A Base of Observations and a Base of Knowledge for «Carotid constriction» Disease Formed by the Ontology for Medical Diagnostics

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1 A Base of Observations and a Base of Knowledge for «Carotid constriction» Disease Formed by the Ontology for Medical Diagnostics Mery Yu. Chernyakhovskaya, and Philip M. Moskalenko Abstract--The paper presents fragments of the formalized description of the base of observations and the base of knowledge for «carotid constriction» disease. The ontology for medical diagnostics is used as a basis. The base of knowledge is formed in terms of the base of observations. Index Terms--Base of knowledge, base of observations, medical diagnostics, carotid I. INTRODUCTION A development of knowledge bases and databases for funds of medical knowledge which are in compliance with contemporary expert knowledge representation is a topical task. Its solution allows extending of functional capabilities of modern expert systems in medical diagnostics and of the computer bank of knowledge [1] in particular. The aim of this work is to present a formal description for the carotid constriction disease [2]-[7] built on the basis of ontology for medical diagnostics [8]-[10]. The necessity of the work lies also in the fact that the carotid constriction disease is asymptomatic and thus its done in time diagnostics and treatment might prevent a development of severe complications like strokes, thrombosis, rupture of a blood vessel etc. II. ONTOLOGY DESCRIPTION Observations can be grouped and are either simple or composite (with internal structure). Elements of the structure of composite observation are called characteristics. A simple observation and a characteristic are described with a set of values either qualitative (listed in description) or quantitative (set by a range and units). Qualitative values can be either incompatible or compatible. The latter one can have a normal value (if any) or one or more abnormal values at a time. The research was supported by RFBR (research projects a, a) and FEB RAS (project 12-III-А-01I-016). Mery Yu. Chernyakhovskaya is with the Institute for Automation and Control Processes, Russian Academy of Sciences, Russia. (DSc, Leading Researcher, chernyah@iacp.dvo.ru) Philip M. Moskalenko is with the Institute for Automation and Control Processes, Russian Academy of Sciences, Russia. (PhD, Researcher, philipmm@iacp.dvo.ru) ISBN: As it is stated in [9], [10] knowledge about a disease consists of descriptions of its reasons and of its clinicalmanifestations for observations. Each one of the later consists of descriptions of its modality and of variants of development. A modality has one of the following values: «necessity» (N) or «possibility» (P). Each variant is a sequence of dynamics periods. Each period is characterized with its minimum length, maximum length and a set of possible values. In this paper most clinical manifestations have exactly one variant of development, which is not numbered in this case. Each variant consists of either 1 or two dynamics periods of which the last one lasts over the whole remaining observation period. The base of observations consists of traditional groups of observations: complaints, life history, anamnesis of disease, objective study, laboratory findings, instrumental findings [2]-[7]. III. BASE OF OBSERVATIONS Group of observations «Complaints» transient ischemic attacks (TIA), memory lessening, faints, incoordination, lassitude, dizziness, vision disorder in one eye, vision disorder in both eyes, transient paralysis, aglutition, tinnitus, headache. Transient ischemic attacks (TIA) Presence: absent 1, Sudden loss of vision (combined): absent, left eye, right eye, shadow in front of eyes. Vision disorders: absent, flashing flies in front of eyes, veil in front of eyes, attacks of «amaurosis fugax», lowering of acuity, pain in eye socket. Localization of vision disorders (combined): left eye, right eye. Weakness (combined): absent, left side of body, right side of body, left Numbness (combined): absent, left side of body, right side of body, left Pricking (combined): absent, left side of body, right side of body, left Temporary loss of speech: Scrambled speech: Ability to understand others: Temporary loss of control of a hand: 1 A normal value of an observation or its characteristics is written in italic and placed first.

2 Temporary loss of control of a leg: Coordination of movement: normal, difficult, impaired. Dizziness: Sudden unreasonable acute headache: Length of attack: [1/6; 24], hrs. Restoration of impaired functions: Memory lessening Faints Incoordination Lassitude Dizziness Vision disorder in one eye absent, transient, constant. Vision disorder in both eyes absent, transient, constant. Transient paralysis absent, of one hand, of one leg, of both hands, of both legs. Aglutition Tinnitus Presence: Periodicity: transient, constant. Headache Group of observations «Life history» presence of atherosclerosis, risk factors for carotid Presence of atherosclerosis Confirmation (combined): absent, clinical, instrumental, surgical. Factors promoting occurrence of atherosclerosis (combined): absent, trauma of arterial wall, arterial hypertension, smoking, hyperlipoidemia, hyperglycemia. Risk factors for carotid constriction Relatives with atherosclerosis of any location: absent, Age: less than 60 years old, 60 and more years old. Cholesterol level (combined): normal, increase of lowdensity lipoprotein (bad cholesterol), increase in triglycerides in blood. Smoking: Arterial hypertension: Diabetes: Obesity: Sedentary lifestyle: Group of observations «Anamnesis of disease» presence of TIA in the past, possible harbinger of a stroke. Presence of TIA in the past Presence: absent, happened once, happened several times. Stroke: Outcome of a stroke: all functions recovered, not all functions recovered, no functions recovered. Possible harbinger of a stroke (combined): memory lessening, faints, dizziness, visual impairment, transient paralysis of legs, transient paralysis of hands. Group of observations «Objective study» palpation of carotid arteries, auscultation of carotid arteries, palpation of radial arteries, different values of systolic and diastolic pressure on hands, Battistoni sample, Carotid syndrome, ophthalmologic manifestations. Palpation of carotid arteries Pulse at left side: normal, weakened, absent. Pulse at right side: normal, weakened, absent. Auscultation of carotid arteries Murmur at left side (over whole length of carotid while breath-holding): absent, reduced, weakened, hardly audible. Murmur at right side (over whole length of carotid while breath-holding): absent, reduced, weakened, hardly audible. Palpation of radial arteries Pulse at left side: normal, weakened, absent. Pulse at right side: normal, weakened, absent. Different values of systolic and diastolic pressure on hands Battistoni sample positive (digital occlusion of the opposite to the damaged carotid leads to dizziness, numbness of the upper extremities, faints and convulsions), negative (digital occlusion of the damaged carotid leads to dizziness, numbness of the upper extremities, faints and convulsions). Carotid syndrome Eye-lesion: absent, at the side of blood vessel Hemiparesis: absent, at the opposite side of blood vessel Ophthalmologic manifestations Amaurosis fugax: Hollenhorst plaques: Occlusion of retinal arteries: Hypotensive retinopathy: Eye ischemic syndrome: Group of observations «Laboratory findings» general blood test, study of hemostasis (trombocyte aggregation, coagulogram), general urine test, biochemical blood test (blood lipids: cholesterol, trigliceride, LDL, HDL), atherogenicity rate.

3 Group of observations «Instrumental findings» ultrasound examination of carotid, ultrasound dopplerography of carotid, ultrasound duplex scan (with colored Doppler mapping), angiography of carotid, CT of neck blood vessels, Magnetic resonance angiography (MRA), Arteriography. Ultrasound examination of carotid Atherosclerotic lesions: Localisation of atherosclerotic lesions: Constrictions: Localisation of constrictions: Disruptions in the course of blood vessels: absent, Localisation of disruptions in the course of blood vessels: Malformations of blood vessels: Screening of vascular plaques: inclusion of calcium, hemorrhages, ulceration, roughness of plaques tops. Thickness of the intima: normal (not more than 0.86mm for women, not more than 1.17mm for men), enlarged (more than 0.86mm for women, more than 1.17mm for men). BASE OF KNOWLEDGE Group of observations «Complaints» Transient ischemic attacks (TIA) Presence Sudden loss of vision (P) 1) left eye; 2) right eye; 3) left eye [1; 24] hrs, then right eye AND left eye; 4) right eye [1; 24] hrs, then right eye AND left eye; 5) right eye AND left eye; 6) shadow in front of eyes. Vision disorders (P) flashing flies in front of eyes, veil in front of eyes, attacks of «amaurosis fugax», lowering of acuity, pain in eye socket. Localization of vision disorders (P) 1) left eye; 2) right eye; 3) left eye [1; 24] hrs, then right eye AND left eye; 4) right eye [1; 24] hrs, then right eye AND left eye; 5) right eye AND left eye. Weakness (P) left side of body, right side of body, left Numbness (P) left side of body, right side of body, left Pricking (P) left side of body, right side of body, left Temporary loss of speech Scrambled speech Ability to understand others Temporary loss of control of a hand Temporary loss of control of a leg Coordination of movement (P) 1) difficult; 2) impaired; 3) difficult [1;24] hrs, then impaired. Dizziness Sudden unreasonable acute headache Length of attack (P) [1/6; 24], hrs. Restoration of impaired functions (P) 1) absent [1;24] hrs, then present; Memory lessening Faints Incoordination Lassitude Dizziness Vision disorder in one eye (P) Vision disorder in both eyes (P) Transient paralysis (P) of one hand, of one leg, of both hands, of both legs. Aglutition Tinnitus Presence Periodicity (P) Headache Group of observations «Life history» Presence of atherosclerosis Confirmation (P) clinical, instrumental, surgical. Factors promoting occurrence of atherosclerosis (P) trauma of arterial wall, arterial hypertension, smoking, hyperlipoidemia, hyperglycemia. Risk factors for carotid constriction Relatives with atherosclerosis of any location (P)

4 Age (P) 60 and more years old. Cholesterol level (P) increase of low-density lipoprotein (bad cholesterol), increase in triglycerides in blood. Smoking Arterial hypertension Diabetes Obesity Sedentary lifestyle Group of observations «Anamnesis of disease» Presence of TIA in the past Presence (P) 1) happened once; 2) happened several times. Stroke Outcome of a stroke (P) 1) all functions recovered; 2) not all functions recovered 3) no functions recovered. Possible harbinger of a stroke (P) memory lessening, faints, dizziness, visual impairment, transient paralysis of legs, transient paralysis of hands. Group of observations «Objective study» Palpation of carotid arteries Pulse at left side (P) 1) weakened; Pulse at right side (P) 1) weakened; Auscultation of carotid arteries Murmur at left side (over whole length of carotid while breath-holding) (P) 1) reduced; 2) weakened; 3) hardly audible. Murmur at right side (over whole length of carotid while breath-holding) (P) 1) reduced; 2) weakened; 3) hardly audible. Palpation of radial arteries Pulse at left side (P) 1) absent; 2) weakened. Pulse at right side (P) 1) absent; 2) weakened. Different values of systolic and diastolic pressure on hands Battistoni sample (P) 1) positive (digital occlusion of the opposite to the damaged carotid leads to dizziness, numbness of the upper extremities, faints and convulsions); 2) negative (digital occlusion of the damaged carotid leads to dizziness, numbness of the upper extremities, faints and convulsions). Carotid syndrome Eye-lesion (P) at the side of blood vessel Hemiparesis (P) at the opposite side of blood vessel Ophthalmologic manifestations Amaurosis fugax Hollenhorst plaques Occlusion of retinal arteries Hypotensive retinopathy Eye ischemic syndrome Group of observations «Laboratory findings» Group of observations «Instrumental findings» Ultrasound examination of carotid Atherosclerotic lesions Constrictions Disruptions in the course of blood vessels Malformations of blood vessels Screening of vascular plaques (P) 1) inclusion of calcium; 2) hemorrhages; 3) ulceration; 4) roughness of plaques tops. Thickness of the intima (P) enlarged (more than 0.86mm for women, more than 1.17mm for men). CONCLUSION The formalized fragments of description of the base of observations and the base of knowledge for carotid constriction disease are presented. The base of knowledge is formed in terms of the base of observations. Observations are joined into several groups and have quantitative and qualitative values which may be either combined or not. A short description for the used model of ontology is given.

5 The presented descriptions of bases might be used in intelligent medical systems for patient observation and expert diagnostics, in simulators and as a tutorial in education. REFERENCES [1] M. Chernyakhovskaya, A. Kleschev, and F. Moskalenko, "An idea of a computer knowledge bank on medical diagnostics," in International Journal "INFORMATION TECHNOLOGIES & APPLICATIONS", Institute of Information Theories and Applications FOI ITHEA. Sofia, Bulgaria, V.15, N.4, 2008, pp [2] D. Djibladze, A. Krasnikov, O. Lagoda, and D. D. Barkhatov, "Asymptomatic stenosises of carotid arteries pool," in Atmosfera, N.2, 2005, pp [3] D. Djibladze, "Pathology of the carotid arteries and the problem of ischemic stroke (clinical, ultra-sound and hemodynamic aspects)," Мoscow, 2002, 167p. [4] A. Pokrovskiy et. All, "Angiology and vascular surgery," N.22, 2000, pp.45. [5] The Asymptomatic Carotid Atherosclerosis Study Group, "Study design for randomized prospective trial of carotid endarterectomy for asymptomatic atherosclerosis," Stroke, V.20, 1989, pp [6] The European Carotid Surgeгy Trialists Collaborative Group,"Risk of stroke in the distribution of an asymptomatic carotid artery," Lancet, V.345, 1995, pp [7] Executive committee for the Asymptomatic Carotid Atherosclerosis Study, "Endarterectomy for Asymptomatic Carotid Artery Stenosis, " JAMA, V.273, 1995, pp [8] M. Chernyakhovskaya, A. Kleschev, F. Moskalenko, Part 1. An informal description and definitions of basic terms," Algorithmic and Mathematical Foundation of the Artificial Intelligence, International book series "Information Science & Computing", Institute of Information Theories and Applications FOI ITHEA, Sofia, Bulgaria, N.1, V.2, 2008, pp [9] M. Chernyakhovskaya, A. Kleschev, F. Moskalenko, Part 2. A formal description of cause-and-effect relations," Algorithmic and Mathematical Foundation of the Artificial Intelligence, International book series "Information Science & Computing", N.1, Supplement to the International Journal "INFORMATION TECHNOLOGIES & KNOWLEDGE" Volume 2/2008. Institute of Information Theories and Applications FOI ITHEA. Sofia, Bulgaria, 2008, pp [10] M. Chernyakhovskaya, A. Kleschev, F. Moskalenko, Part 3. A formal description of the causes of signs values and of diseases," Algorithmic and Mathematical Foundation of the Artificial Intelligence. International book series "Information Science & Computing", N.1. Supplement to the International Journal "INFORMATION TECHNOLOGIES & KNOWLEDGE", Institute of Information Theories and Applications FOI ITHEA. Sofia, Bulgaria, V.2, 2008, pp