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Lay Summary 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.

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.

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.

Diverticulitis in admitted inpatients is well reported. This study examined colonic diverticulitis treated in the emergency department (ED). 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. 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). 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. •The majority of patients presenting for ED treatment of diverticulitis in 2010 were younger than 65.•Fully 13% of patients presenting for ED treatment of diverticulitis were younger than 40.•A significant association between patient age and sex was observed, with younger diverticulitis patients more likely to be male and older patients more likely to be female.•More than half of all patients presenting to the ED with a primary diagnosis of diverticulitis were admitted to inpatient care.•Surgical intervention was relatively uncommon, even among patients in the oldest age group.

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 C57BI/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.

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.

INTRODUCTION:The prevalence of inflammatory bowel disease (IBD, ulcerative colitis (UC) and Crohn's disease (CD)) has been estimated to be approximately 400-600 per 100,000 persons in the United States,3 but this relies on data skewed heavily towards Caucasian populations. Previous studies have suggested that IBD prevalence in Asia is much lower, around 30-60 per 100,000.7 A recent study highlighted higher rates and more extensive UC in migrant groups than in their home countries.5 However, the overall trend with IBD being more prevalent in Caucasians compared to Asians has been shown previously. One caveat to this is in South Asians, who have a higher incidence and prevalence of UC compared to the indigenous population of the UK.5 In this study we seek to further breakdown the prevalence of IBD among Asian subgroups in a Northern California integrated health care delivery system.METHODS:Adults aged 18 years and older diagnosed with IBD between 1/1/2014-12/31/2014 were identified with ICD-9 diagnosis codes for UC (556.x) and CD (555.x). We calculated overall period prevalence of IBD, UC and CD by race/ethnicity, including Asian subtypes.RESULTS:Among 7,766 Kaiser Permanente Northern California (KPNC) members with IBD, the prevalence of IBD was higher in Caucasians compared to Asians (377 vs 125 per 100,000, P < 0.01 Table 1). However, when Asians were further subclassified, the period prevalence among South Asians was significantly higher than not only the other Asian subgroups, but also the Caucasian group (504 vs 377 per 100,000). Breaking up IBD into CD and UC, the period prevalence among Asians continued to be significantly lower than Caucasians (Table 2). However, among South Asians the prevalence of UC is again higher than that of Caucasians (417 vs 208 per 100,000). Interestingly, the prevalence of CD is less among South Asians compared to Caucasians (87 vs 169 per 100,000).CONCLUSION:Our data from a diverse patient population in Northern California show an overall lower prevalence of IBD in Asian compared to Caucasian patients overall but a higher prevalence among South Asians. Our data is consistent with prior Canadian and UK studies.5 Most American studies combine South Asians into the Asian category, which shows a deceptively decreased prevalence compared to the Caucasian population. Further studies are needed to understand the etiology of this finding and seek to further explore the differences among Asian subpopulations.Table 1.Prevalence of IBD, UC, and CD by Race/Ethnicity SubgroupsTable 2.Prevalence of IBD, UC, and CD by Asian Subgroups