Background Mechanical revascularization procedures performed for treatment of acute ischemic stroke have increased in recent years. Data suggest association between operative volume and mortality rates. Understanding procedural allocation and patient access patterns is critical. Few studies have examined these demographics. Methods Data were collected from the 2008 Nationwide Inpatient Sample database. Patients hospitalized with ischemic stroke and the subset of individuals who underwent mechanical thrombectomy were characterized by race, payer source, population density, and median wealth of the patient's zip code. Demographic data among patients undergoing mechanical thrombectomy procedures were examined. Stroke admission demographics were analyzed according to thrombectomy volume at admitting centers and patient demographics assessed according to thrombectomy volume at treating centers. Results Significant allocation differences with respect to frequency of mechanical thrombectomy procedures among stroke patients existed according to race, expected payer, population density and wealth of the patient's zip code(p<0.0001). White,Hispanic, Asian/Pacific Islander patients received endovascular treatment at higher rates than Black and Native American patients. Compared to White stroke patients, Black(p<0.001), Hispanic(p<0.001),Asian/Pacific Islander(p<0.001) and Native American stroke patients(<0.001) all demonstrated decreased frequency of admission to hospitals performing mechanical thrombectomy procedures at high volumes. Among treated patients, Blacks(p=0.0876), Hispanics(p=0.0335), and Asian/Pacific Islanders(p<0.001) demonstrated decreased frequency in mechanical thrombectomy procedures performed at high volume centers when compared to Whites. While present, socioeconomic disparities were not as consistent or pronounced as racial differences. Conclusions We demonstrate variances in endovascular acute stroke treatment allocation according to racial and socioeconomic factors in 2008. Efforts should be made to monitor and address potential disparities in treatment utilization.

Mature hormone patterns are established within several months of and even prior to menarche in normal-weight perimenarcheal girls. Factors determining menstrual bleeding in perimenarcheal girls may not be solely dependent on reproductive hormones or the neuroendocrine axis.

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Objective We have previously characterized the reproductive hormone profile in infertile women with diminished ovarian reserve (DOR) as being distinct from that seen in age comparable healthy controls. Hypothesizing that DOR reflects accelerated reproductive aging, we herein compare urinary reproductive hormone dynamics between young women with DOR and a population of chronologically older perimenopausal controls. Methods In this prospective observational study, urinary levels of pituitary gonadotropins (FSH and LH) and metabolites of estrogen (E1c) and progesterone (Pdg) were assessed in daily morning urine samples collected in a spontaneous menstrual cycle in 8 infertile premenopausal women with DOR and in 11 perimenopausal controls. Areas under the curves (AUC) were calculated for the respective measured hormones, and comparisons were made using Mann-Whitney U test. Results Urinary E1c levels were significantly attenuated in premenopausal women with DOR compared to the older perimenopausal cohort. Despite the relatively lower estrogen, a significantly more pronounced LH surge was evident in the younger population. Early follicular FSH was lower in the women with DOR, but luteal urinary Pdg excretion was comparable in the two groups. Conclusion Our data suggest distinctions in functioning of the central (hypothalamic-pituitary) and peripheral (ovarian) components of the hypothalamic-pituitary-ovarian axis in premenopausal women with DOR compared to chronologically older perimenopausal controls. Increased hypothalamic-pituitary sensitivity to estrogen positive feedback is suggested in premenopausal women with DOR. Our observations identify DOR as a distinct entity in the paradigm of reproductive senescence.