Gut microbiome composition in lean patients with NASH is associated with liver damage independent of caloric intake: A prospective pilot study.

BACKGROUND AND AIM: The aim of the study was to compare the gut microbiomes from obese and lean patients with or without NASH to outline phenotypic differences. METHODS AND RESULTS: We performed a cross-sectional pilot study comprising biopsy-proven NASH patients grouped according to BMI. Microbiome DNA was extracted from stool samples, and PCR amplification was performed using primers for the V4 region of the 16S rRNA gene. The amplicons were sequenced using the Ion PGM Torrent platform, and data were analyzed using QIIME software. Macronutrient consumption was analyzed by a 7-day food record. Liver fibrosis ≥ F2 was associated with increased abundance of Lactobacilli (p = 0.0007). NASH patients showed differences in Faecalibacterium, Ruminococcus, Lactobacillus and Bifidobacterium abundance compared with the control group. Lean NASH patients had a 3-fold lower abundance of Faecalibacterium and Ruminococcus (p = 0.004), obese NASH patients were enriched in Lactobacilli (p = 0.002), and overweight NASH patients had reduced Bifidobacterium (p = 0.018). Moreover, lean NASH patients showed a deficiency in Lactobacillus compared with overweight and obese NASH patients. This group also appeared similar to the control group with regard to gut microbiome alpha diversity. Although there were qualitative differences between lean NASH and overweight/obese NASH, they were not statistically significant (p = 0.618). The study limitations included a small sample size, a food questionnaire that collected only qualitative and semi-quantitative data, and variations in group gender composition that may influence differences in FXR signaling, bile acids metabolism and the composition of gut microbiota. CONCLUSION: Our preliminary finding of a different pathogenetic process in lean NASH patients needs to be confirmed by larger studies, including those with patient populations stratified by sex and dietary habits.

Experience of freezing human oocytes using sodium-depleted media.

Human embryo cryopreservation techniques enable the storage of surplus embryos created during assisted reproduction procedures; however, the existence of these same surplus embryos has sparked further debate. What can be their fate once they are no longer desired by their parents or if the parents are deceased? Thus, the level of interest in the cryopreservation of oocytes has increased, as has the necessity for further scientific study. This study had the objective of reporting 10 years of experience of freezing and thawing human oocytes from patients who did not wish to freeze embryos. A total of 159 cycles using frozen­thawed oocytes were performed (mean age 33.7 years). Survival and fertilization rates were 57.4% and 67.2%, respectively. Cleavage rate was 88.4% and the pregnancy rate was 37.7%. Clinical pregnancy was observed in 43 cycles (27.0%) with 14.5% of transferred embryos implanted. These pregnancies delivered 19 boys and 23 girls, two pregnancies are ongoing and nine were miscarriages. The average gestational week was 37.6 weeks and birthweight was 2829.2 g. These data suggest that the use of frozen­thawed oocytes in IVF represents a reasonable alternative for those patients not comfortable with the cryopreservation of supernumerary embryos.

Impact of community health centers and Medicaid on the use of health services.

The impact of improved access to health care through the Federal community health center (CHC) and Medicaid programs was examined in five urban low-income areas. Data on access to care and physician, hospital, and dental services utilization were collected by baseline and followup health surveys in the CHCs' services areas. There was a shift in use from hospital clinics to CHCs. Followup surveys indicated that 23 percent of the population reported CHCs as usual source of care. Travel time to source of care was reduced for users of CHCs. Medicaid coverage of the population in the survey areas increased from 16 to 37 percent between the baseline and followup surveys, an interval of 4 to 7 years. Increases occurred in the use of physicians and dental care between the baseline and followup surveys, but the rates scarcely kept pace with the national rates. Respondents who reported CHCs as their usual source of care, however, had a higher rate of physician visits and a lower rate of hospitalization compared with those using private physicians or hospital clinics as the usual source of care. Respondents with Medicaid coverage usually had higher physician and hospital use, irrespective of usual source of care. Both CHC and Medicaid programs contributed to increased use of dental care by providing financial and dental care resources. Although these two programs greatly facilitated the use of health services, disparity in physician and dental utilization remains between the five low-income areas and the averages for the nation.

Factors associated with increased dental care utilization in five urban, low-income areas.

Survey data were used to measure change in dental utilization in five urban low-income areas as a result of increased financial (Medicaid) and facility (community health centers) access to dental care. The average annual dental visit between the baseline and follow-up surveys showed a dramatic increase in four of the five survey areas. With the exception of Roxbury, Massachusetts, where the rate was already high in the earlier survey, the dental visit rate in the remaining areas increased 33 to 80 per cent compared to an increase of only 7 per cent nationally between 1969 and 1975. Both CHC and Medicaid programs made important contributions to increased dental care. Among persons who saw a dentist in the year in these areas, 25 per cent reported CHC as their usual source of dental care and 46 per cent reported that their dental care costs in the year were borne by Medicaid. In spite of recent increases, however, the average annual dental visit rate was only 1.0 in the five areas compared to 1.6 nationally, which is 60 per cent higher. The generally low dental utilization levels among persons covered by Medicaid or served by CHCs may indicate that much of the increased dental utilization which occurred in these areas was limited to taking care of existing dental problems while neglecting preventive dental care.

Dental visits by income and race in ten urban and two rural areas.

Household surveys in 12 low income areas found large differences in dental visit rates after control for income and race. The dental visit rate for Red Hook (NYC) exceeded the national rate whereas in seven of the areas the rate was below national averages by 40 per cent or more. The ranges in dental visit rate for low income Blacks was from two-thirds the national rate (in two areas of the South) to two to three times greater than the comparable national rate (in three areas of the Northeast). Lesser but nevertheless large variations among area dental visit rates existed for other race and income groups.

Access to usual source of care by race and income in ten urban areas.

In terms of less access to private sources of care (as distinguished from hospital-public clinics) and longer travel time to usual source of care, poverty areas are at a disadvantage. Within the ten areas studied, the poor have less access than the nonpoor, with access differences even greater between the races than between income groups. Blacks generally have less than whites when income differences are taken into account. Both the type of usual source of care and travel time appear to be related to differential utilizations of ambulatory care resources: persons reporting private sources of care and persons with shorter travel time to their usual source of care tend to make more physician visits in a year. Mechanisms for public financing of health care will not likely alleviate the problems of inaccessibility presented by poverty areas. It is in these areas of low access that public responsibility to organize and locate facilities will continue even after the advent of a fairly comprehensive payment mechanism for health care among the poor.

Need for publicly financed family planning services as measured by seven area surveys.

PIP: Data collected in 1972 from 7 diverse communities in the United States were used to determine the impact of federally assisted family planning programs. On the average 56% of low income women were at risk of an unwanted pregnancy. Of these, 40% were receiving family planning services from organized family planning programs and 22% from private physicians. More than 1/2 the women were using either the IUD or pill, and 15% were not using any contraceptive method. Fertility rates were higher for low-income than for high-income women, although the use of effective methods was similar. Because of the similarity of the findings to national estimates, it is suggested that national estimates can reliably be used for local programming.^ieng

How much do family planning programs cost?

PIP: The results of 2 cost studies on family planning programs are compared. National Analysts, Inc. studied 45 family planning programs for the program years 1968-1969. Westinghouse Population Center studied 27 family planning projects of 25 agencies for the program year 1970-1971. The Westinghouse projects were considerably larger in terms of operating costs than the National Analysts programs. Comparisons are made by way of multiple graphs and statistical tables. Per patient costs and the distribution of costs between direct medical services and indirect costs are consistent between the 2 studies. The results emphasize economies of scale and diseconomies of very large scale. From a cost basis, the ideal family planning project characteristics are: 1) a patient volume of approximately 3000; 2) a budget size of about $175,000; and 3) an institutional base. Programs with 1-site services were less costly than those with multiple sites or those using private physicians to provide the primary medical services.^ieng