| Objective:Based on the electronic medical records of Xi'an Encephalopathy Hospital of traditional Chinese Medicine,this paper explored the construction of knowledge graph about TCM diagnosis and treatment of infantile cerebral palsy and the explicit method of treatment-related tacit knowledge,so as to find a new approach for the discovery,visualization,management,learning and dissemination of new knowledge of TCM diagnosis and treatment of children with cerebral palsy.In addition,we attempted to lay a foundation for the optimization of TCM diagnosis and treatment scheme of pediatric cerebral palsy and the construction of auxiliary diagnosis and treatment system.Methods:1.Study on the construction of knowledge map of TCM diagnosis and treatment of cerebral palsy:the main sources of knowledge are electronic medical records,doctor's orders,scores of evaluation scales of patients with cerebral palsy,clinical diagnosis and treatment guidelines and teaching materials.First of all,entity tagging,concept and relation extraction and terminology standardization are carried out for semi-structured data.Secondly,referring to the existing semantic Network Framework of traditional Chinese Medicine language system(TCMLS-SN)(ISO 19465-2017)and the Traditional Chinese medicine—Categories of traditional Chinese medicine(TCM)clinical terminological systems(ISO/TS17938-2014),the ontology framework of cerebral palsy is defined,and the knowledge base for diagnosis and treatment of cerebral palsy is constructed referring to the "seven-step method" developed by Stanford University,and the model layer of knowledge graph is formed.Then,the labeled entity is matched with the ontology to form the data layer of the knowledge graph.The manual construction of the ontology framework uses the ontology construction software Protege,and the data is stored in the Neo4j graph database.The semantic query,application display,and subsequent knowledge update and maintenance of the knowledge graph are realized through graph database.2.Analysis of hospitalization treatment schemes for children with cerebral palsy and comparison of the curative effects of common schemes:a retrospective analysis was made on the diagnosis and treatment of children with cerebral palsy under the age of 7 from 2013 to 2019.It is concluded that the basic population characteristics,prevalence(including cerebral palsy and common diseases),hospitalization time and treatment plan(including the type of treatment,utilization rate and combined use of methods)of preschool children with cerebral palsy.This part of the statistical analysis mainly uses descriptive analysis.A comparative study was conducted on the efficacy of the three most commonly used similar treatments between groups.The included patients were cerebral palsy patients who were evaluated by Gesell Developmental Schedules twice before and after hospitalization.The evaluation results of Gesell Development scale were used as the observation index,including the development quotient of four dimensions:motor energy,material energy,speech energy and human ability.According to the analysis of the baseline situation of patients in each group(including age,sex,classification of cerebral palsy,duration of hospitalization and development quotient before treatment),the patients were divided into three levels:infancy,early childhood and preschool according to their age.The curative effects of the three treatment schemes in the subgroup were compared and analyzed,and the covariance analysis was mainly used in the statistical analysis.3.The regularity of acupuncture prescription for cerebral palsy and the indication found:the first acupuncture prescriptions of patients with cerebral palsy under the age of 7 who received acupuncture treatment in hospital and was primarily diagnosed as cerebral palsy were analyzed by data mining.To find out the rules of acupoint selection of clinical acupuncture in the treatment of infantile cerebral palsy and the characteristics of the adaptation population corresponding to the acupuncture prescription.The cases of infantile cerebral palsy with acupuncture prescription in the record of the first course of disease and has been evaluated the therapeutic effect at discharge were included.First of all,the core prescription of acupuncture treatment of total cerebral palsy sample is analyzed by complex network algorithm,and the core or basic acupoints of acupuncture treatment of cerebral palsy are obtained.Secondly,the community of children with cerebral palsy is detected based on the similarity of acupoints in acupuncture prescription,and the characteristic of sub-population of cerebral palsy is selected,the similarity degree is Jaccard similarity coefficient,and the community detection algorithm is Fast Unfolding(BGLL)efficient community detection algorithm.Then according to the distribution of acupoints and symptom characteristics in each subgroup,find out the characteristic acupoints and characteristic symptoms of each subgroup;Combined with the core acupoints obtained by the complex network analysis of each subgroup to form the acupuncture prescription of the corresponding population.Finally,the characteristic symptoms and acupuncture prescription rules of each subgroup of cerebral palsy were summarized.Results:1.Construction of knowledge graph for diagnosis and treatment of cerebral palsy with traditional Chinese medicine.Combined with guidelines,teaching materials,hospital electronic medical records and previous TCM disease ontology,the ontology framework of cerebral palsy is constructed,including patients with cerebral palsy,diagnosis of cerebral palsy,causes of cerebral palsy,symptoms of cerebral palsy and treatment of cerebral palsy,and 12 kinds of interclass relations,which are used as the model layer of the knowledge graph.According to the purpose of the study,the diagnosis and treatment data of 3852 patients with cerebral palsy were imported into the Neo4j map database through Python,including disease names(various types of cerebral palsy,diagnosis of other combined diseases),syndrome types,symptoms,acupoints,formulas,herbs,treatment methods and other types,as well as the relationship like "causes","treat","has"and so on.Around the content of the diagnosis and treatment plan for the treatment of infantile cerebral palsy with acupuncture and medicine,2970 nodes and 38160 relationships were constructed under 6 kinds of tags and 5 kinds of relations,which were used as the data layer of the knowledge graph.Finally,it initially realizes the visual display and semantic retrieval function of the knowledge graph of acupuncture combined with medicine in the treatment of cerebral palsy.2.Analysis of hospitalization treatment schemes for children with cerebral palsy and comparison of curative effects of common schemes.The knowledge related to the treatment method and its effect is a kind of tacit knowledge,which can be transformed into explicit knowledge on the basis of evaluating the efficacy of the treatment scheme.This study analyzed the diagnosis and treatment schemes of 1304 hospitalized children in Xi'an Encephalopathy Hospital of Traditional Chinese Medicine,and evaluated the effect of neural rehabilitation treatment on some children with cerebral palsy who received three groups of commonly used treatment regimens.Based on the results,the knowledge graph of cerebral palsy was supplemented and improved,and the explicit methods of this kind of tacit knowledge were also discussed.The 1304 children aged 0 to 6 years old who were primarily diagnosed as cerebral palsy were analyzed.The results showed that the age of boys was similar to that of girls,and the treatment time was about 70 days.Among the 3006 admissions of 1304 people,the number of admissions of boys(1782)was more than that of girls(1224).Among them,71.03%of cerebral palsy was the most common spastic cerebral palsy,followed by dyskinetic cerebral palsy,with 232 person-times(12.61%),followed by hypotonia type(8.37%)and mixed type(6.74%).The TCM syndromes of children with cerebral palsy mainly include liver strength and spleen weakness syndrome,liver and kidney deficiency syndrome,spleen and kidney deficiency syndrome,phlegm and blood stasis syndrome and so on.Liver strength and spleen weakness syndrome is the most common syndrome in the population.Infection and inflammation occupy an important position in the most common concomitant diseases,and upper respiratory tract infection,acute bronchitis and bronchopneumonia are similar to those of the whole patients with cerebral palsy in the hospital.Besides,diseases such as developmental malformations and digestive system diseases are more prominent in the younger age group.According to the doctor's advice,the treatment methods are divided into 10 categories,namely,acupuncture,massage,rehabilitation,physiotherapy,cupping,scraping,western medicine,traditional Chinese medicine,proprietary Chinese medicine and surgery.According to statistics,more than 60%of patients used rehabilitation,acupuncture,western medicine,proprietary Chinese medicine,massage,physiotherapy,the utilization rates of acupuncture and rehabilitation were more than 92%and 97%respectively.However,the utilization rate of traditional Chinese medicine,cupping,surgery and scraping is relatively low.In acupuncture therapy,ordinary acupuncture treatment is still the most common treatment,accounting for 92%of all acupuncture treatments,followed by acupoint injection(74.36%)and acupoint catgut embedding(55.85%).Based on the analysis of the number and combination of treatments commonly used during hospitalization,75.9%of the 3006 patients with cerebral palsy received 5-7 treatments,of which the most common were those who received 6 treatments(31.7%).According to the frequency statistics of the treatment schemes received by all patients,it was found that there were 81 treatment combinations,among which the most commonly used treatment schemes were "rehabilitation,physiotherapy,western medicine,acupuncture,massage,proprietary Chinese medicine","rehabilitation,physiotherapy,western medicine,acupuncture,massage,proprietary Chinese medicine" and "rehabilitation,western medicine,acupuncture,massage,proprietary Chinese medicine".Taking the developmental age of each dimension of Gesell development schedules as the observation index,the changes of the mental age of children with cerebral palsy before and after treatment in the basic group(rehabilitation,western medicine,acupuncture,massage,proprietary Chinese medicine)were evaluated.The results showed that the difference was statistically significant(P<0.05).The mental age after treatment was higher than that before treatment,indicating that the treatment was effective.Comparison of the effects of three commonly used hospitalization treatment schemes for infantile cerebral palsy:taking the development quotient of each dimension of the Gesell Development scale as the observation index,it was concluded that the therapeutic effects of infantile and preschool children with spastic cerebral palsy were the same after 3 months of treatment,and there was no significant difference in the scores of development quotient of each dimension(P>0.05).It is suggested that in the process of multi-measures combined treatment of infantile cerebral palsy.The increase of combination therapy does not mean the efficacy is better,and the efficacy of some treatments for children with cerebral palsy is open to question.New entities and relations were extracted from the comparative study conclusion of three common therapeutic options for patients with cerebral palsy.8 entities,3 relations and 28 triples were added to the knowledge graph to complete the missing knowledge.3.Discovery of acupuncture prescriptions and their indication for children with cerebral palsy and improvement of knowledge graph of TCM diagnosis and treatment for cerebral palsyThe acupuncture acupoints of 943 patients aged 0 to 6 years old who were effective in acupuncture treatment were analyzed.the general conditions of the patients who received acupuncture treatment in this hospital were as follows:the age of boys(2.92 ± 1.69 years old)was similar to that of girls(2.88 ± 1.62 years old).The hospitalization time was about 80 days.Judging from the subtype of cerebral palsy,spastic cerebral palsy was still dominant(42.1%),followed by hypotonia(7.32%)and involuntary exercise(6.15%).According to the statistics of diagnosis frequency,the order of syndrome diagnosis is liver strong and spleen weak syndrome,spleen and kidney deficiency syndrome,liver and kidney deficiency syndrome,spleen and kidney deficiency syndrome.The acupoint prescriptions of children with cerebral palsy treated with acupuncture were statistically analyzed.There were 90 acupoints in 943 acupuncture prescriptions of cerebral palsy.Four kinds of acupoints were used:fourteen meridian acupoints,meridian external strange acupoints,Jiao Shunfa scalp acupuncture and Jin three needles created by Professor Jin Rui.According to the order of frequency from high to low,the top three utilization rates are foot motor sensory area,Sanyinjiao and sports area,with a utilization rate of more than 80%;cerebral palsy acupuncture uses more Yang meridian acupoints,mainly limb acupoints;the efficacy is mainly to improve movement and balance disorders.The core acupoints of 943 patients with cerebral palsy were analyzed by complex network algorithm.It was concluded that the motor area,foot motor sensory area and Sanyinjiao were the most important acupoints in the acupuncture prescription.Xuehai,Yanglingquan,Fenglong,Taichong,balance area,Hegu,Houxi,Shenmai and so on.Three subpopulations of cerebral palsy were obtained by using algorithms such as community division and complex network analysis.The corresponding relationship between acupuncture prescription and the symptom characteristics of the patients is as follows:(1)foot motor sensory area,blood sea,Fenglong,balance area,Ganshu,Pishu,Xuanzhong,Weizhong,Shousanli,Waiguan,Chengfu,Yanglingquan,Xingjian,motor area treat the patients(called P0 for short)with following symptoms,such as low brain maturity,dyskinesia,hypertonia,abnormal posture and equilibrium disorder.Children with cerebral palsy have limited ability of self-movement,disadvantageous movement of limbs and joints,disturbance of fine motor development,accompanied by digestive disorder and mental retardation.(2)The motor area,foot motor sensory area,Sanyinjiao,Xuehai,Yanglingquan,Fenglong,Taichong,balance area,Hegu,Shenmai and Houxi treat the patients(called P2 for short)with following characteristics,such as high brain maturity,standing or walking ability,and poor fine motor function,hypertonia and abnormal gait.(3)The motor area,foot motor sensory area,Sanyinjiao,Yaoyangguan,Zusanli,Shenshu,Shousanli,Pishu,Dazhui,Sishencong,Zhi San Zhen,speech area 1-3,Baihui,Shanglianquan were used to treat the patients(called P4 for short)with following characteristics,such as hypotonia,mental retardation,abnormal gait like long stride and glassy eyes.The knowledge graph is used to query the acupoints of patients with similar characteristic symptoms of P0/P2/P4.The query results show that the therapeutic acupoints for P0's and P2's characteristic symptoms can cover the core acupoints and characteristic acupoints in the results of data mining,and the acupoint query results about P4' s characteristic symptoms also include all core acupoints in the treatment law as mentioned earlier,which proves the reliability of the law obtained by data mining to a certain extent.Conclusion:1.Knowledge graph technology is an appropriate tool for disease-related knowledge classification,display,query and search of complex and difficult diseases such as pediatric cerebral palsy.The construction and visualization of the knowledge system of cerebral palsy can be realized by establishing the knowledge graph of pediatric cerebral palsy,which includes disease,syndrome,symptom,treatment,effect,so as to find a new way for the dissemination and learning of TCM diagnosis and treatment knowledge of cerebral palsy.It can provide tools and methods for the formulation and optimization of clinical scheme of disease diagnosis and treatment.2.By methods combination of clinical efficacy evaluation,data mining and other technologies to analyze the diagnosis and treatment data of patients with cerebral palsy,to obtain the relevant tacit knowledge of TCM treatment of cerebral palsy and extract the concept and relationship to complete the knowledge graph of diagnosis and treatment of children with cerebral palsy.This method realizes the transformation of tacit knowledge to explicit knowledge and improves the content and construction method of knowledge graph,which is an effective means of externalization of tacit knowledge.3.Through the analysis of clinical treatment methods and evaluation of curative effect,it is found that in clinical practice,the formulation of diagnosis and treatment scheme for infantile cerebral palsy is lack of standardization,the purpose of combined therapy is not clear,and the treatment needs to be further optimized.In this study,three acupuncture experiences of acupoints selection to treat cerebral palsy were analyzed from the clinical data of patients who responded to treatment,which are consistent with the results of knowledge graph retrieval,which can provide a reference for clinical acupuncture treatment for children with cerebral palsy. |
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