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Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

Objective-To better understand emotional information processing in pediatric inflammatory bowel disease (IBD) and its relationship with depression. Pediatric IBD is associated with higher rates of depression than seen in other physical diseases and in community samples. In systemic inflammation, proinflammatory cytokines have been implicated in altering activity in brain regions known to affect emotion processing and emotion regulation in depression.Methods-We examined differences in pupillary responses as a marker of brain function in response to negative emotional information in youths (age 8-17) with IBD both with (n = 8) and without (n = 15) comorbid depression who were receiving high dose steroid treatment. We compared their responses to each other and to depressed youths without IBD (n = 20), and healthy youths (n = 22).Results-Youths with IBD demonstrated greater pupillary responses to the initial presentation of negative emotional stimuli regardless of their depression status (p = 0.05). In contrast, depressed youths, regardless of their IBD disease status, demonstrated a greater constriction of the pupil 10 to 12 seconds after exposure to negative stimuli. This constriction was associated with greater depressive severity and lower albumin levels.Conclusions-IBD may be associated with increased sensitivity to negative emotional stimuli above and beyond depression diagnosis. Depressed youths potentially demonstrate affective blunting, emotional avoidance, or a failure to regulate emotion after exposure to negative emotional information. Thus, there appear to be unique contributions of medical disease and depression to physiological indications of emotional reactivity, but these factors do not appear to interact.

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