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To assess the influence of periodontal disease on cerebral hemorrhage and its clinical course, we examined the association of the serum IgG titer of periodontal pathogens with hemorrhage growth and 3-month outcome. We consecutively enrolled 115 patients with acute cerebral hemorrhage (44 females, aged 71.3 ± 13.1 years) and used ELISA to evaluate the serum IgG titers of 9 periodontal pathogens: Porphyromonas gingivalis, Aggregatibacter (A.) actinomycetemcomitans, Prevotella intermedia, Prevotella nigrescens, Fusobacterium (F.) nucleatum, Treponema denticola, Tannerella forsythensis, Campylobacter rectus, and Eikenella corrodens. Significant hematoma growth was defined as an increase in the volume of >33% or an absolute increase in the volume of >12.5 mL. A poor outcome was defined as a 3 or higher on the modified Rankin Scale. We observed hemorrhage growth in 13 patients (11.3%). Multivariate analysis revealed that increased IgG titers of A. actinomycetemcomitans independently predicted the elevated hemorrhage growth (odds ratio 5.26, 95% confidence interval 1.52-18.25, p = 0.01). Notably, augmented IgG titers of F. nucleatum but not A. actinomycetemcomitans led to a poorer 3-month outcome (odds ratio 7.86, 95% confidence interval 1.08-57.08, p = 0.04). Thus, we demonstrate that elevated serum IgG titers of A. actinomycetemcomitans are an independent factor for predicting cerebral hemorrhage growth and that high serum IgG titers of F. nucleatum may predict a poor outcome in patients with this disease. Together, these novel data reveal how systemic periodontal pathogens may affect stroke patients, and, should, therefore, be taken into consideration in the management and treatment of these individuals., Competing Interests: Hirofumi Maruyama reports research support from Eisai, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Shionogi, Teijin Pharma, Fuji Film, Boehringer Ingelheim, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Kyowa Hakko Kirin, Sanofi, Novartis, Kowa Pharmaceutical, Astellas Pharma, Tsumura, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, and Mylan which are unrelated to the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare that they have no conflicts of interest.

Oral health conditions and cerebral small vessel disease, such as white matter lesions or cerebral microbleeds (CMBs), are associated with the incidence of stroke. The purpose of this study was to examine the associations between oral health conditions (serum IgG titers of periodontal pathogens) with the presence or severity of CMBs in acute stroke patients. From January 2013 to April 2016, acute stroke patients were registered in two hospitals. Serum samples were evaluated for antibody titers against 9 periodontal pathogens using the ELISA method. The cut-off points for reactivity (the positive decision point) to each antigen were defined as more than a mean ELISA unit + 1 standard deviation (after logarithmic transformation) in all subjects. CMBs were evaluated on T2*-weighted MRI. In all, 639 patients were evaluated (ischemic, n = 533 and hemorrhagic, n = 106; 73.1 ± 12.9 years old). Among these patients, 627 were available for CMB evaluation. Among the 9 evaluated periodontal pathogens, only Campylobacter rectus (C. rectus) was associated with the presence of CMBs. the prevalence of positive serum antibody titers against C. rectus was higher among patients with CMBs than among those without CMBs (14.6% vs. 8.7%, P = 0.025). In addition, positive serum antibody titers against C. rectus remained one of the factors associated with the presence of CMBs in multivariate logistic analysis (odds ratio 2.03, 95% confidence interval 1.19-3.47, P = 0.010). A positive serum antibody titer against C. rectus was associated with the presence of CMBs in acute stroke patients., Competing Interests: Dr. Maruyama reports grants and personal fees from Eisai, grants and personal fees from Pfiser, grants and personal fees from Takeda Pharmaceutical, grants and personal fees from Otsuka Pharmaceutical, grants and personal fees from Nihon Pharmaceutical, grants and personal fees from Teijin Pharma, grants from Shionogi, grants and personal fees from Fuji Film, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Sumitomo Dainippon Pharma, grants and personal fees from Nihon Medi-Physics, grants and personal fees from Bayer, grants and personal fees from MSD, grants and personal fees from Daiichi Sankyo, grants and personal fees from Kyowa Kirin, grants and personal fees from Sanofi, grants and personal fees from Novartis, grants and personal fees from Kowa Pharmaceutical, grants and personal fees from Astellas Pharma, grants and personal fees from Japan Blood Products Organization, grants and personal fees from Mitsubishi Tanabe Pharma, personal fees from Ono pharmaceutical, personal fees from Biogen, personal fees from Bristol-Myers Squibb, grants from Mylan which are unrelated to the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare that they have no conflicts of interest.

Background: Fabry disease is an X-linked lysosomal storage disorder caused by mutations in GLA, which encodes the enzyme α-galactosidase A (α-Gal A). Although the prevalence of Fabry disease in patients with stroke has been reported to range from 0% to 4%, few cohort studies have examined Japanese stroke patients. We aimed to clarify the prevalence of Fabry disease and the frequency of GLA mutations among patients with young-onset stroke in Japan., Methods: From April 2015 to December 2016, we enrolled patients with young-onset (≤60 years old) ischemic stroke or intracerebral hemorrhage. We measured α-Gal A activity and the concentration of globotriaosylsphingosine in plasma. Genetic evaluations were performed in patients with low α-Gal A activity or high concentrations of globotriaosylsphingosine., Results: Overall, 516 patients (median age of onset, 52 years old; 120 women) were consecutively enrolled in this study. Five patients (4 men and 1 woman) had low α-Gal A activity, and no patients were detected with the screen for plasma globotriaosylsphingosine levels. The genetic analysis did not identify a causative mutation responsible for classic Fabry disease in any of the patients, but 2 patients (.4%) carried the p.E66Q in GLA., Conclusions: No patient with Fabry disease was detected in our young-onset stroke cohort., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Purpose: Prognostic values of blood glucose levels following admission remain unclear. We investigated associations between blood glucose levels during the initial 72 h and outcomes of acute ICH., Methods: Participants comprised hyperacute ICH patients who received intravenous antihypertensive treatment. Blood glucose levels were measured on admission and at 24 and 72 h after starting treatment, along with hemoglobin (Hb)A1c level on admission. Associations with clinical outcomes of hematoma expansion (>33% increase), none to minimal disability (3-month modified Rankin Scale [mRS] 0-1) and bedridden or death (3-month mRS 5-6) were analyzed., Results: Of the 176 patients (70 women; 65 ± 12 years), 30 (18%) showed hematoma expansion, and 33 (19%) had none to minimal disability and 15 (10%) were bedridden or died. On multivariate regression analysis, blood glucose at 24h (per 10mg/dl odds ratio [OR], 0.84; 95% confidence interval [CI], 0.69-0.98) and blood glucose at 72 h (OR, 0.75; 95%CI, 0.59-0.92) were inversely associated with none to minimal disability, and blood glucose at 24h (OR, 1.14; 95%CI, 1.00-1.30) was positively associated with bedridden or death. No parameters were associated with hematoma expansion., Conclusions: High blood glucose levels at 24 and 72 h were independently associated with poor functional outcomes 3 months after ICH. We need to investigate whether blood glucose control during the acute period ameliorates clinical outcomes., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Strains of Streptococcus mutans expressing the cell surface collagen‐binding protein, Cnm, encoded by cnm (cnm‐positive S. mutans), are associated with hypertensive intracerebral hemorrhage (ICH) and the occurrence of cerebral microbleeds (CMBs). Small diffusion‐weighted imaging (DWI) hyperintensities in patients with acute ICH are also associated with CMBs. However, the association between cnm‐positive S. mutans and DWI hyperintensities is unclear. Hence, this study aimed to investigate the association between cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH. Methods: Patients with acute ICH were prospectively registered at three hospitals. Dental plaque specimens were collected within 4 days after admission, and cnm‐positive S. mutans was detected using the polymerase chain reaction. Magnetic resonance imaging at 14 ± 5 days after admission was used to evaluate DWI hyperintensities and CMBs. Results: A total of 197 patients were enrolled in this study. cnm‐positive S. mutans was detected in 30 patients (15.2%), and DWI hyperintensities were observed in 56 patients (28.4%). Patients with cnm‐positive S. mutans had a higher frequency of DWI hyperintensities (50.0% vs 24.6%; p = 0.008) and a higher number of CMBs (5.5 vs 1.5; p < 0.001) than those without cnm‐positive S. mutans. Multivariable logistic analysis revealed that the presence of cnm‐positive S. mutans was independently associated with DWI hyperintensities (OR 2.38; 95% CI 1.01–5.61; p = 0.047) after adjusting for several confounding factors. Conclusion: This study found an association between the presence of cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH. [ABSTRACT FROM AUTHOR]