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The purpose of this study was to examine the relationships among winter sports participants’s servicescape, perceived value and behavioral intentions. In oder to achieve the purpose of this study, 305 questionnaires were surveyed. Frequency analysis, correlation analysis, confirmatory factor analysis and structural equation model analysis were conducted by using SPSS 23.0 and AMOS 23.0. The results of this study were as follows. First, Servicescape had a positive influence on the functional factors of perceived value. Second, Functional factors of perceived value had a positive influence on the behavioral intentions. Third, Servicescape had a positive influence on the emotional factors of perceived value. Fourth, Emotional factors of perceived value had a positive influence on the behavioral intentions. Fifth, Servicescape had a positive influence on the behavioral intentions. Discussions and additional implications were also suggested.

Plant-based recombinant protein production systems are powerful tools that can be used instead of microbial and animal cell culture systems. The aim of this study was to establish a stable brazzein production system from carrot cell suspension using bioreactor. Using Agrobacterium-mediated transformation (stress-inducible SWPA2 promoter and brazzein gene), three transgenic lines (TC1, 11, 12) were generated. During the TC12 culture period, cell proliferation increased rapidly up to 15 days, and the maximum cell division rate (log phase) was reached after 6 days of culture. Fresh weight peaked at day 18, 3.8-fold (7.6 g 100 mL−1) higher than on day 1, and gene expression was tenfold higher on day 27 than on day 0. The brazzein-encoding gene was also analyzed after treatment with various stress factors for increase of brazzein gene expression, and abscisic acid (ABA) and hydrogen peroxide (H2O2) proved most effective. In particular, the gene expression was enhanced 2.5-fold with 220 μM H2O2 and 2.8-fold with 50 μM ABA, compared with controls. Transgenic cells were then transferred to various types of air-lift bioreactor, and the column bioreactor achieved a higher biomass (238.9 g L−1) than cone and balloon bioreactors. These results demonstrate an efficient protein production system for brazzein using an air-lift bioreactor that may be suitable for the use in the food industry.

Background When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels. Methods The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management. Results Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for 10 years showed a slightly lower HbA1c target achievement rate of

Background The increasing use of electronic medical record (EMR) systems for documenting clinical medical data has led to EMR data being increasingly accessed for clinical trials. In this study, a database of patients who were prescribed statins for the first time was developed using EMR data. A clinical data mart (CDM) was developed for cohort study researchers. Methods Seoul St. Mary's Hospital implemented a clinical data warehouse (CDW) of data for ~2.8 million patients, 47 million prescription events, and laboratory results for 150 million cases. We developed a research database from a subset of the data on the basis of a study protocol. Data for patients who were prescribed a statin for the first time (between the period from January 1, 2009 to December 31, 2015), including personal data, laboratory data, diagnoses, and medications, were extracted. Results We extracted initial clinical data of statin from a CDW that was established to support clinical studies; the data was refined through a data quality management process. Data for 21,368 patients who were prescribed statins for the first time were extracted. We extracted data every 3 months for a period of 1 year. A total of 17 different statins were extracted. It was found that statins were first prescribed by the endocrinology department in most cases (69%, 14,865/21,368). Conclusion Study researchers can use our CDM for statins. Our EMR data for statins is useful for investigating the effectiveness of treatments and exploring new information on statins. Using EMR is advantageous for compiling an adequate study cohort in a short period.

SummarySocial networking services (SNS)-based online communities are good examples of improving quality of care by incorporating information technology into medicine. Therefore, we created an SNS-based community care webpage for communication among patients with diabetes mellitus (DM). We aimed to identify what diabetic patients wanted to know and were interested in by analyzing their posts and classified content in which users were interested.As opposed to the existing physician-focused health information websites, we built a patient-focused experience exchange website, “I love insulin (http://www.iloveinsulin.co.kr).” The DM communication webpage was divided into “My Web-Chart,” “My community-free board,” and “Life & Health.” The contents analysis targeted users’ postings, and replies were classified by theme from May 2012 to June 2013. The data included number of questions asked, answers, and question-to-answer (QA) ratio in each category.A total of 264 patients registered on the “I Love Insulin” website. The most frequent topic of posts classified as questions were about diabetes itself (23%), diet (22%), and glucose levels (19%). Conversely, most answers and information provided by users were about daily life with no relationship to diabetes mellitus (54%). While there were many questions about diet, there were very few answers (2%). Whereas there was much provision of knowledge about general DM, sharing diet information was rare. The ratios of answers to questions on diet (ratio=0.059, 1/17), glucose level (ratio=0.067, 1/15), insulin regulation (ratio=0.222, 2/9) and webpage (ratio=0.167, 1/6) were significantly low compared to DM itself (all p < 0.001).Patients in Korea with DM tend to have insufficient knowledge about diet and insulin regulation; continuously providing diet and insulin regulation information are desirable. It is hoped that the patients would be motivated to participate actively by “knowledge sharing.” Through this process, patients learn about their diseases not from the physicians but from among themselves.Citation: Kim H-S, Jeong YJ, Baik SJ, Yang SJ, Kim TM, Kim H, Lee H, Lee S-H, Cho JH, Choi I-Y, Yoon K-H. Social networking services-based communicative care for patients with diabetes mellitus.

There has been a rapid increase in the use of the electronic medical record (EMR) system. In the present review, we evaluated the applicability of EMR data in terms of the efficacy of various 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) that are currently available. EMR systems will become more valuable for easily accessing, collecting, verifying, and analyzing data. Therefore, an EMR-based clinical pilot study can be conducted quickly prior to performing a large-scale randomized controlled trial (RCT), and it can focus the clinical research before an RCT is performed. Although there are still many limitations in EMR-based clinical research, new information will be available after a large amount of data is collected in the future. EMR data can save time and labor compared with conventional clinical study data, and this is the most important advantage of conventional long-term studies; thus, these data will be advantageous to clinical researchers.

The primary objective of our study was to evaluate the frequency of suspected heparin-induced thrombocytopenia (HIT) among patients treated with different formulations of heparin and investigate the factors that affect the incidence of HIT. This study is an electronic medical record (EMR)-based large-scale retrospective cohort study conducted from 2009 to 2014 in Korea. After hospitalization, patient platelet count was determined before heparin was prescribed, and all platelet count values obtained during hospitalization were extracted. Suspected HIT was estimated by three 4Ts scores (acute thrombocytopenia, timing onset and other possible causes), which when combined yielded a high probability of HIT. Among 6046 patients enrolled in this study, HIT was suspected in 641 cases (10.6%) and a statistically significant increase in HIT incidence rate was observed for three heparins used (p < 0.001). Dalteparin (HR = 0.55, p = 0.036) and enoxaparin (HR = 0.40, p < 0.001) showed a relatively low HIT incidence rate, compared to unfractionated heparin. Majority of suspected HIT cases (76.9 and 66.7%) occurred in days 8-10 and 5-7 of dalteparin and enoxaparin treatments, respectively. Most of the patients medicated with dalteparin were cancer patients; however, no statistically significant relationship was observed between HIT occurrence and cancer. HIT can cause serious complications, making early diagnosis crucial. Clinical practitioners first prescribing heparin should focus on preventing and detecting complications early by conducting frequent, regular platelet counts before and after heparin administration.

The ACC/AHA 2013 guideline recommends high-intensity statin therapy for a decrease in low-density lipoprotein cholesterol (LDL-C) level by >50% among patients with baseline values of ≥190 mg/dL (approximately 4.872 mmol/L); however, this value should be modified before applying it to Korean populations. We investigated the statin-specific LDL-C-lowering effects in Korean patients with baseline LDL-C value ≥ 4.872 mmol/L. Data of patients prescribed a statin for the first time from January 2009 to December 2013 were assessed. In patients with baseline LDL-C value ≥ 4.872 mmol/L, laboratory data for a maximum of 6 months from the date of first statin prescription were collected. Among 33,721 patients who were prescribed a statin for the first time, 655 patients had a baseline LDL-C value ≥ 4.872 mmol/L (1.9%). Of these, 179 patients were analysed. Patients receiving moderate-intensity statins were divided into 2 groups based on LDL-C reduction rate (p=0.0002), defined as moderate-high- (atorvastatin 20 mg, rosuvastatin 10 mg, simvastatin 20 mg) and moderate-low-intensity (atorvastatin 10 mg, pitavastatin 2 mg, pravastatin 40 mg) statin groups. LDL-C reduction rates did not significantly differ between the moderate-high- and high-intensity statin groups (p=0.4895). We found that some moderate-intensity statins demonstrated a LDL-C lowering effect of more than 50% in Korean patients with a baseline LDL-C value ≥ 4.872 mmol/L. Our results reflect the need of a large-scale, randomized, controlled trial on partial reclassification of statins for patients with baseline LDL-C value ≥ 4.872 mmol/L before adopting ACC/AHC guidelines in Korea. This article is protected by copyright. All rights reserved.

The magnesium sulfate solution digestion test carried out for resistance of concrete containing waste glass powder on magnesium sulfate attack. Moreover, it yielded S.D.F index was used for the criteria of quantitative assessment to the resistance of magnesium sulfate for the purpose of evaluation of chemical deterioration on concrete. Furthermore, to evaluate for micro-cracks within concrete and external corrosion, the weight variation of specimens and the dynamic elasticity were compared and analyzed and also the applicability was examined using the analysis of product of hydration through out observing external deformation and micro-structural deformation.

Purpose: To assess spatial and temporal pressure changes in patients with repaired aortic coarctation compared with young healthy volunteers using 4D flow MRI and derived 4D pressure difference maps. Methods: 4D flow MRI of the thoracic aorta was performed at 1.5 T in 13 patients after aortic coarctation repair without recoarctation (mean age: 18.8 years, 5 female, 8 male) and 13 healthy volunteers (mean age: 22.9 years, 4 female, 9 male). 4D pressure difference maps were computed based on the Navier-Stokes equation. The thoracic aorta was divided into four segments: ascending aorta, aortic arch, proximal descending aorta, and distal descending aorta. Results: Mean spatial pressure range at mid systole for patients/volunteers was (in mm Hg): ascending aorta 1.8/1.6 (p= ns), arch 4.8/1.7 (p= 0.02), proximal descending 8.9/1.6 (p < 0.001), and distal descending 2.8/1.6 (p= 0.002). Spatial pressure profiles along the aortic centerline demonstrated pressure gradients in patients affecting both aortic arch and proximal descending aorta. Mean maximum slope of local pressure amplitudes for patients/volunteers was (in mm Hg/cm): ascending aorta 7.4/2.5 (p= ns), arch 6.6/2.1 (p < 0.001), proximal descending 12.1/1.9 (p= 0.002), and distal descending 3.9/2.1 (p= 0.002). Conclusion: Noninvasive 4D pressure difference mapping derived from 4D flow MRI showed significant spatial and temporal changes in patients with repaired aortic coarctation compared with young healthy volunteers, particularly affecting aortic arch and proximal descending aorta, but also distal descending aorta. The technique can characterize such changes not only noninvasively but also in great detail.

Several approaches for the non-invasive MRI-based measurement of the aortic pressure waveform over the heart cycle have been proposed in the last years. These methods are normally based on time-resolved, two-dimensional phase-contrast sequences with uni-directionally encoded velocities (2D PC-MRI). In contrast, three-dimensional acquisitions with tridirectional velocity encoding (4D PC-MRI) have been shown to be a suitable data source for detailed investigations of blood flow and spatial blood pressure maps. In order to avoid additional MR acquisitions, it would be advantageous if the aortic pressure waveform could also be computed from this particular form of MRI. Therefore, we propose an approach for the computation of the aortic pressure waveform which can be completely performed using 4D PC-MRI. After the application of a segmentation algorithm, the approach automatically computes the aortic pressure waveform without any manual steps. We show that our method agrees well with catheter measurements in an experimental phantom setup and produces physiologically realistic results in three healthy volunteers.

In management of cardiovascular diseases, information about the patient-specific behavior of blood flow and pressure can be essential. In the human aorta, velocity-encoded magnetic resonance imaging (MRI) is the only method capable of measuring complete time-resolved three-dimensional vector fields of the blood flow velocities. Additionally, computations of relative blood pressure from this data source have been presented in recent years. Thus, velocityencoded MRI can be a valuable measurement technique for both blood flow and blood pressure values in diagnostics and therapy control of aortic diseases. In the last years, we have developed the software framework MEDIFRAME for cardiovascular diagnostics based on MRI acquisitions. In this article, we apply our in-house developed software framework for a MRI-based hemodynamic analysis in five patients with surgically treated aortic coarctations. We compared our results to a control group of five healthy volunteers. The study included the measurement of blood flow velocities by phase-contrast MRI and the subsequent computation of relative blood pressure values. We generated a set of suitable visualizations for flow and pressure and created centerline diagrams of the cross-sectional area, flow and mean relative blood pressure. Additionally, characteristic values were computed from the centerline diagrams for every subject. In the vast majority of the visualization and quantification techniques of our software framework, we observed significant effects of the treated aortic coarctations. Therefore, we draw the conclusion that this kind of MRI-based hemodynamic analysis can be a valuable tool for diagnostics and therapy control of aortic coarctations.

Dealing with cardiovascular diseases the velocity-encoded magnetic resonance imaging (PC-MRI) is a well-known technique to acquire non-invasive measurements of the blood flow. However, the application of conventional vessel segmentation methods in PC-MR images often leads to problems due to the reduced quality of the morphology image. We proposed a robust centerline extraction method in PC-MR images to overcome those problems. The method yielded satisfying results for the centerline extraction of large vessels but did not consider vessel branches. Therefore, in this paper we present an approach for the detection of bifurcations in PC-MR images. The developed algorithm requires two inputs: the previously computed centerline points of the main vessel and a minimal user input. For each point on the centerline it determines, if there exists a bifurcation in the cross-sectional plane at that position. This is accomplished by an a* path finding algorithm, which computes the path costs for a potential bifurcation point to its corresponding center point. The path costs are determined by the combination of different features derived from the morphology and flow information. By comparison of all cost sums, bifurcations can be detected due to their low amount/value. The algorithm, evaluated on 7 volunteer and 12 patient PC-MRI datasets, yielded satisfying results.

Background Private local clinics in Korea have little experience with information technology (IT)-based glucose monitoring (ITGM). Our aim is to examine user satisfaction and the possibility of using ITGM service practically. Methods Patients sent their blood glucose levels to physicians in local clinics. The physicians reviewed the blood glucose values online and provided personal consultations through text messaging or phone calls. Thereafter, a satisfaction survey on the ITGM service, the modified Morisky scale, and patient assessment of chronic illness care were administered. Results One hundred and seventy patients from seven private local clinics used the ITGM. Overall satisfaction, including that about the ITGM service, the device, and its usefulness, was rated higher than “mostly satisfied” (score 4.2±0.8 out of 5.0) and even higher among the elderly. Satisfaction was positively associated with age, especially in those older than 60 years. The main reason for intent for future use of the service was the time/place flexibility. Highly motivated patients tended to answer positively regarding information satisfaction (P=0.0377). Conclusion Our study is the first to investigate ITGM satisfaction in private local clinics. The feasibility of users utilizing ITGM should be clarified, and future clinical research on the service's clinical effects and cost-benefit analysis is needed.

To obtain hemodynamic-relevant parameters in case of cardiovascular diseases the velocity-encoded magnetic resonance imaging (PC-MRI) is used for the non-invasive measurement of the blood flow in terms of 3D velocity fields. During the segmentation of the vessel lumen in those datasets conventional segmentation methods often fail due to reduced image quality. In this paper we present a method for the centerline extraction of great vessels in PC-MR images using additional features extracted from vector flow information. The proposed algorithm can be divided in the following steps: the propagation along the vessel course by using streamlines and the largest eigenvector, the radial search for the vessel boundary, the determination of the center position in the cross-sectional plane of the vessel and the adjustment of the propagation step size subject to the vessel curvature. This is done by using a combination of morphology and flow information: the Sobel filtered and the threshold filtered image as morphologic features as well as the coherence values of the flow vectors and the behaviour of the blood flow streamlines within the vessel and around the borders as flow features. The developed algorithm was evaluated on clinical PC-MRI datasets with encouraging results. The centerline points of the entire aorta as well as corresponding border points were successfully extracted for 16 out of 17 examined datasets. For the detection of the vessel boundary the features extracted from flow information showed to yield more reliable results than morphology features.

Full-length cDNA copies of the segment 4 (M1) genes of US Bluetongue viruses serotypeo-2, -10, -11, -13, and -17 were selectively amplified using genomic double-stranded RNA segments from purified BTV virions as templates and a modified polymerase chain reaction (Clamp-R). They were then cloned into pUC 19 plasmids and both strands of several clones were sequenced. The length of all five segment 4 genes is 1981 nucleotides, which is 30 nucleotides shorter than that of the BTV serotype- 10 reported by Y. Yu, A. Fakusho, and P. Roy (Nucleic Acids Res. 15, 7206 (1987)). The 5′-and 3′-noncoding regions of all five segment 4 genes are identical among all serotypes. The plus sense strand of the BTV segment 4 gene, which encodes the VP4 protein, possesses a single long open reading frame with an initiation codon (ATG) at nucleotides 9-1l and a stop codon (TAA) at nucleotides 1941-1943. This open reading frame encodes for a protein of 644 amino acid residues with a predicted molecular weight of about 75 kDa and a pl of +7 to +7.9. A potential leucine zipper motif was detected near the carboxyl terminus of the deduced VP4 amino acid sequence. The phylogenetic analysis using the sequences of these five cognate segment 4 genes is consistent with the results of our previous phylogenetic studies of cognate genome segments 5, 6, 8, 9, and 10. Serotype-10, -11, -13, and -17 are closely related and serotype-2 is the most distantly related among the five US BTV serotypes.

Purpose : This study investigated the clinical course and prognostic factor of very low birth weight infants (VLBWI) with hemodynamically significant congenital heart defects (CHDs). Methods : Medical records of 1,098 VLBWI with birth weight Gr III), and periventricular leukomalacia. Cardiac surgery was performed on 13 patients (39%). Nine patients received staged operations, and 10 patients received early intervention. The overall mortality in patients who had CHD was higher than in the patients who did not have CHD (27% vs. 16%). In patients with CHD, congenital abnormalities or chromosomal disorders were more important factors for increased mortality (86% vs. 11%) than the degree of complexity of CHD (19% vs. 42%). Conclusion : The most important prognostic factors of VLBWI with CHD are the associated congenital abnormalities or chromosomal disorders.

Purpose : To report our experience of gastrointestinal (GI) operations (OP) performed in very low birth weight infants (VLBWI) and to evaluate their clinical characteristics. Methods : Among the 1,117 VLBWI admitted to the SMC neonatal intensive care unit from November 1994 to February 2007, the medical records of 37 infants who underwent GI OP (except inguinal hernia OP) and 1,080 VLBWI without GI OP were retrospectively reviewed. Results : The mean gestational age () and birth weight (979241 g vs. 1,071271 g) of the 37 VLBWI who underwent the GI OP was lower than the VLBWI without GI OP group (n=1,080). Mortality rates in the GI OP group were significantly higher than in the non GI OP group (28% vs. 15%, P