Laser conization assisted by crypt visualization for cervical intraepithelial neoplasia

Objective: To describe intraoperative visualization of crypts and its effects on specimen clearance, safety, and clinical results of excisional treatment of cervical intraepithelial neoplasia (CIN). Methods: We treated 147 patients with high-grade CIN (II-III) and colposcopically-assessed endocervical extension, using a CO, laser instrument in a day-hospital setting. Endocervical walls were stained preoperatively with a 2% methylene blue aqueous solution. Cervical conization was done by laser under colposcopic vision. Stromal incision and cone shape were directed laterally to the endocervical crypts by intraoperative visualization in transparency of the stain. Results: We were able to make stromal incisions at minimal and uniform radial distances from the cervical canal, thus allowing individualized cone shape and optimal bleeding control. Median (range) base diameter and height of specimens were 18 (13-24) and 20 (15-26) mm, respectively. The final histologic diagnosis was CIN II in 35 patients, CIN III in III, and microinvasive carcinoma in one. Endocervical disease extension was confirmed in 103 patients (70%); the median (range) length of CIN in the 99 evaluable cases was 15.6 (0.5-25.7) mm, and crypt involvement was found in 39 (26.5%). All lateral margins were free of dysplasia. Four specimens (2.7%) had positive apical margins. No significant complications occurred, and fertility did not seem to be impaired. With a median (range) follow-up period of 68 (60-92) months, only 1.4% of patients experienced recurrence; two patients, both with involved crypts, had recurrent dysplasia at 23 and 45 months, respectively. Conclusion: Laser microsurgical conization assisted by crypt visualization facilitates safe and complete removal of CIN extending into the endocervix

Multi-Indicator harvest strategies for Data-Limited fisheries: A practitioner guide to learning and design

As the world population grows, fisheries practitioners will be under increased pressure to address global challenges in data-limited fisheries management. With a focus on addressing localized and case-specific management needs, we provide a practical guide to the design and development of multi-indicator frameworks for fishery management. In a data-limited context, indicators are observations or estimates of the state of the fishery resource that are typically proxies for variables of interest, rather than quantities such as stock biomass estimated from data-rich stock assessments. Indicator frameworks structure the integration and interpretation of indicators to guide tactical fishery decision-making, often when the application of more formal analytical assessments is not feasible, yet where indicators in combination provide insight into stock status. With a focus on multi-indicator frameworks, we describe a pragmatic approach for their development via a set of organizational steps, considering a wide spectrum of types and severity of information limitations. We highlight where multi-indicator frameworks can be insightful and informative in relation to single indicator approaches but also point to potential pitfalls, with emphasis on critical evaluation and detection of performance flaws during the design phase using methods such as management strategy evaluation

Unsung hero Robert C. Gallo

Not availabl

Unsung Hero Robert C. Gallo

Awarding the Nobel prize in physiology or medicine to Francoise Barré-Sinoussi and Luc Montagnier for the discovery of HIV-1, the causative agent of AIDS, is timely given the harm that the virus continues to inflict on the people of the world. While these awardees fully deserve the award, it is equally important to recognize the contributions of Robert C. Gallo. Gallo definitively proved HIV-1 as the cause of AIDS through the successful isolation and long-term cultivation of HIV-1 and developed a diagnostic kit that prevented new infections and saved thousands of lives. These contributions, together with Gallo's earlier discovery of interleukin-2 (fundamental for growing HIV-1 in vitro) and of HTLV-1, the first human pathogenic retrovirus, warrant equal recognition