A simple approach to prepare self-assembled, nacre-inspired clay/polymer nanocomposites.

Inspired by the relationship between the well-ordered architecture of aragonite crystals and biopolymers found in natural nacre, we present a facile strategy to construct large-scale organic/inorganic nacre-mimetics with hierarchical structure via a water-evaporation driven self-assembly process. We connect LAPONITE®-nanoclay platelets with each other using carboxymethyl cellulose, a cellulose derivative, thus creating thin, flexible films with a local brick-and-mortar architecture. The dried films show a pronounced resistance against tensile forces allowing for stronger thin films than nacre. In terms of functionalities, we report excellent glass-like transparency along with exceptional shape-persistent flame shielding. We also demonstrate that through metal ion-coordination we can further strengthen the interactions between the polymers and the nanoclays, and thus enhanced mechanical, and thermal properties as well as resistance against swelling and dissolution in aqueous environments. We believe that our simple pathway to fabricate such versatile polymer/clay nanocomposites can open avenues for inexpensive production of environmentally friendly, biomimetic materials in aerospace, wearable electrical devices, and in the food packaging industry.

Evaluation of cell and DNA damage induced by panoramic radiography.

BACKGROUND: X-rays are potential mutagenic agents that can cause both the gene mutations and chromosomal aberrations. AIMS: In this study, the micronucleus (MN) test and the comet assay methods are implemented in order to observe the damage that can occur in the cell nucleus and in the structure of DNA of the patients who underwent a panoramic examination. METHODS AND MATERIALS: In our study, buccal mucosa swabs were obtained just before the radiography and 2 weeks after the radiography from 30 volunteer patients who had to take radiographs due to dental diagnosis. Changes in the nuclei of 1,000 cells of each swab sample had been counted under a light microscope and recorded. Besides, 100 cells of each other swab samples were analyzed by the comet assay. Comet assay parameters namely tail length and percentage of DNA in tail, which indicate the level of DNA damage were analyzed and compared in both groups. Statistical analysis was performed by using the Statistical Package for the Social Sciences (Version 21). RESULTS: In our study, the results of percentage of DNA in tail and tail length before and after X-ray exposure were statistically significant (P < 0.001). Likewise, increase in the MN frequency observed in buccal mucosa cells after X-ray exposure was found significant (P < 0.001). CONCLUSIONS: As a result, panoramic radiographs taken during dental diagnosis and treatment cause cytotoxicity and DNA damage in oral mucosal cells. Panoramic radiographs should be applied only when necessary, using an accurate radiographic technique and radioprotection criteria.

Various simultaneous nail changes due to valproic acid use.

There are only a few case reports about nail changes due to valproic acid in the literature despite its widespread use. We present a 50-year-old man who had onycholysis, roughness of the nail surface and brownish-yellow discoloration of both fingernails and toenails, which remarkably ameliorated upon cessation of valproic acid.

Cutaneuos findings in patients with predialysis chronic kidney disease.

BACKGROUND: Several cutaneous findings are seen in dialysis dependent chronic kidney disease (CKD) patients. However, there are only a few small studies on cutaneous findings in predialysis CKD patients. We aimed to determine cutaneous findings in predialysis CKD patients. METHODS: This was a cross-sectional study. Consecutive predialysis CKD patients from nephrology outpatient clinic in a university affiliated hospital were recruited to this study. Detailed dermatologic examination was performed by a senior dermatologist. Blood urea, creatinine, hepatitis B surface antigen and hepatitis C antibody test were studied for each participant. RESULTS: A total of 365 consecutive predialysis CKD patients (stages 2-5) included in the study. Three hundred and fifty-eight patients (98.1%) had at least one dermatologic finding. The most common cutaneous finding was xerosis (64.9%) followed by hair findings (41.4%), pruritus (19.2%), pigmentary changes (17.5%), nail findings (15.3%) and oral mucosal findings (9.3%). Longitudinal striations was the most common nail finding, diffuse brown hyperpigmentation was the most common pigmentary change, coated tongue was the most common oral mucosal finding and androgenetic alopecia was the most common hair finding. Frequency and diversity of dermatologic findings did not change across CKD stages. CONCLUSIONS: This is the largest study investigating dermatologic findings in a well-characterized predialysis CKD patient population. We found that at least one cutaneous finding was present in almost all of the CKD patients. Cutaneous findings are very common and diverse among predialysis CKD patients.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements.

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginning of the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginningof the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Les infections sur cathéter central sont l'un des problèmes les plus importants dans les unités de soins intensifs au niveau mondial. Un ensemble de soins dispensés en cas d'infections sur cathéter central a été introduit dans une unité de soins intensifs médicaux et chirurgicaux de 13 lits à Kocaeli (Turquie) en janvier 2010. Le degré d'application de l'ensemble de soins a été évalué du début du troisième trimestre 2010 jusqu'à juin 2013 et comparé aux taux d'infections sur cathéter central. Au cours de la période suivant l'intervention, parmi les 2196 patients ayant séjourné dans l'Unité des soins intensifs, 732 cathéters centraux posés pendant 4366 jours cumulés ont été soumis à observation. Le retour d'information fourni au personnel a permis de renforcer la culture de la sécurité du patient en unité de soins intensifs.Les taux d'infections sont restés nuls pendant les 38 mois ayant suivi la mise en oeuvre. Il existait une forte corrélation négative entre le degré d'application de l'ensemble de soins et les taux d'infections sur cathéter central. La mise en oeuvrede cet ensemble de soins concernant les cathéters centraux, associée à l’accent mis sur le degré d'application de toutes ses composantes et une culture de la sécurité du patient, a permis d'atteindre et de maintenir un taux zéro d'infection sur cathéter central dans cette unité de soins intensifs.

The effect of resveratrol on the prevention of cisplatin ototoxicity.

One of the most important adverse effects of cisplatin, a chemotherapeutic agent which is widely used in the treatment of cancer patients, is hearing loss. This has primarily been associated with the loss of inner ear hairy and spiral ganglion cells due to oxidative stress. Resveratrol is known to be an antioxidant agent, which has the theoretical potential of preventing cisplatin-related ototoxicity. This experimental study was approved by Animal Ethics Committee of Inonu University (2008-20) and supported by Inonu University Scientific Research Projects Support Fund (2009-17). Thirty-four 3-month-old Wistar albino female rats weighing 210-270 g were used in the study. The animals were allocated into four groups: in cisplatin group (Group A), a single dose of 12 mg/kg cisplatin was administered intraperitoneally to 10 rats; in cisplatin + resveratrol group (Group B), a single dose of 12 mg/kg cisplatin and 10 mg/kg resveratrol were administered intraperitoneally for 5 days to 10 rats; in resveratrol group (Group C), 10 mg/kg resveratrol was administered intraperitoneally for 5 days to seven rats and in control group (Group D), resveratrol solvent (5% alcohol-95% physiological saline) was administered intraperitoneally for 5 days to seven rats. Resveratrol administration has begun 1 day before cisplatin administration in the group treated with cisplatin and resveratrol combination. Distortion product otoacoustic emission (DPOAE) (Grason Stadler, Madison, USA) measurements were performed in the same ear of all rats (right ear) under general anesthesia at baseline, 1st and 5th days after drug administration. Statistically significant distortion product amplitude reductions were found in the cisplatin group at 1,418, 2,003, 3,363, 5,660, 8,003 and 9,515 Hz frequencies. Whereas in the cisplatin + resveratrol group, statistically significant difference was found between 1st and 5th day measurements only at 3,996 Hz frequency. No significant differences were noted between the measurements either in the resveratrol or in the control groups. According to these results, cisplatin-related ototoxicity has been greatly prevented by resveratrol use.

Displacement of a maxillary third molar into the buccal space: anatomical implications apropos of a case.

A few cases of accidental displacement of molars into adjacent anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, or the lateral pharyngeal space, during surgical interventions have been reported. This report describes the displacement of a maxillary third molar into the buccal space and discusses the anatomical implications.

Is the pathological examination of routine tonsillectomy and adenoidectomy specimens necessary? A retrospective study of 559 adenoidectomy and 1132 tonsillectomy specimens and a literature review.

OBJECTIVE: There is still no consensus about the necessity of histopathological analysis of routine tonsillectomy and adenoidectomy specimens. In this study, our goal was to determine the incidence of unexpected pathological findings in routine tonsillectomy and adenoidectomy specimens. The results are discussed in the light of current literature. MATERIALS AND METHODS: The patient data were obtained from the archives of the departments of otorhinolaryngology and pathology. Between November 1992 and July 2006, chronic, recurrent infections or obstructive problems led to bilateral tonsillectomies, adenoidectomies, and adenoidectomies plus tonsillectomies being performed in 435, 502, and 770 patients respectively. Five hundred and fifty-nine of 1272 adenoidectomy specimens and 1132 of 2410 tonsillectomy specimens were sent to the department of pathology for histopathological examination. RESULTS: The histopathological results for all the adenoidectomy specimens reported chronic inflammatory processes. Only one of 1132 tonsillectomy specimens involved granulomatous inflammation, while 1131 were chronic inflammatory processes. CONCLUSION: On the basis of the result of our study and review of the published literature, the microscopic analysis of routine tonsillectomy and/or adenoidectomy specimens may not be necessary, especially in young patients with no clinically suspicious factors for malignancy. However, all patients must be carefully examined for evidence of malignancy before surgery.

Silent sinus syndrome.

We present a case of silent sinus syndrome (SSS) who underwent unilateral surgical endoscopic maxillary meatotomy. Orbital floor reconstruction is delayed after follow up. Enophthalmos recovered 8 months after the surgery and radiologic findings improved. SSS is a clinical entity that should be kept in mind in the differential diagnosis of enophthalmos and can be treated successfully via endoscopic approach.

Lateralizations of head-neck cancers are not associated with peripheral asymmetry of cell-mediated immunity.

Earlier studies have reported right-sided lateralization for different organ cancers except breast cancer. In the present study, lateralization of head-neck cancers and their relation with the peripheral cell-mediated immune asymmetry was investigated. The sample was comprised of 42 men and 20 women diagnosed with cancer in the head-neck region. The diagnosis of cancer was made histopathologically. To measure the cell-mediated (type IV) immunity of both forearms, the tuberculin test (PPD test) was used in the subjects previously sensitized by BCG vaccine during the first year of age. Significant right-sided lateralization in men and the significant left-sided lateralization in women were observed in this study. There was no relation between the lateralization of cancer and the asymmetry of tuberculin reaction or the peripheral cell-mediated immune asymmetry.

Plasma viscosity, an early cardiovascular risk factor in women with subclinical hypothyroidism.

OBJECTIVE: It is controversial, if subclinical hypothyroidism increases cardiovascular risk. Plasma viscosity is a hemorheological parameter, which is accepted as an early cardiovascular risk factor. We investigated the alterations in plasma viscosity in women with subclinical hypothyroidism. DESIGN: 40 female patients with subclinical hypothyroidism and 31 age- and weight-matched healthy women were included. Free thyroxine (FT4), thyroid stimulating hormone (TSH), lipid parameters, fibrinogen, C-reactive protein (CRP) levels, hematocrit and plasma viscosity were measured in all subjects. MAIN OUTCOME: Plasma viscosity, total cholesterol and low density lipoprotein were significantly increased and high density lipoprotein was significantly decreased in patients with subclinical hypothyroidism. No significant correlation was found among the parameters. CONCLUSION: Increased plasma viscosity in patients' group suggests that cardiovascular risk might be increased in patients with subclinical hypothyroidism. As far as we could reach, this is the first study concerning plasma viscosity in subclinical hypothyroidism.

The effects of magnesium sulphate on sevoflurane minimum alveolar concentrations and haemodynamic responses.

BACKGROUND AND OBJECTIVE: Magnesium administered before anaesthesia induction results in a significant reduction in intravenous anaesthetic consumption. The purpose of this study was to evaluate whether the dose of intravenous magnesium sulphate reduces the minimum alveolar anaesthetic concentration of sevoflurane for endotracheal intubation (MACEI) and skin incision (MAC), and attenuates haemodynamic responses. METHODS: We studied 60 patients who were scheduled for elective surgery. Patients were not premedicated before induction of anaesthesia and were randomly assigned to receive intravenous saline 0.9% (Group I, n = 20) or magnesium sulphate 30 mg kg(-1) bolus + 10 mg kg(-1) h(-1) continuous infusion (Group II, n = 20) or 50 mg kg(-1) bolus + 10 mg kg(-1) h(-1) continuous infusion (Group III, n = 20). RESULTS: Median and 95% confidence limits for sevoflurane MACEI were 2.68 (2.48-2.85), 2.88 (2.70-3.06) and 2.96 (2.70-3.16), and for sevoflurane MAC were 2.08 (1.76-2.40), 2.26 (2.08-2.47) and 2.40 (2.19-2.68) in Groups I, II and III, respectively. The differences in MACEI and MAC among groups were not statistically significant, except Group III in MAC study (P < 0.05). Mean arterial pressures and heart rate did not increase in Groups II and III after endotracheal intubation and skin incision. CONCLUSIONS: Magnesium sulphate administered before induction of anaesthesia increases MAC of sevoflurane and reduces cardiovascular responses to intubation.

The alteration of sister chromatid exchange frequencies in Behçet's disease with and without HLA-B51.

BACKGROUND: The analysis of sister chromatid exchange (SCE) is a cytogenetic technique used to show DNA damage as a result of an exchange of DNA fragments between sister chromatids. It is known that there is an increased SCE frequency in Behçet's disease (BD). OBJECTIVE: To investigate whether human leucocyte antigen (HLA)-B51-positive patients with Behçet's disease exhibit higher SCE frequencies than those without HLA-B51. METHODS: Lymphocytes from 75 patients (38 women, 37 men) and from 50 controls (28 women, 22 men) were cultured in darkness for 72 h in the presence of bromodeoxyuridine. Metaphase chromosomes were stained with a fluorescence plus Giemsa technique after a standard harvest procedure. For HLA-B51 typing, DNA was extracted from ethylenediaminetetraacetic acid blood samples and HLA-B5 allele genotyping was performed by the polymerase chain reaction (PCR)-sequence specific primer method. RESULTS: Thirty-nine of 75 patients with BD (52%) and 15 of 50 controls (30%) were found HLA-B51-positive. The SCE frequencies in HLA-B51-positive patients were higher than in HLA-B51-negative ones (P < 0.001), whereas no difference was detected in the control group. CONCLUSION: This study revealed that there was a significant association between elevated SCE frequencies and existence of HLA-B51 patients with BD.

DNA damage, DNA susceptibility to oxidation and glutathione level in women with polycystic ovary syndrome.

Recent studies have addressed the possibility of an association between polycystic ovaries and ovarian cancer. DNA damage is the first step of the carcinogenesis, and susceptibility to cancer, in general, is characterized by high DNA damage. Free radical-mediated DNA damage and impaired antioxidant defence have been implicated as contributory factors for the development of cancer. This study evaluates DNA damage (strand breakage, base oxidation, formamidopyrimidine DNA glycosylase (Fpg) sensitive sites), H2O2-induced DNA damage, a marker of DNA susceptibility to oxidation and glutathione (GSH) level, a powerful antioxidant, in women with polycystic ovary syndrome (PCOS). Women with PCOS showed a significant decrease in GSH level, a significant increase in DNA strand breakage and H2O2-induced DNA damage. Although Fpg-sensitive sites were higher in the PCOS group compared to the control group, the difference did not reach a statistically significant level. Significant correlations were found between free testosterone and DNA strand breakage (r = 0.46, p<0.01) and free testosterone and H2O2-induced DNA damage (r = 0.41, p<0.05). The data indicate that DNA damage and susceptibility of DNA to oxidative stress are increased in women with PCOS and may explain the association between PCOS and ovarian cancer.