Quadruple amputation, defined as the loss of all four limbs, is an exceptionally rare condition. Conventional gait training is particularly challenging in this population because the absence of upper limbs limits the ability to grasp assistive devices that are essential for maintaining balance and stability during walking. End-effector robot-assisted gait training offers an alternative rehabilitation strategy that enables upright mobility and task-specific gait training for patients who experience substantial difficulty performing conventional gait training. This approach provides safe, repetitive, and hands-free gait training for individuals with quadruple amputation, resulting in measurable improvements in balance, ground reaction force, and functional mobility. We report two cases of successful amputee gait rehabilitation using an end-effector–type gait robot in two females (aged 72 and 51 years) with quadruple amputation.

A 7-year-old, 4.6 kg spayed female Korean short hair cat presented for health screening with occasional vomiting but had no significant medical history or remarkable clinical symptoms. Radiographic examination revealed bifurcation of the proximal part of the right 9th rib, extending into the caudo-ventral direction of the thoracic cavity without abnormalities in the vertebrae or other organs. This report highlights the importance of understanding radiographic findings and discusses the clinical significance of bifid ribs in veterinary medicine, especially during surgical procedures and trauma management. Advanced diagnostic imaging, including computed tomography, could provide potential valuable insights for detecting such rib anomalies and evaluating their significance. It is crucial that these types of rib anomalies are properly diagnosed in practice to ensure effective treatment and management. Further research into the genetic or developmental factors associated with rib anomalies in veterinary patients is recommended.

Background: Intravenous artesunate is the first-line treatment for severe malaria; however, clinical deterioration may occur duringtreatment. This study aimed to identify risk factors associated with clinical deterioration and to construct a risk-scoring system. Methods: We retrospectively reviewed medical records of adult patients who received at least one dose of intravenous artesunate formalaria at the National Medical Center between January 2014 and December 2023. Clinical deterioration was defined as the new on-set of any severe malaria symptom after artesunate administration. Multivariable logistic regression analysis was conducted to identify independent predictors. Results: Among 98 patients included in the final analysis, 29 (29.6%) experienced clinical deterioration.Multivariable analysis revealed that female sex (adjusted odds ratio (aOR) 4.3, 95% confidence interval (CI) 1.0-19.0), age ≥60 years (aOR 3.4, 95% CI 0.8-14.3), presence of jaundice at admission (aOR 4.3, 95% CI 1.1-16.5), and elevated alanine aminotransferase (ALT) level (aOR 2.6, 95% CI 1.0-6.8) were independently associated with increased risk of clinical deterioration. Based on these factors, a risk scoring system (range: 0-5 points) was constructed and showed a stepwise increase in deterioration risk by score. Conclusions Female sex, advanced age, jaundice, and elevated ALT were independent predictors of clinical deterioration in malaria patients treated with artesunate. The proposed risk score may aid in early identification of high-risk patients and guide clinical deci-sion-making.

Purpose: This study analyzed educational needs of home care nurses to improve the quality of home care service and identify priority educational subjects. Methods: This study analyzed the training priorities of 54 home care nurses working at community service centers or public health centers in Seoul, Korea, using the Borich Needs Assessment and the Locus of Focus model. The home care nurses’ tasks were categorized into 21 tasks and 85 task elements. Results: Six priority educational subjects were identified: 1) health assessment and monitoring, 2) nursing records and information management, 3) health education and counseling techniques, 4) home care supplies management, 5) recipient identification and communication skills, and 6) care recipient classification and management. Activities related to one-on-one health management, such as health screening, measurements, and disease management counseling, were found to be high priorities. In contrast, small group program planning and operation were rated as a low priority. Conclusion This study underscores the importance of incorporating identified educational needs into training curricula for home care nurses. Regular assessment and integration of these needs into educational programs are crucial for enhancing nursing competence and service quality.

Brain abscess, a life-threatening infection, can result from hematogenous spread. Although uncommon, Klebsiella pneumoniae can lead to brain abscess and systemic dissemination. In this case report, Klebsiella pneumoniae brain abscess, linked with prostate abscess, in a 57-year-old diabetic male with liver cirrhosis and hepatitis B, resulted in fatal sepsis despite antibiotic therapy. This case underscores Klebsiella's grave risk in immunocompromised patients, highlighting brain abscess and high mortality. Early diagnosis, treatment, and evaluation for multiple organ involvement are crucial.

Purpose: This study analyzed educational needs of home care nurses to improve the quality of home care service and identify priority educational subjects. Methods: This study analyzed the training priorities of 54 home care nurses working at community service centers or public health centers in Seoul, Korea, using the Borich Needs Assessment and the Locus of Focus model. The home care nurses’ tasks were categorized into 21 tasks and 85 task elements. Results: Six priority educational subjects were identified: 1) health assessment and monitoring, 2) nursing records and information management, 3) health education and counseling techniques, 4) home care supplies management, 5) recipient identification and communication skills, and 6) care recipient classification and management. Activities related to one-on-one health management, such as health screening, measurements, and disease management counseling, were found to be high priorities. In contrast, small group program planning and operation were rated as a low priority. Conclusion This study underscores the importance of incorporating identified educational needs into training curricula for home care nurses. Regular assessment and integration of these needs into educational programs are crucial for enhancing nursing competence and service quality.

Diabetes is a growing global health issue, with diet playing a crucial role in prevention and management. Protein, an essential nutrient for growth, repair, and metabolism, can significantly influence diabetes risk and control. High-protein diets, especially those rich in animal proteins, have been linked to increased risk of type 2 diabetes, while plant-based proteins may offer protective benefits. Studies suggest that excessive animal protein intake, particularly from red and processed meats, can increase diabetes risk due to higher saturated fat content. Conversely, plant-based proteins, such as soy, tofu, and nuts, are associated with improved insulin sensitivity and reduced inflammation. Protein supplements—especially whey and soy proteins—are known to help maintain muscle mass and improve metabolic indicators. However, the evidence supporting these benefits remains limited, and excessive protein intake may increase risks of other negative effects, such as impaired kidney function. Therefore, caution is advised when using these supplements. A balanced approach that emphasizes plant-based proteins while moderating animal protein intake is recommended for diabetes prevention and management. Future research should focus on personalized dietary strategies for optimal health outcomes.

Objective: This study aims to investigate the implementation rate and influencing factors of confirmatory tests for women with abnormal cervical cytology results in the Korean nationwide cervical cancer screening program. Methods: The National Health Insurance Service (NHIS) database was utilized to identify all Korean women who have participated in the Korean nationwide cervical cancer screening program from January 2011 and December 2021 using the NHIS database. Multiple logistic regression analysis was performed to estimate the multivariate odds ratio and evaluate the patients’ characteristics. Results: The rate of abnormal Papanicolaou (Pap) smears showed an initial increase from 2011 to 2015 and subsequently reached a plateau after 2016. When examining specific subcategories, cases of atypical squamous cells of undetermined significance (ASC-US) increased from 28,546 cases (1.1%) in 2011 to 62,850 cases (1.7%) in 2021. In contrast, cases of HSIL and SCC declined from 3,535 cases (0.14%) to 2,763 cases (0.07%) and from 383 cases (0.01%) to 179 cases (0.005%), respectively. Furthermore, the implementation rate of confirmatory tests for women with abnormal cytology increased from 8,865 cases (21.0%) in 2011 to 39,045 cases (51.2%) in 2021. Regarding the specific subcategory of ASC-US, the number of confirmatory tests exhibited a substantial increase from 4,101 cases (14.4%) in 2011 to 30,482 cases (48.5%) in 2021. For SCC, there was no significant change, with 216 cases (56.4%) in 2011 and 102 cases (57.0%) in 2021. The implementation rate of confirmatory tests was found to be significantly associated with results of abnormal Pap smear, age, and residence. Notably, economic status did not emerge as a significant factor affecting the likelihood of undergoing confirmatory tests. Conclusions The severity of abnormal Pap smear results is a reliable indicator of the probability of undergoing a confirmatory test. Additional endeavors are required to improve the implementation rate among women who have received abnormal Pap smear results.

Acute basilar artery (BA) occlusion is a key etiology of devastating posterior circulation stroke, unless recanalization is performed early. Recanalization therapy is determined synthetically based on symptom onset time, stroke severity, and brain imaging. Herein, we report the case of a 72-year-old male patient presenting with minor neurological symptoms, but with thrombotic occlusion at the BA tip. Transcranial Doppler (TCD) showed systolic flow reversal along the vertebrobasilar arteries, and the patient benefited from endovascular thrombectomy. This case highlights the critical role of TCD in identifying hemodynamic insufficiency and determining the implementation of endovascular interventions to mitigate stroke progression.