Echocardiographic prediction of patent ductus arteriosus in need of therapeutic intervention

Aim: To evaluate the efficacy of various echocardiographic markers in predicting a patent ductus arteriosus (PDA) in need of treatment. Methods: Forty‐five preterm infants with a mean (SD) gestational age of 27.7 (1.9) weeks underwent echocardiography at a postnatal age of 24 ± 6 and 72 ± 6 h. Four echocardiographic markers were studied: ductus diameter, ductal flow Doppler curves, the left atrial to aortic root (LA/Ao) ratio and Doppler pixels representing ductal shunting. Results: Twenty‐eight infants had a PDA with a detectable left‐to‐right shunt. Of these, 12 (43%) were treated for a shunt through the PDA. Ductal diameter was the most accurate echocardiographic marker when it came to predicting a significant shunt, with a sensitivity of 89%, a specificity of 70%, a positive likelihood ratio of 2.97 and a negative likelihood ratio of 0.16 at the age of 72 h. The efficacy of the method at 72 h of age was 84%. The corresponding efficacy of the pulsatile Doppler curve was 72%, percentage of green colour pixels 63% and the LA/Ao ratio 53%. Conclusion: Ductus diameter appears to be the most important variable in determining the need for therapeutic intervention for PDA in preterm infants.     

Amplatzer封堵器介入治疗动脉导管未闭疗效分析

目的 评价Amplatzer封堵器介入治疗动脉导管未闭(PDA)的临床疗效。方法 对10例管型PDA患儿用Amplatzer PDA封堵器进行堵闭，2例窗型PDA用Amplatzer房间隔双伞封堵器堵闭。在透视下经6F输送器置入封堵器，术后10分钟，行右心导管检查及主动脉弓降部造影，术后24小时、1、3个月分别行彩色多普勒超声心动图、血常规及肝肾功能检查，评价治疗效果。结果 本组技术成功率为100％，患儿心脏双期连续性杂音均消失，术后10分钟主动脉弓降部造影显示少量残余分流2例，均为窗型PDA。术后24小时超声心动图示上述2例仍有微量分流。术后24小时、1、3个月行彩色多普勒超声心动图检查，均未发现残余分流、PDA再通及封堵器移位，血常规及肝肾功能检查均正常。2例有分流的患儿术后均出现急性溶血，经积极内科治疗后好转。其余10例无并发症发生。结论 应用Amplatzer封堵器介入治疗PDA安全有效，近中期疗效满意，远期疗效尚待进一步观察。对窗型PDA可试用Amplatzer房间隔封堵器堵闭。对术后发生急性溶血者可采用内科治疗。     

自制下颌骨骨折复位牵引器在坚固内固定术中的应用

目的评价自制下颌骨骨折复位牵引器在下颌骨骨折手术中的应用价值。方法采用自行研制的获国家专利的下颌骨骨折复位牵引器应用在进行坚固内固定手术的68例下颌骨骨折患者。结果68例患者术后切口无感染，均Ⅰ期愈合。全部病例恢复到术前咬合关系。68例术后X线复查未见骨折愈合不良或假关节形成。结论在下颌骨骨折坚固内固定手术中应用自制下颌骨骨折复位牵引器能够使骨折复位更加接近于伤前的解剖形态，避免出现骨折线过紧或过松而发生铪干扰问题。具有操作简便、固定可靠、疗效确切、患者痛苦小、恢复快等优点，值得临床推广应用。     

How Do Publicly Reported Medicare Quality Metrics for Radiologists Compare With Those of Other Specialty Groups?

PurposeTo characterize and compare the performance of radiologists in Medicare’s new Physician Compare Initiative with that of other provider groups.MethodsCMS Physician Compare data were obtained for all 900,334 health care providers (including 30,614 radiologists) enrolled in Medicare in early 2015. All publicly reported metrics were compared among eight provider categories (radiologists, pathologists, primary care, other medical subspecialists, surgeons, all other physicians, nurse practitioners and physician assistants, and all other nonphysicians).ResultsOverall radiologist satisfaction of all six Physician Compare Initiative metrics differed significantly from that of nonradiologists (all P ≤ .005): acceptance of Medicare-approved amount as payment in full, 75.8% versus 85.0%; Electronic Prescribing, 11.2% versus 25.1%; Physician Quality Reporting System (PQRS), 60.5% versus 39.4%; electronic health record participation, 15.8% versus 25.4%; receipt of the PQRS Maintenance of Certification Program Incentive, 4.7% versus 0.3%; and Million Hearts initiative participation, 0.007% versus 0.041%. Among provider categories, radiologists and pathologists demonstrated the highest and second-highest performance levels, respectively, for the two metrics (PQRS and MOC) with specialty-specific designs, but they ranked between fifth and eighth in all remaining non–specialty-specific metrics.ConclusionsThe performance of radiologists and pathologists in Medicare’s Physician Compare Initiative may relate to the extent to which metrics are tailored to the distinct aspects of their practices as diagnostic information specialists. If more physician participation in these programs is desired, more meaningful specialty-specific (rather than generic) metrics are encouraged.     

动脉导管未闭合并肺动脉高压堵闭术

目的 :评价动脉导管未闭 (PDA)合并肺动脉高压堵闭术的临床应用价值。方法 :本组 1 4例PDA合并肺动脉高压患者实施了蘑菇伞堵闭术 ,术前常规进行导管检查和主动脉弓造影。结果 :术前肺动脉压 67.0± 2 4 .6/37.8±8 9mmHg,主动脉压为 88.5± 1 4 .6/46 .5± 1 1 .3mmHg。术后 30min肺动脉压降为 49.8± 1 3 .3/2 0 .2± 1 2 .3mmHg(P <0 0 0 1 ) ,动脉压升至 95 .6± 1 8.4/58.0± 1 2 .1mmHg(P <0 .0 5)。成功率 1 0 0 % ,无严重并发症。结论 :经导管堵闭术治疗PDA合并肺动脉高压 ,是一种疗效好 ,创伤小的介入治疗 ,值得推广。     

Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)

Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004–2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long‐term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥3. Eighty‐five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty‐seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long‐term health of survivors are warranted.     

Transfemoral closure of patent ductus arteriosus: An alternative to surgery in older patients

Two patients with congestive heart failure underwent successful closure of patent ductus arteriosus (PDA) at ages 58 and 63, respectively, using the transfemoral technique of Porstmann and Sato. The long-term benefits obtained in these two patients suggests a potential role for this technique in the elderly patient with PDA