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Appendicitis is the most common acute abdominal complication during pregnancy. If appendix perforation occurs there is an increasing risk of preterm delivery and other pregnancy complications. To assess the outcome of pregnancy after appendectomy, the mode of surgery used, appendectomy rates, and complications. A prospective cohort study of pregnant women with, or without, appendectomy at South Stockholm General Hospital, December 2015 to February 2021 in a setting where pregnant women are prioritized for surgery and laparoscopic surgery was standard of care in first half of pregnancy. Data on preoperative imaging, surgical method, intraoperative findings, microscopic findings, hospital stay, pregnancy, and 30-day complications were prospectively recorded in a local appendectomy register. A non-pregnant control group was gathered comprising women of fertile age in the same study interval. During the study period 50 pregnant women, of whom 44 gave birth, underwent appendectomy of 38 199 women giving birth. There were no differences between women with or without appendectomy in proportion of preterm delivery (4.5% vs. 5.6%), small-for-gestational age (2.3% vs. 6.2%), or Cesarean delivery (18.2% vs. 20.4%). The rate of appendix perforation was 19% in non-pregnant control group compared to 12% among pregnancy. There was no case of perforated appendix in the second half of pregnancy. However, women with gestational age > 20 weeks more frequently had an unaffected appendix compared to those operated ≤ 20 gestational weeks (4/11 vs. 2/39, p =.005). Laparoscopic surgery was used in 97% of non-pregnant control group, 92% of appendectomies ≤ 20 weeks gestation, and in 27% >20 weeks. As compared to first half, the appendectomy rate was three times lower during the second half of pregnancy. Pregnant women had priority for surgery < 6 h compared to < 24 h among non-pregnant women, this resulted in a shorter time-to-surgery among pregnant women (p <.001) Routine laparoscopic surgery and time priority for pregnant surgery is associated with a low risk of perforation, preterm birth and other complications. However, a low threshold for surgery may increase the risk of a negative exploration. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the ability of demographic and sonographic variables and the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) classification to predict preoperatively tumor recurrence or progression in women with endometrial cancer.Methods: The study included 339 women with histologically confirmed endometrial cancer who underwent expert transvaginal ultrasound in a single center before surgery as part of the prospective International Endometrial Tumor Analysis 4 study or who were evaluated using the same protocol. The tumors were classified according to histotype, FIGO (International Federation of Gynecology and Obstetrics) grade and FIGO stage. In addition, molecular analysis was performed for classification into the four ProMisE subtypes: polymerase-ϵ exonuclease domain mutations (POLE EDM), mismatch repair proteins deficiency (MMR-D), protein 53 wild type (p53 wt) and protein 53 abnormal (p53 abn). Demographic and preoperative sonographic characteristics, tumor recurrence or progression and survival were compared between the ProMisE subgroups. Cox regression analysis was used to identify prognostic factors associated with recurrence or progression, using univariable models to study crude associations and multivariable models to study adjusted associations. Logistic regression and receiver-operating-characteristics (ROC)-curve analysis were used to assess the predictive ability of the preoperative prognostic factors regarding recurrence or progression of cancer within 3 years after surgery, and to compare their predictive ability to that of the European Society for Medical Oncology (ESMO) preoperative (based on depth of myometrial invasion, histotype and grade) and postoperative (based on histotype, grade, surgical stage and lymphovascular space invasion) risk classifications. In a separate subanalysis, cases were stratified according to ProMisE p53 abn status (present vs absent) and sonographic tumor size (anteroposterior (AP) diameter < 2 cm vs ≥ 2 cm).Results: Median follow-up time from surgery was 58 months (interquartile range, 48-71 months; range, 0-102 months). Recurrence or progression of cancer occurred in 51/339 (15%) women, comprising 14% of those with MMR-D, 8% of those with POLE EDM, 9% of those with p53 wt and 45% of those with p53 abn ProMisE subtype. On multivariable analysis, age, waist circumference, ProMisE subtype and tumor extension and AP diameter on ultrasound were associated with tumor recurrence or progression. A multivariable model comprising ProMisE subtype, age, waist circumference and sonographic tumor extension and size (area under the ROC curve (AUC), 0.89 (95% CI, 0.85-0.93)) had comparable ability to predict tumor recurrence/progression to that of a multivariable model comprising histotype, grade, age, waist circumference and sonographic tumor extension and size (AUC, 0.88 (95% CI, 0.83-0.92)), and better predictive ability than both the preoperative (AUC, 0.74 (95% CI, 0.67-0.82); P < 0.01) and postoperative (AUC, 0.79 (95% CI, 0.72-0.86); P < 0.01) ESMO risk classifications. Women with a combination of non-p53 abn subtype and tumor size < 2 cm (164/339 (48%)) had a very low risk (1.8%) of tumor recurrence or progression.Conclusions: The combination of demographic characteristics, sonographic findings and ProMisE subtype had better preoperative predictive ability for tumor recurrence or progression than did the ESMO classification, supporting their use in the preoperative risk stratification of women with endometrial cancer. The combination of p53 status with ultrasound tumor size has the potential to identify preoperatively a large group of women with a very low risk of recurrence or progression. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. - Legal Statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. [ABSTRACT FROM AUTHOR]

By combining simultaneous data from an instrumented Air--Sea Interaction Spar (ASIS) buoy and a 30-m tower, profiles of wind and turbulence characteristics have been obtained at several heights from about 1 to 30 m above the water surface during swell conditions. Five cases formed as averages over time periods ranging from 2.5 to 9.5 h, representing quasi-steady conditions, have been selected. They represent a range of typical wave age and include wind-following swell cases and cross-swell cases. For relatively large wave age, the wind profile exhibits a well-defined maximum in the height range 5-10 m; for more modest wave age, this maximum turns into a sharp 'knee' in the wind profile. Below the maximum (or knee), the wind increases rapidly with height; above that point the wind is very nearly constant up to the highest measuring level on the tower, 30 m. Analysis of balloon data from one day with swell indicates that the layer with constant wind in fact extends to the top of the boundary layer, in this case ~200 m. Analysis of the complete swell dataset from the 45 days of the 2003 Baltic Swell experiment shows that the results concerning wind profile shape obtained from the selected cases are generally valid in this experiment. Analysis of the nondimensional wind profile [[phi].sub.m] shows that Monin--Obukhov scaling is not valid during swell. Wind and turbulence characteristics are found not to vary to a significant degree with the wind/swell angle within the range of angles encountered, [+ or -]90[degrees].

Analysis of the turbulent kinetic energy (TKE) budget for five slightly unstable cases with swell has been performed based on measurements of mechanical production, buoyancy production, turbulent transport, and dissipation at five levels over the sea. from 2.5 to 26 m. The time rate of change and advection of TKE were found to be small, so the TKE residual is interpreted as an estimate of the pressure transport term ([T.sub.p]). In two cases with high wave age, the [T.sub.p] term is a gain at all heights. For three cases with smaller wave age, [T.sub.p] is a loss in the TKE budget below 5-10 m and a gain for greater heights, where the decrease is exponential, thus showing the combined effects of swell waves and a range of waves traveling slower than the wind. The TKE budget for a case with growing sea bur similar wind speed and stability as some of the swell cases has [T.sub.p] close to zero at all heights. It is shown that the observed characteristic wind profile with either a low-level maximum in the 5-10-m range or a distinct 'knee' at that height is an effect of the [T.sub.p] term.