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  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Med.</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <title-group>
        <article-title>Construction automatique d'une ontologie de maladies par une approche descendante</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Ihssen Belhadj</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Christian Jacquelinet</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Agence de la biomédecine</institution>
          ,
          <addr-line>Saint-Denis La Plaine, France BelhadjIhssene(at)gmail.com</addr-line>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Laboratoire d'informatique médicale et de bioinformatique, Faculté de médecine de l'université Paris 13</institution>
          ,
          <addr-line>Bobigny</addr-line>
        </aff>
      </contrib-group>
      <pub-date>
        <year>1995</year>
      </pub-date>
      <volume>34</volume>
      <fpage>15</fpage>
      <lpage>24</lpage>
      <abstract>
        <p>This paper examines through an experimental approach the feasibility of an automatic disease ontology generation. The proposed method is based on a systematic specialization of concepts starting from a given model of knowledge and ontology of domain primitive attributes. The implementation of this method has permitted to generate test ontologies that were evaluated manually and by the use of Formal Concept Analysis auditing methods. This implementation has shown that it is possible to create automatically a multiontology concept hierarchy that highlights. Résumé: Cet article examine expérimentalement la faisabilité d'une méthode de génération automatique d'une ontologie de maladies. La méthode proposée repose sur une spécialisation systématique des concepts à partir d'un modèle donné des connaissances et d'une ontologie des attributs primitifs. L'implémentation de cette méthode a permis de faire des générations d'ontologies qui ont été évalué manuellement et en utilisant des méthodes de Formal Concept Analysis. Cette implémentation a montré qu'il est possible de créer une ontologie de concept multi-hiérarchique selon différents points de vue à partir d'un modèle générique des connaissances d'un domaine et une ontologie de ses concepts primitifs.</p>
      </abstract>
      <kwd-group>
        <kwd />
        <kwd>Ontologies construction</kwd>
        <kwd>top-down approach</kwd>
        <kwd>disease concept</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>1</p>
    </sec>
    <sec id="sec-2">
      <title>Introduction</title>
      <p>Agence de la biomédecine maintains a national information system (AB-IS) to
support its missions concerning the evaluation of organ retrieval and transplantation
activities, the management of the national waiting list and the epidemiology of end
stage renal diseases in France (Strang et al, 2005. &amp; Couchoud C et al, 2006.,
BenSaid et al, 2003). AB-IS comprises a contextual terminological server that was
build according to sound ontological foundations (Jacquelinet et al 2003a.,
Jacquelinet et al, 2003b). A first component of this terminological server is an
ontological editor that permits to describe the semantic structure of each new concept
according to a knowledge model that is automatically inherited from its supertypes
but manually specialized to provide the most accurate semantic structure.</p>
      <p>A second component is a terminological resources manager that allows integrating
any kind of terminological resources.</p>
      <p>The need to provide ontology able to support the lateral integration of many
terminologies emerged as a crucial requirement with the inclusion of the French
ESRD REIN registry as a contributor the European ESRD registry using EDI
technologies in the realm of the Nephro-Quest project (Jager &amp; Zoccali, 2008). The
new ERA-EDTA Thesaurus (ET) and the Thesaurus of the French Society of
Nephrology (TSN) are both detailed terminologies but unfortunately organized
around different axis so that the provision of smallest common supertypes for many
concepts of the TSN that have no exact equivalent or no unique supertype. This led us
to examine the feasibility of an automatic disease ontology generation by systematic
specialization of concepts from a given knowledge model and according to the
hierarchical structure of the attributes.
2
2.1</p>
    </sec>
    <sec id="sec-3">
      <title>Materials et methods</title>
      <sec id="sec-3-1">
        <title>Study framework</title>
        <p>To generate concepts from a starting root concept, we use: The description
knowledge model related to the root concept, the primitive pre-existing domain
ontology that supports its constituents and all their subtypes, a set of specialization,
differentiation and combining principles guiding the generation process.
2.2</p>
      </sec>
      <sec id="sec-3-2">
        <title>Disease Description Model</title>
        <p>In (Bertaud V, 2007) was analyzed how diseases are represented in existing
terminological resources such as UMLS (Bodenreider, 2004). It has concluded that
diseases are often defined as pathological entities resulting from pathological
processes. This definition is of a little use once interesting to computerize diseases
definitions because of the constant evolution of medical knowledge on pathological
processes. To address this issue one can consider diseases as patterns of data
providing information about a patient that are useful for the diagnosis process. Hence,
the question of defining a DDM can be dealt by the specification of a generic data
structure considering that only discriminating knowledge is required to split, to
abstract and to make a domain ontology.</p>
        <p>In the Work of (Jacquelinet et al, 2003b) addressing the issue of retrieving from
medical text information about patient, it was used conceptual graphs formalism
(CGs) to represent diseases using a Description Model (DDM) as in Fig.1. Concepts
related to terms are described with simple CGs that relates a concept to other concepts
by the mean of conceptual relations.</p>
        <p>[Disease](Has_Location)
(Has_Lesion)
(Has_Evolution)
…
(Has_Attribute_ n)</p>
        <p>[Anatomical_Entity_to_Specify]
[Lesion_to_Quantify]
[Evolution_to_Specify]</p>
        <p>[Discriminating attribute_n]
Thus, as example, one can represent the concept of “Chronic renal disease” as bellow
(Fig.2):</p>
        <p>In this example, [Chronic Kidney Disease] is defined by three attributes: a
location which is the kidney, a lesion that is not specified and an evolution that is
chronic. The concepts [Rein], [Lesion to quantify], [Chronicity] constitute the
attributes that define and discriminate the concept [Chronic Kidney Disease]. Each
attribute refers to an elementary pre-existing concept with a fixed position in a
predefined concepts hierarchy. This hierarchy should reflect the underlying reality
through a domain theory (Bodenreider &amp; Burgun, 2005). Moreover, one can build a
space of attributes-based domain concepts by an automatic specialization of DKM.
2.3</p>
      </sec>
      <sec id="sec-3-3">
        <title>Generative Principles</title>
        <p>We assume here that the location of a given concept in a hierarchy is given by its
semantic structure: the order relation between two concepts is derived according to
specialization/generalization operations that permit to transform a semantic structure
so as it defines a new resulting to a new concept (Rassinoux et al, 1992).
2.3.1</p>
        <sec id="sec-3-3-1">
          <title>Specialization operation</title>
          <p>Let C, C’, two concepts defined by two graphs: C: D → (RC) → C1 (1), C’: D
→ (RC) → C2 (2).</p>
          <p>If C1 is a specialization of C2, then C’ is a specialization of C. We note our
specialization rule: C1 &lt; C2 =&gt; C &lt; C’ (3). Our seed knowledge model is defined to
comprise the supertypes of all specialized attributes of its specializations. As a result,
(3) is the sole specialization we need to use. The specialization of concepts is
performed by the acquisition of specialized attribute. This principle defines a useful
rule to organize a hierarchy that is lattice multiple inheritance.
2.3.2</p>
        </sec>
        <sec id="sec-3-3-2">
          <title>Combinatory restriction rules</title>
          <p>Let C be a root concept related to its DDM. C: D – (RC1) C1, (RC2) C2. We
experimented 3 different combinatory rules. Combinatory rule 1 assumes that all the
subtypes of C1 can be combined with the subtypes of C2 with no restriction.
Combinatory rule 2 restricts the generation of concept to those combining terminal
specializations of DDM attributes. More interestingly, we introduced the possibility to
add a exclusivity property to certain subtypes of the attributes related to the DDM.
The combinatory restriction rule 3 imposes that a specialization of the DDM defining
a generated concept comprises a maximum of 1 exclusive differentiating attribute, all
other combined attributes be non exclusive specializations.
2.3.3</p>
        </sec>
        <sec id="sec-3-3-3">
          <title>Siblings Opposition Principles</title>
          <p>In the Primitive Domain ontology, the hierarchy of KM sub-types comprises
intermediate concepts that support the siblings opposition principle and its unicity
according to (Zweigenbaum et al, 1995). For example:</p>
          <p>Existing Etiological_Process</p>
          <p>Etiological Process according to its acknowledgement &lt;e&gt;</p>
          <p>Unknown Etiological Process
Known Etiological Process &lt;e&gt;</p>
          <p>Unspecified Etiological Process
Specified Etiological Process &lt;e&gt;</p>
          <p>Etiological_Process according to its type &lt;e&gt;</p>
          <p>Hypofunction
Dysfunction
Hyperfunction
Hyperfunction according to Anatomical Entity &lt;e&gt;</p>
          <p>Cardiac HyperFunction
…….</p>
          <p>Lesion to Quantify &lt;e&gt;</p>
          <p>Unquantified Lesion
Quantified Lesion &lt;e&gt;</p>
          <p>Unexisting Lesion</p>
          <p>Existing Lesion
With combinatory restriction rule 1, we will generate some:
Disease(Has Evolution)→ [Quantified Lesion] &lt;e&gt;
(has Etiology)→ [Specified Etiological Process] &lt;e&gt;</p>
          <p>Such a Concept will not exist with combinatory restriction rule 3 that will impose
to specialize exclusive opposition principle weaving concepts before to hybridize with
another exclusive opposition principle wearing concept.
2.4</p>
        </sec>
      </sec>
      <sec id="sec-3-4">
        <title>Auditing Method</title>
        <p>Formal Concept Analysis (FCA) can be described as a method for attributes
exploration (Granter &amp; Wille, 1999). It has been applied for building, completion and
evaluation of ontologies (Baader et al, 2007, Jiang et al, 2003, Jiang et al, 2009a.)
The work (Jiang et al, 2009b) describes an FCA auditing method that inspired us to
adapt it to the framework of our study. In fact, FCA can be used to represent
semantically a concept definition by formal contexts which could be visualized by a
lattice diagram.</p>
        <p>The figure 3, the lattice diagram corresponding to this context is illustrated in the
figure below. Therefore, we thought to make possible to convert the whole and/or part
of generated concepts in a FCA formal one valued context.
The objects in FCA will refer to the generated objects and the attributes to all of the
relation signatures involving the concept except subsumption relations. In other terms
we hided “is-a” relations so that the formal context refers to only to its attributes
relations. Otherwise, applying these methods required to develop accessorily a
module that allowing exporting generated concept to an XML file compatible with
Concept Explore (http://conexp.sourceforge.net/ ) software implementing FCA
toolbox.
Using protégé, 3 sample primitive ontologies were built, ranging from a small to
larger coverage domain ontology built in group involving epidemiologists and
medical computer scientists by abstracting definitions of sound disease related
concepts. These sample ontologies served as test input for the generation algorithm.
The simplest sample input ontology comprised 21 concepts according to three axes
[Anatomical location], [Evolution], [Lesion].</p>
        <p>The DDM was built with Existential quantifiers of disease concept. The use of the
input and/or output ontology required the development of an import / export module
to and from OWL format ontology. This enables our algorithm to use a large panel of
Protégé tools and plug-ins.</p>
        <p>Primitive Attributes
ontology</p>
        <p>Disease Description</p>
        <p>Model
The exploitation of this ontology is done via an ad-hoc database format supported by
a MySQL database system. In this format, a main table contains a list of all concepts
while another contains signatures of relations instances according to the following
formalism: (head Concept-Relation- tail Concept). The name of each concept is
standardized by a module which generates its name based on its attributes. This
allows a unique identification of concepts and to request about duplicate concepts or
supertypes.
2.5.2</p>
        <sec id="sec-3-4-1">
          <title>Implementation of generation method</title>
          <p>The design of the implementation of our method was based on the idea that every
concept shares multiple points of view that are determined by its structure and need to
be saturated by attributes. The saturation process is done by acquisition of new
attributes, leading to a concept hierarchy alternating concepts with abstract attributes
wearing the differentiating points of view and concepts whose attributes are direct and
concrete specializations of the differentiating points of view. To illustrate the
generation process, we can by summarizing the model described in figure 2, make a
first level generation: [Diseases according to its evolution], [Diseases according to
lesion to quantify], [Diseases according to its location].We can for example start
from [Kidney Disease], a concrete specialization of [Diseases according to its
location]. kidney disease according to their evolution, we can make a second level
generation as showed in figure 1. This generation use [Specified Evolution] abstract
sub-hierarchy to generated new concepts. Therefore, generated concepts starting from
[Disease According To Its Evolution] are: [Chronic Kidney Disease] and [chronic
Kidney Disease]. These concepts saturate [Specified evolution] point of view. This
concept itself will become a genius and tend to make subtypes because there still exist
points of view that are not saturated. In this example, at this step, an unsaturated point
of view is [Lesion to quanitfy].</p>
          <p>[Kidney Disease]
(has_Location)
(has_Lesion)
(has_Evolution)</p>
          <p>[Kidney]
[Lesion to quantify]
[Evolution to specifiy]</p>
          <p>Specified Evolution (Point Of View)</p>
          <p>Chronicity</p>
          <p>Acuteness</p>
          <p>Every time a new attribute is added, a new concept is generated after verifying it
complies with integrity rules we can personalize by adding conditional clauses. The
concept is then added to knowledge base and the new acquired attribute is instantiated
as a new relation signature.</p>
          <p>And so on, the algorithm still runs while unsaturated concepts are still existing and
until deploying all of the points of view. The visualization of generated ontology is
done by using a Java interface specially developed for this purpose. It helps to browse
the subsumption hierarchy of concepts as well as viewing attributes, supertypes and
subtypes.</p>
        </sec>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>Results</title>
      <p>A first test permitted to generate a total of 157 concepts starting from a primitive
conceptual hierarchy of 21 concepts and a DDM including three attributes. In this
test, we examined manually a sample of subsumption relationships between the
generated ontology and the lattice diagram. All the relations examined in FCA are
concordant with the generated ontology subsumption relations. A first result is that
FCA identifies automatically subsumption relations.</p>
      <p>A second test aimed to observe the combinatory explosion while increasing each
time a primitive a more finely conceptual hierarchy. The last one comprises 110
concepts and generated ontology of 12000 concepts according to a DDM including
four attributes.</p>
      <p>A third test consisted of repeating the previous test but after adding clauses
referring to restriction rules defined in the method above. We can say, then, that
combinatory restrictions rules reduced considerably the combinatory explosion.
Thinner
4</p>
    </sec>
    <sec id="sec-5">
      <title>Discussion – Conclusion</title>
      <p>We have described and implemented a method of automatic generation of diseases
definitions ontology based on a systematic combination of attributes and exclusively
by a top-down approach. The implementation of this method showed that it is
possible to create a multi-hierarchical concept ontology according different views
from a starting domain concepts model and ontology of primitive domain concepts.
This can be of a major methodological interest in building contextual domain
reference ontologies. Future works will focuse not only on the generation method but
also on the quality and usability of the generated ontology.
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knowledge bases using formal concept analysis, Proceedings of the twentieth international joint
conference on artificial intelligence (IJCAI-07), AAAI Press (2007).
The renal epidemiology and information network (REIN): a new registry for end-stage renal
disease in France. Nephrol Dial Transplant 2006 Feb: 21(2):411-8.).</p>
      <p>GRANTER B &amp; WILLE R. (1999) Formal concept analysis: mathematical foundations. Berlin:
Springer; 1999: ISBN: 3-540-62771-5.</p>
      <p>JACQUELINET C, BURGUN A, DELAMARRE D, STRANG WN, DJABBOUR S, BOUTIN B, LE BEUX P.
(2003) Developing the ontological foundations of a terminological system for end-stage
diseases, organ failure, dialysis and transplantation. Int J Med Inform. Jul; 70(2-3):317-28.
JACQUELINET C, BURGUN A, DJABBOUR S, DELAMARRE D, CLERC P, BOUTIN B, LE BEUX P.
(2003). A contextual coding system for transplantation and end stage diseases. Stud Health
Technol Inform 2003:95:457-62.</p>
      <p>JAGER, K.J. &amp; ZOCCALI, C. (2008). Quality of care in end-stage renal disease: the importanceof
comparing ‘apples with apples’. Nephrol Dial Transplant; 23: 1116.)
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formal concept analysis, J Am Med Inform Assoc 16 (1) (2009), pp. 89–102. JIANG G.,
OGASAWARA K., ENDOH A. &amp; SAKURAI T. (2003) Context-based ontology building support in
clinical domains using formal concept analysis, Int J Med Inform 71 (1) (2003), pp. 71–81.
JIANG G., PATHAK J. &amp; CHUTE CG. (2009b) Formalizing ICD coding rules using Formal
Concept Analysis, J Biomed Inform. 2009 Jun; 42(3):504-17.</p>
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Data System. Stud Health Technol Inform 2005: 116:77-82.</p>
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