GJETC report 2018 : intensified German-Japanese cooperation in energy research ; key results and policy recommendations

The challenges and also potentials of the energy transition are tremendous in Germany, as well as in Japan. Sometimes, structures of the old energy world need "creative destruction" to clear the way for innovations for a decarbonized, low-risk energy system. In these times of disruptive changes, a constructive and sometimes controversial dialog within leading industrial nation as Japan and Germany over the energy transition is even more important. The German-Japanese Energy Transition Council (GJETC) released a summarizing report for the first project phase 2016-2018. It includes jointly formulated recommendations for politics as well as a controversial dialogue part. The Council jointly states and recommends that: Ambitious long-term targets and strategies for a low-carbon energy system must be defined and ambitiously implemented; Germany and Japan as high technology countries need to take the leadership. Both countries will have to restructure their energy systems substantially until 2050 while maintaining their competitiveness and securing energy supply. Highest priority is given to the forced implementation of efficiency technologies and renewable energies, despite different views on nuclear energy. In both countries all relevant stakeholders - but above all the decision-makers on all levels of energy policy - need to increase their efforts for a successful implementation of the energy transition. Design of the electricity market needs more incentives for flexibility options and for the extensive expansion of variable power generation, alongside with strategies for cost reduction for electricity from photovoltaic and wind energy. The implementation gap of the energy efficiency needs to be closed by an innovative energy policy package to promote the principle of "Energy Efficiency First". Synergies and co-benefits of an enhanced energy and resource efficiency policy need to be realized. Co-existence of central infrastructure and the growing diversity of the activities for decentralization (citizens funding, energy cooperatives, establishment of public utility companies) should be supported. Scientific cooperation can be intensified by a joint working group for scenarios and by the establishment of an academic exchange program

Subarachnoid hemorrhage associated with cerebral hyperperfusion syndrome after simultaneous carotid endarterectomy and coronary artery bypass grafting procedures: A case report and review of the literature

Background: Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) is a potentially devastating complication of carotid endarterectomy (CEA) or carotid artery stenting. Intracranial hemorrhage can comprise of intracerebral hemorrhage or subarachnoid hemorrhage (SAH), but SAH after CEA is rare. We report a case of SAH associated with CHS that followed simultaneous CEA and coronary artery bypass grafting (CABG). Case description: A 78-year-old man developed left-sided hemiparesis and was admitted to our institution. A preoperative study showed severe stenosis of the right carotid artery associated with markedly reduced cerebral blood flow (CBF), and a CEA was scheduled after initiating medical treatment. However, the patient developed unstable angina requiring an emergency CABG before undergoing an elective CEA. Given the risk of stroke associated with performing CABG alone, simultaneous CEA and CABG were urgently performed. The patient received dual antiplatelet therapy preoperatively and anticoagulation intraoperatively for the CABG procedure, and the anticoagulation was continued postoperatively due to the development of atrial fibrillation. Three days after the surgery, the patient developed a headache and magnetic resonance imaging demonstrated right-sided cortical SAH. Single-photon emission computed tomography revealed a significantly increased CBF. Therefore, the SAH appears to have been associated with CHS after the CEA. The hemorrhage was managed conservatively and resolved without an associated neurological deficit. Conclusion: SAH after CEA is rare clinical manifestation of CHS. Simultaneous CEA and CABG, or aggressive perioperative antithrombotic therapy, may increase the risk of its occurrence. Early diagnosis and careful management are important for favorable outcomes

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