Expulsion Time Research Articles

Gilaburu extract (Viburnum opulus Linnaeus) is as effective as Tamsulosin in medical expulsive therapy of distal ureteral calculi.

To compare the extract of Gilaburu (Viburnum opulus Linnaeus) and Tamsulosin as a medical expulsive therapy (MET) in patients with distal ureteral calculi of 10mm or less. Data of 86 patients were prospectively collected. The patients were divided into two groups. In the first group, Viburnum opulus 1000mg peroral 3×2 and diclofenac 50mg peroral on-demand (n=43), in the second group Tamsulosin 0.4mg peroral 1×1 and diclofenac 50mg peroral on-demand (n=43) was given for MET in patients with distal ureteral calculi. Stone expulsion rates, time until expulsion, additional analgesic requirement, need for emergency admission, need for additional treatment were evaluated. In addition, subgroup analyses of ≤5 and 5-10mm were also performed. There was no difference between the groups in terms of stone expulsion rates and time until the expulsion in all stones. Additional analgesic requirement and need for emergency admission were found to be lower in the Viburnum opulus group (37.2% vs 65.1%, P=.017 and 11.6% vs 34.8%, P=.02, respectively). In subgroup analyses, while stone expulsion rates were similar in subgroups, it was found shorter in the time until expulsion, lower additional analgesic requirement and need for emergency admission in V. opulus group than Tamsulosin group in 5-10mm stone size subgroup (7.1±4.2 vs 11.8±5.2, P=.005, 32.2% vs 77.7%, P=.001 and 12.9% vs 40.7%, respectively). V. opulus can be used effectively and safely for the treatment of MET in distal ureteral calculi.

Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial.

ABSTRACTPurpose:To compare the effects of tadalafil, tamsulosin, and placebo as a medical expulsive therapy (MET) for distal ureteral calculi.Materials and Methods:This prospective randomized double-blind clinical trial was conducted on 132 renal colic patients with distal ureteric stones (≤10mm) over a period of 12 months. Patients were randomly divided into three groups. Patients in group A received tamsulosin 0.4mg, in group B received tadalafil 10mg, and in group C received placebo. Therapy was given for a maximum of 4 weeks. The rate of stone expulsion, duration of stone expulsion, the dose and the duration of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesic use, and adverse effects of drugs were recorded.Results:Demographic profiles were comparable between the 3 groups. Although the stone expulsion rate in group A (72.7%) was higher in comparison to group B(63.6%) and group C(56.8%), it was not considered statistically significant (P=0.294). Shorter mean time to stone expulsion was significantly observed in group A (17.75±75), than group B(21.13±1.17) and group C(22.25±1.18) (P=0.47). The mean number of analgesic use was 9.8±5.09 days in group A, 14.6±7.9 days in group B, and 12.6±22.25 days in group C, this difference was significant (P=0.004). The analgesic requirement (doses of NSAIDs and pethidine) in group A was significantly lower than other groups (P<0.05). Also, patients in group A reported fewer headaches compared to other groups (P=0.011).Conclusion:Tamsulosin as medical expulsive therapy is more effective for distal ureteric stones with less need for analgesics and less stone expulsion time than tadalafil.

Clinical Efficacy and Safety Study of Mifepristone with Misoprostol Treatment in Patients with Missed Abortion.

Currently, medication abortion is widely used in clinical practice in China. The aim of this study was to investigate the effect of mifepristone with misoprostol treatment on the efficacy of patients with missed abortion (MA) and the safety of this drug regimen. 95 patients with MA treated in our hospital from February 2019 to April 2021 were collected as the subjects of this study, and the patients were divided into the control and the research groups according to different treatment modalities. Among them, 46 cases in the control group were treated by diethylstilbestrol combined with oxytocin and 49 cases in the research group were treated by mifepristone combined with misoprostol, and both groups underwent curettage after medication. The rates of complete abortion, time of embryo expulsion, time of operation, intraoperative bleeding, time of postoperative vaginal bleeding, amount of vaginal bleeding, rate of one-time curettage, the levels of serum estradiol (E2), progesterone (P), β-chorionic gonadotropin (β-hCG), and interleukin-18 (IL-18), and the incidence of adverse effects in the two groups were examined and compared. Alanine transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and serum creatinine (Scr) were used as indicators to evaluate the safety of the drug. The results showed that the rates of complete abortion and one-time curettage were significantly higher in the study group than in the control group, while the time of embryo expulsion, operation time, intraoperative bleeding, postoperative vaginal bleeding time, and vaginal bleeding were significantly lower than in the control group. The serum E2, P, and β-hCG levels before curettage in both groups were significantly higher, and IL-18 levels were significantly lower than those at the time of admission, with E2, P, and β-hCG levels increasing more and IL-18 levels decreasing more in the research group. After drug treatment, no abnormal changes in liver and kidney functions were observed in both groups, and the incidence of adverse reactions was at a similar and lower level in both groups. This shows that mifepristone with misoprostol is a safer and more effective drug regimen for the treatment of MA, which can regulate the levels of serum sex hormones and inflammatory factors in the body, promote the shedding of placental tissue, and create conditions for improving the rate of curettage.

Thermal Maturation Regime Revisited in the Dongying Depression, Bohai Bay Basin, East China

To the accurate reconstruction of the hydrocarbon generation history in the Dongying Depression, Bohai Bay Basin, East China, core samples of the Eocene Shahejie Formation from 3 shale oil boreholes were analyzed using organic petrology and organic geochemistry methods. The shales are enriched in organic matter with good to excellent hydrocarbon generation potential. The maturity indicated by measured vitrinite reflectance (%Ro) falls in the range of 0.5–0.9% and increases with burial depth in each well. Changes in biomarker and aromatic hydrocarbon isomer distributions and biomarker concentrations are also unequivocally correlated with the thermal maturity of the source rocks. Maturity/depth relationships for hopanes, steranes, and aromatic hydrocarbons, constructed from core data indicate different well locations, have different thermal regimes. A systematic variability of maturity with geographical position along the depression has been illustrated, which is a dependence on the distance to the Tanlu Fault. Higher thermal gradient at the southern side of the Dongying Depression results in the same maturity level at shallower depth compared to the northern side. The significant regional thermal regime change from south to north in the Dongying Depression may exert an important impact on the timing of hydrocarbon maturation and expulsion at different locations. Different exploration strategies should be employed accordingly.

Tamsulosin Versus Alfuzosin as Medical Expulsion Therapy for Distal Ureteric Calculi: An Analytical Study

Introduction: Urolithiasis is one of the most common urological problems. About 20% of urolithiasis accounts for ureteric calculi among which 2/3rd patients present with distal ureteric calculi. Alpha blockers are commonly used for effective treatment of ureteric calculi. The aim of this study was to compare effectiveness of Tamsulosin and Alfuzosin as medical expulsion therapy. Methods: This analytical study was carried out at National Medical College Department of Surgery, Urology Unit, Birgunj from October 2020 to March 2021. Ethical clearance (FNMC/439/075/76) was obtained from institutional review committee. Total 100 cases were included in the study who presented with distal ureteric calculi of &lt;10 mm. The patients receiving Tamsulosin were recruited in Group T and those receiving Alfuzosin were recruited into Group A. The choice of treatment was made by the treating surgeons. Tamsulosin 0.4 mg was used for the patients in Group T and 10 mg Alfuzosin was used in Group A. Patients were followed-up weekly for 4 weeks. Stone expulsion rate, time to stone expulsion, colic episodes, emergency visit, use of analgesics and drug-related side-effects were recorded. Results: The rate of expulsion of stone in Tamsulosin group was 64% and that in Alfuzosin group was 66%. The expulsion time in Tamsulosin group was 4.28±3.49 days and that in Alfuzosin group was 5.02±4.09 days which was statistically insignificant (p=0.33). Mean episodes of colic and use of analgesics were similar in both groups. Backache was the most common side effect in both groups. Conclusion: Efficacy of both Alfuzosin 10 mg and Tamsulosin 0.4 mg as medical expulsion therapy is comparable to each other with minimum side effects of both the drugs.

Juvenile social defeat stress exposure favors in later onset of irritable bowel syndrome-like symptoms in male mice

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder. Traumatic stress during adolescence increases the risk of IBS in adults. The aim of this study was to characterize the juvenile social defeat stress (SDS)-associated IBS model in mice. Juvenile mice were exposed to an aggressor mouse for 10 min once daily for 10 consecutive days. Behavioral tests, visceral sensitivity, immune responses, and fecal bacteria in the colon were evaluated in 5 weeks after SDS exposure. Social avoidance, anxiety- and depression-like behavior, and visceral hypersensitivity were observed. Juvenile SDS exposure significantly increased the number of 5-HT-containing cells and calcitonin gene-related peptide-positive neurons in the colon. The gut microbiota was largely similar between the control and juvenile SDS groups. The alterations in fecal pellet output, bead expulsion time, plasma corticosterone concentration, and colonic 5-HT content in response to restraint stress were exacerbated in the juvenile SDS group compared with the control group. The combination of juvenile SDS and restraint stress increased the noradrenaline metabolite 3-Methoxy-4-hydroxyphenylglycol (MHPG) content and MHPG/noradrenaline ratio in the amygdala when compared with restraint stress in control mice. These results suggest that juvenile SDS exposure results in later onset of IBS-like symptoms.

Dexketoprofen vs. Tamsulosin vs. Silodosin vs. Tadalafil as Medical Expulsive Therapy for Distal Ureteral Stones in Men.

To assess the effectiveness of the use of dexketoprofen, tamsulosin, silodosin, and tadalafil in medical expulsive therapy for distal ureteral stones in male patients. Cohort study. Department of Urology, Gazi Hospital, Samsun, Turkey, from March 2020 to March 2021. Adult males satisfying the inclusion criteria were randomly assigned into dexketoprofen (Group 1), tamsulosin (Group 2), silodosin (Group 3), or tadalafil (Group 4) treatment arms. The primary endpoint consisted of the stone expulsion rate at the end of four weeks, while the secondary endpoints were the expulsion rate after two weeks and the occurrence of adverse events. Clinical findings were then compared among the study groups. Altogether 193 patients, 50 (25.9%) in group 1, 48 (24.9%) in group 2, 49 (25.4%) in group 3, and 46 (23.8%) in group 4, were enrolled in the study. No significant difference was determined in terms of age, body mass index, stone characteristics, expulsion time, pain episodes, or total analgesic consumption among the four groups. Expulsion rates in the fourth week were 48%, 79.2%, 81.6%, and 78.3% in groups 1, 2, 3, and 4, respectively. Stone expulsion rates were significantly greater in groups 2, 3, and 4 compared to group 1 (p <0.001), but no significant differences were determined between groups 2, 3, and 4. No severe adverse effects occurred throughout the study period. Tamsulosin, silodosin and tadalafil exhibited higher expulsion rates for distal ureteral stones in male patients, although none was significantly superior to the others. All three are safe, efficacious, and well-tolerated, with only very minor side-effects. Key Words: Dexketoprofen, Distal ureteral stones, Medical expulsive therapy, Silodosin, Tadalafil, Tamsulosin.

Efficacy of Tamsulosin and Alfuzosin in Management of Distal Ureteral Stones

Introduction: Urinary tract calculi are the most frequent condition in urology clinics worldwide. The overall prevalence is about 5 % and lower urinary tract stones account for 70% among them. Medical expulsive therapy has been used to treat distal ureteric stone as it reduces symptoms and facilitates stone expulsion. The aim of this study is to evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones.&#x0D; Materials and Methods: A total of 87 patients with distal ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group A patients (n-30) received 0.4 mg of tamsulosin daily, group B patients (n-29) received 10 mg of alfuzosin daily and group C patients (n-28) received 75 mg of diclofenac sodium. Patients in all groups received diclofenac sodium for one week and then as required. Follow-up was done on a weekly basis for 4 weeks. The stone expulsion rate, time for stone expulsion, and side-effects were recorded in each group.&#x0D; Results: The mean stone size (5.66, 5.79, 5.67) mm and age (29.1, 30.31, 29.4) were comparable in each group. The stone expulsion rate was 83.3%, 79.3%, and 50% in groups A, B, and C respectively. It showed that both the study groups (Group A and Group B) were effective than the control group (p-value 0.006 and 0.02 respectively) but there was no difference between tamsulosin and alfuzosin (p-value 0.69). The duration of stone expulsion was 11.5 days, 11.8 days, and 17.3 days for Group A, B, and C respectively. The drugs related side effects reported by patients were mild and transient.&#x0D; Conclusion: The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other.

Systematic Review of Efficacy and Safety of Silodosin in Medical Expulsive Therapy for the Management of Ureteral Stones – Based on Indian Evidences

Introduction: Urolithiasis is quite a common disorder affecting around two million people in India every year. Minimally invasive therapies are effective treatment measures in most of the cases. However, a watchful waiting approach with pharmacotherapy promotes the expulsion of stones in a shorter time. We hereby review the efficacy and safety of silodosin, a selective α-1A adrenoceptor antagonist, in medical expulsive therapy for the management of urolithiasis based on the evidences in Indian population. Methods: Medical Subject Headings (MeSH) keywords which were used to systematically search electronic databases: PubMed/Medline, Cochrane Library and Google Scholar from their inception to February 2020 were “Silodosin”, “Ureteral calculi”, “Medical expulsive therapy”, “India”, “randomised controlled trials” and “prospective observational studies”. A total of 29 relevant studies could be found and were included in our analysis. Results: The primary outcomes considered were the stone expulsion rate (SER) and stone expulsion time (SET) along with pain episodes and safety outcomes like orthostatic hypotension and retrograde ejaculation. Eight studies with a total of 1064 patients were identified as evidences considering Indian population which compared silodosin with controls like tamsulosin or tadalafil. Conclusions: Silodosin is highly effective in Indian population for increasing stone expulsion for those with ureteral stones (distal ureteral stones with diameter ≥5 mm and ≤10 mm) with shorter expulsion times along with fewer episodes of pain. It is also effective in post-lithotripsy for accentuating clearance rate and curtailing time to passage of the stones.

Manometric parameters, when measured with the 3-dimensional high-definition anorectal manometry probe, poorly predict prolonged balloon expulsion time.

There are little data evaluating the performance of the 3-dimensional high-definition anorectal manometry (3D-HDAM) system in the diagnosis of dyssynergic defecation. Physical properties of the thicker, rigid, 3D-HDAM probe may have implications on the measurements of anorectal pressures. Our aim was to compare 3D-HDAM to balloon expulsion test and magnetic resonance (MR) defecography. Consecutive constipated patients referred for anorectal function testing at the Calgary Gut Motility Centre (Calgary, Canada) between 2014 and 2019 were assessed. All patients underwent anorectal manometry with the 3D-HDAM probe, and a subset underwent BET or MR defecography. Anorectal manometric variables were compared between patients who had normal and abnormal BET. Over the study period, 81 patients underwent both 3D-HDAM and BET for symptoms of constipation. 52 patients expelled the balloon within 3 minutes. Patients with abnormal BET had significantly lower rectoanal pressure differential (RAPD) (-61 vs. -31mmHg for normal BET, p=0.03) and defecation index (0.29 vs. 0.56, p=0.03). On logistic regression analysis, RAPD (OR: 0.99, 95% CI: 0.97-0.99, p=0.03) remained a negative predictor of abnormal BET. On ROC analysis, RAPD had an AUC of 0.65. There was good agreement between dyssynergic patterns on 3D-HDAM and defecographic evidence of dyssynergia (sensitivity 80%, specificity 90%, PLR 9, NLR 0.22, accuracy 85%). Manometric parameters, when measured with the 3D-HDAM probe, poorly predict prolonged balloon expulsion time. RAPD remains the best predictor of prolonged balloon expulsion time. The 3D-HDAM probe may not be the ideal tool to diagnose functional defecatory disorders.

A Novel Expulsion Control Strategy With Abnormal Condition Adaptability for Resistance Spot Welding

Abstract Welding expulsion is a common problem in the resistance spot welding (RSW) process, which severely impacts weld quality and surrounding facilities. Existing expulsion control strategies are ineffective for complex and changeable welding conditions. This article studied the growth relationship between weld nugget and corona bond under two abnormal conditions: edge proximity (EP) and initial sheet gaps (IG). It is testified that expulsion would occur when the nugget size exceeds the corona bond size under EP and IG conditions. Reducing the welding current before the expulsion time can increase the size difference between the corona bond and the weld nugget, thereby delay and even eliminate the occurrence of expulsion. In this way, a novel online expulsion control strategy, named short-time current regulation (STCR), is proposed through the expulsion moment analysis of historical weld data. The effect of the new control strategy is verified with workpieces ranging from low carbon steel to ultra-high strength steel. Experimental results showed that STCR can effectively reduce the amount of expelled metal, decrease the indentation depth, and increase the nugget diameter. The method not only works well under one specific abnormal condition but also adapts to the transition between different welding conditions. This novel expulsion control strategy can help achieve the expulsion-free RSW process in mass production without frequent manual offline optimization of welding parameters.

Effects of Ni coating thickness on the microstructure and mechanical properties of resistance-welded WC-Co/B318 steel joints

WC-Co pellets electroplated with different Ni coating thicknesses and B318 steel were resistance welded for carbide-tipped saw blade applications. The effects of the Ni coating thickness on the welding process, interfacial microstructures, and mechanical properties of the joints were investigated. The results showed that the shear force increased before decreasing as the Ni coating thickness increased. When the coating thickness was 40 μm, expulsions began to appear during welding, while a thicker coating resulted in longer expulsion times. Voids and macro cracks were generated at the joints because of the expulsions, which reduced the shear force of the joint. The XRD results of the welding slag and the EDS results of the interface indicate that the microstructures can be divided into five phase categories: light gray (Fe3W3C), gray (Co3W3C), white (WC), fishbone eutectic structure (Fe6W6C), and dark [(γ Fe, Ni) solid solutions]. As a thicker Ni coating hinders reactions between molten Fe and dissolved WC, the joint interface contained more Fe6W6C at 20 μm and 30 μm but had more bulk Fe3W3C at 40 μm and 50 μm. The upper part of the joint showed brittle fractures on the WC-Co side, while most of the lower part fractured at the interface. Only the joints at 20 μm and 30 μm had a small fracture area on the steel side. Moreover, the fracture on the steel side at 30 μm showed elongated shear dimples, which explains the maximum shear force of the joint at 30 μm.

New developments in defecatory studies based on biomechatronics

IntroductionDefecation is a complex process that is difficult to study and analyze directly. In anorectal disease conditions, the defecation process may be disturbed, resulting in symptoms including fecal incontinence and constipation. Current state-of-the-art technology measures various aspects of anorectal function but detailed analysis is impossible because they are stand-alone tests rather than an integrated multi-dimensional test. ObjectivesThe need for physiologically-relevant and easy-to-use diagnostic tests for identifying underlying mechanisms is substantial. We aimed to advance the field with integrated technology for anorectal function assessment. MethodsWe developed a simulated stool named Fecobionics that integrates several tests to assess defecation pressures, dimensions, shape, orientation and bending during evacuation. A novelty is that pressures are measured in axial direction, i.e. in the direction of the trajectory. Using this novel tool, we present new analytical methods to calculate physiologically relevant parameters during expulsion in normal human subjects. ResultsData are reported from 28 human subjects with progressively more advanced versions of Fecobionics. A new concept utilizes the rear-front pressure (preload-afterload) diagram for computation of novel defecation indices. Fecobionics obtained physiological data that cannot be obtained with current state-of-the-art technologies. ConclusionFecobionics measures well known parameters such as expulsion time and pressures as well as new metrics including defecation indices. The study suggests that Fecobionics is effective in evaluation of key defecatory parameters and well positioned as an integrated technology for assessment of anorectal function and dysfunction.

Porosity evolution in organic matter-rich shales (Qingshankou Fm.; Songliao Basin, NE China): Implications for shale oil retention

The Songliao Basin is an important hydrocarbon province of Northeastern China and has a long history of conventional oil and gas production. Nowadays, unconventional resource estimation becomes increasingly important and particularly shale oil/gas production from mature source rocks in the Central Depression may be of great relevance for the regional exploration strategy. The Qingshankou Formation is a promising source rock reservoir. However, for shale oil/gas production to be successful, a refined understanding of the distribution of hydrocarbons within the low-permeable rocks, as well as the timing of hydrocarbon expulsion and its linkage to changing pore characteristics, are key requirements. Therefore, a multi-analytical geochemical and porosity study was conducted on a set of 12 oil-prone, alginite-rich samples from a depth range from 200 to 2500 m in order to understand the linkage of burial compaction, hydrocarbon generation and pore evolution. Macro- (>50 nm) and mesopores (2–50 nm) were investigated by a combination of nitrogen gas adsorption/desorption measurements at 77 K and broad ion beam – scanning electron microscopy. The adsorption tests were conducted on samples before and after solvent-extraction in order to study the effects of soluble organic matter (OM) on pore distributions. These data were compared with organic petrographical observations, bulk geochemical parameters before and after extraction, as well as extract yields from the bulk source rock in order to link structural and geochemical changes in the interval from immature to late peak oil mature (0.4–0.9 %Rr). Total SEM-visible macro- and mesoporosity (φBIB) is generally limited, but a weak trend of total φBIB with quartz contents indicates the importance of brittle minerals for pore preservation. A depth trend towards smaller average pore sizes, higher pore aspect ratios, as well as preferentially bedding-parallel pore orientations reflects burial compaction. An observable deficiency of pores <100 nm in φBIB size distributions, as well as differential BJH mesopore volumes of up to 20% (original vs. extracted), show that pore occlusion by high-molecular weight bitumen changes the apparent pore characteristics particularly for samples from the oil window. A maximum of extractable organic matter (EOM), soluble S2bitumen, S1 normalized to total organic carbon (TOC) contents, as well as saturated vs. aromatic compound ratios determined from source rock extracts, is reached at a vitrinite reflectance of 0.8 %Rr. An interpreted maximum of shale oil in place at ~0.8 %Rr is followed by a decline in these parameters for the samples at slightly higher thermal maturity (0.9 %Rr). This may indicate the onset of hydrocarbon expulsion at >0.8 %Rr, corresponding with a decrease in the differential BJH volume and less visible pre-oil solid bitumen. The gas storage and retention behavior of the investigated shales may abruptly change with ongoing thermal maturation, as matrix pores are liberated from occluding hydrocarbons.

Transcervical foley catheter and oxytocin compared with transcervical foley catheter alone for induction of labour

Objective: To evaluate whether transcervical Foley catheter with Oxytocin used concurrently for induction of labour (IOL) increases the delivery rate within 24 hours as compared to transcervical Foley catheter alone. Methodology: 220 women with Bishop score ≤6 undergoing IOL were randomized into a concurrent transcervical Foley catheter &amp; Oxytocin group and a transcervical Foley catheter alone group and delivery rate ≤24 hours was assessed as primary outcome. Results: Of the 220 women who completed the trial, there were 110 subjects (52 nulliparae and 58 multiparae) randomized in each group. Delivery rate within 24 hours was &gt; 95% in both groups (96.36% vs 95.45%, p=0.748). Oxytocin use was significantly longer in the concurrent group than in Foley alone group (10.50 vs 7.75 hours). Multiparae fared better than nulliparae in both the groups in terms of parameters like delivery rate within 24 hours (concurrent group: 100 vs 92.30%, p=0.046; &amp; Foley only group: 98.27 vs 94.23%, p=0.342), delivery in 12 hours, caesarean sections, Foley expulsion time, oxytocin required and successful inductions. They also delivered much faster (combined group: 9 vs 12 hours; Foley only group: 9.41 vs 12.5 hours). Conclusion: Both methods- combined and Foley catheter alone is equally good for IOL. Concurrent use of oxytocin at the initiation of IOL exposes to a longer duration of oxytocin without expediting the induction thereby questioning oxytocin’s efficacy on the unprimed cervix. Thus concurrent methods (Foley &amp; Oxytocin)) offers no extra advantage over the conventional methods (Foley alone) for IOL.

513 PHENOTYPIC CHARACTERIZATION OF FUNCTIONAL DEFECATORY DISORDERS USING SIMULTANEOUS MR DEFECOGRAPHY AND MANOMETRY

BACKGROUND & AIMS High resolution manometry (HRM) is widely used to diagnose defecatory disorders (DD). Contrary to conventional concepts, many healthy people have a negative rectoanal gradient during evacuation (ie, anal > rectal pressure), which undermines our understanding of the mechanisms of normal defecation and DD. Perhaps this is partly because manometry is performed in an empty rectum in the left lateral position. Aimed to better understand the mechanisms of normal defecation and DD, we simultaneously measured rectoanal pressures and evacuation in healthy and constipated women. METHODS We assessed anorectal and abdominal wall motion and rectal evacuation of gel with MR defecography, and pressures with water-perfused manometry in 28 healthy women and 26 women with constipation. Phenotypes were identified by K-means cluster analysis. The unconditional exact test (chi-squared statistic) evaluated the relationship between these clusters and outcomes, ie, balloon expulsion time [BET], subject status (healthy versus constipation) and evacuation. RESULTS Twenty seven participants (19/27 healthy women, 8/26 patients, P 25% of gel). The BET was >60s in 4 controls and 9 patients (P=0.1). The cluster analysis identified 3 distinct clusters, which were defined by pressure and motion variables (Figure 1); BET and rectal evacuation were not variables in the cluster analysis. During evacuation, the rectal pressure, anorectal junction descent, abdominal diameter, and anal diameter were all smaller while the anal canal was longer in cluster 1 (3 evacuators [E], 21 nonevacuators [NE]) (P CONCLUSIONS Manodefecography uncovers 3 clusters in DD. Cluster 1, which predominantly comprises nonevacuators, is characterized by limited abdominal expansion, a spastic pelvic floor, and inadequate rectal pressure during evacuation. By contrast to cluster 1, 24 of 30 (80%) subjects in clusters 2 and 3 were evacuators. In these subjects, abdominal expansion, rectal pressure, and anal opening were preserved; resting anal pressure was lower in cluster 2 than 3. Most patients with DD do not have isolated rectal or anal dysfunctions but rather a combination of impaired abdominal expansion, rectal propulsion, anal opening, and perineal descent during evacuation. Download : Download high-res image (170KB) Download : Download full-size image Figure 1 . The cluster analysis, which was based of 7 variables (Table 1), uncovered 3 distinct clusters. These clusters are plotted using the first two principal components from the 7 variables. The principal component analysis is only used to depict the data; it was not used for the K-means cluster analysis. Cluster 1 predominantly comprises nonevacuators (filled symbols), while clusters 2 and 3 are predominantly evacuators (open symbols). These clusters (1 versus 2 and 3) were associated with evacuator status (P Download : Download high-res image (69KB) Download : Download full-size image Table 1 . Table showing the values of the variables corresponding to centroids of the clusters. During evacuation(e), cluster 1 (3 evacuators[E], 21 nonevacuators [NE]) had lower rectal pressure, anorectal junction descent, abdominal diameter, anal diameter, and a longer anal canal. Cluster 2 (15 E, 4 NE) was characterized by lower anal resting pressure. Compared to clusters 1 and 2, patients in cluster 3 (9 E, 2 NE) had greater anal resting pressure but more anal relaxation during evacuation.

Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis.

Medical expulsive therapy has been found to be effective for distal ureteric stones; however, which drug is most efficacious in terms of stone expulsion rate (SER) and stone expulsion time (SET) is not known. With this review we aimed to compare the efficacy of various drug treatments for distal ureter stones used as medical expulsive therapy in terms of SER and SET. Systematic literature search was conducted to include all the randomised study comparing various drug interventions for lower ureter stones. Standard preferred reporting items for systematic review and meta-analysis for network meta-analysis (PRISMA-NMA) were pursued. In this review, 50 randomised studies with 12,382 patients were included. For stone expulsion rate (SER), compared with placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained, naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared with placebo only tadalafil plus silodosin, nifedipine plus steroid, alfuzosin, silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as monotherapy is no more effective than control group.

Efficacy of Phloroglucinol Tamsulosin Combination Therapy for Medical Expulsion of Lower Ureteral Calculi and Influence on Patients’ Cys-C Level

Objective: Phloroglucinol is a myotropic, non-atropine and non-papaverine smooth muscle antispasmodic which directly acts on the smooth muscles of the gastrointestinal tract and the urogenital tract with no anticholinergic effect, no symptoms like xerostomia, visual impairment, dysuria, hypotension, increased heart rate, and arrhythmia etc. To investigate the efficacy of phloroglucinol tamsulosin combination therapy for medical expulsion of lower ureteral calculi and influence on patients’ Cys-C level. Methods: Equally randomized 136 patients with lower ureteral calculi in our hospital into mono therapy group (phloroglucinol alone) and combination therapy group (additional tamsulosin was advised). The expulsion rate, expulsion time, stone diameter and levels of IL-10, CRP, NGAL, Cys-C, KIM-1 were compared between two groups, also with the effectiveness and the rate of adverse reactions. Results: The combination therapy group showed higher expulsion rate (P 0.05). Conclusions: Phloroglucinol tamsulosin combination therapy had clear advantages on medical expulsion of lower ureteral calculi in respect of higher expulsion rate and elevated IL-10, CRP, NGAL, Cys-C and KIM-1 levels with larger stone diameter in a shorter time.

A comparison of rectoanal pressures during Valsalva maneuver and evacuation uncovers rectoanal discoordination in defecatory disorders.

It is suggested that patients with defecation disorders (DD) strain excessively or do a Valsalva maneuver (VM) during evacuation, resulting in rectoanal discoordination, which hinders rectal evacuation. However, definitive data are lacking. Rectoanal pressures during evacuation and a VM were measured with seated high-resolution manometry (HRM) in 64 healthy and 136 constipated women with a normal (84 women, C-normal) or prolonged (52 women, C-abnormal) balloon expulsion time (BET). The number of abnormal rectoanal parameters during evacuation and the joint distribution of pressures during evacuation and a VM were used to discriminate between controls and C-abnormal BET patients. The peak anal pressure (5s) during a VM accounted for 0%, 26%, and 49% of the variance in anal pressure during evacuation in healthy women, C-normal BET, and C-abnormal BET. The association between anal pressure during a VM and evacuation was stronger in C-abnormal BET than in healthy women and C-normal BET (p for interaction <0.001). Fifty-eight of 64 controls and 33 of 52 C-abnormal BET patients had no or one abnormal parameter during evacuation; hence, the probability of C-abnormal BET was 33/91 (36%). In patients with no or one abnormal parameter during evacuation, a logistic model based on anal pressures during evacuation and a VM discriminated between controls and patients with C-abnormal BET with a sensitivity and a specificity of 67% and 75%. Assessment of rectoanal pressures during evacuation and a VM uncovers rectaoanal discoordination and facilitates the diagnosis of DD in selected patients.

EVALUATION OF EFFICACY OF SILODOSIN VERSUS SILODOSIN WITH DEFLAZACORT IN EXPULSION OF LOWER URETERIC CALCULI

Objectives: To compare the efcacy of silodosin versus silodosin with deazacort in expulsion of lower end ureteric calculi, in terms of episodes of pain,stone expulsion rate,stone expulsion time ,analgesic requirements and side effects Introduction: Ureteric calculi represent 20% of urinary stones. Ureteroscopy and Shock wave lithotripsy proven the method of treatments for lower ureteric stones; however, they are expensive and not risk free. Aconservative approach is becoming more popular as a result of advances in pharmacological therapy which reduces the symptoms and helps in stone expulsion. We performed a randomized controlled prospective study to evaluate the efcacy of Deazacort in combination with alpha blocker silodosin in medical management of symptomatic lower Ureteric stones of ≤8 mm size. Material and methods: A prospective randomised controlled study was conducted on 60 patients, age ≥ 18 , who had unilateral lower ureteric stone of ≤ 8 mm. Patients were divided into three groups. Group 1 received silodosin 8 mg for 14 days,Group 2 received silodosin 8 mg plus deazacort 30mg daily for 14 days and Group 3 (control) received diclofenac potassium (75 mg ) when required. The patients were followed-up by ultrasonography ,plain radiograph KUB and computed tomography (in some cases). Results: There was a higher stone expulsion rate of 95% in Group 2 as compared to Group 1(85%) and Group 3(35%) . Group 2 showed a signicant advantage for stone expulsion time ,decreased pain episodes and analgesic use. Two patients, one in group 1 and group 2, reported retrograde ejaculation. Conclusion: The results showed that silodosin with deazacort , increases the stone expulsion rate, decrease the stone expulsion time, decreases the mean number of pain episodes and decreases the mean analgesic dosage requirement. But larger study is required to establish its efcacy for expulsion rate which will be statistically signicant.