Therapeutic effects of Gambi-jung for the treatment of obesity.

Obesity is known as metabolic syndrome and it affects many tissues including adipose tissue, liver, and central nervous system (CVS). Gambi-jung (GBJ) is a modified prescription of Taeumjowi-tang (TJT), which has been used to treat obesity in Korea. GBJ is composed of 90% Ephedra sinica Stapf (ES). Therefore, the present study was designed to assess the antiobesity effects of GBJ and to compare the effects of GBJ and ES on obesity. GBJ administration remarkably reduced the body weight, Body mass index (BMI), and body fat percentage compared to the ES administration in human subjects. GBJ-treated mice had lower white adipose tissue (WAT) amounts than ES-treated mice. GBJ and ES administration enhanced adenosine monophosphate-activated protein kinase (AMPK) expression in 3T3-L1 adipocytes, epididymal WAT and liver of HFD-induced obese mice. Moreover, GBJ and ES reduced food intake by suppressing the mRNA levels of orexigenic peptides, agouti-related protein (AgRP) and neuropeptide-Y (NPY), as well as AMPK in the brain of HFD-induced obese mice. Furthermore, GBJ-treated mice had dramatically lower expression of macrophage marker F4/80 in epididymal WAT than those of ES-treated mice. Based on these results, we suggest the use of GBJ as a natural drug to control weight gain.

Relationship between Tongue Temperature Estimated by Infrared Thermography, Tongue Color, and Cold-Heat Pathological Patterns: A Retrospective Chart Review Study.

Tongue diagnosis is a technique used to determine cold-heat pathologic patterns (CHPPs). Herein, we reviewed electronic medical records of tongue temperature measured using infrared thermography (IRT), tongue color (luminance, green/red, and blue/yellow balance), cold-heat pattern questionnaires (CHPQ), and body temperature for 134 women with gynecological problems (age, 38.97 ± 11.49 years). The temperatures of seven tongue regions (root, center, tip, and both sides of the center and root) were determined, and the effects of age, regional differences, and their correlations with color parameters were examined. Factor analysis was conducted separately with the 10 cold pattern (CP) and 10 heat pattern (HP) items. Tongue temperature showed an age effect (ß; -0.198 to -0.210) and regional differences (both sides of the root > center and root > tip). Tongue temperature was positively correlated with luminance (r: 0.236-0.246), indicating that a higher temperature was associated with a brighter color. The factor analysis extracted two factors (cold sensitivity-pain and discharge-complexion factors) from the CP items and three factors (heat sensation-pain, discharge-breath, and cold preference-thirst factors) from the HP items. Tongue temperature was negatively correlated with the discharge-complexion factor of CP and the discharge-breath factor of HP (r: -0.171 to -0.203), indicating that a lower tongue temperature may be a consequence of emission of excessive heat in HP and a lower blood perfusion in CP. Body temperature did not correlate with the CHPQ factor scores. In conclusion, tongue temperatures measured using IRT may be a partial indicator of CHPPs.

Multidimensional Aspects of de qi Sensations in MASS and ASQ Assessment: A Pilot Study.

Background. De qi comprises varied senses depending on the individual. No single method can yet fully measure the multiple dimensions of de qi adequately. Objective. We examined the advantages of implementing multiple questionnaires for de qi measurement. Methods. Fourteen participants completed a preacupuncture questionnaire regarding their perception toward acupuncture treatment. After acupuncture stimulation at the HT7 point, de qi sensations were measured by MASS and ASQ. In groups with different levels of expectation, we compared the subtotal scores of each phase in the ASQ, as well as the VAS de qi intensity and MASS index using Kruskal-Wallis test. For the structural comparison of questionnaires, we first performed Spearman's rank correlation test between the scores of individual descriptors in MASS and ASQ. The subtotal scores of each phase in ASQ was compared with VAS de qi intensity and MASS index. Results. The subtotal score of the manipulation phase in ASQ strongly correlated with the VAS score of de qi intensity (Spearman's ρ = 0.654, p = 0.011) and MASS index (Spearman's ρ = 0.488, p = 0.076). MASS and ASQ showed strong correlations in certain analogous descriptors. Unpleasant perceptions toward acupuncture treatment did not significantly correlate with overall de qi intensity. Conclusions. De qi sensations in acupuncture treatment have multidimensional aspects. Intensity of stimulation, ASQ, and MASS index assess somewhat restricted aspects of de qi. Those questionnaires have exclusive differences of sets in spite of their strong intersections. Use of multiple questionnaires may enable a more comprehensive understanding of de qi properties and the elicitation of relevant construction in de qi features of acupuncture.

Feasibility study of transfer function model on electrocardiogram change caused by acupuncture.

BACKGROUND: Acupuncture treatments that regulate the heart are used to treat various clinical disorders and conditions. Although many studies have been conducted to measure quantitatively the effects of acupuncture, thus far, models that describe these effects have not been established. The purpose of this study was to derive a transfer function model of acupuncture stimulation within the electrocardiograms based on the periods before, during, and after acupuncture. METHODS: Fourteen healthy subjects were included in this clinical trial. Five-minute electrocardiograms were captured before, during, and after acupuncture at HT7. For each period, signal-averaged electrocardiograms were created from all of the subjects' 5-min electrocardiograms for that period. Individual transfer functions, which has the highest average goodness of fit, were derived for each period pair. By averaging individual transfer functions, generalized transfer functions were derived. RESULTS: The transfer function with the highest average goodness of fit was a fraction with 4th order numerator and 5th order denominator. Fourteen individual transfer functions were derived separately for each pair of periods: before and during acupuncture, during and after acupuncture, and before and after acupuncture. Three generalized transfer functions were derived by averaging individual transfer functions for each period pair. CONCLUSION: The three generalized transfer functions that were derived may reflect the electrocardiogram changes caused by acupuncture. However, this clinical trial included only 14 subjects. Further studies with control groups and more subjects are needed. This clinical trial has been registered on the Clinical Research Information Service, Republic of Korea (No. KCT0001944). The first enrolment of subject started at 2 June 2015 and this trial was retrospectively registered at 14 June 2016.

Perception Study of Traditional Korean Medical Students on the Medical Education Using the Dundee Ready Educational Environment Measure.

Background. In Korea, a few studies regarding traditional Korean medicine (TKM) education have been conducted. The aim of this study is to evaluate students' perceptions regarding TKM education in Korea and compare them with those of other countries using a quantitative scale, Dundee Ready Educational Environment Measure (DREEM). Materials and Methods. We conducted a survey using DREEM in a TKM college. Totally, 325 students responded to this survey and we performed the descriptive statistics of scores in all items, subscales, and total. Additionally, subgroup comparisons according to gender, school year, and academic achievement were analyzed. Results. Mean overall DREEM score was 94.65 out of 200, which is relatively low compared to previous studies. Particularly, perceptions regarding subscales of learning, atmosphere, and self-perceptions were interpreted as problematic. There was no statistically significant difference between genders in spite of some differences among groups based on school year or academic achievement. Conclusions. We could examine students' perceptions regarding TKM education at a TKM college using DREEM for which validity and reliability were verified. TKM education was perceived relatively poor, but these quantitative indicators suggested which parts of education need improvement. We expect DREEM to be used widely in TKM or traditional medical education field.

Reliability and validity of tongue color analysis in the prediction of symptom patterns in terms of East Asian Medicine.

OBJECTIVE: To examine whether color parameters of tongue inspection (TI) using a digital camera was reliable and valid, and to examine which color parameters serve as predictors of symptom patterns in terms of East Asian medicine (EAM). METHODS: Two hundred female subjects' tongue substances were photographed by a mega-pixel digital camera. Together with the photographs, the subjects were asked to complete Yin deficiency, Phlegm pattern, and Cold-Heat pattern questionnaires. Using three sets of digital imaging software, each digital image was exposure- and white balance-corrected, and finally L* (luminance), a* (red-green balance), and b* (yellow-blue balance) values of the tongues were calculated. To examine intra- and inter-rater reliabilities and criterion validity of the color analysis method, three raters were asked to calculate color parameters for 20 digital image samples. Finally, four hierarchical regression models were formed. RESULTS: Color parameters showed good or excellent reliability (0.627-0.887 for intra-class correlation coefficients) and significant criterion validity (0.523-0.718 for Spearman's correlation). In the hierarchical regression models, age was a significant predictor of Yin deficiency (ß = 0.192), and b* value of the tip of the tongue was a determinant predictor of Yin deficiency, Phlegm, and Heat patterns (ß = - 0.212, - 0.172, and - 0.163). Luminance (L*) was predictive of Yin deficiency (ß = -0.172) and Cold (ß = 0.173) pattern. CONCLUSION: Our results suggest that color analysis of the tongue using the L*a*b* system is reliable and valid, and that color parameters partially serve as symptom pattern predictors in EAM practice.

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.

Relationships between pathological patterns and vocal qualities estimated by acoustic parameters.

OBJECTIVE: To examine whether vocal characteristics estimated by acoustic parameters were associated with phlegm, yin deficiency, or cold-heat patterns. METHODS: A total of 75 college students (males:females = 53:22) aged 19-24 years were enrolled in this study. Each subject was asked to complete the phlegm pattern questionnaire (PPQ), yin deficiency questionnaire (YDQ) and cold-heat questionnaire (CHQ). For the acoustic analysis, each subject was asked to produce a sustained vowel sound (/a/) for 3 s to be used to calculate acoustic parameters. Then, habitual fundamental frequency (F0), jitter, shimmer, F0tremor, mean F0, standard deviation of F0, maximum F0, minimum F0, normalized noise energy, harmonic-to-noise ratio, signal-to-noise ratio, amplitude tremor, and power ratio were calculated using the Dr. Speech software. Finally, four hierarchical regression models with pattern questionnaire scores as dependent variables were formed to examine which factors among acoustic parameters, sex, and age were predictive of those pattern scores. RESULTS: PPQ, YDQ, heat, and cold pattern scores all formed significant regression model equations and the adjusted R2 values were 0.281, 0.164, 0.156, and 0.170, respectively. There were aging effects in the PPQ and YDQ models (standardized ß=0.199, 0.271, respectively). Vocal tremor-related F0 tremor and vocal ringing-related power ratio parameters were associated with PPQ and YDQ scores. Gender was directly predictive of PPQ and indirectly moderated the relationship between power ratio and YDQ score. Vocal pitch-related habitual F0 and mean F0 were associated with heat and cold scores. These results indicate that the vocal qualities of phlegm- and yin deficiency-susceptible subjects tend to be ringing and less tremorous, and those of heat- and cold-susceptible subjects tend to be high-pitched. CONCLUSION: Our study results suggest that vocal characteristics estimated by acoustic parameters are partially predictive of phlegm, yin deficiency, heat, and cold patterns. In terms of phlegm and yin deficiency patterns, there were direct or moderating effects of sex and age.

Development and validation of a Lao Juan questionnaire.

OBJECTIVES: Lao Juan (LJ, ) is a syndrome described in Chinese medicine (CM) that manifests with fatigue, fever, spontaneous sweating, indigestion, work-induced pain, weakness of the limbs, and shortness of breath. The present study was conducted to examine the reliability and validity of a Lao Juan Questionnaire (LJQ). METHODS: A total of 151 outpatients and 73 normal subjects were asked to complete the LJQ. Seventy-three normal subjects were additionally asked to complete the Chalder Fatigue Scale (CFS). Twelve clinicians determined whether the 151 outpatients exhibited LJ or not. The internal consistency and construct validity for the LJQ were estimated using data from the outpatient subjects. The CFS data were used to examine the concurrent validity of the LJQ. Total LJQ scores and the clinicians᾿diagnoses of the outpatients were used to perform receiver operating characteristics (ROC) curve analyses and to define an optimum cut-off score for the LJQ. RESULTS: The 19-item LJQ had satisfactory internal consistency (α=0.828) and concurrent validity, with significant correlations between the LJQ and the CFS subscales. In the test of construct validity using principal component analysis, a total of six factors were extracted, and the overall variance explained by all factors was 59.5%. In ROC curve analyses, the sensitivity, specificity, and area under the curve were 76.0%, 59.2%, and 0.709, respectively. The optimum cut-off score was defined as six points. CONCLUSIONS: Our results suggest that the LJQ is a reliable and valid instrument for evaluating LJ.

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.

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.

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.

Cervical coupling motion characteristics in healthy people using a wireless inertial measurement unit.

Objective. The objectives were to show the feasibility of a wireless microelectromechanical system inertial measurement unit (MEMS-IMU) to assess the time-domain characteristics of cervical motion that are clinically useful to evaluate cervical spine movement. Methods. Cervical spine movements were measured in 18 subjects with wireless IMUs. All rotation data are presented in the Euler angle system. Amount of coupling motions was evaluated by calculating the average angle ratio and the maximum angle ratio of the coupling motion to the primary motion. Reliability is presented with intraclass correlation coefficients (ICC). Results. Entire time-domain characteristics of cervical motion were measured with developed MEMS-IMU system. Cervical range of motion (CROM) and coupling motion range were measured with high ICCs. The acquired data and calculated parameters had similar tendency with the previous studies. Conclusions. We evaluated cervical motion with economic system using a wireless IMU of high reliability. We could directly measure the three-dimensional cervical motion in degrees in realtime. The characteristics measured by this system may provide a diagnostic basis for structural or functional dysfunction of cervical spine. This system is also useful to demonstrate the effectiveness of any intervention such as conventional medical treatment, and Korean medical treatment, exercise therapy.

Association rule mining and network analysis in oriental medicine.

Extracting useful and meaningful patterns from large volumes of text data is of growing importance. In the present study we analyze vast amounts of prescription data, generated from the book of oriental medicine to identify the relationships between the symptoms and the associated medicines used to treat these symptoms. The oriental medicine book used in this study (called Bangyakhappyeon) contains a large number of prescriptions to treat about 54 categorized symptoms and lists the corresponding herbal materials. We used an association rule algorithm combined with network analysis and found useful and informative relationships between the symptoms and medicines.

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.

Relationships of Un and Gi seasons of birth to clinical symptoms and signs.

OBJECTIVES: Season of birth (SOB) is a medical term used to describe the relationship between the season in which one is born and his or her physiologic and pathological characteristics. In East Asian medicine, the Un-Gi SOB is based on the Yin-yang-Five Phases theory. The purpose of this study is to examine the relationship between Un-Gi SOB and a multitude of clinical symptoms and signs, and to examine which of the Un and Gi seasons has the greatest impact on these symptoms and signs. METHODS: Using the Delphi method, three Un-Gi experts formulated a 26-item questionnaire consisting of clinical symptoms and signs, with each item rated on a Likert 7-point scale. A total of 1057 Korean adolescents (583 males, 474 females) completed the 26-item questionnaire. After identifying the Un and Gi seasons of all subjects, item scores were evaluated to determine whether there was a difference between Un and Gi seasons. RESULTS: For Un seasons, males born in the Wood season had greater indigestion and were less physically active, whereas females born in the Earth season were better able to concentrate but had slower rates of growth. For Gi seasons, males born in the Fire season had greater indigestion and morning fatigue, and males born in the Earth season had higher tension. There was no relationship between symptoms, signs, and the Gi SOB in females. This indicates that males born in Wood Un and Gi seasons are susceptible to Earth-related clinical problems, whereas females born in the Earth Un season are susceptible to Earth-related clinical problems. CONCLUSIONS: The study results suggest that Un-Gi seasons based on the Yin-yang-Five Phases are related to clinical symptoms and signs, with significant differences between genders.

Clinical utility of paced breathing as a concentration meditation practice.

OBJECTIVES: The present study examined changes in electroencephalogram (EEG) and heart rate variability (HRV) parameters during paced breathing (PB) and their relationships with self-reported personality traits. METHODS: Fifty-eight meditation-naive subjects (36 men, 22 women) ranging in age from 20 to 30 years completed the Temperament and Character Inventory (TCI). After a spontaneous breathing session, participants were asked to breathe in 6-s cycles, guided by an acoustic stimulus. EEG, HRV, and respiratory data were recorded during spontaneous and paced breathing. We calculated the powers for the EEG and HRV parameters based on the most regular respiratory curve observed over a 5-min period. RESULTS: In terms of HRV parameters, the high-frequency power increased and the low frequency-to-high frequency ratio decreased during PB. The low-frequency power did not change. In terms of EEG parameters, low-frequency alpha power, a marker of internal attention, globally increased and theta power, a marker of an advanced meditative state, locally decreased. This indicates that parasympathetic activity and internal attention increased, whereas an advanced meditative state was inhibited during PB. Of the personality traits, harm avoidance, novelty seeking, persistence, self-directedness, and self-transcendence were related to changes in low- and high-frequency alpha powers. CONCLUSIONS: Our results suggest that PB can be utilized as a concentration meditation practice for novices, and that individual differences such as personality traits should be considered when PB is offered for clinical or experimental purposes.

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 of a valid and reliable phlegm pattern questionnaire.

OBJECTIVES: The present study was conducted to examine the reliability and validity of a Phlegm Pattern Questionnaire (PPQ) that was developed within the context of Traditional Chinese Medicine. METHODS: A total of 292 normal subjects and 61 inpatients were asked to complete the PPQ. Among the 292 normal subjects, 73 college students were additionally asked to complete the Profile of Mood States (POMS) and the Chalder Fatigue Scale (CFS). Three (3) clinicians determined whether the 61 inpatients exhibited the Phlegm Pattern (PP). The authors estimated the internal consistency and construct validity for the PPQ using data from the normal and inpatient subjects. The POMS and CFS data were used to evaluate the concurrent validity of the PPQ. PPQ data and the clinicians' diagnoses of the inpatient subjects were used to estimate the sensitivity and specificity and to define the optimum cut-off point of the PPQ. RESULTS: The PPQ had satisfactory internal consistency (α=0.902 in normal subjects, α=0.919 in inpatient subjects) and concurrent validity, with significant correlations between the total score of the PPQ and all of the POMS and CFS subscales. In a test of construct validity using principal component analysis, a total of six factors were extracted, and the overall variance explained by all factors was 58.9%. In the test of discriminant validity using receiver operating characteristic curve analysis, the sensitivity, specificity, and area under the curve were 83.78%, 83.33%, and 0.860, respectively. The optimum cut-off level was defined as five points. CONCLUSIONS: These results suggest that the PPQ is a reliable and valid self-rating instrument for estimating the severity of PP.

N-acetylcysteine versus AScorbic acid for preventing contrast-Induced nephropathy in patients with renal insufficiency undergoing coronary angiography NASPI study-a prospective randomized controlled trial.

BACKGROUND: Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired renal failure and affects mortality and morbidity. There has been no study comparing the efficacy of N-acetylcysteine (NAC) and ascorbic acid that have potential for CIN prevention in patients with renal insufficiency. METHODS: We conducted a prospective randomized controlled trial. A total of 212 patients who had pre-existing renal impairment with basal creatinine clearance < or =60 mL/min and/or serum creatinine (SCr) level of > or =1.1 mg/dL, were randomized to have either high-dose NAC (1,200 mg orally twice a day before and on the day of coronary catheterization, n = 106) or ascorbic acid (3 g and 2 g orally before, and 2 g twice after coronary catheterization with a 12-hour interval, n = 106). The primary end point was the maximum increase of SCr level, and the secondary end point was the incidence of CIN. RESULTS: The maximum increase of SCr level was significantly lower in NAC group than in ascorbic acid group as follows: -0.03 +/- 0.18 mg/dL versus 0.04 +/- 0.20 mg/mL, respectively (P = .026). Patients with diabetes or who had received a high dose of contrast media experienced significantly less rise of SCr level with NAC than ascorbic acid; in diabetic subgroup, -0.05 +/- 0.22 mg/dL versus 0.09 +/- 0.29 mg/mL, respectively (P = .020); in patients with high dose of dye, -0.03 +/- 0.17 mg/dL versus 0.04 +/- 0.21 mg/mL, respectively (P = .032). The incidence of CIN, the secondary end point, tended to be in favor of NAC rather than ascorbic acid, 1.2% versus 4.4%, respectively (P = .370). Notably, among the diabetes patients, the NAC significantly lowered CIN rate than ascorbic acid, 0% (0/38) versus 12.5% (4/32), respectively (P = .039). CONCLUSION: High-dose NAC seems more beneficial than ascorbic acid in preventing contrast-induced renal function deterioration in patients, especially diabetic patients, with renal insufficiency undergoing coronary angiography.