Does Preoperative Urodynamic Testing Improve Surgical Outcomes in Patients Undergoing the Transobturator Tape Procedure for Stress Urinary Incontinence? A Prospective Randomized Trial

Abhinav Agarwal,Sudheer Rathi,Pranab Patnaik,Dipak Shaw,Madhu Jain,Sameer Trivedi,Udai Shankar Dwivedi 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.12

Purpose: Urodynamic studies are commonly performed as part of the preoperativework-up of patients undergoing surgery for stress urinary incontinence (SUI). Weaimed to assess the extent to which these urodynamic parameters influence patientselection and postoperative outcomes. Materials and Methods: Patients presenting with SUI were randomly assigned to twogroups: one undergoing office evaluation only and the other with a preoperative urodynamicwork-up. Patients with unfavorable urodynamic parameters (detrusor overactivity[DO] and/or Valsalva leak point pressure [VLPP]<60 cm H2O and/or maximumurethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamictesting group. All patients in both groups underwent the transobturator midurethralsling procedure. Evaluation for treatment success (reductions in urogenital distressinventory and incontinence impact questionnaire scoring along with absent positivestress test) was done at 6 months and 1 year postoperatively. Results: A total of 72 patients were evaluated. After 12 patients with any one or moreof the abnormal urodynamic parameters were excluded, 30 patients were finally recruitedin each of the “urodynamic testing” and “office evaluation only” groups. At boththe 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positiveprovocative stress test) were significantly better in the urodynamic testing groupthan in the office evaluation only group (p-values significant for all outcomes). Conclusions: Our findings showed statistically significantly better treatment outcomesin the urodynamic group (after excluding those with poor prognostic indicators suchas DO, low VLPP, and MUCP) than in the office evaluation only group. We recommendexploiting the prognostic value of these urodynamic parameters for patient counselingand treatment decisions.

Obesity and Cecal Intubation Time

Deepanshu Jain,Abhinav Goyal,Jorge Uribe 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.2

Background/Aims: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors. Methods: A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2]: I, <24.9; II, 25 to 29.9; III, ≥30). CI time was used as a marker for a difficult colonoscopy. Mean CI times (MCT) were compared for statistical significance using analysis of variance tests. Results: A total of 926 subjects were included. Overall MCT was 15.7±7.9 minutes, and it was 15.9±7.9 and 15.5±7.9 minutes for men and women, respectively. MCT among women for BMI category I, II, and III was 14.4±6.5, 15.5±8.3, and 16.2±8.1 minutes (p=0.55), whereas for men, it was 16.3±8.9, 15.9±8.0, and 15.6±7.2 minutes (p=0.95), respectively. Conclusions: BMI had a positive association with CI time for women, but had a negative association with CI for men.

Predicting Colonoscopy Time: A Quality Improvement Initiative

Deepanshu Jain,Abhinav Goyal,Stacey Zavala 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.6

Background/Aims: There is lack of consensus on the optimal time allotted for colonoscopy, which increases patient wait times. Ouraim was to identify and quantify the individual pre-procedural factors that determine the total procedure time (TPT) of colonoscopy. Methods: This retrospective study involved 4,494 subjects, undergoing outpatient colonoscopy. Effects of age, sex, body mass index,abdominal surgery history, procedure indication (screening, surveillance, or diagnostic), procedure session (morning or afternoon),and endoscopist’s experience (fellow or attending) on TPT were evaluated using multiple regression analysis. A p<0.05 was consideredsignificant. Results: A total of 1,239 subjects satisfied the inclusion/exclusion criteria. Women, older individuals, and those with a history ofabdominal surgery were found to have a shorter TPT (p>0.05) as did afternoon session colonoscopies (p=0.004). Less experiencedendoscopists had longer TPTs (p>0.05). Screening (p=0.01) and surveillance (p=0.008) colonoscopies had a longer TPT than diagnosticprocedures. Overall, the F-value of the regression model was 0.0009. Conclusions: The indication for colonoscopy and the time of day have statistically significant associations with TPT. These results willhelp in streamlining workflow, reduce wait time, and improve patient satisfaction.

De-novo Gastrointestinal Anastomosis With Lumen Apposing Metal Stent

Deepanshu Jain,Ankit Chhoda,Abhinav Sharma,Shashideep Singhal 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.5

Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy oftenrequire surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologiesrequires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumenapposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site ofobstruction, can potentially achieve similar effcacy, with a much lower complication rate. In our study cohort (n=79), the compositetechnical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used:43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occludedgastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique,and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required anechoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain orperitonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.

Study of fertility restoration and genetic diversity of drought-tolerant breeding lines for hybrid rice (Oryza sativa L.) development

Singh Vijayata,Priyadarshi Rahul,Singh Akhilesh Kumar,Jain Abhinav 한국작물학회 2022 Journal of crop science and biotechnology Vol.25 No.1

The identifcation of fertility restoration and genetic diversity of drought-tolerant breeding lines will be useful for the development of promising drought-tolerant rice hybrids. The extent of genetic variation of 204 drought-tolerant breeding lines based on the coefcient of parentage (COP) and test crossing with IR 58025A is studied. The linked molecular markers to Rf genes were screened on identifed maintainers and restorers. The average value of COP for 204 drought-tolerant breeding lines was 0.21, which indicates genetic divergence in breeding lines. Four major groups comprising of 81 IR 64 type, 37 Apo type, 28 Vandana type, 6 WAB type and 52 others were identifed. Out of 204 breeding lines, 37 (18.14%) maintainers, 55 (26.96%) partial maintainers, 63 (30.88%) partial restorers and 49 (24.02%) restorers were identifed. Rf genes linked molecular markers RM7466 and RM443 on chr. 1; RM6344 on chr. 7 and RM6100, RM1108, RM216, RM171 and RM244 on chr. 10 were found associated with restorers and maintainers. These Rf genes linked molecular markers might be furthermore used in marker-assisted restorer selection in cytoplasmic male sterile-WA system from large source nurseries to avoid usual test crosses in the hybrid rice development programme. The identifed restorer and maintainers may be used for the development of high-yielding drought-tolerant rice hybrids.