Nightguard vital bleaching: a long-term study on efficacy, shade retention. side effects, and patients' perceptions

BACKGROUND

The scientific literature is lacking in long-term clinical data on the duration of efficacy and post-treatment side effects of nightguard vital bleaching.

PURPOSE

This longitudinal clinical study was undertaken (1) to determine the clinical efficacy and duration of efficacy at 3, 6, and 47 months post treatment of a peroxide-containing whitening solution; (2) to evaluate safety issues with respect to using a peroxide whitening solution; and (3) to determine patients' perceptions of the whitening technique.

MATERIALS AND METHODS

This project was part of a nightguard vital bleaching study involving human participants. The study teeth for efficacy and duration of efficacy when using a 10% carbamide peroxide solution were the four maxillary central and lateral incisors, with the tooth shade being taken from the middle third of the tooth. Safety issues evaluated were the changes in gingival index (GI), plaque index (PI), nonmarginal gingival index (NMGI), nongingival oral mucosal index (NGOMI), and tooth vitality (TV). Radiographic changes of the study teeth and the patients' perceptions of tooth sensitivity (TS) or gingival irritation (Girr) during treatment and post treatment were also evaluated.

RESULTS

The active 10% carbamide peroxide whitening solution used in this study was effective in lightening teeth (98%), and this effect was sustained at a mean of 47 months post treatment in 82% of the participants. When evaluating safety issues, 66% of the participants using the active solution reported TS or Girr. No one reported TS or Girr or any other adverse effects at the end of the study.

CONCLUSIONS

The results of this study concur with those of previously reported studies that nightguard vital bleaching using a 10% carbamide peroxide whitening solution according to the manufacturer's instructions is efficacious and safe, with minimal side effects. In addition, long-term shade retention was reported by 82% of the participants at the end of the study, with no adverse side effects.

CLINICAL SIGNIFICANCE

Results of this study should reassure dentists that nightguard vital bleaching is a safe, effective, and predictable method to lighten teeth. The whitening effect lasted up to 47 months in 82% of the patients, with no adverse side effects reported at the end of the study.

Microsomal triglyceride transfer protein: does insulin resistance play a role in the regulation of chylomicron assembly?

We have previously demonstrated that diabetes is associated with an increase in intestinal microsomal triglyceride transfer protein (MTP) mRNA in both the rat and rabbit models. The present study was designed to investigate the relationship between MTP expression and chylomicron assembly in an insulin resistant non-diabetic animal model. Ten insulin resistant Zucker obese fa/fa rats and ten lean fa/minus sign rats were examined at 8-10 weeks of age. The lymph duct was cannulated and lymph collected for 4 h. Lymph chylomicrons were isolated by ultracentrifugation and their composition determined. RNA was extracted from intestinal mucosa and from the liver. MTP mRNA was measured using the RNase protection assay. Blood sugar in the fatty rats was significantly higher (6.3 +/-1.2 vs. 5.4 +/-0.4 P<0.05) and plasma insulin was almost six times that of the lean rats (P<0.001). Plasma cholesterol and phospholipid but not triglyceride were significantly increased in the obese animals (P<0.01). Obese animals secreted significantly more lymph chylomicron apo B48 (0.05 +/-0.02 vs. 0.02 +/-0.01 mg/h P<0.005), triglyceride (9.7 +/-5.3 vs. 3.8+/-1.9 mg/h P<0.005) and phospholipid (1.5 +/-0.7 vs. 0.4 +/-0.3 mg/h P<0.001). The only difference in the chylomicron particle composition between the two groups was a significant increase in phospholipid (P<0.01). Intestinal MTP mRNA expression was significantly higher in the fatty compared to the lean rats (22.1 +/-9.5 vs. 7.8+/-5.6 amol MTP mRNA/microg total RNA P<0.001) as was hepatic MTP mRNA expression (6.9 +/-3.5 vs. 3.4 +/-1.5 amol MTP mRNA/microg total RNA, P<0.01). Thus in this animal model of insulin resistance, increased MTP, which was associated with increased chylomicron particle number, may play a crucial role in the development of atherosclerosis.

Regulation of nuclear poly(A) addition controls the expression of immunoglobulin M secretory mRNA

B-cell differentiation is accompanied by a dramatic increase in cytoplasmic accumulation and stability of the IgM heavy chain (mu) secretory mRNA. Despite considerable effort, the mechanism is unknown. We have identified three short motifs upstream of the secretory poly(A) site, which, when mutated in the mu heavy chain gene, significantly increase the accumulation of the secretory form of poly(A)(+) mRNA relative to the membrane form and regulate the expression of the secretory poly(A) site in a developmental manner. We show that these motifs bind U1A and inhibit polyadenylation in vitro and in vivo. Overexpression of U1A in vivo results in the selective inhibition of the secretory form. Thus, this novel mechanism selectively controls post-cleavage expression of the mu secretory mRNA. We present evidence that this mechanism is used to regulate alternative expression of other genes.

Experience-dependent changes in cerebral functional connectivity during human rapid eye movement sleep

One function of sleep is hypothesized to be the reprocessing and consolidation of memory traces (Smith, 1995; Gais et al., 2000; McGaugh, 2000; Stickgold et al., 2000). At the cellular level, neuronal reactivations during post-training sleep in animals have been observed in hippocampal (Wilson and McNaughton, 1994) and cortical (Amzica et al., 1997) neuronal populations. At the systems level, using positron emission tomography, we have recently shown that some brain areas reactivated during rapid-eye-movement sleep in human subjects previously trained on an implicit learning task (a serial reaction time task) (Maquet et al., 2000). These cortical reactivations, located in the left premotor area and bilateral cuneus, were thought to reflect the reprocessing--possibly the consolidation--of memory traces during post-training rapid-eye-movement sleep. Here, the experience-dependent functional connectivity of these brain regions is examined. It is shown that the left premotor cortex is functionally more correlated with the left posterior parietal cortex and bilateral pre-supplementary motor area during rapid-eye-movement sleep of subjects previously trained to the reaction time task compared to rapid-eye-movement sleep of untrained subjects. The increase in functional connectivity during post-training rapid-eye-movement sleep suggests that the brain areas reactivated during post-training rapid-eye-movement sleep participate in the optimization of the network that subtends subject's visuo-motor response. The optimization of this visuo-motor network during sleep could explain the gain in performance observed during the following day.

Nightguard vital bleaching and its effect on enamel surface morphology

BACKGROUND

The effect that nightguard vital bleaching (NGVB) has on enamel surface morphology is a subject of debate. Previous studies that have evaluated the effect of NGVB on the enamel surface report minimal changes to changes that appear to worsen post-treatment. The purpose of this in vivo NGVB study was to evaluate by scanning electron microscopy (SEM) the effects that 10% carbamide peroxide has on enamel morphology after 2 weeks of treatment and at 6 months post-treatment.

MATERIALS AND METHODS

Ten patients participated in the study. Each participant wore a guard filled with an active whitening solution for 8 to 10 hours per day for 14 treatment days. An impression of the study teeth (maxillary incisors) was taken at baseline, after 14 days of treatment, and at 6 months post-treatment, and an epoxy cast made. The epoxy casts were prepared for viewing under the SEM and photographs were taken at 200 times and 2,000 times magnification. Six examiners evaluated changes in enamel surface morphology by comparing the SEM photographs taken at baseline, on treatment day 14, and at 6 months post-treatment. Still masked, the examiners also compared each patient's baseline:treatment day 14 and baseline:6 months post-treatment photographs with photographs of a known standard.

RESULTS

This in vivo study demonstrated that a 14-day regimen of NGVB using a 10% carbamide peroxide solution had minimal effect on the surface morphology of enamel and that the effects did not worsen over time.

Results of a collaborative study of the EDNAP group regarding the reproducibility and robustness of the Y-chromosome STRs DYS19, DYS389 I and II, DYS390 and DYS393 in a PCR pentaplex format

A collaborative exercise was carried out by the European DNA Profiling Group (EDNAP) in the frame work of the STADNAP program, i.e. standardization of DNA profiling in Europe, in order to evaluate the performance of a Y-chromosome STR pentaplex, which includes the loci DYS19, DYS389 I and II, DYS390 and DYS393 and to determine whether uniformity of results could be achieved among different European laboratories. Laboratories were asked to analyze the five Y-STRs using singleplex and multiplex conditions in three bloodstains and one mixed stain (95% female and 5% male). All the laboratories reported the same results even for the mixed stain included in the exercise. This demonstrates the reproducibility and robustness of Y-chromosome STR typing even with multiplex formats and proves the usefulness of Y-STR systems for analyzing mixed stains with a male component.A total of 930 male samples from 10 different populations from Europe were also analysed for all the loci included in the pentaplex. Eight of these ten populations also included haplotype data. As for single gene analysis, haplotype diversity was higher in Germany and Italy and lower in Western European countries and Finland. Pairwise haplotype analysis shows the Finnish departure from the rest of the populations and a relatively homogeneity in the other European populations with F(ST) estimates lower than 0.05.UPGMA analysis shows an association of Western European population (Ireland, UK, Portugal and Galicia) on the one hand and central European populations on the other.

Meta-analysis of dietary restriction during fecal occult blood testing

CONTEXT

Dietary restriction is often recommended during fecal occult blood testing (FOBT) as a means of increasing test accuracy, but concern surrounds whether such restriction also reduces the chance that patients will complete the test.

PURPOSE

We conducted a systematic review and meta-analysis to determine if advice about dietary restrictions affects the rate of completion of FOBT and the rate of positive results.

METHODS

We searched the MEDLINE database and hand-searched the bibliographies of other systematic reviews and clinical practice guidelines to identify randomized trials of advice to perform dietary restriction during FOBT. We included only trials that reported the proportion of patients who completed the occult blood tests (completion rate). When such information was available, we also recorded the proportion of patients who had positive test results (positivity rate).

RESULTS

Five randomized trials met our inclusion criteria. All used guaiac-based Hemoccult tests; none reported results from rehydrated test slides. In four trials, there was little or no difference in test completion between patients assigned to dietary restriction and those with no restriction. In one small trial that used an especially restrictive diet, completion was 21 percentage points lower in the restricted group. Positivity rates were reported in four trials, none of which found a statistically significant difference between groups. Meta-analysis showed no difference in the summary positivity rate between those assigned to dietary restriction versus those not restricted (difference in positivity rate, 0%; 95% CI, -1% to 1%).

CONCLUSIONS

Available data suggest that advice to perform modest dietary restriction during unrehydrated FOBT does not affect the completion rate, but more severe restrictions may. Dietary restriction also does not appear to affect positivity rates. On the basis of these data, physicians do not need to advise patients to restrict their diet for nonrehydrated FOBTs.

Assessment of constipation management in long-term care patients

OBJECTIVES

To determine the prevalence of diagnosed constipation among nursing home patients; to assess the prevalence of routine (at least one time per week for 4 consecutive weeks) laxative use; and to investigate prescribing practices.

DESIGN

A retrospective multi-center medical record evaluation.

SETTING

Any one of 25 nursing facilities representative of a long-term care pharmaceutical provider's geographical coverage.

PARTICIPANTS

All patients under the age of 65, and/or who had resided in the facility for less than 4 weeks, and/or who were placed in a specialty care bed (eg, Alzheimer's disease, hospice, HIV/AIDS) were excluded.

RESULTS

A total of 712 resident charts meeting initial inclusion criteria were screened, 392 (55%) of which had a documented diagnosis of constipation and/or routine laxative use. Approximately 28% (CI +/- 3.3) of residents had a documented diagnosis of constipation. The rate of laxative use within the same sample population of 712 patients was 53.8% (CI +/- 3.7). Of the 392 patients with a diagnosis of constipation and/or routine laxative use, over 72% had at least one diagnosis or medication known to precipitate constipation. The most commonly prescribed laxatives were stool softeners (26.2%), saline laxatives (18.4%) and stimulant/irritant laxatives (15.6%). Almost half of the laxative users were prescribed more than one agent.

CONCLUSION

This study supports the concern that there is often a gap between documentation of symptoms and constipation treatment decisions. No correlation was found between the specific laxative prescribed and the presence or absence of a documented diagnosis of constipation. Treatment decisions should be based on thorough examination and individualized patient needs. Furthermore, there is a need to increase monitoring for drug effectiveness.

Exploring women's beliefs regarding urinary incontinence

The purpose of this study was to explore and describe women's beliefs, knowledge, and need for education regarding female urinary incontinence (UI). Findings suggest that almost half of the women surveyed believed UI was normal. A majority believed it is a problem for women, but felt they could not talk about it freely. Most knew professional help was available and indicated they would seek help if incontinent, but expressed a need for more information. They varied in their beliefs regarding the efficacy of various treatment modalities. Implications for nursing practice are discussed.

Does the mode of inhalation affect the bronchodilator response in patients with severe COPD?

Spacing devices improve lung deposition of aerosols from metered dose inhalers (MDI) but it is sometimes difficult for dyspnoeic patients to perform maximal breaths with breath-holds needed to inhale the aerosols from them. Our aim was to determine whether the response to bronchodilators (BD) depended on the method of inhalation. We studied 20 patients with moderately severe chronic obstructive pulmonary disease (COPD) with a mean age of 68 years and a mean of forced expiratory volume in 1 sec (FEV1) of 41% predicted. In a randomized, cross-over fashion they inhaled terbutaline 1.5 mg (six puffs) followed by ipratropium 120 microg (six puffs) via MDI and nebuhaler with either two inspirations to total lung capacity and a 10-sec breath-hold per puff or with six tidal breaths per puff. Before and after BDs we measured FEV1, forced vital capacity (FVC), airways resistance using interrupter method (Rint) and 6-min walking distance (6MWD). Subsequently, we re-tested nine of these patients with the two methods of inhalation, before and after conventional doses (terbutaline 500 microg+ipratropium 40 microg), then after terbutaline 1 mg and ipratropium 80 microg and finally after nebulized terbutaline 5 mg and ipratropium 500 microg to sec whether there was a dose-dependent difference in effect between the two methods. Spirometry, slow vital capacity (SVC). inspiratory capacity and shuttle walking tests were monitored. In the original 20 patients there were highly significant improvements in all parameters after inhalers, with no significant difference between methods of inhalation. Median improvements after BDs were: FEV1 0.221 and 0.191, FVC 0.501 and 0.381 and 6MWD 40 m and 44 m, for maximal breaths and tidal breathing, respectively. For nine patients, tidal and maximal breaths produced similar effects on lung function and exercise tolerance at both doses of BDs. Nebulized BDs only improved shuttle distances slightly when compared with either method of inhalation from MDI and spacer but had no additional effect on lung function. In conclusion, in patients with moderately severe COPD, BDs given by metered dose inhaler via nebuhaler have similar effects whether given by six easy tidal breaths or the more difficult two maximal breaths with breath-hold. This holds true at small or larger doses of BD. Either method of inhaling six puffs of the BDs can be used as an effective alternative to nebulized aerosol.

A longitudinal assessment of diverging verbal and non-verbal abilities in the Williams syndrome phenotype

Jarrold et al. (1998) presented evidence to suggest that verbal and non-verbal abilities develop at different rates in individuals with the Williams syndrome phenotype. However, this evidence was derived from cross-sectional rather than longitudinal data. The current report presents data from a series of follow up assessments which examine the development of vocabulary and pattern construction abilities in 15 of the original sample of 16 individuals, over a 40 month period. The results confirm the original predictions, as mental age equivalent scores for vocabulary increase more rapidly than scores for the pattern construction test; a finding, which appears unlikely to be due to practice effects.

Health department clinics as pediatric immunization providers: a national survey

OBJECTIVE

To describe a national sample of health department immunization clinics in terms of populations served, patient volume trends, services offered, and immunization practices.

METHODS

Telephone survey conducted with health departments sampled from a national database, using probability proportional to population size.

RESULTS

All (100%) 166 sampled and eligible clinics completed the survey. The majority of pediatric patients were uninsured (42%) or enrolled in Medicaid (34%). Most children (69%) and adolescents (70%) were referred to the health department, with only 12% using these clinics as a medical home. A number of clinics (72%) reported recent increases in adolescents served. Less than 25% of clinics offered comprehensive care, 47% conducted semiannual coverage assessments, and 76% and 38% operated recall systems for children and adolescents. Storage of records in an electronic database was common (83%).

CONCLUSIONS

Although the majority of these clinics do not provide comprehensive care, they continue to serve vulnerable children, including adolescents, Medicaid enrollees, and the uninsured, and may represent the main contact with the healthcare system for such patients. Because assuring the immunization of these children is essential to their health and the health of our nation as a whole, this immunization safety net must be preserved. Experience implementing key recommendations such as coverage assessment and feedback as well as reminder or recall may enable health department staff to assist private provider colleagues. Further research is needed to investigate how patient populations, services offered, and immunization practices vary by different clinic characteristics.

Challenges with studies investigating longevity of dental restorations--a critique of a systematic review

OBJECTIVES

A systematic review is a method of evaluating the published and unpublished literature relating to a specific area or topic. The objectives of this paper are to identify and discuss problems encountered in synthesising the available literature; and to make recommendations for the future conduct and reporting of clinical trials that aim to determine the longevity of dental restorations.

DATA SOURCES

Studies were identified by a wide search of published and unpublished material in any language using a large number of general and specialist data bases, hand searching of key dental journals and searching of abstracts from conference proceedings.

STUDY SELECTION

Pre-defined inclusion criteria based on objective outcome measures of restoration longevity and study designs were applied to determine study selection.

CONCLUSIONS

A review of the longevity of dental restorations completed recently encountered substantial problems in designing an appropriate protocol to address this issue. The review found that many of the factors reported previously as affecting restoration longevity could not be confirmed using the agreed systematic review protocol that incorporated an objective study design. Further, the multiplicity of study designs, and reporting methods found in the literature made meta-analyses impossible. A proforma is proposed in order to aid the design of future research into the longevity of restorations.

Association of involvement in psychological self-regulation with longer survival in patients with metastatic cancer: an exploratory study

There have been numerous anecdotal claims that when patients are dedicated users of a variety of psychological self-regulation strategies, including relaxation, mental imaging, cognitive restructuring and meditation, such dedication may have a life-prolonging effect. Our aim was to test this possibility more rigorously, in patients with metastatic cancer.A prospective, longitudinal, correlative study was carried out on 22 patients with varying kinds of medically incurable metastatic cancer. The intervention was one year of weekly group psychological therapy. Extensive verbal data (patients' written homework and therapists' notes) were collected over the year. The extent of each patient's involvement with psychological work was estimated following a qualitative analysis of these data. Patients were classed as showing high, moderate, or low involvement on the basis of a quantitative rating of categories defined by the analysis. These three subgroups did not differ significantly in their expected median survival duration as estimated from independent quantitative predictions by a large panel of oncologists who analyzed the patients' medical charts at time of study entry.A significant relationship was found between degree of involvement in psychological work and survival duration. Results are presented as Kaplan-Meier survival curves (Fig. 2;P = 0. 006, Log Rank test) and as a graphic display of the median survival of each of the three groups (Fig. 3). The main likely confounders (medical status, age, quality of life, and attendance at therapy) were similar across subgroups and did not change the relation between psychological work and survival duration. Limitations in the design are discussed. However, the strong effects observed support clinical observations that dedicated involvement in psychological self-regulation may prolong the life of some patients with metastatic cancer.

Effects of a computerized treatment simulation on patient expectations for orthognathic surgery

One hundred forty-six patients, ranging in age from 15 to 50 and presenting with a moderate to severe dentofacial disharmony requiring orthodontics and orthognathic surgery, were randomly assigned to 2 preparation strategy groups: standard presurgical consultation with or without a computerized treatment simulation presentation. The demographic profiles of the 2 groups were similar. Viewing a treatment simulation did not have a significant effect on the anticipation of social/interpersonal or general health problems in the first month after surgery. These 2 areas of concern were significantly related to psychological well-being. Psychologically distressed patients, whether or not they saw a simulation, expected significantly more problems in social/interpersonal relations and in general health during the first month after surgery. A treatment simulation presentation did affect patients' overall expectations of problems in the first month after surgery and their concerns about symptom recovery. However, the impact of the presentation was related to the patient's psychological well-being. In the standard presurgical consultation group, the average anticipated level of overall problems and discomfort during recovery was significantly higher for patients who reported elevated psychological distress than for those who did not. In the treatment simulation group, the average level of concern was similar for those patients who reported distress and those who did not. Preparation strategy was not significantly related to the long-term expectation of improvement after treatment. Long-term expectation of treatment improvement was related to psychological distress and gender. Men tended to report similar expectations regardless of psychological well-being, while women who were distressed anticipated significantly more improvement overall, in self-image, and in general health after treatment than women who were not distressed.

Auditory cortex accesses phonological categories: an MEG mismatch study

The studies presented here use an adapted oddball paradigm to show evidence that representations of discrete phonological categories are available to the human auditory cortex. Brain activity was recorded using a 37-channel biomagnetometer while eight subjects listened passively to synthetic speech sounds. In the phonological condition, which contrasted stimuli from an acoustic /dae/-/tae/ continuum, a magnetic mismatch field (MMF) was elicited in a sequence of stimuli in which phonological categories occurred in a many-to-one ratio, but no acoustic many-to-one ratio was present. In order to isolate the contribution of phonological categories to the MMF responses, the acoustic parameter of voice onset time, which distinguished standard and deviant stimuli, was also varied within the standard and deviant categories. No MMF was elicited in the acoustic condition, in which the acoustic distribution of stimuli was identical to the first experiment, but the many-to-one distribution of phonological categories was removed. The design of these studies makes it possible to demonstrate the all-or-nothing property of phonological category membership. This approach contrasts with a number of previous studies of phonetic perception using the mismatch paradigm, which have demonstrated the graded property of enhanced acoustic discrimination at or near phonetic category boundaries.

Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias

BACKGROUND

The association between antecedent head injury and AD is inconsistent.

OBJECTIVE

To examine the association between early adult head injury, as documented by military hospital records, and dementia in late life; and to evaluate the interaction between head injury and APOE epsilon4 as risk factors for dementia.

METHODS

The study had a population-based prospective historical cohort design. It included men who were World War II Navy and Marine veterans, and were hospitalized during their military service with a diagnosis of either a nonpenetrating head injury or another unrelated condition. In 1996 to 1997, military medical records were abstracted to document the occurrence and details of closed head injury. The entire sample was then evaluated for dementia and AD using a multistage procedure. There were 548 veterans with head injury and 1228 without head injury who completed all assigned stages of the study. The authors estimated risk of dementia, specifically AD, using proportional hazards models.

RESULTS

Both moderate head injury (hazard ratio [HR] = 2.32; CI = 1.04 to 5.17) and severe head injury (HR = 4.51; CI = 1.77 to 11.47) were associated with increased risk of AD. Results were similar for dementia in general. The results for mild head injury were inconclusive. When the authors stratified by the number of APOE epsilon4 alleles, they observed a nonsignificant trend toward a stronger association between AD and head injury in men with more epsilon4 alleles.

CONCLUSIONS

Moderate and severe head injuries in young men may be associated with increased risk of AD and other dementias in late life. However, the authors cannot exclude the possibility that other unmeasured factors may be influencing this association.

Use of lipid lowering drugs for primary prevention of coronary heart disease: meta-analysis of randomised trials

OBJECTIVE

To summarise the effect of primary prevention with lipid lowering drugs on coronary heart disease events, coronary heart disease mortality, and all cause mortality.

DESIGN

Meta-analysis.

IDENTIFICATION

Systematic search of the Medline database from January 1994 to June 1999 for English language studies examining drug treatment for lipid disorders (use of the MeSH terms "hyperlipidemia" and "anticholesteremic agents," keyword searches for individual drug names, and a search strategy for identifying randomised trials to capture relevant articles); identification of older studies through systematic reviews and hand search of bibliographies.

INCLUSION CRITERIA

All randomised trials of at least one year's duration that examined drug treatment for patients with no known coronary heart disease, cerebrovascular disease, or peripheral vascular disease and that measured clinical end points, including all cause mortality, coronary heart disease mortality, and non-fatal myocardial infarctions.

DATA EXTRACTION

Review of the articles and extracted relevant data by two authors separately, with disagreements resolved by consensus.

RESULTS

Four studies met eligibility criteria. Drug treatment reduced the odds of a coronary heart disease event by 30% (summary odds ratio 0.70, 95% confidence interval 0.62 to 0.79) but not the odds of all cause mortality (0.94, 0.81 to 1.09). When statin drugs were considered alone, no substantial differences in results were found.

CONCLUSIONS

Treatment with lipid lowering drugs lasting five to seven years reduces coronary heart disease events but not all cause mortality in people with no known cardiovascular disease.

Experience-dependent changes in cerebral activation during human REM sleep

The function of rapid-eye-movement (REM) sleep is still unknown. One prevailing hypothesis suggests that REM sleep is important in processing memory traces. Here, using positron emission tomography (PET) and regional cerebral blood flow measurements, we show that waking experience influences regional brain activity during subsequent sleep. Several brain areas activated during the execution of a serial reaction time task during wakefulness were significantly more active during REM sleep in subjects previously trained on the task than in non-trained subjects. These results support the hypothesis that memory traces are processed during REM sleep in humans.

Mechanisms of gastrointestinal copper absorption in the African walking catfish: copper dose-effects and a novel anion-dependent pathway in the intestine

In mammals, copper (Cu) absorption occurs mostly in the small intestine, and some of the Cu transporters involved in its uptake have been characterised. In fish, however, the regions of the gut involved in Cu absorption and the membrane transport mechanisms responsible for gastrointestinal Cu uptake are unknown. Everted gut sacs and isolated perfused intestine of Clarias gariepinus were used to explore Cu absorption (at 22 degrees C). Gut sacs exposed to 100 micromol l(−1) mucosal solution Cu ([Cu](m)) showed that Cu was mostly (70 %) absorbed in the middle and hind intestine. Most of the accumulated Cu was located in the mucosa. In perfused intestines, cumulative Cu absorption from the mucosal solution to the serosal perfusate was greatest at 10 micromol l(−1) [Cu](m) and decreased at higher values of [Cu](m), while tissue accumulation of Cu showed a dose-dependent elevation. Absorption efficiency therefore declined with increasing Cu dose, and basolateral transport was the limiting factor in Cu uptake. Serosal applications of the P-type ATPase inhibitor vanadate (100 micromol l(−1)) or the anion transport inhibitor DIDS (100 micromol l(−1)) caused threefold increases in net Cu uptake (at [Cu](m)=10 micromol l(−1)). The vanadate effect was explained by a reduction in transepithelial potential rather than inhibition of Cu-ATPase, but the DIDS effect was not. Transepithelial potential, water transport and tissue [Cu] were not affected by DIDS, but tissue [K(+)] was elevated. Removal of Cl(−) simultaneously from both the mucosal and serosal solutions caused a 10-fold reduction in the rate of Cu uptake, while removal of Cl(−) from the mucosal solution only completely abolished Cu absorption to the serosal perfusate. Transepithelial potential effects are discussed. We conclude that Cu absorption occurs mostly in the intestine and is normally driven by a basolateral Cu/anion symport that prefers Cl(−).

Early postsurgery experience of prostate cancer patients and spouses

PURPOSE

The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery.

DESCRIPTION OF STUDY

As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery.

RESULTS

Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption.

CLINICAL IMPLICATIONS

Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.