BackgroundEvidence of the consequences of different prehospital pathways before mechanical thrombectomy (MT) in large vessel occlusion stroke is inconclusive. The aim of this study was to investigate the infarct extent and progression before and after MT in directly admitted (mothership) versus transferred (drip and ship) patients using the Alberta Stroke Program Early CT Score (ASPECTS).MethodsASPECTS of 535 consecutive large vessel occlusion stroke patients eligible for MT between 2015 to 2019 were retrospectively analyzed for differences in the extent of baseline, post-referral, and post-recanalization infarction between the mothership and drip and ship pathways. Time intervals and transport distances of both pathways were analyzed. Multiple linear regression was used to examine the association between infarct progression (baseline to post-recanalization ASPECTS decline), patient characteristics, and logistic key figures.ResultsASPECTS declined during transfer (9 (8–10) vs 7 (6-9), p<0.0001), resulting in lower ASPECTS at stroke center presentation (mothership 9 (7–10) vs drip and ship 7 (6–9), p<0.0001) and on follow-up imaging (mothership 7 (4–8) vs drip and ship 6 (3–7), p=0.001) compared with mothership patients. Infarct progression was significantly higher in transferred patients (points lost, mothership 2 (0–3) vs drip and ship 3 (2–6), p<0.0001). After multivariable adjustment, only interfacility transfer, preinterventional clinical stroke severity, the degree of angiographic recanalization, and the duration of the thrombectomy procedure remained predictors of infarct progression (R2=0.209, p<0.0001).ConclusionsInfarct progression and postinterventional infarct extent, as assessed by ASPECTS, varied between the drip and ship and mothership pathway, leading to more pronounced infarction in transferred patients. ASPECTS may serve as a radiological measure to monitor the benefit or harm of different prehospital pathways for MT.

Although women bear. the brunt of gonococcal infection-related morbidity, few large studies of gonorrhea treatment in women have been conducted. In a multicenter, double-blind, placebo-controlled trial, 181 evaluable women with uncomplicated gonorrhea were treated with ciprofloxacin (250 mg orally; 94 women) or ceftriaxone (250 mg intramuscularly; 87 women). Twenty-four percent of the participants were infected with antibiotic-resistant Neisseria gonorrhoeae. Cervical gonorrhea was cured in 100%o (93 of 93) of the women treated with ciprofloxacin and 99% (83 of 84) receiving ceftriaxone. All pharyngeal (n = 5) or rectal (n = 20) infections treated with ciprofloxacin were cured, as were ceftriaxone-treated patients with pharyngeal (n = 6) or rectal (n = 21) infection. Geometric mean MICs (range) for 248 pretreatment isolates were: penicillin, 0.28 (0.015 to 8.0); tetracycline, 0.46 (0.06 to 4); ciprofloxacin, 0.003 (0.002 to 0.015); and ceftriaxone, 0.004 (0.001 to 0.125) ,ug/ml. Both drugs were well tolerated. Despite the high prevalence of antibiotic-resistant gonococci in these populations, 250 mg of oral ciprofloxacin was as effective as an injection of ceftriaxone.Despite the more than 30% decline in gonorrhea cases reported in the decade of the 1980s, infections due to Neisseria gonorrhoeae continue to be the most common reportable bacterial disease in the United States (5). The proportion of isolates resistant to penicillin or tetracycline also has increased dramatically.Although not yet a major problem in the United States, development of resistance to alternative therapies such as spectinomycin or even the newer quinolones is a continuing concern (1, 5, 15). In addition, gonorrhea rates tend to be highest in Americans aged 15 to 24 years, but late consequences which disproportionately affect women (e.g., infertility, ectopic pregnancy) often do not become apparent until years after the acute infection. Paradoxically, while gonorrhea and its sequelae tend to most profoundly affect females, studies of gonorrhea therapy predominantly report data for men. To provide more data on the treatment of gonorrhea in women and on the utility of ciprGfloxacin, a currently recommended alternative to ceftriaxone for gonorrhea treatment, we conducted a prospective, multicenter, randomized, double-blind, placebo-controlled trial comparing 250 mg of oral ciprofloxacin with 250 mg of intramuscular ceftriaxone for therapy of uncomplicated gonorrhea in women attending sexually transmitted disease (STD) clinics. MATERIALS AND METHODSStudy design. The study was a prospectively conducted, randomized, double-blind, placebo-controlled trial in which all participants received both an injection and a single oral dose of medication. All medications were administered by a third party who had been instructed not to inform the study * Corresponding author.clinician of the therapeutic regimen utilized. Patients randomized to ciprofloxacin therapy received one 250-mg tablet of ciprofloxacin orally and an injection of sterile 0.9% sodium c...