Background-Although the participation of inflammation in atherogenesis is widely recognized, the identification of the different components has not been clarified. In particular, the role of inflammation in plaque destabilization is not fully understood. Methods and Results-Our main findings were as follows: (1) In a microarray experiment, we identified visfatin, one of the most recently identified adipokines, as a gene that was markedly enhanced in carotid plaques from symptomatic compared with plaques from asymptomatic individuals. This finding was confirmed when carotid plaques from 7 patients with asymptomatic and 14 patients with symptomatic lesions were examined with real-time reverse transcription polymerase chain reaction. (2) Immunohistochemistry showed that visfatin was localized in areas that were rich in lipid-loaded macrophages. (3) The relationship between visfatin and unstable lesions was also found in patients with coronary artery disease, demonstrating a strong visfatin immunostaining in lipid-rich regions within the material obtained at the site of plaque rupture in patients with acute myocardial infarction. (4) Both oxidized low-density lipoprotein and tumor necrosis factor-␣ increased visfatin expression in THP-1 monocytes, with a particularly enhancing effect when these stimuli were combined. (5) Visfatin increased matrix metalloproteinase-9 activity in THP-1 monocytes and tumor necrosis factor-␣ and interleukin-8 levels in peripheral blood mononuclear cells. Both of these effects were abolished when insulin receptor signaling was blocked. Conclusions-Our

The International Working Group on the Diabetic Foot (IWGDF) has been publishing evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This publication represents a new guideline addressing the use of classifications of diabetic foot ulcers in routine clinical practice and reviews those which have been published. We only consider systems of classification used for active diabetic foot ulcers and do not include those that might be used to define risk of future ulceration. The guidelines are based on a review of the available literature and on expert opinion leading to the identification of eight key factors judged to contribute most to clinical outcomes. Classifications are graded on the number of key factors included as well as on internal and external validation and the use for which a classification is intended. Key factors judged to contribute to the scoring of classifications are of three types: patient related (end‐stage renal failure), limb‐related (peripheral artery disease and loss of protective sensation), and ulcer‐related (area, depth, site, single, or multiple and infection). Particular systems considered for each of the following five clinical situations: (a) communication among health professionals, (b) predicting the outcome of an individual ulcer, (c) as an aid to clinical decision‐making for an individual case, (d) assessment of a wound, with/without infection, and peripheral artery disease (assessment of perfusion and potential benefit from revascularisation), and (d) audit of outcome in local, regional, or national populations. We recommend: (a) for communication among health professionals the use of the SINBAD system (that includes Site, Ischaemia, Neuropathy, Bacterial Infection and Depth); (b) no existing classification for predicting outcome of an individual ulcer; (c) the Infectious Diseases Society of America/IWGDF (IDSA/IWGDF) classification for assessment of infection; (d) the WIfI (Wound, Ischemia, and foot Infection) system for the assessment of perfusion and the likely benefit of revascularisation; and (e) the SINBAD classification for the audit of outcome of populations.

Scavenger receptors (SRs) are a ‘superfamily’ of membrane-bound receptors that were initially thought to bind and internalize modified low-density lipoprotein (LDL), though it is currently known to bind to a variety of ligands including endogenous proteins and pathogens. New family of SRs and their properties have been identified in recent years, and have now been classified into 10 eukaryote families, defined as Classes A-J. These receptors are classified according to their sequences, although in each class they are further classified based in the variations of the sequence. Their ability to bind a range of ligands is reflected on the biological functions such as clearance of modified lipoproteins and pathogens. SR members regulate pathophysiological states including atherosclerosis, pathogen infections, immune surveillance, and cancer. Here, we review our current understanding of SR structure and function implicated in health and disease.

Abstract-Transcranial Doppler ultrasound is capable of detecting microembolic material, both gaseous and solid, within the intracranial cerebral arteries. To avoid discrediting this promising and exciting new technique, experts in this field met in January 1997 in Frankfurt, Germany, to discuss the limitations and problems of embolus detection and to determine guidelines for its proper use in clinical practice, as well as in scientific investigations. In particular, the authors suggest that studies report the following parameters: (1) ultrasound device, (2) transducer type and size, (3) insonated artery, (4) insonation depth, (5) algorithms for signal intensity measurement, (6) scale settings, (7) detection threshold, (8) axial extension of sample volume, (9) fast Fourier transform (FFT) size (number of points used), (10) FFT length (time), (11) FFT overlap, (12) transmitted ultrasound frequency, (13) high-pass filter settings, and (14) recording time. There was agreement that no current system of automatic embolus detection has the required sensitivity and specificity for clinical use.(Stroke. 1998;29:725-729.)

We used a combination of transcranial Doppler ultrasonography and single-photon emission computed tomography to noninvasively assess changes in the diameter of the middle cerebral artery induced by sublingual nitroglycerin in 10 healthy subjects. Nitroglycerin reduced mean blood flow velocities without concurrently changing regional cerebral blood flow in the perfusion territory of this vessel. Our results strongly suggest that nitroglycerin causes vasodilatation of the basal intracranial arteries. (Stroke 1989;20:1733-1736 T ranscranial Doppler ultrasonography (TCD) is a new noninvasive examination method that enables the measurement of blood flow velocities in the basal intracranial arteries.1 The assessment of changes in velocity alone does not, however, provide direct information regarding changes in diameter if there is a concurrent change in blood flow through the artery. A combination of TCD examination of a particular major intracranial artery and measurement of regional cerebral blood flow (rCBF) in the perfusion territory of this vessel theoretically allows assessment of diameter changes since it may be assumed that each major intracranial artery supplies a defined weight of brain tissue. The aim of our study was to use these two methods to assess the effects of nitroglycerin on the diameter of the middle cerebral artery (MCA) and to determine if this substance causes changes in global or regional blood flow. Subjects and MethodsTen healthy volunteers (seven men and three women, aged 24-44 [mean 32.4] years) participated in the study. Blood flow velocity in the MCA and rCBF in the estimated perfusion territory of this vessel were measured before and after the sublingual administration of 1 mg nitroglycerin.Blood flow velocity in the MCA was measured in all 10 subjects using a 2-MHz range-gated pulsedwave Doppler instrument (TC2-64, EME, Uberlin-

During left heart catheterization, cerebral microemboli, especially those which are solid, may damage the brain. Cardiac catheterization may therefore pose a greater risk for the brain than previously acknowledged.

Background and Purpose: The aim of this study was to determine the ability of transcranial Doppler ultrasonography when used to assess cerebral vasoreactivity. The results of this method were compared with regional cerebral blood flow measurements.Methods: Forty-three patients with symptoms suggesting cerebrovascular disease took part Transcranial Doppler findings in the middle cerebral arteries were compared with regional cerebral blood flow in the corresponding perfusion territories before and after acetazolamide administration.Results :

A detailed clinical study of 77 spontaneous cluster headache attacks has been carried out. The information was recorded during a period when patients were without medication and with the use of methods which were not dependent on the patients' memory of events. The findings stress the usual rapid onset and termination of attacks, and their short duration. There was a preponderance of attacks beginning during sleep and the majority of daytime attacks began when patients were physically relaxed. No significant difference between nocturnal and daytime attacks was found as regards severity or temporal profiles. A significant positive correlation was found between severity of maximal pain and both duration of maximal pain and total duration of attacks. "Abortive attacks" accounted for 16% of attacks. The apparent spontaneous arrest of these attacks does not appear to be due to special features of patient activity prior to or during attacks, nor are they restricted to a refractory period following more severe attacks.