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Objectives: To evaluate the dynamic evolution process of overall brain health in liver transplantation (LT) recipients, we employed a deep learning–based neuroanatomic biomarker to measure longitudinal changes of brain structural patterns before and 1, 3, and 6 months after surgery. Methods: Because of the ability to capture patterns across all voxels from a brain scan, the brain age prediction method was adopted. We constructed a 3D-CNN model through T1-weighted MRI of 3609 healthy individuals from 8 public datasets and further applied it to a local dataset of 60 LT recipients and 134 controls. The predicted age difference (PAD) was calculated to estimate brain changes before and after LT, and the network occlusion sensitivity analysis was used to determine the importance of each network in age prediction. Results: The PAD of patients with cirrhosis increased markedly at baseline (+ 5.74 years) and continued to increase within one month after LT (+ 9.18 years). After that, the brain age began to decrease gradually, but it was still higher than the chronological age. The PAD values of the OHE subgroup were higher than those of the no-OHE, and the discrepancy was more obvious at 1-month post-LT. High-level cognition-related networks were more important in predicting the brain age of patients with cirrhosis at baseline, while the importance of primary sensory networks increased temporarily within 6-month post-LT. Conclusions: The brain structural patterns of LT recipients showed inverted U-shaped dynamic change in the early stage after transplantation, and the change in primary sensory networks may be the main contributor. Key Points: • The recipients' brain structural pattern showed an inverted U-shaped dynamic change after LT. • The patients' brain aging aggravated within 1 month after surgery, and the subset of patients with a history of OHE was particularly affected. • The change of primary sensory networks is the main contributor to the change in brain structural patterns. [ABSTRACT FROM AUTHOR]

Background Treatment recommendations for patients with neuroendocrine tumors (NETs) include the use of octreotide long-acting release (LAR) for long-term therapy and immediate-release (IR) as rescue therapy to control the breakthrough symptoms of carcinoid syndrome (CS). High doses of LAR are commonly used in clinical practice. This study aimed to evaluate the real-world utilization of LAR and preceding IR use at the prescription and patient levels. Methods We used an administrative claims database (2009-2018) containing privately insured enrollees. We calculated the normalized LAR dose from pharmacy claims and the initial mean IR daily dose at the prescription level. At the patient level, we conducted a retrospective cohort study that included patients continuously enrolled with ≥1 pharmacy claim of LAR and evaluated the frequency and the clinical reason for dose escalation of LAR. The definition of the above-label maximum dose of LAR was ≥30 mg/4 weeks. Results Nineteen percent of LAR prescriptions had an above-label maximum dose. Only 7% of LAR prescriptions had preceding IR use. There were 386 patients with NETs or CS vs. 570 with an unknown diagnosis. Comparing patients with NETs or CS to those with an unknown diagnosis, 22.3% vs. 11.0 % experienced dose escalations and 29.0% vs. 26.6% had IR use before dose escalation, respectively. LAR dose escalation occurred in 50.9% vs. 39.2% for symptom control, 12.3% vs. 7.1% for tumor progression control, and 16.6% vs. 6.0% for both reasons in NETs/CS and unknown groups, respectively. Conclusion Octreotide LAR dosing above the label-maximum dose is common and IR rescue dosing appears to be underutilized. [ABSTRACT FROM AUTHOR]

The associations of early-life head circumference (HC) with child neurodevelopmental and mental health among generally healthy population remain unclear. We aimed to examine the associations of early-life HC trajectories with cognitive development and emotional and behavioral problems in adolescence and to identify the HC growth-sensitive period. We conducted a prospective, community-based birth cohort study in rural western China, and 745 adolescents aged 10-14 years were followed between June and December 2016. We assessed their HC eight times during the first 2 years of life and their adolescent cognitive, emotional, and behavioral outcomes using the Wechsler Intelligence Scale for Children-IV and Youth Self-Report-2001, respectively. We applied group-based trajectory modeling to identify the HC trajectories and conditional growth to derive the HC growth-sensitive periods. We identified five distinct HC trajectories characterized as Start below average-then decrease (7.8% of the sample), Start below average-then increase (6.8%), Start average-then decrease (33%), Consistently average (38%), and Consistently above average (14%). Infants in the trajectory of consistently above average had higher cognitive scores in adolescence compared to those from suboptimal trajectories, with adjusted mean differences ranging from 2.84 to 8.99 points. The conditional gains showed that the HC growth-sensitive period was between 0 and 18 months for child cognition. We found null associations between HC measures and adolescent emotional and behavioral problem scores.Conclusion: Early-life HC trajectories were associated with adolescent cognitive development. HC may serve as an inexpensive screening tool to monitor child development at risk during the first 18 months, particularly in resource-limited settings.What Is Known: • Postnatal head circumference (HC) has been shown to be associated with cognitive development in infants who were born premature and/or fetal growth restriction, while inconsistent associations were reported among generally healthy populations, especially in low- and middle- income countries, challenging its utility in public health practices.What Is New: • Adolescents in the HC growth trajectory of consistently above average had higher cognitive scores compared to those with other suboptimal trajectories, while null findings were observed for adolescent emotional and behavioral health. • HC may serve as an inexpensive screening tool to monitor child development at risk during the first 18 months of life, particularly in resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: Preterm birth and fetal growth restriction are associated with linear growth faltering and suboptimal cognitive development in childhood.Objectives: We aimed to investigate whether and to what extent the associations between adverse birth outcomes and cognitive development in mid-childhood and early adolescence are mediated by postnatal stature.Methods: We used data from a prospective birth cohort of children born to women who participated in a large cluster-randomized trial of antenatal micronutrient supplementation in rural western China. Children were followed up for anthropometric assessments at 6, 12, and 24 mo of age and in mid-childhood (7-9 y). Cognitive development was assessed in mid-childhood (n = 669) and early adolescence (n = 735; 10-12 y) using the Wechsler Intelligence Scale for Children-IV. We conducted a causal mediation analysis to evaluate the proportion of the association of low birth weight (LBW; <2500 g), small-for-gestational age (SGA; <10th percentile), and preterm birth (<37 weeks of gestation) with cognitive development in mid-childhood and early adolescence that was mediated by postnatal length/height-for-age and -sex z score (LAZ/HAZ) during the first 2 y of life and in mid-childhood.Results: LBW and SGA, but not preterm birth, were associated with lower cognitive test scores in mid-childhood and early adolescence. The proportion of the total association of SGA with adolescent cognitive development that was mediated by LAZ/HAZ at 6, 12, and 24 mo of age and in mid-childhood was 25%, 32%, 32%, and 27%, respectively. The corresponding proportions for LBW were 25%, 32%, 16%, and 24%, respectively.Conclusions: The association of LBW and SGA with cognitive development in mid-childhood and adolescence is not largely mediated by postnatal stature during the first 2 y of life. Postnatal interventions that address the antecedent causes of poor child growth and development, rather than early childhood growth alone, are more likely to mitigate the risk of suboptimal development among SGA and LBW children. This trial was registered at www.isrctn.com as ISRCTN08850194. [ABSTRACT FROM AUTHOR]

Background: Evidence on anemia and associated factors among young adolescent girls and boys in rural western China is limited.Methods: We used data from a follow-up study of adolescents (10-14 years) born to women who participated in a randomized trial of antenatal micronutrient supplementation in western China. Anemia was defined by World Health Organization standards. Logistic regression was used to examine the factors associated with anemia.Results: The overall prevalence of anemia was 11.7% (178/1517). Female adolescents were 1.73 (95% CI 1.21, 2.48) times more likely to have anemia as compared to males. Adolescents whose mothers had completed high school were 0.35 (95% CI 0.13, 0.93) times less likely to be anemic, compared to those of whom had < 3 years of formal education. Household wealth was also inversely associated with anemia. The association of puberty status with anemia was modified by adolescent sex (P-value for interaction was 0.04); males with greater than mild pubertal development had reduced odds (OR 0.35, 95% CI 0.15, 0.83) of anemia while there was no association among females (OR 0.72, 95% CI 0.29, 1.78). Consumption of flesh foods (OR 0.58, 95% CI 0.38, 0.89), eggs (OR 0.60, 95% CI 0.38, 0.93), and having a meal frequency of three times or more per day (OR 0.68, 95% CI 0.48, 0.96) were also associated with a lower likelihood of anemia.Conclusions: Anemia was a mild public health problem among young adolescents in rural western China. Nutritional and social determinants were identified as predictors, warranting interventions to reduce the risk of anemia among this critical age group. [ABSTRACT FROM AUTHOR]

We aimed to comprehensively examine the association of breast-feeding, types and initial timing of complementary foods with adolescent cognitive development in low- and middle-income countries. We conducted a prospective cohort study of 745 adolescents aged 10–12 years who were born to women who participated in a randomised trial of prenatal micronutrient supplementation in rural Western China. An infant feeding index was constructed based on the current WHO recommendations. Full-scale intelligence quotient (FSIQ) was assessed and derived by the fourth edition of the Wechsler Intelligence Scale for Children. The duration of exclusive or any breast-feeding was not significantly associated with adolescent cognitive development. Participants who regularly consumed Fe-rich or Fe-fortified foods during 6–23 months of age had higher FSIQ than those who did not (adjusted mean differences 4·25; 95 % CI 1·99, 6·51). For cows'/goats' milk and high protein-based food, the highest FSIQ was found in participants who initially consumed at 10–12 and 7–9 months, respectively. A strong dose–response relationship of the composite infant feeding index was also identified, with participants in the highest tertile of overall feeding quality having 3·03 (95 % CI 1·37, 4·70) points higher FSIQ than those in the lowest tertile. These findings suggest that appropriate infant feeding practices (breast-feeding plus timely introduction of appropriate complementary foods) were associated with significantly improved early adolescent cognitive development scores in rural China. In addition, improvement in Fe-rich or Fe-fortified foods complementary feeding may produce better adolescent cognitive development outcomes. [ABSTRACT FROM AUTHOR]

Aim: To determine the correct ShangRing size for paediatric circumcision using the no-flip technique.Methods: A cohort of 104 boys (from 6 to 14 years) underwent ShangRing circumcision at Ningbo First Hospital, China. The patients were randomly divided into three groups according to the different methods used for choosing the ring size. For Group A, the ring size was chosen using the ShangRing measuring tape; for Group B, ring size was chosen based on the diameter of penis measured using a self-designed scale plate; and for Group C, ring size was chosen based on the diameter of the glans measured using the self-designed scale plate. The surgery duration, foreskin dorsal slit rate, intra-operative and post-surgery pain score, pain duration, post-surgery ring detachment duration, pain score for ring detachment, complication rate and satisfaction rate were compared.Results: Group A had the highest dorsal slit rate and the longest surgical period. There were no significant differences in intra-/post-surgery pain or ring detachment duration among the three groups. The post-surgery oedema rate and foreskin asymmetry occurrence rate was the highest in Group A at 40.62 and 21.88%, respectively. Group C had the highest satisfaction rate (97.14%), with a significant difference from Group A (75.00%). Oedema and asymmetry of the foreskin increased, while the satisfaction rate simultaneously decreased when a larger ShangRing was chosen.Conclusions: The size of the ShangRing should be chosen in accordance with the diameter of the glans in paediatric ShangRing circumcision using the no-flip technique. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of Serenoa repens among patients with benign prostatic hyperplasia (lower urinary tract symptoms/benign prostatic hyperplasia [LUTS/BPH]) in China.Methods: We conducted a double blind, placebo-controlled study of 354 patients with LUTS/BPH from 19 institutions, to evaluate the efficacy and safety of Serenoa repens. Participants were randomly assigned (1:1) into the Serenoa repens extract (320 mg) or placebo groups for 24 weeks. Primary efficacy parameters were changes in International Prostate Symptom Score and peak urinary flow from baseline to each assessment. Secondary efficacy parameters included improvement of storage symptom and voiding symptom scores, prostate volume, urinary frequency, and total prostate-specific antigen level. Other parameters assessed were quality of life score, a four-item male sexual function questionnaire score, and International Index of Erectile Function score across the consecutive double-blind visits.Results: Statistically significant improvement in the peak urinary flow, International Prostate Symptom Score, scores of storage symptoms and voiding symptoms, quality of life score, four-item male sexual function questionnaire score, and International Index of Erectile Function score were observed in the Serenoa repens extract group compared with those in the placebo group (P <.05). Two (1.18%) of 169 patients in the placebo group and 3 (1.89) of 159 patients in the Serenoa repens extract group experienced 1 or more adverse events.Conclusion: The Serenoa repens extract was effective, safe, well-tolerated, and clinically and statistically superior to placebo in the target LUTS/BPH population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and efficacy of a novel approach of microscopic subinguinal varicocelectomy with a "pulling" strategy.Materials and Methods: Fifty-two male patients with varicocele were enrolled in this study. Twenty-six patients underwent conventional microscopic subinguinal varicocelectomy, whereas the remaining 26 patients accepted our novel approach of treatment. In this method, with a subinguinal incision, we dissociated the spermatic cord from the external ring. And thus we pulled the spermatic cord down and away from the external ring and exposed the spermatic cord that initially was proximal to the external ring in the surgical field. The remainder of the procedure was similar to that of the conventional method. Follow-up was made at 1 and 3 months. Postoperative complications were recorded and sperm parameters were evaluated by semen analysis.Results: Fewer vein branches were ligated in the novel method group compared with the conventional method group (6.9 ± 2.1 vs 9.8 ± 2.2, P < .001; t = -5.316). There was no significant difference in the number of testicular arteries or lymphatic ducts between the 2 groups. The mean microsurgical operative time in the novel method group was significantly shorter than that in the conventional method group (34.7 ± 6.5 minutes vs 45.7 ± 8.8 minutes, P < .001; t = -5.621). The incidence of postoperative complications was similar for the 2 groups. There was no significant difference regarding semen quality improvement between the 2 groups.Conclusion: This study demonstrates that our novel approach of microscopic subinguinal varicocelectomy with a "pulling" strategy significantly reduces the number of internal veins to ligate and shortens operating time, with no increase in complications. It is a safe and effective method of varicocele treatment. [ABSTRACT FROM AUTHOR]

Background: Dietary methylmercury intake can occur not only through fish ingestion but also through rice ingestion; however, rice does not contain the same beneficial micronutrients as fish.Objectives: In rural China, where rice is a staple food, associations between prenatal methylmercury exposure (assessed using maternal hair mercury) and impacts on offspring neurodevelopment were investigated.Methods: A total of 398 mothers were recruited at parturition at which time a sample of scalp hair was collected. Offspring (n=270, 68%) were assessed at 12 months using the Bayley Scales of Infant Development-II, yielding age-adjusted scores for the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI).Results: Among 270 mothers, 85% ingested rice daily, 41% never or rarely ingested fish/shellfish and 11% ingested fish/shellfish at least twice/weekly. Maternal hair mercury averaged 0.41μg/g (median: 0.39μg/g, range: 0.079-1.7μg/g). In unadjusted models, offspring neurodevelopment (both MDI and PDI) was inversely correlated with hair mercury. Associations were strengthened after adjustment for fish/shellfish ingestion, rice ingestion, total energy intake (kcal), and maternal/offspring characteristics for both the MDI [Beta: -4.9, 95% Confidence Interval (CI): -9.7, -0.12] and the PDI (Beta: -2.7, 95% CI: -8.3, 2.9), although confidence intervals remained wide for the latter.Conclusions: For 12-month old offspring living in rural China, prenatal methylmercury exposure was associated with statistically significant decrements in offspring cognition, but not psychomotor development. Results expose potential new vulnerabilities for communities depending on rice as a staple food. [ABSTRACT FROM AUTHOR]