Experimental studies of endothelial regeneration in rabbit carotid arteries after endarterectomy : Spindle and ovoid type cells of a normal diet group versus a hypercholesterolemia group

Endothelial regeneration of the rabbit carotid artery was investigated after endarterectomy, which involved the removal of a 4 mm length including the endothelium, internal elastic laminae and part of the muscle layer of the media. Regeneration was studied at intervals from 1 hour to 8 weeks after surgery. There were two groups, Group A consisting of Japan White rabbits fed a standard diet and Group B consisting of rabbits fed a 1% cholesterol diet for a month prior to surgery and continued until the annimals were sacrificed. The healing process of the endarterectomized arterial wall was observed using light microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The origin of regenerated cells was examined with immunohistochemical double-labeled staining. Scanning electron microscopy (SEM) showed two kinds of regenerated cells which were observed on the luminal surface of the endarterectomized wall, namely, spindle type and ovoid type cells in both Group A and Group B. Complete endothelial regrowth was confirmed 2 weeks after surgery in both groups. After the endothelial regrowth was completed, the ovoid type cells were localized in the low shear stress area. Transmission electron microscopy (TEM) showed both the spindle type and ovoid type cells consisted of pinocytotic vesicles and demonstrated tight-junction adherence, which confirmed their endothelial origin. Immunohistochemical findings showed both the spindle type and ovoid type cells stained positively for anti-Factor VIII antibody in Group A and stained positively for anti-CD31 antibody in Group B, which confirmed their endothelial origin. In Group B the speed of the endothelial regrowth was not remarkably delayed from that in Group A, but SEM revealed enlarged spindle type cells and irregular-sized ovoid type cells. TEM showed vacuoles existed in both spindle type and ovoid type cells. In addition, foam cells which were stained for antimacrophage cell antibody RAM11 migrated subendothelially, after which intimal thickening was observed. It could be suggested that the reason for the low rate of clinically postoperative restenosis after carotid endarterectomy is that preoperative control leads to the reduction of risk factors of atherosclerosis, and consequently clinical endothelial regeneration of the human carotid artery after endarterectomy is likely to resemble that of the rabbit carotid artery in Group A

Mental changes in PD with STN-DBS

The physical benefits of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease(PD) patients are well documented, but the mental benefits are uncertain, particularly in Japanese patients. This study evaluated the clinical and neuropsychological characteristics before and after STN-DBS surgery in Japanese PD patients. PD patients (n=13, age 67.0 ± 7.8 years) were evaluated pre-surgery (baseline) and at one and six months post-surgery by two trained psychiatrists. The motor symptoms were assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. The neuropsychological and psychiatric tests performed were the Mini-Mental State Examination, the Wisconsin Card Sorting Test (WCST), the verbal fluency test (VFT), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HAM-A). The UPDRS motor score (p<0.001) and HAM-A score (p=0.004) showed significant improvement at one month post-surgery, but a significant decline was observed in the WCST total error (p=0.005) and the semantic VFT score (p<0.001). The phonetic VFT also showed a substantial decline (p=0.015) at one month post-surgery. At six months post-surgery, the improvement in the UPDRS motor score was maintained, and the scores on the neuropsychological and psychiatric tests had returned to baseline. Although bilateral STN-DBS did not appear to have long-term effects on neuropsychological and psychiatric outcomes, the microlesion effects associated with STN-DBS appear to increase the risk of transient cognitive and psychiatric complications. These complications should be monitored by careful observation of neurological and psychiatric symptoms

Mental changes in PD with STN-DBS

The physical benefits of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease(PD) patients are well documented, but the mental benefits are uncertain, particularly in Japanese patients. This study evaluated the clinical and neuropsychological characteristics before and after STN-DBS surgery in Japanese PD patients. PD patients (n=13, age 67.0 ± 7.8 years) were evaluated pre-surgery (baseline) and at one and six months post-surgery by two trained psychiatrists. The motor symptoms were assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. The neuropsychological and psychiatric tests performed were the Mini-Mental State Examination, the Wisconsin Card Sorting Test (WCST), the verbal fluency test (VFT), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HAM-A). The UPDRS motor score (p<0.001) and HAM-A score (p=0.004) showed significant improvement at one month post-surgery, but a significant decline was observed in the WCST total error (p=0.005) and the semantic VFT score (p<0.001). The phonetic VFT also showed a substantial decline (p=0.015) at one month post-surgery. At six months post-surgery, the improvement in the UPDRS motor score was maintained, and the scores on the neuropsychological and psychiatric tests had returned to baseline. Although bilateral STN-DBS did not appear to have long-term effects on neuropsychological and psychiatric outcomes, the microlesion effects associated with STN-DBS appear to increase the risk of transient cognitive and psychiatric complications. These complications should be monitored by careful observation of neurological and psychiatric symptoms

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era