Machine learning identifies metabolic dysfunction associated steatotic liver disease in patients with diabetes mellitus.

BACKGROUND & AIMS: The presence of metabolic dysfunction associated steatotic liver disease (MASLD) in patients with diabetes mellitus (DM) is associated with a high risk of cardiovascular disease, but is often under-diagnosed. The objective is to develop machine learning (ML) models for risk assessment of MASLD occurrence in patients with DM. METHODS: Feature selection determined the discriminative parameters, utilized to classify DM patients as those with and without MASLD. The multiple logistic regression (MLR) model's performance was quantified by sensitivity, specificity, percentage of correctly classified patients, and receiver operating characteristic (ROC) curve analysis. Decision curve analysis (DCA) assessed the model's net benefit for alternative treatments. RESULTS: We studied 2000 patients with DM (mean age 58.85±17.37 years; 48% women). Eight parameters: age, body mass index, type of DM, alanine aminotransferase, aspartate aminotransferase, platelet count, hyperuricaemia, and treatment with metformin were identified as discriminative. The experiments for 1735 patients show that 744/991 (75.08%) and 586/744 (78.76%) patients with/without MASLD were correctly identified (sensitivity/specificity: 0.75/0.79). The area under ROC (AUC) was 0.84 (95%CI: 0.82-0.86), while DCA showed a higher model's clinical utility, ranging from 30-84% threshold probability. Results for 265 test patients confirm the model's generalizability (sensitivity/specificity: 0.80/0.74, AUC: 0.81 [95%CI: 0.76-0.87]), whereas unsupervised clustering identified high-risk patients. CONCLUSIONS: A ML approach demonstrated high performance in identifying MASLD in patients with DM. This approach may facilitate better risk stratification and cardiovascular risk prevention strategies for high-risk patients with DM at risk of MASLD.

Machine learning identification of risk factors for heart failure in patients with diabetes mellitus with metabolic dysfunction associated steatotic liver disease (MASLD): the Silesia Diabetes-Heart Project.

BACKGROUND: Diabetes mellitus (DM), heart failure (HF) and metabolic dysfunction associated steatotic liver disease (MASLD) are overlapping diseases of increasing prevalence. Because there are still high numbers of patients with HF who are undiagnosed and untreated, there is a need for improving efforts to better identify HF in patients with DM with or without MASLD. This study aims to develop machine learning (ML) models for assessing the risk of the HF occurrence in patients with DM with and without MASLD. RESEARCH DESIGN AND METHODS: In the Silesia Diabetes-Heart Project (NCT05626413), patients with DM with and without MASLD were analyzed to identify the most important HF risk factors with the use of a ML approach. The multiple logistic regression (MLR) classifier exploiting the most discriminative patient's parameters selected by the χ2 test following the Monte Carlo strategy was implemented. The classification capabilities of the ML models were quantified using sensitivity, specificity, and the percentage of correctly classified (CC) high- and low-risk patients. RESULTS: We studied 2000 patients with DM (mean age 58.85 ± SD 17.37 years; 48% women). In the feature selection process, we identified 5 parameters: age, type of DM, atrial fibrillation (AF), hyperuricemia and estimated glomerular filtration rate (eGFR). In the case of MASLD( +) patients, the same criterion was met by 3 features: AF, hyperuricemia and eGFR, and for MASLD(-) patients, by 2 features: age and eGFR. Amongst all patients, sensitivity and specificity were 0.81 and 0.70, respectively, with the area under the receiver operating curve (AUC) of 0.84 (95% CI 0.82-0.86). CONCLUSION: A ML approach demonstrated high performance in identifying HF in patients with DM independently of their MASLD status, as well as both in patients with and without MASLD based on easy-to-obtain patient parameters.

Clinical Trial: Probiotics in Metformin Intolerant Patients with Type 2 Diabetes (ProGasMet).

BACKGROUND: For decades, metformin has been the drug of first choice in the management of type 2 diabetes. However, approximately 2-13% of patients do not tolerate metformin due to gastrointestinal (GI) side effects. Since metformin influences the gut microbiota, we hypothesized that a multi-strain probiotics supplementation would mitigate the gastrointestinal symptoms associated with metformin usage. METHODS AND ANALYSIS: This randomized, double-blind, placebo-controlled, single-center, cross-over trial (ProGasMet study) assessed the efficacy of a multi-strain probiotic in 37 patients with metformin intolerance. Patients were randomly allocated (1:1) to receive probiotic (PRO-PLA) or placebo (PLA-PRO) at baseline and, after 12 weeks (period 1), they crossed-over to the other treatment arm (period 2). The primary outcome was the reduction of GI adverse events of metformin. RESULTS: 37 out of 82 eligible patients were enrolled in the final analysis of whom 35 completed the 32 weeks study period and 2 patients resigned at visit 5. Regardless of the treatment arm allocation, while on probiotic supplementation, there was a significant reduction of incidence (for the probiotic period in PRO-PLA/PLA-PRO: P = 0.017/P = 0.054), quantity and severity of nausea (P = 0.016/P = 0.024), frequency (P = 0.009/P = 0.015) and severity (P = 0.019/P = 0.005) of abdominal bloating/pain as well as significant improvement in self-assessed tolerability of metformin (P < 0.01/P = 0.005). Moreover, there was significant reduction of incidence of diarrhea while on probiotic supplementation in PRO-PLA treatment arm (P = 0.036). CONCLUSION: A multi-strain probiotic diminishes the incidence of gastrointestinal adverse effects in patients with type 2 diabetes and metformin intolerance.

Machine learning profiles of cardiovascular risk in patients with diabetes mellitus: the Silesia Diabetes-Heart Project.

AIMS: As cardiovascular disease (CVD) is a leading cause of death for patients with diabetes mellitus (DM), we aimed to find important factors that predict cardiovascular (CV) risk using a machine learning (ML) approach. METHODS AND RESULTS: We performed a single center, observational study in a cohort of 238 DM patients (mean age ± SD 52.15 ± 17.27 years, 54% female) as a part of the Silesia Diabetes-Heart Project. Having gathered patients' medical history, demographic data, laboratory test results, results from the Michigan Neuropathy Screening Instrument (assessing diabetic peripheral neuropathy) and Ewing's battery examination (determining the presence of cardiovascular autonomic neuropathy), we managed use a ML approach to predict the occurrence of overt CVD on the basis of five most discriminative predictors with the area under the receiver operating characteristic curve of 0.86 (95% CI 0.80-0.91). Those features included the presence of past or current foot ulceration, age, the treatment with beta-blocker (BB) and angiotensin converting enzyme inhibitor (ACEi). On the basis of the aforementioned parameters, unsupervised clustering identified different CV risk groups. The highest CV risk was determined for the eldest patients treated in large extent with ACEi but not BB and having current foot ulceration, and for slightly younger individuals treated extensively with both above-mentioned drugs, with relatively small percentage of diabetic ulceration. CONCLUSIONS: Using a ML approach in a prospective cohort of patients with DM, we identified important factors that predicted CV risk. If a patient was treated with ACEi or BB, is older and has/had a foot ulcer, this strongly predicts that he/she is at high risk of having overt CVD.

Relationship of vitamin D deficiency with cardiovascular disease and glycemic control in patients with type 2 diabetes mellitus: the Silesia Diabetes-Heart Project.

INTRODUCTION: Vitamin D (VD) has a pleiotropic effect on many health­related aspects, yet the results of studies regarding vitamin D deficiency (VDD) and both glycemic control and cardiovascular disease (CVD) are conflicting. OBJECTIVE: The aim of this work was to determine the prevalence of VDD and its associations with CVD and glycemic control among patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: This was an observational study in T2DM patients recruited at the diabetology clinic in Zabrze, Poland (April-September 2019 and April-September 2020). The presence of CVD was determined based on medical records. Blood biochemical parameters, densitometry, and carotid artery ultrasound examination were performed. Control of diabetes was assessed based on glycated hemoglobin A1c (HbA1c) levels. A serum VD level below 20 ng/ml was considered as VDD. RESULTS: The prevalence of VDD in 197 patients was 36%. CVD was evident in 27% of the patients with VDD and in 33% of the patients with VD within the normal range (vitamin D sufficiency [VDS]) (P = 0.34). The difference between the groups regarding diabetes control was insignificant (P = 0.05), as for the VDD patients the median value (interquartile range) of HbA1c was 7.5% (6.93%-7.9%), and for VDS patients it was 7.5% (6.56%-7.5%). The VDD patients were more often treated with sodium­glucose cotransporter­2 inhibitors (SGLT­2is) (44% vs 25%; P = 0.01). CONCLUSIONS: About one­third of the patients showed VDD. The VDD and VDS groups did not differ in terms of CVD occurrence and the difference in glycemic control was insignificant. The patients with VDD were more often treated with SGLT­2is, which requires further investigation.

Machine Learning Predicts Cardiovascular Events in Patients With Diabetes: The Silesia Diabetes-Heart Project.

We aimed to develop a machine learning (ML) model for predicting cardiovascular (CV) events in patients with diabetes (DM). This was a prospective, observational study where clinical data of patients with diabetes hospitalized in the diabetology center in Poland (years 2015-2020) were analyzed using ML. The occurrence of new CV events following discharge was collected in the follow-up time for up to 5 years and 9 months. An end-to-end ML technique which exploits the neighborhood component analysis for elaborating discriminative predictors, followed by a hybrid sampling/boosting classification algorithm, multiple logistic regression (MLR), or unsupervised hierarchical clustering was proposed. In 1735 patients with diabetes (53% female), there were 150 (8.65%) ones with a new CV event in the follow-up. Twelve most discriminative patients' parameters included coronary artery disease, heart failure, peripheral artery disease, stroke, diabetic foot disease, chronic kidney disease, eosinophil count, serum potassium level, and being treated with clopidogrel, heparin, proton pump inhibitor, and loop diuretic. Utilizing those variables resulted in the area under the receiver operating characteristic curve (AUC) ranging from 0.62 (95% Confidence Interval [CI] 0.56-0.68, P < 0.01) to 0.72 (95% CI 0.66-0.77, P < 0.01) across 5 nonoverlapping test folds, whereas MLR correctly determined 111/150 (74.00%) high-risk patients, and 989/1585 (62.40%) low-risk patients, resulting in 1100/1735 (63.40%) correctly classified patients (AUC: 0.72, 95% CI 0.66-0.77). ML algorithms can identify patients with diabetes at a high risk of new CV events based on a small number of interpretable and easy-to-obtain patients' parameters.

An Automatic Biopsy Needle Detection and Segmentation on Ultrasound Images Using a Convolutional Neural Network.

Needle visualization in the ultrasound image is essential to successfully perform the ultrasound-guided core needle biopsy. Automatic needle detection can significantly reduce the procedure time, false-negative rate, and highly improve the diagnosis. In this paper, we present a CNN-based, fully automatic method for detection of core needle in 2D ultrasound images. Adaptive moment estimation optimizer is proposed as CNN architecture. Radon transform is applied to locate the needle. The network's model was trained and tested on the total of 619 2D images from 91 cases of breast cancer. The model has achieved an average weighted intersection over union (the weighted Jaccard Index) of 0.986, F1 Score of 0.768, and angle RMSE of 3.73°. The obtained results exceed the other solutions by at least 0.27 and 7° in case of F1 score and angle RMSE, respectively. Finally, the needle is detected in a single frame averagely in 21.6 ms on a modern PC.

Chronic wounds multimodal image database.

A multimodal wound image database was created to allow fast development of computer-aided approaches for wound healing monitoring. The developed system with parallel camera optical axes enables multimodal images: photo, thermal, stereo, and depth map of the wound area to be acquired. As a result of using this system a multimodal database of chronic wound images is introduced. It contains 188 image sets of photographs, thermal images, and 3D meshes of the surfaces of chronic wounds acquired during 79 patient visits. Manual wound outlines delineated by an expert are also included in the dataset. All images of each case are additionally coregistered, and both numerical registration parameters and the transformed images are covered in the database. The presented database is publicly available for the research community at https://chronicwounddatabase.eu. That is the first publicly available database for evaluation and comparison of new image-based algorithms in the wound healing monitoring process with coregistered photographs, thermal maps, and 3D models of the wound area. Easily available database of coregistered multimodal data with the raw data set allows faster development of algorithms devoted to wound healing analysis and monitoring.

Automated size-specific dose estimates using deep learning image processing.

An automated vendor-independent system for dose monitoring in computed tomography (CT) medical examinations involving ionizing radiation is presented in this paper. The system provides precise size-specific dose estimates (SSDE) following the American Association of Physicists in Medicine regulations. Our dose management can operate on incomplete DICOM header metadata by retrieving necessary information from the dose report image by using optical character recognition. For the determination of the patient's effective diameter and water equivalent diameter, a convolutional neural network is employed for the semantic segmentation of the body area in axial CT slices. Validation experiments for the assessment of the SSDE determination and subsequent stages of our methodology involved a total of 335 CT series (60 352 images) from both public databases and our clinical data. We obtained the mean body area segmentation accuracy of 0.9955 and Jaccard index of 0.9752, yielding a slice-wise mean absolute error of effective diameter below 2 mm and water equivalent diameter at 1 mm, both below 1%. Three modes of the SSDE determination approach were investigated and compared to the results provided by the commercial system GE DoseWatch in three different body region categories: head, chest, and abdomen. Statistical analysis was employed to point out some significant remarks, especially in the head category.

Adolescent age estimation using voice features.

In this paper, a method for evaluating the chronological age of adolescents on the basis of their voice signal is presented. For every examined child, the vowels a, e, i, o and u were recorded in extended phonation. Sixty voice parameters were extracted from each recording. Voice recordings were supplemented with height measurement in order to check if it could improve the accuracy of the proposed solution. Predictor selection was performed using the LASSO (least absolute shrinkage and selection operator) algorithm. For age estimation, the random forest (RF) for regression method was employed and it was tested using a 10-fold cross-validation. The lowest absolute error (0.37 year ± 0.28) was obtained for boys only when all selected features were included into prediction. In all cases, the achieved accuracy was higher for boys than for girls, which results from the fact that the change of voice with age is larger for men than for women. The achieved results suggest that the presented approach can be employed for accurate age estimation during rapid development in children.

Prediction of menarcheal status of girls using voice features.

A method for evaluating the menarcheal status of girls on the basis of their voice features is presented in the paper. The registration procedure consists of voice recording and measuring 20 anthropological features. The input feature vector is a combination of voice and anthropometric parameters, counting 220 features. The optimal set of parameters was selected using five different methods: Method A - stepwise regression (first forward, then backward regression) performed on features with statistically different means/medians; Method B - stepwise regression (forward and backward) on all features, with age; Method C - stepwise regression as in B; including age, Method D - all features with statistically different means/medians, Method E - all features excluding age. For classification purposes three methods were employed: random forest (RF), support vector machine (SVM) and linear discriminant analysis (LDA) classifier. They were tested with 10-fold cross validation. The classification accuracy for RF using only voice features is higher than using only anthropometric data: 86.86% vs. 81.02% respectively. For the other two classifiers, the results do not show as large a difference: 80.60% vs. 82.80% for SVM and 80.66% vs. 82.34% for LDA. The advantage of voice features is more noticeable with sensitivity: 91.92% vs. 83.06% for RF. The obtained results suggest that the presented method can be used for automatic recognition of girls' menarcheal status using voice signal.