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Aim This study aimed to capture the experience of parents of youth with recent onset Type 1 diabetes who initiated use of continuous glucose monitoring (CGM) technology soon after diagnosis, which is a new practice. Methods Focus groups and individual interviews were conducted with parents of youth with Type 1 diabetes who had early initiation of CGM as part of a new clinical protocol. Interviewers used a semi-structured interview guide to elicit feedback and experiences with starting CGM within 30 days of diagnosis, and the benefits and barriers they experienced when adjusting to this technology. Groups and interviews were audio recorded, transcribed and analysed using content analysis. Results Participants were 16 parents (age 44.13 ± 8.43 years; 75% female; 56.25% non-Hispanic White) of youth (age 12.38 ± 4.15 years; 50% female; 50% non-Hispanic White; diabetes duration 10.35 ± 3.89 months) who initiated CGM 11.31 ± 7.33 days after diabetes diagnosis. Overall, parents reported high levels of satisfaction with starting CGM within a month of diagnosis and described a high level of reliance on the technology to help manage their child's diabetes. All participants recommended early CGM initiation for future families and were committed to continue using the technology for the foreseeable future, provided that insurance covered it. Conclusion Parents experienced CGM initiation shortly after their child's Type 1 diabetes diagnosis as a highly beneficial and essential part of adjusting to living with diabetes.

International audience; Objectives: To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life.Design: Prospective cohort study.Setting: University Teaching Hospital of La Conception, Marseille, France.Participants: Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy.Main outcome measures: Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject.Results: The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03).Conclusions: Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer.

The surgical management of droopy nose remains problematic. Corrective techniques described in the literature1 may be difficult to perform or sometimes lead to unsatisfactory results. Dome sutures or grafts such as columellar strut often give good initial results but may deteriorate over time 2, 3. This article is protected by copyright. All rights reserved.

Aim To determine the effects of acute caffeine ingestion on glycaemia during moderate to vigorous intensity aerobic exercise and in recovery in individuals with Type 1 diabetes. Methods A total of 13 patients with Type 1 diabetes [eight women, five men: mean ± sd age 25.9 ± 8.8 years, BMI 71.9 ± 11.0 kg, maximal oxygen consumption 46.6 ± 12.7 ml/kg/min, body fat 19.9 ± 7.2%, duration of diabetes 14.4 ± 10.1 years and HbA1c 55 ± 8 mmol/mol (7.4 ± 0.8%)] were recruited. Participants ingested capsules that contained gelatin or pure caffeine (6.0 mg/kg body mass) and performed afternoon exercise for 45 min at 60% maximal oxygen consumption on two separate visits with only circulating basal insulin levels. Results The main finding was that a single caffeine dose attenuates the drop in glycaemia by 1.8 ± 2.8 mmol/l compared with placebo intake during exercise (P=0.056). Continuous glucose monitoring data, however, showed that caffeine was associated with elevated glycaemia at bedtime after exercise, compared with placebo, but lower glucose concentrations in the early morning the next day. Conclusions Caffeine intake should be considered as another strategy that may modestly attenuate hypoglycaemia in individuals with Type 1 diabetes during exercise, but should be taken with precautionary measures as it may increase the risk of late-onset hypoglycaemia.

Telerehabilitation aims to solve problems like equitable access to the rehabilitation and cost reduction by providing rehabilitation services at a distance. The largest part of telerehabilitation systems implement a real-time one-to-one process involving patient and therapist. Even though they can be successfully exploited in conditions such as post-traumatic recovery, in complex scenarios, this simple model should be replaced by a more structured collaborative one envisioning a multidisciplinary team.

Background The purpose of this study was to assess the prognostic value of the 3 staging systems found in the literature for sinonasal mucosal melanomas tumors: the Ballantyne staging system modified by Prasad (Ballantyne/Prasad staging system), the American Joint Committee on Cancer (AJCC) TNM classification for mucosal melanomas (mmTNM), and the 2009 AJCC TNM classification for carcinomas of the nasal cavity and sinuses (carTNM). Methods A retrospective study of 35 patients treated between 1995 and 2010 was conducted for this study. Each patient was retrospectively staged using the Ballantyne/Prasad staging system, mmTNM, and carTNM. Results There were 20 women (57.1%) and 15 men (42.9%). Only carTNM was significantly correlated with overall survival (p = .012) and disease-free survival (p = .041). The other 2 classifications were not correlated with survival except for metastatic patients whose overall survival was lower (p = .032). Conclusion On the basis of these findings, we believe that carTNM should be the primary staging system for patients with mucosal melanomas of the sinonasal tract. © 2013 Wiley Periodicals, Inc. Head Neck 36: 311–316, 2014

Background and Purpose Binge eating disorder (BED) is characterized by excessive food intake during short periods of time. Recent evidence suggests that alterations in the endocannabinoid signalling could be involved in the pathophysiology of BED. In this study, we investigated whether pharmacological manipulation of endocannabinoid transmission may be effective in modulating the aberrant eating behaviour present in a validated rat model of BED. Experimental Approach Binge-type eating was induced in female rats by providing limited access to an optional source of dietary fat (margarine). Rats were divided into three groups, all with ad libitum access to chow and water: control (C), with no access to margarine; low restriction (LR), with 2 h margarine access 7 days a week; high restriction (HR), with 2 h margarine access 3 days a week. Key Results Compared with the LR group, the HR group consumed more margarine and this was accompanied by an increase in body weight. The cannabinoid CB1/CB2 receptor agonist Δ9-tetrahydrocannabinol significantly increased margarine intake selectively in LR rats, while the fatty acid amide hydrolase inhibitor URB597 showed no effect. The CB1 receptor inverse agonist/antagonist rimonabant dose-dependently reduced margarine intake in HR rats. Notably, in HR rats, chronic treatment with a low dose of rimonabant induced a selective long-lasting reduction in margarine intake that did not develop tolerance, and a significant and persistent reduction in body weight. Conclusions and Implications Chronic pharmacological blockade of CB1 receptors reduces binge eating behaviour in female rats and may prove effective in treating BED, with an associated significant reduction in body weight. Linked Articles This article is part of a themed section on Cannabinoids. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2013.169.issue-4 & http://dx.doi.org/10.1111/bph.2012.167.issue-8

Objectives/Hypothesis: To evaluate surgical and long-term oncologic outcomes in a series of patients who underwent circular total laryngopharyngectomy with tubed radial forearm free flap as salvage surgery. Study Design: Retrospective study in two tertiary referral centers. Methods: Twenty-one patients who underwent surgery between 2001 and 2010 were included in the study. All patients underwent surgery for recurrence of advanced hypopharyngeal squamous cell carcinoma previously treated by chemoradiotherapy (CRT) or surgery followed by postoperative radiotherapy or CRT. Overall survival (OS) and disease-free survival (DFS) were determined by Kaplan-Meier analysis. The search for parameters that could influence long-term oncologic outcomes was carried out by univariate and multivariate analysis using log-rank test and Cox regression models. Results: Median follow-up was 30 months. The 1, 2, and 5-year OS rates were 46%, 40%, and 16%, and the DFS rates were 42%, 30%, and 15%, respectively. Free flap failure (P [log rank] = .014 and P [Cox] = .016) and positive margins (P [log rank] = .001 and P [Cox] = .001) were found to have a significant negative impact on both OS and DFS in both univariate and multivariate analysis. Conclusions: Salvage surgery remains the only curative option as treatment of recurrent hypopharyngeal squamous cell carcinoma and should be offered to patients when possible. However, selection of patients eligible for this type of surgery and the choice of reconstructive procedure are crucial since long-term survival is clearly correlated with the presence of clear margins and the absence of free flap failure.

Objective: Alterations in plasma lipid profile and in intracellular cholesterol homoeostasis have been described in various malignancies; however, significance of these alterations, if any, in cancer biology is not clear. The aim of the present study was to investigate a possible correlation between alterations in cholesterol metabolism and expansion of leukaemia cell numbers. Materials and methods: Lipid profiles in plasma and in primary leukaemia cells isolated from patients with acute or chronic lymphocytic leukaemia (ALL and CLL) were studied. Results and conclusions: Decreased levels of HDL-C were observed in plasma of leukaemic patients, levels of total cholesterol, LDL-C, triglycerides and phospholipids were unchanged or only slightly increased. As compared to normal lymphocytes, freshly isolated leukaemic cells showed increased levels of cholesterol esters and reduction in free cholesterol. Growth stimulation of ALL and CLL cells with phytohemagglutinin led to further increase in levels of cholesterol esters. Conversely, treatment with an inhibitor of cell proliferation such as the mTOR inhibitor, RAD, caused decline in population growth rate of leukaemia cells, which was preceded by sharp reduction in rate of cholesterol esterification. On the other hand, exposure of leukaemic cells to two inhibitors of cholesterol esterification, progesterone and SaH 58-035, caused 60% reduction in their proliferation rate. In addition to demonstrating tight correlation between cell number expansion and cholesterol esterification in leukaemic cells, these results suggest that pathways that control cholesterol esterification might represent a promising targets for novel anticancer strategies.

The corrosion behavior of corroded, cathodically protected and control (reference) construction steel, previously embedded in concrete, was studied in cement extract (pH 12.6, considered as concrete pore water), using cyclic voltammetry (CVA) and potentiodynamic polarization (PDP). The necessity for this investigation occurred from the previously observed and commented discrepancies in the recorded corrosion parameters for corroded and protected steel in embedded conditions 1. Therefore this study aimed to evaluate how the “naturally” formed in concrete product layers (after 460 days) will influence the electrochemical behavior of the steel in cement extract. The PDP measurements reveal the lowest corrosion resistance to be for the previously corroded steel samples, for which the most active corrosion potential (−0.7 V SCE) and the highest anodic current in the potential region 0 to 0.6 V (SCE) were recorded. The CVA tests support the results from PDP and correlate the properties of the naturally formed layers with the recorded peak current densities and peak potentials with cycling. For all specimens, except the corroded ones, the peak potential initially shifts anodically, which denotes for a high corrosion resistance in the former and low corrosion resistance in the latter case. For the control and protected specimens, the passive current in the potential region of 0 to 0.6 V (SCE) remains almost unchanged with cycling, i.e. the protective properties of the initial layers remain unchanged. Thickening of the film with cycling does not influence the corrosion resistance of the previously formed layers. For the protected specimens, however, a tendency to reach a steady state and change of peak currents' height only were observed, without a pronounced shift to more anodic values. An increase in the peak current only, not accompanied by anodic shift of the peak potential, suggests that the layers in the cathodically protected specimens are more homogeneous and compact. Overall it can be stated that in cement extract, the product layer with lowest corrosion resistance is the one on the surface of the corroded steel reinforcement. The product layers in the protected specimens (although similar to control conditions) are with the highest corrosion resistance.

To unveil cognitive-nigrostriatal correlations in Parkinson's disease (PD), 30 de novo, drug-naive PD patients and 15 patients with essential tremor (Controls, CTR) underwent a neuropsychological (NPS) battery and brain SPECT with [I-123]Ioflupane, as a biomarker of nigrostriatal function. Automatic extraction of uptake at caudate and putamen level was conducted through the BasGan software, also allowing partial volume effect correction. Because of the multicollinearity among neuropsychological tests and among SPECT variables, factor analysis was applied to 16 neuropsychological scores; moreover, the four SPECT variables were merged into a mean SPECT value (mSPECT). Factor analysis identified four NPS factors: a dys-executive (NPS-EX), a visuospatial (NPS-VS), a verbal memory (NPS-VM), and a "mixed" (NPD-MIX) factor. In PD group, there were inverse correlations between UPDRS-III score and both NPS-VS (P < 0.01) and mSPECT (P < 0.05), and a direct correlation between mSPECT and NPS-EX (P < 0.05). Post hoc analysis showed a direct correlation between NPS-EX and caudate uptake in both hemispheres (P < 0.05). Moreover, inverse correlations were found between UPDRS-III and, respectively, putamen uptake in the less affected hemisphere (P < 0.01), and putamen and caudate uptake in the more affected hemisphere (P < 0.05). In CTR, no correlation was found between mSPECT and either NPS or GDS values. Nigro-caudate function affects executive capabilities in PD but not in CTR, which appears to be unrelated to the disease motor severity at its onset. Instead, PD motor severity is related to nigro-putaminal impairment and visuospatial dysfunction. The role of these data as predictive features of cognitive decline and eventually dementia remains to be established in longitudinal studies.

Although rarely considered, especially within the investigation of steel corrosion phenomena or electrochemical protection techniques in reinforced concrete structures, the concrete bulk matrix has a significant contribution in the global performance of the system “reinforced concrete.” This is especially the case when chloride-induced corrosion or electrical current flow [as within impressed current cathodic protection (CP)] are involved. In the latter cases, the concrete bulk matrix undergoes significant alterations in chemical composition, electrical properties, and microstructures, thus influencing the overall performance of the system. This work reports on the microstructural investigation of the bulk concrete matrix and the steel/cement paste interface in reinforced concrete, previously subjected to corrosion and CP for 460 days. The emphasis hereby is to evaluate the altered structural properties, i.e., porosity, pore size, permeability of the bulk cement matrix, and the steel/cement paste interface (translated to bond strength) as a result of chloride-induced corrosion and two types of CP (conventional and pulse), compared to control (non-corroding, non-protected) conditions. The research revealed a major contribution and close dependence of all microlevel interfaces on the global performance of reinforced concrete. The electrical current flow (as in CP applications) was found to bring about unfavorable modifications to the material structure, both in the bulk matrix (reducing porosity) and at the steel/cement paste interface (enlarging interfacial gaps). The derived microstructural parameters show that the conventional CP leads to a higher level of structural heterogeneity, whereas the pulse CP exerts minimal or no effects, maintaining the material properties close to the reference (control) conditions, the underlying mechanism being a more homogeneous material microstructure.

The present study reports on the investigation of conventional and pulse cathodic protection (CP), in terms of steel surface analysis and investigation of the product layers at the steel/cement paste interface, after a long term (460 days) of conditioning and monitoring. The techniques used were: X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Scanning electron microscopy (SEM) and Energy-dispersive X-ray (EDX). Wet chemical analysis was used as supportive evidence for ion concentrations in the vicinity of the steel re-bars. Generally, CP promotes beneficial secondary effects i.e. enhanced OH - concentration and reduced Cl - concentration near the steel surface. Cathodic polarization also results in additional deposition of portlandite, which stabilizes the protective properties of the product layer on the steel surface. Consequently, the fundamental mechanisms, underlying the efficiency of CP techniques in reinforced concrete, are strongly related to beneficial secondary effects of CP, affecting the morphology and transformations of these product layers. Since the experimental evidences to support the aforementioned beneficial effects are rather limited, this study investigates the morphology and composition of the "naturally" formed steel surface layers, along with the properties of the steel/ cement paste interface, on corroding and protected steel reinforcement (in comparison to reference, non-corroding, non-protected conditions) after 460 days of conditioning. For the corroding specimens, the formation and substantial deposition of voluminous corrosion products, with low adherence to the steel surface is relevant (low protective ability), whereas in the protected specimens, a compact and adherent product layer of more stable high valent iron oxides, or calcium substituted such, was observed. To this end, the present work provides the experimental evidence for the fundamental mechanisms, related to the otherwise recognized positive secondary effects of CP in reinforced concrete.

The applicability and efficiency of an alternative for impressed current cathodic protection (CP) for reinforced concrete, based on pulse technology, was investigated. The technique, denoted as pulse CP (pCP), was evaluated on the basis of a comparative analysis to reference (non-corroding), corroding, and conventional CP conditions, in terms of long-term monitoring of electrochemical parameters for the embedded steel with time of corrosion and protection. The hereby reported results are for the total duration of the experiment, i.e., 460 days of conditioning, also presented in comparison with earlier stages. Protection was applied after corrosion was initiated (using corrosion medium of 5% NaCl), at different time intervals (here reported are starting points 60 and 150 days of age). Both CP regimes used current density of 5 or 20 mA/m 2 steel surface. The pulse CP was applied as a pulse-shaped block current (square wave) with the current itself being the feedback control signal, using 12.5―50% duty cycle at 500 Hz to 1 kHz frequency. Under equal environmental conditions and for a comparatively long period of application, the pulse CP was found to perform as effectively as the conventional CP with regard to electrochemical behavior of the steel reinforcement. Furthermore, the pulse CP technique was found to achieve more rapidly the so called "open circuit potential (OCP) passivity" as a result of an enhanced ion transport (chloride withdrawal) and more favorable cement chemistry (increased alkalinity around the steel reinforcement).

The purpose of this study was to investigate cortical dysfunction in Parkinson's disease (PD) patients with amnestic deficit (PD-MCI). Perfusion single photon emission computed tomography was performed in 15 PD-MCI patients and compared (statistical parametric mapping [SPM2]) with three groups, i.e., healthy subjects (CTR), cognitively intact PD patients (PD), and common amnestic MCI patients (aMCI). Age, depression, and UPDRS-III scores were considered as confounding variables. PD-MCI group (P < 0.05, false discovery rate-corrected for multiple comparisons) showed relative hypoperfusion in bilateral posterior parietal lobe and in right occipital lobe in comparison to CTR. As compared to aMCI, MCI-PD demonstrated hypoperfusion in bilateral posterior parietal and occipital areas, mainly right cuneus and angular gyrus, and left precuneus and middle occipital gyrus. With a less conservative threshold (uncorrected P < 0.01), MCI-PD showed hypoperfusion in a left parietal region, mainly including precuneus and inferior parietal lobule, and in a right temporal-parietal-occipital region, including middle occipital and superior temporal gyri, and cuneus-precuneus, as compared to PD. aMCI versus PD-MCI showed hypoperfusion in bilateral medial temporal lobe, anterior cingulate, and left orbitofrontal cortex. PD-MCI patients with amnestic deficit showed cortical dysfunction in bilateral posterior parietal and occipital lobes, a pattern that can be especially recognized versus both controls and common aMCI patients, and to a lesser extent versus cognitively intact PD. The relevance of this pattern in predicting dementia should be evaluated in longitudinal studies.