Should the appendix always be removed during surgery for mucinous ovarian tumors?

Background: Appendectomy is performed in all mucinous ovarian tumors (MOT) identified intraoperatively to ensure microscopic metastases from appendix are not missed. Several recent studies suggested that appendectomy should only be performed in cases with a grossly abnormal appendix or with evidence of pseudomyxoma peritonei. Our study aimed to determine the frequency of malignancy in a grossly normal appendix in women undergoing surgery for borderline or malignant MOT.Methods: In a single institution retrospective study, women undergoing surgery for MOT from January 1, 2008 to June 30, 2016 were included. Women with benign MOT, those with a history of either prior appendicectomy or prior gastrointestinal (GI) malignancy were excluded.Results: Of 266 women identified with MOT, 153 with borderline and malignant MOT were included in the study after application of inclusion criteria. The study population comprised of 29 (18.95%) borderline and 124 (81.05%) malignant MOT. Among the borderline MOT, 13/29 had undergone appendectomy. Five (38.46%) had grossly abnormal appendices of whom 1 had mucinous cystadenoma, 3 had borderline mucinous tumor and 1 had mucinous cystadenocarcinoma of the appendix. Histology was normal in all 8 (61.54%) grossly normal appendices. Among the malignant MOT, 80/124 (64.52%) underwent appendicectomy. Nineteen (23.46%) had grossly abnormal appendices and histology was suggestive of adenocarcinoma of appendix. Histology was normal in all 62 (76.54%) macroscopically normal appendices.Conclusions: Present results suggest that appendectomy be performed only for those appendices that are grossly abnormal or associated with pseudomyxoma peritonei at surgery for MO

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Alien states: Colonial fetishisms and Asian-American migrations.

My dissertation re-maps the relationship between geography, national identity, and racialized/gendered encounters of colonials, natives, and Asian Americans. Drawing on Freudian, Marxist and post-colonial theories of the fetish, I re-examine existing approaches to colonial and Asian American texts, highlighting the intersections between imagined states of identity and the economic, social, and cultural reality colonials and immigrants face upon arrival to a new landscape. Applying models of the fetish and post-colonial theories of subjectivity to imperialist and Asian American narratives, my project links theories of race to imagined geographical spaces. This approach redefines the traditional terms of nationalism and subjectivity and explores the connection between British and Asian American migration narratives. Alien States begins by contextualizing established and contemporary theories of the fetish in relationship to literature of migration and focuses on how desire mediates the reception and interpretation of geography with respect to identity. The first half of my dissertation focuses on British colonial encounters with native populations in turn of the century imperialist migration narratives by John Buchan, Joseph Conrad, Rudyard Kipling, and E. M. Forster. This section details the racial and gendered complications arising from the colonist's attempt to fetishize native and hybrid figures, a process which ultimately leads to a re-evaluation of the colonial presence in the new landscape. The second half of my work discusses the fetish in Asian American narratives. Like the British colonial texts, Asian American narratives also reinvent the American landscape, but the consequences of relocating the fetish on the racialized figure takes a decided twist when Asian American identity is already exoticized by American culture. I examine the allure of America in the Asian American immigrant fiction of Anjana Appachana, Bharati Mukherjee, and Maxine Hong Kingston. By looking at how the conception of geography and the decision to immigrate is mediated by the development of a racialized fetish, I show how cross cultural discourse in an international context influences the construction of America, and how the production of Asian American identity is driven by material and psychological commodifications of cultural traditions.Ph.D.American literatureAsian literatureEnglish literatureEthnic studiesGeographyLanguage, Literature and LinguisticsSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130414/2/9725246.pd

Assessment of nutritional status of gynecological cancer cases in India and comparison of subjective and objective nutrition assessment parameters

Aim: To assess the nutritional status of gynecological cancer patients using scored Patient Generated Subjective Global Assessment (PG-SGA) then compare it with the body mass index (BMI), hemoglobin, serum albumin, and approximate percentage weight lost in last 1 month so as to find any one parameter that can be used in place of the comprehensive assessment tool. Materials and Methods: Sixty gynecological cancer patients were assessed for their nutritional status using BMI, serum albumin, hemoglobin, percentage weight lost in last 1 month, and scored PG-SGA. Correlation, sensitivity, specificity, and predictive values of the former four parameters compared to scored PG-SGA were calculated. Results: 88.33% of cases were at risk of or had some degree of malnutrition according to scored PG-SGA. Serum albumin level ≤ 2 g/dl had highest specificity and positive predictive value at 1, whereas percentage weight lost in last month had better overall sensitivity, specificity, and positive and negative predictive values of 0.5833, 0.9444, 0.875, and 0.7727, respectively. The Pearson′s correlation coefficient between scored PG-SGA and percentage weight lost in last 1 month was 0.784, highest among all the parameters. Conclusion: 88.33% of gynecologic cancer cases had some degree of malnutrition or were at risk of malnutrition. Approximate percentage weight lost in last 1 month, that is, ≥ 5% may be used in place of the comprehensive scored PG-SGA to triage the patients in case the latter is not used for some reason. Severe hypoalbuminemia ≤ 2 g/dl is an indicator of severe malnutrition in gynecologic cancer cases

Role of Percutaneous Nephrostomy in Advanced Cervical Carcinoma with Obstructive Uropathy: A Case Series

Aims and Objective: Over 70% of the cases present in advanced stages of the disease and are associated with poor prognosis and high mortality rates. In many of them, it is difficult to offer definitive treatment as they present in uremia due to associated obstructive uropathy. There are no clear-cut guidelines for performing percutaneous nephrostomy (PCN) in patients of advanced cervical cancer. The results are unpredictable in terms of benefits achieved in these cases. Thus, we evaluated our experiences with PCN in the management of cervical cancer patients presenting with obstructive uropathy. Material and Methods: 15 patients of cervical cancer with obstructive uropathy and deranged renal functions were retrospectively evaluated for the role of PCN in their management Results: PCN was done in 15 patients of advanced cervical cancer. The mean age of patients was 44.5 years. Twelve (80%) patients presented primarily with advanced cervical carcinoma and obstructive uropathy. Three (20%) were already treated. Symptomatic improvement and significant fall of mean serum creatinine value from 7.5 mg% to 0.9 mg% over a period of 1-3 weeks was noted post PCN. Out of 12 patient with primary untreated advanced disease, curative treatment was possible in 3, palliative radiotherapy/chemo-therapy in 7 and only symptomatic treatment in 2 cases, after obstructive uropathy was managed with PCN insertion. Out of 3 already treated patients, 2 were disease free after curative radiotherapy/surgery. PCN was done to prevent permanent kidney damage in them. One patient was defaulter of curative radiotherapy. She had progressive residual disease. Complications like hemorrhage (20%), infection (26%), reinsertion for dislodgment/misplacement (53%), percutaneous leak or perinephric leak (20%), blockage of PCN (33%) were noticed. Conclusion: In spite of inherent, albeit manageable complications, PCN is a simple and safe technique. One of the major benefits observed was ability to administer either curative/palliative radiotherapy or chemotherapy in 85% of patients (11 out of 13 with disease). There was no active disease in remaining 2 patients. Therefore, the decision to attempt PCN in carefully selected cervical cancer patients is justified

Should the appendix always be removed during surgery for mucinous ovarian tumors?

Background: Appendectomy is performed in all mucinous ovarian tumors (MOT) identified intraoperatively to ensure microscopic metastases from appendix are not missed. Several recent studies suggested that appendectomy should only be performed in cases with a grossly abnormal appendix or with evidence of pseudomyxoma peritonei. Our study aimed to determine the frequency of malignancy in a grossly normal appendix in women undergoing surgery for borderline or malignant MOT.Methods: In a single institution retrospective study, women undergoing surgery for MOT from January 1, 2008 to June 30, 2016 were included. Women with benign MOT, those with a history of either prior appendicectomy or prior gastrointestinal (GI) malignancy were excluded.Results: Of 266 women identified with MOT, 153 with borderline and malignant MOT were included in the study after application of inclusion criteria. The study population comprised of 29 (18.95%) borderline and 124 (81.05%) malignant MOT. Among the borderline MOT, 13/29 had undergone appendectomy. Five (38.46%) had grossly abnormal appendices of whom 1 had mucinous cystadenoma, 3 had borderline mucinous tumor and 1 had mucinous cystadenocarcinoma of the appendix. Histology was normal in all 8 (61.54%) grossly normal appendices. Among the malignant MOT, 80/124 (64.52%) underwent appendicectomy. Nineteen (23.46%) had grossly abnormal appendices and histology was suggestive of adenocarcinoma of appendix. Histology was normal in all 62 (76.54%) macroscopically normal appendices.Conclusions: Present results suggest that appendectomy be performed only for those appendices that are grossly abnormal or associated with pseudomyxoma peritonei at surgery for MO