Delays in patients seeking advice have decreased compared to previous studies, while delays in professionals making a diagnosis have not improved considerably. There has been a significant shift towards initial presentation to GMP rather than GDP. Further decrease in delays is possible by improving both population awareness and clinician education.

Introduction. Awake craniotomy is a well-established neurosurgical technique for lesions involving eloquent cortex, however, there is little information regarding patients' subjective experience with this type of surgery. Here we explore the expectations, recall, satisfaction and functional outcome of patients undergoing awake craniotomy. Methods. Three semi-structured interviews using closed- and open-ended questions were conducted with each of 26 consecutive patients (17 males, 9 females; aged 16-78 years) who underwent their first awake craniotomy between 2007 and 2009. Seven patients were interviewed retrospectively, 19 prospectively. Clinical data are included. Results. The following themes emerged from this study: (1) most patients demonstrated a good understanding of the rationale behind awake craniotomy; (2) patients felt the asleep-awake-asleep anaesthetic protocol used in this series was appropriate; (3) patients' confidence and preparedness for surgery was high, attributed to preparation by the surgical team. Seven of 26 (27%) patients had no recollection of being awake. Most patients had a positive anaesthetic and surgical experience, while a minority of patients reported experiencing more than slight pain (2/26; 8%) and discomfort (3/26; 12%), fear (4/26; 15%) or claustrophobia (1/26; 4%) intra-operatively. At follow-up (6 weeks post-operatively), most patients were functionally unimpaired; there was only one permanent neurological complication of surgery. We found that 24/26 (92%) patients were satisfied with their experience; one patient had no opinion and another one was unsatisfied. Five of 26 (19%) patients still reported more than slight discomfort, and 3/26 (12%) reported more than slight pain attributable to the surgery. A summary of the English peer-reviewed literature on the patient experience of awake craniotomy is also incorporated. Conclusions. This study confirms that awake craniotomy using the 'asleep-awake-asleep' anaesthetic protocol is a generally safe and well-tolerated procedure associated overall with satisfactory patients' experiences and neurological outcomes.

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The interrelationship between malignant epithelium and the underlying stroma is of fundamental importance in tumour development and progression. In the present study, we used cancer-associated fibroblasts (CAFs) derived from genetically unstable oral squamous cell carcinomas (GU-OSCC), tumours that are characterized by the loss of genes such as TP53 and p16 and with extensive loss of heterozygosity, together with CAFs from their more genetically stable (GS) counterparts that have wild-type TP53 and p16 and minimal loss of heterozygosity (GS-OSCC). Using a systems biology approach to interpret the genome-wide transcriptional profile of the CAFs, we show that transforming growth factor-β (TGF-β) family members not only had biological relevance in silico but also distinguished GU-OSCC-derived CAFs from GS-OSCC CAFs and fibroblasts from normal oral mucosa. In view of the close association between TGF-β family members, we examined the expression of TGF-β1 and TGF-β2 in the different fibroblast subtypes and showed increased levels of active TGF-β1 and TGF-β2 in CAFs from GU-OSCC. CAFs from GU-OSCC, but not GS-OSCC or normal fibroblasts, induced epithelial-mesenchymal transition and down-regulated a broad spectrum of cell adhesion molecules resulting in epithelial dis-cohesion and invasion of target keratinocytes in vitro in a TGF-β-dependent manner. The results demonstrate that the TGF-β family of cytokines secreted by CAFs derived from genotype-specific oral cancer (GU-OSCC) promote, at least in part, the malignant phenotype by weakening intercellular epithelial adhesion.

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