Diagnostic Accuracy of Computerized Bowel Sound Analysis with Non-Invasive Devices for Irritable Bowel Syndrome:A Systematic Review and Meta-Analysis

Objective To assess the diagnostic accuracy of bowel sound analysis for irritable bowel syndrome(IBS)with a systematic review and meta-analysis.Methods We searched MEDLINE,Embase,the Cochrane Library,Web of Science,and IEEE Xplore databases until September 2023.Cross-sectional and case-control studies on diagnostic accuracy of bowel sound analysis for IBS were identified.We estimated the pooled sensitivity,specificity,positive likelihood ratio,negative likeli-hood ratio,and diagnostic odds ratio with a 95% confidence interval(CI),and plotted a summary receiver operat-ing characteristic curve and evaluated the area under the curve.Results Four studies were included.The pooled diagnostic sensitivity,specificity,positive likelihood ratio,nega-tive likelihood ratio,and diagnostic odds ratio were 0.94(95%CI,0.87‒0.97),0.89(95%CI,0.81‒0.94),8.43(95%CI,4.81‒14.78),0.07(95%CI,0.03‒0.15),and 118.86(95%CI,44.18‒319.75),respectively,with an area under the curve of 0.97(95%CI,0.95‒0.98).Conclusions Computerized bowel sound analysis is a promising tool for IBS.However,limited high-quality data make the results'validity and applicability questionable.There is a need for more diagnostic test accuracy studies and better wearable devices for monitoring and analysis of IBS.

Intraoperative Blood Pressure Lability Acts as a Key Mediator in the Impacts of Goal-Directed Fluid Therapy on Postoperative Complications in Patients Undergoing Major Spine Surgery

Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.

Machine learning improves prediction of severity and outcomes of acute pancreatitis:a prospective multi-center cohort study

Dear Editor,Acute pancreatitis(AP)is a common acute pancreatic disease of variable severity and outcomes(Mederos et al.,2021).According to systemic and local complications,patients can be classified into severe,moderately severe,and mild AP(Banks et al.,2013).About 20%of AP patients develop severe acute pancreatitis(SAP,with persistent organ failures)of whom 20%–50%die.

Regional anesthesia and cancer recurrence in patients with late-stage cancer:a systematic review and meta-analysis

Background:Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial.The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect.We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.Methods:Medline,Embase,and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials(RCTs)and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival(OS)compared with general anesthesia.Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual(eighth edition),and the combined hazard ratio(HR)from random-effects models was used to evaluate the effect of regional anesthesia.Results:A total of three RCTs and 34 cohort studies(including 64,691 patients)were identified through the literature search for inclusion in the analysis.The risk of bias was low in the RCTs and was moderate in the observational studies.The pooled HR for recurrence-free survival(RFS)or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined(RFS,HR=1.12,95%confidence interval[CI]:0.58-2.18,P=0.729,I2=76%;OS,HR=0.86,95%CI:0.63-1.18,P=0.345,I^(2)=48%).Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence(HR=0.87,95%CI:0.78-0.96,P=0.008,I2=71%)and improve OS(HR=0.88,95%CI:0.79-0.98,P=0.022,I^(2)=79%).Conclusions:RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers.The selection of anesthetic methods should still be based on clinical evaluation,and changes to current practice need more support from large,well-powered,and well-designed studies.

Remote video lecture education improves anesthesiology residency training in Tibet of China

To the Editor:The Qinghai-Tibet Plateau,called the roof of the world,is an extremely harsh environment with scarce medical resources.[1]After the founding of the People’s Republic of China,the Chinese government has invested a lot of financial support to develop Tibet Autonomous Region and to improve the quality of healthcare.The life expectancy of the whole district has increased from 36 years old in the 1950s to 68 years old currently,and the population has grown from less than 1 million in the 1950s to 3.31 million today.