Application of artificial intelligence techniques for non-alcoholic fatty liver disease diagnosis: A systematic review (2005-2023)

BACKGROUND AND OBJECTIVES

Non-alcoholic fatty liver disease (NAFLD) is a common liver disease with a rapidly growing incidence worldwide. For prognostication and therapeutic decisions, it is important to distinguish the pathological stages of NAFLD: steatosis, steatohepatitis, and liver fibrosis, which are definitively diagnosed on invasive biopsy. Non-invasive ultrasound (US) imaging, including US elastography technique, and clinical parameters can be used to diagnose and grade NAFLD and its complications. Artificial intelligence (AI) is increasingly being harnessed for developing NAFLD diagnostic models based on clinical, biomarker, or imaging data. In this work, we systemically reviewed the literature for AI-enabled NAFLD diagnostic models based on US (including elastography) and clinical (including serological) data.

METHODS

We performed a comprehensive search on Google Scholar, Scopus, and PubMed search engines for articles published between January 2005 and June 2023 related to AI models for NAFLD diagnosis based on US and/or clinical parameters using the following search terms: "non-alcoholic fatty liver disease", "non-alcoholic steatohepatitis", "deep learning", "machine learning", "artificial intelligence", "ultrasound imaging", "sonography", "clinical information".

RESULTS

We reviewed 64 published models that used either US (including elastography) or clinical data input to detect the presence of NAFLD, non-alcoholic steatohepatitis, and/or fibrosis, and in some cases, the severity of steatosis, inflammation, and/or fibrosis as well. The performances of the published models were summarized, and stratified by data input and algorithms used, which could be broadly divided into machine and deep learning approaches.

CONCLUSION

AI models based on US imaging and clinical data can reliably detect NAFLD and its complications, thereby reducing diagnostic costs and the need for invasive liver biopsy. The models offer advantages of efficiency, accuracy, and accessibility, and serve as virtual assistants for specialists to accelerate disease diagnosis and reduce treatment costs for patients and healthcare systems.

The antibacterial activity of nasturtium officinale extract on common oral pathogenic bacteria

Background

The oral cavity is colonized by a myriad of microorganisms, some of which are proven to be detrimental to human health. There have been numerous efforts to control the population of pathogenic agents in the oral cavity, including the usage of natural phytochemicals obtained from medicinal plants. Nasturtium officinale has long been used in traditional medicine for the management of hypertension, respiratory infections, and hyperglycemia, and its effectiveness against some microbes has been reported.

Aims

To evaluate antimicrobial properties of a hydro-alcoholic extract of N. officinale against common oral pathogens namely Streptococcus mutans, Staphylococcus aureus, Lactobacillus acidophilus, Enterococcus faecalis, and Pseudomonas aeruginosa. Experimental laboratory study. Different dilutions of N. officinale hydro-alcoholic extract were the test solutions, the positive control was a bacterial suspension in sterile phosphate-buffered saline, whereas the negative control was the herbal extract only, without any bacterial inoculation. Hydro-alcoholic extract of N. officinale prepared in five different concentrations (105, 52.5, 26.25, 13.12, 6.56 mg.mL^-1) was tested separately against Streptococcus mutans, Lactobacillus acidophilus, Pseudomonas aeruginosa, Enterococcus faecalis, and Staphylococcus aureus in a test of microdilution assay. Spectrophotometry was used to assess bacterial growth after 24 and 48 h.

Materials and Methods

The data of optical absorbance reads from spectrophotometry were analyzed using repeated-measures analysis followed by Least Significant Differences (LSD) post hoc.

Results

The highest growth inhibitory effect against S. mutans, E. faecalis, and S. aureus was observed at a concentration of 13.12 mg.mL^-1; for L. acidophilus and P. aeruginosa, the most significant inhibition was observed at a concentration of 105 mg.mL^-1.

Conclusion

N. officinale extract effectively inhibited the growth of the tested oral bacteria at different concentrations but was more effective against S. mutans, E. faecalis, and S. aureus and so may be effective in managing some oral microbial infections.

Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015

AIM

Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015.

METHODS

Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs.

RESULTS

From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: -0.5 to -0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged.

CONCLUSIONS

Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.

Meeting American Diabetes Association diabetes management targets: trends in Mauritius

AIMS

To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015.

METHODS

Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA_1c , blood pressure and LDL cholesterol.

RESULTS

In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA_1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009.

CONCLUSIONS

In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.

Effects of dietary energy density on serum adipocytokine levels in diabetic women

This study was aimed to assess the effect of dietary energy density (kcal/g) on serum levels of adipocytokines of type 2 diabetic women. In this randomized parallel design clinical trial, a total of 60 diabetic women (aged 30-60 years; BMI>25 kg/m²) were assigned to consume either a low-energy dense (LED) (65% of energy from carbohydrates and 25% from fats), normal-energy dense (NED) (60% from carbohydrates, 30% from fats), or high-energy dense (HED) diet (55% from carbohydrates and 35% from fats) for 8 weeks. The low-energy dense diet was rich in fruits, vegetables, whole grains, and water, while the high-energy dense diet was rich in fats and oils and limited in fruits and vegetables as compared with the normal-dense diet. At baseline and at the end of intervention fasting blood samples were taken to assess metabolic profile. Women in the LED group consumed significantly more dietary fiber (p<0.001), fruits (p<0.001) and vegetables (p<0.001) than those in the NED and HED groups. We failed to find a significant effect of dietary energy density (kcal/g) on serum adiponectin and visfatin levels. Even the within-group changes in serum adiponectin and visfatin levels were not significant. Consumption of LED and NED diets resulted in a significant increase in serum chemerin levels (p=0.04). Comparison of mean changes of serum chemerin levels across 3 groups revealed a significant difference (p=0.04). Our study provides evidence indicating that consumption of HED diet for 8 weeks among diabetic patients prevented the increase in serum chemerin levels compared with LED and NED diets. Furthermore, we found no significant effect of dietary energy density (kcal/g) on serum adiponectin and visfatin concentrations in the current study.

Role of cell adhesion-associated protein, pinin (DRS/memA), in corneal epithelial migration

PURPOSE

To determine whether the cellular distribution of cell adhesion-associated protein, pinin, is altered during corneal epithelial migration in response to debridement wounding and to determine the effect of overexpression of pinin in cultured epithelial cells.

METHODS

Corneas from guinea pig and embryonic (day 17) chickens were excised, wounded, and placed on organ-culture rafts. At time points from 0 to 24 hours, corneas were cryosectioned and subsequently analyzed by immunofluorescence or immunoelectron microscopy for the presence and distribution of pinin. Cultured epithelial cell line MDCK (Madin Darby canine kidney) confluent monolayers were wounded by scraping and examined by immunofluorescence for pinin and desmoplakin. MDCK cells were transfected with full-length pinin cDNA. After selection in Geneticin, clones of pinin-transfected cells were isolated. Monolayers of transfected cells were scrape-wounded and assayed for their ability to migrate.

RESULTS

Within 2 hours after wounding, although morphologically identifiable desmosomes were present on migrating epithelial cells, the association of pinin to desmosomes was greatly reduced. Finally, after completion of wound closure, pinin returned to the corneal epithelial desmosome. Wounding of confluent epithelial monolayers (MDCK) in vitro demonstrated a very similar change in the distribution of pinin, whereas desmoplakin remained cell boundary-associated. Transfection of pinin into cultured epithelial cells resulted in an overexpression of pinin. Clones of cells expressing high levels of pinin exhibited marked reduction in their ability to migrate after wounding.

CONCLUSIONS

Pinin is involved in corneal epithelium migration. The localization of pinin at or near the desmosome is correlated with the epithelial quiescence. The loss of pinin from the cell boundary correlates with the transition from quiescence to actively migrating. Overexpressing pinin in cultured epithelial cells affects epithelial homeostasis and, in turn, drives the epithelial cells to a hyperstable epithelial adhesive state and inhibits the transition from quiescence to migratory.

Chronic alcohol feeding inhibits atherogenesis in C57BL/6 hyperlipidemic mice

Although there is abundant clinical evidence that the consumption of alcohol (ethanol) in moderate amounts has a protective effect on coronary artery disease, the mechanism of this effect is not understood. The prevailing theory supported by a limited number of clinical and experimental animal studies indicates that the ability of alcohol to elevate serum high-density lipoprotein cholesterol levels is an important mechanism. Although there have been a large number of studies on the effects of alcohol on serum lipoprotein and apolipoproteins on coronary artery disease, there have been very few that have, at the same time, looked directly and systematically at its effects on the histopathological development of atherosclerotic lesions. In the following studies we employed the hyperlipidemic C57BL/6 female mouse model and formulated an all liquid high fat atherogenic diet to provide the mice with the 3% or 6% alcohol. After 22 weeks on this diet, alcohol markedly inhibited the development of fatty streak atherosclerotic lesions in a dose-dependent fashion. Surprisingly, there was a dose-dependent decrease in plasma high-density lipoprotein cholesterol values, which suggests that high-density lipoprotein alterations play little or no role in the amelioration of atherosclerosis in this model.