The incidence of haemorrhagic and thromboembolic events after breast cancer surgery in patients treated with pharmacological thromboprophylaxis

Background. Hemorrhagic events and venous thromboembolic disease, including pulmonary embolism and deep venous thrombosis, are the most important complications after breast cancer surgery. Although hemorrhagic complications are not usually severe and do not have a high mortality risk, venous thromboembolic disease is often associated with high morbidity and mortality rates. Under such circumstances, it is highly important to evaluate the need for systemic antithrombotic prophylaxis as opposed to mechanical interventions and the optimal duration of chemoprophylaxis in patients undergoing breast cancer surgery. Methods. Using the database of the General Surgery Department of “Colţea” Clinical Hospital, we analyzed the data from 2015 to 2018. During this period, pharmacological prophylaxis was used in all patients undergoing breast cancer surgery. Mechanical prophylaxis (intermittent pneumatic compression or graduated compression) has also been recommended, but there was no record of patient compliance. The primary outcome was the occurrence of venous thromboembolic or hemorrhagic events within 30 days after surgery. Results. In our institution, the venous thromboembolic disease rate for breast cancer surgery was 4/540 (0.7%; 95% CI: 0.02-1.9%), being similar to that of other studies. Hemorrhagic events occurred in 29 (5.4%; 95% CI 3.6-7.6%) patients, most commonly as hematoma in 3.3% of the patients. The incidence of hematoma requiring operation was 1.1% (95% CI: 0.4-2.4%), while hematoma treated conservatively was 2.2% (95% CI:1.2-3.8%). Other forms of hemorrhagic events include hemorrhagic drainage and bleeding wound, occurring in 2.0% of the cases. Conclusions. The occurrence of venous thromboembolic events is reduced among patients undergoing primary breast cancer surgery. A current issue is decreasing venous thromboembolic disease rates without increasing the hemorrhagic event rate. Standard guidelines on the antithrombotic prophylaxis of these patients are not well established since studies show contradictory data. Further investigations are needed to determine exactly which type of thromboprophylaxis is more effective

Plan de negocios para una cl?nica oftalmol?gica pedi?trica en Lima

El presente Plan de Negocio tiene como objetivo analizar y sustentar la viabilidad t?cnica financiera para la implementaci?n de una Cl?nica Oftalmol?gica Pedi?trica en Lima. Nace la idea de crear un modelo de negocio orientado a brindar un servicio con excelencia, calidad y tecnolog?a, dirigido a los sectores A y B de la poblaci?n de Lima Metropolitana

Beta-delayed proton emission from 20Mg

Beta-delayed proton emission from 20 Mg has been measured at ISOLDE, CERN, with the ISOLDE Decay Station (IDS) setup including both charged-particle and gamma-ray detection capabilities. A total of 27 delayed proton branches were measured including seven so far unobserved. An updated decay scheme, including three new resonances above the proton separation energy in 20 Na and more precise resonance energies, is presented. Beta-decay feeding to two resonances above the Isobaric Analogue State (IAS) in 20 Na is observed. This may allow studies of the 4032.9(2.4)keV resonance in 19 Ne through the beta decay of 20 Mg, which is important for the astrophysically relevant reaction 15O( $\alpha$ , $\gamma$ )19Ne . Beta-delayed protons were used to obtain a more precise value for the half-life of 20 Mg, 91.4(1.0)ms

First Accurate Normalization of the beta-delayed alpha Decay of N-16 and Implications for the C-12(alpha,gamma)O-16 Astrophysical Reaction Rate

The C-12(alpha,gamma)O-16 reaction plays a central role in astrophysics, but its cross section at energies relevant for astrophysical applications is only poorly constrained by laboratory data. The reduced a width, gamma(11), of the bound 1(-) level in O-16 is particularly important to determine the cross section. The magnitude of gamma(11) is determined via sub-Coulomb a-transfer reactions or the beta-delayed a decay of N-16, but the latter approach is presently hampered by the lack of sufficiently precise data on the beta-decay branching ratios. Here we report improved branching ratios for the bound 1(-) level [b(beta,11) = (5.02 +/- 0.10) x 10(-2)] and for beta-delayed alpha emission [b(beta alpha) = (1.59 +/- 0.06) x 10(-5)]. Our value for b(beta alpha) is 33% larger than previously held, leading to a substantial increase in gamma(11). Our revised value for gamma(11) is in good agreement with the value obtained in a-transfer studies and the weighted average of the two gives a robust and precise determination of gamma(11), which provides significantly improved constraints on the C-12(alpha,gamma) cross section in the energy range relevant to hydrostatic He burning.Peer reviewe

Identification of the crossing point at N=21 between normal and intruder configurations

The beta(-) decay of Mg-34 was used to study the Al-34 nucleus through. spectroscopy at the Isotope Separator On-Line facility of CERN. Previous studies identified two beta-decaying states in Al-34 having spin-parity assignments J(pi) = 4(-) dominated by the normal configuration pi(d(5/2))(-1)circle times nu(f(7/2)) and J(pi) = 1(+) by the intruder configuration pi(d(5/2))(-1) circle times nu(d(3/2))(-1) (f(7/2))(2). Their unknown ordering and relative energy have been the subject of debate for the placement of Al-34 inside or outside the N = 20 "island of inversion." We report here that the 1(+) intruder lies only 46.6 keV above the 4(-) ground state. In addition, a new half-life of T-1/2 = 44.9(4) ms, that is twice as long as the previously measured 20(10) ms, has been determined for Mg-34. Large-scale shell-model calculations with the recently developed SDPF-U-MIX interaction are compared with the new data and used to interpret the mechanisms at play at the very border of the N = 20 island of inversion.Peer reviewe

Decay studies of the long-lived states in Tl-186

Decay spectroscopy of the long-lived states in Tl-186 has been performed at the ISOLDE Decay Station at ISOLDE, CERN. The a decay from the low-spin (2(-)) state in Tl-186 was observed for the first time and a half-life of 3.4(-0.)(4)(+0.5) s was determined. Based on the alpha-decay energy, the relative positions of the long-lived states were fixed, with the (2(-)) state as the ground state, the 7((+)) state at 77(56) keV, and the 10((-)) state at 451(56) keV. The level scheme of the internal decay of the Tl-186(10((-))) state [T-1/2 = 3.40(9) s], which was known to decay solely through emission of 374-keV gamma-ray transition, was extended and a lower limit for the beta-decay branching b(beta) > 5.9(3)% was determined. The extracted retardation factors for the gamma decay of the 10((-) )state were compared to the available data in neighboring odd-odd thallium isotopes indicating the importance of the pi d(3/2) shell in the isomeric decay and significant structure differences between Tl-184 and Tl-186.Peer reviewe

First beta-decay spectroscopy of In-135 and new beta-decay branches of In-134

The beta decay of the neutron-rich In-134 and In-135 was investigated experimentally in order to provide new insights into the nuclear structure of the tin isotopes with magic proton number Z = 50 above the N = 82 shell. The beta-delayed gamma-ray spectroscopy measurement was performed at the ISOLDE facility at CERN, where indium isotopes were selectively laser-ionized and on-line mass separated. Three beta-decay branches of In-134 were established, two of which were observed for the first time. Population of neutron-unbound states decaying via. rays was identified in the two daughter nuclei of In-134, Sn-134 and Sn-133, at excitation energies exceeding the neutron separation energy by 1 MeV. The beta-delayed one- and two-neutron emission branching ratios of In-134 were determined and compared with theoretical calculations. The beta-delayed one-neutron decay was observed to be dominant beta-decay branch of In-134 even though the Gamow-Teller resonance is located substantially above the two-neutron separation energy of Sn-134. Transitions following the beta decay of In-135 are reported for the first time, including. rays tentatively attributed to Sn-135. In total, six new levels were identified in Sn-134 on the basis of the beta.. coincidences observed in the In-134 and In-135 beta decays. A transition that might be a candidate for deexciting the missing neutron single-particle 13/2(+) state in Sn-133 was observed in both beta decays and its assignment is discussed. Experimental level schemes of Sn-134 and Sn-135 are compared with shell-model predictions. Using the fast timing technique, half-lives of the 2(+), 4(+), and 6(+) levels in Sn-134 were determined. From the lifetime of the 4(+) state measured for the first time, an unexpectedly large B(E2; 4(+)-> 2(+)) transition strength was deduced, which is not reproduced by the shell-model calculations.Peer reviewe

The (n, gamma) campaigns at EXILL

At the PF1B cold neutron beam line at the Institut Laue Langevin, the EXILL array consisting of EXOGAM, GASP and ILL-Clover detectors was used to perform (n, gamma) measurements at very high coincidence rates. About ten different reactions were measured in autumn 2012 using a highly collimated cold neutron beam. In spring 2013, the EXOGAM array was combined with 16 LaBr3(Ce) scintillators in the EXILL&FATIMA campaign for the measurement of lifetimes using the generalised centroid difference method. We report on the properties of the set-ups and present first results from both campaigns

Octupole states in Tl-207 studied through beta decay

The beta decay of Hg-207 into the single-proton-hole nucleus Tl-207 has been studied through gamma-ray spectroscopy at the ISOLDE Decay Station (IDS) with the aim of identifying states resulting from coupling of the pi s(1/2)(-1), pi d(3/2)(-1) and pi h(11/2)(-1) shell model orbitals to the collective octupole vibration. Twenty-two states were observed lying between 2.6 and 4.0 MeV, eleven of which were observed for the first time, and 78 new transitions were placed. Two octupole states (s(3/2)-coupled) are identified and three more states (d(3/2)-coupled) are tentatively assigned using spin-parity inferences, while further h(11/2)-coupled states may also have been observed for the first time. Comparisons are made with state-of-the-art large-scale shell model calculations and previous observations made in this region, and systematic underestimation of the energy of the octupole vibrational states is noted. We suggest that in order to resolve the difference in predicted energies for collective and noncollective t = 1 states (t is the number of nucleons breaking the Pb-208 core), the effect of t = 2 mixing may be reduced for octupole-coupled states. The inclusion of mixing with t = 0, 2, 3 excitations is necessary to replicate all t = 1 state energies accurately.Peer reviewe