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Functional Aspects of the Obesity Paradox in Patients with Severe Coronavirus Disease-2019: A Retrospective, Multicenter Study

  • Jeongsu Kim;Jin Ho Jang;Kipoong Kim;Sunghoon Park;Su Hwan Lee;Onyu Park;Tae Hwa Kim;Hye Ju Yeo;Woo Hyun Cho
    • Tuberculosis and Respiratory Diseases
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    • v.87 no.2
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    • pp.176-184
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    • 2024
  • Background: Results of studies investigating the association between body mass index (BMI) and mortality in patients with coronavirus disease-2019 (COVID-19) have been conflicting. Methods: This multicenter, retrospective observational study, conducted between January 2020 and August 2021, evaluated the impact of obesity on outcomes in patients with severe COVID-19 in a Korean national cohort. A total of 1,114 patients were enrolled from 22 tertiary referral hospitals or university-affiliated hospitals, of whom 1,099 were included in the analysis, excluding 15 with unavailable height and weight information. The effect(s) of BMI on patients with severe COVID-19 were analyzed. Results: According to the World Health Organization BMI classification, 59 patients were underweight, 541 were normal, 389 were overweight, and 110 were obese. The overall 28-day mortality rate was 15.3%, and there was no significant difference according to BMI. Univariate Cox analysis revealed that BMI was associated with 28-day mortality (hazard ratio, 0.96; p=0.045), but not in the multivariate analysis. Additionally, patients were divided into two groups based on BMI ≥25 kg/m2 and underwent propensity score matching analysis, in which the two groups exhibited no significant difference in mortality at 28 days. The median (interquartile range) clinical frailty scale score at discharge was higher in nonobese patients (3 [3 to 5] vs. 4 [3 to 6], p<0.001). The proportion of frail patients at discharge was significantly higher in the nonobese group (28.1% vs. 46.8%, p<0.001). Conclusion: The obesity paradox was not evident in this cohort of patients with severe COVID-19. However, functional outcomes at discharge were better in the obese group.

Reconstruction of Anterior Cruciate Ligament in Adolescent (청소년기에 시행한 전방십자인대 재건술)

  • Song Eun Kyoo;Shim Sang Don;Kim Hyung Jong;Kim Hyung Won
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.2
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    • pp.101-108
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    • 2002
  • Purpose: To evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction and to know the results of physeal injury by transphyseal tunnel in adolescents who had remaining growth potential. Materials and Methods : This study involved 12 patients under 19 years old out of 445 patients, who underwent ACL reconstruction between 1993 and 2001. The mean age at the time of operation was 15.9 $(13.1\~16.9)$ years and fellow-up period was 45.1 $(24\~120.6)$ months in avrarge. Autologous quadrupled hamstring tendon was used as graft in 11 cases and bone-patellar tendon-bone in 1 case. Clinical results were evaluated by Lysholm Knee Scoring Scale, range of motion and return to preinjury sports activities. Radiologic results were evaluated by $Telos^{\circledR}$ device. Bone maturity were analyzed by chronological age, standing height and the width of growth plate in AP and lateral view of knee joint at preoperatively. The growth disturbances were evaluated by measuring femorotibial angle, anatomical and mechanical lateral distal femoral angle, mechanical medial proximal tibial angle and leg length and by comparing those of uninjured site in last follow-up teleoroentgenogram. Results : The mean Lysholm Knee score was 51 $(25\~63)$points preoperatively and 98 $(94\~100)$ points at last follow up. The mean anterior displacement of the tibia by using $Telos^{\circledR}$ device was improved from 13.5 $(6\~27)$ mm to 2.9 $(1\~4)$ mm and there were no significant instabilities of the knee in all cases. There were no leg length discrepancies over 1 cm and no statistically significant abnormal alignment of the knee joint in all cases. Conclusion: ACL reconstruction using transphyseal tunnel for restoring stability and knee function is assumed as a good mettled of treatment without significant leg length discrepancy and abnormal alignment of the knee joint.

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Evaluation of the Usefulness of the Self-developed Kw-infrared Reflective Marker in Non-coplanar Treatment (비동일면 치료 시 자체 제작한 Kw-infrared Reflective Marker의 유용성 평가)

  • Kwon, Dong-Yeol;Ahn, Jong-Ho;Park, Young-Hwan;Song, Ki-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.22 no.1
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    • pp.25-32
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    • 2010
  • Purpose: In radiotherapy that takes into account respiration using a RPM (Real time Position Management, Varian, USA) system, which can treat in consideration of the movement of tumor, infrared reflective markers supplied by manufacturers cannot obtain respiratory signal if the couch rotates at a certain angle or larger. In order to solve this problem, the author developed the 3D infrared reflective marker named 'Kw-marker' that can obtain respiratory signal at any angle, and evaluate its usefulness. Materials and Methods: In order to measure the stability of respiratory signal, we put the infrared reflective marker on the 3D moving phantom that can reproduce respiratory movement and acquired respiratory signal for 3 minutes under each of 3 conditions (A: $couch\;0^{\circ}$, a manufacturer's infrared reflective marker B: $couch\;0^{\circ}$, Kw-marker C: $couch\;90^{\circ}$, Kw-marker). By analyzing the respiratory signal using a breath analysis program (Labview Ver. 7.0), we obtained the peak value, valley value, standard deviation, variation value, and amplitude value. In order to examine the rotation error and moving range of the target, we placed a B.B phantom on the 3D moving phantom, and obtained images at a couch angle of $0^{\circ}$ and $90^{\circ}$ using OBI, and then acquired the X, Y and Z values (mm) of the ball bearing at the center of the B.B phantom. Results: According to the results of analyzing the respiratory signal, the standard deviation at the peak value was A: 0.002, B: 0.002 and C: 0.003, and the stability of respiration for amplitude was A: 0.15%, B: 0.14% and C:0.13%, showing that we could get respiratory signal stably by using the Kw-marker. When the couch rotated $couch\;90^{\circ}$, the mean rotation error of the ball bearing, namely, the target was X: -1.25 mm, Y: -0.45 mm and Z: +0.1 mm, which were within 1.3 mm on the average in all directions, and the difference in the moving range of the target was within 0.3 mm. Conclusion: When we obtained respiratory signal using the Kw-marker in non-coplanar treatment where the couch rotated, we could acquire respiratory signal stably and the Kw-marker was effective enough to substitute for the manufacturer's infrared reflective marker. When the rotation error and moving range of the target were measured, there was little difference, indicating that the displacement of the reflector movement in couch rotation is the cause of change in the scale and amplitude of respiratory signal. If the converted value of amplitude height according to couch angle is studied further and applied, it may be possible to perform non-coplanar phase-based gating treatment.

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Design and Full Size Flexural Test of Spliced I-type Prestressed Concrete Bridge Girders Having Holes in the Web (분절형 복부 중공 프리스트레스트 콘크리트 교량 거더의 설계 및 실물크기 휨 실험 분석)

  • Han, Man Yop;Choi, Sokhwan;Jeon, Yong-Sik
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.31 no.3A
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    • pp.235-249
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    • 2011
  • A new form of I-type PSC bridge girder, which has hole in the web, is proposed in this paper. Three different concepts were combined and implemented in the design. First of all, a girder was precast at a manufacturing plant as divided pieces and assembled at the construction site using post-tensioning method, and the construction period at the site will be reduced dramatically. In this way, the quality of concrete can be assured at the manufacturing factory and concrete curing can be well controlled, and the spliced girder segments can be moved to the construction site without a transportation problem. Secondly, a numerous number of holes was made in the web of the girder. This reduces the self-weight of the girder. But more important thing related to the holes is that about half of the total anchorages can be moved from the girder ends into individual holes. The magnitude of negative moment developed at girder ends will be reduced. Also, since the longitudinal compressive stresses are reduced at ends, thick end diaphragm is not necessary. Thirdly, Prestressing force was introduced into the member through multiple stages. This concept of multi-stage prestressing method overcomes the prestressing force limit restrained by the allowable stresses at each loading stage, and maximizes the magnitude of applicable prestressing force. It makes the girder longer and shallower. Two 50 meter long full scale girders were fabricated and tested. One of them was non-spliced, or monolithic girder, made as one piece from the beginning, and the other one was assembled using post-tensioning method from five pieces of segments. It was found from the result that monolithic and spliced girder show similar load-deflection relationships and crack patterns. Girders satisfied specific girder design specification in flexural strength, deflection, and live load deflection control limit. Both spliced and monolithic holed web post-tensioned girders can be used to achieve span lengths of more than 50m with the girder height of 2 m.

Change of Perception after Weight Management Management Education among some Elementary , Middle and High Sehool Students in Seoul (서울 지역 일부 초 , 중 , 고 학생들의 다이어트 교육 실시에 따른 인식 변화에 관한 조사)

  • Jang, Yeong-Ae;Jeong, Hae-Rang;Lee, Hyeon-Jeong
    • Journal of the Korean Dietetic Association
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    • v.8 no.3
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    • pp.269-279
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    • 2002
  • To investigate the change of perception after weight management education in elementary, middle and high school students, a survey was conducted. Same questionnaire was administered twice, before and after weight management education, to 426 students at 9 schools in Seoul area. The mean height, weight and body mass index were 145.5$\pm$8.0cm, 40.0$\pm$8.3kg, 18.6$\pm$3.0 for elementary school students, 160.1$\pm$5.2cm, 50.2$\pm$7.3kg, 19.5$\pm$2.4 for middle school students, and 162.2$\pm$5.0cm, 52.2$\pm$6.4kg, 19.8$\pm$2.3 for high school students, respectively. Before education, their preferred weight and perceived healthy weight was 35.4kg and 37.0kg among elementary school students, 44.8kg and 46.5kg among middle school students, and 47.3kg and 48.9kg among high school students, respectively. Differences between their present body weight and their preferred weight and/or perceived healthy weight appeared to be 4.5kg and 2.9kg in elementary school students, 5.6kg and 4.0kg in middle school students, and 5.1kg and 3.3kg in high school students, respectively. After administering education, the differences decreased to 2.5kg and -0.2kg in elementary school students, 4.2kg and 2.7kg in middle school students, and 4.3kg and 2.0kg in high school students, respectively (p<0.01). And their perception on own body shape was investigated using 5 point scale ('too lean' to 'too fat', 1 to 5) before and after education. The mean values changed from 3.1 to 2.8 in elementary school students, from 3.3 to 3.0 in middle school students, and from 3.4 to 3.2 in high school students (p<0.01). Their satisfaction with own body weight was monitored using 5 point scale ('very satisfied' to 'very unsatisfied', 1 to 5), also. The mean values changed from 3.0 to 2.7 in elementary school students, from 3.6 to 3.2, in middle school students, and from 3.8 to 3.4 in high school students (p<0.01). In the evaluation of their nutrition knowledge about weight control using 10 item quiz, before and after education, the mean quiz score was changed from 6.3 to 7.0 in elementary school students, from 7.0 to 7.9 in middle school students, and from 7.5 to 8.1 in high school students (p<0.01). In summary, nutrition education on weight management improved the subject's perception on perceived healthy weight and own body shape, and satisfaction with present body weight. This result suggests that nutrition education program should incorporate strategies to change incorrect beliefs and knowledge regarding weight control. Onto this, weight control education for students should start from their early age, be repeated periodically and consistently, and focus on the harmful effects of excessive weight loss and information on the practical and scientific ways of weight management.

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Development for Fishing Gear and Method of the Non-Float Midwater Pair Trawl Net (III) - Opening Efficiency of the Model Net attaching the Kite - (무부자 쌍끌이 중층망 어구어법의 개발 (III) - 카이트를 부착한 모형어구의 전개성능 -)

  • 유제범;이주희;이춘우;권병국;김정문
    • Journal of the Korean Society of Fisheries and Ocean Technology
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    • v.39 no.3
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    • pp.197-210
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    • 2003
  • The non-float midwater pair trawl was effective in the mouth opening and control of the working depth in midwater and bottom. In contrast, we confirmed that it was difficult to keep the net at surface above 30 m of the depth by means of the full scale experiment in the field and the model test in the circulation water channel. To solve this problem, the kites were attached to the head rope of the non-float midwater pair trawl. In this study, four kinds of the model experiments were carried out with the purpose of applying the kite to the korean midwater pair trawl. The results obtained can be summarized as follows: 1. The working depth of the non-float midwater pair trawl with the kite was shallower than that of the proto type and non-float type. The working depth of the kite type was approximately 20m with 2 kites and about 5m with 4 kites under 4.0 knot. The working depth was almost constant but the depth of the head rope sank approximately 15m and 10m according to the increase in the front weight and the wing-end weight, respectively. The changing aspect of the working depth was constant, but the depth of the head rope sank approximately 22m according to the increase in the lower warp length (dL). 2. The hydrodynamic resistance of the kite type was almost increased in a linear form in accordance with the flow speed increase from 2.0 to 5.0 knot. The increasing grate of the hydrodynamic resistance tended to increase in accordance with the increase in flow speed. The hydrodynamic resistance of the kite type was larger approximately 5~10 ton larger than that of the non-float type and the proto type. The hydrodynamic resistance of the kite type increased approximately 3ton with the changing of the front weight from 1.40 to 3.50 ton and approximately 4 ton with the changing of the wing-end weight from 0 to 1.11 ton and approximately 5.5 ton with the changing lower warp length (dL) from 0 to 40 m, respectively. 3. The net height of the kite type was increased approximately 10 m with the change in the kite area from $2,270mm^2$ to 4,540 $\textrm{mm}^2$. The net height of the kite type was aproximately 50 m and 30 m larger than that of the proto type and the non-float type, respectively. The changed aspect of the net width was approximately 5m with the variation of the flow speed from 2.0 to 5.0 knot. 4. The filtering volume of the kite type was larger than that of the proto type and the non-float type by 28%, 34% at 2.0 knot of the flow speed and 42%, 41% at 3.0 knot, and 62%, 45% at 4.0 knot, and 74%, 54% at 5.0knot, respectively. The optimal towing speed was approximately 3.0 knot for the proto type and was over 4.0 knot for the non-float type, and the optimal towing speed reached 5.0 knot for the kite type. 5. The opening efficiency of the kite type was approximately 50% and 25% larger than that of the proto type and the non-float type, respectively.

The Establishment of Seongjusa Temple and the Production of Iron Buddhas (성주사 창건과 철불 조성 연구)

  • Kang Kunwoo
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.104
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    • pp.10-39
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    • 2023
  • Seongjusa Temple was founded in Boryeong in Chungcheongnam-do Province by Monk Muyeom (800-888), better known as Nanghye Hwasang. After returning from studying in China, Muyeom stayed in the Silla capital city of Gyeongju for a period. He later settled in a temple that was managed by the descendants of Kim In-mun (629-694). He then restored a burned-out temple and opened it in 847 as a Seon (Zen) temple named Seongjusa. It prospered and grew to become a large-scale temple with several halls within its domains. The influence of Seongjusa in the region can be seen in the Historical Record of Seongjusa Temple on Sungamsan Mountain, which relates that there were seventy-three rooms within the domains of the temple. What is most notable in the record is that the temple is referred to as "栴檀林九間," which means either "a structure with nine rooms built with Chinese juniper wood" or "a place that houses Chinese juniper wood and has nine rooms." Regardless of the interpretation, Seongjusa Temple had a large amount of juniper wood. Around this time, the term "juniper" referred to the olibanum tree (Boswellia sacra) native to the islands of Java and Sumatra in Southeast Asia. It is presumed that at some point after the death of Jang Bogo, the maritime forces that controlled the southwestern coast of Korea may have acquired a large amount of Southeast Asian olibanum wood and offered it to Seongjusa Temple. During the reign of King Munseong, Kim Yang (808-857) patronized Seongjusa Temple and its head monk Muyeom, who enjoyed a lofty reputation in the region. He sought to strengthen his own position as a member of the royal lineage of King Muyeol and create a bridge between the royal family and Seongjusan Buddhist sect. The court of King Wonseong designated Seongjusa Temple as a regional base for the support of royal authority in an area where anti-royal sentiment remained strong. Monk Muyeom is believed to have created an iron Buddha to protect the temple, enlighten the people, and promote regional stability. Given that the Seongjusa community had expanded to include more than 2,000 followers, the iron Buddha at Seongjusa Temple would have been perceived as an image that rallied the local residents. It is assumed that there were two iron Buddhas at Seongjusa Temple. The surviving parts of these Buddhas and the size of their pedestals suggest that they were respectively enshrined in the Geumdang Main Hall and the Samcheonbuljeon Hall of Three Thousand Buddhas. It is presumed that the first iron Buddha in Geumdang was a large statue over two meters in height and the second one was medium-sized with the height over one meter. The Historical Record of Seongjusa Temple on Sungamsan Mountain contains the phrase "改創選法堂五層重閣" which indicates that a multistoried Geumdang was newly built to enshrine a large Buddha sculpture like the first iron Buddha when Seongjusa Temple was founded. Also, according to the Stele of Seongjusa Temple and the surviving finger fragments, the first Buddha was making the fear-not and wish-granting (abhayavarada) mudras. The main Buddha of Seongjusa Temple is possibly Nosana Buddha, just like the main Buddhas at the contemporaneous temples Silsangsa, Borimsa, and Samhwasa. Given that Monk Muyeom studied Hwaeom teachings in his early years and received royal patronage upon his return, it is believed that the retro tendencies of the Hwaeom school, centered on the royal family of the Silla Dynasty, were reflected in Seongjusa temple.

A Practice-Oriented Study on Sawdust File Filteration Composting of High Moisture Pig Slurry (고수분 돈분슬러리의 톱밥여과 퇴비화 현장적용 연구)

  • Ryoo, J.W.
    • Journal of Animal Environmental Science
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    • v.14 no.2
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    • pp.129-138
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    • 2008
  • This study was carried out to investigate the operating characteristics, water balance and chemical properties of compost during the composting with pig slurry on-farm trial. The composting plant with sawdust pile filteration was done in a forced aeration inside a house and equipped with a turning machine moving on a rails. The composting pit was 4.6m wide, 53m long and the maximum height was 2m. A field scale aerobic composting facility was tested the composting efficiency of high moisture pig slurry. The sawdust materials remained 6 months. Pig slurry was added to compost pile every other day during 6 months run. The temperature in compost pile and compost house, and input and output of moisture were measured during composting process. The result are summarized as follows; 1. The temperature of compost was varied in range of at $22.4^{\circ}C{\sim}71.1^{\circ}C$. After turning, the composting temperature decreased to $50^{\circ}C{\sim}36^{\circ}C$ during $3{\sim}5$ hours, and then raised to $64.5^{\circ}C$ 2. The temperature of compost house was maintained $20^{\circ}C{\sim}30^{\circ}C$, and relative humidity was varied in range of $50{\sim}99%$. 3. BOD, CODcr and SS of leachate water was reduced 89.5%, 81.2%, 97.5%, respectively. 4. The content of heavy metal in the final compost was lower those of Korea standards. 5. The amount of effluent was 10.2%. Total evaporation during composting Period were 74.8%. The amount of slurry per $1m^3$ sawdust was $3.16m^3$ without treatment of effluent output.

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The timing of sexual maturation and secular trends of menarchial age in Korean adolescents (한국 청소년의 성성숙 시기 및 장기간의 초경연령 추세분석)

  • Park, Mi Jung;Lee, In-Sook;Shin, Eun-Kyung;Joung, Hyojee;Cho, Sung-Il
    • Clinical and Experimental Pediatrics
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    • v.49 no.6
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    • pp.610-616
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    • 2006
  • Purpose : The purpose of this study was to evaluate the timing of sexual maturation and secular trends of menarchial age in Korean adolescents. Methods : Nine hundred eighty two school students and 119 university female students were included. Tanner's pubertal assessment method was applied using a self-assessment sheet with pictures for their developmental stages. A medical checkup database from 1,156,022 women was also used to analyze the age of menarche from the year 1900 to 1980. Results : Onset of puberty was at $11.3{\pm}1.3$ years(y) in girls and $12.1{\pm}1.5$ y in boys and total pubertal duration was 3.6 y in girls and 3.3 y in boys. Height at the onset of puberty was $146.1{\pm}7.9cm$ in girls and $152.7{\pm}9.8cm$ in boys. Weight at the onset of puberty was $39.3{\pm}6.9kg$ in girls and $47.7{\pm}14.4kg$ in boys. The mean age of menarche was $12.0{\pm}1.0y$ and mean age at nocturnal emission was $12.3{\pm}1.8y$. By age ten, 3.0 percent of girls experienced menarche, which increased to 41.1 percent by age 12, and 98.0 percent by age over 15. By SMR 2 breast stage, 18.2 percent of girls experienced menarche, which increased to 66.1 percent and 91.7 percent by SMR stages 3 and 4, respectively. By SMR 2 pubic hair stage, 52.0 percent and by SMR 3, 93.8 percent of girls experienced menarche. While the menarchial age of women born around 1980 was $12.4{\pm}1.1y$, the menarchial age of women born around 1990 was $12.0{\pm}1.1y$. Age at menarche has been advanced approximately by 2 years between 1900 and 1980 birth cohorts. Conclusion : There was a downward secular trend in pubertal timing. Age at menarche has been advanced by 2 years during the last 80 years. Further large scale, prospective studies, including inspection by specialists, are needed to provide reference data for pubertal timing in Korean adolescents.

Analysis of Actual State of Facilities for Pleurotus eryngii Cultivation - Based on Western Gyeongnam Area - (큰느타리버섯 재배사의 실태분석 - 서부경남지역을 중심으로 -)

  • Yoon Yong Cheol;Suh Won Myung;Yu Chan
    • Journal of Bio-Environment Control
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    • v.13 no.4
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    • pp.217-225
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    • 2004
  • This study was performed to provide the basic knowledge about the mushroom cultivation facilities. Classified current status of cultivation facilities in Gyeongnam province was investigated by questionnaire. The structure of Pleurotus eryngii cultivation facilities can be classified into the simple and permanent frame type. The simple frame structures were mostly single-span type, on the other hand, the permanent frame structures were more multi-span than simple structures. And the scale of cultivation facilities was very different regardless of structural type. But as a whole, the length, width and ridge height were prevailing approximately 20.0 m, $6.6\~7.0m$ and $4.6\~5.0m$ range, respectively. The floor area was about $132\~160\;m^2$, and floor was built with concrete to protect mushrooms from various harmful infection. The roof slope of the simple and permanent type showed about $41.5^{\circ}\;and\;18.6\~28.6^{\circ}$, respectively. The width and layer number of growing bed for mushroom cultivation were around $1.2\~1.6m$, 4 layers in common, respectively. Most of year round cultivation facilities were equipped with cooler, heater, humidifier, and ventilating fan. Hot water boiler was the most commonly used heating system, the next was electric heater and then steam boiler. The industrial air conditioner has been widely used for cooling. And humidity was controlled mostly by ultra-wave or centrifuging humidifier. But some farmers has been using nozzle system for auxiliary purpose. More then $90\%$ of the mushroom house had the independent environment control system. The inside temperature was usually controlled by sensor, but humidity and $CO_2$ concentration was controlled by timer for each growing stage. The capacity of medium bottle was generally 850 cc and 1100cc, some farms used 800 cc, 950 co and 1,250 cc. Most of mushroom producted has been usually shipped to both circulating company and joint market.