of diabetes among U.S. patients aged ≥40, we used data from the National Health and Nutrition Examination Survey 1999−2008. SUA was divided into three levels: T1 (SUA ≥ 420 µmol/L), T2 (300 ≤ SUA < 420 µmol/L), and T3 (SUA < 300 µmol/L). Binary logistic regression and restricted cubic spline analysis were applied to evaluate the association between SUA and chronic complications of diabetes. A trend test was performed as the SUA increased substantially. After full-adjusted confounding factors, patients in the T3 group had a lower risk of diabetic kidney disease, cardiovascular disease, and peripheral neuropathy compared with the T1 group, with a OR (95% CIs) of 0.33 (0.21−0.52), 0.56 (0.36−0.87), and 0.49 (0.27−0.89), respectively. The restricted cubic spline showed a significant positive relationship between SUA and cardiovascular disease and diabetic kidney disease in diabetes patients, but not peripheral neuropathy. Maintaining a SUA of less than 300 µmol/L might be protective against the risk of cardiovascular disease, diabetic kidney disease, and peripheral neuropathy other than diabetic retinopathy compared with a SUA of more than 420 µmol/L in U.S. diabetes patients aged 40 and over.

Bionic Micro-Texture Duplication and RE3+ Space-Selective Doping of Unclonable Silica Nanocomposites for Multilevel Encryption and Intelligent Authentication.

High-capacity optical data storage and information encryption by using glass substrates are fascinating due to merits of expanding the functionality and applicability of the optoelectronic field. However, the development of glass substrate-based multi-dimensional information encryption methods has remained a challenge because of the high hardness, brittleness and melting temperature of glasses. Herein, inspired by the unique natural structure of plant leaves, multicolor micro-texture-based physical unclonable functions (PUFs) fluorescence glass labels (MTPLs) are exploited by using ultraviolet photocurable silica nanocomposites and soft replication method. It is the first time that simultaneous rare-earth ion (RE3+ ) space-selective doping and bionic micro-texture replication onto transparent glass have been realized, in which the doping position and fluorescence color of RE3+ and height information of unclonable micro-texture can be selectively equipped for multilevel information encryption. The prepared micro-scale MTPLs are endowed with tunable multilevel authentication models, including macro-scale multicolor fluorescent 2D patterns, micro-scale pattern, color 3D information and intelligence authentication. A high-performance anti-counterfeiting platform with interactive authentication is also established based on the high robustness and security of MTPLs. Such unclonable bionic MTPLs based on RE3+ space-selective doping and micro-texture duplication provide an effective and potentially universal approach for multilevel encryption and intelligent authentication.

Assessment of causal associations between uric acid and 25-hydroxyvitamin D levels.

Background: Previous observational studies have revealed the association between serum uric acid and 25-hydroxyvitamin D. However, the causality and the direction of the associations remain unknown. Thus, we performed a two-sample bidirectional Mendelian Randomization (MR) analysis to investigate the causal association between uric acid and 25-hydroxyvitamin D and to determine the direction of the association. Method: Based on the summary-level GWAS data from large genome-wide association studies, several steps were taken in our analysis to select eligible single-nucleotide polymorphisms (SNPs), which were strongly related to exposure as the instrumental variables. We used different analytical methods, such as inverse-variance weighting (IVW) method, weighted median, MR-Egger regression, and weighted mode method, to make our result more robust and reliable. The IVW method was used as the primary analysis. The Cochran's Q test, MR-Egger intercept test, MR-PRESSO method, and "leave-one-out" sensitivity analysis was performed to evaluate the heterogeneities, horizontal pleiotropy, and robustness of the results. MR analyses were also conducted using genetic risk scores (GRS) as instrumental variables in both directions by using the same summary-level GWAS data. Results: Our two-sample MR analysis suggested a causal association of genetically predicted uric acid on 25-hydroxyvitamin D [IVW method: ß(SE), -0.0352(0.0149); p = 0.0178], which suggested that a per mg/dl increase in uric acid was associated with a decrease of 0.74 nmol/L of 25-hydroxyvitamin D, and the above results remained stable in the sensitivity analysis. By contrast, four MR methods suggested no causal relationship of 25-hydroxyvitamin D on serum uric acid [IVW ß(SE), 0.0139 (0.0635); p = 0.826; MR-Egger ß(SE), 0.0671 (0.108); p = 0.537; weighted median ß(SE), 0.0933 (0.0495); p = 0.0598; weighted mode ß(SE), 0.0562 (0.0463); p = 0.228, respectively]. After excluding the SNPs, which were associated with confounding factors and outlier SNPs, the IVW method suggested that there was still no causal association of 25-hydroxyvitamin D on serum uric acid. The GRS approach showed similar results. Conclusions: Serum uric acid may causally affect the 25-hydroxyvitamin D levels, whereas the causal role of 25-hydroxyvitamin D on uric acid was not supported in our MR analysis. Our findings suggest that increased levels of uric acid should prompt investigation for vitamin D deficiency.

Dose-Response Relationship of Uric Acid With Fasting Glucose, Insulin, and Insulin Resistance in a United States Cohort of 5,148 Non-diabetic People.

Background: There is a limited number of studies on the dose-response relationship between serum uric acid and impaired glucose metabolism in people without diabetes, and no large-scale research exploring the relationship in women without diabetes is based on menopausal status. Consequently, the present study aimed to investigate the above relationship in United States adults without diabetes. Materials and Methods: Data from 2,498 men and 2,650 women aged ≥20 years were obtained from the National Health and Nutrition Examination Survey 2011-2016 conducted in the United States. Binary logistic regression analysis was applied to evaluate the association between uric acid and impaired glucose metabolism. Restricted cubic spline analysis, sensitivity analysis, and stratified analysis by menopausal status were performed to explore the above relationships. Results: A positive correlation was found between uric acid and the risk of insulin resistance in all participants (P < 0.05). In binary logistic regression analysis, after adjusting for confounding factors, compared with the lowest quartile of uric acid, the odds ratio (95% confidence intervals) of insulin resistance in the highest quartile was 1.9 (1.1-3.1) and 2.2 (1.2-4.3) in men and women, respectively. A significant positive relationship was also observed between uric acid and impaired fasting glucose and hyperinsulinemia in women, while in men, uric acid was positively associated with the risk of hyperinsulinemia but not impaired fasting glucose. Restricted cubic spline showed that the odds ratios of insulin resistance and hyperinsulinemia increased with elevating uric acid levels in both men and women. When stratified by menopause, the association remained significant in pre-menopausal women aged ≥20, but insignificant in post-menopausal women. Conclusion: Uric acid was positively associated with the risk of impaired glucose metabolism in a cohort of United States adults, and uric acid increased the risk of insulin resistance in pre-menopausal, but not in post-menopausal women.

Time- and concentration-dependent stimulation of oxidative stress in chondrocytes by intracellular soluble urate.

BACKGROUND: Gout could result in irreversible bone erosion, and chondrocyte might be involved in the process. Increased soluble urate is the early stage of gout and is strongly oxidative. OBJECTIVE: To explore the effect of intracellular urate on the oxidative status of chondrocytes Methods: A chondrocyte model was used. Serial concentrations of exogenous urate were incubated with chondrocytes for increasing amounts of time. Reactive oxygen species (ROS), oxidant, and anti-oxidant molecules were measured with biochemical assays, rt-PCR, and western blot. A urate transport inhibitor and oxidative inhibitors were used to confirm the effect of exogenous urate. RESULTS: All concentrations of exogenous urate stimulated the production of ROS in a time- and concentration-dependent manner, as well as oxidant molecules, including hydrogen peroxide (H2O2), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, nitric oxide (NO) inducible nitric oxide synthase (iNOS), and these effects, could be inhibited by oxidant inhibitors. However, anti-oxidant molecules, including acidic leucine-rich nuclear phosphoprotein-32A (ANP32A), ataxia-telangiectasia mutated (ATM), heme oxygenase-1 (HO-1), and the transcription factor nuclear factor erythroid 2 (NF-E2)-related (Nrf2), was decreased by high concentrations of exogenous urate after prolonged incubation, but not by low to medium concentrations of exogenous urate. By inhibiting soluble urate trafficking, benzbromarone significantly suppressed the effect of urate stimulus on the oxidant and anti-oxidant molecules. CONCLUSION: Intracellular soluble urate could regulate chondrocyte redox balance in a time and concentration-dependent manner, and would be a target for regulating and protecting chondrocyte function in the early gout stage.

Association between Coffee Consumption, Caffeine Intake, and Metabolic Syndrome Severity in Patients with Self-Reported Rheumatoid Arthritis: National Health and Nutrition Examination Survey 2003-2018.

Rheumatoid arthritis (RA) is chronic inflammatory disease. Although coffee impacts metabolism, no evidence has shown an association between coffee consumption and decreased risk for developing metabolic syndrome (MetS) among RA patients. Hence, we examined the association between coffee consumption and metabolic syndrome severity among 1094 participants with self-reported RA. Accordingly, patients with MetS z-scores of <0 and ≥0 were designated as low- and high-risk groups, respectively. In the fully adjusted model, drinking over two cups of coffee daily was associated with a decrease in the MetS z-score (p = 0.04). Subgroup analysis showed that in the low-risk group, daily intake of <2 cups of coffee was associated with low MetS z-scores (p = 0.003), scores (p = 0.03). Coffee intake was associated with low body mass index (p = 0.03 for 0−2 cups per day; p = 0.02 for >2 cups per day) and low HOMA-IR (ß, −2.62; 95%CI, −5.13 to −0.11; p = 0.04). Our study suggests that coffee, but not decaffeinated coffee consumption and total caffeine intake, is associated with MetS severity in RA.

Exploration of the association between serum uric acid and testosterone in adult males: NHANES 2011-2016.

BACKGROUND: Previous studies have suggested that the possible relationship between serum uric acid (SUA) and testosterone. However, the results of previous studies are controversial and there is limited evidence examining the relationship between SUA and testosterone in a general US population of men. The objective of this study is to explore the correlation of SUA and testosterone among adult males from the US. METHODS: Data from the National Health and Nutrition Examination Survey 2011-2016 were used, including a total of 7,796 male participants aged 18 years or older and excluding those lacking serum testosterone and uric acid data. Clinical characteristics of the participants among different SUA groups and testosterone groups are compared. Univariate and multivariate linear regression analyses were applied to evaluate the association between SUA and testosterone. RESULTS: We found an inverse association between SUA and testosterone after fully adjusted the potential confounding factors in general US adult males. In the multivariate linear regression analysis, we found that increasing age (estimate testosterone percent difference: -0.20% per year, P<0.01), uric acid (estimate testosterone percent difference: -4.40% per md/dL, P<0.01) and BMI (estimate testosterone percent difference: -2.86% per kg/m2, P<0.01) were associated with declining serum testosterone. This association remained significant in sensitivity analysis, while in the stratified analysis, above association was not significant in men with diabetes or aged 65 and over. CONCLUSIONS: SUA levels might be negatively associated with serum testosterone in adult males.

Serum Uric Acid Might Be Positively Associated With Hypertension in Chinese Adults: An Analysis of the China Health and Nutrition Survey.

Background: Previous studies have clarified the relationship between serum uric acid (SUA) and hypertension; most of previous studies suggest that elevated uric acid levels are associated with an increased risk of hypertension, while in China, there are relatively few studies to explore above association. The objective of this longitudinal study is to investigate the correlation of SUA and hypertension in Chinese adults with a nationwide large-scale sample. Methods: Data from the China Health and Nutrition Survey 2009, 2011, and 2016 were used; a total of 8,469 participants (3,973 men and 4,496 women) were involved. This study was conducted separately by gender. Clinical characteristics of the participants among different uric acid groups are compared. The binary logistic regression analysis was conducted to examine the association between SUA and hypertension. Restricted cubic spline analysis with three knots of the SUA concentration were used to characterize the dose-response relationship. Additionally, we compared the incidence of hypertension in the different baseline uric acid groups during follow-up in 2011 and 2015. Results: After the covariates were fully adjusted, we found that elevated uric acid levels were correlated with increased risk of hypertension in both males (p < 0.01) and females (p < 0.01). With 2-year or 6-year of follow-up, we found participants with higher baseline uric acid levels had a higher incidence of hypertension (p < 0.01). In stratified analysis by obesity, above relationship remained significant in nonobesity population (males: p < 0.05, females: p < 0.01) and became nonsignificant in obesity people. In stratified analysis by age, above positively correlation remained significant in middle-aged men (p < 0.05) and elderly women (p < 0.01). Restricted cubic spline revealed the dose-response relationship between SUA and hypertension; we also found that above relationship was much stronger in females. Conclusion: This study suggests that elevated SUA levels might be positively associated with an increased risk of hypertension in general Chinese adults.

Rheumatologists' understanding of refractory gout: a questionnaire survey in China.

OBJECTIVE: To explore the understanding of refractory gout in Chinese rheumatologists. METHODS: We conducted an anonymous survey of rheumatologists attending an annual national academic conference on rheumatism. RESULTS: Of the 910 rheumatologists who completed the questionnaire, 751 (82.5%) had received relevant continuing medical education (CME). Of these, 140 (18.6%) rheumatologists did not select xanthine oxidase inhibitors as the first treatment for patients with chronic tophaceous gout. Of all respondents, 113 (12.4%), 251 (27.6%) and 324 (35.6%) prescribed incorrect maximum doses of allopurinol, febuxostat and benzbromarone, respectively; this tendency was more pronounced in the non-CME group. Most rheumatologists agreed that complications and comorbidities increased the difficulty of gout management and considered the term refractory gout to describe those cases with uncontrolled symptoms, unmet treatment targets or non-shrinkage of tophi after standardized drug treatment. Moreover, 62.8% (472/751) of specialists considered that a diagnosis of refractory gout was appropriate for patients whose lifestyle and compliance failed to improve despite adequate education and regular urate-lowering therapy. CONCLUSIONS: Incorrect and inadequate drug therapy may contribute to some cases of refractory gout, especially in physicians without CME. An emphasis on non-drug therapy and the management of comorbidities and complications may reduce cases of refractory gout.