ObjectivesTo systematically review the efficacy of hypothermia intervention on adult severe craniocerebral injury.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of hypothermia intervention on severe craniocerebral injury from the establishment of the database to July 2nd, 2020.Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 25 RCTs involving 2 949 patients were included. The results of meta-analysis showed that the mortality of hypothermia intervention group was lower than that of normal body temperature group (RR=0.72, 95%CI 0.58 to 0.89, P=0.003), and the prognosis of hypothermia intervention group was better than that of normal body temperature group (RR=1.29, 95%CI 1.15 to 1.46, P<0.000 1).ConclusionsCurrent evidence shows that the hypothermia intervention has a lower mortality rate and a higher prognosis rate in the treatment of adult severe brain injury. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo analyze the short- and long-term therapeutic effects of heart transplantation in children. MethodsA retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023, analyzing their clinical characteristics, surgical data, postoperative complications, and survival rates. ResultsA total of 22 children underwent heart transplantation, including 14 males and 8 females, with a median age of 13.5 (10.0, 15.0) years and a median weight of 41.9 (30.5, 55.4) kg. The primary diseases included: dilated cardiomyopathy in 16 patients, hypertrophic cardiomyopathy in 1 patient, myocardial dysplasia in 3 patients, right ventricular dysplasia in 1 patient, and congenital heart disease with abnormal coronary artery origin in 1 patient. The median age of the donors was 21.0 (13.0, 29.0) years, and the median weight was 50.5 (47.3, 75.0) kg. The blood types of the donors and recipients were the same, with type A in 10 patients, type B in 5 patients, type O in 5 patients, and type AB in 2 patients. Before transplantation, all children had a New York Heart Association cardiac function grade Ⅳ, with 1 patient assisted by intra-aortic balloon pump (IABP), 3 patients assisted by extracorporeal membrane oxygenation (ECMO), 2 patients assisted by continuous renal replacement therapy (CRRT), and 2 patients on mechanical ventilation. Nine patients met the criteria for emergency child status allocation, and the panel reactive antibody level in the patients was<10%. The median cold ischemic time of the donor heart was 355.0 (262.0, 395.5) min, the median aortic cross-clamping time was 45.0 (38.3, 51.3) min, the median mechanical ventilation time was 22.5 (16.8, 52.5) h, the median postoperative hospital stay was 29.5 (20.0, 43.0) d, and the median intensive care unit stay was 6.0 (5.0, 8.3) d. After surgery, 4 patients were assisted by ECMO, 2 patients by CRRT, and 7 patients developed complications, including lung fungal infection in 6 patients, liver and kidney dysfunction in 1 patient, local wound non-union and mediastinal infection in 1 patient, and multiple organ failure in 1 patient. Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3% at 1 year and 3 years; the survival rates of adult heart transplant recipients at our center were 86.7% and 73.8% at 1 year and 3 years, respectively, indicating that the survival rate of children with heart transplantation was higher than that of adult patients. ConclusionHeart transplantation is an effective treatment for end-stage heart failure in children, and the short- and long-term survival rates of children with heart transplantation are superior to those of adults. There are still many difficulties to be solved in pediatric heart transplantation, requiring joint efforts from society and the medical community.
Objective To investigate whether predicted heart mass (PHM) ratio can predict the prognosis of adult heart transplant patients. Methods Clinical data of 309 heart transplant patients in Zhengzhou Seventh People's Hospital from May 2018 to July 2024 were retrospectively analysed. The cut-off value of the PHM ratio was calculated, grouping was conducted according to the truncation value, and the baseline data and prognosis data of the two groups were compared. Results A total of 236 adult heart transplant recipients were included in this study according to the inclusion and exclusion criteria. Cut-off value of the PHM ratio was –0.01. There wer 63 patients in the PHM ratio>–0.01 group and 186 patients in the PHM ratio ≤–0.01 group. The results of univariate analysis revealed that there were statistical differences between the two groups in terms of recipient gender (P<0.001), donor gender (P<0.001). There was no statistical difference in primary disease, recipient blood type, infectious disease, emergency status, preoperative intra-aortic balloon pump (IABP), preoperative extracorporeal membrane oxygenation (ECMO), preoperative continuous renal replacement therapy, preoperative mechanical ventilation, and preoperative blood creatinine (P>0.05). In terms of prognosis, there were statistical differences between the two groups in postoperative ECMO (P=0.043), and postoperative IABP (P=0.006). Survival rate was significantly lower in the PHM ratio ≤ –0.01 group than in that in the PHM ratio>–0.01 group (HR=1.748, 95%CI 1.007-3.035, P=0.047). Multifactorial Cox regression showed that PHM ratio was significantly associated with survival after heart transplantation (HR=0.000 3, 95%CI 0.000 1-0.001 2, P<0.001); recipient sex, donor sex, donor BMI, donor BSA, recipient BMI , recipient BSA did not significantly correlate with post cardiac transplantation survival. Conclusion Predictive heart mass ratios can predict the prognosis of adult heart transplantation, and donor hearts with PHM ratios>–0.01 should be selected as much as possible when performing heart donor evaluation.