Three hundred patients were enrolled in a double-blind, randomized, controlled study designed to investigate the ability of supplemental perioperative oxygen to reduce wound infection. Participants were age 18 to 80 years, had no coexisting serious medical conditions, and were scheduled to undergo elective colorectal surgery at one of 14 participating hospitals in Spain. No patients undergoing minor or laparoscopic surgery were included. Anesthesia and antibiotic prophylaxis were standardized for the study. Patients were randomized by computer-generated codes to receive an oxygen/air mixture of 30% or 80% fraction of inspired oxygen (F10 2 ) intraoperatively and postoperatively for 6 hours. After 6 hours, oxygen was given only in amounts needed to maintain 92% saturation. Postoperative care was determined by the attending surgeon who was unaware of the patient's oxygen group.Wounds were inspected daily and surgical site infections (SSI) were diagnosed according to the definitions of the Centers for Disease Control and Prevention. Infections occurring during the first 14 days were considered for analysis.Nine patients did not meet inclusion criteria. Of the remaining 291 patients, 143 received 30% and 148 received 80% oxygen. The 2 groups were similar in clinical characteristics, including preoperative laboratory studies and risk of infection score. Surgical characteristics, including length of operative procedure, blood loss, and transfusion rate, were also similar between the 2 groups.Fifty-seven patients (19.3%) developed a wound infection. The incidence of wound infection was 35 of 143 (24%) in the 30% F10 2 group and 22 of 148 (14.9%) in the 80% F10 2 patients (P ϭ 0.04). The risk of SSI was 39% lower in the high oxygen group compared with those who received less oxygen (relative risk, 0.61; 95% confidence interval [CI], 0.38-0.98). Other measures of surgical outcome, including return of bowel function, ability to tolerate solid food, ambulation, suture removal, and duration of hospitalization, were not significantly different for the 2 treatment groups. When patients who developed wound infections were compared with those without infection, the group with SSI had a longer time to ambulation (mean, 4.9 vs 3.9 days; P ϭ 0.008), a longer time to staple removal (11.6 vs 10.1 days; P ϭ 0.007), and were in the hospital longer (15.1 vs 10.7 days; P ϭ 0.001).Two patients, both in the 30% oxygen group, died of sepsis during the study period. After multivariate analysis of possible confounding variables, the relative risk of wound infection in patients who received 80% oxygen was 0.46 (95% CI, 0.22-0.95; P ϭ 0.04) compared with those who received 30% oxygen. EDITORIAL COMMENT(In the United States these days, surgical wound infection occurs after less than 1% of abdominal or vaginal hysterectomies. This is a marked reduction in the last 20 years brought about largely because of prophylactic antibiotics. More than 25 prospective, randomized studies have shown the effectiveness of prophylactic antibiotics in reducing pos...

is considered an oncomicroRNA given its abilities to suppress the actions of several tumor suppressor genes and to promote tumor cell growth, invasion and metastasis. Recently, transforming growth factor-beta (TGF-b) is found to up-regulate the expression of miR-21, and elevated miR-21 expression is seen frequently in breast cancer. To evaluate the effect of miR-21 on disease progression and its association with TGF-b, we analyzed miR-21 expression in breast cancer. Fresh tumor samples were collected during surgery from 344 patients diagnosed with primary breast cancer. The expression of miR-21 in tumor samples was measured with a TaqMan Ò microRNA assay using U6 as reference. Levels of miR-21 expression by disease stage, tumor grade, histology, hormone receptor status and lymph node involvement were compared. Cox proportional hazards regression analysis was performed to assess the association of miR-21 expression with disease-free and overall survival. The study results showed that the expression of miR-21 was detected in all tumor samples with substantial variation. High miR-21 expression was associated with features of aggressive disease, including high tumor grade, negative hormone receptor status, and ductal carcinoma. High miR-21 was also positively correlated with TGF-b1. No associations were found between patient survival and miR-21 expression among all patients, but high miR-21 was associated with poor disease-free survival in early stage patients (HR = 2.08, 95% CI: 1.08-4.00) despite no value for prognosis. The study supports the notion that miR-21 is an onco-microRNA for breast cancer. Elevated miR-21 expression may facilitate tumor progression, and TGF-b may up-regulate its expression.

Objective The aim of the study was to describe the features required for diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM). Materials and Methods The International Society of the Study of Vulvovaginal Diseases tasked the difficult pathologic diagnoses committee to develop consensus recommendations for clinicopathologic diagnosis of vulvar lichen planus, lichen sclerosus, and dVIN. The dVIN subgroup reviewed the literature and formulated diagnostic criteria that were reviewed by the committee and then approved by the International Society of the Study of Vulvovaginal Diseases membership. Results Differentiated vulvar intraepithelial neoplasia is the immediate precursor of human papillomavirus (HPV)–independent vulvar squamous cell carcinoma and shows a spectrum of clinical and microscopic appearances, some overlapping with HPV-related neoplasia. The histopathologic definition of dVIN is basal atypia combined with negative or nonblock-positive p16 and basal overexpressed, aberrant negative, or wild-type p53. The most common pattern of dVIN is keratinizing with acanthosis, aberrant rete ridge pattern, and premature maturation. The morphologic spectrum of keratinizing dVIN includes hypertrophic, atrophic, acantholytic, and subtle forms. A few dVIN cases are nonkeratinizing, with basaloid cells replacing more than 60% of epithelium. Vulvar aberrant maturation is an umbrella term for lesions with aberrant maturation that arise out of lichenoid dermatitis and lack the basal atypia required for dVIN. Conclusions Evaluation of women at risk for dVIN and VAM requires a collaborative approach by clinicians and pathologists experienced in vulvar disorders. Close surveillance of women with lichen sclerosus and use of these recommendations may assist in prevention of HPV-independent squamous cell carcinoma through detection and treatment of dVIN and VAM.

The advantage of the new terminology is that it includes all types of vulvar SILs, it provides a solution to the concerns in relation to the application of LAST to vulvar lesion, and it is in accordance with the World Health Organization classification as well as the LAST, creating unity among clinicians and pathologists.

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The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget’s disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).