Clinical and electrocardiographic data available at presentation to the emergency department can be used for the risk stratification of patients with syncope. The OESIL risk score may represent a simple prognostication tool that could be usefully employed for the triage and management of patients with syncope in emergency departments.

These findings indicate that ghrelin reverses endothelial dysfunction in patients with metabolic syndrome by increasing nitric oxide bioactivity, thereby suggesting that decreased circulating levels of the peptide, such as those found in these patients, might play a role in the pathobiology of atherosclerosis.

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This study assessed the presence of endothelial dysfunction in patients with inflammatory bowel diseases (IBDs) and evaluated the possible role of tumor necrosis factor (TNF)-alpha in the pathophysiology of this abnormality. Similar elevations in circulating markers of inflammation (C-reactive protein and interleukin-6) were observed in Crohn's disease and ulcerative colitis compared to controls. Endothelium-dependent vasodilation to acetylcholine was impaired in Crohn's disease, but not in ulcerative colitis. Endothelium-independent vasodilation to sodium nitroprusside, by contrast, was not different among the three groups. The TNF-alpha neutralizing antibody, infliximab, enhanced the responsiveness to acetylcholine, but not to nitroprusside, in Crohn's disease, without modifying vascular responses to both drugs in ulcerative colitis. In conclusion, despite comparable degrees of systemic inflammation in the two IBDs, endothelial dysfunction is a selective feature of Crohn's disease and is beneficially affected by intravascular TNF-alpha neutralization. These findings underscore the role of selective cytokine targeting in improving endothelial function in patients with Crohn's disease.

OBJECTIVE -Obesity is associated with chronic inflammation due to overproduction of proinflammatory cytokines, including tumor necrosis factor (TNF)-␣. We assessed the effects of TNF-␣ neutralization by infliximab on vascular reactivity during hyperinsulinemia in obesity-related metabolic syndrome. RESEARCH DESIGN AND METHODS-Vascular responses to intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside (SNP) were assessed in patients with metabolic syndrome, before and after administration of infliximab.RESULTS -Patients had blunted vasodilator responses to ACh and SNP during hyperinsulinemia compared with control subjects; a potentiation of the responsiveness to both ACh and SNP, however, was observed in patients following infliximab. The antioxidant vitamin C improved the vasodilator response to ACh in patients with metabolic syndrome, but its effect was not further enhanced by concurrent administration of infliximab.CONCLUSIONS -TNF-␣ neutralization ameliorates vascular reactivity in metabolic syndrome during hyperinsulinemia, likely in relation to decreased oxidative stress, thereby suggesting an involvement of inflammatory cytokines in vascular dysfunction of these patients. Diabetes Care 31:1439-1441, 2008C entral obesity is associated with lowgrade, chronic inflammation, which might affect insulin action and thus contribute to both insulin resistance and vascular dysfunction characteristic of metabolic syndrome. Among various inflammatory cytokines, tumor necrosis factor (TNF)-␣ seems to play an important role in the pathophysiology of insulin resistance. However, no clear link has been established between the vascular pathology of metabolic syndrome and a particular inflammatory cytokine in humans. This study, therefore, assessed the effects of TNF-␣ neutralization by the monoclonal antibody infliximab on vascular reactivity during hyperinsulinemia in metabolic syndrome. RESEARCH DESIGN ANDMETHODS -A total of 16 patients with metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel [NCEP ATP] III criteria) and 13 healthy control subjects, approximately matched for sex and age, were recruited for this study. In all patients, waist circumference was Ͼ102 cm in male subjects and Ͼ88 cm in female subjects, thus indicating central obesity. Studies consisted of infusion of drugs into the brachial artery and measurement of forearm blood flow responses by means of straingauge plethysmography. In Study 1, control subjects and 10 patients with metabolic syndrome received infusion of regular insulin (0.2 mU ⅐ kg Ϫ1 ⅐ min Ϫ1 ); after 45 min of insulin infusion, doseresponse curves to graded doses of acetylcholine (ACh) (release of endogenous NO) and sodium nitroprusside (SNP) (exogenous NO donor) were obtained. Thereafter, while keeping insulin infusion constant, patients with metabolic syndrome received infusion of infliximab (200 g/min for 45 min) and doseresponse curves to ACh and SNP were repeated. In Study 2, to assess whether the effect of infliximab on vascular response...