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Chong PQY, Choudhury MM, Chung SR, Yap RTJ, Chia DSY, Jiang JKH, Chin AYH, McGrouther DA. A multivariate analysis on characteristics of hand and wrist tumours: a multiethnic study. Singapore Med J 2024:00077293-990000000-00137. [PMID: 39175263 DOI: 10.4103/singaporemedj.smj-2023-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/27/2023] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Hand tumours are frequently encountered in clinical practice. However, large-scale epidemiological data of soft tissue tumours in the hand are infrequently published. Epidemiological data provide diagnostic cues to guide the workup and management of hand tumours. Assessing significant independent demographic factors and tumour characteristics associated with hand tumours is essential in health care. METHODS A retrospective review of patients who underwent excision of hand tumours in Singapore General Hospital between 2004 and 2015 was conducted. The data collected included age, gender, ethnicity, histological diagnosis, malignancy and location of tumour. Generalised linear latent and mixed models (GLLAMM) analyses were performed. RESULTS A total of 4476 tumours were identified from 4226 patients with a mean age of 51.3 (range 8-101) years and male to female ratio of 1 to 1.15. Most patients were Chinese (75%), followed by Malay (9%), Indian (8%) and others (8%). The most common hand tumours excised were ganglions (43%) (majority in the wrist), followed by giant cell tumours (9%) (commonly in the digits). Most soft tissue tumours were benign (97%), with only 3% of malignant cases. The GLLAMM analyses revealed further potential factors on the status of malignancy, tumour origin and tumour location. CONCLUSION Most soft tissue tumours in the hand and wrist are benign. This can guide workup and counselling of patients before the operation. While malignant tumours are uncommon, they have the potential for significant morbidity and mortality if not appropriately evaluated or treated. The application of GLLAMM analyses showed that age, ethnicity and gender were significant predictors of malignancy.
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Affiliation(s)
- Pamela Qin Yi Chong
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Muntasir Mannan Choudhury
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Sze Ryn Chung
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Robert Tze Jin Yap
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Dawn Sinn Yi Chia
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Jackson Kian Hong Jiang
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Andrew Yuan Hui Chin
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Duncan Angus McGrouther
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Mathieu O, Chaine A, Benassarou M, Combes F, Debelmas A, Lanciaux S, Bertolus C, Bouaoud J. Epidemiology of facial skin cancers managed in a French ambulatory surgical center. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101726. [PMID: 38056693 DOI: 10.1016/j.jormas.2023.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Approximately 80,000 cases of skin cancer are diagnosed annually in France. The management of these cancers can occur in both university hospital centers and ambulatory surgery centers. Limited data exist regarding the epidemiology of cutaneous cancers treated through ambulatory surgery centers. The objective of our study is to describe the epidemiological characteristics of cutaneous cancers managed in a tertiary ambulatory surgery center. METHODS This is a retrospective, single-center observational study. The included patients were those who underwent surgical excision of one or more skin cancers within the maxillofacial department of a tertiary ambulatory surgery center. Clinical, therapeutic, histopathological, and follow-up data (additional surgery if margins were not clear, progression, recurrence, second cancer…) were collected. RESULTS Among the n = 1931 patients operated for a head and neck skin tumor from September 2018 to July 2022, n = 426 (22 %) were diagnosed with cancer upon histological analysis. The median age was 76 years (31-100), with a male-to-female ratio of 1/1. The most frequent locations were the nose (23 %) and cheek (20 %). Ten percent of patients had dual-site skin cancer at initial diagnosis. The most common histological types were basal cell carcinoma (77 %) and squamous cell carcinoma (18 %). Surgical treatment primarily consisted of "excision-reconstruction with local flap" (51 %) or "excision-suture" (34 %). Resection margins were mostly clear (65 %), and only six patients (2 %) experienced local recurrence or progression during follow-up. CONCLUSIONS Skin cancers are prevalent in ambulatory practice. Surgical treatment allows for effective control of the cancer. Photoprotection, particularly in immunocompromised patients, remains crucial for prevention.
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Affiliation(s)
- Olivier Mathieu
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France.
| | - André Chaine
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Mourad Benassarou
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
| | - Floriane Combes
- Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Alexandre Debelmas
- Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Sophie Lanciaux
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Chloé Bertolus
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
| | - Jebrane Bouaoud
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
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Jean-Pierre P, Nouri K. A retrospective analysis of drugs associated with the development of cutaneous squamous cell carcinoma reported by patients on the FDA's adverse events reporting system. Arch Dermatol Res 2024; 316:250. [PMID: 38795220 PMCID: PMC11127877 DOI: 10.1007/s00403-024-03109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 02/22/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer arising from squamous cells of the epidermis. Most cases of cSCC have a good prognosis if detected and treated early; however, certain cases can be aggressive. The primary risk factor for cSCC is prolonged ultraviolet radiation from sun exposure, leading to DNA mutations. Other risk factors have also been observed, including adverse reactions to medications, particularly immunosuppressants. A query of the Food and Drug Administration Adverse Events Reporting System (FAERS) was done, and all reported events of cSCC as adverse events to medication were recorded along with demographic data of patients affected. A total of 4,792 cases of cSCC as an adverse event to medication were reported between 1997 and 2023. Lenalidomide, a chemotherapeutic drug, had the most cases of cSCC as an adverse event. Nine of the top 10 drugs associated with cSCC had immunosuppressive characteristics. While males had higher odds of cSCC associated with corticosteroids and calcineurin inhibitors, females had higher odds of cSCC related to monoclonal antibodies. Geriatric patients accounted for the majority of cSCC cases at 59.7%. Drawing on data from the FAERS database, there's been a consistent increase in cSCC cases as a side-effect to certain medications, with most having immunosuppressive characteristics. Since there is a lack of up-to-date literature overviewing the most implicated medications for cSCC, we aimed to illustrate this better, as well as patient demographics, to better guide clinicians when prescribing these medications.
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Affiliation(s)
- Philippe Jean-Pierre
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 1150 NW 14th Street, Suite 500, Miami, FL, 33136, USA.
| | - Keyvan Nouri
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 1150 NW 14th Street, Suite 500, Miami, FL, 33136, USA
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Cuomo R, Rozen WM, Pentangelo P, Ceccaroni A, Alfano C, Seth I. Human Papillomavirus-Associated Giant Clear Cell Acanthoma and Squamous Cell Carcinoma: A Rare Case Report and Literature Review. J Clin Med 2024; 13:2482. [PMID: 38731009 PMCID: PMC11084788 DOI: 10.3390/jcm13092482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/13/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Clear cell acanthoma (CCA) and squamous cell carcinoma (SCC) represent distinct entities within dermatological oncology, each posing unique diagnostic and therapeutic challenges. CCA is a rare, benign epidermal growth, often not associated with human papillomavirus (HPV) infection, whereas SCC, a more aggressive form of skin cancer, has been linked to both ultraviolet (UV) exposure and HPV. Understanding the co-occurrence of these conditions in a single patient can enhance diagnostic accuracy and therapeutic outcomes. We report a 64-year-old male who underwent an operation for a verruciform lesion in the right groin, which was diagnosed as HPV-positive CCA alongside keratinised SCC. A literature search across January 2024 revealed limited evidence directly linking HPV to CCA, suggesting a need for further investigation. The speculative association between HPV and CCA warrants deeper exploration, especially considering the potential for HPV to contribute to lesion development through indirect mechanisms. The coexistence of CCA and SCC in an elderly patient presents a unique clinical scenario. This emphasises the need for vigilant diagnosis and tailored treatment strategies, highlighting the gap in understanding the pathogenesis of CCA, particularly its potential association with HPV. Further research is crucial for elucidating the complex interactions governing these conditions and for developing targeted interventions.
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Affiliation(s)
- Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Warren M. Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
| | - Paola Pentangelo
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Alessandra Ceccaroni
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Carmine Alfano
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
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Conley J, Perry JR, Ashford B, Ranson M. Ex vivo therapeutic screening of metastatic cSCC: A review of methodological considerations for clinical implementation. Exp Dermatol 2024; 33:e15089. [PMID: 38659312 DOI: 10.1111/exd.15089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common malignancy worldwide, with most deaths caused by locally advanced and metastatic disease. Treatment of resectable metastases is typically limited to invasive surgery with adjuvant radiotherapy; however, many patients fail to respond and there is minimal data to predict response or propose effective alternatives. Precision medicine could improve this, though genomic biomarkers remain elusive in the high mutational background and genomic complexity of cSCC. A phenotypic approach to precision medicine using patient-derived ex vivo tumour models is gaining favour for its capacity to directly assess biological responses to therapeutics as a functional, predictive biomarker. However, the use of ex vivo models for guiding therapeutic selection has yet to be employed for metastatic cSCC. This review will therefore evaluate the existing experimental models of metastatic cSCC and discuss how ex vivo methods could overcome the shortcomings of these existing models. Disease-specific considerations for a prospective methodological pipeline will also be discussed in the context of precision medicine.
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Affiliation(s)
- Jessica Conley
- Faculty of Science, Medicine and Health, School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jay R Perry
- Faculty of Science, Medicine and Health, School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bruce Ashford
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Marie Ranson
- Faculty of Science, Medicine and Health, School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia
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Wunderlich K, Suppa M, Gandini S, Lipski J, White JM, Del Marmol V. Risk Factors and Innovations in Risk Assessment for Melanoma, Basal Cell Carcinoma, and Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:1016. [PMID: 38473375 DOI: 10.3390/cancers16051016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Skin cancer is the most frequently diagnosed cancer globally and is preventable. Various risk factors contribute to different types of skin cancer, including melanoma, basal cell carcinoma, and squamous cell carcinoma. These risk factors encompass both extrinsic, such as UV exposure and behavioral components, and intrinsic factors, especially involving genetic predisposition. However, the specific risk factors vary among the skin cancer types, highlighting the importance of precise knowledge to facilitate appropriate early diagnosis and treatment for at-risk individuals. Better understanding of the individual risk factors has led to the development of risk scores, allowing the identification of individuals at particularly high risk. These advances contribute to improved prevention strategies, emphasizing the commitment to mitigating the impact of skin cancer.
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Affiliation(s)
- K Wunderlich
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Dermatology, Institute Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, 20139 Milan, Italy
| | - J Lipski
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - J M White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Dermatology, Institute Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium
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Seth I, Bulloch G, Qin KR, Xie Y, Sebastian B, Liew H, Rozen WM, Lee CHA. Pre-rehabilitation interventions for patients with head and neck cancers: A systematic review and meta-analysis. Head Neck 2024; 46:86-117. [PMID: 37897197 DOI: 10.1002/hed.27561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To investigate the effect of pre-rehabilitation interventions such as nutrition and exercise for patients with head and neck cancer (HNC). METHODS Web of Science, PubMed, Scopus, Google Scholar, and Cochrane databases were searched up to December 2022. Quality of life, length of hospital stay, postoperative complications, change in body mass index or muscle mass, and functional assessments were the primary outcomes. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The Cochrane Collaboration tool and Newcastle Ottawa scale assessed the quality of included studies. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). Analysis was conducted using RevMan5.4. RESULTS A total of 31 articles were included for quantitative analysis and 15 for qualitative synthesis. Nutrition alone resulted in significant weight retention (2.60; 2.32, 2.88, p < 0.00001), length of stay (-4.00; -6.87, -1.13), p = 0.0006) and complications (0.64; 0.49, 0.83, p = 0.0009). Nutrition and psychoeducation resulted in a significant reduction in mortality rate (0.70; 0.49, 1.00, p = 0.05 and 0.60; 0.48, 0.74, p < 0.00001), and exercise resulted in a significant reduction in dysphagia (0.55; 0.35, 0.87, p = 0.01). Exercise with nutrition resulted in significant improvements in weight loss, length of stay, complications, and dysphagia. Randomized controlled trials (RCTs) had a moderate risk of bias and cohort studies were of fair to good quality. CONCLUSION Prehabilitation programs based on exercise, nutrition, or psychoeducation demonstrated improved post-interventional outcomes in HNC, such as quality of life, and mortality and morbidity. Studies with longer follow-ups and larger sample sizes, and investigations comparing nutritional supplements with exercise programs are needed.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia
| | - Gabriella Bulloch
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirby R Qin
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia
| | - Yi Xie
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | | | - Hann Liew
- Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chun Hin Angus Lee
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Yeo N, Genenger B, Aghmesheh M, Thind A, Napaki S, Perry J, Ashford B, Ranson M, Brungs D. Sex as a Predictor of Response to Immunotherapy in Advanced Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:5026. [PMID: 37894393 PMCID: PMC10605413 DOI: 10.3390/cancers15205026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Approximately 3-5% of patients with cutaneous squamous cell carcinoma (CSCC) develop advanced disease, accounting for roughly 1% of all cancer deaths in Australia. Immunotherapy has demonstrated significant clinical benefit in advanced CSCC in several key phase II studies; however, there are limited data for patients treated outside of clinical trials. This is particularly relevant in advanced CSCC, which is most often seen in elderly patients with significant comorbidities. Thus, we aim to describe our experience with immunotherapy in a cohort of patients with advanced CSCC in Australia. We retrospectively reviewed all advanced CSCC patients treated with immunotherapy within the Illawarra and Shoalhaven Local Health District. Among the 51 patients treated with immunotherapy, there was an objective response rate (ORR) of 53% and disease control rate (DCR) of 67%. Our most significant predictor of response was sex, with male patients more likely to have better responses compared to female patients (DCR 85% vs. 41%, p < 0.0001), as well as improved progression-free survival (HR 4.6, 95%CI 1.9-10.8, p = 0.0007) and overall survival (HR 3.0, 95%CI 1.3-7.1, p = 0.006). Differential expression analysis of 770 immune-related genes demonstrated an impaired CD8 T-cell response in female patients. Our observed ORR of 53% is similar to that described in current literature with durable responses seen in the majority of patients.
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Affiliation(s)
- Nicholas Yeo
- Illawarra Shoalhaven Local Health District (ISLHD), NSW Health, Wollongong, NSW 2500, Australia
| | - Benjamin Genenger
- Molecular Horizons, University of Wollongong, Wollongong, NSW 2500, Australia
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW 2500, Australia
| | | | - Amarinder Thind
- Illawarra Shoalhaven Local Health District (ISLHD), NSW Health, Wollongong, NSW 2500, Australia
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW 2500, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Sarbar Napaki
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2500, Australia
- Anatomical Pathology, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Southern IML/Sonic Healthcare, Wollongong, NSW 2500, Australia
| | - Jay Perry
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Bruce Ashford
- Illawarra Shoalhaven Local Health District (ISLHD), NSW Health, Wollongong, NSW 2500, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Marie Ranson
- Molecular Horizons, University of Wollongong, Wollongong, NSW 2500, Australia
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW 2500, Australia
| | - Daniel Brungs
- Illawarra Shoalhaven Local Health District (ISLHD), NSW Health, Wollongong, NSW 2500, Australia
- Molecular Horizons, University of Wollongong, Wollongong, NSW 2500, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2500, Australia
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