Development of a bowel sound detector adapted to demonstrate the effect of food intake

Objective Bowel sounds (BS) carry useful information about gastrointestinal condition and feeding status. Interest in computerized bowel sound-based analysis has grown recently and techniques have evolved rapidly. An important first step for these analyses is to extract BS segments, whilst neglecting silent periods. The purpose of this study was to develop a convolutional neural network-based BS detector able to detect all types of BS with accurate time stamps, and to investigate the effect of food consumption on some acoustic features of BS with the proposed detector. Results Audio recordings from 40 volunteers were collected and a BS dataset consisting of 6700 manually labelled segments was generated for training and testing the proposed BS detector. The detector attained 91.06% and 90.78% accuracy for the validation dataset and across-subject test dataset, respectively, with a well-balanced sensitivity and specificity. The detection rates evaluated on different BS types were also satisfactory. Four acoustic features were evaluated to investigate the food effect. The total duration and spectral bandwidth of BS showed significant differences before and after food consumption, while no significant difference was observed in mean-crossing rate values. Conclusion We demonstrated that the proposed BS detector is effective in detecting all types of BS, and providing an accurate time stamp for each BS. The characteristics of BS types and the effect on detection accuracy is discussed. The proposed detector could have clinical application for post-operative ileus prognosis, and monitoring of food intake.

Acupuncture for Relieving Abdominal Pain and Distension in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Background: Clinical evidence suggests that acupuncture is effective for relieving abdominal pain and distension in acute pancreatitis (AP). However, there is a lack of systematic reviews and meta-analyses that provide high-quality evidence of the efficacy and safety of acupuncture in this context.Aim: To assess the efficacy and safety of acupuncture for relieving abdominal pain and distension in AP.Methods: We searched the PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, and China Biomedical Literature databases. Randomized controlled trials of acupuncture plus routine treatment (RT) vs. RT alone or RT plus sham/placebo acupuncture were included. Primary outcomes included total effectiveness rate, VAS scores for abdominal pain and distension, and time until relief of abdominal pain and distension. Secondary outcomes included time until recovery of bowel sound, time until first defecation, length of hospital stay, and APACHE II score.Results: Nineteen eligible original studies (n = 1,503) were included. The results showed that acupuncture in combination with RT had a significant advantage in terms of increasing the total effectiveness rate [risk ratio: 1.15; 95% confidence interval (CI): 1.06–1.24; P = 0.001]. Acupuncture also reduced the VAS score for abdominal pain [weighted mean difference (WMD): −1.45; 95% CI: −1.71 to −1.19; P < 0.0001] and the VAS score for abdominal distension (WMD: −0.71; 95% CI: −1.04 to −0.37; P < 0.0001) in patients with AP. Other results also showed the efficacy of acupuncture. One study reported adverse events after acupuncture.Conclusion: Acupuncture in combination with RT has a better effect than RT alone for relieving abdominal pain and distension in AP. More rigorous studies are needed to confirm this result.Systematic Review Registration: PROSPERO CRD42019147503 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=147503).

A RANDOMIZED INTERVENTIONAL STUDY ON EFFECT OF CHEWING GUM ON RECOVERY OF GASTROINTESTINAL FUNCTIONS IN POSTOPERATIVE PATIENTS FOLLOWING ABDOMINAL SURGERIES IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

Background: Post- operative gastrointestinal dysfunction is one of the complications following abdominal surgery which results in delayed return of bowel motility. It causes discomfort, prolonged hospital stay; hospital acquired infection and enhanced treatment cost. This study was conducted with an aim to analyze the clinical outcome of effect of chewing gum mainly to avoid post-operative gastrointestinal dysfunction and to compare the different gastrointestinal variables between cases and control group. Methods: In this study 80 patients were included, 40 Cases and 40. The cases were given chewing gum for duration of 15 minutes at 2nd , 4th and 6thhour of surgery. Bowel sound was auscultated at 3rd, 5th and 7th hour of surgery and outcomes were compared with control group. Control group were given only standard post-operative care. Results: Among cases Mean duration of 1st bowel sound appeared was 9.23±2.2 hours whie among control group was 15.99±3.48 hours and with operating time <1 hour is 5.1 ± 1.04 hours in cases and 6.2 ± .66 hours in control group while with operating time >1 hour it was 5.2 ± 1.03 hours cases and 6.3 ± 0.7 hours in control group. Mean duration of 1st flatus passed among cases was 13.3±2.24 hours while among control group was 26.62 ±2.6 hours and with operating time <1 hour was 13.8 ± 1.03 hours in cases and 16.25 ± 1.5 hours in control group, while it was 13.12 ± 1.96 hours in cases and 17.12 ± 1.5 hours in control group with operating time >1 hour. Mean duration of 1st motion passed among cases was 31.33±2.24 hours and was 44.62± 2.6 hours in control group and it was 48.8 ± 1.2 hours in cases and 50.7 ± 1.27 hours in control group with operating time <1 hour, while it was 48.8 ± 1.2 hours in cases and 51.1 ± 1.46 hours in control group with operating time >1 hour. Result was statistically significant P value (0.001).

Analysis of Gastrointestinal Acoustic Activity Using Deep Neural Networks

Automated bowel sound (BS) analysis methods were already well developed by the early 2000s. Accuracy of ~90% had been achieved by several teams using various analytical approaches. Clinical research on BS had revealed their high potential in the non-invasive investigation of irritable bowel syndrome to study gastrointestinal motility and in a surgical setting. This article proposes a novel methodology for the analysis of BS using hybrid convolutional and recursive neural networks. It is one of the first methods of using deep learning to be widely explored. We have developed an experimental pipeline and evaluated our results with a new dataset collected using a device with a dedicated contact microphone. Data have been collected at night-time, which is the most interesting period from a neurogastroenterological point of view. Previous works had ignored this period and instead kept brief records only during the day. Our algorithm can detect bowel sounds with an accuracy >93%. Moreover, we have achieved a very high specificity (>97%), crucial in diagnosis. The results have been checked with a medical professional, and they successfully support clinical diagnosis. We have developed a client-server system allowing medical practitioners to upload the recordings from their patients and have them analyzed online. This system is available online. Although BS research is technologically mature, it still lacks a uniform methodology, an international forum for discussion, and an open platform for data exchange, and therefore it is not commonly used. Our server could provide a starting point for establishing a common framework in BS research.

Gallstone ileus: Rare Entity for Mechanical Small Bowel Obstruction

Gallstone ileus is common in elderly female population. To obtain a diagnosis of gallstone ileus is a challenge requiring clinical and radiological assistance. It’s a rare cause of intestinal obstruction, accounts approximately 1-4%. Here we report a case of 56 years old lady presented with intestinal obstruction sign and symptoms. Per abdomen examination revealed generalised tenderness with sluggish bowel sound. Abdominal X-ray revealed prominent small bowel with presence of gas till rectum. CT abdomen noted intraluminal mass over distal small bowel loops mimickering intusseption. Exploratory laparotomy with small bowel enterotomy was performed. Intra-operative finding noted impacted gallstone measuring 2x3cm, 360cm from duodenal-jejunal flexure and 50cm from terminal ileum. Post-operative patient had speedy recovery and discharged home. Here we emphasize in elderly female patient presented with sign and symptoms of intestinal obstruction, diagnosis of gallstone ileus should be one of differential diagnosis.

Influencing Factors of Gastrointestinal Function Recovery after Gastrointestinal Malignant Tumor

Gastric cancer is a malignant tumor with a high incidence in the world, and the incidence rate only increases every year. Because of the loss of mental property caused by surgery and postoperative recovery treatment, it has become a difficult problem for many families to solve. Exploring the factors affecting the recovery of gastrointestinal function after surgery to accelerate the recovery has become one of the important research topics of current medical experts and scholars. The purpose of this article is to explore the factors affecting the recovery of gastrointestinal function after gastrointestinal malignancies. In this paper, firstly through experimental investigation, the fasting time and operation method of patients undergoing gastrointestinal malignant tumor surgery are used as variables to conduct a controlled experiment, and the first defecation time, exhaust time, and bowel sound recovery of the experimental subjects after surgery are recorded. Changes in time and other indicators are compared to verify whether they affect the recovery of gastrointestinal function. Experimental data showed that the recovery time of bowel sounds was 29.10 ± 11.09 h in patients with fasting time less than or equal to 2 days after operation, the time of first exhaustion was 28.75 ± 27.80 h, and the time of first defecation was 54.70 ± 39.40 h. The recovery time of bowel sounds in patients with fasting time longer than 2 days was 40.47 ± 9.40 h, the first exhaust time was 71.40 ± 17.54 h, and the first defecation time was 98.30 ± 28.16 h. Therefore, resuming diet as soon as possible after operation is beneficial to the recovery of gastrointestinal function in patients with gastrointestinal malignancies.

A Rare Case of Chronic Suppurative Appendicitis in Neonatal Presenting as Intestinal Malrotation

Neonatal appendicitis (NA) is an extremely rare acute abdomen condition, moreover, if it is a chronic suppurative one. The definite risk factor of NA is barely unknown. The signs and symptoms are often nonspecific and appear after perforation occurs. Most of the cases were found unexpectedly during surgery suspected as other diagnoses. A 7-day-old male neonate presenting lethargic and hypoglycemia since 1 st day of life. Patient drunk breast milk right after since he was born. Meconium was produced <24 h. On the 3 rd day of hospitalization, he experienced bilious vomiting and abdominal distension, so nasogastric tube was installed. Physical examination revealed decreased bowel sound. Investigation showed leucocytosis, slightly increased procalcitonin and abdominal X-ray showed that gas distribution lasted until third part of duodenum followed by minimal gas distribution in the distal part of duodenum. The patient was suspected as distal duodenum stenosis or proximal jejunum. Intraoperatively, it was found that there was second part duodenum malrotation and open Ladd’s procedure was done. During Ladd’s procedure, a perforated appendix was also found. The histopathology result revealed that it was a chronic suppurative appendicitis. Patient was discharged in good condition 20 days after surgery. NA is a rare condition with nonspecific signs and symptoms which was usually found accidentally during surgery suspected as other diagnoses.

THE EFFECT OF SUCKING LOLLIPOPS ON RETURN OF BOWEL FUNCTION AFTER ELECTIVE DISTAL BOWEL SURGERY IN CHILDREN.

BACKGROUND-The phenomenon of cessation of coordinated bowel motility, commonly called as paralytic ileus is well known after certain surgeries. While procedures that involve direct manipulation of gut are almost always associated with post operative paralytic ileus, even orthopaedic surgeries may also cause post operative paralytic ileus. It contributes signicantly in prolonging hospital stay and is associated with abdominal distension, respiratory compromise, nausea and vomiting. Number of pharmacological and non pharmacological agents have been tried to reduce the post operative paralytic ileus. We studied the effect of sucking lollipop on the return of bowel function in children undergoing distal bowel surgery. AIM-To study effect of lollipop sucking on return of bowel function in children undergoing distal bowel surgery in terms of time to return of bowel, passage of stool per anal. MATERIALAND METHODS-Patients undergoing distal bowel stoma closure were assigned to two groups. The experimental group patients were given lollipops 6 hrs postoperatively, time to return of bowel sound and rst passage of stool was noted and analysed. RESULTS-Mean time to return of bowel sounds in the experimental group was 50.25 + 6.016 hrs, while in control group was 65.87 + 8.83 hrs, difference was statistically signicant (P<0.0001).Mean time to passage of stools in experimental group was 72.312 +12.644 hrs , while in control group was 88.25 + 8.38 hrs. difference was statistically signicant(P=0.0002) . CONCLUSION- Sucking lollipop is a safe and effective in reducing duration of post operative paralytic ileus in paediatric patients undergoing elective bowel surgery.

Artificial Intelligence-Based CT Images in Analysis of Postoperative Recovery of Patients Undergoing Laparoscopic Cholecystectomy under Balanced Anesthesia

To explore whether preoperative processing can promote the recovery of gastrointestinal function after laparoscopic cholecystectomy (LC) surgery, in the study, an artificial intelligence-based algorithm was used to segment the CT images to assist doctors in decision making. The patients were divided into observation group (balanced anesthesia) and control group (general anesthesia) with SPSS. The observation group received balanced anesthesia half a day before the operation. The method of balanced anesthesia was to induce 0.2 mg/kg midazolam, 3 mg/kg propofol, 2 μg/kg remifentanil, 0.2 mg/kg vecuronium, 4∼5 mg/(kg·h) propofol, and 9∼11 μg/(kg·h) remifentanil continuous intravenous infusion to maintain anesthesia, and it was stopped once the patient defecated; the control group had general anesthesia in the afternoon after the operation, and it was stopped once the patient defecated. The time before the first exhaust and defecation after the surgery as well as the recovery time of bowel sound was recorded, and the degree of abdominal pain, abdominal distension, and gastrointestinal adverse reactions was evaluated at 22 hours, 46 hours, and 70 hours after the surgery. It was found that the accuracy of the artificial intelligence-based segmentation algorithm was 81%. The reconstruction accuracy of multidimensional liver could be observed at any angle, and the reconstruction accuracy was not lower than the resolution of original input CT. The calculation error was less than 9%, and the volume of whole liver, liver segment, preresection liver, and residual liver was less than 9%. The simulation accuracy of virtual liver surgery was not lower than the resolution of original input CT. The time before the first exhaust and defecation was shorter in the observation group versus the control group ( P < 0.05). The recovery time of bowel sound in the observation group was shorter than that in the control group ( P < 0.05). There was a significant difference in the scores of abdominal distension between the two groups at 22 h and 46 h after surgery ( P < 0.05). It suggested that both the observation group and the control group could improve the symptoms of gastrointestinal adverse reactions after surgery. Nevertheless, balanced anesthesia can shorten the time before the first exhaust and defecation after surgery and promote the recovery of postoperative bowel sound. Furthermore, balanced anesthesia can alleviate abdominal distension, abdominal pain, and gastrointestinal adverse reactions, which should be promoted in clinic.