Subcostal Anterior Quadratus Lumborum Block Versus Epidural Block for Analgesia in Open Nephrectomy: A Randomized Clinical Trial

BACKGROUND: Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies. METHODS: Adults having open partial nephrectomies were randomly allocated to epidural or unilateral subcostal anterior quadratus lumborum block. The joint primary outcomes were opioid consumption measured in morphine equivalents and pain measured on a numeric rating scale (0-10) from postanesthesia care unit (PACU) until 72 hours after surgery. The noninferiority deltas were 30% for opioid consumption and 1 point on a 0-10 scale for pain. Secondary outcomes included patient global assessment of pain management on the third postoperative day, the number of antiemetic medication doses through the third postoperative day, duration of PACU stay, and postoperative duration of hospitalization. RESULTS: Twenty-six patients were randomized to anterior quadratus lumborum block and 29 to epidural analgesia. Neither pain scores nor opioid consumption in the quadratus lumborum patients were noninferior to epidural analgesia. At 72 hours, mean ± standard deviation pain scores in subcoastal anterior quadratus lumborum block and epidural group were 4.7 ± 1.8 and 4.1 ± 1.7, with an estimated difference in pain scores of 0.62 (95% confidence interval [CI], 0.74-1.99; noninferiority P = .21). The median [Q1, Q3] opioid consumption was more than doubled in quadratus lumborum patients at 70 mg [43, 125] versus 30 mg [18, 75] in the epidural group with an estimated ratio of geometric means of 1.69 (95% CI, 0.66-4.33; noninferiority P = .80). Patient global assessment and duration of PACU and hospital stays did not differ significantly in the 2 groups. CONCLUSIONS: We were unable to show that subcostal anterior quadratus lumborum block are noninferior to epidural analgesia in terms of pain scores and opioid consumption for open partial nephrectomies. Effectiveness of novel blocks should be rigorously tested in specific surgical setting before widespread adoption

Kendini Sabote Etme İmgeleri

In the structuring phase of the self, the individual who takes the role model of his/her parents wants to feel safe, to be valued and to be approved by both the family and the society. In the individual’s journey from childhood to adulthood, the inadequacy of nutrition from the sources that will satisfy his/her spiritual and physical needs and the traumatic experiences may lead to destructive and derogatory tendencies and also the division during the phase of the construction of identity. The experience of the divided self (real and false self) can prevent the individual from constructing both his/her subjective and social position according to his/her own subjective wishes and desires. This confrontation of subject between the real (self) and false (social) can lead to self-sabotage tendency and cause many negative emotions (fear, anxiety, anger, self-enclosed) and behaviors (self-realization), which turn into selfdestructive violence and this may end up to the experience of identity that is distant from the essence. In this study; it has been approached to the relationship between the individual, who demonstrate the tendency of self-sabotage and the art that plays a kinetic role to come out his/her conflicts about the self. This relationship will be examined from the point of an artist, who uses the his/her own body as an art object to defeat his/her self and reflects the spiritual conflicts in the inner world by using images that bear the traces of the concept of self-sabotage. The effects of selfsabotage on creativity and productivity will be identified with the artist and in particular with the positive acquisitions, which brings to the art.Benliğinin yapılanma aşamasında, öncelikli olarak ebeveynlerini rol model alan birey, bu süreçte kendini güvende hissetmek, değer görmek ve hem ailesi hem de toplum tarafından onaylanma ihtiyacı güder. Bireyin çocukluktan erişkinliğine kadar uzanan yolculuğunda, tinsel ve fiziksel ihtiyaçlarını doyumuna ulaştıracak kaynaklardan yeterince beslenememesi hatta bu yolculuğa travmatik deneyimlerin eşlik etmesi, benliğinde yıkıcı ve aşağılayıcı yönelimlerin yuvalanmasına sebebiyet vereceği gibi kimliğinin inşa aşamasında bölünme yaşamasına da neden olabilmektedir. Deneyimlenen bu bölünmüş benlik (gerçek ve sahte benlik) bireyin hem öznel hem de toplumsal konumunu kendi öznel varlığının arzuladığı biçimde inşa etmesini engelleyebilmektedir. Öznenin gerçek (öz) ve sahte (sosyal) benliği arasında gerçekleşen bu çatışma durumu, bireyin kendini sabote etme eğilimine iterek, birçok olumsuz duygu (korku, endişe, öfke, içe kapanma) ve davranış özyıkıcı şiddete dönüşerek özünden uzak bir kimlik deneyimlemesine sebebiyet verebilmektedir. Bu çalışmada; kendini sabote etme eğilimi gösteren bireyin, kendi benliği ile ilgili yaşadığı çatışmaları ortaya çıkarmasında kinetik bir rol oynayan sanat ile ilişkisi ele alınacaktır. Bu ilişki ise sanatçının kimi zaman bedenini bir sanat nesnesi olarak kullanıp öznelliğini bozguna uğratarak, iç dünyasında barındırdığı ruhsal çatışmaları “kendini sabote etme” kavramının izlerini taşıyan imgelerle sanat eserlerine yansıtılması altında incelenecektir. Kendini sabote etme kavramının yaratıcılık ve üretkenliğe olan etkileri, sanatçıya ve bilhassa sanata kattığı etkili dönüşümler özdeşleştirilecektir

1940 Romanya’dan Türkiye’ye Tatar göçü

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2017.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Ünsal, Mehmet Süha

Identification of risk factors for alcohol relapse in liver transplant patients with alcohol-related liver disease

[No abstract available

Copolymers of 3-arylthieno[3,2-b]thiophenes bearing different substituents - Synthesis, electronic, optical, sensor and memory properties (Supplementary Material)

Supplementary material for the article titled "Copolymers of 3-arylthieno[3,2-b]thiophenes bearing different substituents: Synthesis, electronic, optical, sensor and memory properties

Risk factors for thrombosis risk in patients with cancer

Aim: To evaluate the factors associated with Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in cancer patients. Materials and Methods: A total of 237 cancer patients who underwent lower extremity venous Doppler Ultrasonography (USG) and/or pulmonary computed tomography angiography (PCTA) were included. Patients’ demographic characteristics; chemotherapy data; immobilization status; use of central venous catheter; histories of 4-day-long bed rest, surgery within the last 6 months, long anesthesia for at least 2 hours, smoking, patients’ laboratory tests, ABO blood group, PCTA and lower extremity Doppler USG results were retrospectively reviewed through the hospital information management system. Results: The median age was 62 (age range 25 to 89). Thrombosis was detected in 83 patients according to the results of venous Doppler USG and/or PCTA of those patients who underwent imaging. Immobilization status (p=0.019), history of surgery within the last 6 months (p=0.02), anesthesia more than 2 hours (p=0.012) and 4-day-long bed rest (p=0.03) were found to be significantly associated with related risk of thrombosis. Additionally, thrombosis was found more frequently in the non-O group (especially group B) than in O group (p:0.024). Conclusions: Besides well-known risk factors, blood group may be related with risk of thrombosis in the patients with the cancer diagnosis Keywords: ABO blood group, Cancer, Pulmonary thromboembolism, Deep vein thrombosi

Effectiveness of fixed-dose combination of paritaprevir, ritonavir, ombitasvir, and dasabuvir in patients with chronic hepatitis C virus infection and chronic kidney diseases: real-life experiences

Introduction Both hepatitis C virus infection (HCV) and chronic kidney disease (CKD) have been comorbid illnesses with increasing morbidity and mortality. The present study was conducted to present real-life experiences about treatment of HCV and CKD with a fixed-dose combination of paritaprevir 150 mg/day, ritonavir 100 mg/day as a booster, ombitasvir 25 mg/day, and dasabuvir 250 mg twice/day, the PROD regimen. Patients and methods This was a multicenter, retrospective cohort study. Seventy-five patients with both HCV and CKD were treated with a PROD-based regimen with or without ribavirin. Fifty-three of 75 patients were on maintenance hemodialysis program. Seven patients had compensated liver cirrhosis. The patients with genotype 1a or compensated liver cirrhosis were treated with the PROD regimen and ribavirin in a dose of 200 mg every other day for 12 weeks. The patients with genotype 1b were treated with PROD for 12 weeks. The patients with genotype 4 were treated with a combination of paritaprevir, ritonavir, ombitasvir, and ribavirin 200 mg every other day. Results All patients except one were HCV-RNA negative (98.6%) at the end of treatment. One patient had decompensated after the fourth day of therapy. She stopped the treatment, and she was exitus after 2 months. Two patients died of reasons not related to the drugs 2 months after negativity of HCV-RNA. Sustained viral rate 12 weeks after treatment was found in 96% of the patients. Conclusion The PROD regimen was very effective and safe for treatment in patients with HCV and CKD who were in stages 4 and 5. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved