Patient-reported outcomes for immediate breast reconstruction with mastectomy among breast cancer patients in Pakistan.

Objectives: To evaluate the effect of immediate breast reconstruction with mastectomy in the local population. METHODS: The quasi-experimental, control study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised patient data from April 2017 to December 2020, of breast cancer patients who underwent mastectomy with or without immediate breast reconstruction. Those who underwent mastectomy were labelled as control group A, while patients with immediate breast reconstruction were labelled as intervention group B. Data was analysed using SPSS 20. RESULTS: Of the 66 patients, 33(50%) were in each of the 2 groups. Group B had significantly more patients aged <40 years than group A (p=0.01), more patients with graduate-level education (p=0.04), and more patients who were either unmarried or divorced (p=0.05) than group A. Group B patients had higher mean scores for satisfaction with breasts (p=0.001) and psychosocial wellbeing (p=0.001) than those in in group A. Mean scores for adverse effects of radiotherapy were significantly higher in group B than in group A (p=0.04). CONCLUSIONS: Better health-related outcomes were reported by patients who underwent immediate breast reconstruction with mastectomy.

Correlation of intra operative specimen imaging with final histopathology in breast conserving surgery for breast cancer.

Objectives: To determine the effectiveness of specimen mammography in breast conserving surgery cases with respect to reduction in margin positivity rate, and to see whether the rate of secondary surgeries is decreased by intra-operative excision based on specimen mammography evaluation. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2018 to December 2019 related to all female breast cancer patients who underwent mastectomy or breast conserving surgery with the involvement of specimen mammography. Sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography were calculated. Data was analysed using SPSS 20. RESULTS: Of the 226 patients initially assessed, 65(28.7%) were excluded, and the final sample comprised 161(71.2%) women with mean age 46.71±10.47 years. The sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography for the sample were 65.8%, 80.8%, 54% and 87.3%, respectively. Performing specimen mammography for intra-operative margin assessment in 12 patients was likely to spare one patient from re-excision. CONCLUSIONS: Intra-operative specimen mammography was found to be a reliable tool for assessing margin status.

Heat and mass transfer with entropy optimization in hybrid nanofluid using heat source and velocity slip: a Hamilton-Crosser approach.

The modeling and analysis of hybrid nanofluid has much importance in industrial sector where entropy optimization is the key factor in different processes. This mechanism is also used in medical industry, where it can be used for separation of blood cells (red and white blood cells, platelets and plasma) by centrifuge process, treating cancers, and drug transport. In light of this importance, current study is focused on mathematical modeling and analysis of blood based hybrid nanofluid between rotating disks with various shapes of nanoparticles. The shape factors are taken into account with Hamilton-Crosser model as spherical, brick, cylinder and platelet in the current scenario, with special reference to entropy optimization. In order to solve modeled nonlinear and non-dimensional system, optimal homotopy analysis approach is utilized through Wolfram MATHEMATICA 11.3 software. Error estimation and convergence analysis confirms that obtained semi-analytical solutions are valid and reliable. Velocity, temperature and concentration profiles are analyzed against important fluid parameters. Fluid velocity decreased in all directions when unsteady parameter [Formula: see text] and Darcy number Da increased while the slip parameters [Formula: see text] and [Formula: see text] decreased the nanofluid velocity. It is observed that in case of brick shaped nanoparticles, fluid temperature is enhanced as compared to other shape factors in the study. Minimal entropy generation is captured in case of spherical nanoparticles, while highest heat transfer is observed in platelet shaped nanoparticles. Furthermore, numerical optimization of entropy is performed against different values of [Formula: see text] and volume fractions [Formula: see text] and [Formula: see text]. Minimized entropy is recovered to be zero when [Formula: see text], [Formula: see text] and [Formula: see text].

Unsteady hybrid nanofluid (Cu-UO2/blood) with chemical reaction and non-linear thermal radiation through convective boundaries: An application to bio-medicine.

This study is focused on modeling and simulations of hybrid nanofluid flow. Uranium dioxide UO2 nanoparticles are hybrid with copper Cu, copper oxide CuO and aluminum oxide Al2O3 while considering blood as a base fluid. The blood flow is initially modeled considering magnetic effect, non-linear thermal radiation and chemical reactions along with convective boundaries. Then for finding solution of the obtained highly nonlinear coupled system we propose a methodology in which q-homotopy analysis method is hybrid with Galerkin and least square Optimizers. Residual errors are also computed in this study to confirm the validity of results. Analysis reveals that rate of heat transfer in arteries increases up to 13.52 Percent with an increase in volume fraction of Cu while keeping volume fraction of UO2 fixed to 1% in a base fluid (blood). This observation is in excellent agreement with experimental result. Furthermore, comparative graphical study of Cu,CuO and Al2O3 for increasing volume fraction is also performed keeping UO2 volume fraction fixed. Investigation indicates that Cu has the highest rate of heat transfer in blood when compared with CuO and Al2O3. It is also observed that thermal radiation increases the heat transfer rate in the current study. Furthermore, chemical reaction decreases rate of mass transfer in hybrid blood nanoflow. This study will help medical practitioners to minimize the adverse effects of UO2 by introducing hybrid nano particles in blood based fluids.

Analysis of blood flow of unsteady Carreau-Yasuda nanofluid with viscous dissipation and chemical reaction under variable magnetic field.

Blood flow analysis through arterial walls depicts unsteady non-Newtonian fluid flow behavior. Arterial walls are impacted by various chemical reactions and magnetohydrodynamic effects during treatment of malign and tumors, cancers, drug targeting and endoscopy. In this regard, current manuscript focuses on modeling and analysis of unsteady non-Newtonian Carreau-Yasuda fluid with chemical reaction, Brownian motion and thermophoresis under variable magnetic field. The main objective is to simulate the effect of different fluid parameters, especially variable magnetic field, chemical reaction and viscous dissipation on the blood flow to help medical practitioners in predicting the changes in blood to make diagnosis and treatment more efficient. Suitable similarity transformations are used for the conversion of partial differential equations into a coupled system of ordinary differential equations. Homotopy analysis method is used to solve the system and convergent results are drawn. Effect of different dimensionless parameters on the velocity, temperature and concentration profiles of blood flow are analyzed in shear thinning and thickening cases graphically. Analysis reveals that chemical reaction increases blood concentration which enhance the drug transportation. It is also observed that magnetic field elevates the blood flow in shear thinning and thickening scenarios. Furthermore, Brownian motion and thermophoresis increases temperature profile.

Unsteady hybrid nanofluid ([Formula: see text], MWCNTs/blood) flow between two rotating stretchable disks with chemical reaction and activation energy under the influence of convective boundaries.

Hybrid nanofluids are extensively analyzed in recent studies due to their better performance in numerous areas such as heat and mass transfer enhancement, biological fluid movement, medical equipment, heat exchangers, electronic cooling and automotive industry. In current study the nanoparticle concentration utilized is much important in biomedical industry. Major applications include drug delivery, radio-pharmaceuticals, centrifuging blood to obtain red blood cells and plasma, medical implants, onco therapeutics and photo thermal cancer therapy. In this regard, the primary focus of this study is to simulate a blood based unsteady hybrid nanofluid flow between two rotating, stretching disks and convective boundaries. The two nanoparticles in this study are uranium dioxide [Formula: see text] and multi-walled carbon nanotubes MWCNTs. The hybrid nanofluid is under the influence of magnetohydrodynamic effects and chemical reaction with activation energy. The governing partial differential equations (PDEs) are transformed into ordinary differential equations (ODEs) using suitable similarity transform. Homotopy analysis method is used to solve the non-linear system of ODEs and [Formula: see text]-curves are plotted to find suitable region of [Formula: see text] for convergent series solution. Velocity profile is examined for axial, radial and tangential direction against various fluid parameters. Temperature and concentration profiles are analyzed for both convective and non-convective cases. It is observed that convective boundaries result in elevated temperature when compared with non-convective case. Moreover, skin friction, heat and mass transfer rates are also examined with respect to changing volume fraction [Formula: see text].The results revealed that skin friction and rate of heat transfer increases with increase in volume fraction of both nanoparticles [Formula: see text] and MWCNTs while the mass transfer rate depicts contrasting behavior.

Efficacy of pre - operative axillary ultrasonography in excluding nodal disease: Can it replace sentinel lymph node biopsy in early stage breast cancer?

OBJECTIVE: To determine false negative rate, negative predictive value and the factors predicting false negativity of pre-treatment axillary ultrasound. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data from January 2019 to December 2020 of patients with normal lymph nodes on ultrasound, tumour stages T1, T2 or T3 having invasive cancer who underwent sentinel lymph node biopsy. Ultrasound findings were compared with the biopsy results, dividing the sample into false negative group A and true negative group B. Clinical, radiological, histopathological parameters and therapeutic strategies were compared between the two groups. Data was analysed using SPSS 20. RESULTS: Of the 781 patients with mean age 49.39±11.51 years, 154(19.7%) were in group A and 627(80.2%) were in group B, with negative predictive value of 80.2%. Initial tumour size, histopathology, tumour grade, receptors, timing of chemotherapy, and type of surgery has significant difference between the groups (p<0.05). Multivariate analysis showed larger, high-grade, progesterone receptor negative and human epidermal growth factor receptor 2 positive tumours were significantly associated with lower false negative rate on axillary ultrasound (p<0.05). CONCLUSIONS: Axillary ultrasound was found to be effective in ruling out axillary nodal disease, especially in patients with high-burden axillary disease, aggressive tumour biology, larger tumour size and higher timour grade.

Breast conservation surgery (BCS) for breast cancer in a resource limited country - Are we upto the challenge!

OBJECTIVE: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. RESULTS: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). CONCLUSION: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome.