The fundamental study for the standardisation and objectification of pattern identification in traditional Korean medicine for stroke (SOPI-Stroke): Development and interobserver agreement of the Korean standard pattern identification for stroke (K-SPI-Stroke) tool

Hypermethylation of the TSPOAP1-AS1 Promoter May Be Associated with Obesity in Overweight/Obese Korean Subjects

Obesity is a major chronic disease associated with the risk of serious cardiovascular or endocrinal diseases, such as hypertension, diabetes, atherosclerosis and stroke. Considerable interest has been directed towards the potential effects of epigenetic variations in obesity. In this study, we evaluated DNA methylation level at the promoter region of the gene encoding TSPO-associated protein 1 antisense RNA 1 (TSPOAP1-AS1) in 80 overweight/obese subjects (body mass index (BMI) > 25) and 104 non-obese subjects who participated in the SOPI-Stroke study in Korea. DNA methylation was measured using bisulfite amplicon sequencing (BSAS). A general linear model or relative correlation was used to determine the effects of DNA methylation on obesity and obese phenotypes. Notably, the mean level of DNA methylation was significantly higher in the overweight/obese group than in the non-obese group (18.62% vs. 17.18%). Further analyses revealed significant positive correlations of the BMI, the serum total cholesterol and low-density lipoprotein cholesterol levels with the DNA methylation level (p = 0.0493, p = 0.003, and p = 0.0094, respectively). The study findings suggest an association between DNA methylation at the TSPOAP1-AS1 promoter and overweight/obesity. Accordingly, methylation in this promoter region might be a potential predictor of obesity.

The Study of Misclassification Probability in Discriminant Model of Pattern Identification for Stroke

Background. Pattern identification (PI) is the basic system for diagnosis of patients in traditional Korean medicine (TKM). The purpose of this study was to identify misclassification objects in discriminant model of PI for improving the classification accuracy of PI for stroke. Methods. The study included 3306 patients with stroke who were admitted to 15 TKM hospitals from June 2006 to December 2012. We derive the four kinds of measure (D, R, S, and C score) based on the pattern of the profile graphs according to classification types. The proposed measures are applied to the data to evaluate how well those detect misclassification objects. Results. In 10–20% of the filtered data, misclassification rate of C score was highest compared to those rates of other scores (42.60%, 41.15%, resp.). In 30% of the filtered data, misclassification rate of R score was highest compared to those rates of other scores (40.32%). And, in 40–90% of the filtered data, misclassification rate of D score was highest compared to those rates of other scores. Additionally, we can derive the same result of C score from multiple regression model with two independent variables. Conclusions. The results of this study should assist the development of diagnostic standards in TKM.

Interobserver reliability of four diagnostic methods using traditional korean medicine for stroke patients

Objective. The aim of this study is to evaluate the consistency of pattern identification (PI), a set of diagnostic indicators used by traditional Korean medicine (TKM) clinicians. Methods. A total of 168 stroke patients who were admitted into oriental medical university hospitals from June 2012 through January 2013 were included in the study. Using the PI indicators, each patient was independently diagnosed by two experts from the same department. Interobserver consistency was assessed by simple percentage agreement as well as by kappa and AC₁ statistics. Results. Interobserver agreement on the PI indicators (for all patients) was generally high: pulse diagnosis signs (AC₁ = 0.66–0.89); inspection signs (AC₁ = 0.66–0.95); listening/smelling signs (AC₁ = 0.67–0.88); and inquiry signs (AC₁ = 0.62–0.94). Conclusion. In four examinations, there was moderate agreement between the clinicians on the PI indicators. To improve clinician consistency (e.g., in the diagnostic criteria used), it is necessary to analyze the reasons for inconsistency and to improve clinician training.

Perception of pattern identification in traditional medicine: a survey of Korean medical practitioners

OBJECTIVE

To survey assesses the perception of pattern identification (PI) diagnosis of Traditional Medicine (TM) by Korean medical doctors (KMDs).

METHODS

A total of 14,485 KMDs affiliated with the Association of Korean Medicine were sent surveys via email, and 1646 (11.1%) responded to the questionnaire on their perception of PI diagnosis.

RESULTS

Of the 1646 respondents, more than ninety percent (1562, 94.9%) reported that they treated patients using PI. The most critical problem with PI diagnosis was the lack of objective diagnostic indicators (561, 34.1%). Ninety percent had issues diagnosing patients because of different diagnoses between KMDs (1491, 90.5% ). The majority of respondents thought herbal medicine was most related to PI (1528, 92.8%). Half of the respondents answered that PI of Ba Gang was the most commonly used PI system. Participants reported that it was most important to study standardisation of PI diagnosis and to develop standardised PI diagnoses using the classification system of the Korean Standard Classification of Diseases. The foremost PI type that physicians thought should be included in standardisation and objectification of PI ofTKM was the PI of Ba Gang.

CONCLUSION

Our data suggest that we should focus on the standardisation of PI diagnosis and PI of Ba Gang in future research on PI diagnosis in TM. However, we cannot completely discount the possibility that a biased selection of subjects and a low response rate limit the generalisability of the findings.

Differential Association of Uncoupling Protein 2 Polymorphisms with Pattern Identification among Korean Stroke Patients: A Diagnostic System in Traditional Korean Medicine

Uncoupling protein 2 (UCP2), a mitochondrial protein present in many organs and cell types, is known to dissipate the proton gradient formed by the electron transport chain. Its function is correlated with predictive parameters, such as obesity, diabetes, and metabolic syndromes. We analyzed the distribution of UCP2 polymorphisms in stroke patients diagnosed with one of the following four stroke subtypes based on the TKM standard pattern identification (PI): Qi-deficiency (QD), Dampness and Phlegm (D&P), Yin-deficiency (YD), and Fire and Heat (F&D). We studied a total of 1,786 stroke patients (397/QD, 645/D&P, 223/YD, and 522/F&D, 586/normal). Genotyping for the G-1957A, G-866A and A55V UCP2 polymorphisms was performed using the TaqMan. G-866A and A55V were significantly associated with the D&P and H&F subtypes. The frequency of subjects with the A allele of G-866A was significantly lower than the frequency of subjects with the GG type. The A55V polymorphism was also shown similar effect with G-866A in the dominant model. In contrast, no SNPs were shown to be associated with the QD or YD subtypes in this study. These results showed that the G-866A and A55V UCP2 polymorphisms may be genetic factors for specific PI types among Korean stroke patients.