Influencing Factors Of Uric Acid Excretion And Urinary Calculi In Male Gout Patients

Research questions and objectives:Patients with gout are prone to nephrolithiasis for perplexing reasons.Current literature suggests an association between stone risks with uric acid excretion,the disease status of gout and other comorbidities.The present study aims to investigate the influencing factors for uric acid excretion and stone occurrence in male gouty patients in order to shed light on stone risk management.Methods:The cross-sectional study included the following:1.The investigation of influencing factors for uric acid excretion.Male gouty patients were recruited who first presented at our Gout Clinic during January 2014 and January 2020 and whose uric acid excretion was recorded within six months from the first encounter.‘The cumulative score of metabolic syndrome-related diseases'was defined to represent the severity of the metabolic syndrome.Whether SUA,UUA,FEUA,CUA,24hUUA and 24hUV changed accordingly were analyzed.Multiple linear regression analysis was then employed for influencing factors of FEUA,CUA and 24hUUA.2.The investigation of influencing factors for stone occurrence.Male gouty patients were recruited who first presented at our Gout Clinic during January 2017 and January 2020 and their clinical characteristics were examined.Based on their comorbidities,the patients were grouped using cluster analysis.Eventually,a stone prediction model for male gouty patients without CKD was established using Logistic analysis.Results:1.Seventy-two patients were included.(1)With the increasing cumulative score of metabolic syndrome-related diseases,an increasing trend was found of UUA(p<0.001)and 24hUV was decreasing(p=0.035).(2)Multiple regression analysis revealed multiple influencing factors of uric acid excretion.Age,SUA,dyslipidemia,fatty liver,the interaction between low 24hUV and SUA and interaction between low 24hUV and eGFR were significantly related to FEUA.eGFR,SUA,the interaction between low 24hUV and eGFR,and interaction between low 24hUV and SUA were significantly related to CUA.SUA,mildly impaired renal function,low 24hUV,and interaction between low 24hUV and mildly impaired renal function were significantly related to 24UUA.2.A total of 352 patients were included.(1)Compared with those without stone,patients with stone had longer disease course of gout(p=0.006),lower SUA level(p=0.019)and higher BMI(p=0.031).(2)Stone occurrence showed an increasing trend with a higher cumulative score of metabolic syndrome-related diseases(p=0.010).(3)Gouty patients were clustered into three distinct groups.Patients in the group with the highest stone rate also tended to be older,have longer disease course and more severe disease status of gout,and frequently had comorbid hypertension,dyslipidemia,diabetes,coronary artery disease and CKD.The group second to the highest was.characterized by a high rate of obesity,dyslipidemia,fatty liver and abnormal liver function.The one with the lowest stone rate showed fewer metabolic abnormalities.(4)Using Logistic regression,the stone disease in gouty patients without CKD could be predicted with age,disease course,SUA and BMI.The disease risk was among the highest for patients in their forties,with a disease course of 5~10 years,with SUA lower than 420umol/L and for those who were overweight or obese.Conclusions:1.(1)With increasing severity of the metabolic syndrome,patients with gout tended to have lower 24hUV and more concentrated urine,therefore an increased risk of stone.(2)FEUA,CUA and 24hUUA of gouty patients were associated with age,course,dyslipidemia,fatty liver,kidney function and urine volume.Copious urine volume can facilitate the excretion of SUA.2.(1)CKD,metabolic syndrome-related disorders are closely related to stone in gouty patients.Control of these comorbidities may help reduce stone risks.(2)Management of gout and weight reduction may reduce the stone risk for gouty patients without CKD,therefore it may serve as an early intervention for CKD prevention.Background:The COVID-19 outbreak has taken great tolls on every industry,among which the health care profession is the most affected.The shortage of nurses has become more prominent than ever during this outbreak.Therefore,encouraging employment and promoting confidence in the nursing profession is paramount.Objective:Nursing students are the reserve army of the nursing profession.Their career opinions are likely to affect their career decision and in turn the development of the nursing profession.This study is intended to explore whether and how COVID-19 affects nursing students' career perspectives and their wills to pursue this career.Positive and negative influencing factors are identified.Method:The researchers recruited nursing students via the"snowballing" approach and conducted semi-structured telephone interviews about the effects of COVID-19 on their career decisions.Each interview lasted 30 to 60 minutes.Based on the grounded theory,the researchers coded key information of the interview and made an inductive analysis to derive themes.Results:Among the 17 nursing students,only one had intended to leave the nursing profession before the outbreak.During the outbreak,none of them had changed their career choice,yet multiple influencing factors caused them to alter their career perspectives.These included four themes:the nursing profession,the healthcare professionals,the country and the society,and factors on other levels.Increased physical and mental burden,higher risk of occupational exposure,the unrecognized need of the female workers,and other negative events incited negative emotional reflections and worries among the nursing students.In the meantime,an enhanced sense of professional identity,practical expertise,the strength of role models,an improved attitude of the society,and media coverage all brought about positivity and encouragement to the nursing students.Conclusions:During this major public health event,the nursing students did not change their career choice but were still influenced by numerous factors.In order to better prepare for similar future events and increase confidence among the nurses,the reserve of medical staff and resources need to be improved.The importance of recognizing the needs of female nurses and their expertise should be stressed.National and industrial support to alleviate their burden can help avoid the pernicious circle between more talent drain and a heavier workload.Furthermore,understanding and respect of the nursing profession from society greatly influence nurses' career opinions.The country,the society and the medial should cooperate to provide support for the nursing profession to deal with the national and global nursing shortage.