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Gong T, Huang Q, Zhang Q, Cui Y. Postoperative outcomes of pediatric patients with perioperative COVID-19 infection: a systematic review and meta-analysis of observational studies. J Anesth 2024; 38:125-135. [PMID: 37897542 DOI: 10.1007/s00540-023-03272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To quantify the risk of adverse postoperative outcomes in pediatric patients with COVID-19 infection. METHODS We searched PubMed, Embase, Cochrane Library from December 2019 to 21 April 2023. Observational cohort studies that reported postoperative early mortality and pulmonary complications of pediatric patients with confirmed COVID-19-positive compared with COVID-19-negative were eligible for inclusion. We excluded pediatric patients underwent organ transplantation or cardiac surgery. Reviews, case reports, letters, and editorials were also excluded. We used the Newcastle-Ottawa Scale to assess the methodological quality and risk of bias for each included study. The primary outcome was postoperative early mortality, defined as mortality within 30 days after surgery or during hospitalization. The random-effects model was performed to assess the pooled estimates, which were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). RESULTS 9 studies involving 23,031 pediatric patients were included, and all studies were rated as high quality. Compared with pediatric patients without COVID-19, pediatric patients with COVID-19 showed a significantly increased risk of postoperative pulmonary complications (PPCs) (RR = 4.24; 95% CI 2.08-8.64). No clear evidence was found for differences in postoperative early mortality (RR = 0.84; 95% CI 0.34-2.06), postoperative intensive care unit (ICU) admission (RR = 0.80; 95% CI 0.39-1.68), and length of hospital stay (MD = 0.35, 95% CI -1.81-2.51) between pediatric patients with and without COVID-19. CONCLUSION Perioperative COVID-19 infection was strongly associated with increased risk of PPCs, but it did not increase the risk of postoperative early mortality, the rate of postoperative ICU admission, and the length of hospital stay in pediatric patients. Our preplanned sensitivity analyses confirmed the robustness of our study findings.
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Affiliation(s)
- Tianqing Gong
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Qinghua Huang
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Qianqian Zhang
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Yu Cui
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, China.
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Del Rey de Diego P, Martínez García E, Tormo de Las Heras C, García Fernández E. Adaptation to a monography pediatric hospital of the recommendations for the early detection of active COVID-19 infection prior to hospital admission, performance of diagnostic tests and surgical procedures. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:608-609. [PMID: 37678463 DOI: 10.1016/j.redare.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 09/09/2023]
Affiliation(s)
- P Del Rey de Diego
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - E Martínez García
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - C Tormo de Las Heras
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - E García Fernández
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Pantalos G, Papachristidou S, Mavrigiannaki E, Zavras N, Vaos G. Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review. Diagnostics (Basel) 2023; 13:2571. [PMID: 37568934 PMCID: PMC10417690 DOI: 10.3390/diagnostics13152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.
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Affiliation(s)
- George Pantalos
- Pediatric Intensive Care Unit, Penteli General Children’s Hospital, 15236 Athens, Greece
| | - Smaragda Papachristidou
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece;
| | - Eleftheria Mavrigiannaki
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - Nikolaos Zavras
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - George Vaos
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
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Del Rey de Diego P, García EM, de Las Heras CT, Fernández EG. [ADAPTATION TO A MONOGRAPHY PEDIATRIC HOSPITAL OF THE RECOMMENDATIONS FOR THE EARLY DETECTION OF ACTIVE COVID-19 INFECTION PRIOR TO HOSPITAL ADMISSION, PERFORMANCE OF DIAGNOSTIC TESTS AND SURGICAL PROCEDURES]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:S0034-9356(23)00137-8. [PMID: 38620142 PMCID: PMC10300280 DOI: 10.1016/j.redar.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Indexed: 04/17/2024]
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Iantorno SE, Skarda DE, Bucher BT. Concurrent SARS-COV-19 and acute appendicitis: Management and outcomes across United States children's hospitals. Surgery 2023; 173:936-943. [PMID: 36621446 PMCID: PMC9820025 DOI: 10.1016/j.surg.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nonoperative management of acute appendicitis is a safe and effective alternative to appendectomy, though rates of treatment failure and disease recurrence are significant. The purpose of this study was to determine whether COVID-19-positive children with acute appendicitis were more likely to undergo nonoperative management when compared to COVID-19-negative peers and to compare clinical outcomes and healthcare use for these groups. METHODS A retrospective cohort study of children <18 years with acute appendicitis across 45 US Children's Hospitals during the first 12 months of the COVID-19 pandemic was performed. Operative management was defined as appendectomy or percutaneous drain placement, whereas nonoperative management was defined as admission with antibiotics alone. Multivariable hierarchical logistic regression using an exact matched cohort was used to determine the association between COVID-19 positivity and nonoperative management. The secondary outcomes included intensive care unit admission, mechanical ventilation, length of stay, nonoperative management failure rates, and hospital variation in nonoperative management. RESULTS Of 17,481 children in the cohort, 581 (3.3%) were positive for COVID-19. The odds of nonoperative management was significantly higher in the COVID-19-positive group (adjusted odds ratio [95% confidence interval]: 13.4 [10.7-16.8], P < .001). Patients positive for COVID-19 had increased odds of intensive care unit admission (adjusted odds ratio [95% confidence interval]: 3.78 [2.01-7.12], P < .001) and longer length of stay (median 2 days vs 1 day, P < .001). Hospital rates of nonoperative management ranged from 0% to 100% for COVID-19-positive patients and 0% to 42% for COVID-19-negative patients. CONCLUSION Children with concurrent acute appendicitis and COVID-19 positivity are significantly more likely to undergo nonoperative management. Both groups experience infrequent nonoperative management failure rates and rare intensive care unit admissions. Marked hospital variability in nonoperative management practices was demonstrated.
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Affiliation(s)
- Stephanie E Iantorno
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - David E Skarda
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brian T Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Kadiyani L, Ramakrishnan S. COVID-19 and heart disease in children: What have we learned? Ann Pediatr Cardiol 2023; 16:81-86. [PMID: 37767179 PMCID: PMC10522153 DOI: 10.4103/apc.apc_104_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/29/2023] Open
Affiliation(s)
- Lamk Kadiyani
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Harwood R, Rad L, Kelly C, Shelton C, Shepherd E, Roderick M, Whittaker E, Dyke S, Patel SV, Gent N, Kenny SE. Lateral flow test performance in children for SARS-CoV-2 using anterior nasal and buccal swabbing: sensitivity, specificity, negative and positive predictive values. Arch Dis Child 2023; 108:137-140. [PMID: 36657801 PMCID: PMC9887373 DOI: 10.1136/archdischild-2022-324353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if the sensitivity of the lateral flow test is dependent on the viral load and on the location of swabbing in the respiratory tract in children. DESIGN Phase 1: Routinely performed reverse transcriptase PCR (RT-PCR) using nose and throat (NT) swabs or endotracheal (ET) aspirates were compared with Innova lateral flow tests (LFTs) using anterior nasal (AN) swabs. Phase 2: RT-PCR-positive children underwent paired AN RT-PCR and LFT and/or paired AN RT-PCR and buccal LFT. SETTING Tertiary paediatric hospitals. PATIENTS Children under the age of 18 years. Phase 1: undergoing routine testing, phase 2: known SARS-CoV-2 positive. RESULTS Phase 1: 435 paired swabs taken in 431 asymptomatic patients resulted in 8 positive RT-PCRs, 9 PCR test failures and 418 negative RT-PCRs from NT or ET swabs. The test performance of AN LFT demonstrated sensitivity: 25% (4%-59%), specificity: 100% (99%-100%), positive predictive value (PPV): 100% (18%-100%) and negative predictive value (NPV): 99% (97%-99%).Phase 2: 14 AN RT-PCR-positive results demonstrated a sensitivity of 77% (50%-92%) of LFTs performed on AN swabs. 15/16 paired buccal LFT swabs were negative. CONCLUSION The NPV, PPV and specificity of LFTs are excellent. The sensitivity of LFTs compared with RT-PCR is good when the samples are colocated but may be reduced when the LFT swab is taken from the AN. Buccal swabs are not appropriate for LFT testing. Careful consideration of the swabbing reason, the tolerance of the child and the requirements for test processing (eg, rapidity of results) should be undertaken within hospital settings. TRIAL REGISTRATION NUMBER NCT04629157.
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Affiliation(s)
- Rachel Harwood
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK .,Cellular and Molecular Physiology, University of Liverpool, Liverpool, UK
| | - Laura Rad
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Cliff Shelton
- Wythenshawe Hospital, Manchester, Greater Manchester, UK
| | | | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sanjay Vallabh Patel
- Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nick Gent
- Mathematical modelling, UKHSA, London, UK
| | - Simon E Kenny
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK,Medical Director for Children and Young People, NHS England and NHS Improvement North West, Manchester, UK
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Saynhalath R, Sanford EL, Efune PN. Calculation error alters interpretation of pulmonary complications in children with SARS-CoV-2 undergoing surgery. Anaesthesia 2022; 78:259. [PMID: 36039011 PMCID: PMC9538717 DOI: 10.1111/anae.15849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Affiliation(s)
- R. Saynhalath
- University of Texas Southwestern and Children's HealthDallasTXUSA
| | - E. L. Sanford
- University of Texas Southwestern and Children's HealthDallasTXUSA
| | - P. N. Efune
- University of Texas Southwestern and Children's HealthDallasTXUSA
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Cortegiani A, Tripodi VF, Castioni CA, Esposito C, Galdieri N, Monzani R, Rispoli M, Simonini A, Torrano V, Giarratano A, Gratarola A. Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:29. [PMID: 37386538 PMCID: PMC9214464 DOI: 10.1186/s44158-022-00058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient's surgical process. METHODS The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent. RESULTS Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect. CONCLUSION A balanced preoperative multidisciplinary risk-benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery.
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Affiliation(s)
- Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Francesco Tripodi
- Department of Surgery, Anesthesia and Intensive Care Unit, Policlinico Gaetano Martino, University of Messina, Messina, Italy
| | - Carlo Alberto Castioni
- IRCCS, Istituto Delle Scienze Neurologiche, UOC Anestesia E Rianimazione, Bologna, Italia
| | - Clelia Esposito
- Critical Area Department, Anesthesia and Intensive Care, AO Dei Colli, Vincenzo Monaldi Hospital, Naples, Italy
| | - Nicola Galdieri
- Critical Area Department, Intensive Care in Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Roberta Monzani
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Marco Rispoli
- Critical Area Department, Anesthesia and Intensive Care, AO Dei Colli, Vincenzo Monaldi Hospital, Naples, Italy
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, Ancona, Italy
| | - Vito Torrano
- Department of Emergency and Urgency, Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
| | - Angelo Gratarola
- Department of Emergency, Anesthesia and Intensive Care Unit, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy
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Nielson C, Suarez D, Taylor IK, Huang Y, Park AH. Surgical outcomes inchildren with perioperative SARS-CoV-2 diagnosis. Am J Infect Control 2022; 50:602-607. [PMID: 35301061 PMCID: PMC8920958 DOI: 10.1016/j.ajic.2022.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 01/02/2023]
Abstract
Objective To understand whether perioperative SARS-CoV-2 infection increases risk of pulmonary complications in children. Methods A retrospective cohort study of children who underwent surgery with perioperative SARS-CoV-2 infection at a children's hospital from March 1, 2020, to June 30, 2021. Uninfected, age-matched control patients who underwent the same procedure as infected patients over the past ten years were included in the study in a 3:1 ratio to infected patients. Primary outcomes were 7- and 30-day mortality. Secondary outcomes were development of pulmonary complications, readmission, length of hospital or ICU stay, and oxygen administration in post-anesthesia care unit (PACU). Results Our study included 73 patients who underwent surgery with perioperative diagnosis of SARS-CoV-2, and 218 control patient undergoing similar procedures. One total mortality event was observed within 7 days in an uninfected control patient, and none occurred in infected patients. Perioperative SARS-CoV-2 infection was associated with increased risk for pulmonary complications in univariate analysis. Infection was not associated with any of our other secondary outcomes. Symptomatic SARS-CoV-2 infection and timing of diagnosis was not associated with development of pulmonary complications among infected patients. Conclusions Children with perioperative SARS-CoV-2 infection may be at increased risk for development of pulmonary complications. Larger studies should be performed to confirm our results.
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Affiliation(s)
- Christopher Nielson
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel Suarez
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Isabel K Taylor
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Yiqing Huang
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Albert H Park
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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