Zhaoxing Pan

• MB, PhD
• Statistician at University of Colorado

Introduction Limited data exist regarding the effect of pre-operative risk factors on fetal survival for patients undergoing fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). The primary objective of this study was to determine the pre-operative variables predictive of single and dual fetal survival at birth for sub...

Objectives Unsedated transnasal esophagoscopy (TNE) is an innovative and minimally invasive technique becoming more commonplace in pediatric gastroenterology. The advantages include no anesthesia, decreased cost, and less time away from work and school. There is no published data evaluating postprocedure adverse events (AE) with TNE. The aim of thi...

Background Anesthesiologists manage life-threatening, critical events in a fast-paced, high-distraction atmosphere, with little time to deliberate about treatment options. The Society for Pediatric Anesthesia developed the Pedi Crisis 2.0 Mobile Application to assist in managing critical pediatric perioperative events. We hypothesized that the appl...

Background: Long-term (≥12 months) randomized trials evaluating the efficacy of intermittent fasting (IMF) as a dietary weight loss strategy are limited. Furthermore, no studies have compared IMF versus daily caloric restriction (DCR) when both interventions are provided in the context of a guidelines-based behavioral weight loss program. Objecti...

The purpose of this paper is to serve as a catalyst for the human-animal interaction research field to improve scientific rigor and accelerate the knowledge of field-based physiological responses during equine-assisted services in youth with autism spectrum disorder. This paper outlines the best practices for collecting and analyzing electrocardiog...

Background Endoscopy, standard-of-care for monitoring Eosinophilic Esophagitis (EoE), assesses mucosal inflammation. The Esophageal String Test (EST ® ), a minimally invasive swallowed capsule and immunoassays, quantifies EoE inflammation. We determined whether the EST/EoEScore can monitor disease in patients undergoing treatment. Methods Thirty-t...

Purpose Hip subluxation and dislocation are known problems for children with spinal muscular atrophy (SMA). Medical complexity of these children typically results in absence of monitoring and intervention for pathologic hips. Patterns of hip migration and acetabular morphology in SMA have not been described. This study examines the natural progress...

Introduction The current paper aimed to assess the feasibility of a modified intervention protocol named “Occupational Therapy using Zones of Regulation Concepts in an Equine Environment” (OT-ZOR Equine). Methods A single arm A-B feasibility study was conducted, involving 14 autistic youth ages 6-13 years who first received 10-weeks of occupationa...

Background: The differential effects of pecans versus other popular snack foods on appetite and blood markers of metabolism and satiety have not been well studied. This study investigated the effects of a single mid-morning snack of pecans or tortilla chips on subjective appetite, food intake, blood measures of hormones and metabolites, and resting...

There is a lack of peer-reviewed research on occupational therapy using Zones of Regulation™ concepts for autistic youth. The purpose of this article is to describe the feasibility of a newly-developed occupational therapy intervention using Zones of Regulation™ concepts (OT-ZOR) for autistic youth. Specifically, we aimed to evaluate: (a) participa...

Loss of ovarian function imparts increased susceptibility to obesity and metabolic disease. These effects are largely attributed to decreased estradiol (E 2 ), but the role of increased follicle stimulating hormone (FSH) in modulating energy balance has not been fully investigated. Previous work that blocked FSH binding to its receptor in mice sugg...

Objectives Eosinophilic gastritis (EoG) and duodenitis (EoD) are rare conditions that are poorly understood. Our aim was to describe the natural history of children with varying degrees of gastric or duodenal eosinophilia with respect to disease complications and histologic and endoscopic longitudinal trajectories. Methods The electronic medical r...

Transnasal endoscopy (TNE) with virtual reality (VR) distraction allows for unsedated pediatric upper endoscopy. Understanding the pediatric population that is successful with TNE is imperative for patient selection and experience. We developed a “TNEase Score” to assess patient tolerance from the physician's assessment. The aim of this study was t...

Objective Weight loss of ≥10% improves glucose control and may remit type 2 diabetes (T2D). High‐protein (HP) diets are commonly used for weight loss, but whether protein sources, especially red meat, impact weight loss‐induced T2D management is unknown. This trial compared an HP diet including beef and a normal‐protein (NP) diet without red meat f...

Background: Biliary atresia (BA) is likely caused by a common phenotypic response to various triggers; one proposed trigger, cytomegalovirus (CMV), may lead to worse outcomes. The aim of this study was to determine the severity of disease and pretransplant outcomes of infants with BA, who have evidence of CMV (CMV+) at diagnosis compared with CMV-...

Although swallowed topical steroids are effective in inducing histological remission in eosinophilic esophagitis (EoE), their efficacy is limited by treatment nonadherence. In this study, we objectively measured adherence rates to swallowed topical steroids in adolescents with EoE over the course of 8 weeks and analyzed the association between adhe...

Background: Little is known regarding the impact of race, ethnicity, and socioeconomic status on the health outcomes of children with Eosinophilic esophagitis (EoE). Objective: To 1) identify demographic characteristics of children diagnosed with EoE in a large tertiary care center, and 2) determine associations between a patient's demographics...

Introduction The aim of this feasibility and proof-of-concept study was to examine the use of a novel wearable device for automatic food intake detection to capture the full range of free-living eating environments of adults with overweight and obesity. In this paper, we document eating environments of individuals that have not been thoroughly desc...

Background The literature supports quantifying the maximum force/tension generated by one’s forearm muscles such as the hand grip strength (HGS) to screen for physical and cognitive frailty in older adults. Thus, we postulate that individuals with cerebral palsy (CP), who are at higher risk for premature aging, could benefit from tools that objecti...

Insufficient protein intake is a common challenge among older adults, leading to loss of muscle mass, decreased function and reduced quality of life. A protein intake of 0.4 g/kg body weight/meal is recommended to help prevent muscle loss. The purpose of this study was to assess whether the protein intake of 0.4 g/kg body weight/meal could be achie...

Background: To compare the acute and chronic effects of frequent, short physical activity (PA) bouts spread throughout the day to a time-matched intervention consisting in a single continuous daily bout of PA on glucose control and potential underlying mechanisms in adults at risk of developing type 2 diabetes (T2D). Methods: BURST2D is a single-ce...

Background: Symptom distress is related to decreased quality of life (QOL) among children with cancer, with high levels of pain, nausea, and anxiety reported. Creative arts therapy (CAT) has been related to improved QOL and symptoms in pediatric oncology, but the quality of evidence is mixed. Objective: This article aims to examine the QOL sympt...

Research Objectives To evaluate the relationship of cerebral palsy (CP) motor severity, as measured by the Gross Motor Functional Classification System (GMFCS), on healthcare access. Design A prospective, cross-sectional cohort study. Setting Accredited clinical motion analysis laboratory at a regional children's hospital. Participants 72 ambula...

Introduction: Morbidity of the left atrioventricular valve (LAVV) remains the leading indication for reoperation on atrioventricular septal defects (AVSDs). While qualitative 2D and quantitative 3D risk factors have been identified, no quantitative 2D measurement yet exists to predict poor postoperative outcomes. The aim of this study was to evalua...

Background Combined estrogen and progestin hormonal contraceptives (CHCs, including combined oral contraceptives, hormonal patches, or vaginal rings) expose women to supraphysiologic levels of reproductive hormones, which in turn suppress endogenous estrogen and progesterone. Sustained elevations of synthetic estrogen/progestin or suppression of en...

Objective: To evaluate the impact of type and dose of swallowed topical steroids (STS) and concurrent steroid therapy on the development and resolution of adrenal insufficiency (AI) in pediatric eosinophilic esophagitis (EoE). Methods: We performed a retrospective case-control study of pediatric EoE subjects in a single tertiary care center, who...

Introduction/purpose: Dietary restriction (DIET) and aerobic exercise (AEX) interventions may impact energy balance differently. Our aim was to describe the effects of weight loss interventions via DIET or AEX on measures of energy balance. Methods: Adults with overweight or obesity were randomized to 12 weeks of DIET or AEX with similar calorie...

Objective Achieving functional recovery after cesarean delivery is critical to a parturient’s ability to care for herself and her newborn. Adequate pain control is vital, and without it, many other aspects of the recovery process may be delayed. Reducing opioid consumption without compromising analgesia is of paramount importance, and enhanced reco...

Objectives: Celiac disease (CeD) autoimmunity and coexisting inflammatory bowel disease (IBD) present a diagnostic dilemma. Our aims were to describe the phenotype of children with IBD and CeD seropositivity and evaluate provider confidence for diagnosing CeD in this population. Methods: We performed a single-center retrospective cohort study of...

Abstract Vibration controlled transient elastography (FibroScan) is used to predict the severity of liver fibrosis and steatosis. In pediatrics, few studies have been performed directly comparing liver histologic features with FibroScan liver stiffness measurements (LSMs) and controlled attenuation parameters (CAPs). The FibroScan–aspartate aminotr...

Background The standard of care for treating overweight and obesity is daily caloric restriction (DCR). While this approach produces modest weight loss, adherence to DCR declines over time and weight regain is common. Intermittent fasting (IMF) is an alternative dietary strategy for reducing energy intake (EI) that involves >60% energy restriction...

Objectives: To 1) assess the macronutrient and micronutrient intake in adolescents with liver biopsy proven NAFLD (with and without NASH) and lean controls; 2) determine nutritional predictors of disease severity amongst these groups. Methods: Adolescents with biopsy proven NAFLD and lean controls completed the Harvard Food Frequency Questionnai...

Background A fast rate of eating is associated with a higher risk for obesity but existing studies are limited by reliance on self-report and the consistency of eating rate has not been examined across all meals in a day. The goal of the current analysis was to examine associations between meal duration, rate of eating, and body mass index (BMI) an...

Emerging evidence suggests therapeutic horseback riding improves self-regulation behaviors, social functioning, and language in youth with autism spectrum disorder (ASD). It has been theorized that interacting with horses is calming for youth with ASD, which may influence social and language outcomes. The current study is an exploratory secondary m...

Objective To describe best practices for manual nutritional analyses of data from passive capture wearable devices in free-living conditions. Method 18 participants (10 female) with a mean age of 45 ± 10 years and mean BMI of 34.2 ± 4.6 kg/m² consumed usual diet for 3 days in a free-living environment while wearing an automated passive capture dev...

Background: Benefits of mother's own milk (MOM) for infants in neonatal intensive care units (NICUs) are well known. Many mothers provide for their infant's feedings during their entire hospitalization while others are unable. Knowledge is limited about which infant and maternal factors may contribute most to cessation of MOM feedings. Purpose:...

Introduction: Many barriers prevent individuals from regularly engaging in physical activity (PA), including lack of time and access to facilities. Providing free gym membership close to one's work may alleviate both time and financial barriers, increase PA, and result in greater weight loss. The purpose of this secondary analysis was to determine...

Mental health is a growing concern in pediatric celiac disease (CD). This study utilized the Revised Children's Anxiety and Depression Scale (RCADS) to investigate anxiety and depression symptom rates. Participants were children ages 8 to 17 years (M=11.7, SD=2.7; N=175) with biopsy-proven CD (Median=1.1 years post-diagnosis, IQR=0-4) categorized i...

Background The standard-of-care for treating overweight and obesity is daily caloric restriction (DCR). While this approach produces modest weight loss, adherence to DCR declines over time and weight regain is common. Intermitting fasting (IMF) is an alternative dietary strategy for reducing energy intake (EI) that involves > 60% energy restriction...

Introduction: Children with cancer experience distress and decreased quality of life (QOL). Creative arts therapy (CAT) is a therapeutic modality which may improve QOL. This study examined the relationship between CAT and QOL in children and adolescents with cancer. Secondary aims explored relationships between CAT and emotional reactions, resilien...

Background Three-dimensional echocardiography (3DE) evaluation of right ventricular (RV) volumes and ejection fraction (EF) is increasingly utilized for clinical serial assessments and management in children. This study aims to generate sex-specific reference values and Z score equations for RV volumetric parameters, independent of age and body siz...

Background Esophageal remodeling is a factor in disease progression and symptom severity for patients with Eosinophilic Esophagitis (EoE). Remodeling can begin early in children, resulting in stricture and food impaction. Detection of esophageal remodeling often depends on endoscopy and appreciated only in its later stages. Objective We sought to...

Research Objectives Adults with cerebral palsy (CP) have higher risk of developing geriatric syndromes. Mild cognitive impairment (MCI) is an intermediate stage between healthy aging and dementia, often co-morbid with cardiovascular disease (CVD). We recently showed an “accelerated aging model”, where CP shares similar CVD risk factors with MCI, po...

Breaking up sedentary behavior with short-frequent bouts of physical activity (PA) differentially influences metabolic health compared with the performance of a single-continuous bout of PA matched for total active time. However, the underlying mechanisms are unknown. We compared skeletal muscle mitochondrial respiration (high-resolution respiromet...

Adults with cerebral palsy (CP) have higher risk of developing geriatric syndromes. Mild cognitive impairment (MCI) is an intermediate stage between healthy aging and dementia, often co-morbid with cardiovascular disease (CVD). We recently showed an “accelerated aging model”, where CP shares similar CVD risk factors with MCI, potentially accounting...

Background: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular complications include left ventricular dysfunction and coronary artery abnormalities (CAA). Little is known, however, about the interaction between LV function...

Background Angelman syndrome (AS) patients often respond to low glycemic index therapy to manage refractory seizures. These diets significantly affect quality of life and are challenging to implement. These formulations may have benefits in AS even in the absence of biomarkers suggesting ketosis. Objectives We aimed to compare an exogenous medical...

Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management. We compared patterns of PA in a cohort of weight loss maintainers (WLM, n...

Objective Mathematical equations that predict resting energy expenditure (REE) are widely used to derive calorie prescriptions during weight‐loss interventions. Although such equations are known to introduce group‐ and individual‐level error into REE prediction, their validity has largely been assessed in weight‐stable populations. Therefore, this...

Unlabelled: The eosinophilic esophagitis (EoE) endoscopic reference score (EREFS) is a validated system for description, recognition, and reporting of EoE findings during esophagogastroduodenoscopy (EGD). This scoring system correlates with esophageal eosinophilia and therapeutic responses and has validated diagnostic accuracy with good inter- and...

Esophageal food impactions (EFI) are associated with esophageal pathology, most commonly eosinophilic esophagitis (EoE). Obtaining biopsies provides opportunity for diagnosis, which is important since treatment of EoE decreases the risk for future EFI. Outpatient follow-up rates remain suboptimal and outcomes of patients without timely follow-up ar...

Purpose Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube. Design and Methods Pediatric Intensive Care Unit (PICU) patients were enrolled...

Background and aims Esophageal dilation improves dysphagia but not inflammation in eosinophilic esophagitis (EoE) patients. We investigated if dilation modifies the association between symptoms and esophageal eosinophil count (eos/hpf). Methods Adults enrolled in a multisite, prospective Consortium of Gastrointestinal Eosinophilic Disease Research...

Objective To measure adherence rates to swallowed topical steroids in children with eosinophilic esophagitis (EoE), describe factors related to adherence, and determine the association between adherence, symptoms, perceived disease severity, and quality of life in children with EoE. Study design Subjects in this cross-sectional study of 117 childr...

Background Pes planovalgus is common in children with cerebral palsy. Although severity influences treatment, there still lacks standard clinical measurements to objectively quantify pes planovalgus in this population. The comparison of pedobarographic data and radiographic measurements to clinical evaluation has not been reported in this populatio...

Background Individuals with overweight or obesity commonly underreport energy intake (EI), but it is unknown if the tendency to underreport persists in formerly obese individuals who lose significant weight and maintain their weight loss over long periods of time. Objective Assess the accuracy of self-reported EI in successful weight loss maintain...

Background Three‐dimensional echocardiography (3DE) evaluation of left ventricular (LV) volume and function in pediatrics compares favorably with cardiac magnetic resonance imaging. The aim of this study was to establish from a multicenter, normal pediatric z‐score values of 3DE left ventricular volumes and function. Methods Six hundred and ninety...

Little is known about the impact of sarcopenia (reduced muscle mass and function) in pediatric chronic liver disease. We compared psoas muscle surface area (PMSA), measured at the 4th lumbar vertebrae, in children listed for liver transplantation (LT) to that of healthy controls and studied the impact of sarcopenia on transplant-associated outcomes...

Background: Three-dimensional echocardiography (3DE) evaluation of left ventricular (LV) volume and function in pediatrics compares favorably with cardiac magnetic resonance imaging. The aim of this study was to establish from a multicenter, normal pediatric z-score values of 3DE left ventricular volumes and function. Methods: Six hundred and ninet...

BACKGROUND Right ventricular (RV) function is a major contributor to the outcome of pulmonary arterial hypertension (PAH). Adult studies demonstrated that regional and global changes in RV deformation are prognostic in PAH using 3-dimensional echocardiography (3DE). However, regional and global dynamic changes in RV mechanics have not been describe...

Objectives: Exclusive enteral nutrition (EEN) is infrequently used in the United States but is an effective treatment for pediatric Crohn's disease (CD). Limited data exists regarding patient and parent perspectives on this treatment modality. The aim of this study was to determine parent and provider perspectives regarding EEN and understand pare...

Objective: No data currently exist on the reproducibility of photographic food records compared to diet diaries, two commonly used methods to measure dietary intake. Our aim was to examine the reproducibility of diet diaries, photographic food records, and a novel electronic sensor, consisting of counts of chews and swallows using wearable sensors...

Objective This study aimed to perform a preliminary investigation of the impact of combined hormonal contraceptive (CHC) use on weight loss during an 18‐month behavioral weight‐loss trial. Methods Adults (n = 170; 18‐55 years; BMI 27‐42 kg/m²) received a weight‐loss intervention that included a reduced‐calorie diet, a progressive exercise prescrip...

BACKGROUND: Baseline cardiovascular fitness may be a significant predictor of future success in a comprehensive behavioral weight loss program (BWLP). Yet, few studies have examined the association between baseline fitness and future weight loss. PURPOSE: To determine the association between baseline fitness and changes in body weight and device-me...

Background and Aims Removal of gastric button batteries (BBs) remains controversial. Our aim was to better define the spectrum of injury and to characterize clinical factors associated with injury from retained gastric BBs. Methods Multicenter retrospective cohort study from January 2014 through May 2018. Pediatric gastroenterologists from 4 pedia...

There is a wide range of emotion regulation (ER)‐related impairment observed in autism spectrum disorder (ASD), which is associated with both internalizing and externalizing problems. Although the importance of ER is widely acknowledged in the ASD literature, little is known about factors associated with variability in ER impairment. Given the iden...

Objective Appetite responses to 3 days of overfeeding (OF) were examined as correlates of longitudinal weight change in adults classified as obesity prone (OP) or obesity resistant (OR). Methods OP (n = 22) and OR (n = 30) adults consumed a controlled eucaloric and OF diet (140% of energy needs) for 3 days, followed by 3 days of ad libitum feeding...

Background Right ventricular (RV) function is an important determinant of outcomes in pulmonary hypertension (PH). RV-arterial coupling ratio using stroke volume (SV) to end-systolic volume (ESV) has been shown to be an independent predictor of outcome in adults with PH. SV/ESV has not been used in pediatrics to predict outcomes. We compared SV/ESV...

The in vivo net energy content of resistant starch (RS) has not been measured in humans so it has not been possible to account for the contribution of RS to dietary energy intake. We aimed to determine the in vivo net energy content of RS and examine its effect on macronutrient oxidation. This was a randomized, double-blind cross-over study. Eighte...

The current obesity epidemic is staggering in terms of its magnitude and public health impact. Current guidelines recommend continuous energy restriction (CER) along with a comprehensive lifestyle intervention as the cornerstone of obesity treatment, yet this approach produces modest weight loss on average. Recently, there has been increased intere...

There is preliminary research suggesting that animal-assisted activities can improve social interactions of children with autism spectrum disorder. This pilot study sought to investigate the benefits of animal-assisted activities with dogs and psychiatrically hospitalized youth with autism spectrum disorder. Participants were recruited from a speci...

Objectives: To investigate the association between childhood surgical interventions, walking ability, and gross motor function in adults with Cerebral Palsy. Design: Prospective cross-sectional study. Participants: Male (47.2%) and female (52.8%) adults (Mean age: 25.0�5.3; Range: 18.5-48.7) all with CP (NZ72). Interventions: N/A. Setting: An accre...

Background: Most fetal deaths are unexplained. Long QT syndrome is a genetic disorder of cardiac ion channels. Affected individuals, including fetuses, are predisposed to sudden death. We sought to determine the risk of fetal death in familial long QT syndrome, in which the mother or father carries the long QT syndrome genotype. In addition, we as...

Objectives: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomark...

Objective This study aimed to evaluate the impact of timing of exercise initiation on weight loss within a behavioral weight loss program. Methods Adults with overweight or obesity (N = 170; age 18‐55 years; BMI 25‐42 kg/m²; 83.5% women) were enrolled in an 18‐month behavioral weight loss program consisting of a reduced‐calorie diet, exercise, and...

Clinical Implications Despite the intention to adhere to their swallowed topical steroids, adolescents with eosinophilic esophagitis have poor planning and low medication adherence rates. A digital sensor and mobile health tool may better assess adherence rates. TO THE EDITOR: Swallowed topical steroids are a mainstay of treatment for eosinophilic...

Objective: To evaluate whether children with eosinophilic esophagitis (EoE) demonstrated an association between health-related quality of life (HRQoL) improvements and symptom reduction during 12 months of treatment; to examine age-related EoE discrete symptom presentation; and to describe residual symptom and HRQoL burden. Methods: Children age...

Purpose: To understand the relationship of walking speed to self-reported pain, fatigue, and physical function in adults with CP. Methods: Design: Cross-sectional study. Setting: Accredited clinical motion analysis laboratory in a regional children's hospital. Participants: 72 ambulatory patients ⩾ 18 years of age, diagnosed with CP, who pre...

Objective: We sought to compare the obstetrical outcomes in patients who underwent midtrimester cerclage placement with or without prior amniocentesis in a single center cohort. Methods: A retrospective medical record review in a single academic institution was undertaken of all patients who underwent either an exam or ultrasound indicated cerclage...

Introduction Evidence suggests a reciprocal relationship between obesity-related health behaviors and sleep. The objective of this analysis was to examine whether changes in sleep duration affected energy intake (EI) and levels of moderate-vigorous PA (MVPA) within a behavioral weight loss intervention. Methods A total of 91 adults with overweight...