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Chaisrisawadisuk S, Oliver KJ, Constantine S, Azzopardi J, Anderson PJ, Moore MH. Fibrodysplasia Ossificans Progressiva: A Case Report with Pseudo-Ankylosis of the Temporomandibular Joint. Cleft Palate Craniofac J 2024; 61:897-900. [PMID: 36536588 DOI: 10.1177/10556656221146598] [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] [Indexed: 02/17/2024] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare condition characterized by progressive heterotopic ossifications and congenital hallux valgus deformities. The common underlying genetic cause is an ACVR1 mutation, resulting in altered bone morphogenetic protein (BMP) regulation. Trauma and/or minor procedures aggravate the abnormal bony formation in soft tissues. This report presents a 3-year-old child with this condition who presented pseudo-ankylosis of the temporomandibular joint (TMJ) after minor craniofacial trauma. Abnormal ossification in the medial pterygoid muscle was identified as the causative abnormality for the presentation with trismus.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kelly J Oliver
- Paediatric Dental Unit, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Sarah Constantine
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jonathan Azzopardi
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Peter J Anderson
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Mark H Moore
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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Constantine S, Salter A, Louise J, Anderson PJ. The Adelaide Facial Bone Rule: A simple prediction model and clinical guideline for the presence of facial fractures using CT brain scans in victims of minor trauma. Injury 2024; 55:111302. [PMID: 38220564 DOI: 10.1016/j.injury.2023.111302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/17/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Facial fractures bleed, resulting in high-density fluid in the sinuses (haemosinus) on computed tomography (CT) scans. A CT brain scan includes most maxillary sinuses in the scan field, which should allow detection of haemosinus as an indirect indicator of a facial fracture without the need for an additional CT facial bone scan, yet no robust evidence for this exists in the literature. The aim of this study was to determine whether the presence of haemosinus on a CT brain scan, alone or in combination with other clinical information, can predict the presence of facial fractures. METHODS 1231 adult patients, who had both brain and facial CT scans performed on the same day, were selected from a seven year period. Patients were eligible if scans were requested for trauma. Brain and facial scans were reviewed separately for the presence of facial fractures, haemosinus, emphysema and intra-cranial haemorrhage. Prediction modelling was used to assess whether findings from brain scans could be used to identify patients requiring further CT scanning. FINDINGS The full prediction model included four predictors and showed excellent discrimination (AUROC 0.982; 95 % CI 0.971 - 0.993). A simplified model, more suitable for clinical implementation, used only facial fractures and haemosinus as predictors. This model showed only marginally poorer discrimination (AUROC 0.964; 95 % CI 0.945 - 0.983) and excellent performance on other measures. CONCLUSION Based on the excellent performance of the simplified prediction model, we present the Adelaide Facial Bone Rule: The absence of blood in the sinuses or facial fractures on a CT brain scan means a CT facial bone scan does not need to be routinely performed in the setting of clinically-determined minor trauma.
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Affiliation(s)
- Sarah Constantine
- Department of Radiology, The Queen Elizabeth Hospital, Department of Medicine, University of Adelaide, 28 Woodville Road, Woodville South SA 5011, Australia.
| | - Amy Salter
- School of Public Health, Level 4, 50 Rundle Mall, Rundle Mall Plaza, North Terrace, The University of Adelaide, Adelaide SA 5005
| | - Jennie Louise
- Women's and Children's Hospital Research Centre, Biostatistics Unit, South Australian Health and Medical Research Institute, Level 7, Women's and Children's Hospital, 72 King William Rd, North Adelaide SA 5006
| | - Peter J Anderson
- Senior Consultant Craniofacial Surgeon, Facial Fracture Service, Royal Adelaide Hospital, Port Road, Adelaide SA 5000; Affiliate Professor, Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide SA 5000
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Constantine S, Moore L. The use of post-mortem CT in the investigation of pregnancy losses. Pathology 2023. [DOI: 10.1016/j.pathol.2022.12.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Werth V, White B, Dgetluck N, Hally K, Constantine S, Aggarwal R, Fiorentino D, Lundberg IE, Oddis CV. OP0162 EFFICACY AND SAFETY OF LENABASUM IN THE PHASE 3 DETERMINE TRIAL IN DERMATOMYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSafe and effective treatments are of significant unmet need in DM. Lenabasum, a CB2 agonist that activates resolution of inflammation, improved skin disease, patient-reported outcomes, and biomarkers in a Phase 2 study of DM patients with active skin disease.ObjectivesTo evaluate the efficacy and safety of lenabasum in a Phase 3 double-blind study in DM.MethodsDM patients ≥ 18 years old with active skin with or without muscle involvement were enrolled in 55 sites in North America, Europe, and Asia-Pacific. Stable doses of background immunosuppressants were allowed. Subjects were randomized 2:1:2 to lenabasum 20 mg BID, lenabasum 5 mg BID, or placebo BID for 52 weeks, with visits ≤ 8 weeks apart. The study was stopped after all subjects completed Week 28. Some subjects had completed Week 52 by then. The primary efficacy endpoint was Total Improvement Score (TIS) at Week 28 and a secondary efficacy endpoint was TIS at Week 52, for lenabasum 20 mg BID vs placebo.Results175 subjects (69 lenabasum 20 mg BID, 35 lenabasum 5 mg BID, 71 placebo BID) received study drug; 167 completed Week 28, and 103 completed Week 52. The most common reasons for study discontinuation were study stopped by Sponsor (34.3%), withdrawal of consent (4.5%), and adverse events (AEs, 3.9%), with similar rates among groups. Baseline demographics and disease measurements were similar among groups and in total subjects were (mean or %): age 52.0 years; 81.1% female, 75.4% White; MMT-8 133.3; CDASI activity score 23.4; HAQ-DI 0.84, MDGA 5.55, EMGA 5.23; and PtGA 5.12. Corticosteroids were used by 48.1% and 38.0%, immunoglobulins by 5.8% and 7.0%, and other immunosuppressives by 51.0% and 54.9%, and monoclonal antibodies by 8.7% and 7.0% of lenabasum and placebo groups at baseline, respectively. The primary efficacy endpoint was not met - mean (SD) TIS score was 28.3 (19.75) vs 27.2 (19.23) at Week 28 for lenabasum 20 mg BID vs placebo, p = 0.3311, MMRM. Week 52 values were 40.6 (16.88) vs 34.8 (19.94), p = 0.2290. When analyses were restricted to subjects with muscle weakness at baseline (MMT8 < 142), TIS scores and treatment differences were greater and reached nominal statistical significance at Week 40, p = 0.0172. Mean (SD) improvements in CDASI activity score were numerically greater but not statistically different between lenabasum 20 mg BID group vs placebo at Week 28 [-7.1 (7.76) vs -5.8 (8.88) points, p = 0.2775] and Week 52 [-10.0 (9.45) vs -6.2 (12.8) points, p = 0.0932]. When restricting analysis of participants without muscle weakness (MMT-8 = 150), improvement in CDASI activity score was greater in the lenabasum 20 mg BID group vs placebo at Week 28, p = 0.0461, and Week 52 p = 0.0059.Treatment-emergent AEs (TEAEs) occurred in 87.0%, 85.7%, and 87.3% of lenabasum 20 mg BID, lenabasum 5 mg BID, and placebo groups, with no deaths. Related TEAEs leading to withdrawal of study product were infrequent, occurring in 1.4%, 0%, and 2.0% of subjects in the same groups. Serious TEAEs occurred in 11.6%, 8.6%, and 4.2% of subjects in the lenabasum 20 mg BID, lenabasum 5 mg BID, and placebo groups. No serious TEAE preferred term occurred in more than 1 subject in any group. TEAE occurring in ≥ 10% of lenabasum 20 mg BID subjects were (% lenabasum vs % placebo): dermatomyositis (flare) 27.5% vs 40.8%; diarrhea 14.5% vs 8.5%; dizziness 13.0% vs 4.2%; nausea 11.6% vs 4.2%; headache 10.1% vs 14.1%; and arthralgia 10.1% vs 2.8%.ConclusionAlthough, primary or secondary endpoints were not met in the study, subgroup analysis of patients with muscle weakness and without muscle weakness, showed improvement in muscle strength and rash, respectively in lenabasum 20 mg BID group vs placebo. Lenabasum was administered safely and was well-tolerated in this study.Disclosure of InterestsVictoria Werth Speakers bureau: University of Pennsylvania, who own the copyright for the CLASI and SDASI, Consultant of: AbbVie, Amgen, Argenx, AstraZeneca, Biogen, BMS, Celgene, Chrysalis, CSL Behring, Cugene, Eli Lilly, EMD Serono, Genentech, GSK, Incyte, Idera, Janssen, Kirin, Medimmune, Medscape, Nektar, Octapharma, Pfizer, Principa, Regeneron, Resolve, and Viela Bio, Grant/research support from: AstraZeneca, Biogen, Celgene, Corbus Pharmaceuticals, Genentech, Gilead, Janssen, Pfizer, Syntimmune, and Viela Bio, Barbara White Shareholder of: Corbus Pharmaceuticals, Employee of: Previous employee of Corbus Pharmaceuticals, Nancy Dgetluck Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Kathleen Hally Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Scott Constantine Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Rohit Aggarwal Consultant of: For Abbvie, Q32, Alexion, AstraZeneca, BMS, Boehringer Ingelheim, Corbus, Csl Behring, EMD Serono, Galapagos, Janssen, Kezar, Jubliant, Kyverna, Mallinckrodt, Merck, Novartis, Octapharma, Pfizer, Octazyme, Roivant, Scipher., Grant/research support from: BMS, Mallinkrodt, EMD Serono, Q32, Pfizer, David Fiorentino Consultant of: Corbus Pharmaceuticals, Grant/research support from: Corbus Pharmaceuticals, Ingrid E. Lundberg Shareholder of: Roche and Novartis., Consultant of: Corbus Pharmaceuticals Inc, Astra Zeneca, Bristol Myer´s Squibb, Corbus Pharmaceutical, EMD Serono Research & Development Institute, Argenx, Octapharma, Kezaar, Orphazyme, and Janssen, Grant/research support from: Astra Zeneca, Chester V Oddis Consultant of: Corbus Pharmaceuticals
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Constantine S. Imaging in craniocervical trauma. Pathology 2022. [DOI: 10.1016/j.pathol.2021.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Constantine S, Niznik P. Antenatal Ultrasound Imaging for Analysis of Human Craniosynostosis. Methods Mol Biol 2022; 2403:295-310. [PMID: 34913131 DOI: 10.1007/978-1-0716-1847-9_20] [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] [Indexed: 06/14/2023]
Abstract
The cranial sutures can be imaged sonographically in the fetus as early as the end of the first trimester; however, fetal position and maternal body habitus can present significant challenges to clear visualization. Antenatal identification of craniosynostosis is important for delivery planning, and there are a number of available ultrasound techniques and imaging signs to assist with accurate diagnosis of both single suture craniosynostosis and syndromic multisutural fusions.
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Affiliation(s)
- Sarah Constantine
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, SA, Australia.
| | - Piotr Niznik
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, SA, Australia
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Chaisrisawadisuk S, Constantine S, Lottering N, Moore MH, Anderson PJ. Incidence of persistent metopic suture in Australia: findings from 1034 three-dimensional computed tomography scans. Childs Nerv Syst 2021; 37:3871-3879. [PMID: 34351437 DOI: 10.1007/s00381-021-05313-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the incidence of persistent, open metopic sutures in contemporary Australians aged 24 months and older. METHODS Metopic suture evaluation was conducted on retrospective cranial/cervical computed tomography scans of patients aged 24 to 252 months who presented to the Women's and Children's Hospital in Adelaide, Australia, between 2010 and 2020. Suture ossification was graded according to Lottering scoring system based on 4 stages, on three-dimensional volume-rendered reconstructions (stage 1: fibrous tissue interface, stage 2: commenced fusion, stage 3: complete fusion and stage 4: obliterated suture). The complete persistent sutures were classified as stage 1. Partially closed sutures were classified into stages 2 and 3, while completely closed sutures were defined as stage 4. RESULTS One thousand thirty-four patients (61.2% male and 38.8% female) were included, with a mean age at scan of 66 months. More than half of patients were subject to scanning due to closed-head injuries. The incidence of persistent (completely open) metopic suture was 4.8% (2.3% in males and 2.5% in females). In comparison, a partially closed metopic suture was found in 6.3% of the study cohort, with the remaining sutures located along the metopic suture line, at the glabella, mid-part of the suture, bregma and glabella-bregma areas. CONCLUSION The prevalence of persistent metopic sutures in our study of the Australian population is 4.8%, and it is equally distributed between the genders. The pattern of suture closure can commence from any location along the suture line, which is in contrast to the existing literature.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia. .,Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Sarah Constantine
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Nicolene Lottering
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Mark H Moore
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Peter J Anderson
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
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Werth V, Concha J, Burroughs J, Okawa J, Feng R, Jobanputra A, Borucki R, Hally K, Hejazi E, Tillinger M, Constantine S, Dgetluck N, White B. POS0315 LONG-TERM SAFETY AND EFFICACY OF LENABASUM DURING 3 YEARS IN AN OPEN-LABEL EXTENSION (OLE) OF A PHASE 2 STUDY OF LENABASUM IN REFRACTORY SKIN DISEASE IN DERMATOMYOSITIS (DM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lenabasum is a synthetic, non-immunosuppressive, selective cannabinoid receptor type 2 agonist that activates resolution of inflammation. Lenabasum had acceptable safety and tolerability and improved efficacy outcomes in the initial 16-week double-blinded, randomized, placebo-controlled Part A of Phase 2 trial JBT101-DM-001 (NCT02466243) in DM subjects with refractory skin involvement. In that study, lenabasum or placebo was added to stable background treatment, with immunosuppressive therapies allowed.Objectives:To assess long-term safety and efficacy in DM subjects in this study.Methods:Subjects who completed Part A of the Phase 2 study (n = 22) were eligible to receive oral lenabasum 20 mg BID in an open-label extension (OLE) that assessed safety and efficacy at 4 weeks, then every 8 weeks.Results:20/22 (91%) eligible subjects enrolled in the OLE, following a mean interval of 31 weeks from the end of Part A, during which they continued to receive standard-of care treatments, to the start of the OLE during which lenabasum 20 mg BID was added. 17/20 (85%) subjects were on stable baseline immunosuppressive drugs. At the time of this data cut-off, 17 subjects were still enrolled, 17 had completed 140 months (2.7 years), and 15 had completed 156 months (3 years) of OLE dosing.All OLE subjects experienced at least 1 adverse event (AE), with 118 AEs during the OLE through Dec 2020. Most AEs were mild (n = 111, 94%), with 2 severe AEs (fatigue and metastatic prostate cancer) considered unrelated to lenabasum. AEs occurring in ≥ 3/20 OLE subjects were: URI (n = 5); fatigue (n = 4); nausea (n = 3); common cold (n = 3); UTI (n = 3); and DM flare (n = 3). No serious AEs related to lenabasum have been reported in this OLE to date. No subject discontinued the OLE because of an AE related to lenabasum.Improvement was seen in multiple physician- and patient-reported efficacy outcomes. CDASI activity score improved through the first 15 months of lenabasum treatment in the OLE and remained stable thereafter, with an improvement of ~20 points from the beginning of the study maintained from Month 15 through Year 3 in the OLE. CDASI damage score increased through the first year of the OLE, even though skin activity was decreasing, but lessened thereafter, returning after 3 years to about the same level it was at the beginning of the OLE. Other outcomes shown in Figure 1 followed the same general pattern as CDASI activity score, with improvement through the first 12-16 months of the OLE, then stability thereafter. Of note, 2 subjects had disease flares shortly after stopping lenabasum for conclusion of the OLE.Conclusion:Lenabasum continues to have a favorable safety and tolerability profile in the OLE of the Phase 2 trial JBT101-DM-001 with no serious AEs or study discontinuations related to lenabasum. The CDASI activity score and multiple other physician and patient-reported outcomes improved and have remained stable, showing durability of improvement in these patients with refractory skin disease. Skin damage was reversible and began to improve once skin activity stabilized. The limitations of attributing this improvement to lenabasum in the setting of open-label dosing is acknowledged. These data support further testing of lenabasum for the treatment of DM, and a Phase 3 study of lenabasum in DM is ongoing.Figure 1.Change from Baseline in Selected Efficacy Outcomes in OLE of Phase 2 Trial JBT101-DM-001Disclosure of Interests:Victoria Werth Grant/research support from: Investigator for Corbus Pharmaceuticals and received funding to conduct trials, Josef Concha: None declared, Julie Burroughs: None declared, Joyce Okawa: None declared, Rui Feng: None declared, Anisha Jobanputra: None declared, Robert Borucki: None declared, Kathleen Hally Employee of: Employee of Corbus Pharmaceuticals, Emily Hejazi: None declared, Michael Tillinger Employee of: Employee of Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech T, Stevens W, Gordon J, Kafaja S, Matucci-Cerinic M, Distler O, Lee EB, Levy Y, Jun JB, Constantine S, Dgetluck N, White B, Furst D, Denton C. OP0171 PHASE 3 TRIAL OF LENABASUM, A CB2 AGONIST, FOR THE TREATMENT OF DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lenabasum is an oral CB2 agonist that attenuates inflammation and fibrosis in SSc animal models and showed clinical benefit with acceptable safety in a Phase 2 trial in dcSSc.Objectives:Test efficacy and safety of lenabasum in a Phase 3 trial in dcSSc.Methods:Subjects ≥18 years old with disease duration ≤ 6 years were randomized 1:1:1 to lenabasum 5 mg, 20 mg, or placebo (PBO), all BID, with stable background immunosuppressant therapy (IST) allowed. The primary efficacy endpoint was ACR CRISS score, and secondary endpoints were ΔmRSS, ΔHAQ-DI, and ΔFVC, all at Week 52 for lenabasum 20 mg vs PBO.Results:363 adults were dosed; 37 (10%) stopped study drug early, with only 1 subject (PBO cohort) stopping due to adverse event (AE). Baseline demographics were similar among groups. Disease duration was ≤ 3 years in 60% and 66%, mean mRSS score was 22.0 and 23.3, and background IST was used by 89% and 84% of lenabasum 20 mg and PBO groups, respectively.Safety results showed serious AEs and severe AEs occurred in 9.2% and 5.8% vs 14.6% and 13.0%, respectively, of lenabasum 20 mg and PBO groups.Efficacy results (Table) demonstrated:Table 1.Primary and secondary efficacy endpoints and post-hoc analyses, Week 52Group, by IST treatmentCohortNΔmRSS, mean (SD)ΔFVC% mean (SD)ΔFVC, mL mean (SD)ΔHAQ-DI mean (SD)ACR CRISS medianmITT population, MMRM primary analysis methodAllPlacebo123-8.1 (7.72)-1.0 (8.68)-51 (317)-0.13 (0.468)0.887Lenabasum 20 mg120-6.7 (6.59)-1.6 (6.91)-78 (265)-0.13 (0.436)0.888Placebo subjects, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417All ISTPlacebo97-8.9 (7.07)-1.0 (9.2)-43 (330)-0.17 (0.474)0.936MMF, no other ISTPlacebo29-10.7 (8.1)-0.58 (7.1)-37 (235)-0.12 (0.456)0.935MMF ≤ 2 years, no other ISTPlacebo23-11.7 (8.1)-0.3 (6.0)-41 (197)-0.13 (0.495)0.935Non-MMF ≤ 2 yearsPlacebo24-6.7 (6.2)-1.4 (7.87)-52 (281)-0.15 (0.357)0.931Post-hoc comparisons, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417Lenabasum 20 mg10-6.3 (6.02)-2.3 (5.58)-99 (209)-0.06 (0.498)0.811Established IST1Placebo26-6.1 (5.35)-4.6 (10.11)-170 (350)-0.17 (0.445)0.619Lenabasum 20 mg38-7.4 (5.08)-0.4 (5.70)2-21 (233)3-0.07 (0.357)0.941Established IST, subjects with ILDPlacebo22-5.9 (5.28)-3.7 (5.43)-133 (206)-0.10 (0.372)0.553Lenabasum 20 mg33-7.2 (5.70)-1.0 (10.5)-47 (365)-0.06 (0.391)0.8192 P = 0.0386 two-sample t-test; 3 P = 0.0481 two-sample t-test; other comparisons were not significant• No significant differences were seen in primary and secondary efficacy endpoints. Primary MMRM analyses with treatment-by-time-by-subgroup interactions showed that background mycophenolate (MMF) significantly influenced the outcome•oSubjects on no IST with disease duration ≤3 years were only 7% of PBO subjects and showed little improvement on PBO, in line with other dcSSc trials in which IST was restricted. Post-hoc subgroup analyses of these subjects on no IST suggested improvement in ΔmRSS and ΔHAQ-DI, for lenabasum 20 mg vs PBO•uUnexpectedly high improvement occurred in PBO subjects receiving IST, notably those on MMF started within 2 years of baseline•nPost-hoc analyses of subjects on established IST (MMF or, if no MMF, ≥ 1 non-MMF IST started > 2 years before baseline) suggested improvement in ΔFVC% (nominal P = 0.0386) and ΔFVC mL (nominal P = 0.0481) for lenabasum 20 mg vs PBO. Improvement in FVC was also seen in subjects on established IST who had ILD at baseline, lenabasum 20 mg vs PBO•mACR CRISS score demonstrated a ceiling effect and correlated most highly with ΔmRSS (r = -0.739) and moderately with MDGA (-0.432), HAQ-DI (-0.362), FVC% (0.366), and PtGA (-0.288)Conclusion:Lenabasum was safely used in this study. Unexpectedly high improvement on background IST, especially MMF, has not been previously reported at this level. The primary endpoint was not met. Post-hoc analyses showed greater improvement in lenabasum- vs PBO-treated subjects who were not on background IST and those on established IST, including subjects with ILD.Disclosure of Interests:Robert Spiera Consultant of: Abbvie, Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Formation Biologics, Mitsubishi Tanabe, Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Formation Biologics, Sanofi, Inflarx, Astra Zeneca, Kadmon, Masataka Kuwana Speakers bureau: Boehringer-Ingelheim, Chugai, Janssen, Consultant of: Boehringer-Ingelheim, Chugai, Corbus, Grant/research support from: Boehringer-Ingelheim, Chugai, MBL, Ono Pharmaceuticals, Tanabe-Mitsubishi, Dinesh Khanna Shareholder of: Eicos Sciences, Inc (less than 5%). Leadership/Equity position – Chief Medical Officer, CiviBioPharma/Eicos Sciences, Inc, Consultant of: Acceleron, Actelion, Abbvie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead, Galapagos, Genentech/Roche, GSK, Horizon, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis, and United Therapeutics, Grant/research support from: NIH, Immune Tolerance Network, Bayer, BMS, Horizon, Pfizer, Laura Hummers Consultant of: CSL Behring, Boehringer Ingelheim, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Corbus, Boehringer Ingelheim, Medpace, Kadmon, Cumberland, CSL Behring, Tracy Frech Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Wendy Stevens Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jessica Gordon Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Research funding for EICOS Pharmaceuticals and Cumberland Pharmaceuticals., Suzanne Kafaja Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Marco Matucci-Cerinic Consultant of: Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Oliver Distler Consultant of: Consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB., Eun Bong Lee Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Yair Levy Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jae-Bum Jun Consultant of: Consultant to Boehringer Ingelheim Korea, Jeil Pharma, Dae Woong Pharma, Kwangdong Pharma, and Sama Pharma., Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals, Daniel Furst Consultant of: Corbus, Galapagos, Pfizer, CSL Behring, Mitsubishi Tanabi, Actelion, Amgen, Novartis, Roche/Genentech, Gilead, Talaris, and Boehringer Ingelheim., Grant/research support from: grants from Corbus, Galapagos, GSK, Pfizer, Talaris, CSL Behring, Mitsubishi Tanabi, Christopher Denton Consultant of: Consultancy fees and/or honoraria from Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics
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Constantine S, Kiermeier A, Anderson P. Sonographic indicators of isolated fetal sagittal craniosynostosis during pregnancy. J Med Imaging Radiat Oncol 2020; 64:626-633. [PMID: 32530572 DOI: 10.1111/1754-9485.13068] [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] [Received: 03/22/2020] [Revised: 04/30/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The antenatal diagnosis of sagittal craniosynostosis can be challenging, but there are several published papers describing a traumatic outcome to both the affected fetus and the mother during delivery of a scaphocephalic child. The antenatal imaging from affected children was collected along with the mother's obstetric history. The aim of this study was to identify antenatal ultrasound features that may assist the diagnosis of sagittal synostosis before birth, to enable appropriate delivery planning and avoid both maternal and fetal trauma during birth. METHODS Antenatal ultrasound scans in both the second and third trimesters were traced for 36 children with sagittal synostosis. The initially diagnostic CT scans were also sourced. A delivery history was collected from the hospital case notes where available. RESULTS The affected group showed a statistically significant reduction in cephalic index during the second half of pregnancy compared with the normal population which became slightly more brachycephalic (P = 0.001). Regression analysis showed an average reduction in cephalic index of 0.57 units per month. There was also a much higher rate of malpresentation and surgical deliveries in the affected group than the normal population. There was a relationship between sagittal craniosynostosis and breech presentation and an associated higher rate of surgical deliveries. CONCLUSION It is possible to detect sagittal synostosis in the third trimester of pregnancy which may assist with delivery planning.
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Affiliation(s)
- Sarah Constantine
- Department of Medical Imaging, Women's and Children's Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andreas Kiermeier
- Statistical Process Improvement Consulting and Training Pty Ltd, Gumeracha, South Australia, Australia
| | - Peter Anderson
- Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Constantine S, Roach D. Anomalous vasculature in the neck diagnosed by ultrasound. Australas J Ultrasound Med 2020; 23:264-268. [PMID: 34760605 PMCID: PMC8411688 DOI: 10.1002/ajum.12211] [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] [Indexed: 11/11/2022] Open
Abstract
Anomalous vascular anatomy was detected in the neck of a 52-year-old female with a Klippel-Feil anomaly. Ultrasound identified three separate arteries in the left carotid sheath without any branching or bifurcations. The vascular waveforms were used to identify the vessels as the internal carotid artery, external carotid artery and vertebral artery. This rare vascular anomaly was confirmed with CT angiography.
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Affiliation(s)
- Sarah Constantine
- Department of RadiologyThe Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
- The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Denise Roach
- Department of RadiologyThe Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
- The University of AdelaideAdelaideSouth AustraliaAustralia
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Werth V, Pearson D, Okawa J, Feng R, Concha J, Patel B, Hejazi E, Cornwall C, Constantine S, White B. 610 Safety and efficacy of lenabasum in refractory skin-predominant dermatomyositis subjects treated on an open-label extension of trial JBT101-DM-001. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Constantine S, Clark B, Kiermeier A, Anderson PP. Panoramic radiography is of limited value in the evaluation of maxillary sinus disease. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:237-246. [PMID: 30477956 DOI: 10.1016/j.oooo.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to determine (1) the diagnostic efficacy of orthopantomography (OPG) in the diagnosis of sinus diseases by using cone beam computed tomography (CBCT) as the imaging gold standard, (2) which diseases can be diagnosed by using panoramic radiography or CBCT, and (3) the interobserver agreement of 2 experienced dental radiologists. STUDY DESIGN The images of 714 individuals who underwent OPG and CBCT on the same day were assessed separately by 2 dental radiologists. The results were compared by using Gwet's AC1 statistical methods. RESULTS In total, 1322 maxillary sinuses were imaged. The sensitivity of OPG for the detection of any maxillary sinus pathology was poor compared with CBCT, but the specificity was high. The sensitivity of OPG for detecting mucosal thickening was 36.7%. The positive predictive value of OPG for diagnosing mucosal thickening was 79.9 %, but the negative predictive value was 51.9%. Interobserver agreement was strong (≥0.912) for all lesions except mucosal thickening. CONCLUSIONS Panoramic imaging has low efficacy in the diagnosis of sinus disease, even when examined by experienced dental radiologists. OPG can be useful in excluding disease, but 3-dimensional scanning is necessary for the definitive investigation of sinus lesions.
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Affiliation(s)
- Sarah Constantine
- Clinical Senior Lecturer, University of Adelaide, Faculty of Health Sciences, Adelaide, SA, Australia; South Australian Dental Service, Adelaide Dental Hospital, University of Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia; Queen Elizabeth Hospital, Department of Radiology, Woodville South, SA, Australia; Women's and Children's Hospital, Department of Medical Imaging, North Adelaide, SA, Australia.
| | - Bruce Clark
- Retired Craniomaxillofacial Radiologist, Women's and Children's Hospital, Department of Medical Imaging, North Adelaide, SA, Australia
| | - Andreas Kiermeier
- Director, Statistical Process Improvement Consulting and Training Pty Ltd., Statistical Process Improvement Consulting and Training Pty Ltd, Gumeracha, SA, Australia
| | - Professor Peter Anderson
- Director of Research, Australian Craniofacial Unit, Women's and Children's Hospital, Australian Craniofacial Unit, Women's and Children's Hospital, North Adelaide, SA, Australia
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Constantine S, Roach D, Liberali S, Kiermeier A, Sarkar P, Jannes J, Sambrook P, Anderson P, Beltrame J. Carotid Artery Calcification on Orthopantomograms (CACO Study) - is it indicative of carotid stenosis? Aust Dent J 2018; 64:4-10. [DOI: 10.1111/adj.12651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 12/14/2022]
Affiliation(s)
- S Constantine
- South Australian Dental Service; The Queen Elizabeth Hospital; Women's and Children's Hospital; Adelaide South Australia Australia
- The University of Adelaide; Adelaide South Australia Australia
| | - D Roach
- The University of Adelaide; Adelaide South Australia Australia
- The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - S Liberali
- Special Needs Unit; Adelaide Dental Hospital; SA Dental Service; Adelaide South Australia Australia
| | - A Kiermeier
- Statistical Process Improvement Consulting and Training Pty Ltd; Gumeracha South Australia Australia
| | - P Sarkar
- The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J Jannes
- Central Adelaide Local Health Network; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - P Sambrook
- SA Dental Service; Head of Unit OMS; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - P Anderson
- Australian Craniofacial Unit; Women's and Children's Hospital; Adelaide South Australia Australia
| | - J Beltrame
- Michell Professor of Medicine; The Queen Elizabeth Hospital; University of Adelaide; Cardiology Academic Lead; Central Adelaide Local Health Network; Adelaide South Australia Australia
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Werth V, Hejazi E, Pena S, Haber J, Feng R, Patel B, Concha J, Constantine S, White B. 605 Study of safety and efficacy of lenabasum, a cannabinoid receptor type 2 agonist, in refractory skin-predominant dermatomyositis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- HQ Dang
- Department of Radiology; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - S Constantine
- Department of Radiology; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - PJ Anderson
- Australian Craniofacial Unit; Women's and Children's Hospital; Adelaide South Australia Australia
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Constantine S, David D, Anderson P. The use of obstetric ultrasound in the antenatal diagnosis of craniosynostosis: We need to do better. Australas J Ultrasound Med 2016; 19:91-98. [DOI: 10.1002/ajum.12016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sarah Constantine
- Women's and Children's Hospital; North Adelaide South Australia Australia
- Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
| | - David David
- Women's and Children's Hospital; North Adelaide South Australia Australia
- Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - Peter Anderson
- Women's and Children's Hospital; North Adelaide South Australia Australia
- Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
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Constantine S, Wilkinson C. Double trouble: The importance of reporting chorionicity and amnionicity in twin pregnancy ultrasound reports. J Med Imaging Radiat Oncol 2014; 59:66-9. [DOI: 10.1111/1754-9485.12268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 11/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Constantine
- Department of Perinatal Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - Chris Wilkinson
- Department of Perinatal Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
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Bilton D, Pressler T, Fajac I, Clancy J, Sands D, Minic P, Cipolli M, La Rosa M, Galeva I, Solé A, Dupont L, Goss C, Mayer-Hamblett N, Quittner A, Constantine S, Gupta R, Konstan M. WS7.3 Once-daily liposomal amikacin for inhalation is noninferior to twice-daily tobramycin inhalation solution in improving pulmonary function in cystic fibrosis patients with chronic infection due to Pseudomonas aeruginosa. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60048-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Bone hemangiomas are extremely rare in the ribs, with only a handful of cases reported in the literature. A case of a rib hemangioma is presented in which the pre-resection diagnosis was an aggressive chest wall tumor. The plain film, CT, MRI and bone scan features of the lesion were reviewed with the pathological correlation. On imaging, the lesion was expansile and lytic, and it also had fine bony trabeculae. The lesion also demonstrated growth beyond a disrupted bony cortex, suggesting malignancy. This case report adds to the literature on this rare condition and discusses the issues in the diagnosis of chest wall tumors.
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Affiliation(s)
- Khimseng Tew
- Department of Radiology, The Queen Elizabeth Hospital, South Australia, Australia.
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Wong M, Kong A, Constantine S, Pathi R, Parrish FJ, Verma R, Lim C, Steer C. Radiopathological review of small bowel carcinoid tumours. J Med Imaging Radiat Oncol 2009; 53:1-12. [DOI: 10.1111/j.1754-9485.2009.02031.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kerem E, Wilschanski M, Elfring G, Hirawat S, Pugatsch T, Reha A, Constantine S, Peltz S, Miller L. Quantitative cough assessment in cystic fibrosis (CF). J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60225-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sermet-Gaudelus I, Leal T, De Boeck K, Casimir G, Hanssens L, Hage P, Roussel D, Mogenet A, Hirawat S, Elfring G, Constantine S, Miller L. PTC124 induces CFTR full-length production and activity in children with nonsense-mutation-mediated CF. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60084-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
We present a patient with an enlarging calf mass 36 years after a tibia and fibula fracture. He developed a peroneal nerve palsy after the accident, which was probably due to a subclinical compartment syndrome. Imaging of the leg was consistent with calcific myonecrosis. The diagnosis was confirmed histologically. The radiopathological findings of calcific myonecrosis are discussed.
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Affiliation(s)
- Sarah Constantine
- Department of Radiology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.
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van Slambrouck S, Daniels A, Hooten C, Brock S, Jenkins A, Ogasawara M, Baker J, Adkins G, Elias E, Agustin V, Constantine S, Pullin M, Shors S, Kornienko A, Steelant W. Effects of crude aqueous medicinal plant extracts on growth and invasion of breast cancer cells. Oncol Rep 2007. [DOI: 10.3892/or.17.6.1487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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White C, Willett K, Mitchell C, Constantine S. Making a difference: education and training retains and supports rural and remote doctors in Queensland. Rural Remote Health 2007. [DOI: 10.22605/rrh700] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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White CD, Willett K, Mitchell C, Constantine S. Making a difference: education and training retains and supports rural and remote doctors in Queensland. Rural Remote Health 2007; 7:700. [PMID: 17430081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
INTRODUCTION Access to appropriate continuing medical education (CME) opportunities has been identified by many researchers as a key factor in retaining medical practitioners in rural and remote communities. There has, however, been very little research that has measured the actual effectiveness of CME programs on retention. The purpose of this article is to provide some evidence as to the efficacy of rurally relevant CME programs in retaining medical practitioners in rural and remote communities. METHODS Evaluation data provided by 426 to 429 CME workshop attendees over a 3 year period has been aggregated to explore participants' perceptions as to whether access to CME has been effective in increasing their confidence in practising in rural and remote communities, reducing professional isolation and increasing commitment to remain in rural practice. RESULTS Data from 429 respondents suggest that 94% agree or strongly agree that access to CME contributes to confidence in practising in rural and/or remote locations. Similarly, data suggest that 93% of respondents (n = 427) agree or strongly agree that access to CME alleviates professional isolation. When asked whether they were less likely to remain in rural practice without access to CME, 80% of respondents (n = 426) agreed or strongly agreed that they were less likely to remain without access. CONCLUSION The provision of CME based on the expressed needs of rural and remote medical practitioners tends to be well received and highly valued by workshop respondents. We suggest that professional support through the provision of rurally relevant workshop-delivered CME is an effective strategy in retaining doctors in rural and remote communities.
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Affiliation(s)
- Colin D White
- Health Workforce Queensland, Brisbane, Queensland, Australia.
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Abstract
Gastrointestinal manifestations of disease are present in most adults with cystic fibrosis. Radiologists are familiar with the classical imaging characteristics of end-stage pulmonary disease and the radiological findings of meconium ileus in neonates. As most patients now live into adulthood, recognition of the imaging appearances of abdominal disease is important to enable prompt diagnosis and treatment. Accordingly, this article presents typical imaging appearances of the adult gastrointestinal manifestations of cystic fibrosis.
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Affiliation(s)
- S Constantine
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Abstract
Renal abscesses are uncommon in children, and usually present with a high fever and flank pain. We report a 9-year-old girl who presented with abdominal pain and cough. While the finding of multiple lung nodules and a renal mass prompted the initial diagnosis of Wilms' tumour, biopsy showed multiple renal abscesses with secondary lung involvement. The imaging findings and pathology correlation are provided.
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Affiliation(s)
- Sarah Constantine
- Department of Medical Imaging, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia.
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Abstract
Oesophageal dissection with intramural haematoma formation can be difficult to diagnose. Endoscopy can be diagnostic, but imaging techniques including computed tomography and contrast swallows can both accurately demonstrate a dissection and exclude many other pathologies. A case utilizing both imaging modalities to diagnose and monitor the condition in a patient with a bleeding disorder is presented.
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Affiliation(s)
- Sarah Constantine
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Constantine S, Gardecki JA, Zhou Y, Ziegler LD, Ji X, Space B. A Novel Technique for the Measurement of Polarization-Specific Ultrafast Raman Responses. J Phys Chem A 2001. [DOI: 10.1021/jp004277x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gardecki JA, Yu G, Constantine S, Peng J, Zhou Y, Ziegler LD. A unified treatment of ultrafast optical heterodyne detected and Z-scan spectroscopies. J Chem Phys 2001. [DOI: 10.1063/1.1342015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Muhtaseb M, Olver JM, Constantine S. Massive basal cell carcinoma in a schizophrenic patient: treatment options and constraints. Br J Ophthalmol 2001; 85:117-8. [PMID: 11201948 PMCID: PMC1723678 DOI: 10.1136/bjo.85.1.110h] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ji X, Ahlborn H, Space B, Moore PB, Zhou Y, Constantine S, Ziegler LD. A combined instantaneous normal mode and time correlation function description of the optical Kerr effect and Raman spectroscopy of liquid CS2. J Chem Phys 2000. [DOI: 10.1063/1.481539] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhou Y, Constantine S, Harrel S, Ziegler LD. The probe frequency dependence of nonresonant femtosecond pump–probe nuclear responses: Undercutting vibrational inhomogeneities. J Chem Phys 1999. [DOI: 10.1063/1.478489] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pandey RK, Constantine S, Tsuchida T, Zheng G, Medforth CJ, Aoudia M, Kozyrev AN, Rodgers MA, Kato H, Smith KM, Dougherty TJ. Synthesis, photophysical properties, in vivo photosensitizing efficacy, and human serum albumin binding properties of some novel bacteriochlorins. J Med Chem 1997; 40:2770-9. [PMID: 9276023 DOI: 10.1021/jm9702894] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The synthesis, photophysical characteristics, in vivo photosensitizing efficacy, human serum albumin (HSA) binding properties, and skin phototoxicity of some stable bacteriochlorins were investigated. The novel bacteriochlorins, obtained from chlorophyll-a, have long-wavelength absorptions in the range lambda max = 734-758 nm. Preferential migration of ethyl over methyl substituents among ketobacteriochlorins obtained in the pinacol-pinacolone rearrangements of vic-dihydroxybacteriochlorins was confirmed by NOE studies. The bacteriochlorins show relatively low fluorescence quantum yields. Among all the bacteriochlorins the triplet states were quenched by ground state molecular oxygen in a relatively similar manner, yielding comparable singlet oxygen quantum yields. In preliminary in vivo studies (DBA/2 mice, transplanted with SMT/F tumors), ketobacteriochlorins were found to be more photodynamically active than the related vic-dihydroxy analogues. Replacement of the methyl ester functionalities with di-tert-butylaspartic acids enhanced the in vivo efficacy. Site specific human serum albumin (HSA) binding studies indicated a direct correlation between the ability of the compound to bind to the diazepam binding site (albumin site II) and the in vivo photosensitizing efficacy.
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Affiliation(s)
- R K Pandey
- Department of Radiation Biology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Constantine S, Zhou Y, Morais J, Ziegler LD. Dispersed Optical Heterodyne Detected Birefringence and Dichroism of Transparent Liquids. J Phys Chem A 1997. [DOI: 10.1021/jp971227s] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Constantine
- Department of Chemistry, Boston University, Boston, Massachusetts 02215
| | - Y. Zhou
- Department of Chemistry, Boston University, Boston, Massachusetts 02215
| | - J. Morais
- Department of Chemistry, Boston University, Boston, Massachusetts 02215
| | - L. D. Ziegler
- Department of Chemistry, Boston University, Boston, Massachusetts 02215
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Pandey RK, Sumlin AB, Constantine S, Aoudla M, Potter WR, Bellnier DA, Henderson BW, Rodgers MA, Smith KM, Dougherty TJ. Alkyl ether analogs of chlorophyll-a derivatives: Part 1. Synthesis, photophysical properties and photodynamic efficacy. Photochem Photobiol 1996; 64:194-204. [PMID: 8787014 DOI: 10.1111/j.1751-1097.1996.tb02442.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The synthesis, preliminary in vivo biological activity, singlet oxygen and fluorescence yields of a series of alkyl ether derivatives of chlorophyll-alpha analogs are described. For short-chain carbon ethers (1-7 carbon units), it was observed that the biological activity increased by increasing the length of the carbon chain, being maximum in compounds with n-hexyl and n-heptyl chains. Related sensitizers prepared by reacting 2-(1-bromoethyl)-2-devinylpyropheophorbide-alpha with (sec)alcohols were found to be less effective. Under similar treatment conditions, photosensitizers containing cis- and trans- 3-hexenyl side chains were ineffective. Thus, both stereochemical and steric factors caused differences in sensitizing activity. In general, pyropheophorbide-alpha analogs were found to be more active than related chlorin e6 derivatives, in which the isocyclic ring (ring "E") was cleaved. Related photosensitizers in the 9-deoxy- series were found to be as effective as the corresponding pyropheophorbide-alpha analogs. The photosensitizers prepared from pyropheophorbide-alpha methyl ester and chlorin e6 trimethyl ester have long wavelength absorption at 660 nm (epsilon 45 000 to 50 000). Reduction of the carbonyl group in the pyropheophorbide-alpha to methylene (ring E) resulted in a blue shift to 648 nm (epsilon 38 000).
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Affiliation(s)
- R K Pandey
- Department of Radiation Biology, Roswell Park Cancer Institute, Buffalo, NY 14263-0001, USA
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