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By John Schieszer
Medical Minutes 

New 'smart toilet' will be able to analyze stool

Also: Sniffing out ovarian cancer; latest recommendations for optimal exercise


July 1, 2021 | View PDF

Smart toilet may be able to analyze stool

For the first time, researchers are suggesting that an artificial intelligence tool can be used for long-term tracking and management of chronic gastrointestinal ailments. Scientists at Duke University have added an artificial intelligence tool to the standard toilet to help analyze patients’ stool and give gastroenterologists the information they need to provide appropriate treatment, according to a new study. This novel technology could assist in managing chronic gastrointestinal issues such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

“Typically, gastroenterologists have to rely on patient self-reported information about their stool to help determine the cause of their gastrointestinal health issues, which can be very unreliable,” said lead study investigator Dr. Deborah Fisher, an associate professor of medicine at Duke University in Durham, North Carolina. “Patients often can’t remember what their stool looks like or how often they have a bowel movement, which is part of the standard monitoring process. The Smart Toilet technology will allow us to gather the long-term information needed to make a more accurate and timely diagnosis of chronic gastrointestinal problems.”

The technology can be retrofitted within the pipes of an existing toilet. Once a person has a bowel movement and flushes, the toilet will take an image of the stool within the pipes. The data collected over time can provide a better understanding of a patient’s stool form (loose, normal or constipated) and if there is the presence of blood. The Smart Toilet could help diagnose problems and point to the right treatment.

To develop the artificial intelligence image analysis tool for the Smart Toilet, researchers analyzed 3,328 unique stool images found online or provided by research participants. All images were reviewed and annotated by gastroenterologists according to the Bristol Stool Scale, a common clinical tool for classifying stool. The researchers found that the algorithm accurately classified the stool form 85.1% of the time and blood detection had an accuracy of 76.3%.

“We are optimistic about patient willingness to use this technology because it’s something that can be installed in their toilet’s pipes and doesn’t require the patient to do anything other than flush,” said lead study investigator Sonia Grego, who is the founding director of the Duke Smart Toilet Lab. “An IBD flare-up could be diagnosed using the Smart Toilet and the patient’s response to treatment could be monitored with the technology. This could be especially useful for patients who live in long-term care facilities who may not be able to report their conditions and could help improve initial diagnosis of acute conditions.”

The prototype has promising feasibility, but it is not yet available to the public. Researchers are developing additional features of the technology to include stool specimen sampling for biochemical marker analysis.

Electronic nose sniffs out cancer

There may be a whole new way to identify pancreatic and ovarian cancer. An odor-based test that sniffs out vapors emanating from blood samples was able to distinguish between benign and pancreatic and ovarian cancer cells with up to 95% accuracy, according to a new study from researchers at the University of Pennsylvania and Penn’s Perelman School of Medicine, Philadelphia, Pennsylvania.

The researchers developed a tool that uses artificial intelligence and machine learning to decipher the mixture of volatile organic compounds (VOCs) emitting off cells in blood samples. They found that this could serve as a non-invasive approach to screen for harder-to-detect cancers, such as pancreatic and ovarian.

“It’s an early study but the results are very promising,” said A. T. Charlie Johnson, who is a Professor of Physics and Astronomy in Penn’s School of Arts & Sciences. “The data show we can identify these tumors at both advanced and the earliest stages, which is exciting. If developed appropriately for the clinical setting, this could potentially be a test that’s done on a standard blood draw that may be part of your annual physical.”

The E-nose system is equipped with nanosensors calibrated to detect the composition of VOCs, which all cells emanate. Previous studies from the researchers demonstrated that VOCs released from tissue and plasma from ovarian cancer patients are distinct from those released from samples of patients with benign tumors.

Among 93 patients, including 20 patients with ovarian cancer and 20 with benign ovarian tumors, the vapor sensors discriminated the VOCs from ovarian cancer with 95% accuracy and pancreatic cancer with 90% accuracy. The tool also correctly identified all patients with early-stage cancers.

The technology’s pattern recognition approach is similar to the way people’s own sense of smell works, where a distinct mixture of compounds tells the brain what it’s smelling. The tool was trained and tested to identify the VOC patterns more associated with cancer cells and those associated with cells from healthy blood samples in 20 minutes or less.

An exercise cocktail may be optimal approach

A new study from the University of Alabama at Birmingham (UAB) is suggesting there are multiple ways to achieve the same health benefits from exercise, as long as your exercise “cocktail” includes plenty of light physical activity. The study employed data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study, a long-running national study of differences in stroke.

“For decades, we’ve been telling people that the way to stay healthy is to get at least 30 minutes of exercise five days a week,” said study investigator Keith Diaz, an assistant professor of behavioral medicine and director of the Exercise Testing Laboratory at the Center for Behavioral Cardiovascular Health at Columbia University Vagelos College of Physicians and Surgeons. “But even if you’re one of the few adults who can stick to this advice, 30 minutes represents just 2% of your entire day.”

The recommendation about how much exercise to do is not wrong per se, according to Diaz. However, it may be insufficient depending on how individuals spend the rest of their waking day. Previous studies tended to look at the impact of one type of activity or another in isolation. But each activity has either harmful or beneficial effects on health.

Only with the recent advent of inexpensive and easy-to-use activity monitors, which can be worn by study participants throughout the day, have researchers been able to address the question. With data from six such studies including more than 130,000 adults in the United Kingdom, United States and Sweden, the authors used a technique called compositional analysis to determine how different combinations of activities affect mortality.

They found the benefits of 30 minutes of moderate to vigorous exercise depend on how you spend the rest of the day. The current recommendation of 30 minutes per day of moderate to vigorous physical activity reduced the odds of an earlier death by up to 80% but only for some individuals.

“It is not as simple as checking off that ‘exercise’ box on your to-do list,” said Diaz. “A healthy movement profile requires more than 30 minutes of daily exercise. Moving around and not remaining sedentary all day also matters.”

The researchers found that people who spent just a few minutes engaging in moderate to vigorous physical activity lowered their risk of early death by 30% as long as they also spent six hours engaging in light physical activity.

“Getting 30 minutes of physical activity per day or 150 minutes per week is what’s currently recommended, but you still have the potential to undo all that good work if you sit too long,” said study investigator Virginia Howard, a professor of epidemiology in the UAB School of Public Health.

The researchers say a cocktail formula of 3 to 1 is best. They found that getting three minutes of moderate to vigorous activity or 12 minutes of light activity per hour of sitting was optimal for improving health and reducing the risk of early death.

“This new formula gets at the right balance between moderate to vigorous exercise and sitting to help people lead longer, healthier lives,” said Howard.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at

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John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.

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