Adnexectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery versus laparoscopy: results of a first randomised controlled trial (NOTABLE trial).

OBJECTIVE: To compare adnexectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) versus laparoscopy. DESIGN: Parallel group, 1:1 single-centre single-blinded randomised trial, designed as non-inferiority study with a margin of 15%. SETTING: Belgian teaching hospital. POPULATION: Non-pregnant non-virgin women with an intact uterus and without obliteration of the pouch of Douglas scheduled to undergo removal of an adnexal mass assessed to be benign on ultrasound by IOTA criteria. METHODS: Randomisation to laparoscopy (control group) or vNOTES (experimental group). Stratification according to adnexal size. Blinding of participants and outcome assessors by sham incisions. MAIN OUTCOME MEASURES: The primary outcome measure was adnexectomy by the allocated technique. Secondary outcomes included duration of surgery, pain scores and analgesics used, quality of life and adverse events. RESULTS: We randomly assigned 67 participants (34 to the vNOTES group and 33 to the laparoscopy group). The primary end point was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the laparoscopy group: the one-sided 95% upper limit for the differences in proportions of conversion was estimated as 13%, which is below the predefined non-inferiority margin of 15%. The secondary outcomes demonstrated a shorter duration of surgery, lower pain scores, lower total dose of analgesics and a trend for more adverse events in the vNOTES group. CONCLUSIONS: vNOTES is non-inferior to laparoscopy for a successful adnexectomy without conversion. vNOTES allowed shorter operating times and less postoperative pain but there was a trend for more adverse events.

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial.

OBJECTIVE: To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus total laparoscopic hysterectomy (TLH) as a day-care procedure. DESIGN: Parallel group, 1:1 randomised single-centre single-blinded trial, designed as a non-inferiority study with a margin of 15%. SETTING: Belgian teaching hospital. POPULATION: Women aged 18-70 years scheduled to undergo hysterectomy for benign indications. METHODS: Randomisation to TLH (control group) or vNOTES (experimental group). Stratification according to uterine volume. Blinding of participants and outcome assessors. MAIN OUTCOME MEASURES: The primary outcome was hysterectomy by the allocated technique. We measured the proportion of women leaving within 12 hours after hysterectomy and the length of hospital stay as secondary outcomes. RESULTS: We randomly assigned 70 women to vNOTES (n = 35) or TLH (n = 35). The primary endpoint was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the TLH group: the one-sided 95% upper limit for the differences in proportions of conversion was estimated as 7.5%, which is below the predefined non-inferiority margin. More women left the hospital within 12 hours after surgery after vNOTES: 77 versus 43%, difference 34% (95% CI 13-56%), P = 0.007. The hospital stay was shorter after vNOTES: 0.8 versus 1.3 days, mean difference -0.5 days, (95% CI -0.98 to -0.02), P = 0.004. CONCLUSIONS: vNOTES is non-inferior to TLH for successfully performing hysterectomy without conversion. Compared with TLH, vNOTES may allow more women to be treated in a day-care setting. TWEETABLE ABSTRACT: RCT: vNOTES is just as good as laparoscopy for successful hysterectomy without conversion but allows more day-care surgery.

Sensory and motor development in mice: genes, environment and their interactions.

Sensory and motor developmental tests were designed to characterize spontaneous mutations in rodents. These tests are currently used to investigate developmental abnormalities associated with gene overexpression or gene targeting in mice. Here, we present an overview of our studies focused on 15 tests designed to measure sensory and motor development from birth to weaning in mice. Psychometric characteristics and factorial structure of these measures are considered first. The genetic correlates of these measures obtained with neurological mutants and gene mapping are compared. As a general rule, the contribution of genotype to the phenotypic variance of sensory and motor measures of development is low, inviting exploration of other sources of variation. Results from ovary transplantation, embryo transfer and fostering methods indicate that different components of maternal environment (cytoplasmic, uterine or postnatal) contribute to the behavioral phenotype. Although more difficult to detect, interactions between genotype and environment are involved.

Genetic architecture of testis and seminal vesicle weights in mice.

Comparisons across 13 inbred strains of laboratory mice for reproductive organ (paired seminal vesicles and paired testes) weights indicated a very marked contrast between the C57BL/6By and NZB/BINJ mice. Subsequently these strains were selected to perform a quantitative genetic analysis and full genome scan for seminal vesicle and testis weights. An F(2) population was generated. The quantitative genetic analyses indicated that each was linked to several genes. Sixty-six short sequences for length polymorphism were used as markers in the wide genome scan strategy. For weight of paired testes, heritability was 82.3% of the total variance and five QTL contributed to 72.8% of the total variance. Three reached a highly significant threshold (>4.5) and were mapped on chromosome X (LOD score 9.11), chromosome 4 (LOD score 5.96), chromosome 10 (LOD score 5.81); two QTL were suggested: chromosome 13 (LOD score 3.10) and chromosome 18 (LOD score 2.80). Heritability for weight of seminal vesicles was 50.7%. One QTL was mapped on chromosome 4 (LOD score 9.21) and contributed to 24.2% of the total variance. The distance of this QTL to the centromere encompassed the distance of the QTL linked with testicular weight on chromosome 4, suggesting common genetic mechanisms as expected from correlations in the F(2). Both testis and seminal vesicle weights were associated with a reduction in the NZB/BINJ when this strain carried the Y(NPAR) from CBA/H whereas the Y(NPAR) from NZB/BINJ in the CBA/H strain did not modify reproductive organ weights, indicating that the Y(NPAR) interacts with the non-Y(NPAR) genes. The effects generated by this chromosomal region were significant but small in size.

Loss of aggression, after transfer onto a C57BL/6J background, in mice carrying a targeted disruption of the neuronal nitric oxide synthase gene.

Phenotypic differences among mice with disrupted genes and those with wild-type alleles have not provided the necessary evidence for desired gene/phenotype correlations. These differences could be due to "passenger genes" from the donor 129 strains that are used to produce stem cells. Three variations of attack behavior were measured, using mice carrying a disruption of the neural nitric oxide synthase gene. In the first population, the disrupted gene had been maintained on a mixed background including C57BL/6J and 129 alleles. We have developed a second population in which the disrupted gene was transferred onto a C57BL/6J background during five backcross generations. On the mixed C57BL/6J-129 background, mice homozygous for disrupted Nos1 alleles attacked more frequently, had shorter attack latencies, and presented a greater number of attacks than mice carrying nondisrupted alleles. On the C57BL/6J background, no significant difference persisted between the carriers of the disrupted gene and their noncarrier siblings. The noncarriers on the mixed C57BL/6J-129 background, and the carriers or noncarriers on the C57BL/6J background, did not differ from C57BL/6J. The frequency of attacking males was identical in the homozygous carriers of the disrupted gene, in the mixed C57BL/6J-129 background, and in the 129/SvPas, which approximates the 129/SvJae strain from which the stem cells were derived to produce the disrupted Nos1 gene. These results suggest that Nos1 disruption was not implicated in attack behavior. A possible passenger-gene effect from the 129 donor strain is discussed.

Genetic dissection of gustatory sensitivity to bitterness (sucrose octaacetate) in mice.

Genes implicated in consumption of a bitter compound, sucrose octaacetate (SOA), were investigated using a full genomic scanning strategy. For a 0.1 mM concentration, two QTL reached 5.8 and 6.5 lod scores on chromosomes 2 (77 cM) and 11 (14 cM), respectively. For a 1 mM concentration, the Soa linkage on chromosome 6 (58 cM, lod score 9.4) was replicated, and another QTL was found on chromosome 19 (15 cM, lod score 3.2). Candidacy of previously identified genes in the close vicinity of the peak of the QTL was examined.

Genetic correlation between steroid sulfatase concentration and initiation of attack behavior in mice.

The pairing region of the X-Y chromosomes recombines at male meiosis. We previously found that offense behavior in male mice, measured by initiation of attack against a conspecific male, was linked to this region. Only one functional gene (coding for steroid sulfatase or Sts) is mapped on this region as of yet, suggesting that it could be a candidate for offense behavior. We estimated the genetic correlation between the concentration of STS protein in the liver and the initiation of attack behavior in 11 strains of inbred mice. The high correlation (close to reliability) coefficient of the behavioral phenotype indicates the implication of STS in offense behavior. Recent investigations have demonstrated the involvement of STS in neurosteroid biochemical pathways, and several lines of evidence indicate that neurosteroids interact with neurotransmitters. These conclusions and our present results support the hypothesis that sulfatation of steroids may be the prime mover of a complex network, including genes shown to be implicated in aggression by mutagenesis.

Preweanling sensorial and motor development in laboratory mice: quantitative trait loci mapping.

Chromosomal mapping of genes linked with 19 measures of sensorial, motor, and body weight development were investigated. Chromosomal mapping is the first step towards gene identification. When a genomic region is shown to be linked to a trait, it is possible to select a reduced number of candidate genes that have been previously mapped on this region. The involvement of every gene can be individually tested either by molecular (transgenesis, homologous recombination) or traditional methods (congenicity). Mapping was performed using 389 males and females from two inbred strains of laboratory mice C57BL/6By and NZB/BlNJ, their reciprocal F1s and F2s. Thirty-six Quantitative Trait Loci (QTL) were mapped, 12 reached the 3.13 lod score, being thus considered as confirmed. These QTL were tentatively labeled: Cliff Drop Aversion (Cliff Qtl), Geotaxia (Geot Qtl), Vertical Clinging (VertCling Qtl), Bar Holding with the 4 paws (BH4P Qtl), Age at Eyelid Opening (Aeyo Qtl), Visual Placing (Vispl Qtl), Startle Response (Start Qtl1, Start Qtl2), Body Weight at Day 10 in Males pooled with Females (Bwefmd10 Qtl), and Body Weight at Day 30 in males (Bwemd30 Qtl). For the majority of the developmental measures, the QTL that were mapped contributed little to the phenotypic variance, even when mitochondrial DNA contribution was included: Righting Response (12.7%), Cliff Drop Aversion (10%), Crossed Extensor Response (18.1%), Geotaxia (16.2%), Bar Holding Response for 10 s (12.1%), Bar Holding Response with 4 paws (8.1%), Vertical Clinging (9.3%), Vertical Climbing (5%), Startle Response (21.2%), Eyelid Opening (14.6%), Visual Placing (22%), Body Weight at Day 10 (27%), Body Weight at Day 15 in Females (52.5%), Body Weight at Day 15 in Males (17%), Body Weight at Day 30 in Females (42%), and Body Weight at Day 30 in Males (48%). A factorial analysis of the correlations between the measures of development did not provide evidence of a general factor. A general genetic factor of development was also rejected because few common genetic correlates were discovered for the 19 measures of development (Body Weight at Days 15 and 30 in Females on Chromosome 2, Eyelid Opening and Body Weight at Day 10 on Chromosome 5 and mitochondrial genome for five measures). Co-identification of genes, the function of which were previously known thanks to newly discovered QTL, should help to explain the function of QTL. Present data help to highlight candidate regions including several genes that could be candidates for the QTL function. Large confidence intervals were obtained as usual from the F2 intercrossed population. More stringent methods are suggested for more efficient co-identification.

Neuronal and behavioral differences between Mus musculus domesticus (C57BL/6JBy) and Mus musculus castaneus (CAST/Ei).

Previous studies have demonstrated that classical inbred strains of laboratory mice do not exhibit large genetic distances when simple sequence repeats (SSRs) are used to test for their polymorphisms whereas mice from wild origin exhibit high polymorphisms (more than 90%) for these sequence when compared with classical inbred strains of laboratory mice. The difference between Mus musculus castaneus and C57BL/6J reaches 98% and F1s male and female are fertile. These two properties pave the way for gene mapping derivating segregating generations between these strains. The phenotypical characteristics of Mus musculus castaneus have not been investigated, unfortunately. The first screening of Mus musculus castaneus and C57BL/6By was carried out for sensorial and motor development, spontaneous behavior in new environment, paw preference, maternal behavior, aggression in two different situations and time to learn escape in a water maze. Morphometry of hippocampus and weight of the male reproductive organs for measures that have been reported to be correlated with several of the examined behavior are also reported. The authors tested also reactivity to one drug (beta-CCM) revealing seizure proneness. The two strains differ for 69% of the reported measures. Comparison to other strains for the same measures obtained in the laboratory for identical tests with mice reared in identical situations provided the mean to compare Mus musculus castaneus with a large set of more or less traditional mice. This strain has the most extreme position for 80% of the comparisons.

Vocalizations in newborn mice: genetic analysis.

Two kinds of vocalizations are produced by newborn mice: whistles (between 50 and 150 ms in length), having a narrow bandwidth in each strain that ranges from 30 to 90 kHz; and clicks, which are shorter (about 1 ms) and have a larger bandwidth. These vocalizations were individually recorded in 1-day-old pups from seven inbred strains of laboratory mice, at two temperatures (23 +/- 0.5 and 15 +/- 0.5 degrees C). The numbers of clicks and whistles were counted under these two conditions. Moreover, the length and frequencies at the beginning, apex, and end of the whistles were measured during the 15 degrees C condition. Correlations, including several components-additivity, epistasis (between homozygous loci), and maternal environment-were calculated between the characteristics of the whistles during the 15 degrees C condition. Clicks and whistles were also counted from 1 to 8 days of age during the 15 degrees C condition. The numbers of clicks and whistles were age dependent, with a decrease from day 1 to day 8 for the clicks and a consistent production of whistles. A quantitative genetic analysis was also performed on the 1-day-old pups from the Mendelian generations produced by the inbred strains most contrasting for the number of whistles produced in the cold condition: NZB/BINJ and CBA/H. The heterozygous genotype of the mother induced an increment of the number of whistles. Moreover, a significant part of the additive variance was suspected from the first design, and found with the second one, for this variable. Quantitative genetic analysis showed significant dominance and epistasis between homozygous loci and homozygous and heterozygous loci. This points to multigenic correlates for the number of whistles in this population. The significant additive values for all the variables recorded during the 15 +/- 0.5 degrees C condition and for the number of whistles produced during the 23 +/- 0.5 degrees C condition are compatible with an effect that indicates neither directional nor stabilizing selection. This result is examined in the light of the multichannel sensorial process implicated in maternal behavior in mice.

Epidural abscess: case report and review of the literature.

Spinal epidural abscess is an uncommon site of infection, resulting in back pain, fever, weakness and loss of sensibility. These signs should suggest the diagnosis, and quick confirmation by MRI should be performed. Immediate surgical decompression and antibiotherapy is necessary, because this is the base of a possible successful functional recovery. Empiric therapy consisting of high dose of penicillinase-resistant antibiotics is advised because most often an epidural abscess is caused by Staphylococcus aureus. However, because other bacteria can be involved, an aminoglycoside or a cephalosporin should be added to the empiric treatment, until the results of the cultures are known. When diagnosis and therapy are delayed, permanent paralysis and death are common.