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Luttrell JB, Nieri CA, Mamidala M, Sheyn A. Retraction notice to "Outcomes and considerations in children with developmental delay undergoing tonsillectomy" [Int. J. Pediatr. Otorhinolaryngol. 164 (January 2023) 111393]. Int J Pediatr Otorhinolaryngol 2023:111839. [PMID: 38378401 DOI: 10.1016/j.ijporl.2023.111839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Jordan B Luttrell
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chad A Nieri
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Madhu Mamidala
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Benaim EH, Nieri C, Mamidala M, Herr MJ, Sheyn A, Gillespie MB. High-intensity focused ultrasound for benign thyroid nodules: Systemic review and meta-analysis. Am J Otolaryngol 2023; 44:103999. [PMID: 37478539 DOI: 10.1016/j.amjoto.2023.103999] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/08/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a less invasive option offered for the treatment of large, compressive, benign thyroid nodules. METHODS Observational studies of more than five participants using HIFU in the management of benign thyroid nodules from 2000 to 2021 were identified using predefined inclusion criteria. The primary outcome was an estimate of the effectiveness of HIFU. RESULTS Out of 158 studies reviewed, 8 articles were included with 297 patients and 300 nodules. HIFU significantly reduced nodule volume from 1 to 24 months following therapy (weighted mean difference [WMD], 47.68, 95 % confidence interval [CI], 34.13-59.66, p < 0.0001) and achieved favorable success rates (risk ratio [RR], 1.49, 95 % CI, 1.15-1.84, p < 0.001) for 50 % volume reduction. CONCLUSIONS HIFU appears to be a feasible, safe, and effective treatment modality for patients with benign thyroid nodules. Future research, including randomized controlled trials, is needed to determine therapy optimization, and patient selection to identify the potential role of this new therapy.
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Affiliation(s)
- Ezer H Benaim
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Chad Nieri
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Madhu Mamidala
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Michael J Herr
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Anthony Sheyn
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - M Boyd Gillespie
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America.
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Luttrell JB, Nieri CA, Mamidala M, Sheyn A. Outcomes and considerations in children with developmental delay undergoing tonsillectomy. Int J Pediatr Otorhinolaryngol 2023; 164:111393. [PMID: 36473255 DOI: 10.1016/j.ijporl.2022.111393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/06/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Developmental delay (DD) affects one in six children and has been shown to require more health care than the average child [1-2]. Certain recent studies have suggested an increased rate of complications/costs in children with DD [3-5]. Our objective was to perform a retrospective study comparing DD children to non-DD controls in patients presenting for tonsillectomy over a 1-year period to further define the relationship between DD and post-operative complications. METHODS We conducted a retrospective chart review of children undergoing tonsillectomy over a one-year period. We collected demographic information, polysomnogram, comorbidities, complications, and length of stay. A diagnosis of developmental delay was considered if recorded prior to the tonsillectomy or workup was ongoing at the time of tonsillectomy. All data was analyzed using IBM SPSS Statistics 25. RESULTS The final cohort included 400 patients. Our cohort had 56 patients with diagnosis of DD. We recorded 18 complications in the DD population (32.14%) compared to 30 complications in the control group (8.72%) (p < 0.00001). Children with DD had higher incidence of comorbidities (p < 0.00001), complication with comorbidities (p < 0.00001), and incidence of prematurity (p < 0.00001); whereas, they did not have increased length of stay (LOS) (p = 0.33) or complications if premature (p = 0.22). Pre-operative polysomnogram was associated with higher incidence of complication (p = 0.035) in the total population but children with DD did not have higher pre-operative obstructive apnea-hypopnea index (oAHI)compared to the control patients (p = 0.25). CONCLUSION Children with DD were found to have a significantly higher complication rate compared to children without DD in our patient population. They did have higher incidence of additional comorbidities and prematurity. This elevated risk should at least be included in pre-operative counseling, but additionally has potential implications for pre-operative decision making and treatment plans in this high-risk population.
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Affiliation(s)
- Jordan B Luttrell
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chad A Nieri
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Madhu Mamidala
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Coca K, Benaim E, Reed L, Mamidala M, Gillespie MB. Outcomes of Submandibular Stone Removal With and Without Salivary Endoscopes. Laryngoscope 2021; 132:754-760. [PMID: 34378799 DOI: 10.1002/lary.29815] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS For patients with submandibular sialolithiasis, there are many gland-preserving treatment options including sialendoscopy. Sialendoscopy, however, requires expensive instrumentation with limited availability, which may not be required for routine cases. The objective of this study is to compare the outcomes of patients with submandibular sialolithiasis undergoing sialendoscopy versus those undergoing transoral incisional sialithotomy. STUDY DESIGN Longitudinal, prospective study of patient undergoing gland-preserving therapy for submandibular sialolithiasis. METHODS The study was a prospective, nonrandomized trial of 30 patients with submandibular sialolithiasis who received gland-preserving treatment by either sialendoscopy-assisted techniques (Scope group; 14 patients) or transoral sialithotomy with or without dochoplasty (No Scope group; 16 patients). Factors analyzed between the two groups included age, race, gender, size of stone, location of stone, gland(s) involved, surgical method, and modified salivary Oral Health Impact Profile (sOHIP) scores before and after therapy. RESULTS There were no significant differences between the Scope and No Scope groups regarding age, race, or gender. There was a significant difference in stone size between the groups, with the No Scope group having larger stones on average. Both treatments led to statistically significant symptomatic improvement in sOHIP scores. There was no statistically significant difference in salivary quality of life improvement between the Scope and No Scope groups (P = .33). CONCLUSIONS Sialendoscopy is an important diagnostic and therapeutic tool in the management of salivary disorders, but is not associated with improved outcomes in gland-preserving treatments for routine submandibular sialolithiasis. Transoral stone removal alone may have equivalent symptomatic outcomes in the management of select sialoliths. LEVEL OF EVIDENCE III Laryngoscope, 2021.
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Affiliation(s)
- Kimberly Coca
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Ezer Benaim
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Leighton Reed
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Madhu Mamidala
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
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Coca KK, Heiser C, Huntley C, Boon M, de Vries N, Mamidala M, Gillespie MB. Hypoglossal Nerve Stimulation Usage by Therapy Nonresponders. Otolaryngol Head Neck Surg 2021; 166:786-790. [PMID: 34372740 DOI: 10.1177/01945998211036867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to examine differences in therapy usage and outcomes of therapy between responder (R) and nonresponder (NR) groups in an international, multicenter prospective registry of patients undergoing hypoglossal nerve stimulation for obstructive sleep apnea (OSA). STUDY DESIGN Database analysis (level III). SETTING International, multicenter registry. METHODS The studied registry prospectively collects data pre- and postimplantation, including sleep parameters, Epworth score, patient experience, and safety questions, over the course of 12 months. Patients are defined as a "responder" based on Sher criteria, which require a final apnea-hypopnea index (AHI) of ≤20 and a final AHI reduction of >50% at their 12-month follow-up. RESULTS Overall, there were 497 (69%) R and 220 (31%) NR. Most patients in both groups experienced improvement in quality of life following implantation (96% of R; 77% of NR) with reductions in oxygen desaturation index and Epworth score. At final follow-up, the R group demonstrated significantly better adherence to recommended therapy (>4 hours/night) (P = .001), average hours of nightly use (P = .001), final Epworth scores (P = .001), and degree of subjective improvement (P < .001). CONCLUSION Patients classified as NR to upper airway stimulation continue to use therapy with improvement in percent time of sleep with O2 <90%, reduction in daytime sleepiness, and improvement in quality of life. Therefore, ongoing usage of the device should be encouraged in NR patients who note improvement while integrating additional strategies to lower the long-term effects of OSA.
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Affiliation(s)
- Kimberly K Coca
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Clemens Heiser
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany, USA
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nico de Vries
- Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | - Madhu Mamidala
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Al-Alawneh M, Caballero L, DeBroux E, Herr MJ, Petro AC, Thompson J, McLevy J, Wood J, Mamidala M, Sheyn A. Injection Laryngoplasty for the Treatment of Type 1 Laryngeal Clefts: A Single Institution Experience. Ann Otol Rhinol Laryngol 2020; 130:775-780. [PMID: 33218282 DOI: 10.1177/0003489420973237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Standards for treatment of laryngeal clefts remain poorly defined. There are no large case series that report the efficacy of injection laryngoplasty (IL) in the treatment of pediatric Type 1 laryngeal clefts (LC-1). The objective of this study is to measure the effect of IL in young children with LC-1. METHODS A retrospective case series of 130 patients was completed over 3 years at a at a single institution included patients aged 1 month to 8 years, diagnosed with aspiration and penetration issues during swallowing based on a Videofluoroscopic Swallow Study (VFSS). Patients underwent surgical evaluation and intervention using carboxymethylcellulose gel injection. Collected data points included age in months at time of first injection, gender, race, pre- and post-operation VFSS scores, number of injections, co-morbidities and post-operative complications. VFSS scores were evaluated pre- and post-operatively to assess efficacy of intervention. A secondary outcome was efficacy in patients with aspiration compared to those with penetration alone. RESULTS This study included 77 male and 53 female patients. Sixty-two patients (48%) demonstrated a significant post-operative improvement in their swallowing function (P < .05). There were no statistical differences in age, number of injections, or the volume of the first injection. Patients that showed a post-operative improvement in swallowing function were on average 5 months older and had more severe aspiration and penetration compared to those who did not demonstrate a post-operative benefit and underwent less injections. The volume of injection did not appear to play a role in the success rate. CONCLUSION Injecting the inter-arytenoid area in patients with LC-1 appears to confer some benefit to close to half of our patient population. Successful procedures seemed to occur in patients with more severe aspiration and penetration and older age.
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Affiliation(s)
- Mohammad Al-Alawneh
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ladd Caballero
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Elijah DeBroux
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael J Herr
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Jerome Thompson
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer McLevy
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joshua Wood
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Madhu Mamidala
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Abstract
Objectives: Physicians have high rates of burnout with an Otolaryngology burnout rate of 42%. The most studied burnout correlation is increased work hours. More recently, mindfulness training programs have been shown to decrease burnout and increase self-compassion. Regarding burnout studies specific to Otolaryngology residents, there have been few in the past decade. This study explores correlations between burnout and procedure involvement, non-clinical responsibilities and mindfulness practices along with gathering updated work hours data. Methods: A single survey question was shown to be a reliable substitute for Maslach Burnout Inventory in assessing burnout. A survey was sent to all US Otolaryngology residents to investigate the correlation of burnout to post-graduate year, work hours, procedure involvement, non-clinical responsibilities, and mindfulness practices. Residents were asked to answer questions regarding their previous year of training. Results: Overall burnout was 50%. PGY-1 and PGY-5 were completed with a low burnout rate compared to other years. Increased work hours were confirmed to increase burnout. Increased involvement in procedures, decreased exercise, and increased time completing paperwork correlated with increased burnout. No other factors including mindfulness correlated with increased or decreased burnout. However, only 20% who practiced mindfulness training had this training offered by their department or university. Conclusion: Annals of Otology, Rhinology & Laryngology A 50% burnout rate is a concerning rate. Increased work hours and PGY-2 through PGY-4 correlated with increased burnout. Accessibility to mindfulness training was low. As mindfulness training is a proven activity to decrease burnout, more departments could benefit from providing these experiences to their residents.
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Affiliation(s)
- Leighton Reed
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Madhu Mamidala
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rosemary Stocks
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Tansey JB, Hamblin J, Mamidala M, Thompson J, Mclevy J, Wood J, Sheyn A. Dexamethasone Use in the Treatment of Pediatric Deep Neck Space Infections. Ann Otol Rhinol Laryngol 2019; 129:376-379. [DOI: 10.1177/0003489419890349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics. Methods: Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS. Results: Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively ( P = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, P-value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10). Conclusion: Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.
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Affiliation(s)
- James B. Tansey
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - John Hamblin
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Madhu Mamidala
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jerome Thompson
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer Mclevy
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joshua Wood
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
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Rhodes CB, Eid A, Muller G, Kull A, Head T, Mamidala M, Gillespie B, Sheyn A. Postoperative Monitoring Following Adenotonsillectomy for Severe Obstructive Sleep Apnea. Ann Otol Rhinol Laryngol 2018; 127:783-790. [PMID: 30182728 DOI: 10.1177/0003489418794700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients undergoing adenotonsillectomy (T&A) for severe obstructive sleep apnea (OSA) are usually admitted for observation, and many surgeons use the intensive care unit (ICU) for observation due to the risk of postsurgical airway obstruction. Given the limited resources of the pediatric ICU (PICU), there is a push to better define the patients who require postoperative monitoring in the PICU for monitoring severe OSA. METHODS Forty-five patients were evaluated. Patients who had cardiac or craniofacial comorbidities were excluded. Patients undergoing T&A for severe OSA were monitored in the postanesthesia care unit (PACU) postoperatively. If patients required supplemental oxygen or developed hypoxia while in the PACU within the 3-hour monitoring period, they were admitted to the PICU. RESULTS Overall, 16 of 45 patients were admitted to the ICU for monitoring. Patients with an Apnea-Hypopnea Index (AHI) >50 or with an oxygen nadir <80% were significantly more likely to be admitted to the PICU. The mean AHI of patients admitted to the PICU was 40.5, and the mean oxygen nadir was 69.9%. Patients younger than 2 years were significantly more likely to be admitted to the PICU. CONCLUSION Based on the data presented here and academy recommendations, not all patients with severe OSA require ICU monitoring.
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Affiliation(s)
| | - Anas Eid
- 1 University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Grant Muller
- 1 University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amanda Kull
- 1 University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tim Head
- 2 Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Madhu Mamidala
- 1 University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Boyd Gillespie
- 1 University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anthony Sheyn
- 1 University of Tennessee Health Science Center, Memphis, Tennessee, USA
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