Wos Açık Erişimli Yayınlar

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A Local Search Heuristic with Self-tuning Parameter for Permutation Flow-Shop Scheduling Problem
(2009) Dengiz, Berna; Alabas-Uslu, Cigdem; Sabuncuoglu, Ihsan
In this paper, a new local search metaheuristic is proposed for the permutation flow-shop scheduling problem. In general, metaheuristics are widely used to solve this problem due to its NP-completeness. Although these heuristics are quite effective to solve the problem, they suffer from the need to optimize parameters. The proposed heuristic, named STLS, has a single self-tuning parameter which is calculated and updated dynamically based on both the response surface information of the problem field and the performance measure of the method throughout the search process. Especially, application simplicity of the algorithm is attractive for the users. Results of the experimental study show that STLS generates high quality solutions and outperforms the basic tabu search, simulated annealing, and record-to-record travel algorithms which are well-known local search based metaheuristics.
Subcutaneous emphysema, pneumo-orbita and pneumomediastinum following a facial trauma caused by a high-pressure car washer
(2014) Yilmaz, Fevzi; Ciftci, Orcun; Ozlem, Miray; Komut, Erdal; Altunbilek, Ertugrul
Pneumomediastinum is air leakage to mediastinal space from various potential sites, including lung, esophagus, trachea, and neck. It is a rare condition that develops either spontaneously with increased intraalveolar or intrabronchial pressure, or due to trauma. Although cases where face or neck trauma with subcutaneous emphysema that extended to mediastinal cavity via anatomical connections in face and neck have been reported, orbital traumas leading to pneumomediastinum are very rare occurrences that have seldom been reported. This paper documents a 17-year-old male who presented with diffuse subcutaneous emphysema involving paraorbital facial areas, which extended to neck and mediastinal cavity.
Evaluation of Coronary Artery-Saphenous Vein Composite Grafts: The Aortic No-Touch Technique
(2014) Coskun, Isa; Colkesen, Yucel; Demirturk, Orhan Saim; Tunel, Huseyin Ali; Turkoz, Riza; Gulcan, Oner; 24512396
We retrospectively compared the results of conventional coronary artery bypass grafting (CABG) performed on patients who showed no preoperative evidence of serious atherosclerosis of the ascending aorta with the results of the aortic no-touch technique (using coronary artery-saphenous vein composite grafts) on CABG patients who did show such evidence. From 2003 through 2012, 3,152 consecutive patients underwent isolated primary CABG at our hospital. We chose 360 for the current study. The study group (n=120) comprised patients who had undergone operation via the aortic no-touch technique. Propensity-score-matching (1: 2) was used to select the control group of 240 patients who had undergone conventional CABG. Early and late survival rates, reintervention-free survival rates, and freedom from cardiac death were compared. Early and late mortality rates were similar in the study and control groups (P=0.19 vs P=0.29, respectively), as were cardiac-related death (2.5% vs 2.1%, respectively; P=0.53) and overall death (8.3% vs 7.9%, respectively; P=0.51). Overall survival rates were 91.7% vs 92.1% and freedom-from-cardiac-death rates were 97.4% vs 97.5% (P=0.71 vs P=0.78, respectively; mean follow-up period, 5.27 +/- 2.51 yr). Reintervention-free survival rates were also similar (96.7% vs 98.8%, respectively; P=0.2). As a result of the similar rates of early and late survival, reintervention-free survival, and freedom from cardiac death, we conclude that the aortic no-touch technique with composite grafts might be a reasonable option in patients who have atherosclerotic ascending aorta that cannot be clamped.
EFFECTS OF REFERENCE PRICE SYSTEM ON MEDICINES WHICH HAVE ANNUAL AVERAGE HIGHEST AMOUNT OF SALES OF BETWEEN YEARS 2008-2013
(2014) Uman, N.; Tolun, C.; Babacan, S.; Dogan, E.; Vural, I.M.; Dasdag, M. M.; Yilmaz, Safak E.; Malhan, S.; Kahveci, R.; Akbulat, A.; Artiran, G; Kerman, S.; 27201003
A Preliminary Investigation on the Presence of Calcifying Nanoparticles in the Breast Tumor
(2014) Ozkal-Baydin, Pinar; Gocmen, Sedef J.; Erdemli, Esra; Tunc, Ibrahim G.; Sener, Hasan B.; Gumuskaya, Berrak; Sunguroglu, Asuman
Calcium phosphate is deposited in many diseases, but the molecular basis of mineralization remains largely unknown. Biomineralizied calcifications that are formed by calcium deposits are also detected in breast mammograms. Some of the detected microcalcifications are thought to be related with malignancy. Taken together, calcifying nanoparticles (CNP) may be thought as a source of malign calcifications in breast cancers. The aim of the study is to research the presence of CNP in breast tumor tissue. With this aim, the presence of CNP was investigated by culturing 16 patients' breast tumor tissue and from 2 pathologic tissues with transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Their growth was monitored by optical density (OD) at a wavelength of 650 nm. CNP couldn't be found in the analysed tissues. The presence of CNP in the breast tumor tissue was researched for the first time. We could not find CNP in the breast tumor tissue, but we think this research will open a new field of study for researchers.
Amyloid Goiter Due to Familial Mediterranean Fever in a Patient with Byler Syndrome: A Case Report
(2014) Cigerli, Ozlem; Unal, Asli Dogruk; Parildar, Hulya; Demiralay, Ebru; Tarcin, Ozlem; 25337425
Background: Familial Mediterranean Fever (FMF), also inherited with autosomal recessive trait, is characterized by recurrent episodes of fever, arthritis, and serositis. Congenital Byler Syndrome (Progressive Familial Intrahepatic Cholestasis) inherited with autosomal recessive trait and characterized by defective secretion of bile acids. FMF associated Amyloid A deposition occurs in many tissues and organs, but amyloid goiter is a rare entity that leads to enlargement and dysfunction of the thyroid. Case Report: We present a rare case of 24 year old male patient who had liver and kidney transplantation due to Byler Syndrome and secondary amyloidosis related to FMF, diagnosed as rapidly growing large amyloid goiter. Deposits of extracellular amyloid and dense adipose metaplasia diagnostic for amyloid goiter are determined upon histopathological examination of thyroidectomy material. Conclusion: When goiter was detected in cases with history of systemic amyloidosis and rapidly growing goitre, amyloid goiter should be remembered at first. This case is unique since two autosomal genetic disorders are together in the same patient and important as it emphasizes the consequences of consanguineous marriage, early diagnosis and treatment compliance of FMF and the awareness of amyloid goiter in patients followed by primary care physicians and healthcare professionals.
Amiodarone Induced Epididymitis: A Case Report
(2014) Cicek, Tufan; Demir, Canan Cicek; Coban, Gokcen; Coner, Ali
Introduction: Amiodarone is an effective drug for life-threatening arrhythmias like recurrent ventricular fibrillation and atrial fibrillation. Amiodarone creates rarely genitourinary side effects are seen. These are epididymitis, testicular dysfunction and impotance. Amiodarone aggregates and triggers inflammation in the head of the epididym. Case report: We present the case of a patient who developed epididymitis after 17 months of amiodarone therapy, using a low dose (100 mg per day). Although cessation of medication or dose lowering was not performed, remission of the patient only by analgesics is a distinct case reported in urological literature. Conclusions: This case stresses the importance of considering an adverse effect of amiodarone treatment as a cause when making a differential diagnosis of epididymitis.
Depigmented skin and phantom color measurements for realistic prostheses
(2014) Tanner, Paul; Leachman, Sancy; Boucher, Kenneth; Ozcelik, Tuncer Burak
PurposeThe purpose of this study was to test the hypothesis that regardless of human skin phototype, areas of depigmented skin, as seen in vitiligo, are optically indistinguishable among skin phototypes. The average of the depigmented skin measurements can be used to develop the base color of realistic prostheses. Methods and MaterialsData was analyzed from 20 of 32 recruited vitiligo study participants. Diffuse reflectance spectroscopy measurements were made from depigmented skin and adjacent pigmented skin, then compared with 66 pigmented polydimethylsiloxane phantoms to determine pigment concentrations in turbid media for making realistic facial prostheses. ResultsThe Area Under spectral intensity Curve (AUC) was calculated for average spectroscopy measurements of pigmented sites in relation to skin phototype (P=0.0505) and depigmented skin in relation to skin phototype (P=0.59). No significant relationship exists between skin phototypes and depigmented skin spectroscopy measurements. The average of the depigmented skin measurements (AUC 19,129) was the closest match to phantom 6.4 (AUC 19,162). ConclusionAreas of depigmented skin are visibly indistinguishable per skin phototype, yet spectrometry shows that depigmented skin measurements varied and were unrelated to skin phototype. Possible sources of optical variation of depigmented skin include age, body site, blood flow, quantity/quality of collagen, and other chromophores. The average of all depigmented skin measurements can be used to derive the pigment composition and concentration for realistic facial prostheses.
Primary Extranodal Non-Hodgkin's Lymphoma: Clinicopathological Features, Survival and Treatment Outcome in Two Cancer Centers of Southern Turkey
(2014) Mertsoylu, Huseyin; Muallaoglu, Sadik; Besen, Ayberk Ali; Erdogdu, Suleyman; Sezer, Ahmet; Sedef, Ali Murat; Kose, Fatih; Arican, Ali; Ozyilkan, Ozgur
Background: The aim of this study was to assess the epidemiological and clinicopathological characteristics of primary extranodal non-Hodgkin's lymphoma (pENL) patients, focusing on treatment and survival outcome. Materials and Methods: Between October 2003 and March 2012, 802 patients with non-Hodgkin's lymphoma (NHL) were diagnosed and treated in two different cancer centers of Southern Turkey. Results: pENL, constituted 12.4% (100/802) of all NHL studied during this period. Median age of the patients was 56 years (range 17-87 years) and the male: female distribution was 3:2. Eighty-five of 100 patients (85%) were in stage I/II, 9/100 (9%) in stage III, whereas 6/100 (6%) were in stage IV. Head and neck constituted the most common site (51/100, 51%), followed by gastrointestinal tract (GIL) (37/100, 37%), and cerebrum (CL) (5/100, 5%). Diffuse large B cell lymphoma (DLBCL) was the most common histological type, observed in 53% of patients, followed by marginal zone extranodal lymphoma (13%). Most of patients (76%) received a CHOP containing regimen. Complete remission (CR) were achieved in 71% of patients. The median follow-up duration of all patients was reported as 37.6 months (range, 0.8-165 months). This period was reported as 137.5 months (range, 117.5-1578.6 months) in gastrointestinal lymphoma (GIL) patients, 119.0 months (range, 91.8-146.1 months) in head and neck lymphoma (HNL) patients, and 18.4 months (range, 12.6-24.1 months) in cerebral lymphoma (CL) patients. Conclusions: Head and neck, and the gastrointestinal tract were the two most common extranodal sites observed. Histologically DLBC accounted for the majority of cases. Most patients were on earlier stages, had low-low intermediate IPI scores and had a favorable prognosis.
Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy
(2014) Onal, C.; Sonmez, S.; Erbay, G.; Guler, O.C.; Arslan, G.
Objective: This study compared the dosimetry of volumetric-arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) with a dynamic multileaf collimator using the Monte Carlo algorithm in the treatment of prostate cancer with and without simultaneous integrated boost (SIB) at different energy levels. Methods: The data of 15 biopsy-proven prostate cancer patients were evaluated. The prescribed dose was 78 Gy to the planning target volume (PTV78) including the prostate and seminal vesicles and 86 Gy (PTV86) in 39 fractions to the intraprostatic lesion, which was delineated by MRI or MR-spectroscopy. Results: PTV dose homogeneity was better for IMRT than VMAT at all energy levels for both PTV78 and PTV86. Lower rectum doses (V-30-V-50) were significantly higher with SIB compared with PTV78 plans in both IMRT and VMAT plans at all energy levels. The bladder doses at high dose level (V-60-V-80) Were significantly higher in IMRT plans with SIB at all energy levels compared with PTV78 plans, but no significant difference was Observed in VMAT plans. VMAT plans resulted in a significant decrease in the mean monitor units (MUs) for 6,10, and 15 MV energy levels both in plans with and those without SIB. Conclusion: Dose escalation to intraprostatic lesions with 86 Gy is safe without causing Serious increase in organs at risk (OARs) doses. VMAT is advantageous in sparing OARs and requiring less MU than IMRT. Advances in knowledge: VMAT with SIB to intraprostatic lesion is a feasible method in treating prostate cancer. Additionally, no dosimetric advantage of higher energy is observed.
CHARACTERISTICS OF THE MEDICINES WHICH HAVE ANNUAL AVERAGE HIGHEST AMOUNT OF SALES OF BETWEEN YEARS 2008-2013
(2014) Akbulat, A.; Dogan, E.; Babacan, S.; Uman, N.; Tolun, C.; Vural, I. M.; Vural, E. H.; Yilmaz, Safak E.; Dasdag, M. M.; Kahveci, R.; Malhan, S.; Artiran, G.; Kerman, S.; 27201011
How Elementary School Principals' Change Tendencies Are Related With Their Opinion About Curriculum Change
(2014) Altun, Sadegul Akbaba; Buyukkurt, Sener
Leadership is important in change process and change management. Turkish educational system is undergoing a constant change. One of those changes was the change of the elementary school curricula, which had been accepted in the 2004-2005 academic year. Therefore, it is important to understand how school principals, as the persons who are in charge of this change, handle this process. In this respect, this study was aimed to determine school principals' tendencies toward change. Furthermore, it will also be explored whether those tendencies show any significant differences on some variables. Finally, having incorporated school principals' views on curriculum, school principals' change tendencies will be interpreted within this change phenomenon. This study was designed with a mixed methodology. In order to understand school principals' tendencies toward change, a change tendency scale, developed by Akbaba-Altun and Buyukozturk (2011), was utilized. In addition, school principals were asked to narrate their opinions regarding the changed curricula and its reflections on practice. The quantitative data were analysed through descriptive and interpretive analysis whereas the qualitative data were analysed through content analysis. A total of 179 elementary school principals joined the quantitative part of this study, whereas 154 of them participated in the qualitative one. It was observed that school principals were generally homogenous in their change tendencies. Within this context, this finding was supported by the qualitative data, as well. (C) 2014 The Authors. Published by Elsevier Ltd.
Surgical and interventional management of complications caused by acute pancreatitis
(2014) Karakayali, Feza Y.; 25309073
Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
Early clinical predictors of intractable epilepsy in childhood
(2014) Saygi, Semra; Erol, Ilknur; Alehan, Fusun
Aim: In this retrospective study, we evaluated the clinical responses to antiepileptic drug (AED) therapy in pediatric epilepsy patients treated at a single center. Materials and methods: We identified 28 children with intractable epilepsy and 213 patients with drug-responsive epilepsy. Results: Univariate analysis showed that age at onset, high (daily) initial seizure frequency, infantile spasm, history of neonatal seizures, abnormal neurodevelopmental status, neurological abnormalities, mental retardation, remote symptomatic etiology, and abnormal brain imaging results were significant risk factors for the development of intractable epilepsy (P < 0.05). Multivariate logistic regression analysis revealed that high (daily) initial seizure frequency and remote symptomatic etiology were significant and independent risk factors for intractable epilepsy (P < 0.05). Conclusion: Our study suggests that the risk of developing intractable epilepsy in childhood may be predicted, to some extent, by the early clinical course. Early identification of patients at high risk of developing intractable epilepsy will guide appropriate therapy and reduce exposure to ineffectual treatments.
PANCREATIC CYSTIC LYMPHANGIOMA: DIAGNOSTIC APPROACH WITH MDCT AND MR IMAGING
(2014) Macin, G.; Hekimoglu, K.; Uner, H.; Tarhan, C.
Lymphangiomas are rare congenital benign tumors arising from the lymphatic system mostly encountered in the neck and axillary regions of pediatric patients. Pancreatic cystic lymphangiomas very rarely occur in adults. Radio-logically, the lesion may mimic pancreatic carcinoma and should be considered in the differential diagnosis of any patient found to have an abdominal cystic mass. In this article, we present a 50-year-old man who presented with pain in the upper abdomen, nausea, and abdominal swelling. On computed tomography (CT) and magnetic resonance (MR) imaging, a gross septated cystic lesion was detected in the upper abdomen which extended from the pancreatic corpus to the left liver lobe. The patient underwent complete resection of tumor Pathology revealed a cystic lymphangioma.
Use of Mesenchymal Cells to Modulate Immune Suppression and Immune Reconstruction in a Patient with Aplastic Anemia Complicated by Invasive Sino-Orbital Aspergillosis
(2014) Ozdogu, Hakan; Yeral, Mahmut; Boga, Can; Kozanoglu, Ilknur
Cultured human bone marrow mesenchymal cells (MSCs) have immunomodulatory and tissue regenerative properties. This report summarizes the result of post-transplant treatment with MSCs of a 26-year-old patient with aplastic anemia complicated by invasive sino-orbital aspergillosis. The patient was treated with MSCs to benefit from the dual effects of MSCs in immune reconstitution: suppression against alloreactive T cells and facilitation of the re-engraftment process. The patient did not develop acute or chronic graft-versus-host disease. The aspergillus infection healed completely. The engraftment failure was also ended without any complications. During his last visit in his fourth year after transplantation, the patient was in hematological remission. Human bone marrow-derived MSCs seem to have an important role in preventing or overcoming immunological complications in patients who undergo stem cell transplantation.
Evaluation of choroidal thickness using spectral-domain optical coherence tomography in migraine patients during acute migraine attacks: a comparative study
(2014) Karalezli, A.; Simsek, C.; Celik, G.; Eroglu, F.C.; 25257772
Purpose The purpose of this study was to assess choroidal thickness in migraine patients during acute migraine attacks and compare them with healthy controls, using spectral domain optical coherence tomography (OCT). Patients and methods In this prospective case-control study, choroidal thicknesses of 46 migraine patients during acute migraine attacks and 46 age-and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain-OCT device. All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (0900 hours), in order to minimize the effects of diurnal variation. Results There was a statistically significant difference in mean choroidal thickness between the migraine patients during acute migraine attacks (356.3 +/- 21.46 mm) and the controls (302.3 +/- 18.34 mu m; P = 0.000). There were significant differences at all measurement points (P < 0.001 for all). Conclusion The increased choroidal thickness of the migraine patients during acute migraine attacks might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and acute migraine attack.
OPERATING ON PENETRATING TRAUMA TO THE MEDIASTINAL VESSELS
(2014) Yilmaz, T. H.; Evers, T.; Sussman, M.; Vassiliu, P.; Degiannis, E.; Doll, D.; 24520100
Background and Aims: Patients with penetrating trauma of the major vessels of the chest are infrequently encountered. This is due to the fact that the majority of these patients die on scene, as well as due to the overall dramatic decline in the incidence of penetrating trauma in the Western world. A certain proportion of survivors are physiologically stable and can be transferred to adequate care. Patients who are physiologically unstable must be dealt with by the surgeons available without delay. Rapid diagnosis and operation can salvage patients who would otherwise be lost, and all general surgeons should be capable of recognizing these injuries and intervening if a trauma and/or cardiothoracic surgeon is not immediately available. Material and Methods: Technical description of practical emergency surgery approaches to patients bleeding to death from penetrating mediastinal vessel injuries. Results: The scope of this review familiarizes the uninitiated surgeon with the operative management of this rare and lethal type of injuries. Technical aspects are described, and pitfalls as well as tips and tricks of the trade are discussed. Conclusions: Patients with penetrating injuries to the mediastinal vessels can be saved by swift and knowing operative management of this rare and lethal type of injuries, even if a trauma and/or cardiothoracic surgeon is not immediately available.
Efficacy and Safety of First Line Vincristine with Doxorubicin, Bleomycin and Dacarbazine (ABOD) for Hodgkin's Lymphoma: a Single Institute Experience
(2014) Ozdemir, Nuriye; Dogan, Mutlu; Sendur, Mehmet Ali Nahit; Yazici, Ozan; Abali, Huseyin; Yazilitas, Dogan; Akinci, Muhammed Bulent; Aksoy, Sercan; Zengin, Nurullah; 25374196
Background: ABVD (doxorubicin, bleomycin, vinblastine (Vb) and dacarbazine) is the standard regimen in Hodgkin's lymphoma (HL). Vincristine (O) is a mitotic spindle agent like Vb. We aimed to evaluate the efficacy and safety of O as a part of ABOD in HL. Materials and Methods: Patients who had ABOD were enrolled. Stage I-II HL were evaluated for unfavorable risk factors according to NCCN. National Cancer Institute Common Toxicity Criteria was used for toxicity. Results: Seventy-nine HL patients in our center between 2003 and 2007 were evaluated retrospectively. Median follow-up was 54 months. Most of the patients were male in their third decade. Median ABOD cycles were 6 (2-8). Primary refractory disease rate was 17.7% whereas it was 5.1% for early relapse and 5.1% for late relapse disease. Response rates were as 82.3% for complete response, 11.4% for partial response, 5.1% for stable disease and 1.3% for progressive disease. Half of relapsed patients had autologous stem cell transplantation. Estimated 5-year failure-free survival was 71% and significantly longer in early stage patients without risk factors, bulky disease or radiotherapy (RT) (p=0.05, p<0.0001, p=0.02; respectively). Estimated 5-year overall survival was 74% and significantly longer in those who had no RT (p=0.001). Dose modification rate was 5.1% and chemotherapy delay rate was 19%. There were no toxicity-related deaths. Conclusions: ABOD seems to be effective with managable toxicity in HL, even in those with poor prognostic factors.
Epidemiological and Cost Analysis of Self-Poisoning Cases in Ankara, Turkey
(2014) Kavalci, Gulsum; Ethemoglu, Filiz Banu; Batuman, Asli; Kumral, Dilber; Emre, Cengizhan; Surgit, Meltem; Akdikan, Alev; Kavalci, Cemil; 25763203
Background: Poisoning is a global public health problem. Self-poisoning has potentially serious consequences. Follow-up studies have found that 3-10% of self-harm patients eventually succeed. Objectives: This study was designed to investigate the epidemiological, clinical and economical aspects of deliberate self-poisoning patients admitted to Yenimahalle State Hospital Intensive Care Unit. Patients and Methods: The study was carried out retrospectively in Ankara Yenimahalle State Hospital. It included Seventy-one patients over 16 years of age who were admitted to the hospital due to poisoning during 2012. Exposed poisons were classified into one of three categories; pharmaceuticals, pesticides, and alcohols. Cost account was based on the medical invoices at patient discharge. Data were compared using Student's T test and chi-square test. A P value of less than 0.05 was considered significant. Results: The female/male ratio was 2.55. The mean age of the 71 poisoned patients was 28.92 +/- 11.51 years. Most of the poisoning agents were pharmaceuticals (68 cases). Among the pharmaceuticals, antidepressants were involved most often, followed by analgesics. There was no statistically significant difference between pharmaceutical agents in terms of hospital cost (P > 0.05). The mean length of hospital stay was 6.4 +/- 4.3 days. There was a statistically significant difference between the lengths of stay of patients in terms of hospital cost (P < 0.05). Conclusions: The patient cost increased as the length of stay increased due to the policy of bundle pricing.