Association Between Serum Anion Gap and Mortality in Critically Ill Patients with COPD in ICU: Data from the MIMIC IV Database

Background

Serum anion gap (AG) has been proven to be associated with prognosis in critically ill patients. However, few studies have investigated the association between AG and all-cause mortality in critically ill patients with chronic obstructive pulmonary disease (COPD).

Objective

We hypothesized that the initial AG level would predict the mortality risk in critically ill patients with COPD.

Methods

This retrospective cohort study was based on the Medical Information Mart for Intensive Care (MIMIC) IV database. We extracted demographics, vital signs, laboratory tests, comorbidity, and scoring systems from the first 24 hours after patient ICU admission. Multivariable logistic regression analysis models were used to explore the association between serum AG levels and mortality. Interaction and stratified analyses were conducted including age, gender and comorbidity.

Results

A total of 5531 critically ill patients with COPD were enrolled, composed of 53.6% male and 46.4% female with a median age of 73 years. The all-cause mortality of these patients during ICU hospitalization was 13.7%. The risk of all-cause mortality increased as the AG level increased in the univariate logistic regression analysis (OR=1.13, 95% CI: 1.11-1.15, p<0.01). After adjusting for all the covariates in multivariate logistic regression analysis, the odds ratio was 1.06 (95% CI: 1.04-1.09, p<0.01). Compared with the lowest AG group Q1 (≤11mmol/L), the adjusted OR value for AG and mortality in Q2 (12-13mmol/L) was 0.89 (95% CI: 0.63-1.25, p=0.502), Q3 (14-15mmol/L) was 0.95 (95% CI: 0.68-1.34, p=0.788), and Q4 (≥16mmol/L) was 1.49 (95% CI: 1.10-2.02, p=0.009) respectively. In addition, the results of the subgroup and stratified analyses were robust.

Conclusion

AG is positively related to all-cause mortality in critically ill patients with COPD.

Development of an NLR-ID Toolkit and Identification of Novel Disease-Resistance Genes in Soybean

The recognition of pathogen effectors through the nucleotide-binding leucine-rich repeat receptor (NLR) family is an important component of plant immunity. In addition to typical domains such as TIR, CC, NBS, and LRR, NLR proteins also contain some atypical integrated domains (IDs), the roles of which are rarely investigated. Here, we carefully screened the soybean (Glycine max) genome and identified the IDs that appeared in the soybean TNL-like proteins. Our results show that multiple IDs (36) are widely present in soybean TNL-like proteins. A total of 27 Gm-TNL-ID genes (soybean TNL-like gene encoding ID) were cloned and their antiviral activity towards the soybean mosaic virus (SMV)/tobacco mosaic virus (TMV) was verified. Two resistance (R) genes, SRA2 (SMV resistance gene contains AAA_22 domain) and SRZ4 (SMV resistance gene contains zf-RVT domain), were identified to possess broad-spectrum resistance characteristics towards six viruses including SMV, TMV, plum pox virus (PPV), cabbage leaf curl virus (CaLCuV), barley stripe mosaic virus (BSMV), and tobacco rattle virus (TRV). The effects of Gm-TNL-IDX (the domain of the Gm-TNL-ID gene after the TN domain) on the antiviral activity of a R protein SRC7TN (we previously reported the TN domain of the soybean broad-spectrum resistance gene SRC7) were validated, and most of Gm-TNL-IDX inhibits antiviral activity mediated by SRC7TN, possibly through intramolecular interactions. Yeast-two-hybrid (Y2H) and bimolecular fluorescence complementation (BiFC) assays showed that seven Gm-TNL-IDX interacted with SMV-component proteins. Truncation analysis on a broad-spectrum antiviral protein SRZ4 indicated that SRZ4TIR is sufficient to mediate antiviral activity against SMV. Soybean cDNA library screening on SRZ4 identified 48 interacting proteins. In summary, our results indicate that the integration of IDs in soybean is widespread and frequent. The NLR-ID toolkit we provide is expected to be valuable for elucidating the functions of atypical NLR proteins in the plant immune system and lay the foundation for the development of engineering NLR for plant-disease control in the future.

Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography

Pregnancy can cause fluctuations in autoimmune diseases (AD) women, which may aggravate the cardiac damage. Maternal heart function is very important for maternal and fetal health. Therefore, early and accurate evaluation of the heart function of AD pregnant women is necessary. This study was aimed to evaluate the left ventricular (LV) function of AD pregnant women using two-dimensional speckle tracking echocardiography (2DSTE). A total of 96 subjects, including 26 non-pregnant AD patients (AD group), 33 AD pregnant women (AD-P group), and 37 healthy pregnant women (H-P group) were conducted. Baseline clinical and conventional echocardiography characteristics of all the subjects were collected. The 2DSTE was performed to acquire layer-specific strain parameters of LV. Compared with H-P group, AD-P group showed no significant differences in GLSmid and GLSepi. However, the GLSendo (24.10 [22.30 to 25.40] vs. 21.70 [19.05 to 25.15], P = 0.023) and ΔGLS (5.50 [4.80 to 6.00] vs. 4.90 [4.20 to 5.80], P = 0.017) were decreased, while the PSD (27 [23 to 32] vs. 32 [24 to 44], P = 0.014) was increased. At the segmental level, there was no significant difference in apex LSmid and LSepi between the two groups, while the AD-P group showed transmural dysfunction in basal and middle segments, and the LSendo in apex segments (32.84 [28.34 to 34.25] vs. 27.97 [21.87 to 33.61], P = 0.021) were significantly decreased. Compared with AD group, AD-P group showed no significant difference in ΔGLS, PSD, and GLS parameters of three layers. For the segmental level, there were no significant differences in the LSepi of the apex segment and the LS in three layers of the basal and middle segments between the two groups, while LSendo (32.69 [29.13 to 35.53] vs. 27.97 [21.87 to 33.60], P = 0.017) and LSmid (24.70 [22.24 to 27.78] vs. 21.32 [16.91 to 26.11], P = 0.023) in apex segments were significantly lower in AD-P group. The anti-SSA/Ro antibody were positive independently correlated with PSD. In conclusion, layer-specific strain parameters and PSD by 2DSTE provide an accurate and reproducible measurement of myocardial function. There are subclinical LV myocardial dysfunction in AD pregnant women. Besides, the positive of anti-SSA/Ro antibody maybe associated with LV myocardial dysfunction.

A cluster of atypical resistance genes in soybean confers broad-spectrum antiviral activity

Soybean mosaic virus (SMV) is a severe soybean (Glycine max) pathogen. Here we characterize a soybean SMV resistance cluster (SRC) that comprises five resistance (R) genes. SRC1 encodes a Toll/interleukin-1 receptor and nucleotide-binding site (TIR-NBS [TN]) protein, SRC4 and SRC6 encode TIR proteins with a short EF-hand domain, while SRC7 and SRC8 encode TNX proteins with a noncanonical basic secretory protein (BSP) domain at their C-termini. We mainly studied SRC7, which contains a noncanonical BSP domain and gave full resistance to SMV. SRC7 possessed broad-spectrum antiviral activity toward several plant viruses including SMV, plum pox virus, potato virus Y, and tobacco mosaic virus. The TIR domain alone was both necessary and sufficient for SRC7 immune signaling, while the NBS domain enhanced its activity. Nuclear oligomerization via the interactions of both TIR and NBS domains was essential for SRC7 function. SRC7 expression was transcriptionally inducible by SMV infection and salicylic acid (SA) treatment, and SA was required for SRC7 triggered virus resistance. SRC7 expression was posttranscriptionally regulated by miR1510a and miR2109, and the SRC7-miR1510a/miR2109 regulatory network appeared to contribute to SMV-soybean interactions in both resistant and susceptible soybean cultivars. In summary, we report a soybean R gene cluster centered by SRC7 that is regulated at both transcriptional and posttranscriptional levels, possesses a yet uncharacterized BSP domain, and has broad-spectrum antiviral activities. The SRC cluster is special as it harbors several functional R genes encoding atypical TIR-NBS-LRR (TNL) type R proteins, highlighting its importance in SMV-soybean interaction and plant immunity.