The Present and Future of Artificial Intelligence-Based Medical Image in Diabetes Mellitus: Focus on Analytical Methods and Limitations of Clinical Use

Artificial intelligence (AI)-based diagnostic technology using medical images can be used to increase examination accessibility and support clinical decision-making for screening and diagnosis. To determine a machine learning algorithm for diabetes complications, a literature review of studies using medical image-based AI technology was conducted using the National Library of Medicine PubMed, and the Excerpta Medica databases. Lists of studies using diabetes diagnostic images and AI as keywords were combined. In total, 227 appropriate studies were selected. Diabetic retinopathy studies using the AI model were the most frequent (85.0%, 193/227 cases), followed by diabetic foot (7.9%, 18/227 cases) and diabetic neuropathy (2.7%, 6/227 cases). The studies used open datasets (42.3%, 96/227 cases) or directly constructed data from fundoscopy or optical coherence tomography (57.7%, 131/227 cases). Major limitations in AI-based detection of diabetes complications using medical images were the lack of datasets (36.1%, 82/227 cases) and severity misclassification (26.4%, 60/227 cases). Although it remains difficult to use and fully trust AI-based imaging analysis technology clinically, it reduces clinicians’ time and labor, and the expectations from its decision-support roles are high. Various data collection and synthesis data technology developments according to the disease severity are required to solve data imbalance.

Reduced Volume of a Brainstem Substructure in Adolescents with Problematic Smartphone Use

Objectives@#Despite the growing concern regarding the adverse effects related to problematic smartphone use (PSU), little is known about underlying morphologic changes in the brain. The brainstem is a deep brain structure that consists of several important nuclei associated with emotions, sensations, and motor functions. In this study, we sought to examine the difference in the volume of brainstem substructures among adolescents with and without PSU. @*Methods@#A total of 87 Korean adolescents participated in this study. The PSU group (n=20, age=16.2±1.1, female:male=12:8) was designated if participants reported a total Smartphone Addiction Proneness Scale (SAPS) score of ≥42, whereas the remaining participants were assigned to the control group (n=67, age=15.3±1.7, female:male=19:48). High-resolution T1 magnetic resonance imaging was performed, and the volume of each of the four brainstem substructures [midbrain, pons, medulla, and superior cerebellar peduncle (SCP)] was measured. Analysis of covariance was conducted to reveal group differences after adjusting for effects of age, gender, whole brainstem volume, depressive symptoms, and impulsivity. @*Results@#The PSU group showed a significantly smaller volume of the SCP than the control group (F=8.273, p=0.005). The volume of the SCP and the SAPS score were negatively correlated (Pearson’s r=-0.218, p=0.047). @*Conclusion@#The present study is the first to reveal an altered volume of the brainstem substructure among adolescents with PSU. This finding suggests that the altered white matter structure in the brainstem could be one of the neurobiological mechanisms underlying behavioral changes in PSU.

Reduced Volume of a Brainstem Substructure in Adolescents with Problematic Smartphone Use

Objectives@#Despite the growing concern regarding the adverse effects related to problematic smartphone use (PSU), little is known about underlying morphologic changes in the brain. The brainstem is a deep brain structure that consists of several important nuclei associated with emotions, sensations, and motor functions. In this study, we sought to examine the difference in the volume of brainstem substructures among adolescents with and without PSU. @*Methods@#A total of 87 Korean adolescents participated in this study. The PSU group (n=20, age=16.2±1.1, female:male=12:8) was designated if participants reported a total Smartphone Addiction Proneness Scale (SAPS) score of ≥42, whereas the remaining participants were assigned to the control group (n=67, age=15.3±1.7, female:male=19:48). High-resolution T1 magnetic resonance imaging was performed, and the volume of each of the four brainstem substructures [midbrain, pons, medulla, and superior cerebellar peduncle (SCP)] was measured. Analysis of covariance was conducted to reveal group differences after adjusting for effects of age, gender, whole brainstem volume, depressive symptoms, and impulsivity. @*Results@#The PSU group showed a significantly smaller volume of the SCP than the control group (F=8.273, p=0.005). The volume of the SCP and the SAPS score were negatively correlated (Pearson’s r=-0.218, p=0.047). @*Conclusion@#The present study is the first to reveal an altered volume of the brainstem substructure among adolescents with PSU. This finding suggests that the altered white matter structure in the brainstem could be one of the neurobiological mechanisms underlying behavioral changes in PSU.

Comorbid Depression Interferes with Emotional Regulation in Adolescents with Internet Gaming Disorder / 신경정신의학

OBJECTIVES: We investigated the effects of depression on emotional regulation in adolescents with internet gaming disorder. METHODS: A stroop Match-to-Sample task with emotional interference was applied to 36 male adolescents to investigate how emotional stimuli (angry faces) interfered with performance of the stroop task in male adolescents with internet gaming disorder. For evaluation of psychiatric symptoms and personal characteristics, participants were asked to complete self-reports, including Beck Depression Inventory (BDI), Beck Anxiety Inventory, Barratt Impulsiveness Scale, and the Aggression Questionnaire. RESULTS: In emotionally interfered conditions, there was no significant difference of reaction time between the internet gaming disorder group and the healthy control group. However, the internet gaming disorder group showed a tendency of longer reaction time and lower accuracy rate in emotionally interfered condition, which can account for emotion regulation difficulties in the internet gaming disorder group. According to analysis of covariance and stepwise multiple linear regression analysis, BDI score showed association with reaction time of results. CONCLUSION: These results indicate that adolescents with internet gaming disorder may experience more difficulties in emotion regulation during attention-required situations than those in the control group, and comorbid depression contributes to faulty emotional regulation in adolescents with internet gaming disorder.

Comorbid Depression Interferes with Emotional Regulation in Adolescents with Internet Gaming Disorder / 신경정신의학

OBJECTIVES: We investigated the effects of depression on emotional regulation in adolescents with internet gaming disorder. METHODS: A stroop Match-to-Sample task with emotional interference was applied to 36 male adolescents to investigate how emotional stimuli (angry faces) interfered with performance of the stroop task in male adolescents with internet gaming disorder. For evaluation of psychiatric symptoms and personal characteristics, participants were asked to complete self-reports, including Beck Depression Inventory (BDI), Beck Anxiety Inventory, Barratt Impulsiveness Scale, and the Aggression Questionnaire. RESULTS: In emotionally interfered conditions, there was no significant difference of reaction time between the internet gaming disorder group and the healthy control group. However, the internet gaming disorder group showed a tendency of longer reaction time and lower accuracy rate in emotionally interfered condition, which can account for emotion regulation difficulties in the internet gaming disorder group. According to analysis of covariance and stepwise multiple linear regression analysis, BDI score showed association with reaction time of results. CONCLUSION: These results indicate that adolescents with internet gaming disorder may experience more difficulties in emotion regulation during attention-required situations than those in the control group, and comorbid depression contributes to faulty emotional regulation in adolescents with internet gaming disorder.

Deficits in Abstract Thinking Assessed by Theme Identification in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Patients with schizophrenia often have a concrete thinking or an impairment in abstract thinking, but there has been a limitation in quantitatively measuring this cognitive function. The aim of the current study was to investigate a deficit in abstract thinking in patients with schizophrenia using the theme identification task. METHODS: Twenty subjects with schizophrenia and 20 healthy volunteers participated in the behavioral study for theme identification. The visual stimuli were composed of a series of pictures, which contained positive or negative emotional situations. Three words, indicating a main theme of the picture, a theme-related item and a theme-unrelated item, respectively, were presented in the bottom of the pictures, and participants had to select a theme. RESULTS: The patient group selected theme words at significantly lower rate in both emotional conditions than the control group (positive, p=0.002 ; negative, p=0.001). Especially, in the negative condition, the patient group more selected theme-unrelated items than the control group (p=0.001). The rates of theme identification were inversely correlated with scores of the Social Anhedonia Scale (positive, r=-0.440, p=0.007 ; negative, r=-0.366, p=0.028). CONCLUSION: Patients with schizophrenia exhibited an impairment in abstract thinking, and it was remarkable in the negative condition. The ability to think abstractly was associated with the severity of social anhedonia. The impairment of abstract thinking may become one of the reasons for poor social functioning in socially anhedonic patients.

Is the GABA System Related to the Social Competence Improvement Effect of Aripiprazole? An 18F-Fluoroflumazenil PET Study

OBJECTIVE: Patients with schizophrenia who are treated with aripiprazole experience some benefits including an improvement of social competence, but the underlying mechanism of this improvement has not been investigated yet. This study aimed to provide preliminary evidence that the GABA system may be involved in the effect of aripiprazole on social competence. METHODS: Seventeen outpatients with schizophrenia (9 taking aripiprazole and 8 taking risperidone) and 18 healthy controls underwent 18F-fluoroflumazenil PET, and GABAA receptor binding potential was compared between the three groups. RESULTS: Voxelwise one-way ANOVA showed that GABAA receptor binding potentials in the right medial prefrontal cortex (p=0.04) and right dorsolateral prefrontal cortex (p=0.02) were significantly lower in the aripiprazole group than the risperidone group, and those in the left frontopolar cortex (p=0.03) and right premotor cortex (p=0.02) were significantly lower in the aripiprazole group than the risperidone and control groups. CONCLUSION: Our results suggest that aripiprazole administration results in increased GABA transmission in the prefrontal regions, and that these increases may be a neural basis of aripiprazole's clinical benefits on an improvement of social competence.

Deficit of Executive Control of Positive Emotional Information and Its Association with Social Anhedonia in Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Schizophrenia has been considered to be characterized by an abnormality in attention, especially in the executive control. Emotion is an important component of the executive control. The aim of this study was to investigate the influence of emotion on the executive control in patients with schizophrenia. METHODS: Participants were 20 healthy controls and 19 subjects with schizophrenia. They viewed full-color pictures selected from the International Affective Picture System. During each trial, an emotional picture, which was either positive or negative, lit up on either the left or right side. Participants were instructed to respond to the emotional valance of each stimulus by pressing a button with their left or right index finger, while ignoring its presented side. RESULTS: There was a group difference in the response time, and patients with schizophrenia exhibited an impairment in the executive control of emotional information. However, there was no difference in the response time between the emotional conditions. In the patient group, the missing rate in the positive emotional condition was correlated with the severity of social anhedonia, whereas the missing rate in the negative emotional condition was correlated with the severity of positive symptoms. CONCLUSION: Patients with schizophrenia have a deficit in the executive control of positive emotional information as well as negative emotion, but it may be due to different underlying mechanisms.

Deficit of Executive Control of Positive Emotional Information and Its Association with Social Anhedonia in Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Schizophrenia has been considered to be characterized by an abnormality in attention, especially in the executive control. Emotion is an important component of the executive control. The aim of this study was to investigate the influence of emotion on the executive control in patients with schizophrenia. METHODS: Participants were 20 healthy controls and 19 subjects with schizophrenia. They viewed full-color pictures selected from the International Affective Picture System. During each trial, an emotional picture, which was either positive or negative, lit up on either the left or right side. Participants were instructed to respond to the emotional valance of each stimulus by pressing a button with their left or right index finger, while ignoring its presented side. RESULTS: There was a group difference in the response time, and patients with schizophrenia exhibited an impairment in the executive control of emotional information. However, there was no difference in the response time between the emotional conditions. In the patient group, the missing rate in the positive emotional condition was correlated with the severity of social anhedonia, whereas the missing rate in the negative emotional condition was correlated with the severity of positive symptoms. CONCLUSION: Patients with schizophrenia have a deficit in the executive control of positive emotional information as well as negative emotion, but it may be due to different underlying mechanisms.

Anhedonia and Ambivalence in Schizophrenic Patients with Fronto-Cerebellar Metabolic Abnormalities: A Fluoro-D-Glucose Positron Emission Tomography Study

OBJECTIVE: Prefrontal and cerebellar abnormalities have been associated with higher cognitive deficits in schizophrenia. The current study aimed to show whether or not schizophrenic patients with fronto-cerebellar functional abnormalities show more anhedonia or ambivalence. METHODS: Regional cerebral metabolic activity was measured using fluoro-D-glucose positron emission tomography and was compared between 24 patients with chronic schizophrenia and 22 healthy normal volunteers. The existence of regional prefrontal hypofunction and regional cerebellar hyperfunction was investigated in each patient. Demographic and clinical variables including the emotional self-report scales were compared between the subgroups of the patients categorized according to the existence and the absence of the regional dysfunctions. RESULTS: Comparisons between each patient and the total normal controls revealed that 14 of the total twenty-four patients had regional hypofrontal functions, whereas 11 patients had regional hypercerebellar functions. Patients with prefrontal hypofunction showed more severe anhedonia than those without prefrontal hypofunction, whereas patients with cerebellar hyperfunction compared to those without cerebellar hyperfunction had more severe ambivalence. CONCLUSION: It seems that fronto-cerebellar abnormalities may be associated with cardinal emotional features of schizophrenia, such as anhedonia and ambivalence.