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Jaromin J, Markiewicz-Łoskot G, Szydłowski L, Kulawik A. Diagnostic Value of the TpTe Interval in Children with Ventricular Arrhythmias. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12194. [PMID: 34831949 PMCID: PMC8623175 DOI: 10.3390/ijerph182212194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The changes in the period of ventricular repolarization, i.e., QT interval, QTp (Q-Tpeak) and TpTe interval (Tpeak-Tend), make it possible to assess the electrical instability of the heart muscle, which may lead to the development of life-threatening ventricular arrhythmia. The aim of the study was to determine and evaluate the use of differences in T-wave morphology and durations of repolarization period parameters (QT, TpTe) in resting ECGs for children with ventricular arrhythmias. METHODS The retrospective analysis was made of the disease histories of 80 examined children with resting ECGs, which were admitted to the Children's Cardiology Department. The study group consisted of 46 children aged 4 to 18 with ventricular arrhythmias and the control group consisted of 34 healthy children between 4 and 18 years of age, with no arrhythmias. RESULTS The duration of the TpTe interval was significantly (p < 0.001) longer in the group of children with ventricular arrhythmia with abnormal T-wave (bactrian/bifid, humid/biphasic) compared to the TpTe interval in children with ventricular arrhythmia with the normal repolarization period. The duration of the TpTe (p < 0.001), QTcB (p < 0.001) and QTcF (p < 0.001) intervals were significantly longer in the group of children with ventricular arrhythmias and with abnormal T-wave compared to the values of the TpTe, QTcB, and QTcF intervals of the control group with normal morphology of the repolarization period. Only the duration of the TpTe interval was significantly (p = 0.020) longer in the group of children with ventricular arrhythmia without clinical symptoms. CONCLUSIONS Children with benign ventricular arrhythmias recorded on a standard ECG with prolonged TpTe and QT intervals and abnormal T-wave morphology require systematic and frequent cardiac check up with long term ECG recordings due to the possibility of future more severe ventricular arrhythmias. Further follow-up studies in even larger groups of patients are necessary to confirm the values of these repolarization parameters in clinical practice.
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Affiliation(s)
- Joanna Jaromin
- Department of Nursing and Social Medical Problems, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Grażyna Markiewicz-Łoskot
- Department of Nursing and Social Medical Problems, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Faculty of Medical Sciences in Katowice, Medical University in Silesia, 40-752 Katowice, Poland;
| | - Agnieszka Kulawik
- Faculty of Science and Technology, University of Silesia in Katowice, Bankowa 14, 40-007 Katowice, Poland;
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Karahan Z, Ugurlu M, Ucaman B, Veysel Ulug A, Kaya I, Cevik K, Sahin Adiyaman M, Oztürk O, Iyem H, Ozdemir F. Association Between ACE Gene Polymorphism and QT Dispersion in Patients with Acute Myocardial Infarction. Open Cardiovasc Med J 2016; 10:117-21. [PMID: 27347229 PMCID: PMC4897009 DOI: 10.2174/1874192401610010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/02/2016] [Accepted: 02/10/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Angiotensin converting enzyme (ACE) gene polymorphism is associated with high renin-angiotensin system causing myocardial fibrosis and ventricular repolarization abnormality. Based on these findings, this study was designed to determine the association between ACE gene insertion/deletion (I/D) polymorphism and QT dispersion after acute myocardial infarction (MI). Objective and Methods: The study included 108 patients with acute MI. Blood samples were obtained from all the patients for genomic DNA analysis. ECGs were recorded at baseline and at the end of a 6-month follow up. The OT dispersion was manually calculated. Results: The mean age of the patients was 57.5 ±9.9 years (ranging from 36 to 70). The
patients with DD genotype showed longer QT dispersion than patients with II or
DI genotype at the baseline, while at the end of the six-month follow up the
patients with DI genotype showed longer QT dispersion than patients with DD or
II genotypes. However, the magnitude of the QT dispersion prolongation was
higher in patients carrying the ACE D allele than patients who were not carrying
it, at baseline and at the end of six-month follow up (52.5 ±2.6 msn vs.
47.5±2.1 msn at baseline, 57±3.2 msn vs. 53±2.6 msn in months, P: 0.428 and
P: 0.613, respectively). Conclusion: Carriers of the D allele of ACE gene I/D polymorphism may be associated with QT dispersion prolongation in patients with MI.An interaction of QT dispersion and ACE gene polymorphism may be associated with an elevation of serum type I-C terminal pro-collagen concentration, possibly leading to myocardial fibrosis, and increased action potential duration.
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Affiliation(s)
- Zulkuf Karahan
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Murat Ugurlu
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Berzal Ucaman
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Ali Veysel Ulug
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Ilyas Kaya
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Kemal Cevik
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | | | - Onder Oztürk
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Hikmet Iyem
- Gazi Yasargil Education and Research Hospital, Cardiovascular Surgery, Diyarbakir, Turkey
| | - Ferit Ozdemir
- Gazi Yasargil Education and Research Hospital, Cardiovascular Surgery, Diyarbakir, Turkey
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Bieganowska K, Sawicka-Parobczyk M, Bieganowski M, Piskorski J. Tpeak -tend interval in 12-lead electrocardiogram of healthy children and adolescents tpeak -tend interval in childhood. Ann Noninvasive Electrocardiol 2013; 18:344-51. [PMID: 23879274 DOI: 10.1111/anec.12035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Tpeak (Tp) to the Tend (Te) interval is an index of transmural dispersion of repolarization. Prolongation of this interval predisposes to life-threatening ventricular arrhythmias in long QT syndrome, polymorphic catecholaminergic ventricular tachycardia, Brugada syndrome and short QT syndrome and may be an indicator of increased risk of sudden cardiac death. Very little is known about TpTe interval in children and adolescents. METHODS In 131 healthy children (64 girls) aged from 2.3 to 18.5 years (mean 9.1 years) the RR, QT, JT and TpTe intervals were measured manually in all leads of resting electrocardiogram (ECG). The statistical analysis were performed. RESULTS TpTe intervals vary significantly (P < 0.0001) between individual leads-the longest were in lead V3 , the shortest ones in leads III and V1 . Boys had longer TpTe intervals, with statistically significant differences in leads I, aVR and precordial V2 -V6 . Greater values were also observed in older children. TpTe dispersion varied from 6 to 80 ms (mean 38.6 ms ± 14.6 ms, median 40 ms) with no gender differences and greater values in older subjects (P = 0.003). In most leads, higher TpTe/QT and TpTe/JT ratios were seen in boys regardless of age. The TpTe intervals lengthens with lowering heart rate. CONCLUSIONS In healthy children and adolescents, TpTe intervals vary between individual leads of ECG, with the longest in lead V3 . The TpTe interval is longer in boys and in older children and prolongs as heart rate decelerates. TpTe/QT and TpTe/JT ratios are higher in boys. TpTe interval should be measured in precordial leads.
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Affiliation(s)
- Katarzyna Bieganowska
- Cardiology Department of the Children's Memorial Health Institute, 04-730 Warsaw, Poland.
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Hanton G, Yvon A, Racaud A. Temporal variability of QT interval and changes in T wave morphology in dogs as markers of the clinical risk of drug-induced proarrhythmia. J Pharmacol Toxicol Methods 2008; 57:194-201. [DOI: 10.1016/j.vascn.2008.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 03/10/2008] [Indexed: 01/10/2023]
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Angiotensinogen and Angiotensin II Type 1 Receptor Gene Polymorphisms and Changes in Repolarization Parameters in Elderly Chinese: A 4-Year Follow-up Study. Kaohsiung J Med Sci 2008; 24:111-9. [DOI: 10.1016/s1607-551x(08)70138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lin TH, Chiu HC, Lee YT, Su HM, Juo SHH, Voon WC, Lai WT, Sheu SH. The C-allele of tissue inhibitor of metalloproteinases 2 is associated with increased magnitude of QT dispersion prolongation in elderly Chinese - 4-year follow-up study. Clin Chim Acta 2007; 386:87-93. [PMID: 17868665 DOI: 10.1016/j.cca.2007.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 08/07/2007] [Accepted: 08/14/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Matrix metalloproteinases (MMP) and tissue inhibitor of metalloproteinases (TIMP) trigger the signal cascade instigating cardiac remodeling and fibrosis, which lead to changes of repolarization variables. We investigate the influence of MMP9-1562 C/T and TIMP2-418 G/C gene polymorphisms on repolarization parameters including QT dispersion (QTd) and the peak and the end of the T wave interval (Tpe) in a prospective cohort. METHODS Of 1500 people screened, 106 elderly Chinese without organic heart disease were recruited and received electrocardiography at the baseline, second and 4th year follow-ups. The QTc (corrected QT), QTd, QTc dispersion (QTcd) and Tpe were manually calculated. RESULTS Age was 72.7+/-4.1 y (range 62-81 y). QTd, QTcd and Tpe were significantly prolonged (all p <0.001 at the 2nd and 4th year). At the 4th year the magnitude of QTd prolongation but not Tpe was significantly higher in subjects carrying the TIMP2 C-allele than non C-allele carriers (p=0.033) as well as QTcd (p=0.010). This association was still significant in multivariate analyses (p=0.012 and p=0.003 for QTd and QTcd, respectively) but not in MMP9 genotype. CONCLUSIONS The elderly Chinese with TIMP2 C-allele have higher magnitude of QTd and QTcd prolongation.
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Affiliation(s)
- Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Lin TH, Chiu HC, Su HM, Juo SHH, Lee YT, Voon WC, Lai WT, Sheu SH. D-Allele of ACE Polymorphism is Associated With Increased Magnitude of QT Dispersion Prolongation in Elderly Chinese 4-Year Follow-up Study. Circ J 2007; 71:39-45. [PMID: 17186976 DOI: 10.1253/circj.71.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There has not been a longitudinal investigation of the influence of angiotensin-converting enzyme (ACE) insertion/deletion and angiotensinogen (AGT) M235T gene polymorphisms on repolarization parameters, such as QT dispersion (QTd) and the peak and the end of the T-wave interval (Tpe). METHODS AND RESULTS Electrocardiographys were recorded from 106 elderly Chinese at baseline, and 2nd and 4th year follow-up. The corrected QT (QTc), QTd, QTc dispersion (QTcd) and Tpe were manually calculated. Average age was 72.7+/-4.1 years (range 62-81). QTd, QTcd and Tpe were significantly prolonged (all p<0.001 at the 2nd and 4th year). At the 4th year the magnitude of the QTd prolongation, but not Tpe, was significantly higher in subjects carrying the ACE D allele than non-D-allele carriers (p=0.001), as was QTcd (p=0.002). This association was still significant in the multivariate analyses (p<0.001 and p=0.001 for QTc and QTcd, respectively). No significant correlation was found between repolarization parameters and AGT genotype. CONCLUSIONS This longitudinal study shows that the ageing process is associated with prolongation of QTd, QTcd and Tpe after 4 years follow-up. The elderly Chinese subjects with the ACE D-allele had greater prolongation QTd and QTcd.
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Affiliation(s)
- Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
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Opthof T, Coronel R, Wilms-Schopman FJG, Plotnikov AN, Shlapakova IN, Danilo P, Rosen MR, Janse MJ. Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion. Heart Rhythm 2006; 4:341-8. [PMID: 17341400 DOI: 10.1016/j.hrthm.2006.11.022] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/17/2006] [Indexed: 12/19/2022]
Abstract
BACKGROUND The concept that the interval between the peak (T(peak)) and the end (T(end)) of the T wave (T(p-e)) is a measure of transmural dispersion of repolarization time is widely accepted but has not been tested rigorously by transmural mapping of the intact heart. OBJECTIVES The purpose of this study was to test the relationship of T(p-e) to transmural dispersion of repolarization by correlating local repolarization times at endocardial, midmural, and epicardial sites in the left and right ventricles with the T wave of the ECG. METHODS Local activation times, activation-recovery intervals, and repolarization times were measured at 98 epicardial sites and up to 120 midmural and endocardial sites in eight open-chest dogs. In four of the dogs, long-term cardiac memory was induced by 3 weeks of ventricular pacing at 130 bpm because previous data suggest that, in this setting, delayed epicardial repolarization increases transmural dispersion. The other four dogs were sham operated. RESULTS In sham dogs, T(p-e) was 41 +/- 2.2 ms (X +/- SEM), whereas the transmural dispersion of repolarization time was 2.7 +/- 4.2 ms (not significant between endocardium and epicardium). Cardiac memory was associated with evolution of a transmural gradient of 14.5 +/- 1.9 ms (P <.02), with epicardium repolarizing later than endocardium. The corresponding T(p-e) was 43 +/- 2.3 ms (not different from sham). In combined sham and memory dogs, T(p-e) intervals did not correlate with transmural dispersion of repolarization times. In contrast, dispersion of repolarization of the whole heart (measured as the difference between the earliest and the latest moment of repolarization from all left and right ventricular, endocardial, intramural, and epicardial recording sites) did correlate with T(p-e) (P <.0005, r = 0.98), although the latter underestimated total repolarization time by approximately 35%. The explanation for this finding is that parts of the heart fully repolarize before the moment of T(peak). CONCLUSION T(p-e) does not correlate with transmural dispersion of repolarization but is an index of total dispersion of repolarization.
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Affiliation(s)
- Tobias Opthof
- Department of Experimental Cardiology, Experimental and Molecular Cardiology Groups, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Haapalahti P, Viitasalo M, Perhonen M, Mäkijärvi M, Väänänen H, Oikarinen L, Hekkala AM, Salorinne Y, Swan H, Toivonen L. Ventricular Repolarization and Heart Rate Responses During Cardiovascular Autonomic Function Testing in LQT1 Subtype of Long QT Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1122-9. [PMID: 17038145 DOI: 10.1111/j.1540-8159.2006.00506.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the most prevalent LQT1 form of inherited long QT syndrome symptoms often occur during abrupt physical or emotional stress. Sympathetic stimulation aggravates repolarization abnormalities in experimental LQT1 models. We hypothesized that autonomic function tests might reveal the abnormal repolarization in asymptomatic LQT1 patients. METHODS We measured heart rates (HRs) and QT intervals in nine asymptomatic carriers of a C-terminal KCNQ1 mutation and 8 unaffected healthy subjects using an approach of global QT values derived from 28 simultaneous electrocardiographic leads on beat-to-beat base during Valsalva maneuver, mental stress, sustained handgrip, and light supine exercise. RESULTS LQT1 patients exhibited impaired shortening of both QTpeak and QTend intervals during autonomic interventions but exaggerated lengthening of the intervals--a QT overshoot--during the recovery phases. The number of tests with a QT overshoot was 2.4 +/- 1.7 in LQT1 patients and 0.8 +/- 0.7 in unaffected subjects (P = 0.02). Valsalva strain prolonged T wave peak to T wave end interval (TPE) in LQT1 but not in unaffected patients. LQT1 patients showed diminished HR acceleration in response to adrenergic challenge whereas HR responses to vagal stimuli were similar in both groups. CONCLUSIONS Standard cardiovascular autonomic provocations induce a QT interval overshoot during recovery in asymptomatic KCNQ1 mutation carriers. Valsalva maneuver causes an exaggerated fluctuation of QT and TPE intervals partly explaining the occurrence of cardiac events during abrupt bursts of autonomic activity in LQT1 patients.
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Affiliation(s)
- Petri Haapalahti
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.
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Itoh H, Horie M, Ito M, Imoto K. Arrhythmogenesis in the short-QT syndrome associated with combined HERG channel gating defects: a simulation study. Circ J 2006; 70:502-8. [PMID: 16565572 DOI: 10.1253/circj.70.502] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to show the mechanism how the HERG channel gating defects causes life-threatening arrhythmia in the short-QT syndrome, using a simulation model of ventricular action potentials (APs). METHODS AND RESULTS To evaluate the electrophysiological consequences of the short-QT syndrome at the level of the cardiac AP, the Markov model of wild-type (WT) KCNH2 channel was modified to obtain a model of the KCNH2 channel with the N588K mutation associated with the short-QT syndrome. Two parameters (betai and betabeta) were changed to reconstruct the N588K mutant Markov model, which successfully reproduced the experimental results of voltage-clamp recordings. The WT and mutant models were then integrated into the Luo-Rudy theoretical model of the cardiac ventricular AP. Unexpectedly, 1 parameter change alone, which caused gain of function, could shorten the AP duration (APD) but failed to induce early after-depolarizations (EADs). Only the condition with the combined gating defects could lead to EAD. CONCLUSIONS Although the gain of function for KCNH2 shortened APD in the short-QT syndrome, this simulation study suggested that arrhythmogenesis was associated not only with gain of function, but also with accelerated deactivation of KCNH2.
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Affiliation(s)
- Hideki Itoh
- Department of Information Physiology, National Institute for Physiological Sciences, Myodaiji, Okazaki, Japan
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Kinoshita T, Nagata S, Baba R, Kohmoto T, Iwagaki S. Cold-Water Face Immersion Per Se Elicits Cardiac Parasympathetic Activity. Circ J 2006; 70:773-6. [PMID: 16723802 DOI: 10.1253/circj.70.773] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cold-water face immersion (FI) is known to produce physiological changes, including bradycardia, by stimulating the parasympathetic system. However, other factors such as sympathetic activity, intrapleural pressures, and changes in chemical mediators may also contribute to these changes. METHODS AND RESULTS Eight healthy volunteers underwent a series of experiments designed to observe the effects of FI on heart rate and its variability, as detected using wavelet transformation. Each subject was instructed to bend over and put the entire face into an empty basin with and without breathing (protocols 1 and 2, respectively), and then perform FI in warm-water (protocols 3 and 4, respectively) and cold-water (protocols 5 and 6, respectively) while breathing and breath holding. Change in the R-R interval with FI was only significantly greater for protocol 6 than for the control procedure (protocol 1). Also, changes in the natural logarithm of high-frequency power with FI were significantly greater for protocols 5 and 6 than the protocol 1. CONCLUSIONS Bradycardia associated with cold-water FI is mainly attributed to cardiac vagal activity, which is independent of both the change in body position caused by bending over a basin and breath holding.
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Affiliation(s)
- Tomoko Kinoshita
- Department of Paediatrics/Developmental Paediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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