Hemadsorption and fusion inhibition activities of hemagglutinin analyzed by vaccinia virus mutants

Psychometric Validation of the Dampness Syndrome Scale of Chinese Medicine for People in China

Background

Dampness syndrome is a basic syndrome of many major and chronic diseases. Early screening and identification of dampness syndrome are important. The Dampness Syndrome Scale of Chinese Medicine (DSSCM) was developed to measure the occurrence and severity of dampness syndrome. The measurement characteristics of the DSSCM should be further validated. The objective of this study is to evaluate the reliability and validity of the DSSCM based on a cross-sectional survey.

Methods

The development of DSSCM was based on the traditional Chinese medicine (TCM) theory, expert consensus and clinical investigations. Participants were recruited from Guangdong Provincial Hospital of Chinese Medicine and Guangzhou Cadre Health Management Center in Guangdong Province, China. All participants completed the baseline questionnaire and DSSCM. The reliability of the DSSCM was evaluated by internal consistency reliability and test-retest reliability. The factor structure was tested with confirmatory factor analysis (CFA), while discriminant validity was evaluated by calculating the difference between the total score of the DSSCM and its four dimensions for participants with or without dampness syndrome. We used a clinician's diagnosis of dampness syndrome as a criterion to evaluate the criterion validity. Multivariate regression analysis was used to analyze the associations among gender, age, height, and weight and dampness syndrome.

Results

A total of 880 participants were enrolled for psychometric validation and 869 participants were included in the final analyses after exclusion. The mean age of the participants was 42.62±12.86 years. The Cronbach's alpha coefficients for the four dimensions of the DSSCM were 0.809, 0.891, 0.816 and 0.780. The ICCs for the four dimensions of the DSSCM were 0.806, 0.674, 0.780 and 0.760. For validity, the results showed that the DSSCM had good content validity, discriminant validity and criterion validity. For the CFA, the root mean square error of approximation (RMSEA) was 0.091; the standardized root mean square residual (SRMR) was 0.074; the comparative fit index (CFI) was 0.766; and the Tucker-Lewis index (TLI) was 0.745. Weight was found to be associated with the total scores of the DSSCM and its three dimensions.

Conclusion

The DSSCM has good reliability and validity to support its use as a tool for assessing the severity of dampness syndrome. This study provides empirical evidence for future updates to the DSSCM.

Harmonic components of photoplethysmography and pathological patterns: A cross-sectional study

This study aimed to examine whether the 3 harmonic components (HCs) of photoplethysmography (PTG) - total harmonic distortion (THD), harmonic power (HP), and normalized harmonic amplitude (HA) - have aging effects and may serve as an arterial stiffness marker and examine the relationship between HCs and clinical severity of pathological patterns. This study had a retrospective chart review design, and electronic medical records of 173 female patients (age: 38.57 ± 11.64 years) were reviewed. Patients were asked to complete the phlegm, blood stasis (BS), and food retention (FR) pattern questionnaires and underwent PTG and the second derivative of PTG measurements. THD, HP, and HA data were extracted till the 12th HCs from the raw PTG data. THD and HA had an aging effect (β: -0.179 to -0.278) and were related to b/a (r: -02.76 to -0.455) and d/a (r: 0.265-0.360) of the second derivative of PTG. In the younger group (≤33 years), HP and HA were positively correlated with phlegm, BS, and FR patterns (r: 0.257-0.370), while HP was positively correlated with the FR pattern (r: 0.278-0.315) in the middle age group (34-45 years). In the older group (≥46 years), HP and HA were positively or negatively correlated with the phlegm pattern (r: ±0.263 to ±0.440). HCs may serve as an arterial stiffness marker, and may be partially related to phlegm, BS, and FR patterns. Aging effect needs to be considered when utilizing HCs as an indicator of phlegm, BS, and FR patterns.

Efficacy and safety of the herbal formula Naesohwajung-tang for functional dyspepsia: a randomized, double-blind, placebo-controlled, multi-center trial

Background: Current treatment and management options for functional dyspepsia (FD) often fail to alleviate symptoms. Naesohwajung-tang (NHT) is a herbal formula frequently used to treat functional dyspepsia in traditional Korean medicine. However, few animal and case reports on the use of Naesohwajung-tang for functional dyspepsia treatment exist, and the clinical evidence remains deficient. Objectives: This study aimed to evaluate the efficacy of Naesohwajung-tang in patients with functional dyspepsia. Methods: We enrolled 116 patients with functional dyspepsia at two study sites in this 4 weeks, randomized, double-blind, placebo-controlled trial and randomly assigned them to either the Naesohwajung-tang or placebo group. To evaluate the efficacy of Naesohwajung-tang, the primary endpoint was a score on the total dyspepsia symptom (TDS) scale after treatment. The overall treatment effect (OTE), single dyspepsia symptom (SDS) scale, food retention questionnaire (FRQ), Damum questionnaire (DQ), functional dyspepsia-related quality of life (FD-QoL) questionnaire, and gastric myoelectrical activity measured using electrogastrography were evaluated as secondary outcomes. Laboratory tests were performed to confirm the safety of the intervention. Results: The 4 weeks administration of Naesohwajung-tang granules demonstrated a significantly higher reduction in the total dyspepsia symptom (p < 0.05) and a higher degree of improvement in the total dyspepsia symptom (p < 0.01) than the placebo group. Patients who underwent Naesohwajung-tang had a significantly higher overall treatment effect and a greater increase in the degree of improvement in scores such as epigastric burning, postprandial fullness, early satiation, functional dyspepsia-related quality of life, and Damum questionnaire (p < 0.05). Additionally, the Naesohwajung-tang group showed a greater effect in preventing a decrease in the percentage of normal gastric slow waves after meals than the placebo group. As a result of subgroup analyses using the degree of improvement in total dyspepsia symptom, Naesohwajung-tang was found to be more effective than placebo in female, younger patients (<65 years), with a high body-mass index (≥22), overlap type, food retention type, and Dampness and heat in the spleen and stomach systems pattern. There was no significant difference in the incidence of adverse events between the two groups. Conclusion: This is the first randomized clinical trial to verify that Naesohwajung-tang leads on symptom relief in patients with functional dyspepsia. Clinical Trial Registration: https://cris.nih.go.kr/cris/search/detailSearch.do/17613, identifier KCT0003405.

Valid and Convenient Questionnaire Assessment of Chinese Body Constitution: Item Characteristics, Reliability, and Construct Validation

BACKGROUND

Body constitution is a fundamental concept in traditional Chinese medicine (TCM) for clinical diagnosis, treatment of illness, and community-based health promotion. Clinical assessment of patients' body constitutions, however, has never been easy and consistent, even by well-trained clinicians and TCM practitioners. Therefore, questionnaires such as the popular Constitution in Chinese Medicine Questionnaire (CCMQ) can be an appealing and convenient assessment alternative. The present research borrowed advanced methodologies for questionnaire development in psychology and other social sciences to examine the performance of the CCMQ in terms of (i) the strength of relations of each item with its designated constitution, (ii) the reliabilities of each constitution, and (iii) the overall 9-constitution structure. This research provided empirical evidence to support the use of the CCMQ and proposed directions for refinement in future revisions of the CCMQ or similar measures.

METHODS

A total of 1571 volunteers from three villages in southern China participated in the CCMQ survey. The item characteristics, reliabilities, interconstitution correlations, and confirmatory factor analysis of the 9-body-constitution structure were examined.

RESULTS

The results generally supported the appropriateness of the clinical observations (the questionnaire items) and the CCMQ 9-constitution classification structure. Nevertheless, some relatively weaker items, item pairs with similar meanings, and highly overlapping constitutions were identified for future CCMQ revisions.

CONCLUSION

The CCMQ measured the 9 constitutions efficiently and with reasonably good reliability and construct validity. Given the various challenges to assessing TCM body constitutions even by experienced clinicians, the CCMQ provides an appealing alternative to measure the Chinese body constitutions of healthy participants in large-scale research or community health promotion programs. The present study also demonstrated how advanced methodologies in social sciences can help validate and refine the CCMQ and similar complementary medicine measures.

Development of the 8-Item Phlegm Pattern Questionnaire (PPQ-8) Using Rasch Analysis

The 25-item Phlegm Pattern Questionnaire (PPQ) has been widely used to examine the relationship between the phlegm pattern (PP), quality of life, tongue colour, vocal qualities, and dysfunctional breathing. However, the concerns of response burden and differences in the respondent's abilities or item difficulty for the original version of the PPQ have not been sufficiently addressed. This study aimed to develop a short-form PPQ using Rasch analysis, an item response theory. Based on the retrospective data, the response order, differential item functioning (DIF), dimensionality, reliability, concurrent validity, and fitting errors were examined for 291 normal participants and 61 inpatients. The discriminative ability of the short-form PPQ was examined using receiver operating characteristic curve analysis. Along with Rasch analysis, another short-form PPQ was developed using equidiscriminative item-total correlation (EITC) analysis and the results between the two short-form PPQs were compared accordingly. Rasch analysis results suggested a 6-point response category for the PPQ, and finally, 8 items without fitting errors or DIF variability were selected for the PPQ (PPQ-8). The PPQ-8 had satisfactory reliability (person separation index = 2.23), unidimensionality (unexplained variance in the first contrast = 1.598), fitting levels (infit mean square, 0.80-1.39; outfit mean square, 0.79-1.34), sensitivity (70.5%), and specificity (76.5%). The PPQ-8 had a moderate discriminative ability of the PP (area under the curve = 0.759), and the cut-off point was 23. Although the 8-item PPQ developed using EITC analysis showed similar levels of reliability, validity, and discriminative ability of the PP to the PPQ-8, it could not present the information of item hierarchy and differences in the respondents' abilities. In conclusion, the PPQ-8 by Rasch analysis is recommended for future use to evaluate the clinical severity of PP.

Identifying Chinese Medicine Patterns of Tension-Type Headache and Understanding Its Subgroups

Tension-type headache (TTH) is common among adults. Individualized management strategies are limited due to lack of understanding of subtypes of TTH. Chinese medicine (CM) uses the pattern differentiation approach to subtype all health conditions. There is, however, a lack of evidence-based information on CM patterns of TTH. This study aimed to identity common CM patterns of TTH. TTH sufferers were invited for a survey, consisting of a validated Chinese Medicine Headache Questionnaire (CMHQ), Migraine Disability Assessment Test, and Perceived Stress Scale. The CMHQ consisted of information about headache, aggravating and relieving factors, and accompanying symptoms. Principal component analysis was used for factor extraction and TwoStep cluster analyses for identifying clusters. ANOVA was used to compare cluster groups with disability and stress. In total, 170 eligible participants took part in the survey. The commonest headache features were continuous pain (64%); fixed location (74%); aggravated by overwork (74%), stress (74%), or mental strain (70%); and relieved by sleeping (78%). The commonest nonpain symptoms were fatigue (71%) and neck stiffness (70%). Four clusters, differing in their key signs and symptoms, could be assigned to three different CM patterns including ascendant hyperactivity of liver yang (cluster 1), dual qi and blood deficiency (cluster 2), liver depression forming fire (cluster 3), and an unlabelled group (cluster 4). Additionally, over 75% participants in clusters 1 and 2 have episodic TTH, over one-third participants in cluster 3 have chronic TTH, and a majority of participants in cluster 4 have infrequent TTH. The three patterns identified also differed in levels of disability and some elements of coping as measured with PSS. The three CM patterns identified are common clinical presentations of TTH. The new information will contribute to further understanding of the subtypes of TTH and guide the development of targeted intervention combinations for clinical practice and research.

Disruption of Pathological Patterns in a Young Population with Dysfunctional Breathing

Dysfunctional breathing (DB) is characterized by abnormal breathing patterns and often results from psychogenic causes in the absence of organic diseases. Although acupuncture and herbal treatments have been suggested as alternative therapies for DB, few studies have addressed the relationship between DB and pathological patterns from a diagnostic perspective. We asked 237 college students (130 men aged 21.4 ± 1.9 years; 107 women aged 21.4 ± 3.0 years) to complete the Korean version of the General Health Questionnaire-30 (K-GHQ-30) and four validated pathological pattern questionnaires regarding qi and yin deficiencies, phlegm, and cold-heat patterns. The Korean version of the Nijmegen Questionnaire was used to classify participants into DB and non-DB groups. Effects of age, gender, and DB on pathological patterns were examined using simple regression and two-way MANCOVA models. Age had an effect on all pattern scores except heat pattern scores (β: 0.154-0.098). DB group showed a moderate main effect (η 2 = 0.167) on pathological patterns, while gender showed a minimal main effect (η 2 = 0.096); qi and yin deficiencies, phlegm, and cold-heat pattern scores in DB and female groups were higher than those in non-DB and male groups. The K-GHQ-30 scores showed significant positive correlations with the pathological pattern scores (r: 0.243-0.533), indicating that disruption of pathological patterns could be associated with patients' psychological disturbance. In conclusion, these questionnaires may help to identify pathological patterns related to DB and determine individually tailored alternative therapies.

A clinical study on safety and efficacy of Naesohwajung-tang on functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a chronic gastrointestinal disorder diagnosed with dyspeptic symptoms, such as recurrent or persistent postprandial fullness, epigastric pain, burning, and early satiety without any evidence of structural abnormality. In traditional Korean medicine, herbal remedies are one of the preferred treatments for gastrointestinal symptoms. Among them, Naesohwajung-tang (NHT) has been frequently prescribed to improve dyspeptic symptoms for a long time. However, the safety and efficacy of NHT still remain unclear. Therefore, this study aims to evaluate the safety and efficacy of NHT in patients with FD using a randomized controlled trial.

METHODS

This is a protocol for a multi-center, randomized, double-blind, placebo-controlled trial. Total 116 participants aged between 19 and 75 years diagnosed with FD according to the Rome IV diagnosis criteria will be recruited at two Korean medicine hospitals. Eligible participants will be randomly assigned to either a NHT group or a placebo group in a 1:1 ratio. Each participant will be instructed to take NHT or placebo granules three times a day for 4 weeks. The primary outcome is the change in the total dyspepsia symptom score to confirm the efficacy of NHT. The secondary outcomes include overall total effect, single dyspepsia symptom scale, food retention questionnaire, Damum questionnaire, FD-related quality of life, electrogastrography, and safety assessments. Adverse events will be evaluated at every visit. The primary endpoint will be measured at week 4, and then re-evaluated at week 8 through a follow-up phone visit.

DISCUSSION

This trial will evaluate the safety and efficacy of NHT as a treatment of FD. The results of this trial will not only verify whether NHT improves FD symptoms and gastric myoelectrical activity, but also clarify those correlations.

TRIAL REGISTRATION NUMBER

CRIS KCT0003405.

Consensus in Traditional Chinese Medical Diagnosis in Open Populations

Objectives: An acceptable level of diagnostic agreement is a prerequisite for consistent administration of treatment. It is critical for investigating effectiveness of different treatment approaches using multiple practitioners. To the best of our knowledge, no previous investigation of diagnostic consensus using open populations in Chinese medicine (CM) has been reported. Investigations restricted to individual medical conditions, such as have been usually studied, do not reveal any information as to what occurs in real world clinical settings. This knowledge gap led to the current study being conducted. Design/Location/Subjects/Interventions: Investigating diagnostic agreement specifically in Traditional Chinese Medicine (TCM) in an open population, two or three practitioners diagnosed 35 subjects at the University of Technology, Sydney (UTS), TCM clinic. The practitioners were restricted to a list of the 56 most frequently used TCM diagnoses at the UTS clinic. Up to three diagnostic patterns per subject could be selected, with nominated patterns scored between 1 and 5. Outcome measures: Agreement was determined with two criteria, both expressed as simple percentages: pattern and linearly weighted agreements. Results: The results showed that 23% of practitioners obtained pattern agreement, while 19% demonstrated weighted agreement. Conclusion: There appears to be very low diagnostic agreement between practitioners. This is an important finding. If unchallenged by further investigation, the recognition of such poor diagnostic consensus may lead to rejection of TCM theory before it has been adequately assessed. Diagnostic agreement must be improved so that future investigations into treatment effectiveness or mechanisms of action are made on a valid basis. Additionally, the current TCM diagnostic format must be altered to allow the application of chance-removed statistics or the calculation of a standard error with open populations. This article is the first of a series of three that report problems in TCM diagnostic reliability and proposes solutions to the issues outlined.

Efficacy and safety of electroacupuncture in acute decompensated heart failure: a study protocol for a randomized, patient- and assessor-blinded, sham controlled trial

Background

The purpose of this trial is to evaluate the effectiveness and safety of electroacupuncture in the treatment of acute decompensated heart failure compared with sham electroacupuncture.

Methods

This protocol is for a randomized, sham controlled, patient- and assessor-blinded, parallel group, single center clinical trial that can overcome the limitations of previous trials examining acupuncture and heart failure. Forty-four acute decompensated heart failure patients admitted to the cardiology ward will be randomly assigned into the electroacupuncture treatment group (n = 22) or the sham electroacupuncture control group (n = 22). Participants will receive electroacupuncture treatment for 5 days of their hospital stay. The primary outcome of this study is the difference in total diuretic dose between the two groups during hospitalization. On the day of discharge, follow-up heart rate variability, routine blood tests, cardiac biomarkers, high-sensitivity C-reactive protein (hs-CRP) level, and N-terminal pro b-type natriuretic peptide (NT-pro BNP) level will be assessed. Four weeks after discharge, hs-CRP, NT-pro BNP, heart failure symptoms, quality of life, and a pattern identification questionnaire will be used for follow-up analysis. Six months after discharge, major cardiac adverse events and cardiac function measured by echocardiography will be assessed. Adverse events will be recorded during every visit.

Discussion

The result of this clinical trial will offer evidence of the effectiveness and safety of electroacupuncture for acute decompensated heart failure.

Trial registration

Clinical Research Information Service: KCT0002249.

Development of a valid and reliable seven emotions impairment questionnaire and assessment of its predictability for phlegm and blood stasis

OBJECTIVE

To develop and validate a Seven Emotions Impairment questionnaire (SEIQ), to define an optimum cut-off point for the SEIQ, and to examine whether SEI was predictive of Phlegm and Blood Stasis (BS).

METHODS

Two hundred outpatients and 75 college students were asked to complete the SEIQ, the Profile of Mood States (POMS), Phlegm Pattern Questionnaire (PPQ), and BS Questionnaire (BSQ). Twelve clinicians determined whether the outpatients exhibited SEI. SEIQ data were used to examine the internal consistency and determine validity for the outpatients. SEIQ, POMS, PPQ, and BSQ data were used to examine concurrent validity and predictability of SEI for Phlegm and BS in the college students. Total SEIQ scores and the clinicians' diagnoses of the outpatients were considered to define an optimum cut-off score for the SEIQ.

RESULTS

The 18-item SEIQ had satisfactory internal consistency (α = 0.905) and concurrent validity. In the construct validity test, four factors (chest-anxiety, fatigue-depression, working-family-troubles, and sleep-memory) were identified. In the receiver operator characteristic curve curve analysis, the sensitivity, specificity, and area under the curve of the SEIQ were 67.2%, 72.1%, and 73%, respectively. The optimum cut-off score was defined as nine points. SEIQ scores were strongly predictive of Phlegm and BS (β = 0.862 and 0.673, respectively).

CONCLUSION

Based on our results, we concluded that the SEIQ is a reliable and valid instrument for evaluating SEI, and is strongly predictive of Phlegm and BS.

Confirmatory and Exploratory Factor Analysis for Validating the Phlegm Pattern Questionnaire for Healthy Subjects

Background. Phlegm pattern questionnaire (PPQ) was developed to evaluate and diagnose phlegm pattern in Korean Medicine and Traditional Chinese Medicine, but it was based on a dataset from patients who visited the hospital to consult with a clinician regarding their health without any strict exclusion or inclusion. In this study, we reinvestigated the construct validity of PPQ with a new dataset and confirmed the feasibility of applying it to a healthy population. Methods. 286 healthy subjects were finally included and their responses to PPQ were acquired. Confirmatory factor analysis (CFA) was conducted and the model fit was discussed. We extracted a new factor structure by exploratory factor analysis (EFA) and compared the two factor structures. Results. In CFA results, the model fit indices are acceptable (RMSEA = 0.074) or slightly less than the good fit values (CFI = 0.839, TLI = 0.860). Many average variances extracted were smaller than the correlation coefficients of the factors, which shows the somewhat insufficient discriminant validity. Conclusions. Through the results from CFA and EFA, this study shows clinically acceptable model fits and suggests the feasibility of applying PPQ to a healthy population with relatively good construct validity and internal consistency.

Correlations between Phlegm Syndrome of Chinese Medicine and Coronary Angiography: A Systematic Review and Meta-Analysis

Phlegm is one of the most common patterns of coronary artery disease (CAD) in Chinese medicine. Our research was aimed at investigating the association between phlegm syndrome of CAD and coronary angiography (CAG) by meta-analysis. According to inclusion criteria, a total of 30 studies involving 5,055 CAD patients were included. The meta-analysis showed that phlegm syndrome patients were prone to multivessel disease (28 studies, OR = 1.53, 95% CI, 1.24 to 1.88, P < 0.01) and higher Gensini score (2 studies, OR = 5.90, 95% CI, 1.86 to 9.94, P = 0.004), but not obviously relevant to severe stenosis (≥75%) of coronary arteries (13 studies, OR = 1.20, 95% CI, 0.63 to 2.27, P = 0.57). We concluded that the coronary arteries lesions of CAD patients with phlegm syndrome were more severe than those with nonphlegm syndromes. Phlegm syndrome should, therefore, be regarded as a dangerous pattern of CAD with worse prognosis.

Concepts of body constitution, health and sub-health from traditional Chinese medicine perspective

This paper described and discussed the important literature and ideas about the concepts, types and measurement of body constitution, in terms of healthy, sub-healthy and disease status. In view of traditional Chinese medicine, ‘‘healthy” state is a status of relative balance of Yin and Yang to keep our bodily homeostasis. If there are significant physical and/or psychological stressors, such as loss of a beloved one and failure in study or work, the body can no longer keep its own bodily condition balanced and subsequently enter a state of ‘‘sub-health” (sub-optimal health). ‘‘unhealthy” body constitution such as ‘‘Dampness-heat”, ‘‘Cold-dampness” and ‘‘Heat- or Cold- dryness” with a subnormal body temperature and humidity and clinical manifestations such as insomnia, malaise and overweight will be presented. Immediate, appropriate strategies such as modification of life-style and seeking medical treatment can prevent evolution of an illness. Otherwise, the body will enter a disease status with a ‘‘pathological” body constitution of ‘‘Yin or Yang deficiency’’, ‘‘Blood-stasis” and/or ‘‘Phlegm-dampness”. To be complimentary with health promotion and disease prevention in Western medicine, understanding about an individual’s body constitution, together with its determinants (e.g., healthy eating and lifestyle behaviors), can contribute to a more proactive, holistic and individualized healthcare.

Relationships between Pathological Patterns and Quality of Life: Pathway Analysis

Purpose. The purpose of our study was to examine the relationships between pathological patterns and self-rated quality of life (QoL). Methods. A total of 426 Korean subjects participated in this study (male : female = 154 : 272). The subjects were asked to complete Yin Deficiency (YD), Qi Deficiency (QD), Food Stagnation (FS), Blood Stasis (BS), Phlegm, and Seven Emotions Impairment (SEI) pattern Questionnaires and the General Health Questionnaire (GHQ). We formed a pathway model consisting of pathological patterns and QoL questionnaire scores and examined which pathological patterns resulted in decreased QoL using path analysis. Results. Our pathway model had satisfactory fitness levels (GFI = 0.975, NFI = 0.984, and CFI = 0.984) and showed that Phlegm and SEI patterns directly resulted in decreased QoL, whereas QD, YD, FD, and BS indirectly resulted in decreased QoL. The pathway model suggested that the severity or stage of decreased QoL may be estimated by pathological patterns: QD and YD patterns are associated with the early stage; FS and BS patterns are associated with the middle stage; Phlegm and SEI are associated with the later stage of decreased QoL. Conclusion. Our results suggest that pathological patterns directly or indirectly affect decreases in QoL.

Development of a valid and reliable blood stasis questionnaire and its relationship to heart rate variability

OBJECTIVES

The present study was conducted to develop a valid and reliable Blood stasis questionnaire (BSQ), to define its optimum cut-off score, and to examine whether the BSQ score affected cardiovascular autonomic function.

METHODS

Three hundred and thirty-eight outpatients (group A) and 61 inpatients (group B) were asked to complete the BSQ. In addition to the BSQ, heart rate variability parameters were recorded for group A. We estimated the internal consistency and construct validity for the BSQ data from group A. Three clinicians determined whether 61 inpatients (group B) exhibited blood stasis (BS), and we defined the optimum cut-off point for the BSQ using the clinicians' diagnoses and BSQ scores for group B. Finally, the differences in the HRV parameters between the BS and non-BS groups (group A) were examined.

RESULTS

The 12-item BSQ exhibited a satisfactory internal consistency (α=0.813). In the test of construct validity, a total of three factors (pain-lump, dark blue signs, and trauma) were extracted (total percentage of variance=54.8%). ROC curve analyses showed that the BSQ had a high discriminative ability for BS (AUC=0.948, 95% confidence interval 0.895-1.001). The optimum cut-off score for the BSQ was defined as three points. SDNN, TP, LF, and HF were lower in the BS group than in the non-BS group, indicating that the BS pattern partially caused a decrease in sympathetic and parasympathetic activities.

CONCLUSIONS

Our results suggest that the BSQ is a valid and reliable instrument for evaluating BS and BS may partially cause a decrease in cardiovascular autonomic function.

Multivariate Analysis as a Method for Evaluating the Conceptual Perceptions of Korean Medicine Students regarding Phlegm Pattern

Individuals may perceive the concepts in Korean medicine pattern classification differently because it is performed according to the integration of a variety of information. Therefore, analysis about individual perspective is very important for examining the cross-sectional perspective state of Korean medicine concepts and developing both the clinical guideline including diagnosis and the curriculum of Korean medicine colleges. Moreover, because this conceptual difference is thought to begin with college education, it is worthwhile to observe students’ viewpoints. So, we suggested multivariate analysis to explore the dimensional structure of Korean medicine students’ conceptual perceptions regarding phlegm pattern. We surveyed 326 students divided into 5 groups based on their year of study. Data were analyzed using multidimensional scaling and factor analysis. Within-group difference was the smallest for third-year students, who have received Korean medicine education in full for the first time. With the exception of first-year students, the conceptual map revealed that each group’s mean perceptions of phlegm pattern were distributed in almost linear fashion. To determine the effect of education, we investigated the preference rankings and scores of each symptom. We also extracted factors to identify latent variables and to compare the between-group conceptual characteristics regarding phlegm pattern.

Relationships of pulse waveform parameters to mood states and chronic fatigue

PURPOSE

The present study examined if pulse waveform parameters (PWPs) are indicative of mood state and chronic fatigue associated with pathologic patterns in East Asian medicine and if cardiovascular autonomic function is associated with relationships among PWPs, mood, and fatigue.

METHODS

A total of 43 healthy college students (men:women=31:12), ages 19-24, were enrolled in the study. Each subject completed the standard Profile of Mood States and the revised Chalder Fatigue Questionnaire. The current authors developed a MATLAB-based software program to calculate time- and amplitude-related photoplethysmography (PTG) and the parameters of the first and second derivatives of PTG (FDPTG and SDPTG, respectively). Based on peak-to-peak intervals detected using PTG, we also calculated pulse rate variability parameters, such as low frequency (LF), high frequency (HF), total power (TP), and the ratio of low frequency to high frequency power (LF/HF).

RESULTS

In men and women, time-related dicrotic parameters of the FDPTG and SDPTG were indicative of depression and anger related to Liver Qi Stagnancy and Phlegm patterns. In men, time-related dicrotic wave parameters were indicative of mental fatigue associated with the Heart Deficiency pattern, whereas vascular augmentation-related parameters were indicative of physical fatigue associated with the Spleen Deficiency pattern in women. In women, sympathovagal balance-related LF/HF was associated with relationships among vascular augmentation-related parameters, fatigue mood, and chronic fatigue.

CONCLUSIONS

These results suggest that PWPs are indicative of mood state and chronic fatigue associated with pathologic patterns in East Asian medicine. The results also showed significant gender differences.

Development and validation of the Yin deficiency scale

OBJECTIVES

Yin Deficiency (YD) is a pathophysiologic pattern that manifests with emaciation, dry mouth, tidal fever, Five Center Heat, night sweats, and malar flushing. The purpose of the present study was to develop and validate a new YD metric, the Yin Deficiency Scale (YDS), to define an optimum cutoff point for the YDS, and to examine the relationships between YD and Cold-Heat patterns.

METHODS

A total of 169 outpatients and 83 college students were asked to complete the YDS. The college students were also asked to complete the Yin Deficiency Questionnaire (YDQ) and Cold-Heat Questionnaire (CHQ). Twelve clinicians determined whether or not the 169 outpatients had YD. YDS and YDQ data were used to estimate the internal consistency, construct validity, and concurrent validity of the YDS. CHQ data were used to examine the relationships between YDS and CHQ subscale scores. Total YDS scores and the clinicians' diagnoses of the outpatients were used to define an optimum cutoff score for the YDS.

RESULTS

The 27-item YDS had satisfactory internal consistency (α=0.885) and concurrent validity, with correlations between the YDS and YDQ subscale scores. A total of eight factors were extracted in the test of construct validity, using principal component analysis, and the overall variance explained by all factors was 63.1%. Among the eight factors, cough, fever, and skin-related factors were associated only with Heat pattern, whereas pain, urine, and fatigue-related factors were associated with both Cold and Heat patterns. In the receiver operating characteristic curve analysis, the sensitivity, specificity, and area under the curve of the YDS were 73.7%, 84.8%, and 0.875, respectively. The optimum cutoff score was defined as 10 points.

CONCLUSIONS

The results of this study suggest that the YDS is a reliable and valid instrument for evaluating YD.

Reliability and validity of the Korean Standard Pattern Identification for Stroke (K-SPI-Stroke) questionnaire

BACKGROUND

The present study was conducted to examine the reliability and validity of the 'Korean Standard Pattern Identification for Stroke (K-SPI-Stroke)', which was developed and evaluated within the context of traditional Korean medicine (TKM).

METHODS

Between September 2006 and December 2010, 2,905 patients from 11 Korean medical hospitals were asked to complete the K-SPI-Stroke questionnaire as a part of project ' Fundamental study for the standardization and objectification of pattern identification in traditional Korean medicine for stroke (SOPI-Stroke). Each patient was independently diagnosed by two TKM physicians from the same site according to one of four patterns, as suggested by the Korea Institute of Oriental Medicine: 1) a Qi deficiency pattern, 2) a Dampness-phlegm pattern, 3) a Yin deficiency pattern, or 4) a Fire-heat pattern. We estimated the internal consistency using Cronbach's α coefficient, the discriminant validity using the means score of patterns, and the predictive validity using the classification accuracy of the K-SPI-Stroke questionnaire.

RESULTS

The K-SPI-Stroke questionnaire had satisfactory internal consistency (α = 0.700) and validity, with significant differences in the mean of scores among the four patterns. The overall classification accuracy of this questionnaire was 65.2 %.

CONCLUSION

These results suggest that the K-SPI-Stroke questionnaire is a reliable and valid instrument for estimating the severity of the four patterns.