Interobserver Reliability of Tongue Diagnosis Using Traditional Korean Medicine for Stroke Patients

Observation of the tongue, also known as tongue diagnosis, is an important procedure in diagnosis by inspection in Traditional Korean medicine (TKM). We investigated the reliability of TKM tongue diagnosis in stroke patients by evaluating interobserver reliability regarding tongue indicators as part of the project named the Fundamental Study for the Standardization and Objectification of Pattern Identification in TKM for Stroke (SOPI-Stroke). A total of 658 patients with stroke admitted to 9 oriental medical university hospitals participated. Each patient was independently seen by two experts from the same department for an examination of the status of the tongue. Interobserver agreement about subjects regarding pattern identification with the same opinion between the raters (n = 451) was generally high, ranging from “moderate” to “excellent”. Interobserver agreement was nearly perfect for certain signs of special tongue appearance (mirror, spotted, and bluish purple), poor for one of the tongue colors (pale) and moderate for others. Clinicians displayed measurable agreement regarding tongue indicators via both observation and pattern identification consistency. However, interobserver reliability regarding tongue color and fur quality was relatively low. Therefore, it is necessary to improve objectivity and reproducibility of tongue diagnosis through the development of detail-oriented criteria and enhanced training of clinicians

Extraction of Clinical Indicators That Are Associated with the Heat/Nonheat and Excess/Deficiency Patterns in Pattern Identifications for Stroke

The aim of this study is to extract indicators that are associated with the heat/nonheat and excess/deficiency patterns in stroke pattern identification through the large-scale analysis of clinical data. Two experts, who had more than three years of clinical experience with stroke, independently performed the pattern identification. We analyzed indicators of clinical data with two doctors' concurrent diagnoses on the patient's pattern identification. To verify heat/nonheat and excess/deficiency patterns, which are the basic elements of pattern identification, we grouped 960 patients diagnosed as the fire-heat pattern, the Yin deficiency pattern, and the Qi deficiency pattern in to two groups, the heat/nonheat group and the excess/deficiency group. We then extracted significant indicators using univariate and multivariate analysis. As a result of the comparison of 65 indicators, we were able to extract 10 indicators for the heat pattern, 6 for the nonheat pattern, 9 for the excess pattern, and 10 for the deficiency pattern. Extracted indicators in this study can be used for pattern identification in the context of stroke. These are positive indicators from large-scale clinical studies and are greatly expected to be crucial discriminant indicators in individual pattern identification henceforth

Developing indicators of pattern identification in patients with stroke using traditional Korean medicine

Abstract Background The traditional Korean medical diagnoses employ pattern identification (PI), a diagnostic system that entails the comprehensive analysis of symptoms and signs. The PI needs to be standardized due to its ambiguity. Therefore, this study was performed to establish standard indicators of the PI for stroke through the traditional Korean medical literature, expert consensus and a clinical field test. Methods We sorted out stroke patterns with an expert committee organized by the Korean Institute of Oriental Medicine. The expert committee composed a document for a standardized pattern of identification for stroke based on the traditional Korean medical literature, and we evaluated the clinical significance of the document through a field test. Results We established five stroke patterns from the traditional Korean medical literature and extracted 117 indicators required for diagnosis. The indicators were evaluated by a field test and verified by the expert committee. Conclusions This study sought to develop indicators of PI based on the traditional Korean medical literature. This process contributed to the standardization of traditional Korean medical diagnoses.</p

Interobserver reliability of tongue diagnosis using traditional Korean medicine for stroke patients,” EvidenceBased Complementary and Alternative Medicine, vol

Observation of the tongue, also known as tongue diagnosis, is an important procedure in diagnosis by inspection in Traditional Korean medicine (TKM). We investigated the reliability of TKM tongue diagnosis in stroke patients by evaluating interobserver reliability regarding tongue indicators as part of the project named the Fundamental Study for the Standardization and Objectification of Pattern Identification in TKM for Stroke (SOPI-Stroke). A total of 658 patients with stroke admitted to 9 oriental medical university hospitals participated. Each patient was independently seen by two experts from the same department for an examination of the status of the tongue. Interobserver agreement about subjects regarding pattern identification with the same opinion between the raters (n = 451) was generally high, ranging from &quot;moderate&quot; to &quot;excellent&quot;. Interobserver agreement was nearly perfect for certain signs of special tongue appearance (mirror, spotted, and bluish purple), poor for one of the tongue colors (pale) and moderate for others. Clinicians displayed measurable agreement regarding tongue indicators via both observation and pattern identification consistency. However, interobserver reliability regarding tongue color and fur quality was relatively low. Therefore, it is necessary to improve objectivity and reproducibility of tongue diagnosis through the development of detail-oriented criteria and enhanced training of clinicians

Extraction of clinical indicators that are associated with the heat/nonheat and excess/deficiency patterns in pattern identifications for stroke

The aim of this study is to extract indicators that are associated with the heat/nonheat and excess/deficiency patterns in stroke pattern identification through the large-scale analysis of clinical data. Two experts, who had more than three years of clinical experience with stroke, independently performed the pattern identification. We analyzed indicators of clinical data with two doctors’ concurrent diagnoses on the patient’s pattern identification. To verify heat/nonheat and excess/deficiency patterns, which are the basic elements of pattern identification, we grouped 960 patients diagnosed as the fire-heat pattern, the Yin deficiency pattern, and the Qi deficiency pattern in to two groups, the heat/nonheat group and the excess/deficiency group. We then extracted significant indicators using univariate and multivariate analysis. As a result of the comparison of 65 indicators, we were able to extract 10 indicators for the heat pattern, 6 for the nonheat pattern, 9 for the excess pattern, and 10 for the deficiency pattern. Extracted indicators in this study can be used for pattern identification in the context of stroke. These are positive indicators from large-scale clinical studies and are greatly expected to be crucial discriminant indicators in individual pattern identification henceforth

Fabrication of SiO₂/TiO₂ Double-Shelled Hollow Nanospheres with Controllable Size via Sol–Gel Reaction and Sonication-Mediated Etching

Size-controllable double-shell SiO₂/TiO₂ hollow nanoparticles (DS HNPs) were fabricated using a simple sol–gel reaction and sonication-mediated etching. The size of the DS HNPs was controlled using SiO₂ core templates of various sizes. Moreover, monodisperse DS HNPs were produced on a large scale (10 g per 1 batch) using the sol–gel method. The surface area and porosity of intrashell and inner-cavity pores were measured by Brunauer–Emmett–Teller analysis. As a result, 240 nm DS HNPs (240 DS HNPs) exhibited the highest surface area of 497 m² g^–1 and a high porosity. Additionally, DS HNPs showed excellent light-scattering ability as a scattering layer in dye-sensitized solar cells due to their structural properties, such as a composite, double-shell, hollow structure, as well as intrashell and inner cavity pores. The DSSCs incorporating 240 DS HNPs demonstrated an 18.3% enhanced power conversion efficiency (PCE) compared to TiO₂ nanoparticles

Constitutive Overexpression of Cystathionine γ-Synthase in Arabidopsis Leads to Accumulation of Soluble Methionine and S-Methylmethionine

The committing step in Met and S-adenosyl-l-Met (SAM) synthesis is catalyzed by cystathionine γ-synthase (CGS). Transgenic Arabidopsis plants overexpressing CGS under control of the cauliflower mosaic virus 35S promoter show increased soluble Met and its metabolite S-methyl-Met, but only at specific stages of development. The highest level of Met and S-methyl-Met was observed in seedling tissues and in flowers, siliques, and roots of mature plants where they accumulate 8- to 20-fold above wild type, whereas the level in mature leaves and other tissues is no greater than wild type. CGS-overexpressing seedlings are resistant to ethionine, a toxic Met analog. With these properties the transgenic lines resemble mto1, an Arabidopsis, CGS-mutant inactivated in the autogenous control mechanism for Met-dependent down-regulation of CGS expression. However, wild-type CGS was overexpressed in the transgenic plants, indicating that autogenous control can be overcome by increasing the level of CGS mRNA through transcriptional control. Several of the transgenic lines show silencing of CGS resulting in deformed plants with a reduced capacity for reproductive growth. Exogenous feeding of Met to the most severely affected plants partially restores their growth. Similar morphological deformities are observed in plants cosuppressed for SAM synthetase, even though such plants accumulate 250-fold more soluble Met than wild type and they overexpress CGS. The results suggest that the abnormalities associated with CGS and SAM synthetase silencing are due in part to a reduced ability to produce SAM and that SAM may be a regulator of CGS expression

Enhanced Electroresponsive Performance of Double-Shell SiO₂/TiO₂ Hollow Nanoparticles

The double-shell SiO₂/TiO₂ hollow nanoparticles (DS HNPs) are successfully fabricated and adopted as dispersing materials for electrorheological (ER) fluids to investigate an influence of shell structure on ER properties. The DS HNPs-based ER fluid exhibits outstanding ER performance which is 4.1-fold higher compared to that of single shell SiO₂/TiO₂ hollow nanoparticles (SS HNPs)-based ER fluid. The significantly improved ER property of DS HNPs-based ER fluid is ascribed to the enhanced interfacial polarization. In addition, the ER activities of DS HNPs-based ER fluids are examined depending on the particle diameter. The yield stress of DS HNPs-based ER fluids increases up to 302.4 kPa under an electric field of 3 kV mm^–1 by reducing the particle size, which is remarkable performance enough to promise sufficient probability for practical and industrial applications. The enhanced ER performance of the smaller DS HNPs is attributed to the increased surface area of large pores (30–35 nm) within the shells, resulting in a large achievable polarizability determined by dielectric constants. Furthermore, the antisedimentation property is analyzed in order to offer an additional insight into the effect of particle size on the ER fluids