Artificial intelligence-based classification of cardiac autonomic neuropathy from retinal fundus images in patients with diabetes: The Silesia Diabetes Heart Study.

BACKGROUND: Cardiac autonomic neuropathy (CAN) in diabetes mellitus (DM) is independently associated with cardiovascular (CV) events and CV death. Diagnosis of this complication of DM is time-consuming and not routinely performed in the clinical practice, in contrast to fundus retinal imaging which is accessible and routinely performed. Whether artificial intelligence (AI) utilizing retinal images collected through diabetic eye screening can provide an efficient diagnostic method for CAN is unknown. METHODS: This was a single center, observational study in a cohort of patients with DM as a part of the Cardiovascular Disease in Patients with Diabetes: The Silesia Diabetes-Heart Project (NCT05626413). To diagnose CAN, we used standard CV autonomic reflex tests. In this analysis we implemented AI-based deep learning techniques with non-mydriatic 5-field color fundus imaging to identify patients with CAN. Two experiments have been developed utilizing Multiple Instance Learning and primarily ResNet 18 as the backbone network. Models underwent training and validation prior to testing on an unseen image set. RESULTS: In an analysis of 2275 retinal images from 229 patients, the ResNet 18 backbone model demonstrated robust diagnostic capabilities in the binary classification of CAN, correctly identifying 93% of CAN cases and 89% of non-CAN cases within the test set. The model achieved an area under the receiver operating characteristic curve (AUCROC) of 0.87 (95% CI 0.74-0.97). For distinguishing between definite or severe stages of CAN (dsCAN), the ResNet 18 model accurately classified 78% of dsCAN cases and 93% of cases without dsCAN, with an AUCROC of 0.94 (95% CI 0.86-1.00). An alternate backbone model, ResWide 50, showed enhanced sensitivity at 89% for dsCAN, but with a marginally lower AUCROC of 0.91 (95% CI 0.73-1.00). CONCLUSIONS: AI-based algorithms utilising retinal images can differentiate with high accuracy patients with CAN. AI analysis of fundus images to detect CAN may be implemented in routine clinical practice to identify patients at the highest CV risk. TRIAL REGISTRATION: This is a part of the Silesia Diabetes-Heart Project (Clinical-Trials.gov Identifier: NCT05626413).

Liquefaction pathway of corn stalk cellulose in the presence of polyhydric alcohols under acid catalysis.

In this paper, the experiment of cellulose from corn stalk using 1, 2-propylene glycol (PG) and diethylene glycol (DEG) liquefaction catalyzed by phosphoric acid at atmosphere pressure was carried out. The effect of reaction time on the structural changes of cellulose in the liquefaction process of polyhydric alcohols was investigated, aiming at understanding the mechanism of cellulose liquefaction reaction under the action of acid catalyzed polyhydric alcohols. It was found that the liquefaction yield increased first and then decreased with the extension of reaction time, and reached the highest at 150 min (99.34 %). In the phase of increasing liquefaction yield, cellulose was degraded and translated into glucose, which was then converted into plenty of glycosides with PG/DEG. These glycosides were further converted into low molecular weight (LMW) substances such as hydrocarbons, acids, alcohols, esters, ketones, and ethers. At this time, the biofuel contained 70 %-85 % compounds with carbon number less than 25 and 5 %-10 % compounds with carbon number more than 25. As the prolongation of reaction time (after 150 min), quantities of unstable free radicals formed by cellulose degradation could combine with each other or with hydrogen atoms provided by PG/DEG to produce relatively stable macromolecular substances. That is, the polydispersity (Mw/Mn, abbreviated Р= 1.28) of the generated biofuel at this stage no longer decreased. However, liquefaction residue produced at 240 min had changed essentially, which was completely different from the liquefaction residue produced in the early stage of liquefaction. In conclusion, this paper revealed the partial reaction process of cellulose by studying the structural changes in the liquefaction process of polyhydric alcohols, which laid a theoretical foundation for exploring the liquefaction mechanism of cellulose.