Quality of life in young people with Tourette syndrome: a controlled study

Quality of life (QoL) may be adversely affected by Tourette syndrome (TS). Although the core symptoms of this complex neurodevelopmental disorder are tics, patients often present with an array of behavioural difficulties, such as co-morbid obsessive compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD). In this study we investigated whether young people with TS exhibited poorer QoL in comparison to healthy individuals and an epilepsy control group. We also analysed whether greater tic severity or co-morbid OCD and\or ADHD led to greater differences in perceived QoL. The Youth Quality of Life Instrument-Research Version (Edwards et al. in J Adolesc 25:275–286, 2002) was used to assess QoL and a range of clinical scales were administered to assess anxiety, depression and other behavioural symptoms. TS was associated with significant differences in aspects of QoL related to home and social activities, involving peer and family interactions. Patients with more severe tics reported a greater negative impact on QoL. Patients with TS and no associated diagnoses (pure TS) presented with lower QoL scores in the environment domain, poorer perceived QoL in general, and depressive features. Co-morbid OCD appeared to exert a greater impact on self and relationship QoL domains. The presence of both OCD and ADHD as co-morbidities led to more widespread problems. In conclusion, TS can be associated with poorer perceived QoL. Although social aspects of QoL may be more vulnerable to TS in general, co-morbid conditions make an important contribution in determining which aspects of QoL are most affected in the individual.     

Supported p-toluenesulfonic acid as a highly robust and eco-friendly isocyanide scavenger

We document here the use of polymer-supported p-toluenesulfonic acid as a highly effective, robust, economical and eco-friendly isocyanide scavenger. The herein described strategy circumvent the intense and repulsive odor of volatile isocyanides, enabling simplified and odorless workup and purifications. The usefulness of the new scavengers has been validated in a set of diverse isocyanide-based organic transformations and this approach is also amenable to parallel synthesis techniques.     

Colorectal cancer screening comparing no screening,immunochemical and guaiac fecal occult blood tests: A cost‐effectiveness analysis

Comparability of cost‐effectiveness of colorectal cancer (CRC) screening strategies is limited if heterogeneous study data are combined. We analyzed prospective empirical data from a randomized‐controlled trial to compare cost‐effectiveness of screening with either one round of immunochemical fecal occult blood testing (I‐FOBT; OC‐Sensor®), one round of guaiac FOBT (G‐FOBT; Hemoccult‐II®) or no screening in Dutch aged 50 to 75 years, completed with cancer registry and literature data, from a third‐party payer perspective in a Markov model with first‐ and second‐order Monte Carlo simulation. Costs were measured in Euros (€), effects in life‐years gained, and both were discounted with 3%. Uncertainty surrounding important parameters was analyzed. I‐FOBT dominated the alternatives: after one round of I‐FOBT screening, a hypothetical person would on average gain 0.003 life‐years and save the health care system €27 compared with G‐FOBT and 0.003 life years and €72 compared with no screening. Overall, in 4,460,265 Dutch aged 50–75 years, after one round I‐FOBT screening, 13,400 life‐years and €320 million would have been saved compared with no screening. I‐FOBT also dominated in sensitivity analyses, varying uncertainty surrounding important effect and cost parameters. CRC screening with I‐FOBT dominated G‐FOBT and no screening with or without accounting for uncertainty.     

Trastuzumab-resistant HER2-driven breast cancer cells are sensitive to epigallocatechin-3 gallate

Overexpression of the epidermal growth factor receptor family member HER2 is found in approximately 30% of breast cancers and is a target for immunotherapy. Trastuzumab, a humanized monoclonal antibody against HER2, is cytostatic when added alone and highly successful in clinical settings when used in combination with other chemotherapeutic agents. Unfortunately, HER2 tumors in patients develop resistance to trastuzumab or metastasize to the brain, which is inaccessible to antibody therapy. Previously, we showed that the green tea polyphenol epigallocatechin-3 gallate (EGCG) inhibits growth and transformed phenotype of Her-2/neu-driven mouse mammary tumor cells. The different modes of action of EGCG and trastuzumab led us to hypothesize that EGCG will inhibit HER2-driven breast cancer cells resistant to trastuzumab. We studied trastuzumab-resistant BT474 human breast cancer cells, isolated by chronic trastuzumab exposure, and JIMT-1 breast cancer cells, derived from a pleural effusion in a patient who displayed clinical resistance to trastuzumab therapy. EGCG treatment caused a dose-dependent decrease in growth and cellular ATP production, and apoptosis at high concentrations. Akt activity was suppressed by EGCG leading to the induction of FOXO3a and target cyclin-dependent kinase inhibitor p27Kip1 levels. Thus, EGCG in combination with trastuzumab may provide a novel strategy for treatment of HER2-overexpressing breast cancers, given that EGCG can cross the blood-brain barrier.     

Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study

Background

Previous studies have shown an inverse gradient in socioeconomic status for disability after stroke. However, no distinction has been made between the period in the stroke rehabilitation unit (SRU) and the period after discharge. The purpose of this study was to examine the impact of education and equivalent income on motor and functional recovery for both periods.

Methods

419 consecutive patients were recruited from six SRUs across Europe. The Barthel Index (BI) and Rivermead Motor Assessment (RMA) were measured on admission, at discharge and 6 months after stroke. Ordinal logistic regression models were used, adjusting for case mix. Cumulative odds ratios (OR) were calculated to measure differences in recovery between educational levels and income groups with adjustments for case mix.

Results

Patients with a low educational level were less likely to improve on the BI (OR 0.53; 95% CI 0.32 to 0.87) and the RMA arm during inpatient stay (OR 0.54; 95% CI 0.31 to 0.94). For this period, no differences in recovery were found between income groups. After discharge, patients with a low equivalent income were less likely to improve on all three sections of the RMA: gross function (OR 0.20; 95% CI 0.06 to 0.66), leg and trunk (OR 0.22; 95% CI 0.09 to 0.55) and arm (OR 0.30; 95% CI 0.10 to 0.87). No differences were found for education.

Conclusions

During inpatient rehabilitation, educational level was a determinant of recovery, while after discharge, equivalent income played an important role. This study suggests that it is important to develop a better understanding of how socioeconomic factors affect the recovery of stroke patients.Socioeconomic health inequalities have been studied for a long time but the publication of the Black Report¹ in the UK provoked the attention of policy makers for the existence of important health inequalities² and resulted in an increased awareness of these issues in health care in general.³ At the end of the 20th century, some authors even considered socioeconomic health disparities as the most important public health issue.⁴Stroke is no exception to the general findings on health inequalities. The incidence of fatal and non‐fatal strokes shows an inverse gradient over socioeconomic groups. In an unselected population based sample, Thrift and colleagues⁵ found that the incidence rate of both stroke types was higher in disadvantaged areas. These disparities remain in the post‐acute period. The proportion of patients who are dependent or dead at 6 months after stroke varies between groups of different socioeconomic status (SES). Patients with a lower SES are at greater risk for stroke morbidity and stroke mortality compared with higher SES groups.^6,7 However, these associations were not confirmed by other studies.^8,9 In a recent review by Cox and colleagues¹⁰ it was concluded that the association between SES and morbidity and mortality is well known but that the reasons behind this association are far from clear.The socioeconomic gradient in disability after stroke is also observed in the chronic phase. Patients with lower SES experienced more disabilities up to 3 years post‐stroke compared with the group of patients with a higher SES.¹¹ It remains unclear whether these differences are the result of differences in stroke severity at onset or whether they become more prominent over time.Comparison of results between studies may be difficult because of the different methods used to define SES. Several indicators are used to determine SES (eg, education, income). Various models are used explaining health inequalities, and education and income reflect different dimensions of socioeconomic inequalities in health.¹² The behavioural/cultural explanation is perhaps the most widely used.¹³ This model refers to the more systematic unhealthy behaviours and lifestyle in lower socioeconomic groups, in part related to differences in knowledge or awareness of risks. In this model, distinction between SES groups is often based on educational attainment.¹³ The materialist model tries to explain differences in health between SES groups by material factors (eg, housing, work conditions), and income is mainly used as an indicator for material stratification.¹⁴Apart from the choice of SES indicator, differences in how the selected indicator is measured may hamper comparison between studies and make general conclusions more difficult. For example, the measurement of an indicator can be based on an individual level or at a more aggregated area level. Although individual based indicators are preferred,¹⁵ the availability of data is probably an underestimated factor in how indicators are measured.As most functional recovery is expected to take place in the first 5 months after stroke,¹⁶ stroke rehabilitation units (SRUs) may play an important role in minimising discrepancies between socioeconomic groups. However, the influence of SES on recovery during inpatient stay has not been studied. Moreover, illness trajectories are not often considered in the comparison of functional recovery between socioeconomic groups.¹⁷ To the best of our knowledge, no distinction has been made between recovery during stay in an inpatient SRU and after discharge for different SES groups. Therefore, the aim of this study was to assess the association of education and equivalent income with functional and motor recovery for these two periods.