Effects of WeChat follow-up management on the psychological distress, care burden, and quality of life of parents of infants with bronchopulmonary dysplasia: a retrospective cohort study.

Objective: The objective was to explore the impact of WeChat follow-up management on the psychological distress, care burden, and quality of life of parents of infants with bronchopulmonary dysplasia (BPD) receiving in-home care. Methods: This was a retrospective cohort study. A total of 101 parents of infants with BPD who were followed up from January 2016 to January 2022 were included in this study. According to different follow-up methods, these patients were classified into the WeChat group and the routine group. The Depression, Anxiety, and Stress Scale-21 (DASS-21), Zarit Caregiver Burden Interview (ZBI), and WHOQOL-BREF were used. The data on the psychological distress, care burden, and quality of life of the parents in the two groups were analyzed and compared at discharge and at the 3-month follow-up. Results: There was no significant difference in the DASS-21 and ZBI scores at discharge between the parents in the two groups. During the 3-month follow-up, the scores of the DASS-21 anxiety and stress subscale and the ZBI of parents in the WeChat group were significantly lower than those of parents in the routine group (P < 0.05); however, there was no significant difference in the depression subscale score between the two groups (P > 0.05). A comparison of the WHOQOL-BREF score between the two groups showed that the total quality of life score in the WeChat group was significantly higher than that in the routine group (P < 0.05). The scores of the psychological and social relationship fields in the WeChat group were significantly higher than those in the routine group (P < 0.05). The incidence of adverse events during follow-up was significantly lower in the WeChat group than in the routine group (P < 0.05). Conclusion: WeChat follow-up management is helpful to decrease the anxiety and stress, reduce the care burden, and improve the quality of life of parents of infants with BPD receiving in-home care.

Changes in synaptic plasticity and expression of glutamate receptor subunits in the CA1 and CA3 areas of the hippocampus after transient global ischemia.

Excess glutamate release from the presynaptic membrane has been thought to be the major cause of ischemic neuronal death. Although both CA1 and CA3 pyramidal neurons receive presynaptic glutamate input, transient cerebral ischemia induces CA1 neurons to die while CA3 neurons remain relatively intact. This suggests that changes in the properties of pyramidal cells may be the main cause related to ischemic neuronal death. Our previous studies have shown that the densities of dendritic spines and asymmetric synapses in the CA1 area are increased at 12h and 24h after ischemia. In the present study, we investigated changes in synaptic structures in the CA3 area and compared the expression of glutamate receptors in the CA1 and CA3 hippocampal regions of rats after ischemia. Our results demonstrated that the NR2B/NR2A ratio became larger after ischemia although the expression of both the NR2B subunit (activation of apoptotic pathway) and NR2A subunit (activation of survival pathway) decreased in the CA1 area from 6h to 48h after reperfusion. Furthermore, expression of the GluR2 subunit (calcium impermeable) of the AMPA receptor class significantly decreased while the GluR1 subunit (calcium permeable) remained unchanged at the same examined reperfusion times, which subsequently caused an increase in the GluR1/GluR2 ratio. Despite these notable differences in subunit expression, there were no obvious changes in the density of synapses or expression of NMDAR and AMPAR subunits in the CA3 area after ischemia. These results suggest that delayed CA1 neuronal death may be related to the dramatic fluctuation in the synaptic structure and relative upregulation of NR2B and GluR1 subunits induced by transient global ischemia.

[Effects of early mechanical ventilation on oxygenation and hemodynamics in acute high altitude pulmonary edema patients complicated by acute respiratory distress syndrome].

OBJECTIVE: To investigate the effect of early mechanical ventilation on oxygenation and hemodynamic of acute high altitude pulmonary edema (HAPE) patients complicated by acute respiratory distress syndrome (ARDS). METHODS: From May 2001 to December 2006, 8 HAPE patients with secondary ARDS admitted to Germud City People's Hospital were enrolled in the study. All the patients received early invasive mechanical ventilation within 24 hours of HAPE. Hemodynamics, cardiac output, arterial and mixed venous blood gas and oxygen dynamics parameters were determined before and after 96 hours of mechanical ventilation. RESULTS: Before treatment the right atrial pressure (RAP), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance index (PVRI) and shunt (Qs/Qt) were above normal values. Oxygen delivery (DO2), oxygen extraction rate (O2ER), and oxygenation index (PaO2/FiO2) were lower than normal values. After treatment with mechanical ventilation, arterial partial pressure of oxygen (PaO2), PaO2/FiO2, arterial oxygen saturation (SaO2), partial pressure of oxygen of mixed venous blood (PVO2) and mixed venous oxygen saturation (SVO2) were increased significantly compared with those before treatment [PaO2: 70.3±2.9 mm Hg (1 mm Hg=0.133 kPa) vs. 49.9±3.5 mm Hg, t=15.292, P=0.001; PaO2/FiO2: 201.6 ± 4.8 mm Hg vs. 134.5±5.2 mm Hg, t=19.618, P=0.004; SaO2: 0.929±0.021 vs. 0.780±0.073, t=6.226, P=0.002; PVO2: 54.8±2.9 mm Hg vs. 44.9±2.6 mm Hg, t=6.767, P=0.002; SVO2: 0.726±0.017 vs. 0.663±0.053, t=3.262, P=0.008]. Heart rate (HR), RAP, mPAP, pulmonary wedge pressure (PAWP), PVRI, right ventricular stroke work index (RVSWI) and Qs/Qt were decreased significantly compared with those before mechanical ventilation [HR: 73±2 bpm vs. 102±13 bpm, t=6.228, P=0.000; RAP: 6.9±1.0 mm Hg vs. 13.9±1.5 mm Hg, t=3.609, P=0.008; mPAP: 18.5±2.9 mm Hg vs. 41.6±3.0 mm Hg, t=4.773, P=0.000; PAWP: 6.9±2.2 mm Hg vs. 14.0±4.2 mm Hg, t=2.747, P=0.030; PVRI: 26.3±1.7 kPa×s×L(-1) vs. 49.6±10.0 kPa×s×L(-1), t=9.861, P=0.000; RVSWI: 11.0±1.9 g×cm(-1)×min×m(2) vs. 22.0±1.5 g×cm(-1)×min×m(2), t=12.704, P=0.000; Qs/Qt: (26±18)% vs. (35±15)%, t=7.603, P=0.000], and cardiac index (CI), DO2, oxygen consumption (VO2) and O2ER were also increased [CI: 71.68±6.67 mL×s(-1)×m(-2) vs. 70.01±6.67 mL×s(-1)×m(-2), t=2.832, P=0.036; DO2 (L×min(-1)×m(-2)): 460.9±14.0 vs. 410.0±3.1, t=9.268, P=0.000; VO2 (L×min(-1)×m(-2)): 158.5±9.2 vs. 129.9±5.3, t=2.818, P=0.004; O2ER: (20±1)% vs. (18±1)%, t=7.652, P=0.000]. All of the 8 patients survived. CONCLUSIONS: Pulmonary circulation hemodynamic and oxygen dynamic disorders were found in HAPE patients with secondary ARDS. Treatment with early mechanical ventilation not only improved oxygenation but also reduced pulmonary hypertension and increased cardiac output and DO2.