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Turton N, Payne K, Higginson J, Praveen P, Mehanna H, Nankivell P. Prognostic biomarkers for malignant progression of oral epithelial dysplasia: an updated systematic review and meta-analysis. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00056-1. [PMID: 38677951 DOI: 10.1016/j.bjoms.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/29/2024]
Abstract
Oral epithelial dysplasia (OED) is a premalignant condition that carries an appreciable risk of malignant progression. The current grading system for severity, as defined by the World Health Organization, is a valuable clinical tool, but further work is required to improve the accuracy of predicting OED malignant progression. This systematic review aimed to assess progress in prognostic biomarker discovery in OED over the past 16 years. The primary objective was to update the latest evidence on prognostic biomarkers that may predict malignant progression of OED, with strict inclusion criteria of studies with a longitudinal design and long-term follow-up data to enhance the robustness and translational clinical potential of the findings. Of 2829 studies identified through the searching of five databases, 20 met our inclusion criteria. These studies investigated a total of 32 biomarkers, 20 of which demonstrated significant potential to predict malignant progression of OED. Meta-analysis demonstrated the significant prognostic value of four biomarkers: podoplanin, EGFR expression, p16 methylation, and DNA aneuploidy. Our review has identified 20 reported biomarkers with prognostic potential to predict malignant progression in OED, but their translation into clinical practice remains elusive. Further research is required, and this should focus on validating the promising biomarkers identified in large cohort studies, with adherence to standardised reporting guidelines.
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Affiliation(s)
- Natalie Turton
- Institute of Head and Neck Studies and Education (InHANSE) University of Birmingham, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
| | - Karl Payne
- Institute of Head and Neck Studies and Education (InHANSE) University of Birmingham, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - James Higginson
- Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Prav Praveen
- Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE) University of Birmingham, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE) University of Birmingham, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
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Turton N, Aggarwal A, Twohig E, Gallagher J, McVeigh K, Barnard N, Payne K. Integra ® Dermal Regeneration Template in Complex Scalp Reconstruction. J Clin Med 2024; 13:1511. [PMID: 38592375 PMCID: PMC10934645 DOI: 10.3390/jcm13051511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background/Objectives: The need for surgical reconstruction of scalp defects following the excision of cutaneous skin cancers is an increasingly common procedure. Particular challenges arise when considering options for reconstruction of large defects not amenable to local skin flap coverage. The use of skin grafts poses the risk of donor site morbidity. This paper investigates the emerging use of Integra®, a synthetic acellular dermal regeneration template, as an alternative or adjunct to skin grafting in scalp reconstruction. Methods: The study presents a retrospective analysis of 101 patients who underwent Integra®-based reconstruction of scalp defects. Demographics, procedure details, complications, need for further surgery, and time to healing were evaluated. Results: The overall success rate of the one-stage Integra®-only procedure was 95%, with a minor complication rate of 30.7%. Anticoagulation medication was identified as an independent risk factor for post-operative infection, while previous head and neck radiotherapy and increased defect depth were associated with the requirement for a second-stage skin graft. Conclusions: These findings support the consideration of Integra® as a safe and viable alternative for both partial and full thickness scalp defects in a select cohort of complex highly co-morbid patients, reducing complications and the need for additional procedures.
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Affiliation(s)
- Natalie Turton
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
- Birmingham Medical School, University of Birmingham, Birmingham B15 2TT, UK
| | - Aaina Aggarwal
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
- Birmingham Medical School, University of Birmingham, Birmingham B15 2TT, UK
| | - Eoin Twohig
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
| | - James Gallagher
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
| | - Kieron McVeigh
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
| | - Neal Barnard
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
| | - Karl Payne
- Worcestershire Acute Hospitals NHS Trust, Worcestershire WR5 1DD, UK; (A.A.); (E.T.); (J.G.); (K.M.); (N.B.); (K.P.)
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Archer N, Zebic L, Turton N, Higginson J, Idle M, Praveen P, Martin T, Parmar S, Breik O. An evaluation of the clinical utility of C-reactive protein and antibiotic use in patients undergoing major head and neck reconstructive surgery with outcome assessment. Oral Maxillofac Surg 2021; 26:455-461. [PMID: 34599697 PMCID: PMC8486958 DOI: 10.1007/s10006-021-01001-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
Purpose This ambispective observational study aims to evaluate the local utility of peri-operative CRP testing and prophylactic antibiotics in relation to post-operative complications in patients who have undergone major head and neck oncological reconstructive surgery. Results A total of 79 patients were identified for inclusion; CRP testing was undertaken within the first 3 days postoperatively in 78/79 cases. Results demonstrated no benefit of extended prophylactic antibiotic use in reducing post-operative infection. Forty-two post-operative complications arose. In the prospective arm, CRP did not influence the decision to commence antibiotic therapy for any of the surgical site infections. Age, diabetes, smoking, or high body mass index (BMI) did not appear to affect the incidence of postoperative infection (p > 0.05). There is no evidence that more than 24 h of antibiotic prophylaxis is indicated for patients undergoing head and neck reconstructive surgery. Conclusion Everyone who is involved in peri-operative patient care should be educated regarding the appropriate use of CRP testing, with the implementation of protocols required to standardize CRP testing and prophylactic antibiotic prescription.
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Affiliation(s)
- Natalie Archer
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Lara Zebic
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Natalie Turton
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - James Higginson
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Matthew Idle
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Prav Praveen
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Timothy Martin
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Sat Parmar
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Omar Breik
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
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Borghol K, Turton N, Sharp I. Experience of orbital floor fractures in a UK level one trauma centre: a focus on the surgical approach and lid-related complications. Br J Oral Maxillofac Surg 2021; 60:482-487. [PMID: 34952743 DOI: 10.1016/j.bjoms.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
The two surgical approaches to access orbital fractures are transconjunctival and transcutaneous. The aim of this study was to assess the outcomes of orbital repairs with a focus on lid-related complications and their management. A retrospective analysis was carried out over a five-year period (January 2015 to January 2020) to assess all consecutive orbital repairs in our unit. Data were collected for variables including demographics, fracture pattern, surgical approach, and details of postoperative complications. A total of 111 patients were included in the study, 94 were male (85%), the majority being between 16 and 45 years of age. A total of 46 (41%) had isolated orbital floor fractures, 31 (28%) zygomaticomaxillary complex, and 18 (16%) Le Fort pattern fractures. Eighty per cent (n = 91) received a transconjunctival approach as first choice. In the transconjunctival group, six (6.6%) had entropion and increased scleral show, four (4.4%) had ectropion, and none had canthal malposition. In the transcutaneous group (n = 20) there was a higher rate of ectropion (25%, n = 5), a lower rate of entropion (n = 1, 5%) and higher rate of increased scleral show (n = 2, 10%). Factors associated with a higher rate of complications included complex fractures, use of conjunctival sutures, and increased length of time to surgery. Seventy-two per cent of patients who suffered entropion required further surgical treatment. The most common complication of the transconjunctival approach was entropion, and clinicians should have a low threshold for early surgical management. We feel that this should be part of the consenting process, especially in high-risk cases.
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Affiliation(s)
- Khaled Borghol
- Oral & Maxillofacial Department, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Natalie Turton
- Oral & Maxillofacial Department, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Ian Sharp
- Oral & Maxillofacial Department, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
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Turton N, El-Kininy W. Head injury screening and development of the BRAIN acronym. Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.057] [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: 11/25/2022]
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Garg M, Turton N, Bisase B. An audit tool for assessing electronic discharge summaries of head and neck oncology patients. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.232] [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: 10/25/2022]
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Yarnell K, Le Bon M, Turton N, Savova M, McGlennon A, Forsythe S. Reducing exposure to pathogens in the horse: a preliminary study into the survival of bacteria on a range of equine bedding types. J Appl Microbiol 2016; 122:23-29. [PMID: 27659898 DOI: 10.1111/jam.13298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/01/2016] [Revised: 09/13/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022]
Abstract
AIMS To compare the rate of growth of four microbial strains that cause disease in the horse, on four commonly used types of bedding. The moisture-holding capacity of each bedding type was also tested. METHODS AND RESULTS Microbial strains included Streptococcus equi, Streptococcus zooepidemicus, Fusobacterium necrophorum, Dichelobacter nodosus and Dermatophilus congolensis. The bedding types tested were Pinus sylvestris (Scots pine shavings), Pinus nigra (Corsican pine shavings), Picea sitchensis (Sitka spruce shavings), Cannabis sativa (hemp) and chopped wheat straw. A suspension of each microbial strain was spread in triplicate on agar media and incubated in its optimal growth conditions. The viable count (colony-forming unit per ml) was determined for each bacterial strain for the five different bedding types. Pinus sylvestris bedding resulted in significantly less (P = 0·001) bacterial growth of all strains tested. CONCLUSIONS Factors resulting in the inhibition of bacterial growth include the antibacterial effects reported in the Pinacea family and the physical properties of the bedding substrate. Research is currently focussed on the diagnosis and management of disease. Prevention of disease is also important for matters of biosecurity. Strategies should include the provision of a hygienic environment and the use of specific types of bedding. SIGNIFICANCE AND IMPACT OF THE STUDY Bedding choice has implications for global equine health and disease prevention as well as potential benefits in other animal species.
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Affiliation(s)
- K Yarnell
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Southwell, Nottingham, UK
| | - M Le Bon
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Southwell, Nottingham, UK
| | - N Turton
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - M Savova
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - A McGlennon
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Southwell, Nottingham, UK
| | - S Forsythe
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Turton N, Simmons KC. Assessment of the accuracy of C.T. staging of bladder tumours. Australas Radiol 1984; 28:136-9. [PMID: 6517799 DOI: 10.1111/j.1440-1673.1984.tb02491.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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