The Medipol Combination: Novel Rectointercostal Fascial Plane Block and Pectointercostal Fascial Plane Block for Postoperative Analgesia Management After Cardiac Surgery: A Report of 15 Cases.

The parasternal blocks cannot cover the T7 and lower anterior and lateral branches of the thoracoabdominal nerves. In the open heart surgeries, chest drainage tubes are generally outside the target of the parasternal blocks. Recently, Tulgar et al described a novel interfascial plane block technique named "recto-intercostal fascial plane block" (RIFPB). RIFPB is performed between the rectus abdominis muscle and the sixth to seventh costal cartilages. RIFPB targets the anterior and lateral cutaneous branches of the T6-T9 thoracoabdominal nerves. In this clinical report, we want to share our experiences about pectointercostal plane block and RIFPB combination (Medipol Combination) after cardiac surgery.

Continuous serratus posterior superior intercostal plane block for postoperative analgesia management in the patient who underwent right atrial mass excision: a case report.

Serratus posterior intercostal plane block (SPSIPB) is a novel periparavertebral block. It provides anterolateral posterior chest wall analgesia. It is an interfascial plane block, performed under ultrasound guidance, and the visualization of landmarks is easy. It is performed deep into the serratus posterior superior muscle at the level of the third rib. Until now, there have been case reports about the usage of single-shot SPSIPB, but there are no reports about the usage of the block catheterization technique of SPSIPB. Continuous infusion from a catheter of interfascial plane blocks is important for postoperative analgesia management after painful surgeries such as thoracic and cardiac surgeries. Thus, we performed SPSIPB catheterization in a patient who underwent right atrial mass excision with minimally invasive thoracotomy surgery. Here, we present our successful analgesic experience with continuous SPSIPB in this case report.

Gender and exposure to childhood violence are important determinants of domestic violence among academics.

Domestic violence is a common and significant social problem that threatens public health, violates human rights, and poses significant obstacles to national development. This study aimed to evaluate both male and female academics' knowledge and views on domestic violence, and determine its incidence and risk factors among academics. Participants comprised 304 academics working at universities, who were selected by cluster sampling from seven regions of Turkey. Data were analyzed using thematic coding, descriptive statistics, and multivariate logistic regression. Of the 304 participants, 56.9 % were female academics. The incidence of domestic violence among the academics was 21.4 %, with 25.4 % of female and 16.0 % of male academics reporting having experienced it. Academics who were victims of domestic violence were mostly exposed to it from their spouses. Academics also reported experiencing emotional violence. Female academics were 2.3 times more likely to experience domestic violence than men. Academics who were exposed to violence in childhood experienced 14.1 times more domestic violence than those who were not. Although it seems that a high status in society as an academic reduces the rates of exposure to domestic violence, gender, and witnessing or experiencing violence in early childhood are the most important risk factors for this population. The lack of a solution for domestic violence can be attributed to non-deterrent punishments.

Clinical Experience for Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Five Patients. Dermatomal Evaluation and Application of Different Volumes: A Case Series and Review of Literature.

Thoracoabdominal nerves block through perichondrial approach (TAPA) is a novel block and provides abdominal analgesia. TAPA block targets the both anterior and the lateral branches of the thoracoabdominal nerves. Modified-TAPA (M-TAPA) was defined due to the need for blocking certain dermatomes depending on the surgical incision sites. In the literature, the knowledge about the efficiency and dermatomal coverage of M-TAPA is limited. In this case series, we want to report our experiences with this issue.

Comparison of a commercial water-gas shift catalyst and La modified Cu-based catalysts prepared by deposition-precipitation in methanol steam reforming.

Herein, a performance analysis of La-doped copper-based catalysts (CuO/ZrO2/La-Al2O3) in methanol steam reforming (MSR) was conducted and compared with a commercial low temperature water-gas shift catalyst (HiFUEL W220) to produce H2 with low CO selectivity. The physicochemical properties of as-obtained catalysts were characterized by N2 adsorption, XRD, and ICP-OES. Effect of calcination temperature (750 °C and 1000 °C) on the properties of mixed oxide support (La-Al2O3) were discussed based on catalytic activity. The optimum conditions of H2O/CH3OH ratio (1.0-3.0), space-time ratio (WFA0) (40-120 kg s mol-1), and reaction temperature (180-310 °C) were evaluated by a parametric study using the commercial catalyst (HF220). Additionally, thermodynamic equilibrium calculations of experimentally identified components by using Aspen HYSYS process simulation software were also performed to analyze MSR process. The results were indicated that the calcination temperature significantly affected the structural properties and the activity with respect to CO selectivity. An increasing trend in CO selectivity for catalysts with supports calcined at 750 °C and a decreasing trend for catalysts with supports calcined at 1000 °C were observed. Hence, CZ30LA750 and CZ30LA1000 catalysts were selected to attain low CO selectivity and comparable activity when compared to other catalysts and the simulated thermodynamic calculation results.

Investigation of glycerol electrooxidation activity of carbon supported PdCu bimetallic electrocatalyst.

In this study, Pd/C, Cu/C, and a series of PdCu/C bimetallic electrocatalysts were prepared by microwave-assisted modified polyol method to determine glycerol electrooxidation reaction (GOR) activities. The effect of microwave duration on catalyst structure and GOR activity was investigated on PdCu/C bimetallic catalysts. Also, a commercial Pd/C (com-Pd/C) was used to compare catalytic activities with prepared samples. Electrocatalysts were characterized by using X-ray Diffraction (XRD), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES), and Transmission Electron Microscopy (TEM) analyses. In addition, the activity and stability of electrocatalysts for GOR were examined by using cyclic voltammetry (CV) and chronoamperometry (CA). In XRD results, the formation of PdCu alloy structure was observed successfully in all bimetallic catalysts. It was found that the PdCu electrocatalyst with microwave duration of 150 s (PdCu150) was exhibited homogeneous dispersion in TEM images. The particle size of 6.45 nm for PdCu150 was identified from TEM. Furthermore, the performance results were indicated that PdCu150 has the highest activity (36.02 mA/cm2) and stability compared to Pd/C (8.56 mA/cm2), and com-Pd/C (10.23 mA/cm2) in glycerol electrooxidation.

Thermodynamic modelling and optimization of oxy-reforming and oxy-steam reforming of biogas by RSM.

In this study, a comparative thermodynamic equilibrium calculation of biogas oxy-reforming and oxy-steam reforming processes to produce syngas has been conducted by Aspen Plus simulation software. The effects of temperature (600-800°C), pressure (1-20 atm), and inlet O2/CH4 (0-1.0), H2O/CH4 (0-3.0), and CO2/CH4 (0.3-1.0) mole ratios on the equilibrium compositions of products were determined. The operation of the process was optimized using Gibbs free energy minimization method and statistical approach: response surface methodology (RSM). Optimum operating conditions CH4/CO2/O2 = 1:0.51:0.12 at 788°C and 1 atm for oxy-reforming and CH4/CO2/H2O/O2 = 1:0.63:0.19:0.07 at 780°C and 1 atm for oxy-steam reforming were obtained to reach maximum H2 yield, CH4 and CO2 conversions by minimizing carbon selectivity to produce syngas for methanol production.

Gender Imbalance and the Relationship Between Living Donors and Recipients in Liver Transplantations in an Organ Transplant Center in Turkey.

OBJECTIVES: Because of the scarcity of publications on gender differences and the relationship between living donors and recipients in liver transplant procedures, we carried out this study with the objective to examine the gender distribution of donors and recipients and the relationships between donors and recipients in living related-donor liver transplants performed in a university hospital in Ankara, Turkey. MATERIALS AND METHODS: We retrospectively evaluated the data of 549 patients who underwent living related-donor and deceased-donor liver transplant procedures conducted in a university hospital between 1988 and 2017 and the 409 living donors. RESULTS: Males constituted 53.1% of the 409 living related liver donors and 63.6% of the living liver recipients. We found that 72.9% of the deceased-donor liver transplant recipients were also male. Of living related donors, 91.4% were blood relatives, with 74.8% being first-degree relatives. The most common donor-recipient relation was mother to son. Analyses of interspousal donations showed a significant difference between husband to wife and vice versa (7 vs 17; P < .05). CONCLUSIONS: Most recipients and donors in living related-donor liver transplants were males with a young predominance. It is not known whether this might be related to biologic, psychologic, or socio cultural features of patients, gender issues, or economic factors. Further research with qualitative components on the influential factors, including gender, is needed.

Gender Disparity and the Relationship Between Living Donors and Recipients in Kidney Transplants in an Organ Transplant Center in Turkey.

OBJECTIVES: The literature search on kidney transplant procedures performed in Turkey showed that few publications are available about gender distribution and the relationships between living donors and recipients. Therefore, this study aimed to examine the gender distributions and the relationships between donors and recipients of living-donor kidney transplants performed in a university hospital in Ankara, Turkey. MATERIALS AND METHODS: In this study, we retrospectively analyzed the hospital records of living kidney donors (1611 cases) and all 1991 kidney recipients who underwent living-donor and deceased-donor kidney transplant procedures in a university hospital between 1985 and 2017. RESULTS: In the study hospital, the annual average number of living-donor kidney transplants increased from 19 to 49 cases (total of 1611 cases) per year during the analyzed period. Among them, 57.8% of all kidney donors were female (P < .05), whereas 74.7% of the recipients were male (P < .05). Two-thirds (60.0%; 228/380) of deceased-donor kidney recipients were male. First-degree blood relatives accounted for most of the donors, as the most common donor-recipient relation was mother to son (67.3%; 327/486; P < .05). Interspousal donation also showed a significant difference between husband to wife and vice versa (36 vs 145; P < .05). CONCLUSIONS: There was a male and young predominance among recipients and a female and middleaged predominance among donors of living kidney transplants in this hospital. It is not known whether this might be related to possible differences between males and females in demand of kidneys, to socio-cultural and gender inequalities, or to economic factors. Further research with qualitative components on gender factors should be carried out.

A novel process for CO2 capture by using sodium metaborate. Part I: effects of calcination.

This paper presents a comprehensive study on the carbonation of sodium metaborate (NaBO2) and the synthesis of high added value chemicals via NaBO2 and carbon dioxide (CO2). Carbon dioxide (CO2) is a greenhouse gas and NaBO2 is a by-product of sodium borohydride (NaBH4) hydrolysis reaction to produce H2. Therefore their transformation into commercial chemicals is quite important in order to provide a mutual benefit to global warming issue and hydrogen economy. In the presented study, reaction parameters such as hydration factor, furnace type, calcination temperature, and environment are investigated at different levels and optimized. The effects of those key parameters on CO2 fixation yield are discussed. It is found that 400 °C is a key temperature for dehydration and reaction steps. Both dehydrated NaBO2 is obtained and maximum carbonation conversion is reached at 400 °C. Moreover, at relatively low temperatures (below 400 °C), a new reaction pathway is proposed and proved by thermodynamic calculations. Structural properties of NaBO2 are exhibited differences regard to thermal exposure and the conversion is strictly related to the structural properties.

Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: comparison to levonorgestrel-releasing subdermal implant.

STUDY QUESTION: Is it possible to extend the use of the 3-year one-rod etonogestrel (ENG)-releasing subdermal contraceptive implant to 5 years? SUMMARY ANSWER: The extended use of the one-rod ENG-releasing subdermal contraceptive implant showed 100% efficacy in years 4 and 5. WHAT IS KNOWN ALREADY: The initial regulated trials on the ENG-releasing subdermal contraceptive implant conducted in the 1990 s were designed to measure cumulative 3-year efficacy. The ENG-implant has both well established safety and efficacy for up to 3 years. Pharmacokinetic data on ENG show high levels at 3 years and some previous clinical research confirms efficacy beyond the current approved duration of 3 years. Today, many women, because the labeled duration has been reached, have the ENG implant removed at 3 years, increasing costs, inconvenience and risks. STUDY DESIGN SIZE, DURATION: For the first 3 years, this study was an open-label, multi-centre randomized trial comparing the 3-year ENG implant to the 5-year levonorgestrel (LNG)-releasing implant. After 3 years, a subset of 390 ENG participants, consented to extended use. We compared efficacy, side effects and removal procedures of both implants. We used Kaplan-Meier (K-M) analysis. We included an observational cohort of copper intrauterine device (IUD) users as non-users of hormonal contraceptive method for comparative purposes. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study took place in family planning clinics in seven countries worldwide. Women were enlisted after an eligibility check and informed consent, and 1328 women were enrolled: 390, 522 and 416 in the ENG-implant, LNG-implant and IUD groups, respectively. MAIN RESULTS AND THE ROLE OF CHANCE: Over 200 women used the ENG implant for at least 5 years. No pregnancies occurred during the additional 2 years of follow up in the ENG or LNG implant group. The overall 5-year K-M cumulative pregnancy rates for ENG- and LNG- implants were 0.6 per 100 women-years (W-Y) [95% confidence interval (CI): 0.2-1.8] and 0.8 per 100 W-Y [95% CI: 0.2-2.3], respectively. Complaints of bleeding changes were similar; however, ENG-users were more likely than LNG-users to experience heavy bleeding (p < 0.05). The median duration of the implant removal procedure was 64 seconds shorter for the one-rod ENG-implant (inter-quartile range (IQR) = 30.5, 117.5) compared to the two-rod LNG product (IQR = 77.0, 180.0). The 2-year rate for pregnancy in the IUD group compared with the two implant groups combined was 4.1 per 100 W-Y [95% CI: 2.5-6.5]. LIMITATIONS, REASONS FOR CAUTION: Few women were ≤19 years old or nulligravida. Although there was no weight limit for enrolment in the study, the number of women ≥70 kg were few. WIDER IMPLICATIONS OF THE FINDINGS: The results from this study corroborate previous evidence showing high contraceptive efficacy through 4 years for the ENG-implant. Data through 5 years are a novel contribution and further proof of the product's capability to provide safe and effective contraception that rivals the current 5-year LNG-subdermal implant. The findings provide valuable information for policy makers, family planning programmers and clinicians that the ENG-releasing subdermal implant is still highly effective up to 5 years after insertion. Compared to previous efforts, our study population was geographically diverse and our study had the highest number of participants completing at least 5 years of use. TRIAL REGISTRATION: The trial was registered as ISRCTN33378571. STUDY FUNDING/COMPETING INTERESTS: The contraceptive devices and funds for conduct of the study were provided by the United Nations Development Programme/United Nations Population Fund/World Health Organization (WHO)/UNICEF/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), WHO. This report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the WHO. All stated authors have no conflict of interest, except Dr Hubacher who reported grants from United States Agency for International Development, during the conduct of the study; other from Advisory Boards (Teva, Bayer, OCON), outside the submitted work.

The unmet need for safe abortion in Turkey: a role for medical abortion and training of medical students.

Abortion has been legal and safe in Turkey since 1983, but the unmet need for safe abortion services remains high. Many medical practitioners believe that the introduction of medical abortion would address this. However, since 2012 there has been political opposition to the provision of abortion services. The government has been threatening to restrict the law, and following an administrative change in booking of appointments, some hospital clinics that provided family planning and abortion services had to stop providing abortions. Thus, the availability of safe abortion depends not only on permissive legislation but also political support and the ability of health professionals to provide it. We conducted a study among university medical school students in three provinces on their knowledge of abortion and abortion methods, to try to understand their future practice intentions. Pre-tested, structured, self-administered questionnaires were answered by 209 final-year medical students. The students' level of knowledge of abortion and abortion methods was very low. More than three-quarters had heard of surgical abortion, but only 56% mentioned medical abortion. Although nearly 90% supported making abortion services available in Turkey, their willingness to provide surgical abortion (16%) or medical abortion (15%) was low, due to lack of knowledge. Abortion care, including medical abortion, needs to be included in the medical school curriculum in order to safeguard this women's health service.

Introducing medical abortion in Turkey: perspectives of physicians.

OBJECTIVE: To better understand the knowledge, attitudes, and perspectives on medical abortion (MA) held by physicians in Turkey. METHODS: The study was conducted in 4 provinces. Pretested, structured, self-administered questionnaires were answered by 187 obstetricians-gynecologists (ob-gyns) and 268 general physicians (GPs). RESULTS: Although MA is not yet available at reproductive health facilities in Turkey, 96% of the ob-gyns and 82% of the GPs said they had heard about it. Moreover, 60% of the former and 5% of the latter said they had performed MAs, most commonly using misoprostol alone. More than 90% of the ob-gyns and 13% of the GPs had performed surgical abortions, and most (71% and 78%) thought that MA should be offered in the country. CONCLUSION: Most physicians in Turkey are aware of MA, with a large majority supporting its wider use. However, their concerns about the method and the incorrect understanding of its risks and possible complications may explain the reluctance of some physicians to provide MA services. These issues should be covered in physician training programs before the formal introduction of MA, while advocacy efforts press for registering mifepristone and misoprostol for its use.

From research to practice: use of non-physicians in family planning services in Turkey.

During the history of the Republic of Turkey, there have been two population policies: a pro-natalist policy from 1923 to 1965 and an anti-natalist policy after 1965. This study aims to discuss the population planning activities, including the operation researches, the impact of the population planning laws on maternal health and family planning practices in Turkey, with special emphasis on use of non-physicians in family planning services.

Increasing women's choices in medical abortion: a study of misoprostol 400 microg swallowed immediately or held sublingually following 200 mg mifepristone.

OBJECTIVES: To assess the efficacy and acceptability of two misoprostol regimens (400 microg oral or sublingual) following mifepristone for medical abortion. METHODS: Women seeking abortion with gestations of 56 days or less since onset of their last menstrual period were offered medical abortion as an alternative to a surgical procedure. A total of 207 eligible and consenting women were given mifepristone (200 mg oral) and the option of taking 400 microg misoprostol either orally or sublingually two days later, with the option of home-use. Two weeks later, treatment success, satisfaction, and the frequency and acceptability of side effects were assessed. RESULTS: Most women (97.6%) opted for home use of misoprostol and almost three quarters selected the oral route. Overall efficacy, acceptability of side effects and satisfaction were high in both groups. The success rate was lower after sublingual than after oral administration but not significantly so (91.3% vs. 96.3%, p = 0.23, RR: 0.93, 95% CI = 0.85-1.02). The frequency and average duration of side effects in both groups were comparable except for pain/cramps and fever/chills, which were more frequently associated with the sublingual route. CONCLUSIONS: This study re-emphasises the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women.

Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up.

OBJECTIVE: This study aimed to compare immediate postplacental (IPP) and early postpartum (EP) intrauterine device (IUD) insertions with interval (INT) IUD insertions with respect to efficacy and complications. METHODS: The study group consisted of 268 women in whom the following TCu 380A IUD insertions were performed: 84 IPP (less than 10 min), 46 EP (10 min to 72 h) and 138 INT (more than 6 weeks). The women were followed up 8 weeks, 6 months and 12 months after insertion. Complications and pregnancies encountered at the end of 1 year following IPP, EP and INT insertions were compared. The chi-square test and Fisher's Exact Test were used for the evaluation of the data. RESULTS: Complications developed in 40.4% of the women in the IPP group, in 74.4% of the women in the EP group and in 19.2% of the women in the INT group (p<.001). Although no statistically significant difference was found between the groups for uterine perforation and infection (p>.001), there was a statistically significant difference between the groups in the incidence of complete and partial expulsion according to the time of IUD insertion. The overall cumulative pregnancy rate and frequency of pregnancy were found to be higher (p>.05 for both), which are both insignificant for the EP group (2 of 43 women), as compared with the INT (4 of 130 women) and IPP groups (2 of 84 women), and pregnancy rates at 1 year for all groups was 3.1% (8 of 257 women). CONCLUSION: IPP and EP insertion of the TCu 380A IUD is an effective and convenient procedure, and expulsion rates in these groups are higher than in the INT group. Further studies are necessary to determine the cause of the higher expulsion rates and to find ways to reduce such rates.

Study supports the introduction of early medical abortion in Turkey.

In Turkey, there is an unmet need for induced abortion services provided by the public health services, especially in rural and semi-urban areas. The objective of this clinical study was to show that early medical abortion could be introduced safely in Turkey to improve women's access to services. In the study, women aged 18-49 up to 56 days of pregnancy were offered a choice between medical abortion with 200 mg mifepristone followed by 400 mcg oral misoprostol and MVA with local anaesthesia. 209 chose medical and 149 surgical abortion. Data from an additional 112 women were collected to obtain a similar number of surgical abortion cases. Women's preference for and satisfaction with the chosen method, side effects and complications up to the 14-day follow-up visit were recorded. 75% of women who chose medical abortion opted for home use of misoprostol. Pain with medical abortion on average lasted 3.6 +/- 3.0 days and with surgical abortion 3.7 +/- 2.9 days. 90% of women who had medical abortion said they would prefer it again compared to 70% of those having surgical abortion. There were 1.4% ongoing pregnancies in the medical abortion group and none in the surgical group. Provider training and familiarity with medical abortion are crucial. The high incomplete abortion rate indicates that the dose and regimen of misoprostol should be reconsidered. The findings support the introduction of early medical abortion in Turkey.

Results and lessons learned from a small medical abortion clinical study in Turkey.

This article presents results from a small, introductory clinical study offering a simplified regimen medical abortion to women in Turkey. A total of 208 women from five sites were recruited from July 2000 through March 2001. All eligible consenting women were given 200 mg oral mifepristone at the clinic followed by 400 microg oral misoprostol 2 days later either at home or at the clinic. The overall success rate of 84.1% is lower than in previous studies of this regimen, and a surprisingly high proportion of women (9.1%) were diagnosed with incomplete abortion. In spite of the higher than expected failure rate, women expressed a high degree of satisfaction. Several challenges were faced during this study, providing valuable insights about ways to introduce medical abortion into new settings with the best chances for success.

The role and influence of stakeholders and donors on reproductive health services in Turkey: a critical review.

Since 1965, Turkey has followed on anti-natalist population policy and made significant progress in improving sexual and reproductive health. This paper presents a critical review of the national reproductive health policies and programmes of Turkey and discusses the influence of national and international stakeholders and donors on policy and implementation. While government health services have played the primary role in meeting sexual and reproductive health needs, international donor agencies and national non-governmental and other civil society organisations, especially universities, have played an important complementary role. Major donor agencies have supported many beneficial programmes to improve reproductive health in Turkey but their agendas have sometimes not been compatible with national objectives and goals, which has caused frustration. The main conclusion of this review is that countries with clear and strong reproductive health policies can better direct the implementation of international agreements as well as get the most benefit from the support of international donors.