Current Opin Pediatrics

Current Opinion in Pediatrics requires Vancouver format, but
they also ask their authors to add a * or ** and an
annotation
to some of the references.  The asterisks are supposed to go
after the bibliography number e.g.  2 *    5 **
Can this be done in the library for the particular reference
somehow?  Since the number isn't the EndNote reference
number,
I suspect it can't be done except at the very end in the MS
Word paper - right?  Any ideas would be welcomed.
TL Herbert
herbertLmusc.edu
Charleston, SC