Arunachalam, Shivaram P.

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide, accounting for approximately 10% of all cancer cases. Despite the proven effectiveness of conventional screening modalities such as colonoscopy and fecal immunochemical testing (FIT), their invasive nature, high cost, and limited patient compliance hinder widespread adoption. Recent advancements in artificial intelligence (AI) and bowel sound-based signal processing have enabled non-invasive approaches for gastrointestinal diagnostics. Among these, bowel sound analysis—historically considered subjective—has reemerged as a promising biomarker using digital auscultation and machine learning. Objective: This review explores the potential of AI-powered bowel sound analytics for early detection, screening, and characterization of colorectal cancer. It aims to assess current methodologies, summarize reported performance metrics, and highlight translational opportunities and challenges in clinical implementation. Methods: A narrative review was conducted across PubMed, Scopus, Embase, and Cochrane databases using the terms colorectal cancer, bowel sounds, phonoenterography, artificial intelligence, and non-invasive diagnosis. Eligible studies involving human bowel sound-based recordings, AI-based sound analysis, or machine learning applications in gastrointestinal pathology were reviewed for study design, signal acquisition methods, AI model architecture, and diagnostic accuracy. Results: Across studies using convolutional neural networks (CNNs), gradient boosting, and transformer-based models, reported diagnostic accuracies ranged from 88% to 96%. Area under the curve (AUC) values were ≥0.83, with F1 scores between 0.71 and 0.85 for bowel sound classification. In CRC-specific frameworks such as BowelRCNN, AI models successfully differentiate abnormal bowel sound intervals and spectral patterns associated with tumor-related motility disturbances and partial obstruction. Distinct bowel sound-based signatures—such as prolonged sound-to-sound intervals and high-pitched “tinkling” proximal to lesions—demonstrate the physiological basis for CRC detection through bowel sound-based biomarkers. Conclusions: AI-driven bowel sound analysis represents an emerging, exploratory research direction rather than a validated colorectal cancer screening modality. While early studies demonstrate physiological plausibility and technical feasibility, no large-scale, CRC-specific validation studies currently establish sensitivity, specificity, PPV, or NPV for cancer detection. Accordingly, bowel sound analytics should be viewed as hypothesis-generating and potentially complementary to established screening tools, rather than a near-term alternative to validated modalities such as FIT, multitarget stool DNA testing, or colonoscopy.

INTRODUCTION: Clostridioides difficile infection (CDI) presents a significant challenge in patients with inflammatory bowel disease (IBD), with high recurrence rates and complications. Predicting recurrent CDI (rCDI) in patients with IBD is crucial for implementing targeted interventions to improve patient outcomes. This study aimed to develop and validate a predictive model (RecurCDI-IBD) using supervised machine learning to identify patients with IBD at high risk of developing rCDI. METHODS: Data were collected from adult patients with IBD diagnosed with CDI between 2013 and 2021. Inclusion criteria included adult patients with a confirmed diagnosis of CDI and a history of IBD. The Gradient Boosting Machine learning model (XGBoost) was used to train a binary classification model. Feature engineering included demographic data (age and sex), clinical data (IBD subtype, medication use, and comorbidities), and laboratory data. The primary outcome was the occurrence of rCDI within 60 days of the initial CDI episode. RESULTS: The RecurCDI-IBD model achieved an accuracy of 80.05% and an Area Under the Curve of 0.88 for predicting rCDI. Key predictive features included IBD subtype, sex, specific medications (such as steroids and anti-TNF agents), and comorbidities (such as chronic pulmonary and renal disease). DISCUSSION: The RecurCDI-IBD model demonstrates good discriminatory ability with balanced precision and recall in identifying patients with IBD at higher risk for rCDI. These findings highlight the potential of data-driven approaches to support clinical risk assessment. Further studies incorporating larger and more diverse cohorts and prospective external validation are needed to confirm generalizability and optimize clinical applicability.

This study proposes a novel two-dimensional Empirical Mode Decomposition (2D EMD)-based deep learning framework to enhance model performance in multi-class image classification tasks and potential early detection of diseases in healthcare using medical imaging. To validate this approach, we apply it to gastrointestinal (GI) endoscopic image classification using the publicly available Kvasir dataset, which contains eight GI image classes with 1000 images each. The proposed 2D EMD-based design procedure decomposes images into a full set of intrinsic mode functions (IMFs) to enhance image features beneficial for AI model development. Integrating 2D EMD into a deep learning pipeline, we evaluate its impact on four popular models (ResNet152, VGG19bn, MobileNetV3L, and SwinTransformerV2S). The results demonstrate that subtracting IMFs from the original image consistently improves accuracy, F1-score, and AUC for all models. The study reveals a notable enhancement in model performance, with an approximately 9% increase in accuracy compared to counterparts without EMD integration for ResNet152. Similarly, there is an increase of around 18% for VGG19L, 3% for MobileNetV3L, and 8% for SwinTransformerV2. Additionally, explainable AI (XAI) techniques, such as Grad-CAM, illustrate that the model focuses on GI regions for predictions. This study highlights the efficacy of 2D EMD in enhancing deep learning model performance for GI image classification, with potential applications in other domains.

Background: Interstitial lung disease (ILD) involves numerous chronic pulmonary conditions that damage the lung parenchyma and alveolar interstitium. ILD has overlapping clinical and radiological features with other commonly seen cardiac and respiratory conditions. If not identified and treated in a timely manner, it may lead to irreversible fibrosis and a poor prognosis in the patient. The current diagnostic methods are either invasive or reliant on imaging or specialist interpretation, which can lead to diagnostic delay, increased radiation exposure, and healthcare costs. Lung crackles, often under-recognized as a non-specific feature of ILD, may serve as an important diagnostic clue in identifying not only the early stages of ILD but also its subtypes. This review explores the potential of analyzing the lung sounds in ILD through AI-based auscultation. Objective: To provide a comprehensive analysis of the pathophysiological stages of lung injury in ILD, the specific acoustic features, and the location associated with each ILD subtype and to evaluate the current state-of-the-art non-AI and AI methodologies that are used to diagnose ILD. This review aims to analyze the limitations associated with the current modalities and to envision AI-integrated auscultation as a powerful, cost-effective, non-invasive, radiation-free screening tool for early detection of ILD and its subtypes. Content Overview: The review begins with a detailed analysis of the lung sound pathophysiology, exploring the two-stage mechanism of alveolar epithelial injury and fibrosis formation. Existing hypotheses explaining the mechanism behind crackle production and the role of structural anatomy and surface tension in the generation of pathological lung sounds are examined. A tabulated summary of common ILD subtypes is provided, including their inciting events, pathogenesis, anatomical auscultation locations, and prognostic implications. Current diagnostic modalities for ILD, both non-AI and AI-based, are summarized along with their limitations, emphasizing the need for improved diagnostic tools. Discussion: Existing studies suggest that AI-based auscultation can match or exceed the current modalities in its sensitivity and specificity for detecting ILD-related crackles. Clinicians can identify the specific sound pattern and then correlate it with the ILD subtype and understand the prognosis in real time, thereby providing timely intervention to the patient. Additionally, AI-based auscultation can be used in resource-limited settings and can potentially reduce dependence on pulmonology expertise and radiation-based imaging for monitoring the condition. Conclusions: This literature review highlights the clinical potential of AI-based auscultation for early and accurate diagnoses of ILD. Understanding the associated pathological sounds, biomarkers, and genetic mutations linked to different subtypes opens avenues for future development of non-invasive diagnostic panels for ILD in clinical practice.

Phonoenterography (PEG) offers a non-invasive and radiation-free technique to assess gastrointestinal activity through acoustic signal analysis. In this feasibility study, 110 high-resolution PEG recordings (44.1 kHz, 16-bit) were acquired from eight healthy individuals, yielding 6314 prominent bowel sound (PBS) segments through automated segmentation. Each event was characterized using a 279-feature acoustic profile comprising Mel-frequency cepstral coefficients (MFCCs), their first-order derivatives (Δ-MFCCs), and six global spectral parameters. After normalization and dimensionality reduction with PCA and UMAP (cosine distance, 35 neighbors, minimum distance = 0.01), five clustering strategies were evaluated. K-Means (k = 5) achieved the most favorable balance between cluster quality (silhouette = 0.60; Calinski–Harabasz = 19,165; Davies–Bouldin = 0.68) and interpretability, consistently identifying five acoustic patterns: single-burst, multiple-burst, harmonic, random-continuous, and multi-modal. Temporal modeling of clustered events further revealed distinct sequential dynamics, with Single-Burst events showing the longest dwell times, random continuous the shortest, and strong diagonal elements in the transition matrix confirming measurable state persistence. Frequent transitions between random continuous and multi-modal states suggested dynamic exchanges between transient and overlapping motility patterns. Together, these findings demonstrate that unsupervised PEG-based analysis can capture both acoustic variability and temporal organization of bowel sounds. This annotation-free approach provides a scalable framework for real-time gastrointestinal monitoring and holds potential for clinical translation in conditions such as postoperative ileus, bowel obstruction, irritable bowel syndrome, and inflammatory bowel disease.

Background/Objectives: Menopause, marked by permanent cessation of menstruation, is a universal transition associated with vasomotor, genitourinary, psychological, and metabolic changes. These conditions significantly affect health-related quality of life (HRQoL) and increase the risk of chronic diseases. Despite their impact, timely diagnosis and individualized management are often limited by delayed care, fragmented health systems, and cultural barriers. Methods: This review summarizes current applications of artificial intelligence (AI) in postmenopausal health, focusing on risk prediction, early detection, and personalized treatment. Evidence was compiled from studies using biomarkers, imaging, wearable sensors, electronic health records, natural language processing, and digital health platforms. Results: AI enhances disease prediction and diagnosis, including improved accuracy in breast cancer and osteoporosis screening through imaging analysis, and cardiovascular risk stratification via machine learning models. Wearable devices and natural language processing enable real-time monitoring of underreported symptoms such as hot flushes and mood disorders. Digital technologies further support individualized interventions, including lifestyle modification and optimized medication regimens. By improving access to telemedicine and reducing bias, AI also has the potential to narrow healthcare disparities. Conclusions: AI can transform postmenopausal care from reactive to proactive, offering personalized strategies that improve outcomes and quality of life. However, challenges remain, including algorithmic bias, data privacy, and clinical implementation. Ethical frameworks and interdisciplinary collaboration among clinicians, data scientists, and policymakers are essential for safe and equitable adoption.

Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a life-threatening vascular complication of SSc, marked by high morbidity and mortality. Early diagnosis remains a major challenge due to nonspecific symptoms and the limitations of conventional tools such as echocardiography (ECHO), pulmonary function tests (PFTs), and serum biomarkers. This review evaluates the emerging role of artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), in improving the diagnostic landscape of SSc-PAH. A comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, Embase and Google Scholar to identify studies involving AI applications in SSc, pulmonary arterial hypertension (PAH), and their intersection. Evidence indicates that AI models can assist interpretation across modalities, including heart sounds, ECGs, chest X-rays (CXRs), ECHOs, CT pulmonary angiography (CTPA), and omics-based biomarkers. While several models show encouraging diagnostic performance, their accuracy varies by dataset and modality, and most require external validation against right heart catheterization (RHC)-confirmed cohorts. Integrating multimodal data through AI frameworks may enhance early recognition and individualized risk stratification; however, these tools remain exploratory. Future work should emphasize harmonized hemodynamic definitions, transparent validation protocols, and SSc-specific datasets to ensure clinical applicability and reproducibility.

Background: This narrative review examines the role of artificial intelligence (AI) in bowel sound analysis for the diagnosis and management of inflammatory bowel disease (IBD). Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, presents a significant clinical burden due to its unpredictable course, variable symptomatology, and reliance on invasive procedures for diagnosis and disease monitoring. Despite advances in imaging and biomarkers, tools such as colonoscopy and fecal calprotectin remain costly, uncomfortable, and impractical for frequent or real-time assessment. Meanwhile, bowel sounds—an overlooked physiologic signal—reflect underlying gastrointestinal motility and inflammation but have historically lacked objective quantification. With recent advances in artificial intelligence (AI) and acoustic signal processing, there is growing interest in leveraging bowel sound analysis as a novel, non-invasive biomarker for detecting IBD, monitoring disease activity, and predicting disease flares. This approach holds the promise of continuous, low-cost, and patient-friendly monitoring, which could transform IBD management. Objectives: This narrative review assesses the clinical utility, methodological rigor, and potential future integration of artificial intelligence (AI)-driven bowel sound analysis in inflammatory bowel disease (IBD), with a focus on its potential as a non-invasive biomarker for disease activity, flare prediction, and differential diagnosis. Methods: This manuscript reviews the potential of AI-powered bowel sound analysis as a non-invasive tool for diagnosing, monitoring, and managing inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. Traditional diagnostic methods, such as colonoscopy and biomarkers, are often invasive, costly, and impractical for real-time monitoring. The manuscript explores bowel sounds, which reflect gastrointestinal motility and inflammation, as an alternative biomarker by utilizing AI techniques like convolutional neural networks (CNNs), transformers, and gradient boosting. We analyze data on acoustic signal acquisition (e.g., smart T-shirts, smartphones), signal processing methodologies (e.g., MFCCs, spectrograms, empirical mode decomposition), and validation metrics (e.g., accuracy, F1 scores, AUC). Studies were assessed for clinical relevance, methodological rigor, and translational potential. Results: Across studies enrolling 16–100 participants, AI models achieved diagnostic accuracies of 88–96%, with AUCs ≥ 0.83 and F1 scores ranging from 0.71 to 0.85 for differentiating IBD from healthy controls and IBS. Transformer-based approaches (e.g., HuBERT, Wav2Vec 2.0) consistently outperformed CNNs and tabular models, yielding F1 scores of 80–85%, while gradient boosting on wearable multi-microphone recordings demonstrated robustness to background noise. Distinct acoustic signatures were identified, including prolonged sound-to-sound intervals in Crohn’s disease (mean 1232 ms vs. 511 ms in IBS) and high-pitched tinkling in stricturing phenotypes. Despite promising performance, current models remain below established biomarkers such as fecal calprotectin (~90% sensitivity for active disease), and generalizability is limited by small, heterogeneous cohorts and the absence of prospective validation. Conclusions: AI-powered bowel sound analysis represents a promising, non-invasive tool for IBD monitoring. However, widespread clinical integration requires standardized data acquisition protocols, large multi-center datasets with clinical correlates, explainable AI frameworks, and ethical data governance. Future directions include wearable-enabled remote monitoring platforms and multi-modal decision support systems integrating bowel sounds with biomarker and symptom data. This manuscript emphasizes the need for large-scale, multi-center studies, the development of explainable AI frameworks, and the integration of these tools within clinical workflows. Future directions include remote monitoring using wearables and multi-modal systems that combine bowel sounds with biomarkers and patient symptoms, aiming to transform IBD care into a more personalized and proactive model.

Background: Lung cancer remains the leading cause of cancer-related mortality globally, largely due to delayed diagnosis in its early stages. While conventional diagnostic tools like low-dose CT and tissue biopsy are routinely used, they suffer from limitations including invasiveness, radiation exposure, cost, and limited sensitivity for early-stage detection. Liquid biopsy, a minimally invasive alternative that captures circulating tumor-derived biomarkers such as ctDNA, cfRNA, and exosomes from body fluids, offers promising diagnostic potential—yet its sensitivity in early disease remains suboptimal. Recent advances in Artificial Intelligence (AI) and radiomics are poised to bridge this gap. Objective: This review aims to explore how AI, in combination with radiomics, enhances the diagnostic capabilities of liquid biopsy for early detection of lung cancer and facilitates personalized monitoring strategies. Content Overview: We begin by outlining the molecular heterogeneity of lung cancer, emphasizing the need for earlier, more accurate detection strategies. The discussion then transitions into liquid biopsy and its key analytes, followed by an in-depth overview of AI techniques—including machine learning (e.g., SVMs, Random Forest) and deep learning models (e.g., CNNs, RNNs, GANs)—that enable robust pattern recognition across multi-omics datasets. The role of radiomics, which quantitatively extracts spatial and morphological features from imaging modalities such as CT and PET, is explored in conjunction with AI to provide an integrative, multimodal approach. This convergence supports the broader vision of precision medicine by integrating omics data, imaging, and electronic health records. Discussion: The synergy between AI, liquid biopsy, and radiomics signifies a shift from traditional diagnostics toward dynamic, patient-specific decision-making. Radiomics contributes spatial information, while AI improves pattern detection and predictive modeling. Despite these advancements, challenges remain—including data standardization, limited annotated datasets, the interpretability of deep learning models, and ethical considerations. A push toward rigorous validation and multimodal AI frameworks is necessary to facilitate clinical adoption. Conclusion: The integration of AI with liquid biopsy and radiomics holds transformative potential for early lung cancer detection. This non-invasive, scalable, and individualized diagnostic paradigm could significantly reduce lung cancer mortality through timely and targeted interventions. As technology and regulatory pathways mature, collaborative research is crucial to standardize methodologies and translate this innovation into routine clinical practice.