Objective
Cognitive decline occurs in multiple neurodegenerative diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD). Shared underlying mechanisms may exist and manifest as ...shared biomarker signatures. Previously, we nominated plasma epidermal growth factor (EGF) as a biomarker predicting cognitive decline in patients with established PD. Here, we investigate EGF as a predictive biomarker in prodromal PD, as well as AD.
Methods
A cohort of PD patients (n = 236) was recruited to replicate our finding that low baseline EGF levels predict future cognitive decline. Additionally, plasma EGF and cognitive outcome measures were obtained from individuals with normal cognition (NC, n = 58), amnestic mild cognitive impairment (AD‐MCI, n = 396), and Alzheimer's disease (AD, n = 112) in the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort to investigate whether low EGF levels correlate with cognitive status and outcome in AD‐MCI and AD. Third, plasma EGF and cognitive measures were evaluated in the high‐risk asymptomatic Parkinson's Associated Risk Study (PARS) cohort (n = 165) to investigate the association of EGF and cognitive performance in a PD prodromal context.
Results
In both PD and AD‐MCI, low baseline plasma EGF predicted poorer long‐term cognitive outcomes. In asymptomatic individuals at highest risk for developing PD from the PARS cohort, low baseline plasma EGF associated with poorer performance in the visuospatial domain but not in other cognitive domains.
Interpretation
Low plasma EGF at baseline predicts cognitive decline in both AD and PD. Evidence for this signal may exist in prodromal stages of both diseases.
Next Point-of-Interest (POI) recommendation is a longstanding problem across the domains of Location-Based Social Networks (LBSN) and transportation. Recent Recurrent Neural Network (RNN) based ...approaches learn POI-POI relationships in a local view based on independent user visit sequences. This limits the model's ability to directly connect and learn across users in a global view to recommend semantically trained POIs. In this work, we propose a Spatial-Temporal-Preference User Dimensional Graph Attention Network (STP-UDGAT), a novel explore-exploit model that concurrently exploits personalized user preferences and explores new POIs in global spatial-temporal-preference (STP) neighbourhoods, while allowing users to selectively learn from other users. In addition, we propose random walks as a masked self-attention option to leverage the STP graphs' structures and find new higher-order POI neighbours during exploration. Experimental results on six real-world datasets show that our model significantly outperforms baseline and state-of-the-art methods.
Summary
Background
Patients with cirrhosis are at increased risk for osteoporosis, and those who suffer a fracture are at high risk for mortality. Despite this, osteoporosis is often overlooked and ...undertreated. This study aimed to evaluate osteoporosis screening, management, and adverse osteoporosis medication events in patients with cirrhosis.
Methods
We performed a retrospective chart review of adult outpatients with compensated and decompensated cirrhosis seen in single health system over a 6‐year period. Patient demographics, liver and bone health comorbidities, DEXA scan results, and medications were ed.
Results
In total, 5398 patients met criteria. The cohort was predominately white (79.1%) and older (age 59). 44.4% were female. 64.6% had decompensated cirrhosis. Median MELD‐Na score was 12.8. 23.5% had a DEXA scan ordered, approximately 50% completed this test. Patients who were older, female, white, with more severe liver disease, and other osteoporosis risk factors were more likely to have a DEXA scan ordered. 48.5% of patients had osteopenia and 30.2% had osteoporosis on DEXA scan. Only 22.6% of patients with osteoporosis received treatment, most commonly oral bisphosphonates. Oral bisphosphonate prescription was not associated with variceal bleeding (8.4% without vs. 4.8% with, p = 0.487).
Conclusion
A minority of patients with cirrhosis were screened for osteoporosis. The majority screened had osteopenia or osteoporosis on DEXA scan. Less than a quarter of patients with osteoporosis were started on treatment. Real‐world experience of oral bisphosphonate use did not reveal higher rates of gastrointestinal bleeding. There is room for improvement in all aspects of bone health care in cirrhosis.
Retrospective analysis of adult outpatients with compensated and decompensated cirrhosis seen in single health system over a 6‐year period.
BACKGROUNDThe effect of nonalcoholic steatohepatitis (NASH) on mortality or major adverse cardiovascular events (MACE) in non-liver solid organ transplant recipients (NL-SOT) is unknown.METHODSUsing ...a retrospective design, adult NL-SOT recipients who had biopsy-proven NASH were compared NL-SOT recipients with normal liver function tests and imaging; propensity matched at a 1:10 ratio on the following: age, sex, race, transplant year, transplant organ, smoking status, and diabetes status. Both deceased and living donor recipients were included; heart and liver transplant patients were excluded. Primary outcome was incidence of all-cause mortality and MACE (a composite outcome of coronary artery disease, ischemic stroke, and peripheral arterial disease).RESULTSSeven patients (3 kidney and 4 lung transplants) had biopsy-proven NASH and 70 patients without NASH, both groups were predominantly male (53%-57%), White (86%-91%), and overweight (mean body mass index ∼ 26). The majority of patients were on calcineurin inhibitors (≥85%), antimetabolites (≥97%), and prednisone (≥50%). Survival analysis showed that NASH patients had a higher risk of death (hazard ratio HR, 3.24; 95% confidence interval CI, 1.26-8.33, P = 0.02). NASH did not affect the risk of death-censored graft failure (HR, 1.08; 95% CI, 0.14-8.67; P = .94) or the risk of MACE (HR, 1.03; 95% CI, 0.23-4.62; P = .97).CONCLUSIONSIn NL-SOT recipients, NASH is significantly associated with mortality but not with MACE.
LINKED CONTENT
This article is linked to Thomson et al papers. To view these articles, visit https://doi.org/10.1111/apt.17823 and https://doi.org/10.1111/apt.17842
TIPS placement is an effective method for treating a number of complications of portal hypertension. Although this complex procedure has been firmly established in treatment algorithms, more data are ...needed to determine the most efficient and safest ways to perform the procedure.
The purpose of this study was to determine the effect of three different techniques of portal vein (PV) cannulation during TIPS placement on procedure efficiency.
The medical records of patients who underwent TIPS creation between 2005 and 2019 were reviewed. On the basis of the PV access technique used, patients were grouped as follows: group 1 (G1) included patients who underwent a transabdominal ultrasound (US)-guided technique to obtain PV access, group 2 (G2) consisted of those who underwent fluoroscopically guided wedged hepatic portography, and group 3 (G3) included those who underwent percutaneous US-guided PV guidewire placement for fluoroscopic targeting.
Of the 264 patients who underwent TIPS creation, 54 (20.5%) were in G1, 172 (65.1%) were in G2, and 38 (14.4%) were in G3. The mean (± SD) fluoroscopic time in G1 (34.8 ± 16.6 minutes) did not differ from that in either G2 (38.9 ± 20.8 minutes;
= .09) or G3 (29.5 ± 14.6 minutes;
= .06). However, G2 patients had significantly longer fluoroscopic times than G3 patients (
= .005). The mean total anesthesia time in G1 (190.2 ± 45.6 minutes) did not differ from that in G2 (199.7 ± 59.5 minutes;
= .15). However, G3 had a mean anesthesia time (162.6 ± 39.7 minutes) that was significantly shorter than that in both G1 (
= .003) and G2 (
< .001). The mean contrast volume was significantly lower in G1 than in G2 (67.9 ± 36.8 mL vs 87.1 ± 42.9 mL;
= .005). More intrahepatic needle passes were required in G2 (median, 4 passes; interquartile range IQR, 1-7 passes) than in G1 (median, 2 passes; IQR, 1-4 passes;
= .004) and G3 (median, 2 passes; IQR, 1-7.25 passes;
= .04). When complications in G1 and G3 were pooled, this cohort had significantly fewer complications than G2 (
= .01).
Ultrasound-guided PV access and percutaneous PV guidewire placement for fluoroscopic targeting during TIPS creation are associated with shorter procedure and fluoroscopic times and potentially decreased complications.
The present study helps interventional radiologists understand the safest and most efficient way to access the PV, which is a key step during TIPS placement.
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