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High incidence of maternal vitamin B12 deficiency detected by newborn screening: first results from a study for the evaluation of 26 additional target disorders for the German newborn screening panel

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World Journal of pediatrics 2018年第5期14卷 470-481页

作者： Gwendolyn Gramer Junmin Fang-Hoffmann Patrik Feyh Glynis Klinke Peter Monostori Jürgen G.Okun Georg F.Hoffmann division of Neuropediatric and Metabolic Medicine Department of General PediatricsCenter for Pediatric and Adolescent MedicineUniversity Hospital HeidelbergIm Neuenheimer Feld 43069120 HeidelbergGermany

Background Newborn screening (NBS) in Germany currently includes 15 target disorders. Recent diagnostic improvements suggest an extension of the screening panel. Methods Since August 2016, a prospective study evaluating 26 additional target disorders (25 metabolic disorders and vitamin B12-deficiency) in addition to the German screening panel is performed at the Newborn Screening Center Heidel-berg. First-tier results from tandem-MS screening are complemented by second-tier strategies for 15 of the additional target disorders. NBS results of seven patients diagnosed symptomatically with one of the additional target disorders by selective screening since August 2016 are retrospectively evaluated. Results Over a 13-month period, 68,418 children participated in the study. Second-tier analyses were performed in 5.4%of samples. Only 59 (0.1%) of study participants had abnormal screening results for one of the additional target disorders. Target disorders from the study panel were confirmed in 12 children: 13-hydroxy-3-methylglutaryl coenzyme A (CoA)-lyase deficiency, 1 citrullinemia type I, 1 multiple acyl-CoA dehydrogenase-deficiency, 1 methylenetetrahydrofolate reductase-deficiency, and 8 children with maternal vitamin B12-deficiency. In addition, six of seven patients diagnosed symptomatically outside the study with one of the target disorders would have been identified by the study strategy in their NBS sample. Conclusions Within 13 months, the study 'Newborn Screening 2020' identified additional 12 children with treatable con-ditions while only marginally increasing the recall rate by 0.1%. Maternal vitamin B12-deficiency was the most frequent finding. Even more children could benefit from screening for the additional target disorders by extending the NBS panel for Germany and/or other countries.

关键词： Metabolic disorders Newborn screening Second-tier Vitamin B12 deficiency

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Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias

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Asian Journal of Andrology 2023年第1期25卷 93-97页

作者： Raed Al-Taher Mohammad Nofal Ali J Yousef Mohammad Rashdan Amjad Tarawneh Jad Alsmadi Eman Hasan Dalal Alshareefi Danah Alenezi Bashayer Abdulrasoul Department of general Surgery Division of Pediatric SurgerySchool of MedicineThe University of JordanAmman 11942Jordan Department of general Surgery and Anesthesia School of MedicineMutah UniversityKarak 61710Jordan Department of pediatrics School of MedicineMutah UniversityKarak 61710Jordan Department of general and Special Surgery Division of UrologyFaculty of MedicineThe Hashemite UniversityZarqa 13133Jordan

Urethrocutaneous fistula may complicate hypospadias *** noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous *** aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula.A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital(Amman,Jordan).Boys who were aged between 6 months and 5 years,diagnosed with distal hypospadias,and not circumcised were *** primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial *** results showed a total of 163 boys with distal hypospadias;among them,116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap,and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial *** development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month,6 months,and 12 months(6.9%vs 0,10.3%vs 0,and 5.2%vs 0,respectively),and the difference after 6 months was statistically significant(P=0.02).

关键词： distal hypospadias double-layered preputial dartos flap tubularized incised plate urethroplasty urethrocutaneous fistula

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Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma(CHANCE001)

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Signal Transduction and Targeted Therapy 2023年第3期8卷 1198-1207页

作者： Hai-Dong Zhu Hai-Liang Li Ming-Sheng Huang Wei-Zhu Yang Guo-Wen Yin Bin-Yan Zhong Jun-Hui Sun Zhi-Cheng Jin Jian-Jian Chen Nai-Jian Ge Wen-Bin Ding Wen-Hui Li Jin-Hua Huang Wei Mu Shan-Zhi Gu Jia-Ping Li Hui Zhao Shu-Wei Wen Yan-Ming Lei Yu-Sheng Song Chun-Wang Yuan Wei-Dong Wang Ming Huang Wei Zhao Jian-Bing Wu Song Wang Xu Zhu Jian-Jun Han Wei-Xin Ren Zai-Ming Lu Wen-Ge Xing Yong Fan Hai-Lan Lin Zi-Shu Zhang Guo-Hui Xu Wen-Hao Hu Qiang Tu Hong-Ying Su Chuan-Sheng Zheng Yong Chen Xu-Ya Zhao Zhu-Ting Fang Qi Wang Jin-Wei Zhao Ai-Bing Xu Jian Xu Qing-Hua Wu Huan-Zhang Niu Jian Wang Feng Dai Dui-Ping Feng Qing-Dong Li Rong-Shu Shi Jia-Rui Li Guang Yang Hai-Bin Shi Jian-Song Ji Yu-E Liu Zheng Cai Po Yang Yang Zhao Xiao-Li Zhu Li-Gong Lu Gao-Jun Teng Center of Interventional radiology&Vascular Surgery Department of RadiologyZhongda HospitalMedical SchoolSoutheast UniversityNanjing 210009China Department of Minimally invasive Intervention The Affiliated Cancer Hospital of Zhengzhou UniversityZhengzhou 450008China Department of Interventional radiology the Third Affiliated HospitalSun Yat-Sen UniversityGuangzhou 510630China Department of Interventional radiology Union Hospital of Fujian Medical UniversityFuzhou 350001China Department of Interventional radiology Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjing 210009China Department of Interventional radiology The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhou 215006China Hepatobiliary and Pancreatic Interventional Treatment Center Division of Hepatobiliary and Pancreatic SurgeryThe First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Interventional radiology Eastern Hospital of Hepatobiliary SurgeryNavy Medical University(Second Military Medical University)Shanghai 200438China Department of Interventional radiology Nantong First People’s HospitalNantong 226001China Department of Interventional radiology Yancheng Third People’s HospitalYancheng 224008China Department of Minimally Invasive Interventional Therapy Sun YatSen University Cancer CenterGuangzhou 510060China Department of Vascular Surgery Southwest HospitalThird Military Medical University(Army Medical University)Chongqing 400038China. Department of Interventional radiology Hunan Cancer HospitalChangsha 410031China Department of Interventional Oncology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080China Department of Interventional radiology The Hospital of Nantong UniversityNantong 226001China Department of Interventional Therapy Shanxi Tumor HospitalTaiyuan 030001China Department of Interventional radiology Tibet Autonomous Region People’s

There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world *** this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May *** primary endpoint was progression-free survival(PFS)according to modified *** secondary outcomes included overall survival(OS),objective response rate(ORR),and *** performed propensity score matching approaches to reduce bias between two *** matching,228 pairs were included with a predominantly advanced disease *** PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,*** results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.

关键词： hepatocellular targeted matching

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Updated overall survival and circulating tumor DNA analysis of ensartinib for crizotinib-refractory ALK-positive NSCLC from a phase II study

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Cancer Communications 2024年第4期44卷 455-468页

作者： Jing Zheng Tao Wang Yunpeng Yang Jie Huang Jifeng Feng Wu Zhuang Jianhua Chen Jun Zhao Wei Zhong Yanqiu Zhao Yiping Zhang Yong Song Yi Hu Zhuang Yu Youling Gong Yuan Chen Feng Ye Shucai Zhang Lejie Cao Yun Fan Gang Wu Yubiao Guo Chengzhi Zhou Kewei Ma Jian Fang Weineng Feng Yunpeng Liu Zhendong Zheng Gaofeng Li Huijie Wang Shundong Cang Ning Wu Wei Song Xiaoqing Liu Shijun Zhao Lieming Ding Giovanni Selvaggi Yang Wang Shanshan Xiao Qian Wang Zhilin Shen Jianya Zhou Jianying Zhou Li Zhang Department of Respiratory Disease Thoracic Disease CenterThe First Affiliated HospitalCollege of MedicineZhejiang UniversityZhejiang Provincial Clinical Research Center for Respiratory DiseaseHangzhouZhejiangP.R.China Hangzhou Repugene Technology Co. LtdHangzhouZhejiangP.R.China Department of Medical Oncology Sun Yat-sen University Cancer Cen-terState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP.R.China Department of Medical Oncology Jiangsu Cancer HospitalJiangsu Institute of Cancer ResearchThe Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingJiangsuP.R.China Department of Thoracic Oncology Fujian Provincial Cancer HospitalFujian Medical University Cancer HospitalFuzhouFujianP.R.China Department of Medical Oncology-Chest Hunan Cancer HospitalChangshaHunanP.R.China Department of Thoracic Oncology Beijing Cancer HospitalBeijingP.R.China Department of Pulmonary Medicine Peking Union Medical College HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijingP.R.China Respiratory Department of Internal Medicine Henan Provincial Can-cer HospitalAffiliated Cancer Hospital of Zhengzhou UniversityZhengzhouHenanP.R.China Thoracic Medical Oncology Zhejiang Cancer HospitalHangzhouZhejiangP.R.China division of Respiratory Medicine Jinling HospitalNanjing University School of MedicineNanjingJiangsuP.R.China Department of Oncology Chinese People’s Liberation Army(PLA)General HospitalBeijingP.R.China Department of Oncology The Affiliated Hospital of Qingdao UniversityQingdaoShandongP.R.China Department of Thoracic Oncology Cancer CenterWest China HospitalSichuan UniversityChengduSichuanP.R.China Department of Oncology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiP.R.China Department of Medical Oncology Cancer HospitalThe First Affiliated Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityTeaching Hospital of

Background:The initial phase II stuty(NCT03215693)demonstrated that ensartinib has shown clinical activity in patients with advanced crizotinib-refractory,anaplastic lymphoma kinase(ALK)-positive non-small cell lung cancer(NSCLC).Herein,we reported the updated data on overall survival(OS)and molecular profiling from the initial phase Ⅱ ***:In this study,180 patients received 225 mg of ensartinib orally once daily until disease progression,death or *** was estimated by Kaplan‒Meier methods with two-sided 95%confidence intervals(CIs).Next-generation sequencing was employed to explore prognostic biomarkers based on plasma samples collected at baseline and after initiating *** tumor DNA(ctDNA)was detected to dynamically monitor the genomic alterna-tions during treatment and indicate the existence of molecular residual disease,facilitating improvement of clinical ***:At the data cut-off date(August 31,2022),with a median follow-up time of 53.2 months,97 of 180(53.9%)patients had *** median OS was 42.8 months(95%CI:29.3-53.2 months).A total of 333 plasma samples from 168 patients were included for ctDNA *** inferior OS correlated sig-nificantly with baseline ALK or tumor protein 53(TP53)*** addition,patients with concurrent TP53 mutations had shorter OS than those without con-current TP53 *** ctDNA levels evaluated by variant allele frequency(VAF)and haploid genome equivalents per milliliter of plasma(hGE/mL)at baseline were associated with poor ***,patients with ctDNA clear-ance at 6 weeks and slow ascent growth had dramatically longer OS than those with ctDNA residual and fast ascent growth,***,patients who had a lower tumor burden,as evaluated by the diameter of target lesions,had a longer *** Cox regression analysis further uncovered the independent prognostic values of bone metastases,higher hGE,and elevated ALK mutation abundance at 6 we

关键词： anaplastic lymphoma kinase ctDNA ensartinib non-small cell lung cancer overall survival

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Direct puncture of the cavernous sinus for treatment of fistula involving the cavernous sinus

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介入放射学杂志 2004年第S1期13卷 94-96页

作者： Michael Mu Huo Teng National Yang Ming University and Chief Division of Neuroradiology Department of Radiology Taipei Veterans General Hospital

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Computed tomography perfusion imaging as a potential imaging biomarker of colorectal cancer

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World Journal of Gastroenterology 2014年第46期20卷 17345-17351页

作者： Koichi Hayano Takeshi Fujishiro Dushyant V Sahani Asami Satoh Tomoyoshi Aoyagi Gaku Ohira Toru Tochigi Hisahiro Matsubara Kiyohiko Shuto division of Abdominal Imaging and Intervention Department of RadiologyMassachusetts General HospitalBostonMA 02114United States Department of Frontier surgery Chiba university Graduate School of MedicineChiba 260-8677Japan Department of Surgery Teikyo University Medical CenterIchiharaChiba 299-0111Japan

Neovascularization was reported to arise early in the adenoma-carcinoma sequence in colorectal cancer(CRC),and the importance of angiogenesis in cancer progression has been *** tomography(CT)perfusion(CTP)based on high temporal resolution CT images enables evaluation of hemodynamics of tissue in vivo by modeling tracer *** has been reported to characterize tumor angiogenesis,and to be a sensitive marker for predicting recurrence or survival in *** this review,we will discuss the biomarker value of CTP in the management of CRC patients.

关键词： Colorectal cancer Angiogenesis Computed tomography perfusion Antiangiogenic therapy Chemoradiation therapy

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Thermal Ablation in the Management of Adrenal Metastasis Originating from Non-small Cell Lung Cancer： A 5-year Single-center Experience

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Chinese Medical Journal 2017年第17期130卷 2027-2032页

作者： Evanthia I Botsa Ioanna L Thanou Aspasia T Papatheodoropoulou Loukas I Thanos First pediatric Clinic National and Kapodistrian University of Athens Agia Sofia Children&#39 s Hospital Athens 11527 Greece Department of Medical Imaging and Interventional radiology Sotiria General Hospital for Chest Diseases Athens 11527 Greece

Background：Treatment of adrenal metastasis from lung carcinoma may prolong survival in the selected ***,not all patients can undergo surgery;thus,minimally invasive ablation procedures such as radiofrequency ablation （RFA） and microwave ablation （MWA） have gained acceptance as alternative treatment *** study summarized a 5-year single-center experience regarding the evaluation of safety and efficacy of computed tomography （CT）-guided thermal ablation in the management of adrenal metastasis originating from non-small cell lung cancer （NSCLC）.Methods：The data of NSCLC patients ablated for adrenal metastasis at the Department of Diagnostic Imaging and Interventional radiology,general Hospital Sotiria,were retrospectively *** were divided into two groups：RFA group and MWA group according to the therapeutic *** blood tests included measurement of international normalized ratio,partial thromboplastin time,and platelet enumeration.A dual-phase contrast-enhanced spiral CT was performed immediately after the procedure to assess the immediate response after ablation and to screen for related ***-up was performed with CT or magnetic resonance imaging at 1,3,6 months and 1 year after ablation and every 6 months ***：A total of 99 ablation sessions in 71 patients with adrenal metastasis originating from NSCLC were included in the final ***-limited,postablation syndrome occurred in 16/99 （16.1%） of ablation *** procedures were technically *** postablation imaging showed no contrast enhancement of the ablated tumor in all ***-up imaging at 3 months revealed local tumor progression in 8 （22.8%） patients of the RFA group and 7 （19.4%） patients of MWA group,all of them underwent a second session *** 1-year assessment revealed local recurrence of the ablated tumor in six patients （17.1%） of RFA group and seven patients （19.4%） of MWA grou

关键词： Adrenal Metastasis Microwave Nonsmall Cell Lung Cancer Radiofrequency Ablation

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MELD or MELD-Na as a Predictive Model for Mortality Following Transjugular Intrahepatic Portosystemic Shunt Placement

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Journal of Clinical and Translational Hepatology 2023年第1期11卷 38-44页

作者： Arunkumar Krishnan Tinsay A.Woreta Dhananjay Vaidya Yisi Liu James P.Hamilton Kelvin Hong Alia Dadabhai Michelle Ma division of Gastroenterology and Hepatology Johns Hopkins University School of MedicineBaltimoreMDUSA Department of general Internal Medicine Johns Hopkins University School of MedicineBaltimoreMDUSA Department of pediatrics Johns Hopkins University School of MedicineBaltimoreMDUSA division of Interventional radiology Johns Hopkins University School of MedicineBaltimoreMDUSA

Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver ***,there are limited studies to compare the MELD with MELD-Na to predict mortality after ***:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our *** primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS *** performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and ***:There were 186 eligible patients in the *** mean pre-TIPS MELD and MELD-Na were 13 and 15,***,mortality after TIPS was 15%at 30 days and 16.7%at 90 *** a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after *** optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for *** were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.

关键词： Cirrhosis Portal hypertension Model for end-stage liver disease Sodium Transjugular intrahepatic portosystemic shunt Outcomes Mortality

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Should Empyema with or without Necrotizing Pneumonia in Children Be Managed Differently?

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Health 2017年第2期9卷 209-222页

作者： Karine Anastaze Stelle Anne Mornand Nadia Bajwa Isabelle Vidal Mehrak Anooshiravani Aikaterini Kanavaki Constance Barazzone Argiroffo Sylvain Blanchon pediatric Pulmonology Unit Department of Pediatrics University Hospital Geneva Geneva Switzerland division of general pediatrics Department of Pediatrics University Hospital Geneva Geneva Switzerland division of pediatric Surgery Department of Pediatrics University Hospital Geneva Geneva Switzerland pediatric radiology Unit Department of Pediatrics University Hospital Geneva Geneva Switzerland

Background: Necrotizing pneumonia (NP) is an increasing lung infection mostly associated with pleural empyema. Objectives: We aimed to compare children with empyema with and without concomitant NP, in terms of risk factors, management and outcome. Methods: We retrospectively included children hospitalized between 2005-2014 with empyema to whom a computed tomography was performed. We recorded patient characteristics, clinical, biological (blood and pleural fluid) and radiological findings, medical and surgical treatments, and clinical, radiological and functional follow-up. Results: 35 children with empyema were included, including 25 with a concomitant NP. Patients with or without NP were undistinguishable, in terms of characteristics, symptoms at admission or detected pathogens. Pleural leucocytes were significantly higher in the empyema group (p = 0.0002) as pleural LDH (p = 0.002), and pleural/blood LDH ratio (p = 0.0005). Medical and surgical managements were similar between both groups. Complications occurred in 1/10 children with empyema alone (pneumatocele) and 5/25 with concomitant NP (bronchopleural fistula (n = 3), lobectomy, pneumothorax). The hospital length of stay and delay for chest X-ray normalization were similar in both groups. Conclusion: Except for minor biological parameters, the presence of concomitant NP in case of empyema does not change the presentation, clinical features, management and outcome, suggesting that the presence of additional NP to empyema should not be managed differently. Therefore, in case of empyema with suspected concomitant NP, chest CT should probably be restricted to abnormal worsening or when mandatory for surgical treatment.

关键词： Children Necrotizing Pneumonia Empyema

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Cardiac diagnostics before oral propranolol therapy in infantile hemangioma: retrospective evaluation of 234 infants

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World Journal of pediatrics 2018年第3期14卷 254-258页

作者： Giovanni Frongia Ji-Oun Byeon Raoul Arnold Arianeb Mehrabi Patrick Günther division of pediatric Surgery Department of GeneralVisceral and Transplantation SurgeryUniversity Hospital of HeidelbergIm Neuenheimer Feld 11069120 HeidelbergGermany Department of pediatric Cardiology Center for Pediatrics and Adolescent MedicineUniversity Hospital of HeidelbergHeidelbergGermany Department of general Visceral and Transplantation SurgeryUniversity Hospital of HeidelbergHeidelbergGermany

Background The indication and extent of cardiac screening before oral propranolol therapy (OPT) in patients with infantile hemangioma (IH) has been challenged. In this study, we evaluated pre-OPT cardiac diagnostics in a pediatric IH cohort in our department. Methods Retrospective chart review of infants ≤ 12 months old with IH undergoing OPT. The diagnostics prior to OPT, occurrence of complications, and outcome were recorded. Results A total of 234 patients were evaluated. The mean age at the onset of OPT was 4.2 ± 0.3 months, the average dura-tion of OPT was 6.1 ± 0.1 months, and the average follow-up was 12.3 ± 0.7 months. Echocardiograms and electrocardio-grams were performed prior to OPT in all patients. One hundred and three (44.0%) echocardiograms revealed pathological findings, 19 (8.1%) of which were minor (including atrial septal defects, pulmonary stenosis, and patent ductus arteriosus). Pathological findings were observed in 17 (7.3%) of electrocardiograms, only one (0.4%) of which was minor (suspected cardiac arrhythmia, subsequently excluded by long-term electrocardiogram analysis). These findings did not contraindicate OPT and no severe adverse events associated with OPT occurred during the follow-up period. Conclusions Routine cardiac screening by electrocardiogram and echocardiogram before OPT is debatable and not routinely indicated in children with IH. Further studies are necessary to draw definite conclusions on the reasonable indication and extent of this diagnostic approach.

关键词： Cardiac diagnostics Echocardiogram Electrocardiogram Hemangioma Propranolol

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