Clinical decision support system for hypertension medication based on knowledge graph

Knowledge graph and its application in the study of neurological and mental disorders

Neurological disorders (e.g., Alzheimer's disease and Parkinson's disease) and mental disorders (e.g., depression and anxiety), pose huge challenges to global public health. The pathogenesis of these diseases can usually be attributed to many factors, such as genetic, environmental and socioeconomic status, which make the diagnosis and treatment of the diseases difficult. As research on the diseases advances, so does the body of medical data. The accumulation of such data provides unique opportunities for the basic and clinical study of these diseases, but the vast and diverse nature of the data also make it difficult for physicians and researchers to precisely extract the information and utilize it in their work. A powerful tool to extract the necessary knowledge from large amounts of data is knowledge graph (KG). KG, as an organized form of information, has great potential for the study neurological and mental disorders when it is paired with big data and deep learning technologies. In this study, we reviewed the application of KGs in common neurological and mental disorders in recent years. We also discussed the current state of medical knowledge graphs, highlighting the obstacles and constraints that still need to be overcome.

Explainable AI Method for Tinnitus Diagnosis via Neighbor-Augmented Knowledge Graph and Traditional Chinese Medicine: Development and Validation Study

BACKGROUND

Tinnitus diagnosis poses a challenge in otolaryngology owing to an extremely complex pathogenesis, lack of effective objectification methods, and factor-affected diagnosis. There is currently a lack of explainable auxiliary diagnostic tools for tinnitus in clinical practice.

OBJECTIVE

This study aims to develop a diagnostic model using an explainable artificial intelligence (AI) method to address the issue of low accuracy in tinnitus diagnosis.

METHODS

In this study, a knowledge graph-based tinnitus diagnostic method was developed by combining clinical medical knowledge with electronic medical records. Electronic medical record data from 1267 patients were integrated with traditional Chinese clinical medical knowledge to construct a tinnitus knowledge graph. Subsequently, weights were introduced, which measured patient similarity in the knowledge graph based on mutual information values. Finally, a collaborative neighbor algorithm was proposed, which scored patient similarity to obtain the recommended diagnosis. We conducted 2 group experiments and 1 case derivation to explore the effectiveness of our models and compared the models with state-of-the-art graph algorithms and other explainable machine learning models.

RESULTS

The experimental results indicate that the method achieved 99.4% accuracy, 98.5% sensitivity, 99.6% specificity, 98.7% precision, 98.6% F1-score, and 99% area under the receiver operating characteristic curve for the inference of 5 tinnitus subtypes among 253 test patients. Additionally, it demonstrated good interpretability. The topological structure of knowledge graphs provides transparency that can explain the reasons for the similarity between patients.

CONCLUSIONS

This method provides doctors with a reliable and explainable diagnostic tool that is expected to improve tinnitus diagnosis accuracy.

BCSLinker: automatic method for constructing a knowledge graph of venous thromboembolism based on joint learning

Background

Venous thromboembolism (VTE) is characterized by high morbidity, mortality, and complex treatment. A VTE knowledge graph (VTEKG) can effectively integrate VTE-related medical knowledge and offer an intuitive description and analysis of the relations between medical entities. However, current methods for constructing knowledge graphs typically suffer from error propagation and redundant information.

Methods

In this study, we propose a deep learning-based joint extraction model, Biaffine Common-Sequence Self-Attention Linker (BCSLinker), for Chinese electronic medical records to address the issues mentioned above, which often occur when constructing a VTEKG. First, the Biaffine Common-Sequence Self-Attention (BCsSa) module is employed to create global matrices and extract entities and relations simultaneously, mitigating error propagation. Second, the multi-label cross-entropy loss is utilized to diminish the impact of redundant information and enhance information extraction.

Results

We used the electronic medical record data of VTE patients from a tertiary hospital, achieving an F1 score of 86.9% on BCSLinker. It outperforms the other joint entity and relation extraction models discussed in this study. In addition, we developed a question-answering system based on the VTEKG as a structured data source.

Conclusion

This study has constructed a more accurate and comprehensive VTEKG that can provide reference for diagnosing, evaluating, and treating VTE as well as supporting patient self-care, which is of considerable clinical value.

Artificial Intelligence-Based Diagnostic Support System for Patent Ductus Arteriosus in Premature Infants

Background: Patent ductus arteriosus (PDA) is a prevalent congenital heart defect in premature infants, associated with significant morbidity and mortality. Accurate and timely diagnosis of PDA is crucial, given the vulnerability of this population. Methods: We introduce an artificial intelligence (AI)-based PDA diagnostic support system designed to assist medical professionals in diagnosing PDA in premature infants. This study utilized electronic health record (EHR) data from 409 premature infants spanning a decade at Severance Children's Hospital. Our system integrates a data viewer, data analyzer, and AI-based diagnosis supporter, facilitating comprehensive data presentation, analysis, and early symptom detection. Results: The system's performance was evaluated through diagnostic tests involving medical professionals. This early detection model achieved an accuracy rate of up to 84%, enabling detection up to 3.3 days in advance. In diagnostic tests, medical professionals using the system with the AI-based diagnosis supporter outperformed those using the system without the supporter. Conclusions: Our AI-based PDA diagnostic support system offers a comprehensive solution for medical professionals to accurately diagnose PDA in a timely manner in premature infants. The collaborative integration of medical expertise and technological innovation demonstrated in this study underscores the potential of AI-driven tools in advancing neonatal diagnosis and care.

Systematic review of automatic post-stroke gait classification systems

BACKGROUND

Gait classification is a clinically helpful task performed after a stroke in order to guide rehabilitation therapy. Gait disorders are commonly identified using observational gait analysis in clinical settings, but this approach is limited due to low reliability and accuracy. Data-driven gait classification can quantify gait deviations and categorise gait patterns automatically possibly improving reliability and accuracy; however, the development and clinical utility of current data driven systems has not been reviewed previously.

RESEARCH QUESTION

The purpose of this systematic review is to evaluate the literature surrounding the methodology used to develop automatic gait classification systems, and their potential effectiveness in the clinical management of stroke-affected gait.

METHOD

The database search included PubMed, IEEE Xplore, and Scopus. Twenty-one studies were identified through inclusion and exclusion criteria from 407 available studies published between 2015 and 2022. Development methodology, classification performance, and clinical utility information were extracted for review.

RESULTS AND SIGNIFICANCE

Most of gait classification systems reported a classification accuracy between 80%-100%. However, collated studies presented methodological errors in machine learning (ML) model development. Further, many studies neglected model components such as clinical utility (e.g., predictions don't assist clinicians or therapists in making decisions, interpretability, and generalisability). We provided recommendations to guide development of future post-stroke automatic gait classification systems to better assist clinicians and therapists. Future automatic gait classification systems should emphasise the clinical significance and adopt a standardised development methodology of ML model.

Enhancing traditional Chinese medicine diagnostics: Integrating ontological knowledge for multi-label symptom entity classification

In traditional Chinese medicine (TCM), artificial intelligence (AI)-assisted syndrome differentiation and disease diagnoses primarily confront the challenges of accurate symptom identification and classification. This study introduces a multi-label entity extraction model grounded in TCM symptom ontology, specifically designed to address the limitations of existing entity recognition models characterized by limited label spaces and an insufficient integration of domain knowledge. This model synergizes a knowledge graph with the TCM symptom ontology framework to facilitate a standardized symptom classification system and enrich it with domain-specific knowledge. It innovatively merges the conventional bidirectional encoder representations from transformers (BERT) + bidirectional long short-term memory (Bi-LSTM) + conditional random fields (CRF) entity recognition methodology with a multi-label classification strategy, thereby adeptly navigating the intricate label interdependencies in the textual data. Introducing a multi-associative feature fusion module is a significant advancement, thereby enabling the extraction of pivotal entity features while discerning the interrelations among diverse categorical labels. The experimental outcomes affirm the model's superior performance in multi-label symptom extraction and substantially elevates the efficiency and accuracy. This advancement robustly underpins research in TCM syndrome differentiation and disease diagnoses.

[Knowledge Graph-Based Prediction of Potentially Inappropriate Medication]

Objective

To improve the accuracy of potentially inappropriate medication (PIM) prediction, a PIM prediction model that combines knowledge graph and machine learning was proposed.

Methods

Firstly, based on Beers criteria 2019 and using the knowledge graph as the basic structure, a PIM knowledge representation framework with logical expression capabilities was constructed, and a PIM inference process was implemented from patient information nodes to PIM nodes. Secondly, a machine learning prediction model for each PIM label was established based on the classifier chain algorithm, to learn the potential feature associations from the data. Finally, based on a threshold of sample size, a portion of reasoning results from the knowledge graph was used as output labels on the classifier chain to enhance the reliability of the prediction results of low-frequency PIMs.

Results

11 741 prescriptions from 9 medical institutions in Chengdu were used to evaluate the effectiveness of the model. Experimental results show that the accuracy of the model for PIM quantity prediction is 98.10%, the F1 is 93.66%, the Hamming loss for PIM multi-label prediction is 0.06%, and the macroF1 is 66.09%, which has higher prediction accuracy than the existing models.

Conclusion

The method proposed has better prediction performance for potentially inappropriate medication and significantly improves the recognition of low-frequency PIM labels.

Plant disease prescription recommendation based on electronic medical records and sentence embedding retrieval

BACKGROUND

In the era of Agri 4.0 and the popularity of Plantwise systems, the availability of Plant Electronic Medical Records has provided opportunities to extract valuable disease information and treatment knowledge. However, developing an effective prescription recommendation method based on these records presents unique challenges, such as inadequate labeling data, lack of structural and linguistic specifications, incorporation of new prescriptions, and consideration of multiple factors in practical situations.

RESULTS

This study proposes a plant disease prescription recommendation method called PRSER, which is based on sentence embedding retrieval. The semantic matching model is created using a pre-trained language model and a sentence embedding method with contrast learning ideas, and the constructed prescription reference database is retrieved for optimal prescription recommendations. A multi-vegetable disease dataset and a multi-fruit disease dataset are constructed to compare three pre-trained language models, four pooling types, and two loss functions. The PRSER model achieves the best semantic matching performance by combining MacBERT, CoSENT, and CLS pooling, resulting in a Pearson coefficient of 86.34% and a Spearman coefficient of 77.67%. The prescription recommendation capability of the model is also verified. PRSER performs well in closed-set testing with Top-1/Top-3/Top-5 accuracy of 88.20%/96.07%/97.70%; and slightly worse in open-set testing with Top-1/Top-3/Top-5 accuracy of 82.04%/91.50%/94.90%. Finally, a plant disease prescription recommendation system for mobile terminals is constructed and its generalization ability with incomplete inputs is verified. When only symptom information is available without environment and plant information, our model shows slightly lower accuracy with Top-1/Top-3/Top-5 accuracy of 75.24%/88.35%/91.99% in closed-set testing and Top-1/Top-3/Top-5 accuracy of 75.08%/87.54%/89.84% in open-set testing.

CONCLUSIONS

The experiments validate the effectiveness and generalization ability of the proposed approach for recommending plant disease prescriptions. This research has significant potential to facilitate the implementation of artificial intelligence in plant disease treatment, addressing the needs of farmers and advancing scientific plant disease management.