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Safety and efficacy are essential in the process of disease treatment. However, off-label medication use is inevitable because various medications do not contain regulatory labels for pediatric use. We aimed to examine off-label medication use and analyze the risk factors correlated with adverse drug reactions (ADRs). This study was performed retrospectively using electronic medical data from a pediatric intensive care unit (PICU) of a tertiary hospital in Korea from July 2019 to June 2020. A total 6,183 prescribed medications from 502 PICU patients were examined in the present study. A total of 80% were infants or children, and 96.0% of them were treated with off-label medications. It was discovered that 4,778 off-label cases (77.2%) of the top 100 drugs had prescriptions with dosage (67.8%). Drugs prescribed to patients admitted to the cardiothoracic department (odds ratio [OR], 3.248; p = 0.019), total number of medications (OR, 1.116; p = 0.001), and length of PICU stay of ≥ 7 days (OR, 4.981; p = 0.008) were significantly associated with ADRs. ADRs were noted to be more severe in off-label use (p = 0.0426). For appropriate medication use, evidence regarding the safety of off-label medications is required and ultimately reflected in the official regulation.

Background: Healthcare 4.0. refers to the integration of advanced technologies, such as artificial intelligence (AI) and big data analysis, into the healthcare sector. Recognizing the impact of Healthcare 4.0 technologies in laboratory medicine (LM), we seek to assess the overall awareness and implementation of Healthcare 4.0 among members of the Korean Society for Laboratory Medicine (KSLM). Methods: A web-based survey was conducted using an anonymous questionnaire. The survey comprised 36 questions covering demographic information (seven questions), big data (10 questions), and AI (19 questions). Results: In total, 182 (17.9%) of 1,017 KSLM members participated in the survey. Thirty-two percent of respondents considered AI to be the most important technology in LM in the era of Healthcare 4.0, closely followed by 31% who favored big data. Approximately 80% of respondents were familiar with big data but had not conducted research using it, and 71% were willing to participate in future big data research conducted by the KSLM. Respondents viewed AI as the most valuable tool in molecular genetics within various divisions. More than half of the respondents were open to the notion of using AI as assistance rather than a complete replacement for their roles. Conclusions: This survey highlighted KSLM members’ awareness of the potential applications and implications of big data and AI. We emphasize the complexity of AI integration in healthcare, citing technical and ethical challenges leading to diverse opinions on its impact on employment and training. This highlights the need for a holistic approach to adopting new technologies. [ABSTRACT FROM AUTHOR]

Background: In recent decades, the analytical quality of clinical laboratory results has substantially increased because of collaborative efforts. To effectively utilize laboratory results in applications, such as machine learning through big data, understanding the level of harmonization for each test would be beneficial. We aimed to develop a quantitative harmonization index that reflects the harmonization status of real-world laboratory tests. Methods: We collected 2021–2022 external quality assessment (EQA) results for eight tests (HbA1c, creatinine, total cholesterol, HDL-cholesterol, triglyceride, alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA], and prostate-specific antigen [PSA]). This EQA was conducted by the Korean Association of External Quality Assessment Service, using commutable materials. The total analytical error of each test was determined according to the bias% and CV% within peer groups. The values were divided by the total allowable error from biological variation (minimum, desirable, and optimal) to establish a real-world harmonization index (RWHI) at each level (minimum, desirable, and optimal). Good harmonization was arbitrarily defined as an RWHI value ≤1 for the three levels. Results: Total cholesterol, triglyceride, and CEA had an optimal RWHI of ≤1, indicating an optimal harmonization level. Tests with a desirable harmonization level included HDL-cholesterol, AFP, and PSA. Creatinine had a minimum harmonization level, and HbA1c did not reach the minimum harmonization level. Conclusions: We developed a quantitative RWHI using regional EQA data. This index may help reflect the actual harmonization level of laboratory tests in the field. [ABSTRACT FROM AUTHOR]

Background: Clinical management of patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) relies on the viral load (VL). The Cobas 5800 system (Roche Diagnostics) can determine VLs in 200 and 500 μL samples, but the performance of each protocol has not been compared. We evaluated the performance of both protocols for the HBV and HCV tests. Methods: Precision and linearity were verified using commercial panels. Probit analyses were used to determine limits of detection (LoDs). The results obtained with 336 samples were compared using the 200 and 500 μL protocols. Data from 6,737 retrospective HBV and 768 HCV samples were compared to estimate the effects of the different LoDs on the diagnostic results of the protocols. Correlations between protocols were tested with Spearman's rank correlation coefficients (rho). Results: The precision and linearity of both protocols were verified. The LoDs for the 200 and 500 μL protocols were 6.5 and 2.7 IU/mL for HBV and 29.7 and 8.2 IU/mL for HCV, respectively. The agreement between the protocols ranged from 0.8 to 1.0. The results obtained with the HBV and HCV tests showed a strong correlation (rho=0.994). Only 0.4% of HBV and 0.4% of HCV test results were affected by the LoDs of the 200 μL protocol. Conclusions: The Cobas 5800 200 and 500 μL protocols for the HBV DNA and HCV RNA tests demonstrated excellent performance. These findings establish the 200 μL protocol as a new option for low-volume samples, especially for pediatric and difficult-to-bleed patients. [ABSTRACT FROM AUTHOR]

Space debris poses significant threats to spacecraft and human activities in space. Accurate modeling of space debris is crucial for understanding and mitigating these risks, ensuring the sustainability of the space environment. This paper discusses the importance of space debris modeling in the space environment, highlighting its critical role in safeguarding assets in orbit. Two primary methods of space debris modeling, namely the 1D and 3D approaches, are discussed in detail, and their respective strengths and limitations are elucidated. Furthermore, a comprehensive review of existing models, including the space debris evolutionary model (MOCAT, SOLEM, DAMAGE, LEODEEM & GEODEEM, DELTA, and LEGEND) and engineering models (MOCAT-MC, NEODEEM, MASTER, ORDEM), are presented. These models offer valuable insights into the dynamics and characteristics of space debris populations, aiding in formulating effective debris mitigation strategies and orbital capacity problems for reducing the possibilities of Kessler’s syndrome. Additionally, the paper provides insights into the ongoing development of the Korean space debris model, focusing on its methodology and space debris cataloging techniques for modeling space debris environments.

The distant recurrence of intramuscular hemangiomas, especially those involving the chest wall, is extremely rare. This study reports a case of multiple distant recurrences of intramuscular hemangioma in the chest wall after the complete surgical excision of two intramuscular hemangiomas in the upper extremities. A 37-year-old woman was referred to the authors’ hospital with two masses in the left breast detected incidentally on breast ultrasonography (US). US revealed an oval, circumscribed, hypoechoic mass and a complex cystic and solid mass. She had a history of a complete surgical resection of two intramuscular hemangiomas in her left forearm ten years earlier. Recognizing the recurrence risks and multiple intramuscular hemangiomas is critical for appropriate treatment and follow-up plans. This case emphasizes the significance of US findings in assisting clinicians in the early and accurate diagnosis of distant recurrence of multiple intramuscular hemangiomas occurring at unusual sites.

Xylanases require thermal stability to withstand the pelleting process, pH stability to function in the gastrointestinal tract, and resistance to xylanase inhibitors in raw materials to be effective in animal feed. A GH11 family xylanase originating from an anaerobic fungus, Orpinomyces sp. strain PC-2, has high specific activity and resistance to xylanase inhibitors intrinsically. It was engineered using rational protein design methods to obtain a thermal and pH stable enzyme, OXynA-M. OXynA-M showed resistance to three types of xylanase inhibitors, Triticum aestivum xylanase inhibitors TAXI-IB and TAXI-IIA and xylanase inhibitor protein XIP and showed melting temperature of 87.2°C when measured using differential scanning calorimetry. It was stable at all pH between 2.0–10.0 incubated up to 4 h. Xylo-oligosaccharides (XOS) production profile using a wheat arabinoxylan substrate revealed the production of xylobioses up to xylohexaoses, which are known to have prebiotic functionalities. An animal trial was conducted in broiler chickens to evaluate the in vivo efficacy of the xylanase. In total, 600 1-day-old chickens were divided into six dietary treatments, including a positive control (PC) (T1) without the addition of exogenous enzyme and the rest where exogenous xylanase was added at the rates of 1200, 2400, 4800, 9600, and 240000 U/kg of feed from T2–T6. An increase in OXynA-M xylanase improved the performance parameters in the enzyme-treated groups compared with the control. The viscosity of ileal digesta decreased with increasing enzyme dosage. A significantly lower viscosity of 6.54 cP was determined for the minimum dose in T2 (1200 U/kg), and the viscosity was further reduced in T6 (240000 U/kg) (P

Purpose: The purposes of this study were to: (1) examine adolescents' knowledge regarding e-cigarettes and e-cigarette or vaping product use-associated lung injury (EVALI), and (2) describe common misconceptions regarding e-cigarette use. Methods: Adolescents aged 13 to 19 years were recruited in pediatric dental clinics and completed a survey questionnaire regarding their knowledge of e-cigarettes. Results: A total of 66 adolescents participated. Forty-seven adolescents indicated knowledge of e-cigarettes. Forty adolescents recognized that most e-cigarettes contain nicotine, and 49 adolescents reported knowledge of EVALI cases. Adolescents had knowledge of possible lung damage from e-cigarette use. Adolescents also had misconceptions about e-cigarettes containing nicotine and them being less addictive than other tobacco products. Conclusions: Adolescents were aware of e-cigarette or vaping product use-associated lung injury cases, and the majority of them viewed e-cigarette use as harmful to their health. However, some adolescents had misconceptions regarding the safety of e-cigarette use. Oral health providers should recognize that they play an important role in identifying risky behaviors amongst adolescents, incorporate adolescent-specific risk assessments into their clinical practice, and be comfortable providing anticipatory guidance about e-cigarette and nicotine use. [ABSTRACT FROM AUTHOR]

Background: Reference materials are essential for the quality assurance of molecular detection methods. We developed and characterized synthetic norovirus GI and GII RNA reference materials. Methods: Norovirus GI and GII RNA sequences including the ORF1-ORF2 junction region were designed based on 1,495 reported norovirus sequences and synthesized via plasmid preparation and in vitro transcription. The synthetic norovirus GI and GII RNAs were evaluated using six commercial norovirus detection kits used in Korea and subjected to homogeneity and stability analyses. A multicenter study involving five laboratories and using four commercial real-time PCR norovirus detection assays was conducted for synthetic norovirus RNA characterization and uncertainty measurements. Results: The synthetic norovirus GI and GII RNAs were positively detected using the six commercial norovirus detection kits and were homogeneous and stable for one year when stored at -20°C or -70°C. All data from the five laboratories were within a range of 1.0 log copies/µL difference for each RNA, and the overall mean concentrations for norovirus GI and GII RNAs were 7.90 log copies/µL and 6.96 log copies/µL, respectively. Conclusions: The synthetic norovirus GI and GII RNAs are adequate for quality control based on commercial molecular detection reagents for noroviruses with high sequence variability. The synthetic RNAs can be used as reference materials in norovirus molecular detection methods. [ABSTRACT FROM AUTHOR]

Objective: To examine children’s screen time use and sleep patterns over 2 years of the pandemic and the downstream associations with children’s executive functions and behavioural problems, as well as the moderating effects of parental factors. Method: This longitudinal cohort study examined school-aged children’s lifestyle and behavioural changes over 2 years of the pandemic across 6 timepoints (November 2020 to August 2022). Latent growth modeling (LGM) was used to identify changes in screen time and sleep duration and multivariate LGM was used to determine how parental stress, positive parenting, changes in children’s screen time and sleep over time were associated with children’s executive functions and mental health outcomes at the final time point. Results: A total of 198 parents (children’s mean age = 9.14 years) were recruited and followed up. Non-school screen time was elevated at the initial timepoint (3.6 ± 2.3 h). Positive parenting at the initial timepoint was associated with lower screen time use in children (β = −.19, p

Purpose To assess normal CT scans with quantitative CT (QCT) analysis based on smoking habits and chronic obstructive pulmonary disease (COPD). Materials and Methods From January 2013 to December 2014, 90 male patients with normal chest CT and quantification analysis results were enrolled in our study [non-COPD never-smokers (n = 38) and smokers (n = 45), COPD smokers (n = 7)]. In addition, an age-matched cohort study was performed for seven smokers with COPD. The square root of the wall area of a hypothetical bronchus of internal perimeter 10 mm (Pi10), skewness, kurtosis, mean lung attenuation (MLA), and percentage of low attenuation area (%LAA) were evaluated. Results Among patients without COPD, the Pi10 of smokers (4.176 ± 0.282) was about 0.1 mm thicker than that of never-smokers (4.070 ± 0.191, p = 0.047), and skewness and kurtosis of smokers (2.628 ± 0.484 and 6.448 ± 3.427) were lower than never-smokers (2.884 ± 0.624, p = 0.038 and 8.594 ± 4.944, p = 0.02). The Pi10 of COPD smokers (4.429 ± 0.435, n = 7) was about 0.4 mm thicker than never-smokers without COPD (3.996 ± 0.115, n = 14, p = 0.005). There were no significant differences in MLA and %LAA between groups (p > 0.05). Conclusion Even on normal CT scans, QCT showed that the airway walls of smokers are thicker than never-smokers regardless of COPD and it preceded lung parenchymal changes.

Abstract Kombucha is a healthy carbonated beverage made by fermenting tea extracts such as green tea and black tea through symbiotic culture of bacteria and yeast. In this study, fermentation characteristics and radical scavenging activity of ginseng berry kombucha (GBK) by Saccharomyces cerevisiae M-5 and Gluconobacter oxydans were measured. As fermentation time increased, pH decreased and titratable acidity increased. Reducing sugars decreased rapidly on day 3. Alcohol content increased dramatically during this period and then decreased. GBK showed increased radical scavenging activity and increased total flavonoid content on day 18 of fermentation compared to before fermentation. In particular, during GBK fermentation, the content of phenolic compounds such as gallic acid (2.09-fold) and chlorogenic acid (2.11-fold) increased, contributing to antioxidant activity. In addition, the major ginsenosides of GBK were identified as Rg2 (10.1 μg/mg) and Re (6.59 μg/mg), and the content of minor ginsenosides, which are easily absorbed forms, increased 2.19-fold by fermentation. GBK also extended survival in a Drosophila model treated with 15% hydrogen peroxide. GBK also reduced reactive oxygen species (p

Objective: To examine screen time (ST) before and during the pandemic and changes between the two time points in children and youth aged 0 to 21 years, and to identify moderating factors (mean age, male%, report type, geography, and study design). Study design: A literature search of five databases was conducted. Studies written in English, reported ST in minutes or hours before and/or during the pandemic, and were published between January 2020-June 2022 were included. 109 studies were selected from the first screening of 4845 studies, and 91 studies that reported either ST during the pandemic (N = 91) or both ST before and during the pandemic (N = 51) were included in the final analyses. Random-effects meta-analyses were used to derive the mean STs across the studies. Results: The pre-pandemic ST mean was 2.67 ± 0.21 h/d, which was increased to 4.38 ± 0.20 h during the pandemic. Older children (p = 0.006) and boys (p = 0.005) spent more time on screens before the pandemic, but sex differences were no longer evident during the pandemic. In children under 5 years, the pre-pandemic ST mean was 1.91 h/d, which increased to 2.65 h/d during the pandemic, with 0.89 h/d changes. Conclusions: Children and youth's ST exceeded pediatric guidelines before the pandemic, even in children under 5 years, but the current study found significant increases in ST during the pandemic across all ages. This study suggests that ST increases need to be understood in terms of contextual perspectives. Further, identifying vulnerable groups is important to establish practical guidelines and interventions.

In this work the authors investigate the structure-sequence dependance. The ability to design and characterize proteins at interfaces between three common folds suggests that fold switching is an intrinsic feature of protein folding language and likely important in the evolution of protein structure and function.

Abstract Techniques for detecting chemicals dispersed at low concentrations in air continue to evolve. These techniques can be applied not only to manage the quality of agricultural products using a post-ripening process but also to establish a safety prevention system by detecting harmful gases and diagnosing diseases. Recently, techniques for rapid response to various chemicals and detection in complex and noisy environments have been developed using M13 bacteriophage-based sensors. In this review, M13 bacteriophage-based multi-array colourimetric sensors for the development of an electronic nose is discussed. The self-templating process was adapted to fabricate a colour band structure consisting of an M13 bacteriophage. To detect diverse target chemicals, the colour band was utilised with wild and genetically engineered M13 bacteriophages to enhance their sensing abilities. Multi-array colourimetric sensors were optimised for application in complex and noisy environments based on simulation and deep learning analysis. The development of a multi-array colourimetric sensor platform based on the M13 bacteriophage is likely to result in significant advances in the detection of various harmful gases and the diagnosis of various diseases based on exhaled gas in the future.

Dorsal striatum, principally comprising of caudate and putamen, is well-known to support motor function but also various higher-order cognitive functions. This is enabled by developing short- and long-range connections to distributed cortical regions throughout the life span, but few studies have examined developmental changes from young children to adults in the same cohort. Here we investigated the development of dorsal-striatal network in a large (n = 476), single-site sample of healthy subjects 3–42 years of age in three groups (children, adolescence, adults). The results showed that the connectivity within the striatum and to sensorimotor regions was established at an early stage of life and remained strong in adolescence, supporting that sensory-seeking behaviours and habit formation are important learning mechanisms during the developmental periods. This connectivity diminished with age, as many behaviours become more efficient and automated. Adolescence demonstrated a remarkable transition phase where the connectivity to dorsolateral prefrontal cortex emerged but connectivity to the dorsomedial prefrontal and posterior brain, which belong to the ventral attentional and default mode networks, was only seen in adults. This prolonged maturation in between-network integration may explain the behavioural characteristics of adolescents in that they exhibit elaborated cognitive performance but also demonstrate high risk-taking behaviours.

Abbreviated breast magnetic resonance imaging (AB-MRI) has emerged as a supplementary screening tool, though protocols have not been standardized. The purpose of this study was to compare the diagnostic performance of modified and classic AB-MRI and determine MRI features affecting their diagnostic performance. Classic AB-MRI included one pre- and two post-contrast T1-weighted imaging (T1WI) scans, while modified AB-MRI included a delayed post-contrast axial T1WI scan and an axial T2-weighted interpolated scan obtained between the second and third post-contrast T1WI scans. Four radiologists (two specialists and two non-specialists) independently categorized the lesions. The MRI features investigated were lesion size, lesion type, and background parenchymal enhancement (BPE). The Wilcoxon rank-sum test, Fisher’s exact test, and bootstrap-based test were used for statistical analysis. The average area under the curve (AUC) for modified AB-MRI was significantly greater than that for classic AB-MRI (0.76 vs. 0.70, p = 0.010) in all reader evaluations, with a similar trend in specialist evaluations (0.83 vs. 0.76, p = 0.004). Modified AB-MRI demonstrated increased AUCs and better diagnostic performance than classic AB-MRI, especially for lesion size > 10 mm (p = 0.018) and mass lesion type (p = 0.014) in specialist evaluations and lesion size > 10 mm (p = 0.003) and mild (p = 0.026) or moderate BPE (p = 0.010) in non-specialist evaluations.

Teaching point: Homogeneous internal enhancement and washout pattern on DCE-MRI and a low ADC value on DWI in women with breast carcinoma help distinguish primary breast lymphoma from bilateral synchronous breast carcinoma.

Intestinal microbiota mediate the development and regulation of the intestinal immune system either directly or indirectly. Particularly, Bifidobacterium spp. play an important role in regulating the intestinal immunity and intestinal barrier. We demonstrated that Bifidobacterium animalis ssp. lactis HY8002, selected from eight Bifidobacterium strains by in vitro experimentation, had exceptional resistance to digestive tract conditions and high adhesion to intestinal epithelial cells and a positive effect on immunoglobulin A (IgA) secretion by Peyer’s patch cells. Moreover, HY8002 restored the expression of tight junction-related genes, initially reduced by lipopolysaccharide treatment, to normal levels in human intestinal epithelial cells. Notably, HY8002 restored kanamycin-induced reduction in Peyer’s patch cell numbers, serum and fecal IgA levels, and zonula occludens 1 and Toll-like receptor 2 levels in the mouse small intestine. In addition, HY8002 restores microbiome composition disturbed by kanamycin, and these microbiome changes have been found to correlate with TLR2 levels in the small intestine. Moreover, the ability of HY8002 to enhance IgA in Peyer’s patch cells and ZO-1 levels in intestinal epithelial cells was significantly inhibited by a TLR2 blocking antibody, which suggests that the HY8002 improve intestinal barrier function via TLR2. Finally, whole-genome sequencing of HY8002 revealed that it did not possess any known virulence factors. Therefore, HY8002 is a promising, functional probiotic supplement to improve intestinal barrier function by improving intestinal immunity and microbiota balance.

This study aimed to evaluate the hangover relieving effect of ginseng berry kombucha (GBK) fermented with Saccharomyces cerevisiae and Gluconobacter oxydans in in vitro and in vivo models. The antioxidant activity and oxidative stress inhibitory effect of GBK were evaluated in ethanol-treated human liver HepG2 cells. In addition, biochemical and behavioral analyses of ethanol treated male ICR mice were performed to confirm the anti-hangover effect of GBK. The radical scavenging activity of GBK was increased by fermentation, and the total ginsenoside content of GBK was 70.24 μg/mL. In HepG2 cells, in which oxidative stress was induced using ethanol, GBK significantly increased the expression of antioxidant enzymes by upregulating the Nrf2/Keap1 pathway. Moreover, GBK (15 and 30 mg/kg) significantly reduced blood ethanol and acetaldehyde concentrations in ethanol-treated mice. GBK significantly increased the levels of alcohol-metabolizing enzymes, including alcohol dehydrogenase and acetaldehyde dehydrogenase. The balance beam test and elevated plus maze test revealed that high-dose GBK significantly ameliorated ethanol-induced behavioral changes. Collectively, GBK exerted a protective effect against ethanol-induced liver damage by regulating the Nrf2/Keap1 pathway.

Iron plays an important role in macrophage polarization by altering metabolic and redox status. However, the impact of iron on the immune status of macrophages is still controversial. In this study, we report that ferric ammonium citrate (FAC) upregulates PD-L1 expression in macrophages. FAC not only altered the phenotype of macrophages but also led to enriching immune-modulatory T cell subsets. Since iron is known to be a constituent of coenzymes facilitating metabolic processes in mitochondria, we examined the metabolic status of FAC-overloaded macrophages by measuring the oxygen consumption rate (OCR) and the represented coenzyme, aconitase. In addition to enhancement of metabolic processes, FAC accelerated the Fenton reaction in macrophages, which also contributed to the facilitation of oxygen consumption. We reasoned that the enhancement of the OCR leads to the production of reactive oxygen species (ROS), which are directly linked to PD-L1 induction. Using ferrostatin, rotenone, and N-acetyl-L-cysteine, we confirmed that metabolic and redox regulation is responsible for FAC-mediated PD-L1 expression. Furthermore, we suggested that FAC-induced ROS production may explain FAC-mediated pro- and anti-inflammatory responses in macrophages. These findings may extend our understanding of regulating iron concentration during immune checkpoint therapy in cancer patients.

Abstract H3.3, the most common replacement variant for histone H3, has emerged as an important player in chromatin dynamics for controlling gene expression and genome integrity. While replicative variants H3.1 and H3.2 are primarily incorporated into nucleosomes during DNA synthesis, H3.3 is under the control of H3.3-specific histone chaperones for spatiotemporal incorporation throughout the cell cycle. Over the years, there has been progress in understanding the mechanisms by which H3.3 affects domain structure and function. Furthermore, H3.3 distribution and relative abundance profoundly impact cellular identity and plasticity during normal development and pathogenesis. Recurrent mutations in H3.3 and its chaperones have been identified in neoplastic transformation and developmental disorders, providing new insights into chromatin biology and disease. Here, we review recent findings emphasizing how two distinct histone chaperones, HIRA and DAXX, take part in the spatial and temporal distribution of H3.3 in different chromatin domains and ultimately achieve dynamic control of chromatin organization and function. Elucidating the H3.3 deposition pathways from the available histone pool will open new avenues for understanding the mechanisms by which H3.3 epigenetically regulates gene expression and its impact on cellular integrity and pathogenesis.

Background and Objectives: Giant bullae rupture easily and cause tension pneumothorax, which can cause problems during general anesthesia. However, the hemodynamic instability that can occur due to the mass effect of an unruptured giant bulla should not be overlooked. Case report: A 43-year-old male patient visited the emergency room with an abdominal wound. There was a giant emphysematous bulla in the left lung. Emergency surgery was decided upon because there was active bleeding according to abdominal CT. After tracheal intubation, the patient’s blood pressure and pulse rate dramatically decreased. His blood pressure did not recover despite the use of vasopressors and discontinuation of positive pressure ventilation applied to the lungs. Thus, a bullectomy was immediately performed. The patient’s blood pressure and pulse rate were normalized after the bullectomy. Conclusions: If emergency surgery under general anesthesia is required in a patient with a giant emphysematous bulla, it is safe to minimize positive pressure ventilation and remove the giant emphysematous bulla as soon as possible before proceeding with the remainder of the surgery. Tension pneumothorax due to the rupturing of a bulla should be considered first. However, hemodynamic changes might occur due to the mass effect caused by a giant bulla.

The thymidine kinase (TK) and DNA polymerase (pol) genes of the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) are two important genes involved in antiviral resistance. We investigated the genetic polymorphisms of the HSV-TK and pol genes in clinical isolates from Korean HSV-infected patients using next-generation sequencing (NGS) for the first time in Korea. A total of 81 HSV-1 and 47 HSV-2 isolates were examined. NGS was used to amplify and sequence the TK and pol genes. Among the 81 HSV-1 isolates, 12 and 17 natural polymorphisms and 9 and 23 polymorphisms of unknown significance in TK and pol were found, respectively. Two HSV-1 isolates (2.5%) exhibited the E257K amino acid substitution in TK, associated with antiviral resistance. Out of 47 HSV-2 isolates, 8 natural polymorphisms were identified in TK, and 9 in pol, with 13 polymorphisms of unknown significance in TK and 10 in pol. No known resistance-related mutations were observed in HSV-2. These findings contribute to our understanding of the genetic variants associated with antiviral resistance in HSV-1 and HSV-2 in Korea, with frequencies of known antiviral resistance-related mutations of 2.5% and 0% in HSV-1 and HSV-2, respectively.