Postpartum hemorrhage with pelvic arterial embolization,study of 33 cases

Objective: To describe our cases of postpartum hemorrhage (PPH) with pelvic arterial embolization (PAE).

Material and methods: All patients with PPH who underwent PAE in our center in the interval 2011–1016 were retrospectively studied, evaluating the technical procedure, clinical results, and subsequent fertility.

Results: There were 33 cases of PPH with PAE. The majority occurred in primiparous women (N?=?22, 66.6%) who delivered vaginally (N?=?20, 61%). In addition, most PPH with PAE cases had an early onset (N?=?26, 79%) and were caused by uterine atony (N?=?14, 42.4%). Success of PAE occurred in 27 (81.8%) cases and a satisfactory clinical follow-up was the rule, with 21 (64%) women recovering their normal menstruation, and six (18.2%) becoming pregnant in the following years.

Conclusions: PAE is a safe and efficacious technique with minor complications. Moreover, it allows conservation of the uterus with preservation of fertility.     

Evaluation of a deep learning-based computer-aided detection algorithm on chest radiographs: Case–control study

Along with recent developments in deep learning techniques, computer-aided diagnosis (CAD) has been growing rapidly in the medical imaging field. In this work, we evaluate the deep learning-based CAD algorithm (DCAD) for detecting and localizing 3 major thoracic abnormalities visible on chest radiographs (CR) and to compare the performance of physicians with and without the assistance of the algorithm. A subset of 244 subjects (60% abnormal CRs) was evaluated. Abnormal findings included mass/nodules (55%), consolidation (21%), and pneumothorax (24%). Observer performance tests were conducted to assess whether the performance of physicians could be enhanced with the algorithm. The area under the receiver operating characteristic (ROC) curve (AUC) and the area under the jackknife alternative free-response ROC (JAFROC) were measured to evaluate the performance of the algorithm and physicians in image classification and lesion detection, respectively. The AUCs for nodule/mass, consolidation, and pneumothorax were 0.9883, 1.000, and 0.9997, respectively. For the image classification, the overall AUC of the pooled physicians was 0.8679 without DCAD and 0.9112 with DCAD. Regarding lesion detection, the pooled observers exhibited a weighted JAFROC figure of merit (FOM) of 0.8426 without DCAD and 0.9112 with DCAD. DCAD for CRs could enhance physicians’ performance in the detection of 3 major thoracic abnormalities.     

Comparison of sodium nitroprusside and adenosine for fractional flow reserve assessment: a systematic review and meta-analysis

Background: Fractional flow reserve (FFR) has become a useful tool in the assessment of physiological significance of coronary artery stenosis (CAS), and Adenosine (ADE) is associated with a high incidence of transient side effects. Sodium nitroprusside (NPS) has been proposed as an alternative vasodilator agent. A meta-analysis of studies comparing ADE and NPS for FFR assessment in the same coronary lesions was performed.

Methods: Authors searched for articles comparing NPS and ADE for FFR assessment in intermediate coronary lesions published through January 2018. The following keywords were used: ‘fractional flow reserve’ AND ‘nitroprusside’. Data were summarized using weighted mean differences for paired data.

Results: Seven studies were identified comprising 342 patients and 401 lesions. Four studies evaluated intravenous ADE and 3 studies intracoronary ADE administration. Weighted means FFR values obtained with ADE and NPS were 0.8411 and 0.8445, respectively (weighted mean difference: 0.00, 95% confidence interval (CI) ?0.01 to 0.01, p = 0,548). Adverse events were significantly reduced with IC NPS (RR = 0.08, 95%CI 0.02–0.30, P < 0.0001).

Conclusions: NPS produces similar FFR measurements compared to ADE with a significant reduction in adverse effects. These results may support its use as a suitable alternative to ADE for FFR assessment.     

Efficacy and safety of weekly vitamin D3 in patients with fibromyalgia: 12-week,double-blind,randomized, controlled placebo trial

Clinical Rheumatology - FM is a chronic musculoskeletal disorder characterized by the presence of generalized pain. There are contradictory results regarding the prevalence and supplementation...