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trial fibrillation (AF) is a common arrhythmia that represents an independent and evident risk factor for systemic embolism, particularly ischemic stroke, and exerts a significant impact on post-stroke mortality. Interestingly, stroke caused by AF displays distinctive features, such as severe neurological deficits, disability and high mortality, 1 so AF is likely to play an important role in the etiology of perioperative and in-hospital-onset stroke. 2,3 Given the evidence accumulated over the past decade, AF seems to be becoming a greater public health burden and crucial problem for the social welfare of populations of advancing age.The prevalence of AF in adults ≥40 years old is reportedly 0.7% in Korea, which has largely maintained a traditional Asian lifestyle, and 2.3% in the United States. 4,5 In previous population-based studies, 2 implications have been identified: (1) AF is more frequent in men than in women in each generation; and (2) the prevalence of AF increases with age. Indeed, the prevalence of AF has been investigated in several countries, but many epidemiological uncertainties remain, particularly the prevalence in Japanese populations.Circulation Journal Vol.72, June 2008 In this analysis, the Kurashiki Annual Medical Survey (KAMS) was used to investigate the prevalence and clinical factors associated with AF in a large community-based epidemiological study. MethodsThe KAMS study is a prospective population-based investigation of risk factors for AF in men and women aged ≥40 year old. We enrolled the 246,246 adult residents in Kurashiki-city who received an official mail request to participate in a screening health test from May to December 2006. The Kurashiki-city Public Health Center did not send this notification to employees of government, private companies, offices and factories because the Labor Standards Law has regulated that employers should survey the heath of their employees. After excluding residents who were employees, a total of 41,436 residents (mean age, 72.1±11.3 years; 13,963 men) participated in the KAMS study.All participants answered questions on history of illness (hypertension, diabetes mellitus, hypercholesterolemia, cardiac disease, renal dysfunction and liver disease) and smoking status, and underwent physical examinations including blood pressure, electrocardiography (ECG), and blood testing (total cholesterol, triglycerides, fasting glucose and hemoglobin A1c). Body mass index was calculated as weight in kilograms divided by height in meters squared. Arterial blood pressure was carefully measured in the arm with the patient seated after resting for a few minutes, following the Guidelines of Elders' Welfare and Health in Kurashiki-city.

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Background and Purpose: Patients with unknown onset time would be able to receive intravenous thrombolysis when showing diffusion-weighted imaging (DWI)/fluid-attenuated inversion recovery (FLAIR) mismatch. Methods: Consecutive acute stroke patients with unknown onset time were prospectively enrolled. We defined patients as having unknown onset time when the last known normal time (LNT) was not consistent with the first found abnormal time (FAT). Only patients with anterior-circulation stroke and presence of arterial lesion were enrolled. Intravenous thrombolysis was conducted within 3 h from FAT if the patient showed DWI/FLAIR mismatch. Results: From June 2009 to May 2010, 10 patients [median age, 84 years (interquartile range, IQR, 64–90); National Institutes of Health Stroke Scale (NIHSS) score, 14 (IQR, 9–19)] were enrolled. Subjects included 4 patients who developed stroke during sleep, 5 with disturbance of consciousness, and 1 with aphasia. Median interval between LNT and thrombolysis was 5.6 h (IQR, 4.5–9.8) and median interval between FAT and thrombolysis was 2.5 h (IQR, 2.1–2.8). Three patients had internal carotid artery occlusion, 5 had M1 occlusion, and 2 had M2 occlusion. Early recanalization within 24 h was seen in 7 patients (complete recanalization, n = 4; partial recanalization, n = 3). No patients experienced symptomatic cerebral hemorrhage within 48 h. At day 7, 5 patients showed dramatic recovery (defined as ≧10-point reduction in total NIHSS score or score of 0 or 1). At 3 months, favorable outcome (modified Rankin scale score, 0–2) was seen in 4 patients. Conclusion: Acute stroke patients with DWI/FLAIR mismatch may be able to safely receive intravenous thrombolysis.

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