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Milrod CJ, Binney G, Khan MA. Pancytopenia associated with bone marrow infiltration from late relapse of neuroblastoma. Lancet Oncol 2023; 24:e519. [PMID: 38040004 DOI: 10.1016/s1470-2045(23)00520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Charles J Milrod
- Department of Hematology & Oncology, Brown University, Providence, RI, USA.
| | - Geoffrey Binney
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Irwin M, Reynolds L, Binney G, Lipsitz S, Ghelani SJ, Harrild DM, Baird CW, Geva T, Brown DW. Right Heart Remodeling After Pulmonary Valve Replacement in Patients With Pulmonary Atresia or Critical Stenosis With Intact Ventricular Septum. J Am Heart Assoc 2023; 12:e031090. [PMID: 37929755 PMCID: PMC10727386 DOI: 10.1161/jaha.123.031090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
Background Patients with pulmonary atresia or critical pulmonary stenosis with intact ventricular septum (PA/IVS) and biventricular circulation may require pulmonary valve replacement (PVR). Right ventricular (RV) remodeling after PVR is well described in tetralogy of Fallot (TOF); we sought to investigate RV changes in PA/IVS using cardiac magnetic resonance imaging. Methods and Results A retrospective cohort of patients with PA/IVS who underwent PVR at Boston Children's Hospital from 1995 to 2021 with cardiac magnetic resonance imaging before and after PVR was matched 1:3 with patients with TOF by age at PVR. Median regression modeling was performed with post-PVR indexed RV end-diastolic volume as the primary outcome. A total of 20 patients with PA/IVS (cases) were matched with 60 patients with TOF (controls), with median age at PVR of 14 years. Pre-PVR indexed RV end-diastolic volume was similar between groups; cases had higher RV ejection fraction (51.4% versus 48.6%; P=0.03). Pre-PVR RV free wall and left ventricular (LV) longitudinal strain were similar, although LV midcavity circumferential strain was decreased in cases (-15.6 versus -17.1; P=0.001). At a median of 2 years after PVR, indexed RV end-diastolic volume was similarly reduced; cases continued to have higher RV ejection fraction (52.3% versus 46.9%; P=0.007) with less reduction in RV mass (Δ4.5 versus 9.6 g/m2; P=0.004). Post-PVR, RV and LV longitudinal strain remained unchanged, and LV circumferential strain was similar, although lower in cases. Conclusions Compared with patients with TOF, patients with PA/IVS demonstrate similar RV remodeling after PVR, with lower reduction in RV mass and comparatively higher RV ejection fraction. Although no differences were detected in peak systolic RV or LV strain values, further investigation of diastolic parameters is needed.
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Affiliation(s)
- Margaret Irwin
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - Lindsey Reynolds
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - Geoffrey Binney
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - Stuart Lipsitz
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - Sunil J. Ghelani
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - David M. Harrild
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - Christopher W. Baird
- Harvard Medical SchoolBostonMA
- Department of Cardiovascular Surgery, Boston Children’s HospitalBostonMA
| | - Tal Geva
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
| | - David W. Brown
- Harvard Medical SchoolBostonMA
- Department of Cardiology, Boston Children’s HospitalBostonMA
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Cohen MB, Aban I, Artman M, Binney G, Blake A, Boney C, First L, Gessouroun M, Rubin BK, Taylor M, Emmanuel P. Pediatric Chair Turnover and Demographics. J Pediatr 2022; 242:4-7.e3. [PMID: 34390691 DOI: 10.1016/j.jpeds.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mitchell B Cohen
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
| | - Inmaculada Aban
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Artman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Geoffrey Binney
- Department of Pediatrics, Tufts Children's Hospital, Boston, MA
| | | | - Charlotte Boney
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Lewis First
- Department of Pediatrics, The Robert Larner, MD College of Medicine at The University of Vermont and University of Vermont Children's Hospital, Burlington, VT
| | - Morris Gessouroun
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Mary Taylor
- Department of Pediatrics, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
| | - Patricia Emmanuel
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL
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Irwin M, Binney G, Gauvreau K, Emani S, Blume ED, Brown DW. Native Bicuspid Pulmonary Valve in D-Loop Transposition of the Great Arteries: Outcomes of the Neo-Aortic Valve Function and Root Dilation After Arterial Switch Operation. J Am Heart Assoc 2021; 10:e021599. [PMID: 34482704 PMCID: PMC8649553 DOI: 10.1161/jaha.121.021599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Neo-aortic root dilation and neo-aortic regurgitation (AR) are common after arterial switch operation for D-loop transposition of the great arteries. We sought to evaluate these outcomes in patients with bicuspid native pulmonary valve (BNPV). Methods and Results A retrospective analysis of patients with transposition of the great arteries undergoing arterial switch operation at Boston Children's Hospital from 1989 to 2018 matched BNPV patients 1:3 with patients with tricuspid native pulmonary valve by year of arterial switch operation. Kaplan-Meier analyses with log-rank test compared groups for time to first neo-aortic valve reoperation, occurrence of ≥moderate AR, and neo-aortic root dilation (root z score ≥4). A total of 83 patients with BNPV were matched with 217 patients with tricuspid native pulmonary valve. Patients with BNPV more often had ventricular septal defects (73% versus 43%; P<0.001). Hospital length of stay (11 versus 10 days) and 30-day surgical mortality (3.6% versus 2.8%) were similar. During median 11 years follow-up, neo-aortic valve reoperation occurred in 4 patients with BNPV (6.0%) versus 6 patients with tricuspid native pulmonary valve (2.8%), with no significant difference in time to reoperation. More BNPV had AR at discharge (4.9% versus 0%; P=0.014) and during follow-up (13.4% versus 4.3%; hazard ratio [HR], 3.9; P=0.004), with shorter time to first occurrence of AR; this remained significant after adjusting for ventricular septal defects. Similarly, neo-aortic root dilation was more common in BNPV (45% versus 38%; HR, 1.64; P=0.026) with shorter time to first occurrence. Conclusions While patients with BNPV have similar short-term arterial switch operation outcomes, AR and neo-aortic root dilation occur more frequently and earlier compared with patients with tricuspid native pulmonary valve. Further long-term studies are needed to determine whether this results in greater need for neo-aortic valve reoperation.
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Affiliation(s)
- Margaret Irwin
- Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Boston MA
| | - Geoffrey Binney
- Department of Cardiology Boston Children's Hospital Boston MA
| | - Kimberlee Gauvreau
- Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Boston MA
| | - Sitaram Emani
- Harvard Medical School Boston MA.,Department of Cardiovascular Surgery Boston Children's Hospital Boston MA
| | - Elizabeth D Blume
- Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Boston MA
| | - David W Brown
- Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Boston MA
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Gellis L, Binney G, Alshawabkeh L, Lu M, Landzberg MJ, Mayer JE, Mullen MP, Valente AM, Sleeper LA, Brown DW. Long-Term Fate of the Truncal Valve. J Am Heart Assoc 2020; 9:e019104. [PMID: 33161813 PMCID: PMC7763736 DOI: 10.1161/jaha.120.019104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022]
Abstract
Background Long-term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long-term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow-up time was 12.6 years (interquartile range, 5.0-22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow-up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P<0.001) or stenosis (HR, 4.12; P<0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60; P<0.001). During follow-up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root z-score before truncus arteriosus full repair and during follow-up was associated with worsening truncal valve regurgitation. Conclusions Long-term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z-score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.
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Affiliation(s)
- Laura Gellis
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | | | - Laith Alshawabkeh
- Sulpizio Cardiovascular InstituteUniversity of California San DiegoLa JollaCA
| | - Minmin Lu
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michael J. Landzberg
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - John E. Mayer
- Department of Cardiac SurgeryBoston Children’s HospitalBostonMA
- Department of SurgeryHarvard Medical SchoolBostonMA
| | - Mary P. Mullen
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Anne Marie Valente
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Lynn A. Sleeper
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - David W. Brown
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
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Abstract
Post-graduate training for physicians involves a high level of stress. High stress during training has the potential to cause burnout, a well-studied phenomenon in medical trainees. Burnout has previously been shown to increase the risk of mental health problems and medical error in trainees. Little research has been done on the impact of stress on new fellows in general and pediatric cardiology fellows in particular; understanding common sources of stress offers the opportunity to design targeted interventions to support trainee wellness. New trainees in Boston Children's Hospital's Pediatric Cardiology Fellowship program were asked to answer to the following question at the beginning of their training: "What are you afraid of in the coming year?" A qualitative content analysis was done on their anonymous responses. Responses were coded and analyzed for common themes. The overall analysis found that 83% of fellows reported fear of "fellowship/career responsibilities." The second most common theme was "failure/disappointment" (78%) followed by "personal life" (74%), "emotional exhaustion" (61%); least common was "new hospital environment" (37%). The most common individual fear was "increased clinical responsibility" reported by 65% of the new fellows, while 62% reported fears of "imposter syndrome," and 58% about "burnout." We found that fellows commonly report fears about both clinical and personal responsibilities, similar to stressors found in studies on residency. It is important for pediatric cardiology fellowships to develop early and specific interventions designed to assist fellows in managing both their new clinical responsibilities and their other stressors.
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Affiliation(s)
- David W Brown
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Geoffrey Binney
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Zachary Gauthier
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Binney G, Cole-Poklewski T, Roomian T, Trudell EK, Hatoun J, O'Donnell H, Vernacchio L. Effect of an Electronic Health Record Transition on the Provision of Recommended Well Child Services in Pediatric Primary Care Practices. Clin Pediatr (Phila) 2020; 59:188-197. [PMID: 31795757 DOI: 10.1177/0009922819892269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to determine the effect of transitioning between electronic health record (EHR) systems on the quality of preventive care in a large pediatric primary care network. To study this, we performed a retrospective chart analysis of 42 primary care practices from the Pediatric Physicians' Organization at Children's who transitioned EHRs. We reviewed 24 random encounters per week distributed evenly across 6 age categories before, during, and after a transition period. We reviewed encounter documentation for age-appropriate well child services, per American Academy of Pediatrics/Bright Futures guidelines. Logistic regression and statistical process control analysis were used. In the pretransition period, 84.5% of all recommended elements were documented versus 86.4% posttransition (P = .04). Documentation of age-appropriate anticipatory guidance showed significant positive change (69.0% to 80.2%, P = .005), but it was the only subdomain with a statistically significant increase. These increases suggest that EHR transitions have the opportunity to affect the delivery of preventive care.
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Affiliation(s)
- Geoffrey Binney
- Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | | | - Tamar Roomian
- Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - Emily K Trudell
- Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - Jonathan Hatoun
- Pediatric Physicians' Organization at Children's, Brookline, MA, USA.,Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Heather O'Donnell
- Pediatric Physicians' Organization at Children's, Brookline, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's, Brookline, MA, USA.,Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Cole C, Binney G, Casey P, Fiascone J, Hagadorn J, Kim C, Lau J, Wang C, DeVine D, Miller K. Criteria for determining disability in infants and children: low birth weight. Evid Rep Technol Assess (Summ) 2002:1-7. [PMID: 15523747 PMCID: PMC4781106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Ramanna L, Waxman A, Binney G, Waxman S, Mirra J, Rosen G. Thallium-201 scintigraphy in bone sarcoma: comparison with gallium-67 and technetium-MDP in the evaluation of chemotherapeutic response. J Nucl Med 1990; 31:567-72. [PMID: 2341892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study attempts to characterize thallium-201 (201TI) uptake in patients with bone and soft-tissue sarcoma and to compare these findings with gallium-67 (67Ga) and bone scintigraphy with emphasis on evaluating tumor viability before and after chemotherapy. Thirty-eight patients with surgically-proven sarcomas were evaluated. All patients had gallium and thallium studies. Nineteen patients underwent pre- and post-chemotherapy thallium and evaluation. Seven patients also had technetium-99m-MDP (99mTc-MDP) bone scintigraphy comparisons. Pathologic changes pre- and postchemotherapy were graded on the basis of %tumor necrosis as defined histologically. Scintigraphic comparisons demonstrated a high degree of correlation with 201TI and poor correlation with 99mTc-MDP. Thallium-201 was superior to 99mTc-MDP and 67Ga in predicting tumor response to chemotherapy as determined by %tumor necrosis determined histologically. Gallium was superior to Tc-MDP in predicting response to chemotherapy. However, both 67Ga and 99mTc-MDP appear to be affected by factors other than tumor activity.
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Affiliation(s)
- L Ramanna
- Department of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048
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