ORCID Profile
0000-0002-6484-3977
Current Organisations
Flinders Medical Centre
,
Flinders University
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Publisher: Wiley
Date: 06-10-2022
DOI: 10.1111/ANS.18088
Abstract: Carpal tunnel syndrome is a common compressive neuropathy. There is a lack of comprehensive studies evaluating carpal tunnel release (CTR) complications in Australia. This study aimed to evaluate complication rates associated with open and endoscopic CTR in an Australian population, and to identify associated risk factors. Retrospective cohort study of 1287 CTR from 2015 to 2020. Methods of release were endoscopic, open and surgery concomitant with synovectomy or other. Outcomes included wound infection, dehiscence, nerve injury, complex regional pain syndrome, incomplete release, and re‐operation. Statistical analysis included Chi‐squared test, Fisher's exact test, Odds ratio and logistic regression. There were 71 total complications (5.5%), including 35 Clavien–Dindo IIIb complications. There was no difference in complication rates for endoscopic (3.3%) versus open (8.3%) CTR ( P = 0.18). The overall rate of complications was higher in CTR with concomitant surgery (8.5%) compared to CTR alone (5.2%), though this was not statistically significant ( P = 0.058). There was no association between rates of complications and immune suppression (p = 0.55), rheumatoid disease ( P = 0.61), or smoking status ( P = 0.72). Diabetes mellitus was associated with an increased risk of Clavien‐Dindo IIIb complications ( P = 0.028, OR 2.15, 95% CI 1.07–4.32). There was no association between surgical experience and complication rate ( P = 0.55). Open and endoscopic CTR surgeries have similar rates of complications. Diabetes is associated with higher rates of Clavien‐Dindo IIIb complications. Identification of high‐risk patients allows for the application of risk‐mitigation strategies in the perioperative setting.
Publisher: Elsevier BV
Date: 06-2018
Publisher: Wiley
Date: 20-11-2023
DOI: 10.1111/ANS.18167
Abstract: The rotation flap approach (RoFA) mastectomy is a skin‐sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health‐related quality of life between the ROFA mastectomy and standard mastectomy approach. This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST‐Q was administered pre‐operatively and at 3‐, 6‐, 9‐ and 12‐months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. A total of 100 participants were enrolled in the study of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST‐Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post‐operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. The RoFA skin‐sparing mastectomy incision showed no significant difference in results across patient‐reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis.
Publisher: Wiley
Date: 17-05-2020
DOI: 10.1111/ANS.15990
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.GENE.2012.06.024
Abstract: Australian marsupials are unique fauna that have evolved and adapted to unique environments and thus it is likely that their detoxification systems differ considerably from those of well-studied eutherian mammals. Knowledge of these processes in marsupials is therefore vital to understanding the consequences of exposure to xenobiotics. Cytochromes P450 (CYPs) are critically important in the oxidative metabolism of a erse array of both xenobiotics and endogenous substrates. In this study we have cloned and characterized CYP3A70, the first identified member of the CYP3A gene subfamily from Eastern gray kangaroo (Macropus giganteus). A 1665 base pair kangaroo hepatic CYP3A complete cDNA, designated CYP3A70, was cloned by reverse transcription-polymerase chain reaction approaches, which encodes a protein of 506 amino acids. The CYP3A70 cDNA shares approximately 71% nucleotide and 65% amino acid sequence homology to human CYP3A4 and displays high sequence similarity to other published mammalian CYP3As from human, monkey, cow, pig, dog, rat, rabbit, mouse, hamster, and guinea pig. Transfection of the CYP3A70 cDNAs into 293T cells resulted in stable cell lines expressing a CYP3A immuno-reactive protein that was recognized by a goat anti-human CYP3A4 polyclonal antibody. The anti-human CYP3A4 antibody also detected immunoreactive proteins in liver microsomes from all test marsupials, including the kangaroo, koala, wallaby, and wombat, with multiple CYP3A immunoreactive bands observed in kangaroo and wallaby tissues. Relatively, very low CYP catalytic activity was detected for the kangaroo CYP3A70 cDNA-expressed proteins (19.6 relative luminescent units/μg protein), which may be due to low protein expression levels. Collectively, this study provides primary molecular data regarding the Eastern kangaroo hepatic CYP3A70 gene and enables further functional analyses of CYP3A enzymes in marsupials.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-07-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2019
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.BJPS.2022.01.033
Abstract: Normative data for interpreting the BREAST-Q reconstruction module are currently limited to the US population. This study aimed to generate normative BREAST-Q data from women in the Australian general population and compare it to US norms. Secondary aims were to compare normative scores to those of women undergoing breast reconstruction post-mastectomy. Women aged 18 years and older without a history of breast cancer or breast surgery were recruited according to the Australian Census-derived population distribution. Participants completed the pre-operative BREAST-Q Reconstruction module and provided socio-demographic information. A comparison was made to a breast reconstruction patient cohort and published US norms. BREAST-Q data were obtained from 500 women. Mean BREAST-Q scores were as follows: Satisfaction with Breasts (Aus. 50.4 ± 15.2, US 57.8 ± 18.4), Psychosocial Well-being (Aus. 55.4 ± 15.8, US 70.7 ± 17.6), Physical Well-being Chest (Aus. 78.5 ± 14.8, US 92.6 ± 10.7), Physical Well-being Abdomen (Aus. 76.1 ± 19.6, US 78.1 ± 20.3) and Sexual Well-being (Aus. 41.5 ± 20.6, US 56.5 ± 8.2). Australian women with a higher BMI or chronic health condition reported lower scores for four of the five BREAST-Q scales. Lower scores were reported by younger women for Psychosocial Well-being and Sexual Well-being. Mean BREAST-Q scores for the Australian population were significantly lower than US norms in four of the five scales. When compared to normative data, breast reconstruction patients had significantly higher BREAST-Q scores post-operatively in all scales except for Physical Well-being Chest. This study derived only the second set of normative scores for the BREAST-Q reconstruction module reported globally and found that significant differences exist between populations.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.CBPC.2011.07.007
Abstract: Cytochromes P450 (CYPs) are critically important in the oxidative metabolism of a erse array of xenobiotics and endogenous substrates. Previously, we cloned and characterised the CYP2C, CYP4A, and CYP4B gene subfamilies from marsupials and demonstrated important species-differences in both activity and tissue expression of these CYP enzymes. Recently, we isolated the Eastern grey kangaroo CYP3A70. Here we have cloned and characterised the second identified member of marsupial CYP3A gene subfamily, CYP3A78 from the koala (Phascolarctos cinereus). In addition, we have examined the gender-differences in microsomal erythromycin N-demethylation activity (a CYP3A marker) and CYP3A protein expression across test marsupial species. Significant differences in hepatic erythromycin N-demethylation activity were observed between male and female koalas, with the activity detected in female koalas being 2.5-fold higher compared to that in male koalas (p<0.01). No gender-differences were observed in tammar wallaby or Eastern grey kangaroo. Immunoblot analysis utilising anti-human CYP3A4 antibody detected immunoreactive proteins in liver microsomes from all test male and female marsupials including the koala, tammar wallaby, and Eastern grey kangaroo, with no gender-differences detected across test marsupials. A 1610 bp koala hepatic CYP3A complete cDNA, designated CYP3A78, was cloned by reverse transcription-polymerase chain reaction approaches. It displays 64% nucleotide and 57% amino acid sequence identity to the Eastern grey kangaroo CYP3A70. The CYP3A78 cDNA encodes a protein of 515 amino acids, shares approximately 68% nucleotide and 56% amino acid sequence identity to human CYP3A4, and displays high sequence similarity to other published mammalian CYP3As from human, monkey, cow, pig, dog, rat, rabbit, mouse, hamster, and guinea pig. Collectively, this study provides primary molecular data regarding koala hepatic CYP3A78 gene and enables further functional analyses of CYP3A enzymes in marsupials. Given the significant role that CYP3A enzymes play in the metabolism of both endogenous and exogenous compounds, the clone provides an important step in elucidating the metabolic capacity of marsupials.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.BJPS.2016.08.015
Abstract: To assess the clinical effectiveness of breast reconstruction and the utility of the BREAST-Q patient-reported outcomes measure for routine patient care. The BREAST-Q was administered to all patients attending a breast reconstructive service (n = 343) at a University Hospital at each visit. The BREAST-Q was easy to administer in a clinic setting, with a high participation rate (64.2% completing the minimum dataset of three BREAST-Qs). Pre-operatively, women with invasive cancer scored lower than those with DCIS or high-risk status (eg. mean psychosocial well-being scores 51.45 vs 63.74 vs 65.56, p < 0.05). At six months post-mound reconstruction the mean values for immediate and delayed timing of reconstruction were similar, with the change in quality of life from pre-reconstruction to this time-point post-reconstruction being greater in the delayed group (eg. mean improvement in psychosocial well-being scores for immediate 8.90 vs delayed 19.87, p < 0.05). Women with autologous flaps had greater improvements than women with implant-based reconstruction (eg. mean increase in psychosocial well-being scores 20.29 vs 9.58, p < 0.05). Breast reconstruction was highly effective in terms of improving psychosocial (mean pre-op 55.44 vs post-op 71.47, p < 0.001), physical (mean pre-op 69.82 vs post-op 74.78, p < 0.001), and sexual well-being (mean pre-op 38.74 vs post-op 54.17, p < 0.001), as well as satisfaction with breasts (mean pre-op 44.99 vs post-op 64.92, p < 0.001), in this non-selected cohort of patients. Breast reconstruction is highly effective in improving the well-being of women undergoing mastectomy. The BREAST-Q is well suited for clinical effectiveness research and easily incorporated into routine patient care.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.BJPS.2021.05.039
Abstract: The Breast Reconstruction Risk Assessment (BRA) Score tool is a risk calculator developed to predict the risk of complications in in idual patients undergoing breast reconstruction. It was developed in a North American population exclusively undergoing immediate breast reconstruction. This study sought to assess the predictions of the BRA Score tool against the measured outcomes of surgery for an Australian public hospital population, including both immediate and delayed reconstructions. This was a retrospective cohort study of data from women at a single Australian public teaching hospital unit. Data from the Flinders Breast Reconstruction Database was retrieved and compared to BRA Scores calculated for each patient. Receiver operating curve area under the curve analysis was performed as well as Brier scores to compare predicted versus observed complications. BRA Score predictions were reasonable or good (C-statistic >0.7, Brier score <0.09) for the complications of overall surgical complications, surgical site infection (SSI) and seroma at 30 days, and similarly accurate for prediction of the same complications for implant reconstructions at 12 months. There were similar findings between delayed and immediate reconstructions. The BRA Score risk calculator is valid to detect some risks in both patients undergoing immediate and delayed breast reconstruction in an Australian public hospital setting. SSI is the best predicted complication and is well-predicted across both autologous and prosthetic reconstruction types.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-031804
Abstract: To assess the health burden of breast hypertrophy and the comparative effectiveness of breast reduction surgery in improving health-related quality of life. Prospective cohort study. A major public tertiary care hospital in Australia. Women with symptomatic breast hypertrophy who underwent breast reduction surgery were followed for 12 months. A comparison control cohort comprised women with breast hypertrophy who did not undergo surgery. Bilateral breast reduction surgery for women in the surgical cohort. The primary outcome measure was health-related quality of life measured preoperatively and at 3, 6 and 12 months postoperatively using the Short Form-36 (SF-36) questionnaire. Secondary outcome measures included post-surgical complications. 209 patients in the surgical cohort completed questionnaires before and after surgery. 124 patients in the control hypertrophy cohort completed baseline and 12-month follow-up questionnaires. At baseline, both groups had significantly lower scores compared with population norms across all scales (p .001). In the surgical cohort significant improvements were seen across all eight SF-36 scales (p .001) following surgery. Within 3 months of surgery scores were equivalent to those of the normal population and this improvement was sustained at 12 months. SF-36 physical and mental component scores both significantly improved following surgery, with a mean change of 10.2 and 9.2 points, respectively (p .001). In contrast, SF-36 scores for breast hypertrophy controls remained at baseline across 12 months. The improvement in quality of life was independent of breast resection weight and body mass index. Breast reduction significantly improved quality of life in women with breast hypertrophy. This increase was most pronounced within 3 months of surgery and sustained at 12-month follow-up. This improvement in quality of life is comparable to other widely accepted surgical procedures. Furthermore, women benefit from surgery regardless of factors including body mass index and resection weight.
Publisher: Springer Berlin Heidelberg
Date: 2010
Publisher: Wiley
Date: 16-11-2022
DOI: 10.5694/MJA2.51343
Abstract: To assess the cost-effectiveness of breast reduction surgery for women with symptomatic breast hypertrophy in Australia. Cost-utility analysis of data from a prospective cohort study. Adult women with symptomatic breast hypertrophy assessed for bilateral breast reduction at the Flinders Medical Centre, a public tertiary hospital in Adelaide, April 2007 - February 2018. The control group included women with breast hypertrophy who had not undergone surgery. Health care costs (for the surgical admission and other related hospital costs within 12 months of surgery) and SF-6D utility scores (measure of health-related quality of life) were used to calculate incremental costs per quality-adjusted life-year (QALY) gained over 12 months, extrapolated to a 10-year time horizon. Of 251 women who underwent breast reduction, 209 completed the baseline and at least one post-operation assessment (83% intervention group) 124 of 350 invited women waiting for breast reduction surgery completed the baseline and 12-month assessments (35% control group). In the intervention group, the mean SF-6D utility score increased from 0.313 (SD, 0.263) at baseline to 0.626 (SD, 0.277) at 12 months in the control group, it declined from 0.296 (SD, 0.267) to 0.270 (SD, 0.257). The mean QALY gain was consequently greater for the intervention group (adjusted difference, 1.519 95% CI, 1.362-1.675). The mean hospital cost per patient was $11 857 (SD, $4322), and the incremental cost-effectiveness ratio (ICER) for the intervention was $7808 per QALY gained. The probability of breast reduction surgery being cost-effective was 100% at a willingness-to-pay threshold of $50 000 per QALY and 88% at $28 033 per QALY. Breast reduction surgery for women with symptomatic breast hypertrophy is cost-effective and should be available to women through the Australian public healthcare system.
Publisher: American Physiological Society
Date: 04-2010
DOI: 10.1152/AJPLUNG.00226.2009
Abstract: Pulmonary surfactant is synthesized by type II alveolar epithelial cells to regulate the surface tension at the air-liquid interface of the air-breathing lung. Developmental maturation of the surfactant system is controlled by many factors including oxygen, glucose, catecholamines, and cortisol. The intrauterine growth-restricted (IUGR) fetus is hypoxemic and hypoglycemic, with elevated plasma catecholamine and cortisol concentrations. The impact of IUGR on surfactant maturation is unclear. Here we investigate the expression of surfactant protein (SP) A, B, and C in lung tissue of fetal sheep at 133 and 141 days of gestation (term 150 ± 3 days) from control and carunclectomized Merino ewes. Placentally restricted (PR) fetuses had a body weight SD from the mean of control fetuses and a mean gestational Pa O 2 mmHg. PR fetuses had reduced absolute, but not relative, lung weight, decreased plasma glucose concentration, and increased plasma cortisol concentration. Lung SP-A, -B, and -C protein and mRNA expression was reduced in PR compared with control fetuses at both ages. SP-B and -C but not SP-A mRNA expression and SP-A but not SP-B or -C protein expression increased with gestational age. Mean gestational Pa O 2 was positively correlated with SP-A, -B, and -C protein and SP-B and -C mRNA expression in the younger cohort. SP-A and -B gene expression was inversely related to plasma cortisol concentration. Placental restriction, leading to chronic hypoxemia and hypercortisolemia in the carunclectomy model, results in significant inhibition of surfactant maturation. These data suggest that IUGR fetuses are at significant risk of lung complications, especially if born prematurely.
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.TAAP.2004.12.026
Abstract: The UDP glucuronosyltransferases (UGT) are expressed predominantly in the liver and gastrointestinal tract in humans. Their expression varies widely between in iduals, due in part to coding region polymorphisms that alter catalytic function and in part, to differences in the regulation of UGT genes. The latter differences are most likely the result of polymorphisms in the regulatory elements of UGT genes and in the transcription factors that bind to these elements. Several frequent polymorphisms in the promoters of UGT genes have been described however, few of these fall within critical regulatory elements and alter UGT expression. Some rare mutations alter UGT promoter activity in in vitro systems but their effect in the clinic is still to be confirmed. Several transcription factors that regulate UGT gene expression in cells of hepatic and intestinal origin have been identified. These include positive regulators of UGT gene expression such as hepatocyte nuclear factor 1 alpha (HNF1 alpha), octamer transcription factor-1 (Oct-1) and the intestine-specific transcription factor, caudal-related homeodomain protein 2 (Cdx2). Negative regulators include the Pre B cell homeobox factor (Pbx2) and its dimerization partner, Pbx regulating protein 1 (Prep1). Polymorphisms in these transcription factors may cause differences in their interaction and binding to UGT promoters. Current work describing the effects of these transcription factor polymorphisms on UGT expression will be described. Knowledge of UGT promoter elements and the proteins that bind to these elements, as well as knowledge of polymorphisms that alter their function, may aid in the prediction of an in idual's response to chemicals and in the prediction of chemical toxicities.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-02-2020
Publisher: Hindawi Limited
Date: 2004
DOI: 10.1002/HUMU.9260
Abstract: Two novel mutations of the human CLCN1 chloride channel gene, c.592C>G (p.L198V) and c.2255A>G (p.K752R), are described, occurring coincidentally in the one myotonic patient. These in idual mutations and a construct with both mutations in the one cDNA were transcribed and expressed in Xenopus oocytes where channel gating parameters were extracted from chloride currents recorded under voltage cl . We found that the p.L198V mutation has its major effects on the common (or slow) gate of the chloride channel, as do other dominant ClC-1 mutations, and may therefore be causative of the patient's symptoms (when co-expressed with wild-type human ClC-1, the p.L198V mutation exerts a dominant negative effect on common gating) but the p.K752R mutation appears to be innocuous and may be a benign polymorphism. A third mutant, the recently described c.2795C>T (p.P932L), was expressed in HEK 293 cells. Despite the severity of the disease associated with this mutation, chloride currents in cells expressing p.P932L were not significantly different from those of cells expressing wild-type ClC-1.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.CBPC.2010.08.006
Abstract: Cytochromes P450 (CYPs) are critically important in the oxidative metabolism of a erse array of xenobiotics and endogenous substrates. We have previously reported the cloning and characterisation of the koala CYP4A15, the first reported member of the CYP4 family from marsupials, and have demonstrated important species differences in CYP4A activity and tissue expression. In the present study, the cloning of CYP4B1 in the wallaby (Macropus eugenii) and their expression across marsupials is described. Rabbit anti-mouse CYP4B1 antibody detected immunoreactive proteins in lung and liver microsomes from all test marsupials, with relative weak signal detected from the koala, suggesting a species-specific expression. Microsomal 2-aminofluorene bio-activation (a CYP4B1 marker) in wallaby lung was comparable to that of rabbit, with significant higher activities detected in wallaby liver and kidneys compared to rabbit. A 1548bp wallaby lung CYP4B complete cDNA, designated CYP4B1, which encodes a protein of 510 amino acids and shares 72% nucleotide and 69% amino acid sequence identity to human CYP4B1, was cloned by polymerase chain reaction approaches. The results demonstrate the presence of wallaby CYP4B1 that shares several common features with other published CYP4Bs however the wallaby CYP4B1 cDNA contains four extra amino acid residues at the NH₂-terminal, a fundamentally conserved transmembrane anchor of all eukaryote CYPs.
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/ANS.17030
Abstract: Non‐melanoma skin cancers (NMSC) are the most common skin cancers worldwide with research establishing that ultraviolet (UV) radiation influences occurrence. However, recent studies about NMSC tumour frequencies suggested high NMSC predilections in low UV‐exposed skin regions. The ‘Human Surface Anatomy Labeling System’ was used to define 100 skin regions to map NMSC locations excised at Flinders Medical Centre (FMC) between 1 January 2012 and 31 December 2017. Data were retrieved from the FMC histopathology database. A customised phrase algorithm was used to run a systematic word search on the dataset to quantify NMSC locations. A total of 22 303 NMSC excisions were identified 80% were head and neck excisions. Scalp, periocular and nasal regions showed a significantly greater predilection for basal cell carcinomas (BCC). Squamous cell carcinomas (SCC) had significantly more excisions in lip, neck and scalp regions. Regarding gender‐related variations, more males had BCC excisions in ear regions and more females had nasal, lip, and ankle excisions. In SCC excisions, more males had scalp excisions and more females had leg and lip excisions. Considering age‐related variation, significantly higher proportions of BCC were found with forehead excisions compared to scalp, neck and lower limb regions for SCC, all being highest for 60–79‐year age groups. The relationship between NMSC type and anatomical distribution may be partially explained by gender and age affecting NMSC predilections particularly in the head and neck. However, other skin regions could not be explained solely by these factors.
No related grants have been discovered for Tamara Crittenden.