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Background: We evaluated whether serum antibody levels against individual periodontal pathogens are significantly associated with ischemic stroke subtypes and their risk factors. Methods: Patients with acute ischemic stroke (n=132; 74 male and 58 female, 71.3±10.7 years) and patients with no previous stroke (n=77; 38 male and 39 female, 70.7±9.5 years) were consecutively enrolled in this study. Stroke subtype was evaluated based on the TOAST classification. Serum was obtained from each patient after obtaining the patient’s consent to participate in this study. The levels of serum antibodies against Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi) were evaluated by ELISA. Results: The serum-antibody level of Pi was significantly higher in atherothrombotic-stroke patients than in patients with no previous stroke (p Conclusions: Our results suggest that anti-Pg antibody is associated with atrial fibrillation and anti-Pi antibody is associated with carotid artery atherosclerosis. Additionally, anti-Pi antibody may be associated with atherothrombotic stroke through its association with carotid artery atherosclerosis.

Background: We have identified alpha2-macroglobulin as an acute stroke biomarker by using proteomic technologies with two-dimensional gel electrophoresis (2D-PAGE) and liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Alpha2-macroglobulin is known as a protease inhibitor, which enhance procoagulant properties by the neutralization of plasmin, plasminogen activators and metalloproteinases. The objective of this study was to evaluate the usefulness of serum alpha2-macroglobulin levels in acute ischemic stroke patients. Methods: Patients with acute ischemic stroke (n=159; 93 male and 66 female, 71.6±10.3 years) and patients with no previous stroke (n=77; 38 male and 39 female, 70.7±9.5 years) were consecutively enrolled in this study. Stroke subtype was evaluated based on the TOAST classification. Serum alpha2-macroglobulin levels were measured by nephelometry. Results: Serum alpha2-macroglobulin levels at admission in patients with acute ischemic stroke was higher than that in control patients (230.2±5.4 vs. 205.0±7.8 mg/dl, P=0.009). Higher age and white matter lesions by using Fazekas classification were significantly associated with high serum alpha2-macroglobulin levels (P=0.001 and P=0.005). After multivariate logistic regression analysis with sex, age, hypertension, diabetes mellitus, dyslipidemia, and atrial fibrillation, the highest quartile of serum alpha2-macroglobulin levels was independently associated with acute ischemic stroke (OR 1.52, 95% CI 1.13-2.08, P=0.005). Conclusion: Alpha2-macroglobulin, which was identified by using proteomics, was associated with higher age and white matter lesions. Additionally, serum alpha2-macroglobulin levels was associated with acute ischemic stroke independently from the other factors. Increased alpha2-macroglobulin may be involved in pathophysiology of acute ischemic stroke.

Background: Periodontitis increases the risk of atherosclerotic cardiovascular disease and ischemic stroke. In this study, we evaluated whether serum antibody levels against individual periodontal pathogens are significantly associated with ischemic stroke subtypes and their risk factors. Methods: Patients with acute ischemic stroke (n = 132; 74 male and 58 female, 71.3 ± 10.7 years) and patients with no previous stroke (n = 77; 38 male and 39 female, 70.7 ± 9.5 years) were consecutively enrolled in this study. Stroke subtype was evaluated based on the Trial of Org 10172 in Acute Stroke Treatment classification. Serum was obtained from each patient after obtaining their consent to participate in the study. The levels of serum antibodies against Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) were evaluated by ELISA. Serum high-sensitivity C-reactive protein (hs-CRP) levels were measured by nephelometry. Results: Serum hs-CRP levels were significantly associated with acute ischemic stroke even after controlling for acute ischemic stroke, hypertension, diabetes mellitus and bulb/ internal carotid artery (ICA) atherosclerosis which were statistically selected (coefficient 0.245, 95% CI 0.142–0.347, p < 0.0001). The serum-antibody level of Pi was significantly higher in atherothrombotic-stroke patients than in patients with no previous stroke (p = 0.0035). Detectable serum anti-Pg antibody was significantly associated with atrial fibrillation (overall χ2 = 35.5, R2 = 0.18, n = 209, p < 0.0001; anti-Pg antibody: OR 4.36, 95% CI 1.71–12.10, p = 0.0017), and detectable serum anti-Pi antibody was significantly associated with bulb/ICA atherosclerosis after controlling for the statistically selected associated factors (overall χ2 = 46.1, R2 = 0.18, n = 209, p < 0.0001; anti-Pg antibody: OR 16.58, 95% CI 3.96–78.93, p < 0.0001). The levels of serum anti-Pi antibody were significantly associated with atherothrombotic stroke with the statistically selected associated factors excluding bulb/ICA atherosclerosis (overall χ2 = 77.0, R2 = 0.44, n = 129, p < 0.0001; anti-Pi antibody: OR 23.6, 95% CI 2.65–298.2, p = 0.008). However, when we included bulb/ICA atherosclerosis in this model, the levels of serum anti-Pi antibody were no longer significantly associated with atherothrombotic stroke (overall χ2 = 98.0, R2 = 0.56, n = 129, p < 0.0001; anti-Pi antibody: p = 0.107). Conclusions: Our results suggest that anti-Pg antibody is associated with atrial fibrillation and that anti-Pi antibody is associated with carotid artery atherosclerosis. In addition, anti-Pi antibody may be associated with atherothrombotic stroke through its association with carotid artery atherosclerosis. Thus, periodontitis may lead to serious systemic diseases.

Although several studies have reported various causes of ischemic stroke in patients with cancer, only a few have evaluated the clinical relevance of ischemic stroke pathogenesis to cancer. The aim of the present study was to elucidate the clinical characteristics of cancer-associated ischemic stroke.We evaluated 154 ischemic stroke patients without cancer and 57 ischemic stroke patients with cancer who had either received continuous treatment for cancer within 5 years before to the onset of ischemic stroke, or who had been diagnosed with cancer within 1 year after the onset of ischemic stroke. Cancer patients were grouped into "cancer-associated ischemic stroke," the "conventional ischemic stroke," or "other."A total of 15 patients (26%) were classified into the cancer-associated ischemic stroke in cancer patients. In univariate analysis of the cancer-associated ischemic stroke and the others, there were significant differences in the prevalence of hypertension, hyperlipidemia and advanced cancer (clinical stage IV), and the levels of d-dimer, fibrin degradation product and hemoglobin. With multivariate regression analysis of those factors, the prevalence of hypertension, hyperlipidemia and advanced cancer (clinical stage IV), and the levels of D-dimer and fibrin degradation product remained as statistically independent factors, which were associated with cancer-associated ischemic stroke (n = 111, χ(2) =67.21, P0.0001).In acute ischemic stroke, the cancer-associated ischemic stroke is associated with elevated D-dimer and fibrin degradation products, even after controlling hypertension, hyperlipidemia and advanced cancer (clinical stage IV).

This paper is concerned with two themes: (1) characteristics of rural housing development around towns in terms of land use, land-ownership and land-partition and (2) attitudes of local residents to this development.A rural settlement in Shiojiri administrative city, Nagano prefecture, was selected as the study area based on the analysis of the population movement of Shiojiri city. The conclusions are as follows:1. There are four stages in residential development. (1) Dwelling development only for local needs. esidential development for newcomers from the cities. At this stage, only villagers sell land. (3) Height of newcomer-oriented residential development. At this stage, not only villagers but those who live outside the settlement sell land and the marketting of land becomes active. The main providers of land are long-term owners, those with more than 10 years of ownership, and selling land after partition is the norm. In some cases, however, land is sold at the time of inheritance. (4) Flattening of the pace of residential development.2. Residential development moves from one place to another in the periphery of the settlement.3. The main providers of land are farmers from head families. The lump sum of money they get by selling land is used for consumption. The building of a new house for themself is one example. The main reason for newcomers moving into the settlement is the lower price of housing land.4. The established residents have much interest in the residential development. On the one hand, they see the advantages because the arrival of newcomers makes the community active, but on the other, they see the disadvantages because it brings about problems in many aspects of rural life. As for the residents' view of the future land use of the settlement, two types of answers are given; one group wishes to maintain the present land-use pattern, and the other to segregate land for living and for agriculture. The residents who have stronger sense of belonging tend to be more conservative about housing development. Those who support land control by law wish for the segregation of land use between living and agriculture.