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Wang SY, Lu KC, Liang SJ, Huang CJ. A meta-analysis of the predictive values of intraoperative cough test for postoperative outcomes in women undergoing sling procedures. Arch Gynecol Obstet 2020; 302:779-784. [PMID: 32488398 DOI: 10.1007/s00404-020-05623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Shin-Yi Wang
- Department of General Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kuo-Ching Lu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Section 3, Xinglong Road, Wenshan District, Taipei, 116, Taiwan, ROC.,Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - So-Jung Liang
- Departmen of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chun-Jen Huang
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Section 3, Xinglong Road, Wenshan District, Taipei, 116, Taiwan, ROC. .,Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
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Lee HH, Kim DK, Park JW, Lee SY, Ko WJ, Kim YS. Credé maneuver to adjust tape tension during trans-obturator tape mid-urethral sling in mixed urinary incontinence. Int Urogynecol J 2019; 31:809-816. [PMID: 31781825 DOI: 10.1007/s00192-019-04160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/17/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the efficacy of intraoperative extrinsic manual bladder compression (Credé maneuver) for trans-obturator tape adjustment during mid-urethral sling surgery in women with stress urinary incontinence and those with mixed urinary incontinence. METHODS The study included 148 randomly selected women who underwent mid-urethral sling surgery with trans-obturator tape for stress urinary incontinence between January 2016 and May 2017. Subgroup analysis of 66 women with mixed urinary incontinence included 43 patients from the Credé maneuver group and 23 from the non-Credé maneuver group. In the Credé maneuver group, the pattern of urine leakage was determined during the Credé maneuver, and tape tension was adjusted according to the pattern. RESULTS The cure rate was 86.6% and improved rate was 11.9% in the Credé maneuver patients. The cure rate was 50.6% and improved rate was 38.3% in the non-Credé maneuver patients. The success rate was significantly higher in the Credé than in the non-Credé maneuver group (p = 0.023). In subgroup analysis of patients with mixed urinary incontinence, the cure rate was 81.4% and improved rate was 16.3% in the Credé maneuver group. The cure rate was 43.5% and improved rate was 47.8% in the non-Credé maneuver group. The cure rate was significantly higher in the Credé maneuver group (p = 0.007). CONCLUSIONS Intraoperative trans-obturator tape adjustment using the Credé maneuver to identify the leaking pattern significantly improved the success rate in women with mixed urinary incontinence, and Credé maneuver-directed adjustment significantly improved the cure rate.
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Affiliation(s)
- Hyung Ho Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, South Korea
| | - Jae Won Park
- Department of Urology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea
| | - Suk Young Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea
| | - Woo Jin Ko
- Department of Urology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea
| | - Young Sig Kim
- Department of Urology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea.
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Brennand EA, Kim-Fine S. A randomized clinical trial of how to best position retropubic slings for stress urinary incontinence: Development of a study protocol for the mid-urethral sling tensioning (MUST) trial. Contemp Clin Trials Commun 2016; 3:60-64. [PMID: 29736458 PMCID: PMC5935876 DOI: 10.1016/j.conctc.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/28/2016] [Accepted: 04/11/2016] [Indexed: 11/21/2022] Open
Abstract
The goal of this trial is to compare two techniques for tensioning retropubic midurethral slings: a Mayo scissor between the tape and urethra vs. a Babcock clamp creating a measured loop underneath the urethra. The primary outcome is a composite of abnormal bladder function at 12 months post surgery. Abnormal bladder function is defined as bothersome stress incontinence or worsening over active bladder symptoms, a positive cough stress test, re-treatment of stress urinary incontinence, post-operative urinary retention requiring either catheterization beyond 6 weeks or surgical intervention. Secondary outcomes include the duration of post operative urinary retention, quality of life scores, and physical examination. This article describes the rationale and design of this clinical trial, which will be of interest to those who care for patient with pelvic floor disorders such as stress urinary incontinence.
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Affiliation(s)
- Erin A. Brennand
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada
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Nyyssönen V, Talvensaari-Mattila A, Santala M. A prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in patients with stress or mixed urinary incontinence: subjective cure rate and satisfaction in median follow-up of 46 months. Scand J Urol 2013; 48:309-15. [DOI: 10.3109/21681805.2013.863802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Randomized controlled trial of cough test versus no cough test in the tension-free vaginal tape procedure: effect upon voiding dysfunction and 12-month efficacy. Int Urogynecol J 2011; 23:435-41. [DOI: 10.1007/s00192-011-1594-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
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Madhuvrata P, Ford J, Merrick K, Boachie C, Abdel-Fattah M. Voiding dysfunction following suburethral tape. J OBSTET GYNAECOL 2011; 31:424-8. [PMID: 21627428 DOI: 10.3109/01443615.2011.568074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Voiding dysfunction (VD) is relatively common following suburethral tape insertion. Our study aimed to identify perioperative variables that predict VD. Women who underwent suburethral tapes (TVT(TM) and TVT-O(TM)), either as sole procedure or with a concomitant prolapse repair, were studied retrospectively. The primary outcome was women requiring catheterisation and/or re-catheterisation in the postoperative period. A total of 319 women underwent suburethral tapes within the study period: 256 case notes (80.2%) were available for review and 40/256 women (15.6%) developed postoperative VD. No preoperative urinary symptoms were associated with postoperative VD. Univariate analysis demonstrated three variables associated with VD: average flow rate (Q-ave) ≤5th centile (odds ratio (OR) 2.3, 95% CI 1.2-6.5, p = 0.016), a combination of Q-ave and maximum flow rate (Q-max) ≤5th centile (OR 2.8, 95% CI 1.1-6.9, p = 0.030) and concomitant prolapse procedure (OR 3.6, 95% CI 1.5-8.9, p = 0.005). Following multivariate logistic regression Q-ave ≤5th centile and concomitant prolapse procedure showed the strongest association with VD.
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Affiliation(s)
- P Madhuvrata
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospital Foundation Trust, Sheffield, UK.
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Wohlrab KJ, Erekson EA, Korbly NB, Drimbarean CD, Rardin CR, Sung VW. The association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures. Am J Obstet Gynecol 2009; 200:571.e1-5. [PMID: 19223025 DOI: 10.1016/j.ajog.2008.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/08/2008] [Accepted: 11/16/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures. STUDY DESIGN We performed a retrospective cohort study of women undergoing outpatient midurethral sling procedures. Exposure was defined as the type of anesthesia, categorized as regional (spinal or combined spinal/epidural) or nonregional (general endotracheal, monitored anesthesia care with sedation, or local). The outcome, acute postoperative urinary retention, was defined as a failed voiding trial prior to discharge. RESULTS A total of 131 women met our inclusion criteria. Forty-two women (32%) had regional anesthesia and 89 (68%) women had non-regional anesthesia. Overall, 48 women (36.6%) had acute postoperative urinary retention. Women who had regional anesthesia had an increased odds (adjusted odds ratio, 4.4; 95% confidence interval, 1.9-10.2) of acute postoperative urinary retention compared with women receiving nonregional anesthesia. CONCLUSION Regional anesthesia is a risk factor for acute postoperative urinary retention following outpatient midurethral slings.
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Affiliation(s)
- Kyle J Wohlrab
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, RI, USA.
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Dawson T, Lawton V, Adams E, Richmond D. Factors predictive of post-TVT voiding dysfunction. Int Urogynecol J 2007; 18:1297-302. [PMID: 17347790 DOI: 10.1007/s00192-007-0324-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 01/29/2007] [Indexed: 11/24/2022]
Abstract
In this study we assessed the incidence of voiding dysfunction in women 6 months after undergoing a tension-free vaginal tape (TVT) procedure. Logistic regression was then used to look for significantly associated factors from a range of patient, urodynamic and surgical variables. From a group of 267 women we identified 22 (8%) who needed to perform daily intermittent self-catheterisation (ISC) as a result of the TVT surgery. When potential predictive factors were examined individually there were three that appeared to be associated with the need to use ISC: menopausal status,previous incontinence surgery and the centile score for average voiding flow rate (as derived from a volume--flow rate nomogram). Following multivariate logistic regression this flow rate centile score showed the strongest association with post-TVT voiding dysfunction, the likelihood of needing ISC increasing as the centile score fell. This factor has not previously been described but is readily assessed pre-operatively and may be useful in case selection for TVT.
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Affiliation(s)
- Tim Dawson
- Department of Urogynaecology, Liverpool Women's Hospital, Crown St., Liverpool L87SS, UK.
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Vervest HAM, Bisseling TM, Heintz APM, Schraffordt Koops SE. The prevalence of voiding difficulty after TVT, its impact on quality of life, and related risk factors. Int Urogynecol J 2006; 18:173-82. [PMID: 16633883 DOI: 10.1007/s00192-006-0127-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 03/22/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the prevalence of voiding difficulty (VD), quality of life, and related risk factors after tension-free vaginal tape (TVT). DESIGN Prospective cohort study in 703 women with a TVT procedure for stress urinary incontinence. MAIN OUTCOME MEASURES VD stated by women, Urogenital Distress Inventory (UDI-6) question 5 (difficulty in emptying the bladder), maximum flow rate, postvoid residual urine, necessity of postoperative catheterization, tape division, and impact on quality of life (Incontinence Impact Questionnaire, IIQ-7). RESULTS Postoperative catheterization (>24 h) was necessary in 11% and tape division in 1.3% of patients. There were 26% of women who stated VD and 25% reported moderate to great impairment on the UDI-6 after 36 months. While the negative impact on the outcome of TVT in women with abnormal voiding compared to women without is higher, the impact decreased significantly after TVT, implying a considerable improvement in quality of life. Pre-operative existing voiding difficulty and concomitant prolapse surgery were independent risk factors. CONCLUSIONS Symptoms of VD occurred after TVT and caused lesser improvement in quality of life.
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Affiliation(s)
- Harry A M Vervest
- Department of Gynecology and Obstetrics, St. Elisabeth Hospital, P.O. Box 90151, 5000 Tilburg, LC, The Netherlands.
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Koops SES, Bisseling TM, van Brummen HJ, Heintz APM, Vervest HAM. What determines a successful tension-free vaginal tape? A prospective multicenter cohort study: results from The Netherlands TVT database. Am J Obstet Gynecol 2006; 194:65-74. [PMID: 16389011 DOI: 10.1016/j.ajog.2005.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 05/03/2005] [Accepted: 06/07/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to report which preoperative and intraoperative factors influence the success of the tension-free vaginal tape procedure for stress urinary incontinence. STUDY DESIGN This was a prospective cohort study of 809 patients. In 28 teaching hospitals and 13 local hospitals, 54 gynecologists and urologists performed the tension-free vaginal tape procedure. RESULTS Before treatment and 2 years postoperatively, the following question from the Urogenital Distress Inventory for stress urinary incontinence was selected to define success or failure: "Do you experience urinary leakage during physical activity, coughing, or sneezing?" Secondary outcome measurement was the outcome of the doctor's question, "Do you leak during physical activity, coughing, or sneezing?" asked at the 2-year follow-up. Response rate was 78.7%. The success rate was significant higher in all analyses when the surgeons had performed more than 20 tension-free vaginal tape procedures (P = .003; beta = 1.918 [95% confidence interval 1.24-2.97]). General anesthesia had a negative effect on the success of the tension-free vaginal tape (P = .032; beta = 2.21 [95% confidence interval 1.07-4.55]). CONCLUSIONS Inexperience of the surgeon with the tension-free vaginal tape procedure and general anesthesia had a negative effect on the result. We believe that the tension-free vaginal tape should be performed only by experienced surgeons.
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Sokol AI, Jelovsek JE, Walters MD, Paraiso MFR, Barber MD. Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery. Am J Obstet Gynecol 2005; 192:1537-43. [PMID: 15902154 DOI: 10.1016/j.ajog.2004.10.623] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the time to adequate voiding, incidence of urinary retention, and predictors of voiding efficiency and urinary retention after tension-free vaginal tape (TVT) with and without concurrent prolapse surgery. STUDY DESIGN Medical records of patients who underwent TVT between August 1999 and July 2003 were reviewed. Urinary retention was defined as the need for urethrolysis, urethral dilation, or postoperative catheterization for >6 weeks. Linear and logistic regression models were used to determine predictors of time to adequate voiding and urinary retention. RESULTS Two hundred sixty-seven patients were available for analysis; 66% had concurrent prolapse repair, 4% had concurrent laparoscopically assisted vaginal hysterectomy (LAVH), and 30% had an isolated TVT. TVT with and without concurrent prolapse repair or LAVH were statistically similar with respect to median days to voiding (8 vs 5) and the rate of urinary retention (11.2% vs 11.3%). Overall, 4.9% underwent urethrolysis, 1.9% received urethral dilation, and 4.1% required prolonged catheterization. Increasing age, decreasing BMI, and postoperative urinary tract infection were independent predictors of time to adequate voiding. Previous history of incontinence surgery was the only independent predictor of urinary retention (Adjusted odds ratio [AOR] 2.96, 95%CI [1.17-7.06]). CONCLUSION Concurrent prolapse surgery does not appear to significantly alter postoperative voiding efficiency or increase the risk of prolonged urinary retention compared with TVT alone.
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Andonian S, Chen T, St-Denis B, Corcos J. Randomized Clinical Trial Comparing Suprapubic Arch Sling (SPARC) and Tension-Free Vaginal Tape (TVT): One-Year Results. Eur Urol 2005; 47:537-41. [PMID: 15774255 DOI: 10.1016/j.eururo.2004.12.023] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE Suprapubic Arch sling (SPARC) has been initially presented as being comparable to Tension-free Vaginal Tape (TVT) without published trials. To test the safety and efficacy of this new product, we designed a prospective, randomized clinical trial with a minimum follow-up of 1 year. MATERIALS AND METHODS 84 women presenting with Stress Urinary Incontinence (SUI) were randomly assigned to SPARC or TVT as a minimally invasive mid-urethral sling procedure. All patients were re-evaluated at 1, 6, and 12 months. Symptom assessment, Incontinence Impact Questionnaire (IIQ), physical examination, Uro-Dynamic Studies (UDS) and 1-hour pad test were repeated at 1-year follow-up. RESULTS 41 patients were randomized to SPARC and 43 to TVT. The two groups had similar baseline characteristics. Both procedures resulted in similar peri-operative complications: bladder perforation (24% vs. 23%), median estimated blood loss (0-50 ml), median hospital stay (1-night), post-operative analgesia, and persistent urinary retention necessitating tape resection (2 patients in each group). There were three other complications in the SPARC group: tape erosion, infected pelvic hematoma, and urinary tract infection. At 12 months, there was no statistically significant difference between SPARC and TVT, in terms of objective cure rates as determined by 1-hour pad test of less than two grams (83% vs. 95%; p< or =0.1; 12% difference, 95% CI: 25.4% to -1.4%) and subjective cure rates as determined by IIQ scores (49.9+/-25.6 vs. 45.3+/-18.4; p=0.46). CONCLUSIONS At 1-year follow-up, there is no statistically significant difference between SPARC and TVT. Longer follow-up is needed to confirm these results.
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Affiliation(s)
- Sero Andonian
- Division of Urology, Department of Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine, Suite E208, Montreal, Quebec, Canada, H3T 1E2
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Murphy M, Culligan PJ, Arce CM, Graham CA, Blackwell L, Heit MH. Is the cough-stress test necessary when placing the tension-free vaginal tape? Obstet Gynecol 2005; 105:319-24. [PMID: 15684159 DOI: 10.1097/01.aog.0000152305.37853.7e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether the mode of anesthesia (and the resultant ability or inability to perform the cough-stress test) used during the tension-free vaginal tape (TVT) procedure affects postoperative continence. METHODS A cohort of 170 women who underwent the TVT procedure without any other concomitant surgery completed the short form of the Urogenital Distress Inventory (UDI-6) to assess their continence status preoperatively and postoperatively. Chi-squared, t, and Mann-Whitney U tests were used to determine the association between these data and anesthesia type during univariate analysis. RESULTS Both anesthesia groups showed significant improvement from their preoperative UDI-6 scores to their postoperative scores. However, when comparing the change from pre- to postoperative UDI-Stress Symptoms subscale scores between the 2 groups, we found a significant difference. Mean improvement in the local group was 58.3 (+/- 33.8) compared with 41.7 (+/- 39.4) in the general group (P = .02). CONCLUSION Women who undergo TVT show significant improvements in incontinence severity regardless of anesthesia type. However, greater improvements in stress incontinence, as measured by the UDI-Stress Symptoms subscale, are seen when the TVT is placed while using the cough-stress test under local analgesia. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Miles Murphy
- Health Sciences Center, University of Louisville, Louisville, Kentucky, USA.
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