Low expression of fatty acid oxidation related gene ACADM indicates poor prognosis of renal clear cell carcinoma and is related to tumor immune infiltration.

This research aims to identify the key fatty acid beta-oxidation (FAO) genes that are altered in kidney renal clear cell carcinoma (KIRC) and to analyze the role of these genes in KIRC. The Gene Expression Omnibus (GEO) and FAO datasets were used to identify these key genes. Wilcoxon rank sum test was used to assess the levels of acyl-CoA dehydrogenase medium chain (ACADM) between KIRC and non-cancer samples. The logistic regression and Wilcoxon rank sum test were used to explore the association between ACADM and clinical features. The diagnostic performance of ACADM for KIRC was assessed using a diagnostic receiver operating characteristic (ROC) curve. The co-expressed genes of ACADM were identified in LinkedOmics database, and their function and pathway enrichment were analyzed. The correlation between ACADM expression level and immune infiltration was analyzed by Gene Set Variation Analysis (GSVA) method. Additionally, the proliferation, migration, and invasion abilities of KIRC cells were assessed after overexpressing ACADM. Following differential analysis and intersection, we identified six hub genes, including ACADM. We found that the expression level of ACADM was decreased in KIRC tissues and had a better diagnostic effect (AUC = 0.916). Survival analysis suggested that patients with decreased ACADM expression had a worse prognosis. According to correlation analysis, a variety of clinical features were associated with the expression level of ACADM. By analyzing the infiltration level of immune cells, we found that ACADM may be related to the enrichment of immune cells. Finally, ACADM overexpression inhibited proliferation, migration, and invasion of KIRC cells. In conclusion, our findings suggest that reduced ACADM expression in KIRC patients is indicative of poor prognosis. These results imply that ACADM may be a diagnostic and prognostic marker for individuals with KIRC, offering a reference for clinicians in diagnosis and treatment.

Comprehensive analysis of the role of CXCL family members in clear cell renal cell carcinoma.

Background CXCLs are a group of low-molecular-weight growth factors secreted by cells, mainly through G protein-coupled receptors for signal transduction and induction of cell chemotactic motility. Their abnormal expression is linked to immune cell activity in cancer and tumor growth and progression. However, the differential expressions of CXCLs in ccRCC, prognostic prospects, and immune infiltration have not been clearly explored. Objective This study aimed to analyze the expression profile of CXCL family members in clear cell renal cell carcinoma, its prognostic significance, and the correlation between CXCL family members and tumor immunity. Methods The expression difference of CXCLs between ccRCC and normal renal tissues was analyzed by the TCGA database. The prognostic value of CXCLs in ccRCC was analyzed by the Kaplan-Meier Plotter. The copy number variation (CNV) of CXCLs in ccRCC was explored through the GSCA website. The cBioPortal online tool was used to screen out 355 co-expressed genes significantly related to CXCLs. The protein-protein interaction network of co-expressed genes was constructed using the STRING database, and the pathways that significantly enriched these genes were explored using Metascape. We then used the least absolute shrinkage and selection operator (LASSO) regression analysis to develop a predictive risk model for ccRCC patients. The relationship between CXCLs and tumor immune cell infiltration was analyzed. Finally, drugs interacting with CXCLs were analyzed using the DGIdb database. Results It was observed that mRNA expression levels of CXCL-2,-3,-4,-5,-9,-10,-11,-13, and -16 in the tissue of KIRC were higher than normal KIRC tissue. In contrast, CXCL12 expression decreased. Furthermore, CXCL5,-9,-10,-11,-12, and -13 mRNA expression was significantly correlated with the clinical stage. In KIRC patients, elevated CXCL1,-2,-5, and -13 expression was associated with shorter overall survival, while elevated CXCL14 expression was associated with a better prognosis. Through LASSO regression analysis, we obtained a 5-gene prognostic signature. This prognostic feature is associated with the infiltration of multiple immune cells. Conclusion In this study, we evaluated the expression levels of CXCL genes in KIRC and their prognostic potential in KIRC. CXCL-5,-9,-10,-11,-12, and -13 may be associated with ccRCC progression, and CXCL-1,-2,-5,-13, and -14 may be potential prognostic markers.

The Effect of a Three-Level Remote Alliance on Critical Care in Grassroot Areas: A Multi-Center, Retrospective Study.

Purpose: To explore an effective model to promote the homogeneous development of intensive care units (ICUs) in grassroot, impoverished and remote areas. Methods: A three-level remote alliance model (in-place and online assistance) was adopted to guide the cross-talk of ICUs between counties and cities. The observed indicators included the mortality of ICU patients and those with APACHE II scores ≥15 points, deep vein thrombosis, ventilator-associated pneumonia, the completion rate of septic shock goals in 3-hour and 6-hour bundles, and the rates of patient transfers. Results: After the implementation of the remote alliance, there was significant reduction in the mortality of ICU patients in the county and city-level tertiary hospitals (7.6% vs 4.5%, P = 0.004; OR = 1.734, 95% CI 1.189-2.532) and the mortality rates of patients with APACHE II scores ≥15 points (11.9% vs 7.1%, P = 0.004; OR = 1.763, 95% CI 1.189-2.614). There was a significant reduction in the incidence of ventilator-associated pneumonia (0.9% vs 5.0%, P < 0.001) and deep vein thrombosis (52.4% vs 13.6%, P < 0.001). The completion rate of 3-hour bundle therapies for septic shock was significantly improved (95.7% vs 68.4%, P < 0.001), as well as 6-hour bundle therapies for septic shock (97.9% vs 81.6%, P < 0.001). The hospital transfer rate decreased significantly in the grassroots and impoverished areas (2.6% vs 4.7%, P < 0.001). Conclusion: A three-level remote alliance might be helpful in improving the quality of critical care in remote areas and promoting the homogeneous development of disciplines.