Comorbidities, mortality and metabolic profile in individuals with primary biliary cholangitis-A Phenome-Wide-Association-Study

BACKGROUND AND AIMS

Primary biliary cholangitis (PBC) is a chronic, immune-mediated liver disease that can lead to fibrosis and cirrhosis. In this cohort study, we aimed to investigate morbidity and mortality in conjunction with metabolomic changes of PBC in a UK population-based cohort.

METHODS

454 participants with PBC and 908 propensity score (age, sex, BMI, ethnicity) matched controls without liver disease were included in the study. A subset of participants with PBC and controls were analysed for their metabolomic profile. Further, PBC-associated comorbidities were investigated by PheWAS analysis. Lastly, we assessed causes of death in individuals with PBC using a Fine and Grey competing-risks regression model.

RESULTS

Compared to the control group, various pathways associated with the metabolism of amino acids, lipids, and liver biochemistry were significantly enriched in individuals with PBC. We found reduced levels of S-HDL-cholesterol and Glycoprotein Acetyls in individuals with PBC as well as an association with diseases of the circulatory system. Notably, PBC individuals had a higher prevalence of digestive diseases, autoimmune diseases, cardiovascular diseases, anaemias, mental disorders, and urinary tract infections compared to the control group. Strikingly, the overall mortality was almost three times higher in the PBC group compared to the control group, with diseases of the digestive system accounting for a significant elevation of the death rate. A subsequent analysis, enhanced by propensity score matching that included the APRI score, demonstrated that the observed morbidity could not be exclusively attributed to advanced hepatic disease.

CONCLUSIONS

Our study provides a detailed perspective on the morbidity of individuals with PBC. The exploration of potential effects of disease state on morbidity suggest that early detection and early treatment of PBC could enhance patient prognosis and prevent the onset of comorbid diseases. Finally, the metabolomic alterations could represent a link between the pathophysiological processes underlying PBC development, progression, and associated morbidity.

Fear and food: Anxiety-like behavior and the susceptibility to weight loss in an activity-based anorexia rat model

Anorexia nervosa (AN) is a severe psychiatric disorder characterized by energy restriction, low body weight, a fear of gaining weight, and often excessive physical activity. Anxiety disorders appear to constitute a major risk factor for developing AN and are the most frequent comorbidity. Here, the influence of anxiety‐like behavior prior to food restriction on increased physical activity, leading to greater susceptibility to weight loss, was tested in rats. Furthermore, the possible anxiolytic effect of starvation itself was analyzed. A chronic starvation model activity‐based anorexia (ABA) was applied to mimic physiological and behavioral characteristics of AN. During the induction of starvation and acute starvation, food intake was reduced by 70% and the rats lost 25% of their body weight, which was kept stable to imitate chronic starvation. Anxiety‐like behavior was quantified before and after chronic starvation using the elevated plus maze, based on rodents’ aversion to open spaces. Anxiety‐related behavior before food restriction was associated with increased running‐wheel activity during habituation and during the induction of starvation, and predicted faster weight loss in ABA rats. Additionally, food‐restricted animals showed less anxiety‐like behavior after chronic starvation. Animals showing more anxiety‐like behavior appear to be more susceptible to weight loss, partially mediated by increased physical activity. Anxiety‐related behavior was associated with increased physical activity, which in turn was associated with more rapid weight loss. Our data let us assume that food restriction has an anxiolytic effect. These findings demonstrate the importance of considering anxiety disorders in patients with AN.

Gut microbiota and brain alterations in a translational anorexia nervosa rat model

Anorexia nervosa (AN) is an eating disorder that leads to brain volume reduction and is difficult to treat since the underlying pathophysiology is poorly understood. The human gut microbiota is known to be involved in host metabolism, appetite- and bodyweight regulation, gut permeability, inflammation and gut-brain interactions. In this study, we used a translational activity-based anorexia (ABA) rat model including groups with food restriction, running-wheel access and a combination to disentangle the influences on the gut microbiota and associated changes in brain volume parameters. Our data demonstrated that chronic food restriction but not running-wheel activity had a major influence on the gut microbiota diversity and composition and reduced brain volume. Negative correlations were found between global brain weight and α-diversity, and astrocyte markers and relative abundances of the genera Odoribacter and Bifidobacterium. In contrast, the presence of lactobacilli was positively associated with white and grey brain matter volume. ABA and food-restricted rats are an interesting pre-clinical model to assess the causal influence of starvation on the gut microbiome and gut-brain interactions and can help to dissect the underlying pathophysiologic mechanisms relevant to AN.

[Costs and revenues for a birth in Germany]

INTRODUCTION Based on the data of the Institut für das Entgeltsystem im Krankenhaus (InEK) cost and revenue data for deliveries in Germany can be compared. The InEK calculates the cost data for each individual diagnosis-related group (DRG) on the basis of those hospitals that deliver their individual cost data, so-called "Kalkulationshäuser". The InEK only publishes data for patients with standard lengths of stay. It does not deliver data for short- and long-stay patients. Beside these cost data, the InEK publishes the nationwide case volume for each DRG. Having a knowledge of the individual base rate (Landesbasisfallwert), which differs from province (Bundesland) to province and, in addition, the nationwide case weight for each DRG, the average revenues for deliveries in general, vaginal deliveries, and Cesarean sections can be calculated. These revenue data differ not only from province to province, but from hospital to hospital because of the individual hospital-specific base rates.

MATERIALS AND METHODS

The average costs for a delivery in general, a vaginal delivery, and a Cesarean section were calculated on the basis of the DRG Report Browsers 2005/2007-2007/2009 published by the InEK. The costs for short- and long-stay patients were estimated on the basis of a scenario technique. The revenues were calculated on the basis of the published DRG catalogues, which supply individual case weights, and the county-wide base rate. Short- and long-stay revenues again had to be estimated by a scenario technique. In every DRG the cost data create the basis for the case weight two years later.

RESULTS

In relation to the average base rate over all provinces the 2005 costs are higher than the revenues in each province. Even in Rhineland-Palatinate, the county with the highest base rate, costs and revenues are at par. Only the declining costs from 2005-2007 balance the costs and revenues nationwide. But in provinces with low base rates the revenues stay lower than costs. These data demonstrate the pressure of rationalisation on German perinatal medicine and their hospitals. Cost and revenue comparisons with other countries are of lesser interest. Most countries have totally different systems for financing hospitals. In Germany, the published data show only the running costs financed by public and private health-care insurances. Infrastructure costs are financed by the government. In other countries not only the running costs but also the investment costs must be financed by running revenues too.

[Risk of hearing loss caused by high volume music--presenting an educational concept for preventing hearing loss in adolescents]

During an one-hour lecture 277 pupils between 16 and 25 years of age, were questioned about their hearing behaviour and instructed in the consequences of hearing impairment resulting from listening to loud music. Furthermore audiometrics were offered and there was possibility to measure the loudness of the walkman used. A majority visited "discos" and/or used walkman. Over 80% claimed their hearing is good, over 75% knew that loud music can cause damage to hearing. The walkman users suffered more frequently from tinnitus and failed to hear a door bell more often. After the instruction 75% of the pupils were willing to protect their hearing in future. Eight of 89 pupils had a hearing reduction of up to 40 dB(A). The average sound pressure level of the walkman was 104 dB(A).

[Definition and etiologic factors of hypotonic urethra in relation to urinary stress incontinence in the female]

In 555 stress-induced urinary incontinent and 119 continent women patients, we studied the history, clinical and urodynamic investigations to define the hypotonic urethra and to find out important etiological factors of the low urethral closure pressure. The linear depression of the urethral pressure and the urethral closure pressure at rest--well known from literature--has been confirmed in this study. With hypotonic urethra, closure pressure values were found to be below the simple standard deviation from a norm-curve. Also, in cases of stress urinary incontinence, we found a nearly linear depression of closure pressure. The stress incontinent patients could be divided in two groups: 46% with hypotonic urethra, 54% with nearly normal closure pressure. History of former incontinence surgery, but also of other operations such as simple abdominal or vaginal hysterectomy, is correlated with low urethral closure pressure. The degree of closure pressure is correlated with shortening of the functional urethral length. The maximum closure pressure shifts distally. Women, who, despite hypotonic urethras, are continent, build up a positive closure pressure throughout a broad zone of the functional urethral length. Contrarily, in the case of incontinent patients, even a weak coughing spasm, which does not even break through the bladder sphincter in maximum closure, can cause opening of the urethra and establishment of pressure equilibration between bladder and urethra.