Varicella-zoster virus (VZV) establishes lifelong latency following primary infection and can reactivate later in life to cause herpes zoster (HZ) and its debilitating complication postherpetic neuralgia (PHN). The implementation of varicella vaccinations has profoundly altered the epidemiological landscape of VZV. This narrative review examines the current literature to evaluate the impact of these vaccination programs on the incidence of HZ and PHN. Early mathematical models based on the “exogenous boosting” hypothesis predicted a substantial surge in adult HZ due to reduced exposure to circulating wild-type virus. However, long-term epidemiological data demonstrate that the incidence of adult HZ was already increasing prior to the introduction of vaccination programs and did not accelerate post-implementation, suggesting other primary drivers, such as an aging population. This review highlights the significant decline in HZ incidence among vaccinated pediatric populations, as the attenuated vOka vaccine strain is substantially less prone to reactivation than the wild-type virus. Furthermore, HZ that does occur in vaccinated individuals tends to be milder, resulting in a reduced risk of progression to PHN. To address the persistent risk in older adults, a recombinant zoster vaccine is recommended as a highly effective secondary prevention strategy. Despite challenges, such as breakthrough infections and the need for long-term monitoring of vaccine-induced immunity, varicella vaccination remains a cornerstone of public health, offering broad protection across different ages. Further research is needed to fully understand the long-term impact of varicella vaccinations on the incidence of HZ and PHN and to identify additional risk factors for these conditions.

Objective: Research specifically targeting suicidal ideation (SI) in middle-aged populations remains limited. This study aimed to predict future and concurrent SI in middle-aged Korean adults by applying four machine learning (ML) models to a nationally representative longitudinal dataset. Methods: We analyzed data from 8,992 individuals aged 40–64 years who participated in the Korea Welfare Panel Study from the 7th (2011) to the 18th (2022) waves. Four ML algorithms were employed to develop the predictive models. The SHapley Additive exPlanations method was applied to enhance explainability. Results: Approximately half of the participants’ mean age was 49.3±8.2 years (range, 40–64 years) and 52.2% were male. The average annual SI rate between 2011 and 2022 was 2.8%±1.2%. Predictive performance for future SI was satisfactory, with area under the receiver operating characteristic curve (AUC) values of up to 0.806 (logistic regression, LR). Predictions for concurrent SI demonstrated AUC values of up to 0.907 (LR). Key predictors of future SI included subjective health status, satisfaction with family and spousal relationships, housing environment, and educational attainment. Concurrent SI was strongly associated with immediate stressors such as family violence and income dissatisfaction. Conclusion The ML models demonstrated good-to-excellent predictive performance for SI. These findings emphasize the importance of health, family, and socioeconomic factors, alongside mental health indicators in the prevention of SI among middle-aged adults. Building on these findings, tailored intervention strategies that comprehensively address multidimensional risk factors are essential for effective SI prevention.

Purpose: We conducted a nationwide, multicenter, prospective registry study for newly diagnosed patients with peripheral T-cell lymphoma (PTCL) to better define the clinical characteristics, treatment patterns, survival outcomes, and the role of upfront autologous stem cell transplantation (ASCT) in these patients. Materials and Methods: Patients with PTCL receiving chemotherapy with curative intent were registered and prospectively monitored. All patients were pathologically diagnosed with PTCL. Results: A total of 191 patients with PTCL were enrolled in this prospective registry study. PTCL, not otherwise specified (PTCL-NOS) was the most common pathologic subtype (n=80, 41.9%), followed by angioimmunoblastic T-cell lymphoma (AITL) (n=60, 31.4%). With a median follow-up duration of 3.9 years, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 39.5% and 60.4%, respectively. The role of upfront ASCT was evaluated in patients who were considered transplant-eligible (n=59). ASCT was performed as an upfront consolidative treatment in 32 (54.2%) of these patients. There were no significant differences in PFS and OS between the ASCT and non-ASCT groups for all patients (n=59) and for patients with PTCL-NOS (n=26). However, in patients with AITL, the ASCT group was associated with significantly better PFS than the non-ASCT group, although there was no significant difference in OS. Conclusion The current study demonstrated that the survival outcomes with the current treatment options remain poor for patients with PTCL-NOS. Upfront ASCT may provide a survival benefit for patients with AITL, but not PTCL-NOS.

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal. Materials and Methods: We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation. Results: Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529). Conclusion In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.

Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

As the treatment of chronic non-cancer pain gradually increases, clinicians have more opportunities to encounter opioid prescription. However, guidelines for prescribing opioids for chronic non-cancer pain have never been published in Korea. The present guidelines were prepared by reviewing various research data. In cases in which the data were insufficient, recommendations were presented following discussion among experts affiliated with the Opioids Research Group in the Korean Pain Society. The present guidelines may need to be continuously revised and amended as more clinical evidence is acquired.
Analgesics, Opioid* ; Korea* ; Prescriptions

PURPOSE: The large disparity in outcomes of out-of-hospital cardiac arrest (OHCA) between communities makes it important determine pre-hospital factors associated with outcome of OHCA. The study evaluated pre-hospital care performed by 119 rescuers in OHCA and investigated pre-hospital factors that influenced return of spontaneous circulation (ROSC) and automated external defibrillator (AED) use. METHODS: We retrospectively analyzed 119 OHCA patients with presumed cardiac origin admitted to our emergency department transported by 119 rescuers from May 2007 to April 2010. Patients were divided according to achievement of ROSC and AED use prior to comparative analysis. RESULTS: Twenty six patients (21.8%) experienced ROSC and only five patients (4.2%) survived to discharge. In the study area, scene-to-hospital arrival time was significantly shorter in the ROSC group (15.0+/-5.8 minutes) than the non-ROSC group (19.4+/-9.1 minutes) (p=0.02) and electrocardiography (ECG) application was associated with non-AED use. CONCLUSION: Cooperation of emergency medical services and hospitals in the community to reduce hospital arrival time is needed to improve ROSC in OHCA patients. AED use on scene prior to ECG application will be encouraged and higher level training and continuous education of 119 rescuers for AED use will be needed to enhance AED application.
Achievement ; Defibrillators ; Electrocardiography ; Emergencies ; Emergency Medical Services ; Humans ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies

BACKGROUND: Simulation-based training is becoming more wide-spread in clinical education because of the increased technology of patient simulators in conjunction with their increased use by many medical centers. Simulation-based training enhances the learning, clinical skills and judgment of the trainees. However, the effect of repetition of simulation-based training has not yet been evaluated. The purpose of this presentation will be to examine whether the number of experiences could have an influence on the interest of the trainee. METHODS: Simulation-based training was designed as an introductory course for new interns and residents. The training course was divided into three sessions: Airway management training, cardiac massage training and advance cardiac life support mega code training. All the trainees were divided into the new interns and residents group. The two group's performances during conducting the three sessions were monitored by video equipment. All the trainees were debriefed and given a post intervention survey to assess their satisfaction with the simulation-based training. RESULTS: A total of 110 trainees completed the survey. On a four point scale, the students rated their stimulation of interest, the usefulness of the knowledge that they learned and if they enjoyed the simulation. There were no significant differences in the effectiveness of the three sessions of simulation-based training among the groups. CONCLUSIONS: Simulation is a powerful tool to get trainees excited about applying the skills they learned in the classroom. Most trainees in both groups agreed that the exercises were a great experience helpful and exciting. We postulate that the repetition of simulation-based training will not decrease the effectiveness of the training.
Airway Management ; Cardiopulmonary Resuscitation ; Clinical Competence ; Exercise ; Heart Massage ; Humans ; Judgment ; Learning

BACKGROUND: The current study evaluated whether the level of preoperative anxiety assessed by the state-trait anxiety inventory (STAI) affects cardiovascular response during anesthetic induction. Furthermore, we evaluated the utility of the preoperative anxiety scale as a predictive factor for hemodynamic changes. METHODS: One hundred twenty patients who were scheduled to undergo elective surgery under general anesthesia were enrolled in this prospective study. The patients were asked to fill out STAI questionnaires the night before the day of surgery. For 5 minutes after tracheal intubation, changes in vital signs were recorded. The correlation between STAI scores and the percent changes in vital signs during the induction of anesthesia for each subgroup was assessed. In addition, the predictability of the 20% change in vital signs by STAI scores was analyzed using receiver operating characteristics curves. RESULTS: The state anxiety scores of patients 45 years of age or older showed a significant correlation with percent changes in mean blood pressure and heart rate, whereas the state anxiety scores in other subgroups showed no significant correlation with changes in vital signs during the induction of anesthesia. Furthermore, the state anxiety scores in patients 45 years of age or older were shown to be useful in predicting a 20% change in vital signs during anesthetic induction. CONCLUSIONS: The state anxiety scores of patients 45 years of age or above could be a useful tool for predicting changes in vital signs during anesthetic induction. Thus, physician should be mindful of preoperative anxiety.
Anesthesia ; Anesthesia, General ; Anxiety ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Prospective Studies ; Surveys and Questionnaires ; ROC Curve ; Vital Signs

Deep sedation or general anesthesia has been frequently required daily radiation therapy in pediatric patients. We experienced repeated sedation with propofol in a 16-year-old patient who underwent consecutive radiation therapy due to brain tumor. During treatment, the patient showed increased susceptibility to propofol. The brain magnetic resonance imaging (MRI) showed gradual increase in size of brain tumor regardless of radiation therapy. The increased susceptibility of propofol may be related with growth of brain tumor.
Adolescent ; Anesthesia, General ; Brain Neoplasms* ; Brain* ; Deep Sedation ; Humans ; Magnetic Resonance Imaging ; Propofol*