• Pediatric Infection and Vaccine
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• v.29 no.3
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• pp.147-154
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• 2022

The clinical severity of coronavirus disease 2019 (COVID-19) in children is usually mild. Most of the affected patients completely recovered from COVID-19 before being released from approximately 7-day quarantine. However, children with comorbidities are at risk of more severe disease and adverse outcomes. We report three cases of COVID-19-affected adolescents with underlying chronic respiratory difficulty due to neurologic diseases who showed sudden clinical aggravations at the time of discharge, even after full clinical improvement. Patient 1 is a 17-year-old boy with Ullrich congenital muscular dystrophy who had cardiopulmonary arrest 9 days after the initial COVID-19 symptoms. Patient 2 is a 17-year-old girl with intracerebral hemorrhage with infarction in bed-ridden status who had cardiopulmonary arrest 11 days after the initial symptoms. Patient 3 is a 12-year-old boy with intraventricular hemorrhage with hydrocephalus in bed-ridden status who showed multiorgan failure 10 days after the initial symptoms. Remdesivir, dexamethasone, and empirical antibiotics were administered with mechanical ventilation and intensive unit care. Among the three patients, two (patients 1 and 3) were alive, and one (patient 2) expired. Clinicians caring for adolescents with chronic neurologic and/or pulmonary disease should keep in mind that these patients could have sudden deterioration after recovery from the acute phase of COVID-19 around or after the time of discharge.

• Journal of Korean Tunnelling and Underground Space Association
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• v.11 no.3
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• pp.303-314
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• 2009

Image analyses for sheared joint specimens are performed to study asperity degradation characteristics with respect to the roughness mobilization of rock joints. Four different types of joint specimens, which are made of high-strength gypsum materials, are prepared by replicating the three-dimensional roughness of rock joints. About twenty jointed rock shear tests are performed at various normal stress levels. The characteristic and scale of asperity degradation on the sheared joint specimens are analyzed using the digital image analysis technique. The results show that the asperity degradation characteristic mainly depends on the normal stress level and can be defined by asperity failure and wear. The asperity degradation develops significantly around the peak shear displacement and the average amount of degraded asperities remains constant with further displacement because of new degradation of small scale asperities. The shear strength results using high-strength gypsum materials can not fully represent physical properties of each mineral particles of asperities on the natural rock joint surface. However the results of this quantitative estimation for the relationship between the peak shear displacement and the asperity degradation suggest that the characterization of asperity degradation provides an important insight into mechanical characteristics and shear models of rock joints.

• Steel and Composite Structures
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• v.48 no.2
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• pp.163-177
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• 2023

Complex and intricate preparation techniques, the imperative for utmost precision and sensitivity in instrumentation, premature sample failure, and fragile specimens collectively contribute to the arduous task of measuring the fracture toughness of concrete in the laboratory. The objective of this research is to introduce and refine an equation based on the gene expression programming (GEP) method to calculate the fracture toughness of reinforced concrete, thereby minimizing the need for costly and time-consuming laboratory experiments. To accomplish this, various types of reinforced concrete, each incorporating distinct ratios of fibers and additives, were subjected to diverse loading angles relative to the initial crack (α) in order to ascertain the effective fracture toughness (Keff) of 660 samples utilizing the central straight notched Brazilian disc (CSNBD) test. Within the datasets, six pivotal input factors influencing the Keff of concrete, namely sample type (ST), diameter (D), thickness (t), length (L), force (F), and α, were taken into account. The ST and α parameters represent crucial inputs in the model presented in this study, marking the first instance that their influence has been examined via the CSNBD test. Of the 660 datasets, 460 were utilized for training purposes, while 100 each were allotted for testing and validation of the model. The GEP model was fine-tuned based on the training datasets, and its efficacy was evaluated using the separate test and validation datasets. In subsequent stages, the GEP model was optimized, yielding the most robust models. Ultimately, an equation was derived by averaging the most exemplary models, providing a means to predict the Keff parameter. This averaged equation exhibited exceptional proficiency in predicting the Keff of concrete. The significance of this work lies in the possibility of obtaining the Keff parameter without investing copious amounts of time and resources into the CSNBD test, simply by inputting the relevant parameters into the equation derived for diverse samples of reinforced concrete subject to varied loading angles.

• KSCE Journal of Civil and Environmental Engineering Research
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• v.26 no.6C
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• pp.407-419
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• 2006

Situations where support is provided solely in shaft resistance of drilled shafts are where the base of the drilled hole cannot be cleaned so that it is uncertain that any end bearing support will be developed. Alternatively, where sound bed rock underlies low strength overburden material, it may be possible to achieve the required support in end bearing on the rock only, and assume that no support is developed in the overburden. However, where the drilled shaft is drilled some depth into sound rock, a combination of side wall resistance and end bearing can be assumed. Both theoretical and field studies of the performance of rock socketed drilled shafts show that the major portion of applied load is usually carried in side wall resistance. Normal stress at the rock-concrete interface is induced by two mechanisms. First, application of a compressive load on the top of the pile results in elastic dilation of the concrete, and second, shear displacement at the rough surface of the drilled hole results in mechanical dilation of the interface. If the stiffness of the material surrounding the socket with respect to normal displacement is constant, then the normal stress will increase with increasing applied load, and there will be a corresponding increase in the shear strength. In this study, the numerical analyses are carried out to investigate the behavioral characteristics of side of rock socketed drilled shafts. The cause of non-linear head load-settlement relationship and failure mechanism at side are also investigated properly and the design charts are suggested and verified for the leading to greater efficiency and reliability in the pile design.

• Korean Journal of Radiology
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• v.21 no.11
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• pp.1256-1264
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• 2020

Objective: Lung segmentation using volumetric quantitative computed tomography (CT) analysis may help predict outcomes of patients with coronavirus disease (COVID-19). The aim of this study was to investigate the relationship between CT volumetric quantitative analysis and prognosis in patients with COVID-19. Materials and Methods: CT images from patients diagnosed with COVID-19 from February 18 to April 15, 2020 were retrospectively analyzed. CT with a negative finding, failure of quantitative analysis, or poor image quality was excluded. CT volumetric quantitative analysis was performed by automated volumetric methods. Patients were stratified into two risk groups according to CURB-65: mild (score of 0-1) and severe (2-5) pneumonia. Outcomes were evaluated according to the critical event-free survival (CEFS). The critical events were defined as mechanical ventilator care, ICU admission, or death. Multivariable Cox proportional hazards analyses were used to evaluate the relationship between the variables and prognosis. Results: Eighty-two patients (mean age, 63.1 ± 14.5 years; 42 females) were included. In the total cohort, male sex (hazard ratio [HR], 9.264; 95% confidence interval [CI], 2.021-42.457; p = 0.004), C-reactive protein (CRP) (HR, 1.080 per mg/dL; 95% CI, 1.010-1.156; p = 0.025), and COVID-affected lung proportion (CALP) (HR, 1.067 per percentage; 95% CI, 1.033-1.101; p < 0.001) were significantly associated with CEFS. CRP (HR, 1.164 per mg/dL; 95% CI, 1.006-1.347; p = 0.041) was independently associated with CEFS in the mild pneumonia group (n = 54). Normally aerated lung proportion (NALP) (HR, 0.872 per percentage; 95% CI, 0.794-0.957; p = 0.004) and NALP volume (NALPV) (HR, 1.002 per mL; 95% CI, 1.000-1.004; p = 0.019) were associated with a lower risk of critical events in the severe pneumonia group (n = 28). Conclusion: CRP in the mild pneumonia group; NALP and NALPV in the severe pneumonia group; and sex, CRP, and CALP in the total cohort were independently associated with CEFS in patients with COVID-19.

• Journal of the Computational Structural Engineering Institute of Korea
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• v.37 no.4
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• pp.275-282
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• 2024

A recently proposed rapid-disassembly , carbon-minimized dismantle connection was tested using cyclic loading. To better understand the behavior of the test specimen, three-dimensional finite element (3D-FE) analyses were conducted using a "tied model" (bolted contact surfaces are tied together) and a "bolt-slip model" (contact surfaces slip and separate). The tied model suggests that plastic hinging of the beam occurs if the proposed connection behaves rigidly. The bolt-slip model suggests that the proposed connection, if manufactured and assembled properly, can dissipate energy to about 0.5 times that experienced by a rigid connection. However, when compared in a test, its moment-rotation hysteresis curve does not match well, which suggests that the low performance of the test specimen is attributable to a manufacturing deficiency. Regardless, the results corroborate the pinching phenomenon observed in the experimental hysteresis and fracture failure of the test specimen.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.602-613
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• 2010

Background: As life expectancy has been increased, the cardiac valve disease has been increased. In past, mechanical valve for valve replacement surgery was used widely, but it has many weaknesses, such as hemorrhage, teratogenic effect caused by warfarin, acute mechanical failure, taking warfarin during life, etc. So, the tissue valve is used widely and researches for durability of tissue valve are in progress. Tissue valves being used are all imported in Korea, and there is a lack of information on its geometry and design. So, we studied the geometry of porcine aortic and pulmonary valve, and tried to suggest theoretical basis for making the aortic and pulmonary valve. Material and Method: We harvested aortic and pulmonary valves of 25 pigs and measured the geometry of valve at fresh and glutaraldehyde (GA) fixed state. In each group, we measured the diameter of the base, diameter of commissure, valve height, commissural height, etc. Also, for making implantable porcine and bovine pericardial valve, we designed the valve stent form, thickness, height, and leaflet size, form, thickness by different size of valve. Result: The aortic and pulmonary valve geometry and ratio were measured in each group. The right coronary cusp of aortic valve and right facing cusp of pulmonary valve was bigger than other cusps and non coronary cusp was smaller than others (RCC: NCC : LCC=1 : 0.88 : 1). Valve height was correlated to the leaflet size. We designed the outer diameter of stented porcine aortic valve from 19 mm to 33 mm and designed stent height and width, using previous measured ratio of each structure, stent thickness, working thickness (for making valve). Also, we designed the size of stent and form for stented bovine pericardial valve, considering diameter of valve, leaflet length, height and leaflet minimum coaptation area. Conclusion: By measuring of 25 pig's aortic and pulmonary valve geometry and ratio, we can make theoretical basis for making implantable stented porcine valve and bovine pericardial valve in various size. After making implantable valve using these data, it is necessary to do in vivo and in vitro researches, furthermore.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.31-39
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• 2016

Purpose: The aim of this study was to investigate the prognostic factors for Pneumocystis jirovecii pneumonia (PCP) and to evaluate the influence of PCP prophylaxis in pediatric patients. Methods: From January 2002 to April 2015, patients aged <18 years with a diagnosis of confirmed PCP at our institute were reviewed retrospectively. Clinical characteristics and outcomes were compared according to the groups with or without PCP prophylaxis. Risk factors associated with PCP-related death were analyzed by logistic regression analysis. Results: During study period, a total of 24 patients were diagnosed with PCP by immunofluorescence assay and/or PCR. The median age of the patients was 5 years (range, 3 months-18 years) and 23 (96%) had immunocompromised conditions including hematologic disorders with or without hematopoietic stem cell transplantation (n=15), solid organ transplantation (n=4), and primary immune deficiency (n=4). Most common presenting symptoms were tachypnea and cough (92%, each). At the time of diagnosis, 79% (19/24) and 25% (6/24) suffered from respiratory failure and multi-organ dysfunction syndrome (MODS), respectively. Mechanical ventilation was required in 8 (33%) patients and 5 (21%) patients died of PCP. Multivariate analysis showed that MODS at initial presentation was an indicator of poor prognosis (OR, 17.1 [95% CI 1.13-257.67]; P=0.04). Compared to the patients without PCP prophylaxis, the frequency of MODS at diagnosis, need for mechanical ventilation and length of hospital days were significantly less common in the children who received PCP prophylaxis. Conclusions: MODS at presentation was a significant predictor for poor outcome and PCP prophylaxis could alleviate the clinical courses of pediatric PCP. Prospective study will be mandatory to determine the risk factors for development and deterioration of PCP in children.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.204-213
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• 2005

In spite of the improvement in the quality of artificial heart valves and surgical techniques, the incidence of the complications following valve replacement is still high. We reviewed the clinical results of the valve replacements peformed in Korean University Anam Hospital during the last 26 years. Material and Method: The data of 571 patients who received valve replacement between December 1976 and December 2003 were reviewed. Result: There were 304 cases of MVR which was the most common procedure performed. There were 122 cases of AVR, and 111 cases of AVR with MVR. Among the 47 patients who received redo operation 38 cases were redo cases including 31 cases of MVR. $32.5\%$ of the patients who had tissue valve replacement had second valve replacement with 10.2 $\pm$ 3.9 years interval. $24.3\%$ (139/571) of the patients developed valve related complications and cerebral infarction was the highest in frequency. Atrial fibrillation was related with increased complication rates and the mechanical valve replaced group had higher hemorrhagic complication rate than tissue valve replaced group. The operative mortality was $3.68\%$ and the most common cause of the failure was low output syndrome. The operative mortality was higher in the patient group who had valve replacement before the year 1990. The patient group who had mechanical valve replacement had higher operative mortality rate th;3n the tissue valve group. The 5-year survival rate was $92.2\%$ and 10 year survival rate was $85.7\%$. Conclusion: The operative mortality of valve replacement has been improved. The mechnical valve replaced patients had higher hemorrhagic complication rate than the tissue valve replaced patients and more tissue valve replaced patients received redo valve replacement.

• Tuberculosis and Respiratory Diseases
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• v.52 no.4
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• pp.376-384
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• 2002

Background : The mortality from acute respiratory distress syndrome(ARDS) in the late stage, which is characterized by progressive pulmonary fibroproliferation, is ${\geq}80%$. Although previous prospective trials failed to show a survival benefit of steroid therapy in early ARDS, recently, a few of reports have described the survival benefit of the long-term use of steroid in patients with late ARDS. In this study, we analyzed the effect of steroid therapy on patients with late ARDS retrospectively in a single. Medral intensive care unit (MICU). Methods : Over a 3-year period, the medical records of 48 ARDS patients who had been on mechanical ventilation more than 8 days were reviewed. 14 patients were treated by the long-term use of methylprednisolone and another 34 patients served as a control. Both groups were comparable regarding clinical and physiologic data lung injury score(LIS), multiple organ failure score, APACHE III and SAPS II score. Because steroid was instituted after 8 days of advanced mechanical ventilatory support in average, we arbitrarily defined the $8^{th}$ day of ARDS as first day of the study. Results : Initially, the groups had similar PF($PaO_2/FiO_2$) ratio, LIS, APACHE III and SAPS II score. By 7th day after the start of steroid therapy, there were significant improvements in PF ratio, LIS, APACHE III and SAPS II score. The mortality in the steroid treated group was significantly lower(42.9% vs 73.5%, p<0.05). Conclusion : Although the data of this study was retrospective and was not randomized, in order to improve the patient's outcomes, steroid therapy should be considered in late ARDS patients. However, prospective trials are needed to define the indication and the effect of steroid therapy in late ARDS.