The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: A randomized controlled trial

Background: Quadratus lumborum block (QLB) is a fascial plane block. There is no randomized study on the efficacy of QLB for lumbar surgery. We evaluated the efficacy of QLB for postoperative pain management and patient satisfaction after lumbar disc herniation surgery (LDHS). Methods: Sixty patients with ASA score I-II planned for LDHS under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the control group (n = 30). QLB was performed with 30 ml 0.25% bupivacaine in the QLB group. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/ kg tramadol IV was administered as rescue analgesia. Results: There was a reduction in the median static NRS at 0 h and 2 h with QLB compared to the control group (p < 0.05). There was no difference in the resting NRS at any other time point up to 24 h. The median dynamic NRS was significantly lower at 0, 2, 4, 8, and 16 h in the QLB group (p < 0.05). The need for rescue analgesia was significantly lower in the QLB group. The incidence of nausea was significantly higher in the control group. The postoperative patient satisfaction was significantly higher in the QLB group (p < 0.05). Conclusion: We found that the QLB is effective for pain control following LDHS

Cost-effectiveness comparison between palpation- and ultrasound-guided thyroid fine-needle aspiration biopsies

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to perform a cost-effectiveness comparison between palpation-guided thyroid fine-needle aspiration biopsies (P-FNA) and ultrasound-guided thyroid FNA biopsies (USG-FNA).</p> <p>Methods</p> <p>Each nodule was considered as a case. Diagnostic steps were history and physical examination, TSH measurement, Tc^99mthyroid scintigraphy for nodules with a low TSH level, initial P-FNA versus initial USG-FNA, repeat USG-FNA for nodules with initial inadequate P-FNA or USG-FNA, hemithyroidectomy for inadequate repeat USG-FNA. American Thyroid Association thyroid nodule management guidelines were simulated in estimating the cost of P-FNA strategy. American Association of Clinical Endocrinologists guidelines were simulated for USG-FNA strategy. Total costs were estimated by adding the cost of each diagnostic step to reach a diagnosis for 100 nodules. Strategy cost was found by dividing the total cost to 100. Incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between strategy cost of USG-FNA and P-FNA to the difference between accuracy of USG-FNA and P-FNA. A positive ICER indicates more and a negative ICER indicates less expense to achieve one more additional accurate diagnosis of thyroid cancer for USG-FNA.</p> <p>Results</p> <p>Seventy-eight P-FNAs and 190 USG-FNAs were performed between April 2003 and May 2008. There were no differences in age, gender, thyroid function, frequency of multinodular goiter, nodule location and diameter (median nodule diameter: 18.4 mm in P-FNA and 17.0 mm in USG-FNA) between groups. Cytology results in P-FNA versus USG-FNA groups were as follows: benign 49% versus 62% (p = 0.04), inadequate 42% versus 29% (p = 0.03), malignant 3% (p = 1.00) and indeterminate 6% (p = 0.78) for both. Eleven nodules from P-FNA and 18 from USG-FNA group underwent surgery. The accuracy of P-FNA was 0.64 and USG-FNA 0.72. Unit cost of P-FNA was 148 Euros and USG-FNA 226 Euros. The cost of P-FNA strategy was 534 Euros and USG-FNA strategy 523 Euros. Strategy cost includes the expense of repeat USG-FNA for initial inadequate FNAs and surgery for repeat inadequate USG-FNAs. ICER was -138 Euros.</p> <p>Conclusion</p> <p>Universal application of USG-FNA for all thyroid nodules is cost-effective and saves 138 Euros per additional accurate diagnosis of benign versus malignant thyroid nodular disease.</p> <p>Trial registration</p> <p>ClinicalTrials.gov, NCT00571090</p

Short term effects of a low-carbohydrate diet in overweight and obese subjects with low HDL-C levels

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate short-term effects of a low-carbohydrate diet in overweight and obese subjects with low HDL-C levels.</p> <p>Methods</p> <p>Overweight (BMI between 25-30 kg/m²) or obese (BMI over 30 kg/m²) subjects with low HDL-C levels (men with HDL-C <1.03, women <1.29 mmol/l) were invited to the study. A 1400 kcal 75-gram carbohydrate (CHO) diet was given to women and an 1800 kcal 100-gram CHO diet was given to men for four weeks. The distribution of daily energy of the prescribed diet was 21-22% from CHO, 26-29% from protein and 49-53% from fat. Subjects completed a three-day dietary intake record before each visit. Anthropometric indices, body fat ratio, blood lipids, glucose and insulin were measured. Baseline and week-four results were compared with a Wilcoxon signed ranks test.</p> <p>Results</p> <p>Twenty-five women and 18 men participated. Basal median LDL-C level of men was 3.11 and basal median LDL-C level of women was 3.00 mmol/l. After four weeks of a low-carbohydrate diet, the median energy intake decreased from 1901 to 1307 kcal/day, daily energy from carbohydrate from 55% to 33%, body weight from 87.7 to 83.0 kg and HDL-C increased from 0.83 to 0.96 mmol/l in men (p < 0.002, for all). After four weeks of a low-carbohydrate diet, the median energy intake tended to decrease (from 1463 to 1243 kcal, p = 0.052), daily energy from carbohydrate decreased from 53% to 30% (p < 0.001) and body weight decreased from 73.2 to 70.8 kg (p < 0.001) in women, but HDL-C did not significantly change (from 1.03 to 1.01 mmol/l, p = 0.165). There were significant decreases in body mass index, waist circumference, body fat ratio, systolic blood pressure, total cholesterol, triglyceride and insulin levels in all subjects.</p> <p>Conclusions</p> <p>HDL-C levels increased significantly with energy restriction, carbohydrate restriction and weight loss in men. HDL-C levels didn't change in women in whom there was no significant energy restriction but a significant carbohydrate restriction and a relatively small but significant weight loss. Our results suggest that both energy and carbohydrate restriction should be considered in overweight and obese subjects with low HDL-C levels, especially when LDL-C levels are not elevated.</p

Experimental Research of the Usability on Double Acting Intensifiers in Hydroforming

The hydroforming method is especially used for forming lightweight materials like aluminum, magnesium alloys, high strength steels or materials that have limited formability. Intensifiers are the most important component of hydroforming presses. Nowadays single-acting intensifiers are used in hydroforming presses. Single-acting intensifiers provide pressurized liquid by forwarding movement of the piston through one direction and their volumes are limited. The mass of the intensifiers increases significantly depending on their liquid volume capacity and this causes high manufacturing costs. For this reason, two or more single-acting intensifiers which bridged in a parallel circuit are used to manufacture bigger products that require a high volume of liquid. But this method is not an economical solution. So double-acting intensifiers can overcome this problem. The pressurized liquid can be obtained during both forward and backward movement of the piston in double-acting intensifiers which work like a pump. This is why double-acting intensifiers have no volume limit on the contrary of single-acting intensifiers. Yet there are sudden pressure drops in double-acting intensifiers caused by returning movements of the piston to pressurize liquid again. This pressure drops cause some problems to use double-acting intensifiers on hydroforming method. The situation of solving this problem to use double-acting intensifiers on the hydroforming method can eliminate limited volume problem and decrease investment cost of hydroforming presses. In this study, the usability of double-acting intensifiers on hydroforming with die method was investigated. Because of the existing hydroforming press, used in experiments, doesn’t contain any double-acting intensifiers, pressure drops obtained by single-acting intensifier to perform simulated experiment. A die was designed and manufactured to synchronize the blank holder force with pressure drops. This die was integrated on the hydroforming press, located on Selcuk University Hydroforming Laboratory, for the success of the process. Performance of improved system was measured as well as repeatability of applying process parameters and product’s geometry were determined. The AA5754 aluminum alloy used processes, both single- and double-acting intensifier, were compared. Limiting drawing ratios were determined for all processes. It is obtained that pressure drops have no negative influence on formability. Moreover, there is no difference observed in thickness distribution which is an indicator of product’s quality and strength. However, when geometric accuracy was investigated then noticed that the pressure drops count has a good influence on product radius. 5.96 mm product radiuses on the process with single-acting intensifier was obtained 5.92 and 5.10 mm by using double-acting intensifier increasing pressure drop’s frequency

Experimental Research of the Usability on Double Acting Intensifiers in Hydroforming

The hydroforming method is especially used for forming lightweight materials like aluminum, magnesium alloys, high strength steels or materials that have limited formability. Intensifiers are the most important component of hydroforming presses. Nowadays single-acting intensifiers are used in hydroforming presses. Single-acting intensifiers provide pressurized liquid by forwarding movement of the piston through one direction and their volumes are limited. The mass of the intensifiers increases significantly depending on their liquid volume capacity and this causes high manufacturing costs. For this reason, two or more single-acting intensifiers which bridged in a parallel circuit are used to manufacture bigger products that require a high volume of liquid. But this method is not an economical solution. So double-acting intensifiers can overcome this problem. The pressurized liquid can be obtained during both forward and backward movement of the piston in double-acting intensifiers which work like a pump. This is why double-acting intensifiers have no volume limit on the contrary of single-acting intensifiers. Yet there are sudden pressure drops in double-acting intensifiers caused by returning movements of the piston to pressurize liquid again. This pressure drops cause some problems to use double-acting intensifiers on hydroforming method. The situation of solving this problem to use double-acting intensifiers on the hydroforming method can eliminate limited volume problem and decrease investment cost of hydroforming presses. In this study, the usability of double-acting intensifiers on hydroforming with die method was investigated. Because of the existing hydroforming press, used in experiments, doesn’t contain any double-acting intensifiers, pressure drops obtained by single-acting intensifier to perform simulated experiment. A die was designed and manufactured to synchronize the blank holder force with pressure drops. This die was integrated on the hydroforming press, located on Selcuk University Hydroforming Laboratory, for the success of the process. Performance of improved system was measured as well as repeatability of applying process parameters and product’s geometry were determined. The AA5754 aluminum alloy used processes, both single- and double-acting intensifier, were compared. Limiting drawing ratios were determined for all processes. It is obtained that pressure drops have no negative influence on formability. Moreover, there is no difference observed in thickness distribution which is an indicator of product’s quality and strength. However, when geometric accuracy was investigated then noticed that the pressure drops count has a good influence on product radius. 5.96 mm product radiuses on the process with single-acting intensifier was obtained 5.92 and 5.10 mm by using double-acting intensifier increasing pressure drop’s frequency

Effects of reductant type on the combustion synthesis of NiB

Ni-B intermetallic alloys are important filler materials which are used in brazing applications. Carbothermic and aluminothermic synthesis routes are main methods to produce NiB. Carbothermic synthesis is carried out in electric arc furnaces and consumes high amount of energy whereas aluminothermic synthesis mainly uses its own reaction energy. Thus, via aluminothermic synthesis, the consumption of energy drops. Aluminothermic synthesis is a sub-group of combustion synthesis methods and, its name is based on the Al which is used as reductant in reactions. In the present study, aluminothermic synthesis conditions of NiB (mainly containing 15% B by wt.) were investigated for increasing B2O3 stoichiometry in reactants. Moreover, some experiments were conducted to understand the magnesiothermic synthesis conditions, as an alternative reductant. Results were compared to each other and to thermochemical simulations which were carried out by using HSC Chemistry 6.12 and FactSage 7.1 softwares. Chemical analysis, SEM-EDS and XRD were the main techniques to characterize raw materials and the products. Increasing B2O3 stoichiometry and the use of the Mg as reductant positively affected the chemical content of obtained NiB phases although metal recovery yields were lower for magnesiothermic experiments than that of aluminothermic experiments. For instance, in the magnesiothermic experiment carried out with 100% B2O3 stoichiometry, the obtained metallic fraction consisted of 84.2% Ni, 15.1% B and 0.1% Mg

Miyokart enfarktüsü sonrası geç dönemde plazma matriks metalloproteinaz-8 seviyelerinin sol ventrikül hacimleri ve ejeksiyon fraksiyonu ile ilişkisi

Objectives: Enhanced matrix metalloproteinase-8 (MMP-8) activity in the early post-myocardial infarction (MI) period has been related to early remodeling. However, it has been demonstrated that plasma MMP-8 level has a biphasic profle, and the relation between the late plasma levels and remodeling is unclear. We evaluated the plasma MMP-8 levels and its correlates 20±3 months after acute MI. Study design: 58 post-MI patients and 26 control subjects underwent quantitative single-photon emission computed tomography (SPECT) and echocardiography. The plasma MMP-8 levels were measured and its correlates were investigated. Results: The MMP-8 levels were signifcantly higher in post-MI patients [median 3.88 ng/ml, interquartile range (1.88-6.43) vs. 0.67 ng/ml (0.34-2.47); p<0.001]. Plasma MMP-8 levels were signifcantly correlated with left ventricular ejection fraction (LVEF) (?=0.34, p=0.009), end diastolic volume index (EDVi) (?=-0.39, p=0.002) and end systolic volume index (ESVi) (?=-0.40, p=0.002). Conclusion: Plasma MMP-8 levels were found to still be high in post-MI patients 20±3 months after the index event. The levels were signifcantly correlated with left ventricular volume indices and LVEF. We speculate that, in contrast to the relation between the higher early MMP-8 activity and the extent of cardiac remodeling, higher late levels may be associated with relative preservation of left ventricular systolic function.Amaç: Miyokart enfarktüsü (ME) sonrası erken dönemde artmış matriks metalloproteinaz-8 (MMP-8) aktivitesinin erken yeniden şekillenme ile ilişkisi olduğu bilinmektedir. Ancak MMP8’in bifazik bir profile sahip olduğu gösterilmiştir ve geç dönem plazma seviyeleri ile yeniden şekillenme arasındaki ilişki net değildir. Çalışmamızda ME’nin 20±3 ay sonrasında plazma MMP8 seviyelerini ve klinik parametrelerle olan ilişkisini inceledik. Çalışma planı: Miyokart enfaktüsü geçirmiş 58 hasta ve 26 bireylik kontrol grubuna kantitatif tek-foton emisyon bilgisayarlı tomografi (SPECT) ve ekokardiyografi yapıldı. Plazma MMP-8 seviyeleri ölçüldü ve korelasyonları incelendi. Bulgular: Plazma MMP-8 seviyeleri ME geçirmişlerde anlamlı olarak daha yüksek idi [medyan 3.88 ng/ml, çeyreklerarası aralık (1.88-6.43) ve 0.67 ng/ml (0.34-2.47); p<0.001]. Plazma MMP-8 seviyeleri sol ventrikül ejeksiyon fraksiyonu (ρ=0.34, p=0.009), diyastol sonu hacim endeksi (ρ=-0.39, p=0.002) ve sistol sonu hacim endeksi (ρ=-0.40, p=0.002) ile anlamlı olarak korelasyon göstermekte idi. Sonuç: Plazma MMP-8 seviyeleri ME’den sonra 20±3 ay geçmiş olsa bile hala yüksek bulunmuştur. MMP-8 plazma düzeyleri, sol ventrikül hacim endeksleri ve ejeksiyon fraksiyonu arasında anlamlı korelasyon bulunmuştur. Erken dönemdeki yüksek MMP-8 seviyeleri ve yeniden şekillenmenin boyutu arasındaki pozitif ilişkinin aksine, geç dönemdeki yüksek MMP-8 seviyelerinin sol ventrikül sistolik fonksiyonunun göreceli olarak korunması ile ilişkili olabileceğini düşünüyoruz