Long-Term Prognosis of Acute Myocardial Infarction Associated With Metabolic Health and Obesity Status

ObjectiveEmerging evidence supports the favorable cardiovascular health in nonobese subjects with healthy metabolism. However, little is known regarding the prognosis across the range of metabolic phenotypes once cardiovascular disease is established. We examined the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status.MethodsThis is a retrospective study on consecutive patients with AMI admitted to a tertiary hospital between 2014 and 2021. Patients were allocated into the following 4 groups based on metabolic and obesity profile: (1) metabolically healthy obese (MHO), (2) metabolically healthy nonobese (MHNO), (3) metabolically unhealthy obese (MUO), and (4) metabolically unhealthy nonobese (MUNO). Metabolic health was defined in accordance to the Biobank Standardisation and Harmonisation for Research Excellence in the European Union Healthy Obese Project. The primary outcome was all-cause mortality. The Cox regression analysis examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type, chronic kidney disease, smoking status, and left ventricular ejection fraction.ResultsOf 9958 patients, the majority (68.5%) were MUNO, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO had the lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%), and MUNO (22.6%) (P < .001). Compared with MHNO, MUO (hazard ratio [HR], 1.737; 95% confidence interval [CI], 1.282-2.355; P < .001) and MUNO (HR, 1.482; 95% CI, 1.108-1.981; P = .008) had a significantly higher mortality risk but not MHO (HR, 1.390; 95% CI, 0.594-3.251; P = .447), after adjusting for confounders. The Kaplan-Meier curves showed favorable survival in the metabolically healthy and obesity groups, with the highest overall survival in the MHO, followed by MHNO, MUO, and MUNO (P < .001).ConclusionMetabolically healthy and obese patients with AMI have favorable prognosis compared with metabolically unhealthy and nonobese patients. It is equally important to prioritize intensive metabolic risk factor management to weight reduction in the early phase after AMI.     

Comparison of cyclic nucleotide specificity of guanosine 3′,5′-monophosphate-dependent protein kinase and adenosine 3′,5′-monophosphate-dependent protein kinase

Guanosine 3′,5′-monophosphate-dependent protein kinase (cyclic GMP-dependent protein kinase) and adenosine 3′,5′-monophosphate-dependent protein kinase (cyclic AMP-dependent protein kinase) exhibited a high degree of cyclic nucleotide specificity when hormone-sensitive triacylglycerol lipase, phosphorylase kinase, and cardiac troponin were used as substrates. The concentration of cyclic GMP required to activate half-maximally cyclic dependent protein kinase was 1000- to 100-folds less than that of cylic AMP with these substrates. The opposite was true with cyclic AMP-dependent protein kinase where 1000- to 100-fold less cyclic GMP was required for half-maximal enzyme activation. This contrasts with the lower degree of cyclic nucleotide specificity of cyclic GMP-dependent protein kinase of 25-fold when histone H2b was used as a substrate for phosphorylation. Cyclic IMP resembled cyclic AMP in effectiveness in stimulating cyclic GMP-dependent protein kinase but was intermediate between cyclic AMP and cyclic GMP in stimulating cyclic. AMP-dependent protein kinase. The effect of cyclic IMP on cyclic GMP-dependent protein kinase was confirmed in studies of autophosphorylation of cyclic GMP-dependent protein kinase where both cyclic AMP and cyclic IMP enhanced autophophorylation. The high degree of cyclic nucleotide specificity observed suggests that cyclic AMP and cyclic GMP activate only their specific kinase and that crossover to the opposite kinase is unlikely to occur at reported cellular concentrations of cyclic nucleotides.     

The pixie earlobe: a method of correction

A simple method for the correction of the pixie earlobe is documented. This technique preserves the natural free border of the earlobe.     

The proboscis lateralis--a 14-year follow-up

A short historical review of proboscis lateralis is given and some of the important contributions highlighted. Forster was the first to mention this abnormality. I collected 34 cases from the literature (including one of my own) and have divided them clinically into four groups. The proboscis is most commonly associated with deformities of the ipsilateral half nose, the eye, and its adnexa. The various lines of management of this problem are discussed. I recommend dilating the canal of the proboscis as a useful step when it is used for reconstructing the absent heminose. A case of a left proboscis lateralis associated with an ipsilateral heminasal aplasia, a bilateral cleft of the lip and palate, a congenital cleft ala, and microphthalmia with a coloboma of the lower eyelid is documented.     

Purification and partial characterization of stonustoxin (lethal factor) from Synanceja horrida venom.

1. The lethal factor of the stonefish (Synanceja horrida) venom, designated as the stonustoxin, was purified to homogeneity by a two-step procedure on Sephacryl S-200 High Resolution (HR) gel permeation and DEAE Bio-Gel A anion exchange chromatography. 2. Stonustoxin has a native mol. wt of 148,000 and an isoelectric point of 6.9. 3. SDS-polyacrylamide gel electrophoresis revealed two subunits (designated alpha and beta) with mol. wts of 71,000 and 79,000, respectively. 4. The amino acid composition of both subunits and the N-terminal amino acid sequence of the beta subunit were also determined. 5. Purified stonustoxin had an LD50 of 0.017 microgram/g which is 22-fold more potent than that of the crude venom. 6. The toxin exhibited potent haemolytic activity in vitro and edema-inducing activity with a minimum edema dose (MED) of 0.15 micrograms in mouse paw. The edema effect was not antagonized by diphenhydramine.     

A rapid and sensitive enzymatic-radiochemical assay for the determination of triglycerides

An enzymatic-radiochemical method suitable for the determination of triglyceride levels of cells in culture is described. The method is based on the enzymatic hydrolysis of triglycerides to free fatty acids which then complex with 63Ni. The method is rapid, accurate, and inexpensive. The procedure extends the sensitivity of triglyceride measurement to as low as 0.25 nanomoles.     

Utilization of woody biomass in Singapore: technological options for carbonization and economic comparison with incineration

Background, aim and scope  The interest in the use of biomass as a renewable energy resource has rapidly grown over the past few years. In Singapore, biomass resources are mostly from waste wood. This article presents a few technological options, namely carbonization, for the conversion of woody biomass into a solid fuel, charcoal. Materials and methods  In the first stage, a life cycle assessment (LCA) ‘gate-to-gate’ system was developed for a conventional carbonizer system, a modern carbonizer from Japan, and a proposed four-stage partial furnace carbonizer from Tunisia. The potential environmental impacts were generated for global warming potential, acidification, human toxicity and photochemical oxidant potential. Based on the first set of results, the second LCA investigation was carried out comparing the selected carbonizer from Japan and an existing incinerator in Singapore. The second LCA adopted a unique approach combining social costs of pollution with the economic factors of the two biomass conversion technologies. Results  The carbonizer from Japan resulted in approximately 85% less greenhouse gases than the conventional carbonization system and 54% less than the proposed four-stage carbonizer from Tunisia. In terms of acidification and human toxicity, the carbonizers from Japan and Tunisia display nearly similar results—both were considerably lower than the conventional carbonizer. For photochemical oxidant potential, very minimal emissions are generated from the four-stage carbonizer and nearly zero impact is realized for the carbonization technology from Japan. Discussion  From the first set of LCA results, the Japanese carbonizer is favored in terms of its environmental results. The highest environmental impacts from the conventional carbonizer were due to large and uncontrolled emissions of acidic gases, greenhouse gases (particularly CO₂ and CH₄), particulates, and non-methane volatile organic compounds from both fugitive sources and energy requirements. The second LCA addressed the performance of the carbonizer from Japan against an existing incinerator in terms of environmental as well as cost performances. This unique approach translated pollution emissions into monetary costs to highlight the impacts of social health. Conclusions  For the first LCA, the accumulated impacts from the Japanese carbonizer proved to display significantly lower environmental impacts, especially for global warming potential. The overall environmental performance of the four-stage carbonizer from Tunisia ranked slightly lower than the one from Japan and much higher than the conventional carbonizer. The second LCA results displayed a noteworthy improvement of 90% for human health from the modern Japanese carbonizer technology—when compared against conventional incinerators. Without considering health issues or social costs, the total value per ton of wood treated is nearly similar for both incinerator and carbonizer. Recommendations and perspectives  The interest in biomass as raw material for producing energy has emerged rapidly in many countries. However, careful analysis and comparison of technologies are necessary to ensure favorable environmental outcomes. A full life cycle study, along with costs and the impact of pollution on society, should be performed before any large-scale biomass conversion technology is implemented. LCA can be applied to quantify and verify the overall environmental performance of a particular technology of interest as well as further explore the proposed technology in terms of costs and social implications.