Publications by Year: 2024

INTRODUCTION: Climate change is the public health crisis of our time, with young people particularly at risk. Climate change has been associated with increased prevalence of psychiatric disorders. Psychological concerns pertaining to the Earth's future have also been cited as contributing to negative emotions now termed 'climate distress'. While previous reviews have addressed the various ways climate change affects pediatric mental health, this scoping review aims to specifically explore pediatric climate distress and its implications for clinical practice.

METHODS: 2548 articles were extracted from multiple databases, titles, abstracts, and full texts were screened blinded and in duplicate using the web-based platform Covidence. Quantitative and qualitative original research papers published in English between January 1, 2000 and April 29, 2024 that studied pediatric climate distress were included.

RESULTS: Forty-two articles met the inclusion criteria, along with 10 additional grey literature sources. Among quantitative studies, 81 % found that 50 % or more of respondents reported negative climate emotions and 86 % of qualitative studies reported that "all" or "most" respondents expressed negative climate emotions. Additionally, 63 % of studies measuring distress severity reported high distress levels. Therapeutic interventions addressing climate distress were found to be effective and were categorized thematically into three groups: Education-Emotion Focused, Nature-Engagement Based, and Activism-Civic Related.

CONCLUSIONS: This review shows that while there is a growing body of literature that illustrates how young people have negative emotions pertaining to climate change, there is need for increased diagnostic and therapeutic approaches to clinically address these growing challenges.

BACKGROUND AND AIMS: Delayed bleeding (DB) is a common adverse event after endoscopic submucosal dissection (ESD). We evaluated a novel hemostatic powder (UI-EWD, Nexpowder; Medtronic, Minneapolis, Minn, USA) to prevent DB after ESD.

METHODS: This was a multicenter retrospective analysis of ESDs performed between January 2023 and March 2024 in which UI-EWD was applied to prevent DB. Cases in which endoscopic closure of the post-ESD mucosal defect was performed were excluded. DB was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Technical success of UI-EWD was defined as successful delivery and application of the hemostatic powder over the entire mucosal defect.

RESULTS: Eighty-three patients (median age, 66 years) underwent ESD in the esophagus (n = 18), stomach (n = 15), colon (n = 38), and rectum (n = 12). The median lesion size was 50 mm (interquartile range, 41-70 mm). UI-EWD was successfully applied in all defects, although in 2 cases (2.4%) a second delivery catheter had to be used to complete the procedure. DB occurred in 3 patients (3.6%): 2 after gastric ESD and 1 after colonic ESD within 24 hours of the index procedure. None required intervention on repeat endoscopy. There were no cases of perforation. En bloc and R0 resection rates were 96.2% and 88.7%, respectively.

CONCLUSIONS: UI-EWD can be easily applied to mucosal defects after ESD throughout the GI tract. Initial data from this multicenter study demonstrate that the use of UI-EWD was associated with a relatively low rate of DB after ESD. Additional comparative studies are needed to corroborate these preliminary findings.

INTRODUCTION: Increased greenhouse gas emissions since the industrial age have led to higher global temperatures and frequency and severity of climate events, such as heat waves, wildfires, floods, and storms. These changes are adversely affecting human health and increasing disease risk, including risk of allergic diseases. Further understanding of the environmental factors and the cellular and molecular mechanisms mediating these increases can assist in developing strategies to adapt to and mitigate climate change.

MATERIALS AND METHODS: We conducted a scoping review of the literature from 2010 through 2024 using PubMed and Scopus.

RESULTS: Thunderstorms, dust storms, wildfires, and other climate change factors increase allergies both directly and indirectly through increases in particulate matter, pollen, migration of disease vectors and decreases in biodiversity. The epithelial barrier, hygiene, "old friends," and biodiversity hypotheses have been put forward to explain the underlying mechanism mediating these increases.

CONCLUSION: There is an urgent need to reduce the use of fossil fuels to mitigate climate change and protect planetary and human health. While international accords such as the 2015 Paris Agreement have been signed with the aim of lowering greenhouse gases and limiting future global temperature increases, it is clear that increased efforts are needed to meet these goals. Evidence-based solutions for adapting to the increased prevalence of allergic diseases and cost-benefit analysis of current mitigation strategies for lowering allergic diseases are also needed.

Although the hallmark of intestinal failure (IF) management - also known as intestinal rehabilitation - is parenteral nutrition, many of the complications that arise from this complex condition require additional pharmacologic interventions to prevent more serious consequences such as intestinal failure associated liver disease and central line associated bloodstream infections. This brief review highlights some of the more commonly used treatment strategies in pediatric patients with IF along with a review how different types of short bowel anatomy impact drug administration.

Colorectal cancer (CRC) constitutes a significant portion of cancer-related deaths in the United States, topping cancer-related mortality among males under 50 years of age. Despite an increase in overall survival throughout the years, the prognosis of metastatic CRC remains poor. In addition to the classic molecular targets in CRC that include epidermal growth factor receptor, BRAF, and vascular endothelial growth factor pathways, human epidermal growth factor receptor 2 (HER2) amplification is an emerging target that has been successfully targeted in advanced CRC, particularly with anti-HER2 monoclonal antibodies and tyrosine kinase inhibitors. With the introduction of potent HER2-directed antibody-drug conjugates, the number of patients who might be eligible for anti-HER2 therapy is expected to increase dramatically as tumors with lower expression of HER2 (termed HER2 low) have shown relevant response rates across several histologies. Yet, several challenges remain to be addressed in this field, including the standardized method to define HER2-low disease and the most efficient payload in this setting, among others. Future studies will help to further characterize HER2-low CRCs, identify additional predictive biomarkers, and assist in the development of better treatments.

OBJECTIVE: This study aimed to determine whether brain volume at the time of ischemic stroke injury is a better biomarker for predicting functional outcomes than brain atrophy.

BACKGROUND: Brain parenchymal fraction (BPF) has been used as a surrogate measure of global brain atrophy and a neuroimaging biomarker of brain reserve in studies evaluating clinical outcomes after brain injury. Brain volume itself is affected by natural aging, cardiovascular risk factors, and biological sex, among other factors. Recent studies have shown that brain volume at the time of injury can influence functional outcomes, with larger brain volumes being associated with better outcomes.

METHODS: Acute ischemic stroke cases at a single center between 2003 and 2011, with neuroimaging obtained within 48 h of presentation were eligible for the study. Functional outcomes represented by the modified Rankin Scale (mRS) score at 90 days post-admission (mRS score ≤ 2 deemed a favorable outcome) were obtained through patient interviews or per chart review. Deep learning-enabled automated segmentation pipelines were used to calculate brain volume, intracranial volume, and BPF on the acute neuroimaging data. Patient outcomes were modeled through logistic regressions, and a model comparison was conducted using the Bayes information criterion (BIC).

RESULTS: A total of 467 patients with arterial ischemic stroke were included in the analysis, with a median age of 65.8 years and 65.3% of the participants being male. In both models, age and a larger stroke lesion volume were associated with worse functional outcomes. Higher BPF and a larger brain volume were associated with favorable functional outcomes; however, a comparison of both models suggested that the brain volume model (BIC = 501) better explains the data than the BPF model (BIC = 511).

CONCLUSION: The extent of global brain atrophy (and its surrogate biomarker BPF) has been regarded as an important biomarker for predicting functional post-stroke outcomes and resilience to acute injury. In this study, we demonstrate that a higher global brain volume at the time of injury better explains favorable functional outcomes, which can be directly measured in a clinical setting.