Background: The Act on Decisions on Life-Sustaining Treatment (LST) has been implemented in Korea since 2018, yet data on its application in neurocritical care units remain scarce. This study aimed to evaluate the clinical characteristics and outcomes of LST withdrawal or withholding in the neurocritical care unit. Methods: This study was a retrospective analysis conducted at a tertiary university hospital in Busan, South Korea. Among patients admitted to the neurocritical care unit between February 2018 and August 2023, those with documented decisions for LST withdrawal or withholding were enrolled. Demographic and clinical characteristics, underlying and combined conditions, reasons for LST decisions, measures taken, and time from LST withdrawal to death were extracted from medical records. Results: A total of 69 patients were included, with a median age of 67 years, and 38 (55%) were male. Cerebrovascular disease (62%) and traumatic brain injury (22%) were the most common underlying diagnoses. The primary reason for LST decisions was irreversible neurological damage (71%), followed by systemic complications (19%). Mechanical ventilation cessation (91%) and extubation (86%) were most frequently used measures for LST withdrawal. The median time from LST withdrawal to death was 22 minutes. Conclusions Our study demonstrates that LST decisions in the neurocritical care unit predominantly occur among patients with cerebrovascular disease or traumatic brain injury, mostly triggered by neurological deterioration. Most patients died shortly after withdrawal. These findings provide important insight into current LST withdrawal practices in neurocritical care and may assist clinical and ethical decision making in similar settings.

Acute lymphoblastic leukemia (ALL) primarily affects the bone marrow and peripheral blood. Extramedullary manifestations, especially in the sinonasal cavity, are rare and difficult to diagnose. We report a case of B-cell ALL in a 4-year-old girl who initially presented with a sinonasal mass mimicking a primary malignant neoplasm. The patient developed right eye protrusion upon nasal blowing over a period of 2 weeks. Imaging studies revealed an aggressive-appearing mass in the right maxillary sinus with extensive local invasion. The radiologic differential diagnosis included rhabdomyosarcoma, lymphoma, and other pediatric sinonasal malignancies. Histopathologic examination of the biopsy specimen and subsequent bone marrow evaluation established the diagnosis of B-cell ALL with BCR/ABL1 fusion. This case highlights the importance of including ALL in the differential diagnosis of sinonasal masses in pediatric patients, particularly when imaging features suggest an aggressive malignancy accompanied by hematologic abnormalities. A comprehensive evaluation, including imaging studies, routine laboratory tests, tissue biopsy, and bone marrow examination, is crucial for establishing an accurate diagnosis and initiating appropriate treatment.

Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.

Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.

Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.

Purpose: The female sex is reported to have a higher risk of adverse events (AEs) from cytotoxic chemotherapy. Few studies examined the sex differences in AEs and their impact on the use of medical services during adjuvant chemotherapy. This sub-study aimed to compare the incidence of any grade and grade ≥ 3 AEs, healthcare utilization, chemotherapy completion rate, and dose intensity according to sex. Materials and Methods: This is a sub-study of a multicenter cohort conducted in Korea that evaluated the impact of healthcare reimbursement on AE evaluation in patients who received adjuvant chemotherapy between September 2013 and December 2016 at four hospitals in Korea. Results: A total of 1,170 patients with colorectal, gastric, or non–small cell lung cancer were included in the study. Female patients were younger, had fewer comorbidities, and experienced less postoperative weight loss of > 10%. Females had significantly higher rates of any grade AEs including nausea, abdominal pain, stomatitis, vomiting, and neutropenia, and experienced more grade ≥ 3 neutropenia, nausea, and vomiting. The dose intensity of chemotherapy was significantly lower in females, and they also experienced more frequent dose reduction after the first cycle. Moreover, female patients receiving platinum-containing regimens had significantly higher rates of unscheduled outpatient visits. Conclusion Our study found that females experienced a higher incidence of multiple any-grade AEs and severe neutropenia, nausea, and vomiting, across various cancer types, leading to more frequent dose reductions. Physicians should be aware of sex differences in AEs for chemotherapy decisions.

Background: s/Aims: Accurate diagnosis of significant liver fibrosis in patients with chronic hepatitis B (CHB) is crucial when determining whether to initiate antiviral treatment (AVT). We conduct a meta-analysis to assess the diagnostic performance of vibration-controlled transient elastography (VCTE) for significant liver fibrosis in AVT-naïve CHB patients with serum alanine transaminase (ALT) levels within 5-fold the upper limit of normal (ULN). Methods: The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched to identify studies that compared the performance of VCTE and liver biopsy (reference standard) when diagnosing significant liver fibrosis (≥F2) in AVT-naïve CHB patients with ALT within 5-fold the ULN. A hierarchical summary receiver operating characteristic curve (HSROC) and bivariate model were performed to evaluate the diagnostic performance of VCTE in the meta-analysis. Results: Eight studies (2,003 patients) were included. The summary sensitivity and specificity for diagnosis of significant liver fibrosis were 0.78 (95% confidence interval [CI], 0.66–0.86) and 0.72 (95% CI, 0.60–0.82), respectively. The HSROC for the diagnosis of significant liver fibrosis was 0.81 (95% CI, 0.72–0.86). The optimal cutoff value of VCTE for diagnosis of significant liver fibrosis was 7.7 kPa with a sensitivity of 0.64 (95% CI, 0.50–0.76) and specificity of 0.83 (95% CI, 0.72–0.90). Conclusions Our study demonstrated that VCTE has an acceptable diagnostic performance for significant liver fibrosis in AVT-naïve CHB patients with ALT within 5-fold the ULN.

Purpose: We used arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging to evaluate cerebral perfusion abnormalities in patients with seizures within 24 hours of symptom onset. Materials and Methods: A retrospective search of our institutional database identified 27 patients who had undergone ASL perfusion studies for seizures or seizure-like symptoms.The inclusion criteria were as follows: 1) history of seizure, 2) MR examination performed within 24 hour of seizure onset, and 3) localized perfusion abnormality on ASL. We evaluated the presence, location, and extent of perfusion abnormalities on ASL and signal abnormalities on fluid-attenuated inversion recovery (FLAIR), diffusion-weighted image (DWI), and susceptibility-weighted image (SWI), respectively. All pathological MR findings, accompanying focal neurological symptoms, and electroencephalogram (EEG) findings were compared. Results: The mean time from symptom onset to MR examination was 5 h 54 min. All patients (n = 27) showed localized increased perfusion on ASL perfusion imaging. On FLAIR imaging, 20 patients (74.1%) showed hyperintensity in the area of perfusion abnormality.In 19 patients (70.4%), DWI showed hyperintensity of the lesion with decreased apparent diffusion coefficient value (ADC). Seven patients (25.9%) showed a focal parenchymal area of pseudo-narrowed cortical veins on SWI, associated with focal hyperperfusion. In 20 patients (74.1%), the extent of perfusion abnormalities on ASL was greater than that of signal abnormalities on FLAIR or DWI. In 14/16 patients (87.5%) with abnormal EEG findings, the area with EEG findings and the location of the hyperperfusion abnormality on ASL corresponded. Conclusion In patients with seizures within 24 hours of symptom onset, ASL perfusion imaging revealed localized hyperperfusion, which was more frequent than signal intensity abnormalities on FLAIR or DWI. The locations of hyperperfusion areas correlated with EEG abnormalities. Thus, the ASL sequence may be a useful clinical assessment protocol for evaluating patients with seizures.

This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively.Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques.There has been a decrease in intravenous thrombolysis rates, from 12% in 2017–2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for noncardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.