Glucose metabolic reprogramming-related parameters for the prediction of 28-day neurological prognosis and all-cause mortality in patients after cardiac arrest:a prospective single-center observational study

BACKGROUND:We aimed to observe the dynamic changes in glucose metabolic reprogrammingrelated parameters and their ability to predict neurological prognosis and all-cause mortality in cardiac arrest patients after the restoration of spontaneous circulation(ROSC).METHODS:Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Aflliated Hospital of Dalian Medical University from August 1,2017,to May 30,2021,were enrolled.According to 28-day survival,the patients were divided into a non-survival group(n=82) and a survival group(n=38).Healthy adult volunteers(n=40) of similar ages and sexes were selected as controls.The serum levels of glucose metabolic reprogrammingrelated parameters(lactate dehydrogenase [LDH],lactate and pyruvate),neuron-specific enolase(NSE) and interleukin 6(IL-6) were measured on days 1,3,and 7 after ROSC.The Acute Physiology and Chronic Health Evaluation II(APACHE II) score and Sequential Organ Failure Assessment(SOFA) score were calculated.The Cerebral Performance Category(CPC) score was recorded on day 28 after ROSC.RESULTS:Following ROSC,the serum LDH(607.0 U/L vs.286.5 U/L),lactate(5.0 mmol/L vs.2.0 mmol/L),pyruvate(178.0 μmol/L vs.70.9 μmol/L),and lactate/pyruvate ratio(34.1 vs.22.1) significantly increased and were higher in the non-survivors than in the survivors on admission(all P<0.05).Moreover,the serum LDH,pyruvate,IL-6,APACHE II score,and SOFA score on days 1,3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28-day all-cause mortality(all P<0.05).The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve(AUC) of 0.904 [95% confidence interval [95% CI]:0.851–0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950(95% CI:0.911–0.989) with 94.7% specificity for predicting 28-day all-cause mortality,which was the highest among the glucose metabolic reprogramming-related parameters tested.CONCLUSION:Serum parameters related to glucose metabolic reprogramming were significantly increased after ROSC.Increased serum LDH and pyruvate levels,and lactate/pyruvate ratio may be associated with 28-day poor neurological prognosis and all-cause mortality after ROSC,and the predictive eflcacy of LDH during the first week was superior to others.

非核糖体多肽Surugamides生物合成基因簇镶嵌式结构的解析

【目的】多肽化合物Surugamides(sgm)生物合成基因簇包含4个非核糖体多肽合酶(NRPS)基因surA–D,负责2个NRPS生物合成途径。已有报道确认surA基因与SurugamideA产物相关,而surB基因与sgm F产物相关,但对surC和surD基因功能的归属尚没有实验证据。本工作拟在之前研究的基础上进一步确认surA和surD负责Surugamide A产物生物合成,为基因工程改造Surugamides生物合成途径以及研究其NRPS蛋白之间的识别机制提供理论依据。【方法】从海绵中分离放线菌并通过16S rRNA基因序列比对分析其分类单元。通过在线数据库antiSMASH分析基因组序列,发现天然产物生物合成基因簇。通过UPLC-Q-TOF-MS和^(13)CNMR鉴定化合物结构。把构建完成的同源重组双交换质粒导入链霉菌宿主后筛选基因缺失或替换突变株。【结果】从胄甲海绵来源链霉菌S.albidoflavus LHW3101基因组中发现了Surugamides生物合成基因簇,确认了该菌株发酵产物中的化合物sgmA和sgm F。构建了surB和surC基因同时缺失的突变株RJ9,发现RJ9不再产sgm F而仍然产Surugamide A。在缺失突变surB和surC基因的同时在surD基因前引入了组成型强启动子ermEp*,结果发现RJ9产SurugamideA水平是野生型菌株的约2倍。【结论】确认了surB和surC基因与sgmA产物无关。在surD基因前引入强启动子后显著提高了SurugamideA的产量,提示surD基因与sgmA产物相关,结合已报到surA基因与Surugamide A产物相关的证据,进一步确认了surA和surD基因负责Surugamide A生物合成的推论。