Noncontrast Computed Tomography Alberta Stroke Program Early CT Score May Modify Intra-Arterial Treatment Effect in DAWN.

Background and Purpose- It is unknown whether noncontrast computed tomography (NCCT) can identify patients who will benefit from intra-arterial treatment (IAT) in the extended time window. We sought to characterize baseline Alberta Stroke Program Early CT Score (ASPECTS) in DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) and to assess whether ASPECTS modified IAT effect. Methods- Core lab adjudicated ASPECTS scores were analyzed. The trial cohort was divided into 2 groups by qualifying imaging (computed tomography versus magnetic resonance imaging). ASPECTS-by-treatment interaction was tested for the trial coprimary end points (90-day utility-weighted modified Rankin Scale (mRS) score and mRS, 0-2), mRS 0 to 3, and ordinal mRS. ASPECTS was evaluated separately as an ordinal and a dichotomized (0-6 versus 7-10) variable. Results- Of 205 DAWN subjects, 123 (60%) had NCCT ASPECTS, and 82 (40%) had diffusion weighted imaging ASPECTS. There was a significant ordinal NCCT ASPECTS-by-treatment interaction for 90-day utility-weighted mRS (interaction P=0.04) and mRS 0 to 2 (interaction P=0.02). For both end points, IAT effect was more pronounced at higher NCCT ASPECTS. The dichotomized NCCT ASPECTS-by-treatment interaction was significant only for mRS 0 to 2 (interaction P=0.04), where greater treatment benefit was seen in the ASPECTS 7 to 10 group (odds ratio, 7.50 [2.71-20.77] versus odds ratio, 0.48 [0.04-5.40]). A bidirectional treatment effect was observed in the NCCT ASPECTS 0 to 6 group, with treatment associated with not only more mRS 0 to 3 outcomes (50% versus 25%) but also more mRS 5 to 6 outcomes (40% versus 25%). There was no significant modification of IAT effect by diffusion weighted imaging ASPECTS. Conclusions- Baseline NCCT ASPECTS appears to modify IAT effect in DAWN. Higher NCCT ASPECTS was associated with greater benefit from IAT. No treatment interaction was observed for diffusion weighted imaging ASPECTS.

Atresia of the dominant ovarian follicle in rhesus monkeys is detected within 24 hours of estradiol treatment.

Following treatment with estradiol-17ß (E2) on day 6 of the menstrual cycle, degenerative alterations in the microenvironment of the dominant follicle (DF) (follicular fluid [FF], granulosa cells [GC], and oocyte) are readily apparent on day 10, or 96 h after E2 administration. The present study was designed to determine how early such changes could be detected and which indices of atresia were observed first. The DF was identified during laparoscopy on day 5 or 6 of the cycle, and four capsules containing crystalline E2 were inserted s.c. for 24 h. Contents of the DF were aspirated at 24, 48, and 72 h following initiation of E2 treatment. General size and appearance of the DF did not change distinctly with E2 treatment; however, by 48 h FF viscosity was increased markedly. GC viability was not altered with treatment. FF concentrations of estrogen (E) were dramatically reduced at 24 h. These differences were maintained at 48 h and at 72 h. E accumulation by cultured GC was significantly reduced by > eightfold. There appeared a similar trend for reduced progesterone (P) in FF and decreased P production by GC in vitro. These results demonstrate that degenerative alterations in the DF indicative of atresia can be detected as early as 24 h after initiation of E2 treatment; the index of atresia appearing earliest is a reduction in FF concentrations of E, and the first morphological changes in the DF can be observed 24 h later. This study indicates that biochemical alterations precede morphologic changes with E2-induced atresia, and should allow us to begin to determine the earliest events and putative initiation sites of atresia.

Direct effect of estradiol-17ß on progesterone accumulation by ovarian granulosa cells from rhesus monkeys.

We have previously demonstrated that estradiol-17ß (E2) administered in vivo induces atresia of the dominant ovarian follicle (DF). Whether this effect is exerted directly at the ovarian level or by central mediation has not been confirmed. The present study was designed to assess whether E2 in amounts similar to those found in monkey follicular fluid (FF) directly alters in vitro progesterone (P) accumulation by granulosa cells (GC) aspirated from follicles in cycling rhesus monkeys. Follicular contents were aspirated from three to five animals on each of days 8-13 of the cycle. GC were plated at a density of 50,000 viable GC/0.5 ml medium; GC were incubated with 0 or 2-2,000 ng/ml E2, and cultures were maintained for 72 h. P accumulation by GC collected on day 8 and treated with 2 ng/ml E2 was augmented 37.5 ± 5.5% (X ± S. E. M.; P<.05) over controls but was diminished significantly at 20 ng/ml ( -55 ± 18% with respect to controls), 200 ng/ml ( -73.7 ± 13.2%), and 2,000 ng/ml ( -77.3 ± 18.4%). A similar dose-response relationship was noted on other cycle days. At a concentration of 2,000 ng/ml, E2 significantly reduced P 91.5 ± 8.5% (day 10), 81.5 ± 18.5% (day 11), 84.3 ± 4.7% (day 12), and 53.7 ± 15.8% (day 13). We conclude that E2 at concentrations found in FF can inhibit P output by monkey GC through a direct action.