A 71-year-old female patient developed cellulitis-like lesions at the burns from moxibustion of the right calf. The lesion was unilateral, a single confluent lesion with swelling and tenderness. Oral antibiotic treatment was performed with a poor clinical response. The patient was hospitalized and received intravenous broad-spectrum antibiotics, but the lesion progressed without improvement. Considering the possibility of erythema nodosum, the prescription was changed to methylprednisolone, and the redness, warmth and swelling improved the day after. A skin biopsy revealed features suggestive of panniculitis

A 71-year-old female patient developed cellulitis-like lesions at the burns from moxibustion of the right calf. The lesion was unilateral, a single confluent lesion with swelling and tenderness. Oral antibiotic treatment was performed with a poor clinical response. The patient was hospitalized and received intravenous broad-spectrum antibiotics, but the lesion progressed without improvement. Considering the possibility of erythema nodosum, the prescription was changed to methylprednisolone, and the redness, warmth and swelling improved the day after. A skin biopsy revealed features suggestive of panniculitis

A 71-year-old female patient developed cellulitis-like lesions at the burns from moxibustion of the right calf. The lesion was unilateral, a single confluent lesion with swelling and tenderness. Oral antibiotic treatment was performed with a poor clinical response. The patient was hospitalized and received intravenous broad-spectrum antibiotics, but the lesion progressed without improvement. Considering the possibility of erythema nodosum, the prescription was changed to methylprednisolone, and the redness, warmth and swelling improved the day after. A skin biopsy revealed features suggestive of panniculitis

A 71-year-old female patient developed cellulitis-like lesions at the burns from moxibustion of the right calf. The lesion was unilateral, a single confluent lesion with swelling and tenderness. Oral antibiotic treatment was performed with a poor clinical response. The patient was hospitalized and received intravenous broad-spectrum antibiotics, but the lesion progressed without improvement. Considering the possibility of erythema nodosum, the prescription was changed to methylprednisolone, and the redness, warmth and swelling improved the day after. A skin biopsy revealed features suggestive of panniculitis

Background: and Purpose Accurate classification of ischemic stroke subtype is important for effective secondary prevention of stroke. We used diffusion-weighted image (DWI) and atrial fibrillation (AF) data to train a deep learning algorithm to classify stroke subtype. Methods: Model development was done in 2,988 patients with ischemic stroke from three centers by using U-net for infarct segmentation and EfficientNetV2 for subtype classification. Experienced neurologists (n=5) determined subtypes for external test datasets, while establishing a consensus for clinical trial datasets. Automatically segmented infarcts were fed into the model (DWI-only algorithm). Subsequently, another model was trained, with AF included as a categorical variable (DWI+AF algorithm). These models were tested: (1) internally against the opinion of the labeling experts, (2) against fresh external DWI data, and (3) against clinical trial dataset. Results: In the training-and-validation datasets, the mean (±standard deviation) age was 68.0±12.5 (61.1% male). In internal testing, compared with the experts, the DWI-only and the DWI+AF algorithms respectively achieved moderate (65.3%) and near-strong (79.1%) agreement. In external testing, both algorithms again showed good agreements (59.3%–60.7% and 73.7%–74.0%, respectively). In the clinical trial dataset, compared with the expert consensus, percentage agreements and Cohen’s kappa were respectively 58.1% and 0.34 for the DWI-only vs. 72.9% and 0.57 for the DWI+AF algorithms. The corresponding values between experts were comparable (76.0% and 0.61) to the DWI+AF algorithm. Conclusion Our model trained on a large dataset of DWI (both with or without AF information) was able to classify ischemic stroke subtypes comparable to a consensus of stroke experts.

Background: and Purpose The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol (HAS-BLED) scores have been validated in estimating the risks of ischemic stroke and major bleeding, respectively, in patients with atrial fibrillation (AF). This study investigated stroke-specific predictors of major bleeding in patients with stroke and AF who were taking oral anticoagulants (OACs). Methods: Subjects were selected from patients enrolled in the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) nationwide multicenter registry between 2013 and 2015. Patients were excluded if they were not taking OACs, had no brain imaging data, or had intracranial bleeding directly related to the index stroke. Major bleeding was defined according to International Society of Thrombosis and Haemostasis criteria. Cox regression analyses were performed to assess the associations between clinical variables and major bleeding and Kaplan-Meier estimates were performed to analyze event-free survival. Results: Of a total of 3,213 patients, 1,414 subjects (mean age of 72.6 years, 52.5% males) were enrolled in this study. Major bleeding was reported in 34 patients during the median follow-up period of 1.73 years. Multivariable analysis demonstrated that initial National Institutes of Health Stroke Scale scores (hazard ratio [HR] 1.07, p=0.006), hypertension (HR 3.18, p=0.030), persistent AF type (HR 2.51, p=0.016), and initial hemoglobin level (HR 0.74, p=0.001) were independently associated with major bleeding risk. Except for hypertension, these associations remained significant after adjusting for the HAS-BLED score. Intracranial atherosclerosis presented a trend of association without statistical significance (HR 2.21, p=0.050). Conclusions This study found that major bleeding risk was independently associated with stroke-specific factors in anticoagulated patients with stroke and AF. This has the clinical implication that baseline characteristics of patients with stroke and AF should be considered in secondary prevention, which would bring the net clinical benefit of balancing recurrent stroke prevention with minimal bleeding complications.

Background: and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke. Methods: This randomized, open-label, controlled trial assigned patients with recent ischemic stroke <90 days to rosuvastatin/ezetimibe 10/10 mg once daily (ROS10/EZT10) or to rosuvastatin 20 mg once daily (ROS20). The primary endpoint was LDL-C reduction ≥50% from baseline at 90 days. Key secondary endpoints were LDL-C <70 mg/dL and multiple lipid goal achievement, and composite of major vascular events. Results: Of 584 randomized, 530 were included in the modified intention-to-treat analysis. The baseline LDL-C level was 130.2±34.7 mg/dL in the ROS10/EZT10 group and 131.0±33.9 mg/dL in the ROS20 group. The primary endpoint was achieved in 198 patients (72.5%) in the ROS10/EZT10 group and 148 (57.6%) in the ROS20 group (odds ratio [95% confidence interval], 1.944 [1.352–2.795]; P= 0.0003). LDL-C level <70 mg/dL was achieved in 80.2% and 65.4% in the ROS10/EZT10 and ROS20 groups (P=0.0001). Multiple lipid goal achievement rate was 71.1% and 53.7% in the ROS10/EZT10 and ROS20 groups (P<0.0001). Major vascular events occurred in 1 patient in the ROS10/EZT10 group and 9 in the ROS20 group (P=0.0091). The adverse event rates did not differ between the two groups. Conclusion Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke. With the combination therapy, more than 70% of patients achieved LDL-C reduction ≥50% and 80% had an LDL-C <70 mg/dL at 90 days.

As chemicals become common in everyday life, serious burns are increasing due to chemicals. Chemical burns are characterized by continuous tissue destruction until the harmful substances are neutralized. The longer the skin is in contact with the chemical, the deeper the burn can be. In cases of chemical burns caused by glacial acetic acid, the burns were caused by a mixture of a small amount of glacial acetic acid and a large amount of flour. Despite the prolonged contact with the dough, tissue damage was managed through debridement and split thickness skin graft, leading to relatively good results.

Necrotizing fasciitis is a deep soft tissue infection that includes the muscle fascia and subcutaneous fat. It is rare, but it causes necrosis of the muscle, fascia, and subcutaneous tissues. It advances quickly and becomes a life-threatening bacterial infection with high morbidity and mortality. Alcoholics with diabetes are especially vulnerable to necrotizing fasciitis and at high risk of progression to severe sepsis and septic shock. In that sense, early diagnosis and prompt treatment are important in the management of necrotizing fasciitis, especially in diabetic alcoholics. We recently treated necrotizing fasciitis on the left lower leg of a 55-year-old diabetic alcoholic who had not controlled blood sugar for 4 years. In our case, a minor burn wound on the left lower leg caused by the hot ramen soup progressed to necrotizing fasciitis within ten days. The patient who was diagnosed with necrotizing fasciitis of the left lower leg was successfully managed with prompt diagnosis, serial debridement, and a split-thickness skin graft while controlling blood sugar levels.