Background: and Purpose The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0–5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. Results: In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03–1.71) and stroke (aHR=1.32, 95% CI=1.00–1.75). Conclusions The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.

Background: Pemphigus is an autoimmune blistering disease characterized by the production of autoantibodies against desmosomal proteins. Owing to its high mortality rate, prompt and accurate diagnosis of pemphigus is crucial. Objective: To determine the positivity rates of immunoblotting in patients diagnosed with pemphigus using clinical, histopathological, direct immunofluorescence (DIF), and enzyme-linked immunosorbent assay (ELISA). Methods: We retrospectively evaluated 84 patients diagnosed with pemphigus between 2001 and 2021 at the Chonnam National University Hospital in Gwangju, Korea. Results: Among the 55 patients with pemphigus vulgaris included in the immunoblotting study, 46 (83.6%) exhibited positive findings for the 130 kDa band. Of the 29 patients with pemphigus foliaceus, 17 (58.6%) showed positive findings for the 160 kDa band. In cases where autoantibodies were difficult to detect with negative DIF and ELISA results, immunoblotting aided in the diagnosis of 18.2% of pemphigus vulgaris cases and 6.9% of pemphigus foliaceus cases. Conclusion Immunoblotting can serve as an alternative diagnostic method for patients with mild-to-moderate disease or those who have undergone treatment, especially when DIF or ELISA tests yield negative or atypical results.

Background: Primary cicatricial alopecia (PCA) is a rare disease that causes irreversible destruction of hair follicles and affects the quality of life (QOL). Objective: We aimed to investigate the disease awareness, medical use behavior, QOL, and real-world diagnosis and treatment status of patients with PCA. Methods: A self-administered questionnaire was administered to patients with PCA and their dermatologists. Patients aged between 19 and 75 years who visited one of 27 dermatology departments between September 2021 and September 2022 were included. Results: In total, 274 patients were included. The male-to-female ratio was 1:1.47, with a mean age of 45.7 years. Patients with neutrophilic and mixed PCA were predominantly male and younger than those with lymphocytic PCA. Among patients with lymphocytic PCA, lichen planopilaris was the most common type, and among those with neutrophilic PCA, folliculitis decalvans was the most common type. Among the total patients, 28.8% were previously diagnosed with PCA, 47.0% were diagnosed with PCA at least 6 months after their first hospital visit, 20.0% received early treatment within 3 months of disease onset, and 54.4% received steady treatment. More than half of the patients had a moderate to severe impairment in QOL. Topical/intralesional steroid injections were the most common treatment. Systemic immunosuppressants were frequently prescribed to patients with lymphocytic PCA, and antibiotics were mostly prescribed to patients with neutrophilic PCA. Conclusion This study provides information on the disease awareness, medical use behavior, QOL, diagnosis, and treatment status of Korean patients with PCA. This can help dermatologists educate patients with PCA to understand the necessity for early diagnosis and steady treatment.

Background: Trachyonychia is a type of nail dystrophy. Various associated diseases have been linked to it. However, no research has investigated whether clinical features differ depending on the presence of these associated diseases. Objective: This study aimed to describe the epidemiology and clinical features of trachyonychia in South Korea. We also analyzed whether clinical features differed based on the presence of associated diseases. Methods: We retrospectively reviewed medical records and clinical photographs of patients who visited our medical center with trachyonychia as their primary complaint between March 2003 and March 2021. Severity was evaluated using the Physical Global Assessment scale with 5 grades based on the affected area and degree of nail roughness. Results: This study included 100 cases of idiopathic trachyonychia and 24 cases of non-idiopathic trachyonychia.There were no significant differences in age, sex, subtype, severity, symptoms, or the number of affected nails between the two groups. However, patients with non-idiopathic trachyonychia had a significantly longer treatment duration and showed fewer complete responses to treatment. Conclusion While this study showed no significant difference in initial presentation between idiopathic and non-idiopathic trachyonychia, it could not definitively determine treatment response due to uncontrolled treatment modalities in both groups. Therefore, further clinical studies with controlled treatment protocols are warranted.

Background/Aims: With the global increase in patients with solid malignancies, it is helpful to understand the outcomes of intensive care unit (ICU) admission for these patients. This study evaluated the risk factors for ICU mortality and the shortand long-term outcomes in patients with solid malignancies who had unplanned ICU admission. Methods: This retrospective cohort study included patients with solid malignancies treated at the medical ICU of a single tertiary center in South Korea between 2016 and 2022. Results: Among the 955 patients, the ICU mortality rate was 23.5%. Lung cancer was the most common cancer type (34.2%) and was significantly associated with increased ICU mortality (odd ratio [OR] 1.58, p = 0.030). Higher Sequential Organ Failure Assessment scores at ICU admission (OR 1.11, p < 0.001), the need for mechanical ventilation (OR 6.74, p < 0.001), or renal replacement therapy during the ICU stay (OR 2.49, p < 0.001) were significantly associated with higher ICU mortality. The 1-year survival rate after ICU admission was 29.3%, with a median survival of 37 days for patients requiring mechanical deviaventilation, and 23 days for patients requiring renal replacement therapy. Conclusions This study showed that critically ill patients with solid malignancies had poor 1-year survival despite relatively low ICU mortality. These findings highlight the need for careful consideration of ICU admission in patients with solid malignancy, and decision-making should be based on an understanding of the expected short- and long-term prognosis of ICU admission after an informed discussion among patients, families, and physicians.

Background: The incidence of skin cancers has been continuously increasing in Korea. Therefore, it is important to perform repetitive statistical research investigating the distribution and incidence of skin cancers in the same region. Objective: We aimed to analyze the recent trends and changes in the incidence and clinical patterns of skin cancers observed in Gwangju and Chonnam provinces. Methods: We reviewed clinical data and histopathology reports from 3,615 cases of skin cancers out of a total of 102,953 new outpatients during a 10-year period between January 2007 and December 2016. The incidence of tumor and its changes, age, sex, and anatomical site distribution were investigated. We also compared these results with those of our previous skin cancer analysis performed with data obtained over 40 years from the same region. Results: The incidence of skin cancers was 3.51% and steadily increased with time from 2.76% to 4.29%. Basal cell carcinoma (41.08%) was the most common, followed by squamous cell carcinoma (30.95%), malignant melanoma (10.26%), and sarcoma (6.51%). Conclusion The incidence and the average age of skin cancer patients continuously increased compared to that in previous studies. Particularly, squamous cell carcinoma markedly increased and it is thought to be due to the increase in the number of the elderly population and the diagnosis of premalignant lesions.

Background: Diagnosis of atopic dermatitis (AD) in adults is problematic due to its heterogeneous pathogenesis and diverse clinical symptoms. Although various diagnostic tools for AD have been proposed, most focused on pediatric AD. Objective: This study aimed to determine whether the Reliable Estimation of Atopic Dermatitis in Childhood (REACH), a previously reported questionnaire-based diagnostic tool for pediatric AD, may be applicable to adult patients with AD, and to propose a new diagnostic tool for adult AD based on the REACH methodology. Methods: We administered the REACH questionnaire to adult patients with clinically confirmed AD and a control group consisting of patients with other systemic skin diseases that required clinical differentiation from AD. Based on the results of the REACH survey, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of the REACH criteria as compared with clinically confirmed AD were analyzed. Results: A total of 141 adult patients participated in the survey: 91 patients with AD and 50 controls. The sensitivity, specificity, PPV, and NPV of REACH were 92.3%, 46.0%, 78.5%, and 79.4%, respectively. Also, unlike children, adult patients with AD showed a high rate of localized eczema. Conclusion The accuracy statistics of the REACH methodology for diagnosing adult AD showed significant agreement with clinical diagnosis. We propose the more inclusive Reliable Estimation of Atopic Dermatitis (READ) as a diagnostic tool for detecting AD in both children and adults. Adult AD can present with atypical clinical features, and READ has the potential to assist in diagnosis.

Background: There is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric antipseudomonal combination therapy with fluoroquinolones decreases mortality in patients with HAP. Methods: This multicenter, retrospective cohort study included adult patients admitted to 16 tertiary and general hospitals in Korea between January 1 and December 31, 2019.Patients with risk factors for combination therapy were divided into anti-pseudomonal non-carbapenem β-lactam monotherapy and fluoroquinolone combination therapy groups.Primary outcome was 30-day mortality. Propensity score matching (PSM) was used to reduce selection bias. Results: In total, 631 patients with HAP were enrolled. Monotherapy was prescribed in 54.7% (n = 345) of the patients, and combination therapy was prescribed in 45.3% (n = 286).There was no significant difference in 30-day mortality between the two groups (16.8% vs.18.2%, P = 0.729) or even after the PSM (17.5% vs. 18.2%, P = 0.913). After the PSM, adjusted hazard ratio for 30-day mortality from the combination therapy was 1.646 (95% confidence interval, 0.782–3.461; P = 0.189) in the Cox proportional hazards model. Moreover, there was no significant difference in the appropriateness of initial empiric antibiotics between the two groups (55.0% vs. 56.8%, P = 0.898). The proportion of multidrug-resistant (MDR) pathogens was high in both groups. Conclusion Empiric anti-pseudomonal fluoroquinolone combination therapy showed no survival benefit compared to β-lactam monotherapy in patients with HAP. Caution is needed regarding the routine combination of fluoroquinolones in the empiric treatment of HAP patients with a high risk of MDR.