The comparison of postoperative analgesic requirements between modified thoracoabdominal nerve block through perichondrial approach versus wound infiltration analgesia in patients undergoing gynecological laparoscopic surgery: a retrospective, exploratory study

Abstract Introduction Recently, modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) has been introduced as a novel trunk block. To date, studies comparing its clinical advantages with those of existing local anesthetic techniques are scarce. We aimed to compare the analgesic efficacy of M-TAPA to that of wound infiltration analgesia (WIA) in patients who underwent gynecological laparoscopic surgeries. Methods We studied medical records from January 2020 to July 2021 at Hokkaido University Hospital. The primary outcome was the number of analgesic requirements in the first 24 h postoperatively. Secondary outcomes were the time until the first analgesic requirement and adverse events regarding local anesthetic techniques. To address confounding, a regression model was used. Results Data from 90 of 231 patients were analyzed (M-TAPA group, n = 40; WIA group, n = 50). For the primary outcome, means and 95% confidence intervals for each group and between-group differences were as follows: 2.25 (1.74, 2.76), 2.28 (1.81, 2.75), and −0.03 (−0.72, 0.66), respectively. Adjusted mean difference was 0.39 (−0.32, 1.11). There were no significant differences in means between groups, with or without adjustment for covariates (p = 0.93, 0.28). Furthermore, no significant difference was detected in the time until the first analgesic requirement and adverse events related to local anesthesia. Conclusion Our results demonstrate that M-TAPA did not reduce postoperative analgesic requirements compared to WIA. In a future clinical trial, sufficient visceral pain control may be required to evaluate the effectiveness of M-TAPA over WIA in patients undergoing laparoscopic gynecological surgery

Numbers of fish showing concordance and discordance between phenotypic and genotypic sex among those used for genetic mapping.

<p>Numbers of fish showing concordance and discordance between phenotypic and genotypic sex among those used for genetic mapping.</p

Identification of the sex-determining locus in grass puffer (<i>Takifugu niphobles</i>) provides evidence for sex-chromosome turnover in a subset of <i>Takifugu</i> species

<div><p>There is increasing evidence for frequent turnover in sex chromosomes in vertebrates. Yet experimental systems suitable for tracing the detailed process of turnover are rare. In theory, homologous turnover is possible if the new sex-determining locus is established on the existing sex-chromosome. However, there is no empirical evidence for such an event. The genus <i>Takifugu</i> includes fugu (<i>Takifugu rubripes</i>) and its two closely-related species whose sex is most likely determined by a SNP at the <i>Amhr2</i> locus. In these species, males are heterozygous, with G and C alleles at the SNP site, while females are homozygous for the C allele. To determine if a shift in the sex-determining locus occurred in another member of this genus, we used genetic mapping to characterize the sex-chromosome systems of <i>Takifugu niphobles</i>. We found that the G allele of <i>Amhr2</i> is absent in <i>T</i>. <i>niphobles</i>. Nevertheless, our initial mapping suggests a linkage between the phenotypic sex and the chromosome 19, which harbors the <i>Amhr2</i> locus. Subsequent high-resolution analysis using a sex-reversed fish demonstrated that the sex-determining locus maps to the proximal end of chromosome 19, far from the <i>Amhr2</i> locus. Thus, it is likely that homologous turnover involving these species has occurred. The data also showed that there is a male-specific reduction of recombination around the sex-determining locus. Nevertheless, no evidence for sex-chromosome differentiation was detected: the reduced recombination depended on phenotypic sex rather than genotypic sex; no X- or Y-specific maker was obtained; the YY individual was viable. Furthermore, fine-scale mapping narrowed down the new sex-determining locus to the interval corresponding to approximately 300-kb of sequence in the fugu genome. Thus, <i>T</i>. <i>niphobles</i> is determined to have a young and small sex-determining region that is suitable for studying an early phase of sex-chromosome evolution and the mechanisms underlying turnover of sex chromosome.</p></div

Female and male meiotic map of LG (linkage group) 19 in <i>T</i>. <i>niphobles</i> Family 1.

<p>Allelic bridges are indicated by a line connecting female (left) and male (right) linkage map. Genetic distances in centimorgans between adjacent markers are shown. Genetic markers are ordered and placed based on both the linkage analysis of <i>T</i>. <i>niphobles</i> and their comparative location in the fugu genome (on the segmented bar). There was no discrepancy in their order at this resolution of linkage analysis. Since it was not known if sex-reversed fish were present, two male maps were generated under these two conditions. SD* and SD** denote sex-determining locus.</p

Derivative melting curves of PCR products by HRM analysis of SNP7271 at the <i>Amhr2</i> locus from fugu and <i>T</i>. <i>niphobles</i>.

<p>The red curve denotes a profile obtained from a male fugu heterozygous (XY) at the SNP site in exon 9 at the <i>Amhr2</i> locus (SNP7271). The 81 gray curves denote profiles obtained from 40 female and 40 male wild <i>T</i>. <i>niphobles</i>, and one female homozygous (XX) fugu. The same pattern (gray curves) was obtained from another 120 samples of <i>T</i>. <i>niphobles</i> (60 female and 60 male; data not shown), indicating that <i>T</i>. <i>niphobles</i> is homozygous at the SNP7271 position in the <i>Amhr2</i> gene regardless of the sex.</p

Association test for phenotypic sex and marker genotypes, and QTL (quantitative trait loci) analysis in <i>T</i>. <i>niphobles</i> Family 1.

<p>(A) Plot of–log₁₀ (<i>P</i> value) versus chromosome position for the association test. The chromosomal position of the markers was first inferred from the draft genome sequence of fugu, and later confirmed partially by linkage analysis shown in Fig 4B and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190635#pone.0190635.s001" target="_blank">S1B Fig</a>. Closed and open circles indicate data from paternally and maternally inherited markers, respectively. Bonferroni correction gave a significance threshold of–log₁₀ (<i>P</i>) = 2.5 (blue vertical dotted line). The segmented bar next to the–log₁₀ (<i>P</i>) plot illustrates the sequence map of fugu chromosome 19, in which each segment schematic represents a scaffold in the FUGU5/fr3 assembly [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190635#pone.0190635.ref035" target="_blank">35</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190635#pone.0190635.ref036" target="_blank">36</a>]. (B) Chromosome-wide mapping of sex-determining QTL. Log of odds (LOD) scores are plotted in the linkage map of <i>T</i>. <i>niphobles</i> LG19. The blue dotted line indicates chromosome-wide significant (0.1%) levels of LOD scores, calculated from 10,000 permutations. The red line in the graph indicates the 95% Bayesian confidence interval (CI). Genetic markers are ordered and placed based on both the linkage analysis of <i>T</i>. <i>niphobles</i> (in the graph) and their comparative location in the fugu genome (on the segmented bar). There was no discrepancy in the order at this resolution of linkage analysis. The <i>Amhr2</i> locus (in red letters) did not co-segregate with 95% CI (red line).</p

A comparison of SNPs around exon 9 of the <i>Amhr2</i> gene among four <i>Takifugu</i> species and between males and females.

<p>Shown are the 24 SNP sites detected in the partial sequence of the <i>Amhr2</i> gene (intron 8, exon 9, and intron 9). The association between the SNP7271 of the <i>Amhr2</i> gene (flanked by yellow lines) and phenotypic sex is conserved among fugu (<i>T</i>. <i>rubripes</i>), <i>T</i>. <i>poecilonotus</i> and <i>T</i>. <i>pardalis</i>, as reported previously [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190635#pone.0190635.ref026" target="_blank">26</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190635#pone.0190635.ref033" target="_blank">33</a>], but not in <i>T</i>. <i>niphobles</i>. Gray cells indicate that an individual is homozygous for the reference allele, blue cells indicate that an individual is homozygous for the alternative allele, and red cells indicate that an individual is heterozygous. White cells refer to deletions.</p