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The physical domain was divided into hexahedral structured grids blood pressure ranges female purchase diovan 40 mg, with an example shown in Figure 5 blood pressure terms discount 80 mg diovan mastercard. Increasing the nodes number from 310 blood pressure chart with age cheap diovan 80 mg otc,000 to pulse pressure guide discount diovan 80 mg online 2,480,000 resulted in a difference of less than 1% in terms of the spatial mean time averaged wall shear stress. Spatial discretisation of the governing equations was st nd performed via a hybrid 1 /2 order scheme while temporal discretisation was performed via a fully implicit second order backward Euler scheme. The algebraic multigrid method was used to solve the resulting discretised equations. The subject-specific representative venous flow rate waveform was applied at the model inlet which was extended upstream by 6 times the inlet diameter, and zero relative static pressure was specified at the outlet. For the subjects included in this study, the peak Reynolds numbers at the inlet ranged from 30 to 162 and therefore, laminar flow assumption was made. Uncompressed (Pa) Compressed (Pa) Subject Min Max Spatial Mean Min Max Spatial Mean 1 0. Subject 1 Subject 2 128 Subject 3 Subject 4 129 Subject 5 Subject 6 130 Subject 7 Subject 8 131 Subject 9 Subject 10 Figure 5. Previous studies [178, 179] have shown that external compression can reduce flow rate in femoral veins, but no direct measurement data is available about the effect of compression on flow in the deep veins in the calf. The architecture of the deep venous system in the calf is highly variable among subjects. Because observations from the acquired real-time phase-contrast images suggested that there was hardly any change in the shape and size of the veins during a respiratory cycle especially when the compression stocking was on (an example is shown in Figure 5. A similar study was performed by Downie et al [113], but the corresponding venous flow data were estimated from Doppler ultrasound measurement made in the popliteal and great saphenous veins above the level of the stocking, which was the main limitation of the study as stated by the authors. The present study is an improvement over the previous study in that real-time flow measurements in the reconstructed deep vessels within the calf were made and used in the subject-specific analyses of flow and wall shear stress. A reduction in femoral vein flow rates as a result of static external compression was observed in previous studies [178, 179]. The effect of compression on flow rate in other veins in the calf was not evaluated since accuracy of flow measurement could not be guaranteed for veins that are non-perpendicular to the imaging slice and for small veins due to insufficient spatial resolution. Although it is expected that the total flow rate in the calf veins would remain unchanged after compression, the effect of compression on the deep and superficial systems could be different. For cases where compression reduced the flow rate in the deep veins, it is possible that more venous flow was 141 carried by the superficial system. In a previous study where the effect of elastic compression on vessel deformation was evaluated for both the superficial and deep veins, it was found that the mean cross-sectional area reduction was greater in the deep veins (64%) than in the superficial veins (39%) after the application of a flight stocking [18]. The measured waveforms of subjects 5 and 10 suggested the presence of significant reverse flow in the deep vein before compression. It is interesting that subjects 5 and 10 also showed the largest volume reduction among the 10 subjects. The collapse of the deep vein induced by the application of the stocking ceased when a balance between the external and internal pressure was resumed. Increase in the local blood pressure caused by external compression has been found in human calf arteries [180, 181] and femoral veins of dog [178, 179]. The implication of the information is not quite straightforward, but it is possible that under the same external pressure profile, the internal pressure of the deep veins should rise to a similar magnitude after compression, suggesting that the vessels experiencing larger deformation might have 143 lower internal pressure before compression. Although dysfunction of the venous valve at the measurement location could be a reason, considering the age and the medication history of the subjects, and the elimination of the reverse flow after the application of the compression stocking, this would be highly unlikely. Perforator veins can induce disturbances to the flow, but none of them was observed at the velocity measurement location. Since the cross-sectional area reduction of the deep veins, in response to the application of the stocking, outweighed by far the reduction in venous flow rate, the overall effect of compression was to increase blood velocity in the deep veins. In a previous study of four subjects, it was found that the application of the compression stocking reduced the level of pulsatility in the velocity waveform and increased the time averaged blood velocity in the popliteal veins [113]. The influence of external compression on increasing the deep venous blood velocity was consistent with the previous findings, but its effect on the pulsatility was not as significant as indicated before. Previous studies have shown that a steady and high level of wall shear stress is important for the health of the vascular system [16, 17, 169, 170]. In both cases, an increase in the time averaged velocity and a reduction in the waveform pulsatility were induced by the external compression. While the overall results showed that the application of the stocking led to positive influences on the venous flow, the magnitude of the effect was highly variable among subjects. Although the selection of the location of the reconstructed segment was based on the same anatomic landmark, other factors such as the shape and location of the bones, the architecture and mechanical properties of the muscles and other soft tissues, are highly variable and can significantly affect the deformation of the deep veins, which will in turn affect the flow rate in the deep veins. Although the magnitude of the effect was highly variable among subjects, the results demonstrated the positive influence of the stocking on deep venous flow in the calf. Our results also indicated that reduction of the deep vein volume was an important consequence of the application of static external compression, which led to a higher blood velocity even though flow rate in the medial peroneal veins reduced by an average of 7%. Given the significant individual variability found in this study, it would be desirable to refine the procedure used to select a suitable compression stocking for a given individual and increase the sizes and ranges of stockings available in order to optimise their therapeutic effects. This methodology can be employed as a useful tool in evaluating designs of compression stockings. However, there is still a disconnection between the biomechanical parameters which are directly implicated in the biological pathways of venous thrombosis, such as hemodynamic wall shear stress, and the mechanical parameters of the compression devices. In this chapter, a preliminary investigation of the potential of fluid-structure interaction model to predict the influences of external compression on deep venous system is presented. The estimated material function was compared with the hyperelastic model developed in chapter 4. Due to the high complexity of the architecture of the deep vessels, the deep vein in the model was generalized. The solid domain representing the calf tissues was discretized using a finite element method, while the blood flow was assumed to be Newtonian and governed by the Navier-Stokes equations. An Arbitrary Lagrangian Eulerian method was used to capture the interaction between the structure and fluid. Because the external compression was applied within a much shorter period of time compared to the breathing cycle, instead of pulsatile waveforms, a time-averaged volume flow rate was applied to the vessel inlet. Although variable pressure distributions around leg were observed even when using a uniform compression [15], due to the lack of the measured information, a uniform pressure profile was employed as the external load. A properly validated model of this type would offer a potential methodology for investigating the prototype of compression devices, including both compression stockings and intermittent compression device. This approach is efficient for solving flow problems with fixed boundaries, but difficulties arise when moving or deformable interfaces are involved, such as flow in collapsible tubes, and flow around heart or venous valves. In order to simulate moving interfaces, in particular the interface between a fluid and elastic solid, a number of techniques have been developed. Although the degree of freedom for mesh movement provided by the method allows distortions of the continuum, when translations and rotations of the solid are very large or the mesh points display inhomogeneous movements, elements of the fluid domain may become ill-shaped, which can lead to a reduction in the solution accuracy or cause problems in convergence. Remeshing is a common method of dealing with such conditions, but it is a very complicated and time consuming process. In addition, the mapping of solution from the degenerated mesh to the new mesh may introduce artificial diffusion, causing loss of accuracy. In this method, the boundary of solid domain is expressed as a set of non-conforming points immersed in the fluid and mutually interconnected by an elastic law. Another method that is very similar to the immersed boundary method is the fictitious domain method [147, 184], which was first developed within a finite element framework. A (distributed) Lagrange multiplier is used to establish constraint of the fluid and solid domain at their interface, which is extended to the inner body. The application of the multipliers in the weak form, representing the body forces, leads to a distributed manner using an integral formulation in which the forces are imposed. According to the clarity of the images, a section of calf with a length of 12 cm was rebuilt. Due to the complexity of the deep veins architecture, it was not considered possible to attempt an accurate reconstruction of deep vein geometry. An idealised vessel with a circular cross-section was placed in the model to represent the deep vein. Owing to the irregular nature of the solid domain, an unstructured mesh of tetrahedral elements (Ansys element ref: solid185) was generated, which was refined near the vein, as shown in Figure 6. Refining the mesh from 150, 061 nodes to 311,786 nodes produced a difference of 0.


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If the pain medication prescribed does not seem to hypertension 150 100 discount diovan 80mg work for you blood pressure ranges for athletes discount 160mg diovan amex, do not take more pills or take them more often than directed?call your dentist hypertension vascular disease cheap 40mg diovan with mastercard. Swelling and Pain After a tooth is removed blood pressure chart journal quality 160 mg diovan, you may have some discomfort and notice some swelling. To help reduce swelling and pain, try applying an ice bag or cold, moist cloth to your face. Your dentist may give you specific instructions on how long and how often to use a cold compress. When to Call the Dentist If you have any of the following issues, call your dentist immediately. For the first few days, try to chew food on the side opposite the extraction site. Follow-Up If you have sutures that require removal, your dentist will tell you when to return to the office. Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance by Senna Staessens, Frederik Denorme, Olivier Francois, Linda Desender, Tom Dewaele, Peter Vanacker, Hans Deckmyn, Karen Vanhoorelbeke, Tommy Andersson, and Simon F. De Meyer Haematologica 2019 [Epub ahead of print] Citation: Senna Staessens, Frederik Denorme, Olivier Francois, Linda Desender, Tom Dewaele, Peter Vanacker, Hans Deckmyn, Karen Vanhoorelbeke, Tommy Andersson, and Simon F. Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance Haematologica. E-publishing ahead of print is increasingly important for the rapid dissemination of science. Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance 1 1 2 1 2 Senna Staessens, Frederik Denorme, Olivier Francois, Linda Desender, Tom Dewaele, 3,4,5 1 1 2,6 Peter Vanacker, Hans Deckmyn, Karen Vanhoorelbeke, Tommy Andersson, Simon F. Abstract Ischemic stroke is caused by a thromboembolic occlusion of cerebral arteries. Treatment is focused on fast and efficient removal of the occluding thrombus, either via intravenous thrombolysis or via endovascular thrombectomy. Recanalization, however, is not always successful and factors contributing to failure are not completely understood. Although the occluding thrombus is the primary target of acute treatment, little is known about its internal organization and composition. The aim of this study, therefore, was to better understand the internal organization of ischemic stroke thrombi on a molecular and cellular level. Our results show that stroke thrombi are composed of two main types of areas: red blood cell-rich areas and platelet-rich areas. Red blood cell-rich areas have limited complexity as they consist of red blood cells that are entangled in a meshwork of thin fibrin. These findings are important to better understand why platelet-rich thrombi are resistant to thrombolysis and difficult to retrieve via thrombectomy and can guide further improvements of acute ischemic stroke therapy. As a consequence of the impaired cerebral blood flow, irreversible damage occurs in the associated brain tissue. Despite recent advances, efficient recanalization in ischemic stroke patients remains a challenge. As of 2015, several positive trials have instigated large scale implementation of endovascular treatment, 4?9 based on mechanical removal of the occluding thrombus. These positive trials have shown the benefits of this approach, but also revealed procedural challenges that can hamper efficient treatment. One of the most important obstacles in endovascular therapy is that thrombi tend to differ in consistency and removability. Indeed, mechanical thrombectomy is 10 unsuccessful in removing the thrombus in up to 20% of the patients. Beside vascular access, thrombus composition is considered an important factor responsible for thrombectomy 10,11 failure. Notwithstanding the fact that the occluding thrombus is the primary target in both pharmacological and mechanical recanalization therapy, very little is known about the general composition and structural organization of stroke thrombi and about the interplay between their cellular and molecular components. The main reason for this lack of knowledge was the unavailability of stroke thrombi in the past. However, endovascular thrombectomy procedures 11 now provide patient thrombus material for detailed analysis. Good understanding of thrombus structure and composition will be crucial to meet the pressing demand for better pharmacological or endovascular recanalization efficiencies in acute stroke treatment. An increasing number of studies now start reporting first insights on stroke thrombus composition, mostly based on hematoxylin and eosin staining and looking at fibrin and red blood cells only. However, more specific stainings can reveal novel molecular and cellular markers that could be of high relevance for stroke pathophysiology. The aim of this study was to assess and define the internal organization and common structural features of stroke thrombi, using specific immunohistochemical and immunofluorescence histology procedures. Thrombi were retrieved using a stent retriever and/or aspiration device dependent on the judgement of the treating neuro-interventionalist. Thrombus material collected from multiple passes of one patient was pooled and further considered as one thrombus. Of the 188 collected thrombi, eleven thrombi were excluded because insufficient material was available to perform all analyses. Thrombus histology After retrieval, thrombi were gently removed from the device, washed in saline and immediately incubated in 4% paraformaldehyde for 24 hours at room temperature. No substantial differences in the quantity and general organization of these components were found between different sections of a single thrombus (Staessens et al. For immunohistochemical stainings, nucleated cells were stained green using a Methyl Green solution (H-3402, Vector Laboratories). Red blood cells were visualized via their inherent autofluorescence at a wavelength of 555 nm. Negative controls of the immunohistochemical (Supplemental Figure 1A-D) and immunofluorescent (Supplemental Figure 1E-F) staining were achieved by omission of the primary antibody or by using isotype primary antibodies. A more detailed description of all histology procedures is provided in the Supplemental Methods. As depicted in Supplemental Figure 2, the macroscopic appearance of retrieved thrombi was heterogenous in size, shape and color. To better understand the specific characteristics of both regions, we performed a more detailed microscopic analysis. Besides their specific presence in these boundary zones, leukocytes are also abundantly present within the platelet-rich zones. Discussion this study provides a detailed description of compositional features of ischemic stroke thrombi. Why different parts of the same thrombus have such distinct underlying architecture is an intriguing point. Local hemodynamic forces are known to regulate the thrombotic pathways and thus the biochemical makeup of thrombi. Figure 3C) are reminiscent of polyhedrocytes 15,16 observed in contracted thrombi. Thrombus contraction was reported to be reduced in patients with ischemic stroke, but could have profound effects on thrombus organization, thrombus volume (and thus blood flow past thrombo-embolic occlusions) and thrombus 17 density. More studies are needed to fully understand the potential effect of thrombus contraction in ischemic stroke patients. In general, our findings are important to advance our understanding of ischemic stroke pathophysiology and, more importantly, to guide the development of better recanalization strategies in stroke patients via thrombolysis or thrombectomy. Taken together, our detailed histological analysis reveals different structural features in ischemic stroke thrombi that could be highly relevant for developing efficient pharmacological thrombolysis strategies. Even though it may seem intuitive that the retriever devices and techniques available today favor more soft thrombi, the mechanisms that render platelet-rich thrombi more resistant to thrombectomy are not completely understood. Thick fibrin strands have been shown to increase clot rigidity and fibrin was shown to influence the thrombus coefficient of friction 10,40,41 and level of physical compression. Second, the scope of this study was focused on the description of common structural features of patient stroke thrombi and did not include clinical and procedural parameters. Ongoing research on larger sets of stroke thrombi will have to further elucidate the clinical impact of the described structural features.

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The recommendation to arteria spinalis order diovan 80 mg with amex prophylax applies only to blood pressure up heart rate down buy diovan 40mg free shipping the higher-risk patients (Table 2) how quickly do blood pressure medication work order 160 mg diovan overnight delivery. A recent thromboprophylaxis trial in over no prophylaxis were both sponsored by the 3 hypertension uncontrolled quality 40mg diovan,764 critically ill patients reported that the incidence pharmaceutical industry. It would be reasonable to make choices most of these studies have been extracted from the based on patient preference, compliance, and ease of Table 6?[Section 2. It is not known if hospital mechanical thromboprophylaxis have been conducted ized medical patients have a similar risk of skin com in surgical patients. No data are available on the median rate of major bleeding within the study Table 8?[Section 2. Direct ization and one-third between 2 to 3 months after evidence of low to moderate quality in nonsurgical hospitalization. For acutely ill hospitalized medical patients at low risk of thrombosis (Table 2), we recom 2. Remarks: Patients who are particularly averse to the potential for skin complications, cost, and need 2. Indirect evidence 59,60 As both of these trials routinely screened patients provides no support for ultrasonographic screening. For critically ill patients who are bleeding, parison with variable reporting of symptomatic or are at high risk for major bleeding (Table 4), outcomes (Table 14, Table S17). Type of chemo cancer has been treated with the selective estrogen therapy, duration of treatment, and duration of receptor modulator tamoxifen. We did not downgrade, although there was some concern about lack of blinding in some studies; the overall risk of bias was believed to be very low. Overall we decided to downgrade by one level when considering these issues along with imprecision. In ference between the effects of heparin in the two summary, the absolute risk increase of bleeding with subgroups (P5. In summary, there is moderate-quality evidence of a reduction in mortality and high-quality evidence of 4. Warfarin increased both major bleed detrimental effects of prophylactic-dose heparin on Table 16?[Section 4. Four studies blinded patients and providers and all studies blinded outcome adjudicators. None of studies blinded patients, providers, or data collectors, and three studies blinded outcome adjudicators. None of the studies blinded patients, providers, or data collectors, but both studies blinded outcome adjudicators. In chronically immobilized persons resid Fitness to Practice Panel judged that these papers ing at home or at a nursing home, we suggest included coauthors who had not approved the papers against the routine use of thromboprophylaxis and erased the principal investigator from the register (Grade 2C). Death 2,637 (9) Not estimabled Not estimable Estimates not available, but risk extremely low Adverse effects 1,182 (4) Not estimabled Not estimable Not estimable Not estimable. If a stocking is too tight around the knee it can prevent essential venous return, causing the blood to pool around the knee. Some stockings can be slightly thicker than normal leg covering and can be potentially restrictive with tight footwear. It is a good idea to wear stockings around the house prior to travel to ensure a good, comfortable? There was no increased risk of mend panelists or topics, nor are they allowed prepublication access to the manuscripts and recommendations. In addition, the patients included in this trial in the Online Data Supplement at chestjournal. Such trials should have a comparative effec Physicians evidence-based clinical practice guidelines. Antithrom ment of comparison, focus on symptomatic events botic and thrombolytic therapy for ischemic stroke: anti thrombotic therapy and prevention of thrombosis, 9th ed: that matter the most to patients, and report cost effec American College of Chest Physicians evidence-based clinical tiveness analyses. Methodology for the development of antithrombotic therapy and prevention of Acknowledgments thrombosis guidelines: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physi Author contributions: As Topic Editor, Dr Murad oversaw the cians evidence-based clinical practice guidelines. Electronic alerts to pre ated industry research funding for projects related to venous thrombosis and postthrombotic syndrome prevention and treat vent venous thromboembolism among hospitalized patients. A risk assessment support and served as a consultant in areas relating to venous model for the identi? Dr Cook has received donated study drug (dalteparin) at risk for venous thromboembolism: the Padua Prediction from P? Variability in the use blind study of certoparin versus unfractionated heparin to of thromboprophylaxis and outcomes in critically ill medical prevent venous thromboembolic events in acutely ill, non patients. Relative impact quency of unfractionated heparin thromboprophylaxis: A of risk factors for deep vein thrombosis and pulmonary meta-analysis. New onset of enoxaparin as thromboprophylaxis in acutely ill medical venous thromboembolism among hospitalized patients at patients in Spain. Risk fac prophylaxis of venous thrombosis in the hospitalized med tors for venous thrombosis current understanding from an ical patient. Pharm World Sci Anticoagulant prophylaxis to prevent asymptomatic deep 2004 ; 26 (4): 214 220. Randomized low-molecular-weight heparin or unfractionated heparin: a comparison of enoxaparin with unfractionated heparin metaanalysis. Graduated bosis after arthroplasty: the post-arthroplasty screening compression stockings: knee length or thigh length. Role of screening tests for deep ings in the prevention of deep vein thrombosis in patients venous thrombosis in asymptomatic adults with acute spi with acute myocardial infarction. Prevention of venous thromboembo domized trial of graded compression stockings for pre lism: American College of Chest Physicians Evidence-Based vention of deep-vein thrombosis after acute stroke. Thigh-length versus below-knee stockings A prospective registry of 5,451 patients with ultrasound for deep venous thrombosis prophylaxis after stroke: a ran con? A systematic review compression stockings to prevent venous thromboembo of strategies to improve prophylaxis for venous thromboem lism? Physi based guidelines for the prevention of venous thrombo cian alerts to prevent symptomatic venous thromboembo embolism: systematic reviews of mechanical methods, oral lism in hospitalized patients. Deep venous with external pneumatic compression for deep vein throm thrombosis in medical-surgical critically ill patients: preva bosis fail? Cook D, Douketis J, Meade M, et al ; Canadian Critical Care and prevention of thrombosis, 9th ed: American College of Trials Group. Venous thromboembolism and bleeding in Chest Physicians evidence-based clinical practice guide critically ill patients with severe renal insuf? High risk of the critically ill for venous throm Acutely Ill Medical Patients With Prolonged Immobilization) boembolism. Low-molecular-weight phylaxis in acutely ill medical patients with recently reduced heparin and unfractionated heparin in prophylaxis against mobility: a randomized trial. Combined intermittent pneumatic platelet prophylaxis among surgical and medical patients. Prevention of pulmonary embolism and deep vein prothrombotic mutations, and the risk of venous thrombo thrombosis with low dose aspirin: Pulmonary Embolism sis. Ultrasonographic in patients with colorectal cancer: incidence and effect on screening before hospital discharge for deep venous throm survival. Incidence in previously untreated locally advanced or metastatic non of venous thromboembolism and its effect on survival small-cell lung cancer. A randomized clin aspirin for the prevention of recurrent thromboembolism in ical trial evaluating tamoxifen in the treatment of patients newly diagnosed myeloma patients treated with melphalan with node-negative breast cancer who have estrogen-receptor and prednisone plus thalidomide or lenalidomide. Risk of for prevention of breast cancer: report of the National Sur venous thromboembolism with the angiogenesis inhibitor gical Adjuvant Breast and Bowel Project P-1 Study. Venous and arterial throm tion in patients with cancer who have no therapeutic or pro bosis in patients who received adjuvant therapy for breast phylactic indication for anticoagulation. Low-molecular for the prevention of breast cancer: current status of the weight heparin in patients with advanced cancer: a phase 3 National Surgical Adjuvant Breast and Bowel Project P-1 clinical trial. Subcutaneous Institute of Canada Clinical Trials Group Breast Cancer Site heparin treatment increases survival in small cell lung can Group. Chest tamoxifen alone for adjuvant treatment of postmenopausal 1998 ; 113 (1): 165 171. That is the question in platin and paclitaxel with carboplatin and paclitaxel alone central venous catheters.

Statistical analysis was utilized to blood pressure chart too low cheap diovan 160 mg without prescription assess patient demographic 244 characteristics such as age prehypertension at 20 cheap diovan 40 mg on line, length of stay hypertension remedies diovan 80 mg mastercard, comorbidities blood pressure healthy vs unhealthy buy diovan 80 mg cheap, microbiology, surgical management, and survival rates. Conclusions: In this study, a radical surgical approach was not indicated in cases where breast tissue was involved secondarily in both males and females. The preoperative phase of the protocol includes patient counseling, prehabilitation, and optimization of comorbidities. In the holding area before surgery, patients receive acetaminophen, gabapentin, and perphenazine. Intraoperative measures include dexamethasone and ondansetron, with intraoperative Pecs block, and reduction in opioid use. Postoperative analgesia is multimodal, with acetaminophen, ketorolac, gabapentin, and as-needed opioids. Results: Demographic characteristics, including age, gender, race, and comorbidities, of the 2 groups were similar. Surgical characteristics, including laterality, axillary surgery, reconstruction use, and neoadjuvant therapy, were also similar. This was achieved with decreasing overall opioid consumption and without compromising patient pain. Clinicopathologic characteristics, volume of tissue resected, margin status, 30-day readmission for complications, and re excision rates were evaluated. Table: Patient and tumor characteristics 582185 Could cryoablation offer a non-surgical approach for treatment of low-risk, early stage breast cancer? Patients identified with low-risk tumor biology potentially leads to less aggressive treatments. Therefore, the next step would be to identify a subset of patients with low-risk, early-stage breast cancer who could avoid surgical intervention of their breast tumor altogether. Patients are followed by breast imaging at 6 months and then annually up to 60 months post-procedure. Results: To date, of 194 patients initially enrolled, 188 patients had a successful cryoablation procedure and are being followed; 41% with at least 2 years of follow-up, and 13% having been followed for a minimum of 3 years. There are only minor device-related adverse events reported requiring no intervention. In the era of genomic profiling and individualized medicine, cryoablation may provide a tailored, office-based treatment for patients with early-stage, low-risk breast cancer. Furthermore, their ability to temper the systemic inflammation induced by surgery may improve oncologic outcomes. Transient systemic inflammation in surgery could facilitate angiogenesis of dormant micrometastases, proliferation of dormant single cells, and seeding of circulating cancer stem cells, potentially affecting the rate of early relapse. We sought to determine if administering intraoperative ketorolac would increase the incidence of bleeding complications in breast surgery. Methods: A subset analysis of a previously described prospective cohort study including patients undergoing lumpectomy and mastectomy was performed. Patients were divided into 2 groups: those who received intraoperative ketorolac and those who did not. Bleeding complications were defined as severe bruising reported in the medical record or necessitating a call to the on-call physician, or hematoma formation. Results: Seven hundred fifty-eight breast surgeries were performed at a single institution in a 13-month period: 156 lumpectomies met inclusion criteria between July 2017 and February 2018; and of 153 mastectomies, 56 met inclusion criteria between September 2017 and August 2018. Two hundred thirteen patients were included in the total cohort: 101 received intravenous intraoperative ketorolac, and 112 did not. The 2 groups were similar in regards to sex, age, race, comorbidities, tobacco use, and proportion with malignant diagnoses. There were more axillary dissections in the group that did not receive ketorolac (n=16 v. When analyzed together, there was no difference in bleeding complications between the group that received intraoperative ketorolac and those who did not (3% v. There were 3 hematomas, 2 in mastectomy patients who did not receive ketorolac, and 1 in a mastectomy patient who did (1. Other complications including seroma formation were not significantly different between the 2 groups, regardless of surgical modality. Conclusions: In patients undergoing lumpectomy or mastectomy, the rate of bleeding complications including hematoma requiring intervention remained low whether intraoperative ketorolac was used or not. The use of intraoperative ketorolac is a useful adjunct for managing perioperative pain in breast surgery, may improve oncologic outcomes, and does not increase the risk of bleeding. The aim of this study is to evaluate the outcomes of ambulatory mastectomy with the hypothesis that ambulatory mastectomy is safe and feasible. Methods: Institution of an ambulatory mastectomy program in our medical center began in January 2018. A patient care protocol was developed by a team comprising breast and plastic surgery, anesthesiology, and nursing. Patients with significant medical co-morbidities or expected lengthy procedural times were not eligible. We conducted a retrospective analysis of outcomes from a prospectively maintained database of all patients who underwent intended ambulatory mastectomy. Results: Twenty-three patients were scheduled for ambulatory mastectomy in the 10-month study period. The median age of patients who underwent ambulatory mastectomy was 50 (range 28-78), and the median body mass index was 26 (range 18-37). Nine (39%) patients underwent nipple-sparing mastectomy, and 4 (17%) patients had bilateral mastectomies. Nine (39%) patients had pre-pectoral tissue expander reconstruction, and 7 (30%) had retro-pectoral tissue expander reconstruction. Conclusions: Ambulatory mastectomy is a safe and viable option for patients who require mastectomy with proper patient selection, institutional guidelines, and patient buy-in. Table: Characteristics and outcomes of ambulatory mastectomies 250 251 581186 Generating awareness among Indian population through survivors: An innovative model for developing countries Agnimita Giri Sarkar Disha for Cancer, Kolkata, West Bengal, India Background/Objective: To validate a new model for population awareness through breast cancer survivors. Methods: Patients treated for breast cancer were included in the study group (Group A/n=431). The survivors were trained in various performing arts, cancer awareness communication techniques, clinical breast examination, and psychological counselling of the patients undergoing treatment for breast cancer. The survivor-generated mass awareness program using play theatre mode and performing art was implemented. The control group (Group B/n=454) involved awareness generated through didactic lectures by health workers. Both the groups were made to present in the community, which were matched as regards age (Gr A 48 mean age/Gr B 51 years mean age), socioeconomic and educational status. The acceptance of the information by the community in various sub-populations were studied using questionnaires (pre and post-awareness knowledge level assessment in both groups). The significance was marginally more in higher socioeconomic and educated sub-populations, but had poor statistical significance (p=0. Performing arts/play theatre is an excellent mode of reaching the minds of a population that tends to be in a denial mode about the disease. Not only does this have a major impact on the society, it also helps hugely in the physical and mental rehabilitation of the survivors. It can also create a meaningful social and economic rehabilitation scope for the survivors. The study could validate the significance of survivors in generating population awareness in India. Chi-square and t-tests were used to compare study groups on categorical and continuous variables, respectively. Unadjusted survival analyses were performed separately for each categorization of 252 recurrence risk (Traditional Oncotype and TailoRx ranges). Clinical predictors of high-risk scores persisted across traditional clinical and TailoRx ranges. Many surgeons provide opioid prescriptions well in excess of what patients actually use, leading to potential diversion, prolonged use, and opioid dependence. We assessed a health systems intervention to adequately control pain, while reducing opioid prescriptions after ambulatory breast surgery. Methods: A prospective non-inferiority study examined women aged 18-75 years, undergoing elective, ambulatory breast surgery procedures (lumpectomy or mastectomy, with and without sentinel lymph node biopsy or axillary node dissection). This multi-pronged, opioid-sparing strategy consisted of patient education, health care provider education, and intra and post-operative non-opioid analgesia strategies. Patients completed brief pain inventories at their first postoperative clinic visit.

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