RESUMO
BACKGROUND: Internet searches are an increasingly used tool in medical research. To date, no studies have examined Google search data in relation to common gastrointestinal symptoms. AIMS: The aim of this study was to compare trends in Internet search volume with clinical datasets for common gastrointestinal symptoms. METHODS: Using Google Trends, we recorded relative changes in volume of searches related to dysphagia, vomiting, and diarrhea in the USA between January 2008 and January 2011. We queried the National Inpatient Sample (NIS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) during this time period and identified cases related to these symptoms. We assessed the correlation between Google Trends and these two clinical datasets, as well as examined seasonal variation trends. RESULTS: Changes to Google search volume for all three symptoms correlated significantly with changes to NIS output (dysphagia: r = 0.5, P = 0.002; diarrhea: r = 0.79, P < 0.001; vomiting: r = 0.76, P < 0.001). Both Google and NIS data showed that the prevalence of all three symptoms rose during the time period studied. On the other hand, the NHAMCS data trends during this time period did not correlate well with either the NIS or the Google data for any of the three symptoms studied. Both the NIS and Google data showed modest seasonal variation. CONCLUSIONS: Changes to the population burden of chronic GI symptoms may be tracked by monitoring changes to Google search engine query volume over time. These data demonstrate that the prevalence of common GI symptoms is rising over time.
Assuntos
Efeitos Psicossociais da Doença , Transtornos de Deglutição/epidemiologia , Diarreia/epidemiologia , Gastroenteropatias , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Ferramenta de Busca/estatística & dados numéricos , Avaliação de Sintomas , Vômito/epidemiologia , Transtornos de Deglutição/diagnóstico , Diarreia/diagnóstico , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/psicologia , Humanos , Comportamento de Busca de Informação , Internet/tendências , Prevalência , Estatística como Assunto/tendências , Avaliação de Sintomas/psicologia , Avaliação de Sintomas/estatística & dados numéricos , Avaliação de Sintomas/tendências , Estados Unidos/epidemiologia , Vômito/diagnósticoRESUMO
PURPOSE OF REVIEW: Inflammatory bowel disease (IBD) often affects women in their peak reproductive years, and therapy is often continued during pregnancy to maintain stable disease activity. Therapeutic options have expanded over the last 2 decades with the advent of new biologic options. It is, therefore, important for the gastroenterologists and other clinicians caring for patients with IBD to understand safety data regarding the treatment options, both biologic and nonbiologic, in pregnant IBD patients. RECENT FINDINGS: In general, quality of evidence in this area remains low. However, larger prospective studies are beginning to provide evidence regarding the potential safety of biologics both alone and in conjunction with nonbiologic therapy. SUMMARY: The majority of treatment options for IBD appears to be of low risk and may often be continued through pregnancy and lactation. Not treating IBD, for example, by discontinuing therapy prior to or with pregnancy, may pose a greater risk to mother and fetus in many cases.
Assuntos
Terapia Biológica/métodos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Adalimumab , Ácidos Aminossalicílicos/efeitos adversos , Ácidos Aminossalicílicos/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Terapia Biológica/efeitos adversos , Feminino , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Gravidez , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
OBJECTIVES: Patients with inflammatory bowel disease (IBD) need frequent emergency care due to flares of their disease. However, understanding which patients are most vulnerable to repeat emergency care due to recurrent flares of their disease remains poor. METHODS: This was a retrospective cohort study of Kaiser Permanente Northern California health plan members aged ≥18 years between 2009 and 2018. Our primary outcome was occurrence of repeat emergency department (ED) visits with a primary diagnosis code of IBD in the 6 months following their index ED visit. Baseline characteristics and clinical service use patterns were extracted. We used multivariable negative binomial regression analysis to measure the incident risk of a recurrent ED visit within 6 months. RESULTS: We found 2111 patients who met eligibility criteria, of whom 56.7% were female and 39.7% were non-White. During the 6-month observation period, 19.3% (n = 408) returned to the ED for a second IBD flare. In adjusted analyses, we found older age (incident risk ratio [IRR] 0.44, 95% confidence interval [CI] 0.31-0.62 for age 60+ compared to 18-30), higher neighborhood household income (IRR 0.80, 95% CI 0.65-0.98 for income ≥$85,000), and diagnosis of alcohol use disorder were associated with a lower risk of repeat ED utilization (IRR 0.62, 95% CI 0.41-0.93), while presence of mood disorder (IRR 1.26, 95% CI 1.03-1.58), history of opiate prescription (IRR 1.38, 95% CI 1.10-1.73), and corticosteroid prescription (IRR 1.57, 95% CI 1.27-1.95) were associated with increased risk of repeat ED utilization. Prompt outpatient follow-up was not associated with a lower odds of recurrent ED utilization (IRR 0.93, 95% CI 0.75-1.15). CONCLUSIONS: Our study identified multiple patient characteristics associated with higher recurrent short-term use of the ED for IBD care. Although we did not find prompt outpatient follow-up after initial ED visit to be protective, targeted interventions directed at high-risk individuals based on mood disorders, opiate use, or steroid use may help to optimize care and health care utilization.
Assuntos
Doenças Inflamatórias Intestinais , Alcaloides Opiáceos , Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Fatores de Risco , Serviço Hospitalar de EmergênciaRESUMO
BACKGROUND: Celiac disease (CD) is associated with increased rates of neuropsychiatric disease and irritable bowel syndrome, and patients may exhibit visceral hypersensitivity. AIM: The purpose of this study was to determine whether patients with CD have increased sedation requirements during endoscopic procedures. METHODS: In this retrospective cohort study, we identified CD patients undergoing either a colonoscopy or esophagogastroduodenoscopy (EGD), but not a dual procedure. CD patients were matched with control patients according to age, gender and endoscopist. For sedation requirements we defined "high" as falling outside of the 75th percentile of the entire cohort. RESULTS: In the colonoscopy analysis we identified 113 CD patients and 278 controls. In the CD group, 29 individuals (26%) required high amounts of both opioids and midazolam, as compared to 46 (17%) controls (P = 0.05). Differences were similar when considering only opioids (P = 0.06) and midazolam (P = 0.06). In the EGD analysis we identified 314 CD patients and 314 controls who met the inclusion criteria. Among the CD patients, 70 (22%) required high amounts of both opioids and midazolam compared to 51 (16%) controls (P = 0.05). Differences were similar when considering only opioids (P = 0.06) and midazolam (P = 0.04). CONCLUSIONS: Patients with CD require higher doses of sedation during upper and lower endoscopy compared to age and gender-matched controls. Putative explanations, such as visceral hypersensitivity, chronic opioid/anxiolytic use, or underlying neuropsychiatric illness, should be evaluated prospectively.
Assuntos
Analgésicos Opioides/administração & dosagem , Doença Celíaca/diagnóstico , Colonoscopia , Sedação Consciente , Endoscopia do Sistema Digestório , Hipnóticos e Sedativos/administração & dosagem , Midazolam/administração & dosagem , Feminino , Fentanila , Humanos , Masculino , Meperidina/administração & dosagem , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: There are few data on pediatric celiac disease in the United States. The aim of our study was to describe the presentation of celiac disease among children with a normal and an elevated body mass index (BMI) for age, and to study their BMI changes following a gluten-free diet (GFD). PATIENTS AND METHODS: One hundred forty-two children (age 13 months-19 years) with biopsy-proven celiac disease, contained in a registry of patients studied at our center from 2000 to 2008, had follow-up growth data available. Patients' height, weight, and BMI were converted to z scores for age and grouped by BMI as underweight, normal, and overweight. Compliance was confirmed using results of serological assays, and data of noncompliant patients were analyzed separately. Data were analyzed during the observation period and were expressed as change in height, weight, and BMI z score per month of dietary treatment. RESULTS: Nearly 19% of patients had an elevated BMI at diagnosis (12.6% overweight, 6% obese) and 74.5% presented with a normal BMI. The mean duration of follow-up was 35.6 months. Seventy-five percent of patients with an elevated BMI at diagnosis decreased their BMI z scores significantly after adherence to a GFD, normalizing it in 44% of cases. Of patients with a normal BMI at diagnosis, weight z scores increased significantly after treatment, and 13% became overweight. CONCLUSIONS: Both normal weight and overweight frequently occur in North American children presenting with celiac disease. A GFD may have a beneficial effect upon the BMI of overweight and obese children with celiac disease.
Assuntos
Doença Celíaca/epidemiologia , Dieta Livre de Glúten , Sobrepeso/epidemiologia , Adolescente , Índice de Massa Corporal , Peso Corporal , Doença Celíaca/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Obesidade/complicações , Obesidade/dietoterapia , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/dietoterapia , Cooperação do Paciente , Prevalência , Análise de Regressão , Estudos Retrospectivos , Magreza/fisiopatologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Recent evidence has shown that after the initial occlusion, a large portion of stroke patients achieve some degree of reperfusion either through collateral circulation or clot dissolution. However, it appears that this reperfusion may lead to increased inflammation-induced damage. Even though the exact mechanism of this secondary injury is unclear, several experimental studies have indicated an intimate connection between complement and this secondary form of damage. We review the available literature and attempt to identify promising clinical therapeutic targets.
Assuntos
Ativação do Complemento/efeitos dos fármacos , Inativadores do Complemento/uso terapêutico , Traumatismo por Reperfusão/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Animais , Encéfalo/fisiopatologia , Ativação do Complemento/fisiologia , Modelos Animais de Doenças , Humanos , Modelos Biológicos , Neurogênese/efeitos dos fármacos , Traumatismo por Reperfusão/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologiaRESUMO
Inflammation has a significant role in the neurological injury that follows stroke. The receptor for advanced-glycation end products (RAGE) is a multiligand member of the immunoglobulin superfamily that has been implicated in multiple neuronal and inflammatory stress processes. To directly test the role of neuronal RAGE in stroke, we employed two cohorts of transgenic mice, one over-expressing full-length functional human RAGE in neurons, and the other a human RAGE transgene in which deletion of the cytoplasmic domain of the receptor in neurons suppresses signal transduction stimulated by ligands (referred to as dominant negative or DN-RAGE). We found a statistically significant increase in stroke volume in the RAGE over-expressing cohort compared to normal controls, and a trend towards decreased stroke volume in the DN RAGE cohort. These results indicate that RAGE signaling directly contributes to pathology in cerebral ischemia.
Assuntos
Ataque Isquêmico Transitório/metabolismo , Ataque Isquêmico Transitório/patologia , Neurônios/metabolismo , Receptores Imunológicos/metabolismo , Animais , Modelos Animais de Doenças , Regulação da Expressão Gênica/fisiologia , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Estrutura Terciária de Proteína/genética , Receptor para Produtos Finais de Glicação Avançada , Receptores Imunológicos/química , Receptores Imunológicos/genética , Índice de Gravidade de DoençaRESUMO
The complement anaphylatoxin C3a contributes to injury after cerebral ischemia in mice. This study assesses the effect of C3a receptor antagonist (C3aRA) on leukocyte infiltration into the ischemic zone. Transient or permanent middle cerebral artery occlusion (MCAO) was induced in wild-type C57Bl/6 mice. Intraperitoneal C3aRA or vehicle was administered 45 mins before or 1 h after occlusion. Twenty-four hours after occlusion, we harvested brain tissue and purified inflammatory cells using flow cytometry. Soluble intercellular adhesion molecule (ICAM)-1 protein levels were assessed using enzyme-linked immunosorbent assays, and ICAM-1 and C3a receptor (C3aR) expression was confirmed via immunohistochemistry. In the transient MCAO model, animals receiving C3aRA showed smaller strokes, less upregulation of C3aR-positive granulocytes, and less ICAM-1 protein on endothelial cells than vehicle-treated animals; no significant differences in other inflammatory cell populations were observed. C3a receptor antagonist-treated and vehicle-treated animals showed no differences in stroke volume or inflammatory cell populations after permanent MCAO. These data suggest that blocking the binding of C3a to C3aR modulates tissue injury in reperfused stroke by inhibiting the recruitment of neutrophils to the ischemic zone. It further establishes antagonism of the C3a anaphylatoxin as a promising strategy for ameliorating injury after ischemia/reperfusion.
Assuntos
Arginina/análogos & derivados , Compostos Benzidrílicos/farmacologia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/metabolismo , Complemento C3a/antagonistas & inibidores , Granulócitos/patologia , Receptores de Complemento/antagonistas & inibidores , Anafilatoxinas/metabolismo , Animais , Arginina/farmacologia , Encéfalo/patologia , Isquemia Encefálica/patologia , Complemento C3a/metabolismo , Modelos Animais de Doenças , Citometria de Fluxo , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/metabolismo , Infarto da Artéria Cerebral Média/patologia , Molécula 1 de Adesão Intercelular/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fármacos Neuroprotetores/farmacologia , Receptores de Complemento/metabolismo , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologiaRESUMO
The complement cascade has been implicated in ischemia/reperfusion injury, and recent studies have shown that complement inhibition is a promising treatment option for acute stroke. The development of clinically useful therapies has been hindered, however, by insufficient understanding of which complement subcomponents contribute to post-ischemic injury. To address this issue, we subjected mice deficient in selected complement proteins (C1q, C3, C5) to transient focal cerebral ischemia. Of the strains investigated, only C3-/- mice were protected, as demonstrated by 34% reductions in both infarct volume (P<0.01) and neurological deficit score (P<0.05). C3-deficient mice also manifested decreased granulocyte infiltration (P<0.02) and reduced oxidative stress (P<0.05). Finally, administration of a C3a-receptor antagonist resulted in commensurate neurological improvement and stroke volume reduction (P<0.05). Together, these results establish C3 activation as the key constituent in complement-related inflammatory tissue injury following stroke and suggest a C3a anaphylatoxin-mediated mechanism.
Assuntos
Isquemia Encefálica/prevenção & controle , Complemento C3/fisiologia , Inflamação/prevenção & controle , Animais , Isquemia Encefálica/etiologia , Isquemia Encefálica/patologia , Movimento Celular , Modelos Animais de Doenças , Granulócitos , Inflamação/etiologia , Inflamação/patologia , Proteínas de Membrana/antagonistas & inibidores , Camundongos , Camundongos Knockout , Estresse Oxidativo , Receptores de Complemento/antagonistas & inibidores , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologiaRESUMO
Cerebral ischemia and reperfusion initiate an inflammatory process which results in secondary neuronal damage. Immunomodulatory agents represent a promising means of salavaging viable tissue following stroke. The complement cascade is a potent mediator of inflammation which is activated following cerebral ischemia. Complement is deposited on apoptotic neurons which likely leads to injury in adjacent viable cells. Studies suggest that blocking the complement cascade during the early phases of infarct evolution may result in decreased penumbral tissue infarction and limit the extent of brain injury. Additionally, other elements of the complement cascade may play a critical role in cell survival. In this paper, we review the role of the complement cascade in neuronal damage following ischemic injury and emphasize possible therapeutic targets.
Assuntos
Proteínas do Sistema Complemento/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Isquemia Encefálica/fisiopatologia , Humanos , Inflamação/tratamento farmacológico , Neurônios/patologia , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/fisiopatologiaRESUMO
This study examined relative psychiatric burden among patients who presented to the emergency department once or more than once for inflammatory bowel disease visits. Results highlight the need for integration of psychiatric and gastrointestinal care among high-risk inflammatory bowel disease patients.
RESUMO
It has been demonstrated by numerous studies that apoptotic cell death pathways are implicated in ischemic cerebral injury in ischemia models in vivo. Experimental ischemia and reperfusion models, such as transient focal/global ischemia in rodents, have been thoroughly studied and the numerous reports suggest the involvement of cell survival/death signaling pathways in the pathogenesis of apoptotic cell death in ischemic lesions. In these models, reoxygenation during reperfusion provides oxygen as a substrate for numerous enzymatic oxidation reactions and for mitochondrial oxidative phosphorylation to produce adenosine triphosphate. Oxygen radicals, the products of these biochemical and physiological reactions, are known to damage cellular lipids, proteins, and nucleic acids and to initiate cell signaling pathways after cerebral ischemia. Genetic manipulation of intrinsic antioxidants and factors in the signaling pathways has provided substantial understanding of the mechanisms involved in cell death/survival signaling pathways and the role of oxygen radicals in ischemic cerebral injury. Future studies of these pathways could provide novel therapeutic strategies in clinical stroke.
Assuntos
Isquemia Encefálica/metabolismo , Neurônios/metabolismo , Estresse Oxidativo/fisiologia , Transdução de Sinais/fisiologia , Animais , Morte Celular/fisiologia , Sobrevivência Celular/fisiologia , HumanosRESUMO
BACKGROUND: Diverticulitis in admitted inpatients is well reported. This study examined colonic diverticulitis treated in the emergency department (ED). METHODS: The 2010 Nationwide Emergency Department Sample was used to examine relationships among patient age and inpatient admission, surgical intervention, and in-hospital mortality among ED patients with a primary diagnosis of diverticulitis. RESULTS: Of 310,983 ED visits for primary diverticulitis, 53% resulted in hospitalization and 6% in surgical intervention. Most patients 65+ years old were female (69%), and most were hospitalized (63%). Seven percent of ED patients aged 65+ underwent surgery and .96% died in hospital. Patients aged less than 40 years (13% of all admissions) were mostly male (63%), 42% were hospitalized, 4% underwent surgery, and less than .01% died. Compared with patients aged less than 40 years, those 65+ demonstrated greater odds of admission (odds ratio 1.53, 95% confidence interval 1.43 to 1.64) and surgical intervention (odds ratio 1.45, 95% confidence interval 1.27 to 1.65). CONCLUSIONS: Half of ED patients were hospitalized and 6% of ED visits resulted in colectomy. Fully 13% of ED patients were less than 40 years old. Future studies examining outpatient services may further illuminate the epidemiology of diverticulitis.
Assuntos
Doença Diverticular do Colo/cirurgia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados UnidosRESUMO
OBJECTIVES: Pancreatic intraepithelial neoplasia (PanIN), thought to represent the dominant precursor of pancreatic adenocarcinoma (PDAC), is often found synchronously adjacent to resected PDAC tumors. However, its prognostic significance on outcome after PDAC resection is unknown. METHODS: A total of 342 patients who underwent resection for PDAC between 2005 and 2010 at a single institution were identified and stratified according to highest grade of PanIN demonstrated surrounding the tumor. Clinical and pathologic characteristics of each patient and tissue were recorded and analyzed. The primary outcome was length of survival after resection. RESULTS: An absence of PanIN lesions was identified in 32 patients (9%), low grade PanIN without synchronous high grade lesions was identified in 52 patients (15%), and high grade PanIN was found in 258 patients (75%). Median survival were 12.8 months for the non-PanIN group, 26.3 months for the low-grade PanIN group, and 23.8 months for the high-grade PanIN groups (P = 0.043). In multivariable analysis, absence of PanIN was independently associated with poor survival (P = 0.002). CONCLUSIONS: The patients who demonstrate an absence of PanIN in the pancreatic tissue adjacent to the resected PDAC tumor have shorter postresection survival compared with those who demonstrate a PanIN lesion.
Assuntos
Carcinoma in Situ/patologia , Carcinoma Ductal Pancreático/patologia , Pancreatectomia , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal Pancreático/tratamento farmacológico , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/secundário , Carcinoma Ductal Pancreático/cirurgia , Diferenciação Celular , Transformação Celular Neoplásica , Terapia Combinada , Progressão da Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Prognóstico , Resultado do TratamentoRESUMO
Neuroprotective therapy targeting the complement cascade may reduce injury associated with intracerebral hemorrhage (ICH). We investigated the role of C3a-receptor antagonist (C3aRA) after ICH in mice. Autologous whole blood was infused into the right striatum of mice that were treated with C3aRA or vehicle, using both a pre- and postinjury dosing regimen. Hematoma volume, brain water content, and inflammatory cell profile were assessed at 72 h post-ICH. Neurologic dysfunction was assessed by evaluating both spatial memory and sensorimotor capacity. Animals pretreated with C3aRA showed significantly improved neurologic function, brain water content, and granulocyte infiltration relative to vehicle-treated animals when assessed at 72 h. There was no significant difference in hemorrhagic/nonhemorrhagic ratio of microglial activation among all groups. Hematoma volumes were also not significantly different between C3aRA-treated and vehicle-treated animals. Administration of C3aRA beginning 6 h postinjury afforded significant amelioration of neurologic dysfunction as well as a reduction in brain water content. Treatment with C3aRA improved neurologic outcome while reducing inflammatory cell infiltration and brain edema formation after experimental ICH in mice. Results of this study suggest that the C3a receptor may be a promising target for therapeutic intervention in hemorrhagic stroke.
Assuntos
Lesões Encefálicas/prevenção & controle , Hemorragia Cerebral/patologia , Fármacos Neuroprotetores/farmacologia , Receptores de Complemento/antagonistas & inibidores , Animais , Comportamento Animal/efeitos dos fármacos , Lesões Encefálicas/metabolismo , Hemorragia Cerebral/metabolismo , Granulócitos , Hematoma/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microglia/efeitos dos fármacos , Receptores de Complemento/metabolismo , Água/metabolismoRESUMO
Recent studies have focused on elucidating the contribution of individual complement proteins to post-ischemic cellular injury. As the timing of complement activation and deposition after cerebral ischemia is not well understood, our study investigates the temporal pattern of C1q accumulation after experimental murine stroke. Brains were harvested from mice subjected to transient focal cerebral ischemia at 3, 6, 12, and 24 hr post reperfusion. Western blotting and light microscopy were employed to determine the temporal course of C1q protein accumulation and correlate this sequence with infarct evolution observed with TTC staining. Confocal microscopy was utilized to further characterize the cellular localization and characteristics of C1q deposition. Western Blot analysis showed that C1q protein begins to accumulate in the ischemic hemisphere between 3 and 6 hr post-ischemia. Light microscopy confirmed these findings, showing concurrent C1q protein staining of neurons. Confocal microscopy demonstrated co-localization of C1q protein with neuronal cell bodies as well as necrotic cellular debris. These experiments demonstrate the accumulation of C1q protein on neurons during the period of greatest infarct evolution. This data provides information regarding the optimal time window during which a potentially neuroprotective anti-C1q strategy is most likely to achieve therapeutic success.