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Karki KB, Towbin JA, Shah SH, Philip RR, West AN, Tadphale SD, Saini A. Elevated Copeptin Levels Are Associated with Heart Failure Severity and Adverse Outcomes in Children with Cardiomyopathy. Children (Basel) 2023; 10:1138. [PMID: 37508636 PMCID: PMC10377870 DOI: 10.3390/children10071138] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
In children with cardiomyopathy, the severity of heart failure (HF) varies. However, copeptin, which is a biomarker of neurohormonal adaptation in heart failure, has not been studied in these patients. In this study, we evaluated the correlation of copeptin level with functional HF grading, B-type natriuretic peptide (BNP), and echocardiography variables in children with cardiomyopathy. Furthermore, we determined if copeptin levels are associated with adverse outcomes, including cardiac arrest, mechanical circulatory support, heart transplant, or death. In forty-two children with cardiomyopathy with a median (IQR) age of 13.1 years (2.5-17.2) and a median follow-up of 2.5 years (2.2-2.7), seven (16.7%) children had at least one adverse outcome. Copeptin levels were highest in the patients with adverse outcomes, followed by the patients without adverse outcomes, and then the healthy children. The copeptin levels in patients showed a strong correlation with their functional HF grading, BNP level, and left ventricular ejection fraction (LVEF). Patients with copeptin levels higher than the median value of 25 pg/mL had a higher likelihood of experiencing adverse outcomes, as revealed by Kaplan-Meier survival analysis (p = 0.024). Copeptin level was an excellent predictor of outcomes, with an area under the curve of 0.861 (95% CI, 0.634-1.089), a sensitivity of 86%, and a specificity of 60% for copeptin level of 25 pg/mL. This predictive value was superior in patients with dilated and restrictive cardiomyopathies (0.97 (CI 0.927-1.036), p < 0.0001, n = 21) than in those with hypertrophic and LV non-compaction cardiomyopathies (0.60 (CI 0.04-1.16), p = 0.7, n = 21).
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Affiliation(s)
- Karan B Karki
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Jeffrey A Towbin
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Samir H Shah
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Ranjit R Philip
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Alina N West
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Sachin D Tadphale
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Arun Saini
- Section of Pediatric, Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Affiliated Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
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Tadphale SD, Luckett PM, Quigley RP, Dhar AV, Gollhofer DK, Modem V. Fluid Removal in Children on Continuous Renal Replacement Therapy Improves Organ Dysfunction Score. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0043-1764499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
AbstractThe objective is to assess impact of fluid removal on improvement in organ function in children who received continuous renal replacement therapy (CRRT) for management of acute kidney injury and/or fluid overload (FO). A retrospective review of eligible patients admitted to a tertiary level intensive care unit over a 3-year period was performed. Improvement in nonrenal organ function, the primary outcome, was defined as decrease in nonrenal component of Pediatric Logistic Organ Dysfunction (PELOD) score on day 3 of CRRT. The cohort was categorized into Group 1 (improvement) and Group 2 (no improvement or worsening) in nonrenal PELOD score. Multivariable logistic regression analysis was performed to identify independent predictors. A higher PELOD score at CRRT initiation (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.05, 1.18, p < 0.001), belonging to infant-age group (OR: 4.53, 95% CI: 4.40, 5.13, p = 0.02) and greater fluid removal during initial 3 days of CRRT (OR: 1.05, 95% CI: 1.01, 1.10, p = 0.01) were associated with an improvement in nonrenal PELOD score at day 3 of CRRT. FO at CRRT initiation (OR: 0.66, 95% CI: 0.46, 0.93, p = 0.02) and having an underlying oncologic diagnosis (OR: 0.28, 95% CI: 0.09, 0.85, p = 0.03) were associated with worsening of nonrenal PELOD score at day 3 of CRRT. Careful consideration of certain modifiable patient and/or fluid removal kinetic factors may have an impact on outcomes.
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Affiliation(s)
- Sachin D. Tadphale
- Division of Pediatric Cardiology & Critical Care Medicine, UTHSC, Memphis, Tennessee, United States
| | - Peter M. Luckett
- Division of Pediatric Critical Care Medicine, UTSW, Dallas, Texas, United States
| | | | - Archana V. Dhar
- Division of Pediatric Critical Care Medicine, UTSW, Dallas, Texas, United States
| | - Diane K. Gollhofer
- Division of Critical Care Services, Children's Health-Dallas, Dallas, Texas, United States
| | - Vinai Modem
- Pediatric Intensive Care Unit, Cook Children's Medical Center, Fort Worth, Texas, United States
- Department of Pediatrics, TCU and UNTHSC School of Medicine, Fort Worth, Texas, United States
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Radel LJ, Branstetter J, Jones TL, Briceno-Medina M, Tadphale SD, Onder AM, Rayburn MS. Use of Aminophylline to Reverse Acute Kidney Injury in Pediatric Critical Care Patients. J Pediatr Pharmacol Ther 2022; 27:739-745. [DOI: 10.5863/1551-6776-27.8.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE
Acute kidney injury (AKI) is a complication encountered in 18% to 51% of pediatric critical care patients admitted for treatment of other primary diagnoses and is an independent risk factor for increased morbidity and mortality. Aminophylline has shown promise as a medication to treat AKI, but published studies have shown conflicting results. Our study seeks to assess the reversal of AKI following the administration of aminophylline in critically ill pediatric patients.
METHODS
We performed a single-institution retrospective chart review of pediatric inpatients who were diagnosed with AKI and subsequently treated with non-continuous dose aminophylline between January 2016 and December 2018. Data were collected beginning 2 days prior to the initial dose of aminophylline through completion of the 5-day aminophylline course.
RESULTS
Nineteen therapies among 17 patients were included in analysis. Twelve of the therapies resulted in resolution of AKI during the study period. We observed urine output increase of 19% (p = 0.0063) on the day following initiation of aminophylline therapy in the subset of patients whose AKI resolved. Trends toward decreased serum creatinine and lower inotropic support were also noted.
CONCLUSIONS
Based on these findings, aminophylline could be considered a potentially effective medication for use as rescue therapy in critically ill children with AKI. Limitations include small study population and retrospective nature. Further research in this area with a larger study population and a randomized control trial would allow for better characterization of the efficacy of aminophylline in reversal of AKI.
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Affiliation(s)
- Laura J. Radel
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Joshua Branstetter
- Department of Pharmacy (MSR), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Tamekia L. Jones
- Department of Pediatrics and Preventive Medicine (TLJ), University of Tennessee Health Science Center and Children's Foundation Research Institute, Memphis, TN
| | - Mario Briceno-Medina
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Sachin D. Tadphale
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Ali Mirza Onder
- Department of Nephrology (AMO), Children's of Mississippi and University of Mississippi Medical Campus, Jackson, MS
| | - Mark S. Rayburn
- Department of Pharmacy (MSR), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
- Department of Clinical Pharmacy and Translational Science (MSR), University of Tennessee Health Science Center and Children's Foundation Research Institute, Memphis, TN
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Tadphale SD, Zurakowski D, Bird LE, Yohannan TM, Agrawal VK, Lloyd HG, Allen KJ, Waller BR, Hall AM, Sathanandam SK. Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0-4 Years Old. Pediatr Cardiol 2020; 41:1135-1144. [PMID: 32363434 DOI: 10.1007/s00246-020-02363-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 01/21/2020] [Accepted: 04/24/2020] [Indexed: 12/01/2022]
Abstract
The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0-4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child's age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0-4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0-4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.
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Affiliation(s)
- Sachin D Tadphale
- Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA.
| | - David Zurakowski
- Departments of Anesthesiology & Biostatistics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lindsey E Bird
- Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA
| | - Thomas M Yohannan
- Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA
| | - Vijaykumar K Agrawal
- Department of Radiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hannah G Lloyd
- Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA
| | - Kimberly J Allen
- Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA
| | | | - Amber M Hall
- Departments of Anesthesiology & Biostatistics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shyam K Sathanandam
- Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA
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Tadphale SD, Ramakrishnan K, Spentzas T, Kumar TKS, Allen J, Staffa SJ, Zurakowski D, Bigelow WA, Gopal SH, Boston US, Jonas RA, Knott-Craig CJ. Impact of Different Cardiopulmonary Bypass Strategies on Renal Injury After Pediatric Heart Surgery. Ann Thorac Surg 2020; 111:1374-1379. [PMID: 32603703 DOI: 10.1016/j.athoracsur.2020.05.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study is to compare the incidence and severity of acute kidney injury (AKI) after open heart surgery in neonates and infants for two different cardiopulmonary bypass (CPB) strategies. METHODS In all, 151 infants undergoing cardiac surgery were prospectively enrolled between June 2017 and June 2018 at two centers, one using conventional CPB (2.4 L · min-1 · m-2, 150 mL · kg-1 · min-1) with reduction of flow rates with moderate hypothermia and with a targeted hematocrit greater than 25% (center 1, n = 91), and the other using higher bypass flow rates (175 to 200 mL · kg-1 · min-1) and higher minimum hematocrit (greater than 32%) CPB (center 2, n = 60). The primary endpoint was the incidence of postoperative AKI as defined by Acute Kidney Injury Network criteria and risk factors associated with AKI. RESULTS Preoperative characteristics and complexity of surgery were comparable between centers. The overall incidence of early postoperative AKI was 10.6% (16 of 151), with 15.4% (14 of 91) in center 1 and 3.3% (2 of 60) in center 2 (P = .02). Mean lowest flow rates on CPB were 78 mL · kg-1 · min-1 vs 118 mL · kg-1 · min-1 and mean highest hematocrit on separation from CPB were 33% vs 43% at center 1 and 2, respectively (P < .001). Center 1 used less packed red blood cells but more fresh frozen plasma than center 2 (P = .001). By multivariate analysis, only lower flows on CPB (78 vs 96 mL · kg-1 · min-1, P = .043) and lower hematocrit at the end of CPB (33% vs 37%, P = .007) were associated with AKI. CONCLUSIONS In this contemporary comparative study, higher flow rates and higher hematocrit during cardiopulmonary bypass were associated with better preservation of renal function.
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Affiliation(s)
- Sachin D Tadphale
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Karthik Ramakrishnan
- Department of Pediatric Cardiovascular Surgery, Children's National Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington DC
| | - Thomas Spentzas
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - T K Susheel Kumar
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jerry Allen
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William A Bigelow
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Srirupa Hari Gopal
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Umar S Boston
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Richard A Jonas
- Department of Pediatric Cardiovascular Surgery, Children's National Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington DC
| | - Christopher J Knott-Craig
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee.
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Padiyath A, Rettiganti M, Gossett JM, Tadphale SD, Garcia X, Seib PM, Gupta P. Epidemiology and outcomes of cardiac arrest among children with Down Syndrome: a multicenter analysis. Minerva Anestesiol 2017; 83:574-581. [DOI: 10.23736/s0375-9393.16.11561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tadphale SD, Tang X, ElHassan NO, Beam B, Prodhan P. Cavopulmonary Anastomosis During Same Hospitalization as Stage 1 Norwood/Hybrid Palliative Surgery. Ann Thorac Surg 2017; 103:1285-1291. [PMID: 28274521 DOI: 10.1016/j.athoracsur.2017.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/27/2016] [Accepted: 01/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Limited literature has examined characteristics of infants with hypoplastic left heart syndrome (HLHS) who remain hospitalized during the interstage period. We described their epidemiologic characteristics, in-hospital outcomes, and identified risk factors that predict the need for superior cavopulmonary anastomosis (SCPA) during the same hospitalization. METHODS This retrospective multicenter database analysis included infants with HLHS who underwent stage 1 palliation from 2004 through 2013. RESULTS Among 5374 infants with HLHS, 314 (5.8%) underwent SCPA during the same hospitalization as stage 1 palliation. They had a higher incidence of baseline comorbidities, complications, and interventions than infants who were discharged. Despite an overall increase in need for SCPA in the same hospitalization across different eras, there was no significant statistical difference in mortality in the two groups in the same era. Septicemia, necrotizing enterocolitis, modified Blalock-Taussig shunt, cardiac catheterization, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, gastrostomy tube, and antiarrhythmic agents were independently associated with increased odds of undergoing SCPA during the same hospitalization. Patients undergoing right ventricle to pulmonary artery shunt were less likely to remain hospitalized until stage 2 palliation. Nonsurvivors in the SCPA group had greater need for interventions and worse intensive care unit outcomes. CONCLUSIONS Infants with HLHS who remain hospitalized after stage 1 until their stage 2 palliation differ significantly from infants who were discharged. Several clinical characteristics, comorbidities, and need for interventions are associated with the likelihood for undergoing stage 2 palliation during the same hospitalization. Timely identification and intervention of adjustable causes of heart failure may improve outcomes.
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Affiliation(s)
- Sachin D Tadphale
- Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee; Pediatric Critical Care, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
| | - Xinyu Tang
- Department of Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Nahed O ElHassan
- Department of Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Brandon Beam
- Department of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Parthak Prodhan
- Department of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
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