Predicted Body Composition Against COVID-19: A Potential Digital Health Strategy.

This study focused on the associations between predicted lean body mass index (LBMI), appendicular skeletal muscle mass index (ASMI), and body fat mass index (BFMI) with the 2019 coronavirus disease (COVID-19). A nationwide population-based non-underweight cohort of 2,037,714 participants underwent two consecutive biennial health screening examinations, with changes in predicted body composition indices estimated using a multivariable-adjusted logistic regression model. Increased LBMI and ASMI were associated with a lower COVID-19 risk among men who became obese. In COVID-19 patients, increased LBMI, ASMI, and BFMI were associated with a higher risk of extracorporeal membrane oxygenation among obese men.

Moderate-to-Vigorous Physical Activity Changes with the Risk of SARS-CoV-2 Infection: A Nested Case-Control Study.

We identified the association of changes in moderate-to-vigorous physical activity (MVPA) with SARS-CoV-2 infection. From 6,396,500 patients, we performed a nested case-control study who participated in both biennial check-ups. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. From physically inactive patients at period I, the odds increased when engaged in 1-2, 3-4, or ≥5 times of MVPA/week at period II. This study found that MVPA was directly associated with SARS-CoV-2 infection.

Increased Estimated GFR Is Negatively Associated With the Risk of SARS-CoV-2 Infection and Severe COVID-19 Within Normal to Mildly Decreased Levels: Nested Case-Control Study.

BACKGROUND: While accumulating evidence indicates chronic kidney disease as a risk factor for coronavirus disease 2019 (COVID-19), the association between normal or mildly decreased kidney function and COVID-19 is unaddressed. Here, we have examined the association of an increase in estimated glomerular filtration rate (eGFR) with the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes among patients within normal to mildly decreased kidney function. METHODS: The patients who participated in both health screenings from period I (2017-2018) to II (2019-2020) were enrolled to our study. All participants were categorized into four groups according to the changes in eGFR stage from period I to II: 1) persistently stage G1, 2) from stage G2 to G1, 3) from stage G1 to G2, 4) persistently stage G2. In addition, the changes in eGFR value were defined by subtracting its value of period I from II. Patients were followed up for SARS-CoV-2 infection from January 1, 2021 to any diagnosis of COVID-19 or December 31, 2021, whichever happened first. In addition, those with SARS-CoV-2 infection were followed-up for one month after diagnosis to analyze severe COVID-19. Adjusted odds ratio (aOR) was calculated using multivariable-adjusted logistic regression. RESULTS: We identified 159,427 patients with and 1,804,798 patients without SARS-CoV-2 infection. The risk of SARS-CoV-2 infection decreased when eGFR stage changed from G2 to G1 (aOR, 0.957; 95% confidence interval [CI], 0.938-0.977) and persistently maintained at G1 (aOR, 0.966; 95% CI, 0.943-0.990), compared with the persistently stage G2 group. In addition, the risk showed an inverse relationship with changes in eGFR value, which was depicted by restricted cubic spline curves. For the overall risk of severe COVID-19, the persistently stage G1 showed the lowest risk (aOR, 0.897; 95% CI, 0.827-0.972), followed by those from stage G1 to G2 (aOR, 0.900; 95% CI, 0.828-0.978) and those from stage G2 to G1 (aOR, 0.931; 95% CI, 0.871-0.995), compared with the persistently stage G2 group. CONCLUSION: An increase in eGFR was negatively associated with the risk of SARS-CoV-2 infection and severe COVID-19 among normal or mildly decreased kidney function. For severe COVID-19, maintaining higher baseline eGFR may act as a protective factor against its risk.

Risk of Subsequent Primary Cancer in Thyroid Cancer Survivors: A Nationwide Population-Based Study.

Background: Despite obtaining a good prognosis and long life expectancy, survivors of thyroid cancer can nevertheless develop subsequent primary cancer (SPC). We investigated the risk and types of SPC in patients with thyroid cancer and compared them with subjects without thyroid cancer history (controls). Methods: We conducted a nationwide, population-based, retrospective cohort study based on the Korean National Health Insurance Database. A total of 432,654 patients diagnosed with thyroid cancer between 2004 and 2019 were 1:1 matched with controls for age, sex, income, and region of residence. The hazard ratios (HR) and 95% confidence intervals (CI) of SPC were estimated using Cox proportional hazard models. Results: In total, 78,584 (18.2%) patients with thyroid cancer and 49,979 (11.6%) controls were diagnosed with SPCs over a mean follow-up of 6.9 years. Patients with thyroid cancer had a higher risk of SPC at any site (adjusted HR, 1.62; 95% CI, 1.60-1.64) than the controls. The risk of SPCs was particularly high for patients diagnosed with thyroid cancer at a younger age (<40 years) and within 5 years. Conclusions: Medical caregivers should consider the long-term follow-up of patients with thyroid cancer and discuss the risk of SPC, especially if they complain of cancer-related symptoms.

Exercise Frequency Reduction Is Associated With Higher Risk of Infection in Newly Diagnosed Diabetes: A Nationally Representative Cohort Study.

BACKGROUND: Exercise is an important method to control the progression of diabetes. Since diabetes compromises immune function and increases the risk of infectious diseases, we hypothesized that exercise may affect the risk of infection by its immunoprotective effects. However, population-based cohort studies regarding the association between exercise and the risk of infection are limited, especially regarding changes in exercise frequency. The aim of this study was to determine the association between the change in exercise frequency and the risk of infection among patients with newly diagnosed diabetes. METHODS: Data of 10,023 patients with newly diagnosed diabetes were extracted from the Korean National Health Insurance Service-Health Screening Cohort. Self-reported questionnaires for moderate-to-vigorous physical activity (MVPA) were used to classify changes in exercise frequency between two consecutive two-year periods of health screenings (2009-2010 and 2011-2012). The association between changes in exercise frequency and the risk of infection was evaluated using multivariable Cox proportional-hazards regression. RESULTS: Compared with engaging in ≥ 5 times of MVPA/week during both periods, a radical decrease in MVPA (from ≥ 5 times of MVPA/week to physical inactivity) was associated with a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.60; 95% confidence interval [CI], 1.03-2.48) and upper respiratory tract infection (aHR, 1.15; 95% CI, 1.01-1.31). In addition, a reduction of MVPA from ≥ 5 to < 5 times of MVPA/week was associated with a higher risk of pneumonia (aHR, 1.52; 95% CI, 1.02-2.27), whereas the risk of upper respiratory tract infection was not higher. CONCLUSION: Among patients with newly diagnosed diabetes, a reduction in exercise frequency was related to an increase in the risk of pneumonia. For patients with diabetes, a modest level of physical activity may need to be maintained to reduce the risk of pneumonia.

Inverse association between changes in systolic and diastolic blood pressure and risk of depression: A nationally representative cohort study.

BACKGROUND: Depression is one of complex mental disorders with diverse etiological factors but the association between blood pressure (BP) and depression is unknown. We aimed to investigate the association between changes in BP (systolic and diastolic) and incident depression. METHODS: From the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), 224,192 participants who underwent biennial health screenings from period I (2004-05) and II (2006-07) were included in the study. Systolic BP (SBP) and diastolic BP (DBP) categories were defined as follows: SBP into 5 categories (<90 mmHg, 90 mmHg -119 mmHg, 120 mmHg -129 mmHg, 130 mmHg -139 mmHg, ≥140 mmHg) and DBP into 4 categories (<60 mmHg, 60 mmHg -79 mmHg, 80 mmHg -89 mmHg, ≥90 mmHg). Also, BP levels were classified into 5 groups: normal, elevated BP, stage 1 BP, stage 2 BP, hypotension. Using the Cox proportional hazards regression, changes in SBP and DBP between two screening periods and the risk of depression were calculated by adjusted hazard ratio (aHR) and 95 % confidence interval (CI). RESULTS: There were 17,780 depression events during 1.5 million person-year of follow-up. Compared to the participants with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg from both periods, those who decreased SBP from ≥140 mmHg to 120 mmHg-129 mmHg (aHR 1.13; 95 % CI 1.04-1.24; P = 0.001) and those who decreased DBP from ≥90 mmHg to 60 mmHg-79 mmHg (aHR 1.10; 95 % CI 1.02-1.20; P = 0.020) showed a higher risk of depression, respectively. CONCLUSIONS: Changes in SBP and DBP showed an inverse relationship with depression risk.

Association of Physical Activity With SARS-CoV-2 Infection and Severe Clinical Outcomes Among Patients in South Korea.

Importance: The association of moderate to vigorous physical activity (MVPA) with COVID-19 outcomes is unclear and needs to be investigated. Objective: To identify the association of longitudinal changes in MVPA with SARS-CoV-2 infection and severe COVID-19 outcomes. Design, Setting, and Participants: This nested case-control study used data from 6 396 500 adult patients in South Korean who participated in National Health Insurance Service (NHIS) biennial health screenings from period 1 (2017-2018) to period 2 (2019-2020). Patients were followed from October 8, 2020, until the diagnosis of COVID-19 or December 31, 2021. Exposure: Moderate to vigorous physical activity was measured by self-report on questionnaires during both NHIS health screenings and calculated by adding the frequency (times per week) of each moderate (≥30 minutes per day) and vigorous (≥20 minutes per day) physical activity. Main Outcomes and Measures: The main outcomes were a positive diagnosis of SARS-CoV-2 infection and severe COVID-19 clinical events. Adjusted odds ratio (aORs) and 99% CIs were calculated using multivariable logistic regression analysis. Results: A total of 183 350 patients with COVID-19 (mean [SD] age, 51.9 [13.8] years; female, 89 369 [48.7%]; male, 93 981 [51.3%]) among 2 110 268 participants were identified. For participants with vs without COVID-19, the proportion of MVPA frequency at period 2 was 35.8% vs 35.9% for physically inactive, 18.9% vs 18.9% for 1 to 2 times per week, 17.7% vs 17.7% for 3 to 4 times per week, and 27.5% vs 27.4% for 5 or more times per week. Among unvaccinated, physically inactive patients at period 1, the odds for infection increased when engaged in MVPA 1 to 2 times per week (aOR, 1.08; 99% CI, 1.01-1.15), 3 to 4 times per week (aOR, 1.09; 99% CI, 1.03-1.16), or 5 or more times per week (aOR, 1.10; 99% CI, 1.04-1.17) at period 2. Conversely, among unvaccinated patients with MVPA of 5 or more times per week at period 1, the odds for infection decreased when engaged 1 to 2 times per week (aOR, 0.90; 99% CI, 0.81-0.98) or physically inactive (aOR, 0.80; 99% CI, 0.73-0.87) at period 2. The trend of MVPA and incident infection was mitigated when participants were fully vaccinated. Furthermore, the odds for severe COVID-19 showed significant but limited associations with MVPA. Conclusions and Relevance: The findings of this nested case-control study show a direct association of MVPA with risk of SARS-CoV-2 infection, which was mitigated after completion of the COVID-19 vaccination primary series. In addition, higher levels of MVPA were associated with a lower risk of severe COVID-19 outcomes to limited proportions.

FGM-based remote intervention for adults with type 1 diabetes: The FRIEND randomized clinical trial.

Background: The use of flash glucose monitoring (FGM) in conjunction with proper education has been reported to improve glycemic control in people with diabetes on insulin therapy. However, there are still few randomized controlled trials on the educational effect, and an ideal educational model has not been established. This study aimed to estimate the efficacy of remote intervention for glycemic control in adults with type 1 diabetes using FGM. Methods: In this single-center, randomized controlled trial, we enrolled adults with type 1 diabetes (HbA1c ≥7.0%). The participants were randomly assigned (1:1) to either FGM use with remote intervention (intervention group) or FGM use only (control group). Changes in glycemic outcomes such as HbA1c levels and continuous glucose monitoring metrics were evaluated at 12 weeks. Results: Among 36 randomized participants (mean age, 44.3 years; mean baseline HbA1c, 8.9%), 34 completed the study. The remote intervention did not significantly reduce HbA1c levels. FGM use significantly improved HbA1c levels by -1.4% and -0.8% in both groups with and without remote intervention, respectively (P=0.003 and P=0.004, respectively). However, the intervention group showed significant increases in time with glucose in the range of 70-180 mg/dL (TIR; from 49.8% to 60.9%, P=0.001) and significant decreases in time with hyperglycemia (P=0.002) and mean glucose (P=0.017), but the control group did not. Moreover, the TIR (P=0.019), time with hyperglycemia >250 mg/dL (P=0.019), and coefficient of variation (P=0.018) were significantly improved in the intervention group compared to the control group. In particular, the CGM metrics improved gradually as the remote intervention was repeated. Furthermore, the intervention group reported higher treatment satisfaction (P=0.016). Conclusions: Ongoing, personalized education during FGM use may lead to amelioration of glycemic control in adults with type 1 diabetes, even remotely. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04936633, identifier NCT04936633.

Development and validation of a nonalcoholic fatty liver disease-based self-diagnosis tool for diabetes.

Background: Prediction of type 2 diabetes mellitus (DM) has been studied widely. However, a hospital visit was necessary to apply previous prediction models for the evaluation of DM. This study was conducted to develop and validate a hospital visit-free self-diagnosis tool for DM. Methods: Participants who underwent health screening between 2017-2018 (n=7,519; training cohort) and 2019-2020 (n=7,564; validation cohort) were extracted from the Korea National Health and Nutrition Examination Survey (KNHANES). DM was defined as doctor-diagnosed DM in a questionnaire. Logistic regression was used to determine independent predictors for DM, and a multivariable logistic regression-based nomogram was developed for the prediction of DM, which was validated in a cohort consisting of an independent population. The presence of nonalcoholic fatty liver disease (NAFLD) was operationally defined using the KNHANES-NAFLD score. Results: Age, sex, waist circumference, systolic blood pressure, total cholesterol, triglyceride, aspartate aminotransferase, blood urea nitrogen, urinary protein, urinary glucose, and NAFLD were identified as independent predictors for DM. After excluding laboratory variables that require laboratory tests, a simplified multivariable model was conducted based on hospital visit-free variables, including age, sex, waist circumference, systolic blood pressure, and NAFLD. The full and simplified prediction models for DM were presented as nomograms. In the independent validation cohort, the full and simplified DM prediction models were validated with an area under the curve values of 0.903 and 0.824 from the receiver operating characteristic curves, respectively. Conclusions: Involvement of NAFLD has allowed satisfactory prediction of DM without laboratory tests that require a hospital visit. The developed model may be promising in terms of early diagnosis of DM among individuals without hospital visits and may reduce the socioeconomic burden of DM in the real-world, which awaits future prospective trials to confirm.

Enhanced decomposition of caffeine by water plasma combined with mist generator: Effect of operational parameter and decomposition pathway.

Water plasma coupled with mist generator was introduced to perform the decomposition of caffeine (CAF) wastewater. The mist-shaped water molecule was directly used for plasma-forming gas with no additional gas. The influence of arc current on the decomposition of CAF was elucidated in detail. With the increase of input power from 0.8 to 1.1 kW according to arc current, the removal efficiency of total organic carbon (TOC) and CAF increased, reaching 91.1 and 99.8% at 9.5 A, respectively. H2, CO, CO2, and N2 were major effluent gaseous species, of which the H2 generation was more than 40% for all conditions. The concentration of nitrate in the effluent liquids was the highest at 9.5 A due to a higher oxidation environment. The H, O, and OH as reactive species formed via the dissociation of water molecules were demonstrated, and the plasma temperatures were at over 5000 K. The detailed decomposition pathway was deduced based on eleven intermediate products identified in this process. Electron impact and hydroxyl radical were found to take leading roles in the decomposition of CAF.

Health-Screening-Based Chronic Obstructive Pulmonary Disease and Its Effect on Cardiovascular Disease Risk.

Chronic obstructive pulmonary disease (COPD) is considered a major cause of death worldwide, and various studies have been conducted for its early diagnosis. Our work developed a scoring system by predicting and validating COPD and performed predictive model implementations. Participants who underwent a health screening between 2017 and 2020 were extracted from the Korea National Health and Nutrition Examination Survey (KNHANES) database. COPD individuals were defined as aged 40 years or older with prebronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC < 0.7). The logistic regression model was performed, and the C-index was used for variable selection. Receiver operating characteristic (ROC) curves with area under the curve (AUC) values were generated for evaluation. Age, sex, waist circumference and diastolic blood pressure were used to predict COPD and to develop a COPD score based on a multivariable model. A simplified model for COPD was validated with an AUC value of 0.780 from the ROC curves. In addition, we evaluated the association of the derived score with cardiovascular disease (CVD). COPD scores showed significant performance in COPD prediction. The developed score also showed a good effect on the diagnostic ability for CVD risk. In the future, studies comparing the diagnostic accuracy of the derived scores with standard diagnostic tests are needed.

Maternal disease factors associated with neonatal jaundice: a case-control study.

BACKGROUND: Neonatal jaundice is common, and despite the considerable medical costs associated with it, there are still few studies on the maternal factors associated with it. Identification of maternal factors associated with neonatal jaundice is very important in terms of prevention, screening and management of neonatal jaundice. The current study aimed to identify maternal disease factors associated with neonatal jaundice. METHODS: We compared the maternal disease diagnostic codes during pregnancy (study A) and 1 year before conception (study B) in mothers whose insurance claims data included newborns treated for neonatal jaundice before birth registration via the National Health Insurance Service-National Sample Cohort (control group). To decrease the effect of confounding variables, the neonatal jaundice and control groups were matched at a ratio of 1:10 via propensity score matching using covariates including age and income. RESULTS: The matched samples for studies A and B included 4,026 and 3,278 (jaundice group: 366 and 298) delivery cases, respectively. In both studies, the jaundice group had a higher proportion of patients who underwent cesarean section than the control group. In study A, other diseases of the digestive system had the highest odds ratio (OR) (K92; adjusted OR: 14.12, 95% confidence interval [CI]: 2.70-82.26). Meanwhile, gastritis and duodenitis had the lowest OR (K29; adjusted OR: 0.39, 95% CI: 0.22-0.69). In study B, salpingitis and oophoritis had the highest OR (N70; adjusted OR: 3.33, 95% CI: 1.59-6.94). Heartburn had the lowest OR (R12; adjusted OR: 0.29, 95% CI:0.12-0.71). CONCLUSIONS: This study identified maternal disease factors correlated with neonatal jaundice during pregnancy and 1 year before conception. Maternal risk factors for neonatal jaundice included syphilis and leiomyoma during pregnancy, and salpingo-oophoritis before pregnancy. The protective factors included infection, inflammatory diseases, and dyspepsia.

Design of Robust Lubricant-Infused Surfaces for Anti-Corrosion.

A lubricant-infused surface such as an oil-impregnated porous surface has great potentials for various applications due to its omniphobicity. However, the drainage and depletion of the lubricant liquid oil remain practical concerns for real applications. Here, we investigate the effect of a specially designed bottle-shaped nanopore of anodic aluminum oxide, which has a smaller pore diameter in the upper region than the lower one, on the oil retentivity and anti-corrosion efficacy. The effects of the viscosity and volatility of the lubricant oil were further investigated for synergy. Results show that the bottle-shaped pore helps to stably immobilize the lubricant oil in the nanostructure and significantly enhances the robustness and anti-corrosion efficacy, compared to the conventional cylindrical pores with straight walls as well as the hybrid one featured with additional pillar structures. Moreover, the enlarged oil capacity in the bottle-shaped pore allows the oil to cover the underlying metallic surface effectively at cracks, enhancing the damage tolerance with a unique self-healing capability. The oil with a higher viscosity further enhances the benefits so that the bottle-shaped pore impregnated with a higher-viscosity oil shows greater anti-corrosion efficacy. It suggests that the combination of the geometric features of nanopores and the fluid properties of lubricant liquid can lead to a maximized longevity and anti-corrosion efficacy of the liquid-infused surfaces for real applications.

Super anticorrosion of aluminized steel by a controlled Mg supply.

The current anticorrosion strategy makes use of coatings to passively protect the steel, which faces increasing challenge due to the tightened environmental regulations and high cost. This paper reports a new method for achieving a super anticorrosion function in Al-Si alloys through Mg nano-metallurgy, which was characterized by real-time synchrotron measurements. The unique function is based on the formation of an amorphous and self-charge-compensated MgAl2O4-SiO2 phase between the grain boundaries to help prevent the penetration of oxygen species through the grain boundaries. Through this, the corrosion resistance of pristine aluminized steel could be improved almost 20 fold. An analysis of the phases, microstructures of the Mg-coated aluminized layer and corrosion products consistently supported the proposed mechanism. This charge-compensated corrosion resistance mechanism provides novel insight into corrosion resistance.

In-situ one-step synthesis of carbon-encapsulated naked magnetic metal nanoparticles conducted without additional reductants and agents.

C-encapsulated highly pure Ni, Co, and Fe magnetic nanoparticles (MNPs/C) were synthesized by an innovative one-step in-situ plasma in liquid method (solution plasma processing, SPP) without any additional reductants, agents, or treatment. Successful encapsulation of MNPs was demonstrated by using inductively coupled plasma-atomic emission spectrometry and cyclic voltammetry techniques. The obtained X-ray diffraction patterns and transmission electron microscopy images corresponded to MNPs with average diameters of 5 nm and good crystalline structure. The C capsules with spherical shapes (containing onion-like layers) were characterized by uniform sizes (ranging from 20 nm to 30 nm) and chain-like morphologies. The synthesized MNPs/C exhibited superparamagnetic properties at room temperature and might be utilized in data storage, biomedical, and energy applications since various NPs (including bimetallic ones) could be easily prepared by changing working electrodes. This study shows the potential of SPP to be a candidate for the next-generation synthesis method of NPs/C.

A simple synthesis method for nanostructured Co-WC/carbon composites with enhanced oxygen reduction reaction activity.

Co nanoparticles (Co NPs) and nanoscale tungsten carbide (WC) are successfully synthesized simultaneously with mesoporous structured carbon black (C) using an innovative simple method, which is known as solution plasma processing (SPP), and NPs are also loaded onto carbon black at the same time by SPP. The introduction of Co NPs led to not only superior oxygen reduction reaction (ORR) activity in terms of onset potential and peak potential, but also to a more efficient electron transfer process compared to that of pure WC. Co-WC/C also showed durability for long-term operation better than that of commercial Pt/C. These results clearly demonstrate that the presence of Co NPs significantly enhanced the ORR and charge transfer number of neighboring WC NPs in ORR activities. In addition, it was proved that SPP is a simple method (from synthesis of NPs and carbon black to loading on carbon black) for the large-scale synthesis of NP-carbon composite. Therefore, SPP holds great potential as a candidate for next-generation synthetic methods for the production of NP-carbon composites.