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Reder L, Bertelsen C, O’Dell K. Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?—Reply. JAMA Otolaryngol Head Neck Surg 2018; 144:646-647. [DOI: 10.1001/jamaoto.2018.0317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Lindsay Reder
- Keck School of Medicine, Department of Otolaryngology–Head & Neck Surgery, University of Southern California, Los Angeles, California
| | - Caitlin Bertelsen
- Keck School of Medicine, Department of Otolaryngology–Head & Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O’Dell
- Keck School of Medicine, Department of Otolaryngology–Head & Neck Surgery, University of Southern California, Los Angeles, California
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Gastroesophageal Reflux Characteristics and Patterns in Patients with Idiopathic Subglottic Stenosis. Gastroenterol Res Pract 2018; 2018:8563697. [PMID: 29991945 PMCID: PMC6016176 DOI: 10.1155/2018/8563697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/25/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Idiopathic subglottic stenosis represents a spectrum of subglottic disease without a clear underlying cause. Prior studies have implicated a pathogenic role of gastroesophageal reflux disease in idiopathic subglottic stenosis. The aim of this study was to examine the presence and pattern of gastroesophageal reflux in a large cohort of patients with idiopathic subglottic stenosis at a tertiary referral center. Methods We performed a retrospective review of patients with idiopathic subglottic stenosis from January 2010 to December 2016 who had undergone combined pH impedance testing. Patients with prior gastric or esophageal surgery were excluded. Data obtained included esophageal acid exposure times, number of reflux events, patient position during reflux events (defined as upright, supine, or mixed), body mass index, and the presence of proton pump inhibitor therapy. Results 159 patients with the idiopathic subglottic stenosis were identified, of whom 41 had undergone esophageal pH impedance testing. 40 (97.6%) were women, with a mean age of 54.8 (range 31-79) years and BMI of 31.0 (range 17-55). Overall, 19 (46.3%) patients were found to reflux as confirmed by abnormal esophageal acid exposure or abnormal number of reflux events. 15 of the 19 patients with reflux had predominantly upright gastroesophageal reflux disease, whereas 2 had supine and 2 mixed reflux. Discussion In patients with idiopathic subglottic stenosis who underwent evaluation by combined pH impedance, close to half were found to have gastroesophageal reflux disease. The majority of gastroesophageal reflux occurred while the patients were in the upright position.
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Carpenter PS, Pierce JL, Smith ME. Outcomes after cricotracheal resection for idiopathic subglottic stenosis. Laryngoscope 2018; 128:2268-2272. [DOI: 10.1002/lary.27263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Patrick S. Carpenter
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
| | - Jenny L. Pierce
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
| | - Marshall E. Smith
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
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Murphy MK, Motz KM, Ding D, Yin L, Duvvuri M, Feeley M, Hillel AT. Targeting metabolic abnormalities to reverse fibrosis in iatrogenic laryngotracheal stenosis. Laryngoscope 2018; 128:E59-E67. [PMID: 28940431 PMCID: PMC5771827 DOI: 10.1002/lary.26893] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/29/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Management of laryngotracheal stenosis (LTS) remains primarily surgical, with a critical need to identify targets for adjuvant therapy. Laryngotracheal stenosis scar fibroblasts exhibit a profibrotic phenotype with distinct metabolic shifts, including an increased glycolysis/oxidative phosphorylation ratio. This study examines the effects of the glutamine antagonist 6-diazo-5-oxo-l-norleucine (DON) on collagen production, gene expression, proliferation, and metabolism of human LTS-derived fibroblasts in vitro. METHOD Paired normal and scar-derived fibroblasts isolated from subglottic and proximal tracheal tissue in patients with iatrogenic laryngotracheal stenosis (iLTS) were cultured. Proliferation rate, gene expression, protein production, and cellular metabolism were assessed in two conditions: 1) fibroblast growth medium, and 2) fibroblast growth medium with 1 × 10-4 M DON. RESULTS DON treatment reduced cellular proliferation rate (n = 7, P = 0.0150). Expression of genes collagen 1 and collagen 3 both were reduced (n = 7, P = 0.0102, 0.0143, respectively). Soluble collagen production decreased (n = 7, P = 0.0056). As measured by the rate of extracellular acidification, glycolysis and glycolytic capacity decreased (n = 7, P = 0.0082, 0.0003, respectively). adenosine triphosphate (ATP) production and basal respiration decreased (n = 7, P = 0.0045, 0.0258, respectively), determined by measuring the cellular rate of oxygen consumption. CONCLUSION The glutamine antagonist DON reverses profibrotic changes by inhibiting both glycolysis and oxidative phosphorylation in iLTS scar fibroblasts. In contrast to untreated iLTS scar fibroblasts, collagen gene expression, protein production, metabolic rate, and proliferation were significantly reduced. These results suggest DON and/or its derivatives as strong candidates for adjuvant therapy in the management of iatrogenic laryngotracheal stenosis. Enzymes involved in glutamine metabolism inhibited by DON offer targets for future investigation. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E59-E67, 2018.
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Affiliation(s)
- Michael K Murphy
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
| | - Kevin M Motz
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
| | - Dacheng Ding
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
| | - Linda Yin
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
| | - Madhavi Duvvuri
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
| | - Michael Feeley
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
| | - Alexander T Hillel
- Johns Hopkins School of Medicine, Department of Otolaryngology, Baltimore, Maryland, U.S.A
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Fiz I, Bittar Z, Piazza C, Koelmel JC, Gatto F, Ferone D, Fiz F, Di Dio D, Bosse A, Peretti G, Sittel C. Hormone receptors analysis in idiopathic progressive subglottic stenosis. Laryngoscope 2017; 128:E72-E77. [DOI: 10.1002/lary.26931] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/31/2017] [Accepted: 08/22/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology-Head and Neck Surgery, Katharinenhospital; Stuttgart Germany
| | - Zeid Bittar
- Institute for Pathology; Katharinenhospital Stuttgart Germany
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Jan Constantin Koelmel
- Department of Otorhinolaryngology-Head and Neck Surgery, Katharinenhospital; Stuttgart Germany
| | - Federico Gatto
- Endocrinology Unit (DiMI), Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa; Genoa Italy
| | - Diego Ferone
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tuebingen; Tuebingen Germany
| | - Diana Di Dio
- Department of Otorhinolaryngology-Head and Neck Surgery, Katharinenhospital; Stuttgart Germany
| | - Alexander Bosse
- Institute for Pathology; Katharinenhospital Stuttgart Germany
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, Katharinenhospital; Stuttgart Germany
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Motz KM, Yin LX, Samad I, Ding D, Murphy MK, Duvvuri M, Hillel AT. Quantification of Inflammatory Markers in Laryngotracheal Stenosis. Otolaryngol Head Neck Surg 2017; 157:466-472. [PMID: 28485188 DOI: 10.1177/0194599817706930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) Develop a novel method for serial assessment of gene and protein expression in laryngotracheal stenosis (LTS). (2) Assess cytokine expression and determine an immunophenotype in LTS. Study Design A matched comparison of endolaryngeal brush biopsy samples from laryngotracheal scar and normal airway. Setting Tertiary care hospital, 2015-2016. Methods Brush biopsy specimens of laryngotracheal scar and normal trachea were obtained from 17 patients with LTS at the time of operating room dilation and were used for protein and RNA extraction. Gene expression of the TH1 cytokine interferon γ (INF-γ), TH2 cytokine interleukin 4 (IL-4), transforming growth factor β, and collagen 1 (Coll1) was quantified with quantitative real-time polymerase chain reaction. Cytokine analysis was performed with flow cytometry with a cytometric bead array. Results LTS specimens demonstrated a 13.68-fold increase in Coll1 gene expression versus normal ( P < .001, N = 17). Additionally, IL-4 gene expression showed a 3.76-fold increase ( P < .001, N = 17) in LTS scar. When stratified into iatrogenic LTS and idiopathic subglottic stenosis cohorts, INF-γ gene expression was significantly increased in idiopathic subglottic stenosis ( P = .011). Soluble cytokine measurements were below the limit of detection for reliable quantification and thus could not be assessed. Conclusions Brush biopsies from LTS samples can be successfully utilized for RNA extraction and demonstrate the expected increase in Coll1 gene expression associated with LTS. Preliminary gene expression suggests that abnormal collagen production may be mediated by the TH2 cytokine IL-4 and that increased INF-γ expression may represent a key difference between iatrogenic LTS and idiopathic subglottic stenosis. Further analysis of soluble cytokines is needed to confirm these findings.
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Affiliation(s)
- Kevin M Motz
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Linda X Yin
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Idris Samad
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dacheng Ding
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michael K Murphy
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Madhavi Duvvuri
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Alexander T Hillel
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Soliman AMS. Commentary on Menapace et al, "Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques". Otolaryngol Head Neck Surg 2017; 156:781-782. [PMID: 28457219 DOI: 10.1177/0194599817701423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ahmed M S Soliman
- 1 Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL. Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques. Otolaryngol Head Neck Surg 2017; 156:906-911. [DOI: 10.1177/0194599817691955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages. Results Sixteen patients (48%) underwent a single-stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1-3 days). Seventeen patients (52%) underwent a double-staged approach with a median time to decannulation of 35 days (range, 13-100 days). Twenty-four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0-3 days), with a median hospital stay of 4 days (range, 2-7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow-up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%). Conclusions Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long-term follow-up. Patients should be counseled about the potential for worsening voice quality with the open approach.
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Affiliation(s)
- Deanna C. Menapace
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Mara C. Modest
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Dale C. Ekbom
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric S. Edell
- Department of Pulmonology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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Antón-Pacheco JL, Usategui A, Martínez I, García-Herrero CM, Gamez AP, Grau M, Martínez AM, Rodríguez-Peralto JL, Pablos JL. TGF-β antagonist attenuates fibrosis but not luminal narrowing in experimental tracheal stenosis. Laryngoscope 2016; 127:561-567. [DOI: 10.1002/lary.26402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/16/2016] [Accepted: 10/04/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - Alicia Usategui
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
| | - Iván Martínez
- Servicio de Cirugía Torácica; Hospital 12 de Octubre; Madrid Spain
| | - Carmen M. García-Herrero
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
| | - Antonio P. Gamez
- Servicio de Cirugía Torácica; Hospital 12 de Octubre; Madrid Spain
| | - Montserrat Grau
- Unidad de Animalario y Quirófanos Experimentales, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
| | - Ana M. Martínez
- Universidad Francisco de Vitoria, Facultad de Ciencias Sanitarias, Escuela de Farmacia; Universidad Complutense de Madrid; Madrid Spain
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina; Universidad Complutense de Madrid; Madrid Spain
| | | | - José L. Pablos
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
- Servicio de Reumatología, Hospital 12 de Octubre; Universidad Complutense de Madrid; Madrid Spain
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Gelbard A, Katsantonis NG, Mizuta M, Newcomb D, Rotsinger J, Rousseau B, Daniero JJ, Edell ES, Ekbom DC, Kasperbauer JL, Hillel AT, Yang L, Garrett CG, Netterville JL, Wootten CT, Francis DO, Stratton C, Jenkins K, McGregor TL, Gaddy JA, Blackwell TS, Drake WP. Molecular analysis of idiopathic subglottic stenosis for Mycobacterium species. Laryngoscope 2016; 127:179-185. [PMID: 27295947 PMCID: PMC5156582 DOI: 10.1002/lary.26097] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/25/2016] [Indexed: 01/22/2023]
Abstract
Objectives/Hypothesis Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a hallmark of the disease. Epithelial microbiota dysbiosis is found in other chronic inflammatory mucosal diseases; however, the relationship between tracheal microbiota composition and iSGS is unknown. Given the critical role for host defense at mucosal barriers, we analyzed tissue specimens from iSGS patients for the presence of microbial pathogens. Methods Utilizing 30 human iSGS, 20 intubation‐related tracheal stenosis (iLTS), and 20 healthy control specimens, we applied molecular, immunohistochemical, electron microscopic, immunologic, and Sanger‐sequencing techniques. Results With unbiased culture‐independent nucleic acid, protein, and immunologic approaches, we demonstrate that Mycobacterium species are uniquely associated with iSGS. Phylogenetic analysis of the mycobacterial virulence factor rpoB suggests that, rather than Mycobacterium tuberculosis, a variant member of the Mycobacterium tuberculosis complex or a closely related novel mycobacterium is present in iSGS specimens. Conclusion These studies identify a novel pathogenic role for established large airway bacteria and provide new targets for future therapeutic intervention. Level of Evidence NA Laryngoscope, 127:179–185, 2017
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | | | - Masanobu Mizuta
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Dawn Newcomb
- Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee
| | - Joseph Rotsinger
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - James J Daniero
- Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Eric S Edell
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Liying Yang
- Department of Medicine, New York University School of Medicine, New York, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | | | | | - David O Francis
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Charles Stratton
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Kevin Jenkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Tracy L McGregor
- Department of Pediatrics, Division of Medical Genetics, Vanderbilt University, Nashville, Tennessee
| | - Jennifer A Gaddy
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee.,Veterans Affairs Tennessee Valley Healthcare Services, Nashville, Tennessee
| | - Timothy S Blackwell
- Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee.,Veterans Affairs Tennessee Valley Healthcare Services, Nashville, Tennessee
| | - Wonder P Drake
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee
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