ICU新护士培训方案的制订及应用

目的 探讨基于角色转变冲击模型制订的ICU新护士培训方案的应用效果。方法 2018年7月选取6所三级甲等医院入职的100名ICU新护士作为研究对象,随机分为试验组和对照组。试验组按照基于角色转变冲击模型制订的培训方案给予培训,对照组给予常规培训。采用新护士转型冲击评价量表和护理行为六维度量表评价培训效果。 结果 培训后,试验组转型冲击量表总得分及各维度得分均低于对照组,差异有统计学意义（P<0.05）;试验组护理行为六维度量表总分及各维度得分均高于对照组,差异有统计学意义（P<0.05）。结论 ICU新护士培训方案可以减轻ICU新护士转型冲击,提升ICU新护士的岗位胜任力。     

儿科护士健康教育素养评价指标体系的构建

目的 基于德尔菲法构建儿科护士健康教育素养评价指标体系,为护理管理者对儿科护士健康教育素养的测评工具和培训考核提供参考标准。方法 通过查阅国内外文献、半结构式访谈初步构建儿科护士健康教育素养评价指标体系的各级指标;对15名国内专家进行2轮德尔菲专家函询,并对函询结果进行汇总,完成指标的修改,最终形成评价指标体系。结果 通过2轮德尔菲专家函询,构建的儿科护士健康教育素养评价指标体系包含5个一级指标,52个二级指标;2轮专家函询问卷回收率分别为100%、100%,专家函询权威系数分别为0.885、0.890,专家函询的意见协调系数分别为0.152、0.195,显著性检验均为P<0.001。结论 基于德尔菲法构建的儿科护士健康教育素养量表科学、合理、可靠性好,突出了儿科健康教育的特色;函询专家的积极性和权威程度高,协调性较好,可作为评价儿科护士健康教育素养的测评工具。     

新护士规范化培训效果评估体系的构建

目的 构建基于柯氏四级评估模式的新护士规范化培训效果评估体系,以科学地衡量培训效果。方法 通过文献回顾、专家访谈等方法初步拟订新护士规范化培训效果评估体系指标条目及各维度评价时间和方法,采用德尔菲法对从事临床护理管理、临床护理教学管理、院校护理教育的18名专家进行2轮专家函询。结果 本研究构建的新护士规范化培训效果评估体系包括反应层、学习层、行为层和结果层4个一级指标、16个二级指标和48个三级指标。结论 函询过程中,专家协调程度和意见一致程度较高,本研究构建的新护士规范化培训效果评估体系具有一定的科学性和可靠性,可为医院护理管理者评估新护士培训效果和完善培训方案提供科学依据。     

综合医院精神科开放式病房新护士岗位胜任力考核评价指标的构建

目的 构建综合医院精神科开放式病房新护士岗位胜任力考核评价指标,为制订综合医院精神科开放式病房新护士岗位准入提供借鉴。方法 研究小组初拟精神科开放式病房新护士准入岗位胜任力评价指标,采用德尔菲法对17名综合医院的精神科专家进行2轮函询。结果 2轮函询专家的积极系数分别为100%、94%,2轮专家权威系数分别为0.931、0.947,一、二、三级指标的协调系数为0.287、0.255、0.206（均P<0.05）,最后形成了6项一级指标,20项二级指标,35项三级指标的考核评价指标。结论 综合医院精神科开放式病房新护士岗位胜任力考核评价构建方法具科学性、可操作性,专家积极性和权威性高,各级指标专家咨询意见趋于一致,可用于综合医院精神科开放式病房新护士岗位准入、培训效果、修订考核及培训计划的参考工具。     

临床护士循证实践培训体系的构建

目的 构建科学系统的临床护士循证实践培训体系,为培养循证实践临床护理人才提供依据。方法 以循证实践七步模型为依据,通过文献研究、小组讨论拟定临床护士循证实践培训体系专家咨询问卷,采用德尔菲专家咨询法选取25名专家进行2轮函询。结果 2轮专家咨询问卷有效回收率分别为80%、100%,专家权威系数为0.93。最终形成的临床护士循证实践培训体系包括5项一级指标,23项二级指标和61项三级指标。结论 本研究构建的临床护士循证实践培训体系具有较高的可靠性和科学性,对开展临床护士循证实践培训具有较好的指导作用和参考价值。     

综合ICU患者入室前及转出后访视内容标准的构建

目的 构建综合ICU患者入室前及转出后访视内容标准。 方法 采用循证护理、质性研究方法筛选标准指标池,通过专家会议编制原始问卷;采用两轮德尔菲法对30名专家进行函询。 结果 通过两轮专家函询,最终形成5项一级指标、21项二级指标和81项三级指标。两轮专家函询的权威程度为0.82、0.85,协调系数为0.31~0.44。 结论 综合ICU患者入室前及转出后访视内容标准专家意见趋于一致,专家积极性和权威性较高,能够指导综合ICU护士访视实践。     

ICU机械通气患者早期活动护理质量敏感指标的构建

目的 构建ICU机械通气患者早期活动护理质量敏感指标,用于指导护理实践,为早期活动护理质量的评价提供依据。方法 以三维质量结构模型为理论框架,应用约翰霍普金斯循证护理方法进行证据综合,同时结合半结构访谈形成包括3个一级指标、9个二级指标和31个三级指标的函询问卷初稿。通过2轮专家函询确定最终ICU机械通气患者早期活动护理质量敏感指标。结果 2轮专家函询的积极系数均为100%,专家权威系数分别为0.854和0.870,专家意见协调系数为0.312和0.394。最终形成的护理质量敏感指标包括3个一级指标、7个二级指标、28个三级指标。结论 本研究构建的机械通气患者早期活动护理质量敏感指标是一套科学、可靠、可信度较高的评价指标,能够为制订针对机械通气患者早期活动的干预措施提供理论依据。     

质量控制护士岗位胜任力指标体系的构建

目的 构建科学、规范、完整、实用的质量控制护士岗位胜任力指标体系,为质量控制护士的岗位准入、资质认证、能力培养以及考核评价提供参考依据。方法 基于文献回顾、行为事件访谈、半结构化访谈及德尔菲专家函询等方法提取质量控制护士岗位胜任力要素,应用层次分析法和平均分配法,量化分析胜任力的维度、条目及各级评价指标,确定各级指标权重。结果 纳入30名函询专家,2轮函询问卷有效回收率分别为93.3%和100%,第2轮函询专家的熟悉程度系数为0.878,判断依据系数为0.943,权威系数为0.911。最终构建的质量控制护士岗位胜任力指标体系包括一级指标6项（临床实践能力、评判性思维能力、质量评价改善能力、组织与沟通协调能力、培训指导能力、科研创新能力）,二级指标20项,三级指标62项。结论 本研究构建的质量控制护士岗位胜任力指标体系科学、可靠、完整,能为质量控制护士的准入、认证、培养、考评、绩效考核提供量化依据,具有理论和实践意义。     

以情境教学法为基础的儿童基本生命支持培训项目评价体系构建

目的 构建以情景模拟教学为基础的儿童基本生命支持培训项目的评价体系。方法 运用德尔菲专家咨询法对专家进行2轮函询,并运用层次分析法确定各指标权重。结果 通过2轮专家函询,最终形成了3个一级指标,9个二个指标,17个三级指标。2轮专家函询的权威系数分别为0.893 和0.876,第二轮函询结果各级指标的专家协调系数为0.614～0.773。结论 以情景模拟教学为基础的考核评价体系专家咨询意见趋于一致,专家积极性和权威性高,有助于提高教学效果和促进知识掌握。     

基于洋葱模型的妇幼专科医院新护士岗位胜任力模型及指标体系构建

目的 结合妇幼专科医院新护士岗位的实际需要,构建适合妇幼专科医院新护士的岗位胜任力模型及一、二、三级指标体系,为新护士岗位培训提供理论依据。方法 于2020年2—5月,在国内外文献回顾基础上,基于洋葱模型初步建立妇幼专科医院的新护士岗位胜任力模型指标体系,选取33名妇幼护理领域的专家应用德尔菲法对该模型各级指标条目进行2轮专家咨询,提出意见和建议。结果 2轮专家咨询问卷的有效回收率均为100%,专家积极系数高;专家权威系数（Cr）为0.825,专家的权威程度较高;专家的协调程度较高（P<0.05）;最终构建的新护士岗位胜任力模型指标体系包括4个一级指标、15个二级指标、32个三级指标。结论 构建的妇幼专科医院新护士岗位胜任力模型及指标体系较为完善,专家积极性及权威程度高,意见协调程度好,可为新护士岗位培训提供科学的理论依据。     

Development of Oil-in-Gelatin Phantoms for Viscoelasticity Measurement in Ultrasound Shear Wave Elastography

Because tissues consist of solid and fluid materials, their mechanical properties should be characterized in terms of both elasticity and viscosity. Although the elastic properties of tissue-mimicking phantoms have been extensively studied and well characterized in commercially available phantoms, their viscous properties have not been fully investigated. In this article, a set of 14 tissue-mimicking phantoms with different concentrations of gelatin and castor oil were fabricated and characterized in terms of acoustic and viscoelastic properties. The results indicate that adding castor oil to gelatin phantoms decreases shear modulus, but increases shear wave dispersion. For 3% gelatin phantoms containing 0%, 10%, 20% and 40% oil, the measured shear moduli are 2.01 ± 0.26, 1.68 ± 0.25, 1.10 ± 0.22 and 0.88 ± 0.17 kPa, and the Voigt-model coupled shear viscosities are 0.60 ± 0.11, 0.89 ± 0.07, 1.05 ± 0.11 and 1.06 ± 0.13 Pa·s, respectively. The results also confirm that increasing the gelatin concentration increases shear modulus. For phantoms containing 3%, 4%, 5%, 6% and 7% gelatin, the measured shear moduli are 2.01 ± 0.26, 3.10 ± 0.34, 4.18 ± 0.84, 8.05 ± 1.00 and 10.24 ± 1.80 kPa at 0% oil and 1.10 ± 0.22, 1.97 ± 0.20, 3.13 ± 0.63, 4.60 ± 0.60 and 8.43 ± 1.39 kPa at 20% oil, respectively. The phantom recipe developed in this study can be used in validating ultrasound shear wave elastography techniques for soft tissues.     

Dancer perceptions of the cognitive,social, emotional,and physical benefits of modern styles of partnered dancing

ObjectiveTo study dancers’ perceptions of the physical, cognitive, affective, and social benefits of partnered dancing.Method225 dancers (71% female) were recruited through a community ballroom dance center and completed an online survey designed to measure their perceptions of the physical, cognitive, affective, and social benefits of modern, partnered dance styles (swing, Lindy Hop, and ballroom dancing). Subgroups were formed for analyses. For one set of analyses, groups based on length of dance participation were formed: experienced (dancing for more than 2 years) or novice (dancing for less than a year) dancers. For another set of analyses, groups based on frequency of dance practice were formed: committed (dancing at least one or more times per week) or occasional (dancing two or fewer times per month).ResultsThe majority of participants reported perceived benefits in physical fitness, cognition, affect, and social functioning. Experienced dancers reported significantly greater self-perceived physical, social, and cognitive benefits than novice dancers. Committed dancers were more likely than occasional dancers to report improvements in physical fitness, U = 6942, z = 2.38, r = 0.16, p < 0.05. A Mann-Whitney test indicated that self-reported improvements in mood (i.e., feeling less depressed and more happy) were greater for women than for men, U = 3945, z = −3.07, r = 0.20, p < 0.001. Length and frequency of dance participation significantly predicted perceived physical benefits [Χ² (1,6) = 35.463, p <0.001, R² = 0.16] and social benefits [Χ² (1,6) = 15.776, p < 0.05, R² = 0.07], but not cognitive benefits.ConclusionsResults suggest that participation in partnered dance styles is associated with perceived improvements in physical fitness, cognitive functioning, social functioning, mood, and self-confidence, and that perceived benefits may increase as individuals dance more frequently and over longer periods of time.     

Evaluation of Utero-placental and Fetal Hemodynamic Parameters Throughout Gestation in Pregnant Mice Using High-Frequency Ultrasound

Throughout gestation, changes in maternal and fetal Doppler parameters in pregnant mice, similar to those obtained in human fetuses, were detected using high-frequency ultrasound with a 55-MHz linear probe. In the uterine arteries (UtA), fetal umbilical artery (UA) and fetal ductus venosus (DV) peak systolic velocity increased (UtA, p = 0.04; UA, p = 0.0004; DV, p = 0.02), end-diastolic velocity increased (UtA, p < 0.001; UA, p < 0.0001; DV, p = 0.01) and resistance index decreased (UtA, p = 0.0004; UA, p = 0.0001; DV, p = 0.04) toward the end of pregnancy. In the middle cerebral and carotid arteries, end diastolic velocity increased (p = 0.02 and p < 0.0001) and resistance index decreased (both vessels, p < 0.0001). There was a reduction in the pulsatile pattern in the umbilical vein (p < 0.05). The increased velocities and reduced resistance index suggest a progressive increment in blood flow to the fetal mouse toward the end of pregnancy. Fetal and utero-placental vascular parameters in CD-1 mice can be reliably evaluated using high-frequency ultrasound.     

输尿管负压吸引鞘在输尿管软镜碎石术中的价值探讨

目的探讨输尿管负压吸引鞘在输尿管软镜碎石术治疗肾结石中的安全性及有效性。方法回顾性分析96例行输尿管软镜碎石术治疗肾结石患者的临床资料,应用输尿管负压吸引鞘46例(治疗组),未应用50例(对照组),比较两组患者的结石清除率、手术时间、肾盂内压、术后肾绞痛、石街形成情况、术后全身炎症反应综合征(SIRS)、降钙素原(PCT)浓度、白细胞计数、住院时间、住院费用和治疗有效率。结果治疗组肾盂内压在最小值、最大值和平均值方面均明显小于对照组(P0.05);在1个月后检查发现,对照组患者治疗有效率为70.0%,清除率为82.0%,而治疗组患者治疗有效率为84.7%,清除率95.6%,治疗组患者结石治疗有效率和清除率明显优于对照组(P0.05);治疗组和对照组手术时间分别为(86.3±5.2)和(108.6±3.5)min,治疗组明显短于对照组(P0.05);对照组和治疗组术后肾绞痛例数分别为13和2例(P0.05);对照组和治疗组术后石街形成例数分别为11和2例(P0.05);对照组和治疗组术后SIRS分别为10和2例,治疗组术后肾绞痛和石街形成、SIRS例数均明显低于对照组(P0.05);对照组和治疗组住院时间分别为(8.8±1.1)和(7.7±1.2)d,住院费用分别为(23 067.5±392.8)和(21 957.3±378.6)元,治疗组住院时间和住院费用与对照组比较差异无统计学意义(P0.05);对照组和治疗组术后PCT分别为(1.5±0.3)和(0.3±0.1)ng/ml,白细胞计数分别为(14.6±0.5)×109/L和(6.4±0.6)×109/L,术后治疗组患者PCT和白细胞计数明显低于对照组(P0.05)。结论输尿管负压吸引鞘在输尿管软镜碎石术治疗肾结石中安全、有效,缩短手术时长,同时提高结石清除率,减少不良反应发生,应当推广。     

Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study

Objective  The purpose of this study is to investigate the respiratory mechanics, breathing pattern, and pressure-generating capacity of respiratory muscles during the early phases of an acute exacerbation of COPD. Design  Prospective study. Setting  Division of Emergency Critical Care and Chronic Ventilator Unit. Patients  A total of 24 COPD patients: nine patients requiring ventilatory support because of acute respiratory acidosis due to COPD exacerbation (NPPV group, pH 7.28 ± 0.02); seven patients successfully managed with medical therapy only (SB group, pH 7.39 ± 0.04); eight clinically stable, long term mechanically ventilated, COPD patients (IPPV group). Measurements  Respiratory mechanics during a period of unsupported breathing. Results  A rapid shallow breathing, in the presence of a high drive to breath and a high diaphragmatic tension-time index (TT_di), was found in NPPV and IPPV groups compared to the SB group (f/V _T ratio: 118 ± 43 and 137 ± 65, respectively, versus 37 ± 12 breaths/min/L; P _0.1: 5.0 ± 1.0 and 5.4 ± 1.4, respectively, versus 2.2 ± 0.2 cmH₂O, TT_di: 0.168 ± 0.035 and 0.161 ± 0.039, respectively, versus 0.057 ± 0.033); at variance, PEEPi_dyn was greater in IPPV compared to the other two groups. A significant relationship was observed between TT_di ratio and f/V _T (Rho 0.756). Conclusion  During the early phases of an acute exacerbation, patients with COPD and acute respiratory failure had an imbalance between the decreased capacity of the respiratory muscles to generate pressure and the increased respiratory load. This imbalance was similar to that recorded in patients with COPD and chronic ventilatory failure. In both groups, the imbalance was associated with rapid shallow breathing. Among the mechanical constraints to ventilation, only PEEPi,dyn was different between acute and chronic patients with ventilatory failure. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Three LHPP gene‐targeting co‐expressed microRNAs (microRNA‐765, microRNA‐21, and microRNA‐144) promote proliferation,epithelial‐mesenchymal transition,invasion, and are independent prognostic biomarkers in renal cell carcinomas patients

BackgroundRenal cell carcinoma (RCC) is one of the highly malignant tumors in the world. Global Cancer Statistics 2020 estimated that there were 179,368 deaths from kidney tumors. Therefore, exploring the prognostic biomarkers of RCC is of great significance for RCC patients. This study aims to explore the potential mechanism and prognostic value of phospholysine phosphohistidine inorganic pyrophosphate phosphatase (LHPP) gene‐targeting co‐expression microRNAs in RCC patients.MethodsA total of 60 RCC patients were included. Quantitative real‐time PCR (qRT‐PCR), western blotting, and immunohistochemistry were used for LHPP, microRNA‐765, microRNA‐21, and microRNA‐144 levels evaluation. Cell Counting Kit‐8 assay, dual‐luciferase reporter gene assay, invasion assay, and RNA fluorescence in situ hybridization were used for functional analyses.ResultsCompared with adjacent tissues, LHPP levels in cancer tissues were significantly increased (p < .001). Herein, we confirmed that microRNA‐765, microRNA‐21, and microRNA‐144 were direct biological targets of LHPP. MicroRNA‐765 (r = −0.570, p < 0.001), microRNA‐21 (r = −0.495, p < .001), and microRNA‐144 (r = −0.463, p < .001) expression levels were negatively correlated with LHPP expression levels. The high expression levels of microRNA‐765, microRNA‐21, and microRNA‐144 in RCC tissues were associated with poor differentiation, recurrence, and poor prognosis (p < .05). In vitro, microRNA‐765, microRNA‐21, and microRNA‐144 act as oncogenes to promote proliferation, invasion, and epithelial‐mesenchymal transition (EMT) through targeting LHPP.ConclusionsMicroRNA‐765, microRNA‐21, and microRNA‐144 are independent risk biomarkers for RCC patients. Inhibiting the expression levels of microRNA‐765, microRNA‐21, and microRNA‐144 can reduce the proliferation, EMT, and invasion of RCC cells. Therefore, the above three microRNAs are expected to become molecular biomarkers for RCC therapy.     

Depression-like behaviour in rats with mononeuropathy is reduced by the CB2-selective agonist GW405833

The current study assessed whether the chronic constriction injury (CCI) model of neuropathic pain causes depression-like behaviour in animals, and if this depression-like behaviour can be reversed by anti-nociceptive and/or antidepressant drugs. CCI of the sciatic nerve in rats was selected as a neuropathic pain model, mechanical hypersensitivity was assessed by punctuate mechanical stimuli, and depression-like behaviour was evaluated in the forced swimming test (FST) measuring the time of immobility, climbing and swimming. The CCI rats displayed a significant mechanical hypersensitivity (sham 27 ± 2 g, CCI 12 ± 2 g; P < 0.001) and a significant increase in time of immobility (sham 133 ± 14 s, CCI 201 ± 9 s; P < 0.001). As time of swimming was unchanged, immobility was increased at the expense of climbing behaviour (sham 105 ± 17 s, CCI 63 ± 9 s; P < 0.05). There was no difference in ambulation between sham and CCI animals. In sham and CCI animals, desipramine (20 mg/kg) significantly reduced immobility (sham + vehicle 134 ± 19 s, sham + desipramine 79 ± 13 s; P < 0.01, CCI + vehicle 195 ± 8 s, CCI + desipramine 140 ± 11 s; P < 0.05) and increased climbing behaviour (sham + vehicle 118 ± 21 s, sham + desipramine 182 ± 16 s; P < 0.05, CCI + vehicle 59 ± 8 s, CCI + desipramine 112 ± 14 s; P < 0.05) with little effect on mechanical hypersensitivity. In contrast in CCI animals the cannabinoid CB2-selective agonist GW405833 (2,3-dichloro-phenyl)-[5-methoxy-2-methyl-3-(2-morpholin-4-yl-ethyl)-indol-1-yl]-methanone) (30 mg/kg) significantly attenuated immobility (CCI + vehicle 191 ± 7 s, GW405833 145 ± 14 s; P < 0.01) and mechanical hypersensitivity (CCI + vehicle 15 ± 1 g, CCI + GW405833 24 ± 1 g; P < 0.001). Moreover, differently from desipramine, GW405833 did not change the climbing behaviour. These data suggest that rats subjected to the CCI model of neuropathic pain develop depression-like behaviour, which can be reversed by appropriate anti-nociceptive treatment.     

The effects of bisphenol A (BPA) exposure on fat mass and serum leptin concentrations have no impact on bone mineral densities in non-obese premenopausal women

Objectives

Bisphenol A (BPA) exposure may promote obesity, but its effect on bone mineral density (BMD) has not been reported in humans. We aimed to examine the relationships between BPA exposure, body composition, serum estradiol, leptin, osteocalcin levels and BMDs in healthy premenopausal women.

Design and methods

In this cross-sectional study, a total of 246 healthy premenopausal women aged 20 years and older with regular menstrual cycles were investigated. Body mass index (BMI), fat mass, fat-free mass and BMDs were measured by DXA. Serum estradiol, leptin, osteocalcin, urinary BPA and NTx levels were also tested.

Results

Urinary BPA levels were positively associated with fat mass (r = 0.193, p = 0.006) and leptin (r = 0.236, p = 0.001) but not with fat-free mass after adjusting for age and BMI. BPA was not associated with serum estradiol levels, BMDs, or bone resorption marker NTx and bone formation parameter osteocalcin, either. A multivariate stepwise regression analysis confirmed that serum leptin levels were positively influenced by fat mass (β = 0.746, p < 0.001) and BPA (β = 0.127, p = 0.01) but negatively correlated with fat-free mass (β = − 0.196, p < 0.001). However, the changes of BMDs at the lumbar spine (β = 0.298, p < 0.001) and femoral neck (β = 0.305, p < 0.001) were primarily explained by fat-free mass, and were irrelevant of the fat mass, leptin or BPA exposure.

Conclusions

Although BPA exposure is related with increased amount of fat mass and elevated serum leptin levels, it has neutral effect on BMDs in premenopausal women, possibly due to the exclusive role of fat-free mass, which is unrelated to BPA in determining BMDs.     

Involvement of the extracellular matrix proteins periostin and tenascin C in nasal polyp remodeling by regulating the expression of MMPs

BackgroundTissue remodeling caused by increased MMPs is involved in the pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP). We previously found higher levels of periostin and tenascin C in CRSwNPs, but whether they are associated with the dysregulation of MMPs is unknown. Therefore, the present study aimed to investigate the regulatory roles of these two ECM proteins in the expression of MMPs in nasal polyps.MethodsThe concentrations of MMP‐2, MMP‐3, MMP‐7, MMP‐8, MMP‐9, MMP‐12, MMP‐13, TIMP‐1, TIMP‐2, TIMP‐3, TIMP‐4, periostin, and tenascin C in tissue homogenates of 51 patients with chronic rhinosinusitis with and without nasal polyps and 15 control subjects were measured and were analyzed by adjusted logistic regression and spearman correlation test. Primary human nasal polyp fibroblasts and epithelial cells were stimulated ex vivo with periostin and tenascin C and the gene expression of MMPs and TIMPs was determined by means of real‐time PCR.ResultsThe protein levels of MMP‐3, MMP‐7, MMP‐8, MMP‐9, TIMP‐1, TIMP‐2, periostin, and tenascin C were significantly higher in patients with CRSwNPs than in healthy control subjects. The adjusted logistic regression analyses showed that MMP‐3, MMP‐7, MMP‐8, MMP‐9, TIMP‐2, periostin, and tenascin C were related to the occurrence of CRSwNP. Spearman correlation test showed periostin was positively correlated with MMP‐3 and TIMP‐2, and tenascin C was positively correlated with MMP‐3, MMP‐7, MMP‐8, MMP‐9, and TIMP‐2. Periostin stimulated the gene expression of MMP‐3, MMP‐7, MMP‐8, and MMP‐9 in fibroblasts and MMP‐9 in epithelial cells ex vivo. Tenascin C stimulated the expression of MMP‐3, MMP‐7, MMP‐8, and MMP‐9 in epithelial cells. The expression of TIMPs in fibroblasts and epithelial cells was affected by neither periostin nor tenascin C.ConclusionsPeriostin and tenascin C might be involved in the remodeling of nasal polyps by regulating the expression of different MMPs in epithelial cells and fibroblasts. Our findings have the potential to identify key factors of tissue remodeling in CRSwNPs.     

Short-term Evidence in Adults of Anorexigenic Drugs Acting in the Central Nervous System: A Meta-Analysis

PurposeObesity is a chronic clinical condition that is considered one of the most serious health problems in the world because it can cause other chronic metabolic disorders. A meta-analysis was conducted to evaluate the safety and efficacy of 4 central-acting drugs, all approved in Brazil's market for weight loss.MethodsPubMed, EMBASE, and Cochrane library databases were searched from inception until January 2018 to retrieve randomized controlled trials comparing sibutramine, diethylpropion, mazindol, and fenproporex versus placebo in overweight or obese patients. Language was not a restriction for the database searches. We extracted and combined data from studies that reported adverse drug events and weight change. A random effects meta-analytic model was applied in all calculations. The Cochrane Collaboration tool was used to assess the quality and bias of all included studies. Quality of evidence was assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation criteria.FindingsFifty-three studies were included, with a total of 16,903 patients with a median follow-up of 12 weeks (2–260 weeks). The appetite suppressants showed a significant weight loss compared with placebo (mean difference [MD], −4.70 kg; 95% CI, −5.25 to −4.15; I² = 100%; 43 studies). There was an increased total number of adverse events, dry mouth, constipation, insomnia, dizziness, and tachycardia reported in the intervention group (risk ratio [RR], 1.06; 95% CI, 1.01 to 1.10; I² = 20% [22 studies]; RR, 2.08; 95% CI, 1.76 to 2.47; I² = 34% [25 studies]; RR, 2.31; 95% CI, 1.88 to 2.84; I² = 0% [25 studies]; RR, 1.84; 95% CI, 1.40 to 2.39; I² = 0% [17 studies]; RR, 1.78; 95% CI, 1.24 to 2.58; I² = 0% [13 studies]; and RR, 2.01; 95% CI, 1.42 to 2.86; I² = 0% [10 studies], respectively). Sibutramine showed a significant increase in heart rate and mean diastolic pressure compared with placebo (MD, 4.17 beats/min [95% CI, 3.60 to 4.74; I² = 99%; 23 studies]; MD, 1.68 mm Hg [95% CI, 1.29 to 2.07; I² = 98%; 22 studies]).ImplicationsThese drugs are effective for weight loss in overweight and obese patients; however, they increase the risk of adverse events. In fact, the evidence is of low quality, the data availability of studied agents (especially for cardiovascular outcomes) are limited, and the studies are of short duration. PROSPERO identifier: CRD42018091083.