Aims/hypothesis. We examined the association between plasma insulin and cardiovascular mortality in non-diabetic European men and women based on data from eleven prospective studies. Methods. The study population comprised 6156 men and 5351 women aged 30-89 years. Baseline measurements included oral glucose tolerance test, fasting and 2-h plasma insulin, and conventional risk factors. Cox models were used to calculate hazard ratios (HRs) and their 95% confidence intervals, and overall HRs were assessed by meta-analyses. Results. During the 8.8-year follow-up, 362 men and 70 women died from cardiovascular disease. The ageand smoking-adjusted overall HR of cardiovascular mortality for the highest vs the lower quartiles of fasting insulin was 1.58 (95% CI: 1.26-1.97) in men and 2.64 (1.54-4.51) in women. Adjusting for other risk factors in addition, the HR was 1.54 (1.16-2.03) in men and 2.66 (1.45-4.90) in women. For 2-h insulin these HRs were 1.28 (0.99-1.66), 1.87 (0.87-4.02), and 0.85 (0.60-1.21), 1.36 (0.53-3.45). The overall HRs for interquartile ranges for fasting and 2-h insulin, with full adjustment, were 1.13 (1.05-1.22) and 1.11 (1.01-1.23) in men, and 1.25 (1.08-1.45) and 1.11 (0.91-1.36) in women. Conclusions/interpretation. Hyperinsulinaemia, defined by the highest quartile cut-off for fasting insulin, was significantly associated with cardiovascular mortality in both men and women independently of other risk factors. Associations between high 2-h insulin and cardiovascular mortality were weaker and non-significant. Weak positive associations of fasting and 2-h insulin with cardiovascular mortality over interquartile ranges were, however, more similar. Diabetologia (2004) 47:1245-1256 DOI 10.1007/s00125-004-1433 Plasma insulin and cardiovascular mortality in non-diabetic European men and women: a meta-analysis of data from eleven prospective studies The DECODE Insulin Study Group IntroductionThe role of hyperinsulinaemia as an independent risk factor for cardiovascular disease (CVD) has previously been debated. An association between elevated plasma insulin, fasting or oral glucose load, and the risk of CHD or atherosclerotic CVD has been found in many [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] but not in all [17,18,19,20,21] prospective studies. Among the studies showing the positive association between plasma insulin and CVD, the effect of adjustment for other risk factors has varied. In several studies the association remained statistically significant, although attenuated [1,2,3,5,6,7,9,10,12,13,15,16] , whereas in other studies it became non-significant [4,8,11,14]. The majority of the published Corresponding author of the DECODE Insulin Study Group: G. Hu, Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland, Phone: +358-9-19127366, Fax: +358-9-19127313, e-mail: hu.gang@ktl.fi Members of the DECODE Insulin Study Group are listed at the end of the paper studies were carried...

Measuring waist circumference is subject to significant inter-operator variability and could potentially lead to misclassifying patients as having the MetS, or not. Better training of health professionals on how to measure waist circumference properly is needed in order to ensure that patients are not misclassified and that international comparisons of the prevalence of the MetS are reliable.

Cell adhesion molecules are important for localized accumulation of phagocytes at sites of tissue damage. In the present studies, we analyzed the effects of blocking hepatic macrophages on expression of ␤ 2 integrins and intercellular adhesion molecule-1 (ICAM-1) adhesion molecules on liver cells during acute endotoxemia. Flow cytometric analysis revealed distinct subpopulations of macrophages from control animals that varied on the basis of their size and density. In contrast, hepatocytes and endothelial cells were relatively homogeneous. Treatment of rats with endotoxin (5 mg/kg, intravenously) resulted in a time-dependent increase in the percentage of small, dense macrophages and a progressive loss of larger, less-dense cells. In contrast, no major effects were observed on the physical properties of hepatocytes or endothelial cells. ICAM-1 was found to be constitutively expressed on endothelial cells and hepatocytes, as well as on macrophages. Induction of acute endotoxemia resulted in a time-dependent increase in ICAM-1 expression on hepatocytes, which was observed within 3 hours and reached a maximum after 24 hours. An increase in ICAM-1 expression was also observed on endothelial cells and on macrophages at 3 hours, followed by a decrease at 24 to 48 hours. Macrophages and endothelial cells also constitutively expressed ␤ 2 integrins. Induction of acute endotoxemia had no effect on Tissue damage initiates an inflammatory response characterized by an accumulation of macrophages at the site of injury. These cells are primarily derived from blood monocytes. Cell adhesion molecules are a group of membraneassociated proteins present on leukocytes, endothelial cells, and parenchymal cells that facilitate monocyte adherence and emigration out of the blood and into the tissue. Expression of several different classes of cell adhesion molecules have been reported to be up-regulated on liver cells after exposure of animals to hepatotoxic doses of alcohol 1,2 or endotoxin, 3,4 following reperfusion injury, 5,6 and in humans with acute and chronic inflammatory liver diseases. 7-9 Increased quantities of soluble circulating adhesion molecules have also been detected in various models of liver injury. 2,7,8,10 These findings, together with the observation that liver injury is abrogated by administration of antibodies to certain cell adhesion molecules, [4][5][6]11 suggest that they play a role in hepatotoxicity associated with inflammation.Endotoxin is a bacterially derived product known to induce liver injury at toxic doses. 12 We have previously demonstrated that acute endotoxemia is associated with an increase in the number of macrophages in the liver. 13,14 These cells are activated to release reactive oxygen and nitrogen intermediates that we speculate contribute to hepatotoxicity. 14-17 Intercellular adhesion molecule-1 (ICAM-1) is one important cell surface molecule that mediates antigenindependent contact between cells. ICAM-1 serves as a counter-receptor for the ␤ 2 integrins, LFA-1 and MAC-1. [18][19][20] Inter...

Hepatitis C virus (HCV) is normally present in the blood of infected patients; however, it can also be present in some other body fluids. Therefore, in this study, a concurrent presence of HCV-RNA was investigated in oral fluid and urine of 80 Pakistani chronic HCV patients. HCV-RNA was detected in 31 (38.8%) oral fluid and 10 (12.5%) urine samples using RT-PCR in all 80 of the patients whose sera tested positive for HCV-RNA. From this study, it is concluded that, in addition to the blood, HCV RNA can also be found in oral secretions as well as urine of chronic HCV patients.

We report the case of a 52-year-old immunocompetent man with varicella-zoster virus large-vessel vasculopathy and multiple bilateral cerebral infarcts who had no history of skin involvement. Etiologic diagnosis was made by isolation of varicella-zoster virus from a cerebrospinal fluid specimen. The patient had marked improvement in mental status after acyclovir therapy was initiated.