Transforming Growth Factorβ1 Overexpression Is Associated with Insulin Resistance and Rapidly Progressive Kidney Fibrosis under Diabetic Conditions

Association between different insulin resistance indices and all-cause mortality in patients with diabetic kidney disease: a prospective cohort study

Aim

Previous research has shown a strong association between insulin resistance (IR) and both the onset and advancement of diabetic kidney disease (DKD). This research focuses on examining the relationship between IR and all-cause mortality in individuals with DKD.

Methods

This study utilized data obtained from the National Health and Nutrition Examination Survey (NHANES), spanning the years 2001 to 2018. Insulin resistance was assessed using reliable indicators (HOMA-IR, TyG, TyG-BMI, and METS-IR). The relationship between IR indices and survival outcomes was evaluated through weighted multivariate Cox regression, Kaplan-Meier survival analysis, and restricted cubic spline (RCS) modeling. To examine non-linear associations, the log-likelihood ratio test was employed, with piecewise regression models used to establish confidence intervals and identify threshold values. Diagnostic precision and efficacy were gauged using Receiver Operating Characteristic (ROC) curves, Area Under the Curve (AUC) evaluations, and calibration plots. Moreover, to verify the consistency of our results, stratified analyses and interaction tests were conducted across variables including age, gender, Body Mass Index (BMI), hypertension, and cardiovascular status.

Results

This research involved a group of 1,588 individuals diagnosed with DKD. Over a median observation period of 74 months, 630 participants passed away. Using weighted multivariate Cox regression along with restricted cubic spline modeling, we identified non-linear associations between the four insulin resistance indices and all-cause mortality. An analysis of threshold effects pinpointed essential turning points for each IR index in this research: 1.14 for HOMA-IR, 9.18 for TyG, 207.9 for TyG-BMI, and 35.85 for METS-IR. It was noted that levels below these thresholds inversely correlated with all-cause mortality. In contrast, values above these points showed a significantly positive correlation, suggesting heightened mortality risks. The accuracy of these four IR metrics as indicators of all-cause mortality was confirmed through ROC and calibration curve analyses.

Conclusion

In patients with DKD, an L-shaped association is noted between HOMA-IR and all-cause mortality, while TyG, TyG-BMI, and METS-IR exhibit U-shaped relationships. All four IR indices show good predictive performance.

Association of Obesity and Severe Asthma in Adults

The incidence of obesity and asthma continues to enhance, significantly impacting global public health. Adipose tissue is an organ that secretes hormones and cytokines, causes meta-inflammation, and contributes to the intensification of bronchial hyperreactivity, oxidative stress, and consequently affects the different phenotypes of asthma in obese people. As body weight increases, the risk of severe asthma increases, as well as more frequent exacerbations requiring the use of glucocorticoids and hospitalization, which consequently leads to a deterioration of the quality of life. This review discusses the relationship between obesity and severe asthma, the underlying molecular mechanisms, changes in respiratory function tests in obese people, its impact on the occurrence of comorbidities, and consequently, a different response to conventional asthma treatment. The article also reviews research on possible future therapies for severe asthma. The manuscript is a narrative review of clinical trials in severe asthma and comorbid obesity. The articles were found in the PubMed database using the keywords asthma and obesity. Studies on severe asthma were then selected for inclusion in the article. The sections: 'The classification connected with asthma and obesity', 'Obesity-related changes in pulmonary functional tests', and 'Obesity and inflammation', include studies on subjects without asthma or non-severe asthma, which, according to the authors, familiarize the reader with the pathophysiology of obesity-related asthma.

Cell Death in Acute Organ Injury and Fibrosis

Tissue fibrosis is characterized by the excessive accumulation of extracellular matrix in various organs, including the lungs, liver, skin, kidneys, pancreas, and heart, ultimately leading to organ failure [...].