Effect of different surface treatments and ceramic primers on shear bond strength of self-adhesive resin cement to zirconia ceramic.

AIMS: To evaluate the effect of different surface treatments and ceramic primers on the shear bond strength (SBS) of self-adhesive resin cement to zirconia ceramic. MATERIALS AND METHODS: A total of 40 zirconia discs (10 mm in diameter and 3 mm in height; StarCeram Z-Med, H.C. Starck, Selb, Germany) were prepared from pre-sintered zirconia blocks. Discs were divided into two groups according to surface treatment: (a) airborne particle abrasion (sandblasting) with 50-µm Al2O3 particles and (b) 9.5% hydrofluoric acid etching. Each of these groups was subdivided into two groups according to the type of primer applied: (a) Z-Prime Plus primer and (b) Clearfil Ceramic Primer. A self-adhesive resin cement (Multilink Speed, Ivoclar Vivadent, Schaan, Liechtenstein) was used to bond with polyethylene molds. All specimens were tested at thermocycled (5000 cycles at 5-55°C for 30 s) conditions. The SBS of the luting cement to the ceramic was measured in a universal testing machine (1 mm/min). RESULTS: The sandblasted groups showed significantly higher SBS values than the acid-etched groups for both primers (P = 0.0001). Independent of the surface treatment, the Z-Prime Plus primer groups showed higher SBS values than the Clearfil Ceramic Primer groups (P = 0.0001). CONCLUSIONS: Sandblasting is a more effective method to increase bond strength on zirconia ceramics than hydrofluoric acid etching, and the application of Z-Prime Plus primer increases SBS better than Clearfil Ceramic Primer.

Relationship between healthy lifestyle behaviors and health related quality of life in turkish school-going adolescents.

BACKGROUND: The aim of this study is to determine the relationship between healthy lifestyles behaviours and health-related quality of life (HRQOL) among Turkish school-going adolescents. SUBJECTS AND METHODS: This cross-sectional study was conducted among 413 students studying in a secondary school of Istanbul, Turkey. Data were collected using a questionnaire containing socio-demographic characteristics, health promoting lifestyle behaviors and the Turkish generic health-related quality of life questionnaire for children (Kid-KINDL). Data were analyzed using descriptive statistics, t-test, Pearson's product-moment correlation, and a hierarchical multiple regression analysis. RESULTS: Univariate statistics showed that gender, school grade, parental education level, monthly income, and all healthy lifestyles behaviours except for fruit and vegetable intake were associated with adolescents' HRQOL. Multivariate statistics indicated that participation in social activities and talking about their problems were the most important predictors of better HRQOL. Healthy lifestyles behaviours, especially talking about their problems to close friends and/or family members and participation in leisure-time social activity were related to better HRQOL of Turkish adolescents, independently of socio-demographic factors. CONCLUSION: Collaborative efforts among providers of school health and counseling services are urgently needed to improve all aspects of adolescent health.

Fracture resistance and failure modes of lithium disilicate or composite endocrowns.

PURPOSE: The aim of this study was to determine the fracture strength of endocrowns made of lithium disilicate ceramic and two different indirect resin composites. MATERIALS AND METHODS: Forty human mandibular molars were randomly separated into four groups (n = 10 in each group) - Group IN: control group, Group IPS: endocrowns made of lithium disilicate ceramic (IPS e.max CAD, IvoclarVivadent, Schaan, Liechtenstein); Group SL: Endocrowns made of Solidex microhybrid composite (Shofu, Ratingen, Germany); and Group GR: Endocrowns made of Grandia microhybrid composite (GC Europa, Leuven, Belgium). In all of the groups, dual-cure resin cement (Relyx Ultimate Clicker, 3M ESPE, St. Paul, MN, USA) was used to cement the endocrowns. All of the teeth were subjected to fracture by means of a universal testing machine (Instron), and compressive force was applied. The failure type and location after fracture were classified. The data were analyzed using one-way ANOVA, Tukey's post hoc test, and Chi-square test (P < 0.05). RESULTS: Group IPS showed significantly higher fracture strength than Groups SL and GR (P < 0.05). There was no significant difference between the SL and GR groups (P > 0.05). In Group SL, 80% of the specimens exhibited favorable fractures; also, 60% of the specimens exhibited favorable fracture in group GR, and only 10% of the specimens exhibited favorable fracture in group IPS. CONCLUSIONS: The lithium disilicate ceramic endocrowns exhibited higher fracture resistance than indirect composite groups. Both of the composite endocrowns showed more favorable failure than the lithium disilicate ceramic endocrowns.

Comparison of time-dependent two-dimensional and three-dimensional stability with micro-computerized tomography and wettability of three impression materials.

OBJECTIVES: The objective of this study is to explore time-dependent dimensional stability of three different elastomeric impression materials - vinyl polyether silicone (VPES), vinyl polysiloxane (VPS), and polyether (PE) - through micro-computerized tomography (µ-CT) imaging, allows three-dimensional (3D) imaging and measurement without sample preparation or chemical fixation. Materials and Methods: Thirty specimens were created using 3 mm high, 30 mm wide Teflon molds (n = 10). Specimens were scanned with µ-CT on the 1st (T1) h and 1st (T2), 7th (T3), and 14th (T4) days. 3D models were created at the above-mentioned times, volumetric measurements were conducted and dimensional changes were calculated. Diameters and heights of each impression material were measured with 2D analyses. Furthermore, contact angle measurements of these elastomeric impression materials were collected using the sessile drop method during and after polymerization at 0, 2, 5, 20, 60, 120, and 240 s These measurements were made on specimens (n = 10) prepared in standard sizes using a 50 µm deep stainless steel die with dimensions of 62 mm × 20 mm × 3 mm. RESULTS: Evaluation of the dimensional volume changes of the VPES, VPS, and PE measurements showed there to be no statistically significant differences between the T1, T2, T3, and T4 (P > 0.05). Only the decreases in the volume averages of T3 and T4 in the VPES were statistically significant (P < 0.05). As a result of binary comparisons, the evaluation of contact angle measurements of VPES, VPS, and PE materials during and after polymerization were compared. The average contact angle measurements of the VPS group were statistically significantly lower than the averages of the VPES and PE groups (P < 0.01). CONCLUSIONS: VPS was found to be the most stable impression material concerning dimensional change and wettability.

Relationship between MCP1 (-2518A>G) gene variants and ovarian cancer in Turkish population.

The monocyte chemoattractant protein-1 (MCP-1) gene polymorphism(-2518A>G)  in the regulatory region of the MCP-1 protein has been reported to be associated with cancer risk. In this study we aimed to investigate the relationship of MCP-1 (-2518A>G) gene polymorphism and ovarian cancer. MCP-1 genotyping was performed using polymerase chain reaction from blood samples ofovarian cancer patient (n=56) and a control groups (n=52).There was a significant difference in MCP1 (-2518A>G) genotypes between the patient and control groups (p=0.049; x2=6.042). AA carriers were significantly higher in the control group (p=0.014) whereas AG genotype and G allele carriers were significantly higher in the ovarian cancer group (p=0.029, p=0.014, respectively). This study suggests that MCP-1 (-2518A>G) AG genotype and G allele could be considered as risk factor for susceptibility to ovarian cancer.

The effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in the first SCID-mouse endometriosis-model developed in Turkey.

OBJECTIVE: To evaluate the effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in SCID mice. MATERIALS AND METHODS: Prospective, randomized, controlled, experimental study. Experimental Research Center of Yeditepe University (YUDETAM). Thirty female, non-pregnant, nulligravid severe combined immunodeficient (SCID) mice. Endometriotic cells collected from patients with endometriosis were implanted subcutaneously in 30 SCID mice. These mice were randomized into two study groups: in the first group, mice were administered melatonin (20 mg/kg/day) following induction of endometriosis for four weeks; in the second group, nothing was administered. All the mice were given a high dose of exogenous estradiol (50 µg/kg/d, twice weekly). Four weeks after inoculation, necropsies were performed and endometriotic lesions were collected. All the lesions were evaluated histopathologically and the levels of SOD and MDA were assessed in the lesions. RESULTS: Successful implantation was observed in the 28 mice that survived. Mean MDA level was 5.0 ± 1.7 and 8.8 ± 2.6 in the melatonin and control groups, respectively (p = 0.01); mean SOD level was 1.1 ± 0.1 and 1.0 ± 0.1 in the melatonin and control groups, respectively (p = 0.49). Mean histopathological score was lower in the melatonin group (p = 0.04). CONCLUSIONS: Melatonin was effective in the treatment of experimental endometriosis induced in SCID mice.

Effects of aloe vera gel on the induction of endometriosis and regression of endometrial explants in a rat model.

PURPOSE OF INVESTIGATION: To evaluate the preventive and reducing effect of aloe vera gel on surgically-induced endometrial foci in rats. MATERIALS AND METHODS: Twenty-four reproductive aged female non-pregnant, nulligravid Sprague-Dawley albino rats were used. The rats were randomly divided to three groups (Group 1: control, Group 2: aloe vera endometriosis formation, and Group 3: aloe vera endometriosis treatment). A peritoneal lavage using one-ml saline was taken at all the operations for determination of superoxide dismutase (SOD), malondialdehyde (MDA), and catalase (CAT). Forty-eight horns were implanted in 24 rats. RESULTS: All the implants were properly formed after implantation. In Group 3, before aloe vera application, the sum of the volumes was 87.2 ± 20.4 mm³ and after treatment the volumes dropped to 28.9 ± 14.9 mm3 (p = 0.01). As evaluation of aloe vera on the formation of endometriosis in the second operation in Group 2, the sum of the volumes was 2.9±1.4 mm³ and in Group 1, 118.9 ± 20.0 mm3 (p = 0.001). Likewise, similar changes were observed in the histopatological scores. CONCLUSION: The application of aloe vera was seen to raise antioxidant levels in the peritoneal fluid and to reduce oxidative stress markers. Aloe vera is effective in the inhibition of formation and regression of endometriotic lesions.

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE: This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. METHODS: The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. RESULTS: Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary. CONCLUSION: Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

How does electronic cigarette smoking affect sinonasal symptoms and nasal mucociliary clearance?

OBJECTIVE: is to evaluate the sinonasal symptom scores and mucociliary clearance (MCC) after starting to use electronic cigarette METHODOLGY: This prospective randomized single-blind clinical trial was conducted between March 2013 and November 2013. Patients (n=98) admitted to smoking cessation clinic were divided into two groups; Electronic cigarette smokers (group 1) and non-electronic cigarette smokers (group 2). SNOT-22 and saccharin transit time for MCC were evaluated before starting electronic cigarettes and after the third months. RESULTS: SNOT-22 scores and MCC time were evaluated between groups and within groups after 3 months. SNOT 22 scores and MCC measurements showed no difference between groups before the cessation of cigarette smoking (p >0.05). SNOT 22 results of both groups revealed statistically significantly lower scores after the three months (p < 0.05). However, SNOT-22 scores of group 2 was significantly better than group 1 (p > 0.05). Comparison of MCC results of group 2 revealed statistically significantly lower scores after the three months (p < 0.05). However, group 1 did not show any significant difference after three months (p > 0.05). There was a significant difference between the groups at the third month measurements (p < 0.05). CONCLUSIONS: Although EC is widely used as a method of quitting smoking, it has negative effects on the sinonasal symptoms and MCC.

Ultrasound-guided intrauterine insemination versus blind intrauterine insemination: a randomized controlled trial.

PURPOSE: This study was performed to determine the effects of ultrasound (US) guidance during intrauterine insemination (IUI) on pregnancy rate. MATERIALS AND METHODS: This study is a prospective randomized controlled trial which was performed in Women's Health Research and Education Hospital, Infertility Unit. The study enrolled 130 couples who were scheduled to undergo IUI. The couples were randomized according to a computer-generated list into two groups; 1) the ultrasound-guided IUI group included 64 couples (n = 64) treated for 99 cycles 2) blind IUI group included 66 couples (n = 66) treated for 104 cycles. All women underwent controlled ovarian stimulation before IUI. The study's main measurements were pregnancy rate per cycle; pregnancy rate per woman. RESULTS: The pregnancy rates were similar in both the ultrasound-guided (USG) (16.2%, 16/99) and non-ultrasound-guided (NUSG)(12.5%, 13/104) groups (p = 0.386). CONCLUSIONS: The present results suggest a routine ultrasound guidance during IUI is not essential as it does not increase pregnancy rates but it can be used in such cases to overwhelm some sort of difficulties.

Malignant mixed Müllerian tumor with small cell neuroendocrine differentiation: a case report and review of the literature.

INTRODUCTION: Small cell neuroendocrine differentiation (NE) in malignant mixed Müllerian tumors (MMMTs) is a rare and unusual occurrence with very few previously reported cases. There is no consensus regarding its diagnosis, classification, and optimal treatment options. CASE: The authors report a patient with endometrial MMMT and NE differentiation who initially received comprehensive surgery followed by adjuvant chemotherapy containing cisplatin and etoposide. She further underwent metastasectomy and received carboplatin and paclitaxel for the relapse. She is still alive 12 months after the diagnosis. The authors performed a review of literature in order to characterize the clinical phenotype. These patients have a very aggressive disease. Median life expectancy seems to be less than a year. CONCLUSIONS: It is reasonable to perform comprehensive staging surgery followed by adjuvant chemotherapy irrespective to stage of the disease.

Comparison of the histopathological diagnoses of preoperative dilatation and curettage and Pipelle biopsy.

PURPOSE: To evaluate the accuracy of dilatation and curettage (D&C) and Pipelle biopsy for the diagnosis of endometrial pathologies and determine whether the amount of endometrial tissue obtained using these techniques is sufficient for further histopathology of hysterectomy specimens. MATERIALS AND METHODS: Patients undergoing hysterectomy for various indications were evaluated via Pipelle endometrial biopsy or D&C from 2009-2011. A total of 267 women were included with 78 women enrolled in the Pipelle group and 189 in the D&C group. Uterine findings were grouped as normal, hyperplasia, focal lesion, atypia, and atrophy. Histological sections from the Pipelle biopsy or D&C specimens were compared to each other and hysterectomy specimens. RESULTS: The concordance rate between Pipelle biopsy and hysterectomy was 62% and between D&C and hysterectomy was 67%. The sensitivity of Pipelle biopsy and D&C for detecting hyperplasia was 41.7% and 45%, respectively, and for detecting atypia was 71.4% for both techniques. The sensitivity of detecting atrophic endometrial tissue was significantly higher in the D&C group at 80% compared to 37.5% in the Pipelle biopsy group (p = 0.030). All other parameters were similar in both groups. CONCLUSION: Pipelle biopsy and D&C were equally successful for diagnosing endometrial pathologies. Neither Pipelle biopsy nor D&C was adequate for detecting focal endometrial pathologies and endometrial hyperplasia. In contrast, both techniques were sufficient for the diagnosis of atypia. The Pipelle biopsy technique is a reasonable pre-hysterectomy procedure that is more economical, less invasive, and can easily be performed in multiple clinics.

Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey.

In this study, we compared the perinatal and maternal outcomes of women with eclampsia with and without HELLP syndrome. A total of 219 pregnancies complicated by eclampsia with and without HELLP syndrome managed between January 2002 and December 2011, were reviewed. The incidence of eclampsia was 1.7/1,000 deliveries. Among 219 patients with eclampsia, 141 (64.4%) did not develop HELLP syndrome and 78 (35.6%) did develop HELLP syndrome. Maternal age and the rates of nulliparity were similar in both groups. Interval time from eclamptic seizure to delivery was significantly longer in the without-HELLP syndrome group (0.92 ± 0.29 weeks vs 0.16 ± 0.12 weeks, p = 0.028). Furthermore, overall perinatal mortality (particularly after gestational week 32) was significantly higher in the with-HELLP syndrome group (20.5% vs 9.9%, p = 0.029). In conclusion, patients with HELLP syndrome had significantly higher perinatal mortality than those with eclampsia without HELLP syndrome and no regular prenatal care.

Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey.

In this retrospective study, we investigated patient characteristics and fetal and maternal outcomes of placenta praevia and accreta at two tertiary hospitals in Istanbul. A total of 364 pregnancies complicated by placenta praevia with (n = 46) and without (n = 318) placenta accreta managed between January 2005 and December 2010 were reviewed. Among 364 women, 46 (12.6%) had placenta accreta and 318 (87.4%) had placenta praevia without accreta. The rates of curettage history and caesarean delivery were significantly higher in the group with placenta accreta. Furthermore, we found that emergency surgery had negative effects on maternal outcomes in the placenta praevia group. In addition, when accreta was suspected at ultrasound examination in women who had placenta praevia, the mean estimated blood loss during surgery was reduced significantly. If placenta praevia is detected, a careful ultrasound examination should be performed and the patient should undergo elective surgery at a tertiary referral hospital.

Second-stage vs first-stage caesarean delivery: comparison of maternal and perinatal outcomes.

Abstract In this observational study, we investigated the maternal and perinatal complications of caesarean delivery performed in the second stage compared with the first stage of labour at a tertiary hospital in Istanbul. This study was performed from June 2008 to July 2011. Primary maternal outcomes measured included intraoperative surgical complications, surgery duration, need for blood transfusion, endometritis, requirement for hysterectomy, unintended extension and length of hospital stay. Neonatal outcomes included a 5 min Apgar score ≤ 3, admission to a neonatal intensive care unit, fetal injury, septicaemia and neonatal death. In total, 3,817 caesarean deliveries were available for analysis; 3,519 were performed in the first stage, and 298 in the second stage. Caesarean deliveries performed in the second stage were associated with increased intraoperative complications, unintended extensions, need for blood transfusion, higher rates of endometritis and requirement for hysterectomy and were, therefore, associated with longer operation time and hospital stay. Neonatal complications included a significantly low Apgar score at 5 min, increased neonatal death, admission to the neonatal intensive care unit, septicaemia and fetal injury (all p < 0.05). Caesarean deliveries performed in the second stage of labour were associated with higher rates of maternal and neonatal complications, particularly in women who had undergone previous caesarean delivery.

The effects of the informed consent given for cesarean section on anxiety and knowledge.

PURPOSE: To determine the effects of information given before cesarean section on women's anxiety levels and their knowledge about informed consent regarding it. MATERIALS AND METHODS: Sixty women who elected to undergo cesarean section were included in the study. The data were collected using the pregnancy-related clinical information form, informed consent form, cesarean information form, and State and Trait Anxiety Inventory. Kruskal-Wallis test, Mann-Whitney U test, chi-square test and Pearson correlation were used as statistical methods. RESULTS: The women's knowledge scores before and after they were informed about cesarean section were 14.8 +/- 5.5 and 29.8 +/- 2.6, respectively (p < 0.05). Their state anxiety scores before and after they were informed about cesarean section were 28.4 +/- 6.6 and 28.0 +/- 5.9, respectively (p > 0.05). CONCLUSION: It was determined that the participants' pre-training knowledge scores about cesarean section increased significantly after they were informed, and that their state and trait anxiety scores decreased very little after they were informed.

Uterine preservation in placenta percreta complicated by unscarred uterine rupture at second trimester in a patient with repeated molar pregnancies: a case report and brief review of the literature.

Placenta-percreta causing uterine rupture in unscarred uterus is a rare obstetric surgical emergency that can cause maternal and perinatal morbidity and mortality. A 25-year-old woman presented with abdominal pain for four days. Previously, she had undergone two suction curettages for complete hydatiform moles. Ultrasound revealed a non-viable fetus with an estimated gestational age of 21 weeks and free fluid and coagulum in the abdominal cavity. An emergency laparotomy was performed because of the acute abdomen. At exploration, the placenta had invaded the entire thickness of the myometrium and the non-viable fetus was in the abdominal cavity. The uterus was closed with a double-layer of interrupted sutures and uterine-sparing surgery was performed. The patient was discharged on postoperative day seven. The authors present a case of placenta-percreta in an unscarred uterus complicated with uterine rupture during the second-trimester that was managed successfully with uterine repair. They also review the literature briefly and discuss similar cases managed conservatively in the second-trimester.

Eight years of clinical findings and biopsy results of nasopharyngeal pathologies in 1647 adult patients: a retrospective study.

OBJECTIVES: We performed an 8-year retrospective study to evaluate the presentation, clinical findings and nasopharyngeal biopsy results of adult nasopharyngeal pathologies. METHODOLOGY: This study included 1647 patients (801 males and 846 females) admitted to outpatient clinics. All patients underwent a nasopharyngeal biopsy for a nasopharyngeal mass. In addition, a blind biopsy was taken if there was suspicion of nasopharyngeal carcinoma, even in the absence of a mass lesion. The pathological diagnoses were analysed on the basis of the age, sex and clinical presentation of the patients. RESULTS: Patient age ranged between 18 and 85 years; the mean was 36 years. Patient age differed significantly between those with benign and malignant disease (p=0.000); the risk of malignancy increased with age. Benign disease was found in 97.4% of the patients. Reactive lymphoid hyperplasia was the most common condition; it was found in 92.71% of benign cases. Undifferentiated nasopharyngeal cancer was the most common malignant disease, being found in 82.95% of all nasopharyngeal malignancies and in 4.43% of all nasopharyngeal disease. The most common symptom was nasal obstruction. The other main symptoms were hearing loss and neck mass. Neck mass was associated with malignancy. CONCLUSIONS: Benign disease of the nasopharynx is more common than malignant pathology in patients with a nasopharyngeal mass. Although adenoidal tissue undergoes regression in the adolescent period, this tissue may present as the chief cause of nasal obstruction in adults. Age and symptoms may predict malignant disease.

Effect of foreign impurity and growth temperatures on hexagonal structure and fundamental properties of ZnO nanorods.

This study examined the influence of growth temperature and dopant concentration on the properties of Gd- and Ni-doped zinc oxide nanorods (ZnO NRs). ZnO seed layers were deposited on glass substrates using a sol-gel and dip-coating approach. Gd- and Ni-doped ZnO NRs were hydrothermally grown on the seed layers at different temperatures such as 75, 90, and 105°C for a constant growth time of 5 h. The crystal structure, optical, surface morphology views, and electrical properties of the NRs were extensively investigated by x-ray diffraction (XRD), scanning electron microscopy (SEM), UV-visible spectroscopy, and four probe experimental methods. The XRD analysis confirmed the successful substitution of Zn2+ ions by Gd3+ and Ni2+ within the ZnO main matrices. The reordering of hexagonal structures with varied electronegativity, ionic radius dimensions, and valence electron states of Gd and Ni dopants affected seriously the fundamental characteristic features of NRs. The SEM images showed that the ZnO NRs grown at 90°C possessed a more favorable surface morphology and well-defined hexagonal shape compared with those grown at other growth temperatures. Higher dopant concentration led to an increase in NR diameter but a decrease in density depending on the increase in the space between the NRs. Additionally, the optical transmittance was found to generally enhance with increasing dopant concentration. The results obtained highlighted the interplay between growth temperature, dopant type and concentration in tailoring the structural, morphological, and optical properties of Gd- and Ni-doped ZnO NRs, paving the way for the development of optimized nanomaterials for various applications. RESEARCH HIGHLIGHTS: The XRD analysis confirmed the successful substitution of Zn2+ ions by Gd3+ and Ni2+ within the ZnO main matrices. The SEM images showed that the ZnO NRs grown at 90°C possessed a more favorable surface morphology and well-defined hexagonal shape compared with those grown at other growth temperatures. The optical transmittance was found to generally enhance with increasing dopant concentration. The results obtained highlighted the interplay between growth temperature, dopant type and concentration in tailoring the structural, morphological, and optical properties of Gd- and Ni-doped ZnO NRs, paving the way for the development of optimized nanomaterials for various applications.

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. METHODS: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. RESULTS: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) CONCLUSIONS: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey.