Due to the introduction of Smart Advanced Life Support in 2015, paramedics can provide Advanced Cardiovascular Life Support to patients with out-of-hospital cardiac arrest. Although studies have been conducted to confirm the effectiveness of Smart Advanced Life Support for patients with out-of-hospital cardiac arrest, there is a lack of exploration of the experiences that paramedics face in the field in a changed environment. In this paper, I report two cases experienced by paramedics when using Smart Advanced Life Support, including communication with uncooperative caregivers and the burden felt by paramedics. In addition, to promote Smart Advanced Life Support, I propose enhancing paramedic training, establishing communication guidelines with caregivers, expanding the promotion of Smart Advanced Life Support, and providing customized education for the elderly.

난치성 담관결석은 내시경 유두 괄약근 절개술 후 EPLBD, 기계적 쇄석술, 경구담관경 유도하 담관 내 전기수압쇄석술 혹은 레이저 쇄석술, 일시적 플라스틱 담관 스텐트 삽입, 경피경간담관경유도하 쇄석술, 체외충격파쇄석술 등 다양한 시술을 통해 해결될 수 있다. 본고에서는 가용 가능한 다양한 방법을 사용하여 난치성 총담관결석을 제거한 증례를 소개하고 각각의 과정에서의 시술의 어려움을 극복하는 대응방법을 논의하고자 하였다.

Background: Disuse Syndrome is defined as a significantly reduced functional state due to acute disease or surgery. Despite the many advantages to robot rehabilitation, there have been no reported cases of robot rehabilitation being applied to patients with disuse syndrome. Objectives: To investigated report cases of robot rehabilitation in patients diagnosed with disuse syndrome after severe COVID-19 infection. Design: Case report. Methods: The subject of this study was an 81-year-old male who was 161 cm tall and weighed 55.3 kg. At the time of admission to the hospital, the patient had a manual muscle testing (MMT) score of 36 points and a modified barthel index (MBI) score of 7 points. Additionally, the patient had a fall risk assessment score of 10 and a visual analogue scale of 6 for lower back pain. The patient's MMT, trunk impairment scale (TIS), and MBI were followed up. The patient received acute rehabilitation treatment for 4 weeks, followed by additional robotic rehabilitation. For 4 weeks, a standing tilt robot and a wearable robot were applied for 2 weeks each. Results: After 4 weeks of intervention, MMT, TIS, and MBI were improved in the patients. MMT improved from 36 points to 41 points. TIS improved from 0 to 13 points. MBI improved from 7 points to 29 points. Conclusion: There is a need to pay more attention to the rehabilitation of patients with disuse syndrome in recovery rehabilitation hospitals. It is speculated that robot-assisted rehabilitation can be applied to patients with disuse syndrome.

This case report describes the pathological features of pulmonary alveolar proteinosis(PAP) in mouse. Grossly, multiple irregular yellow-grey patches were observed on the lung surface of a C57BL/6 mouse. Histopathologically, the alveolar walls were thickened by type II cell hyperplasia and cellular infiltrates, and the bronchioles and alveolar lumens were filled with amorphous eosinophilic lipoproteinaceous material. This material was positive for Periodic acid-Schiff stain. Gomori methenamine silver staining was negative. Immunohistochemical staining showed that cells in the alveolar wall and lumen were positive for surfactant protein B, chitinase-like protein-3, and CD68. As a result, PAP was diagnosed. This is a rare case of spontaneous PAP in mice, and we report the histopathological characteristics along with the literature.

Because multiple ovulation embryo transfer (MOET) in cattle includes several benefits such as wide spreading of genetically superior offspring for long distance, this biotechnological method has been widely applied to Hanwoo. When the recipients are not stayed close after embryo recovery from donor, the embryos are moved to other farms via several vehicles (car, train, and airplane). However, air travel induces lesser oxygen level, increased vibration, lower air pressure, higher noise, and increased exposure of cosmic radiation to living things than ground level. It was still unknown that fresh embryos obtained from multiple ovulation of Hanwoo could maintain their fertility after being transported via air plane, the present case report introduced a clinical case of MOET in Hanwoo after shipping fresh embryos via air transportation. The donor was multi-ovulated via follicle-stimulating hormone series of injection, which was followed by a gonadotrophin-releasing hormone injection and artificial insemination twice. The embryos were recovered by the uterine flushing, packed in ministraws, transported to recipients for 6 h including 1 h air flight, and then transferred to the synchronized recipients. During pregnancy diagnosis of early gestation period, 5 of 7 recipients (71.4%) presented no heat signs and showed fetal sacs with fluid under transrectal ultrasonography. After normal gestation period, all recipients naturally delivered healthy calves (male n = 2 and female n = 3) without abortion, stillbirth, and premature birth. The present case report indicated that transportation of fresh embryos for MOET via domestic flight in Korea did not affect to their fertility.

This study examined the Democratic People’s Republic of Korea (DPRK)’s illegal trade in UNsanctioned items as revealed in the UN panel of experts report in order to estimate the types of illegal trade in nuclear items, one of the UN-sanctioned prohibited items, and to find efficient ways to block it. Also, The research revealed that DPRK secretly imports UN-sanctioned prohibited items without going through customs through maritime transshipment, conceals or disguises them through identity laundering by falsifying documents at customs clearance, and makes various attempts to escape the international community’s surveillance, such as using a combination of methods such as Re-Flagged and Double-Flagged for identity laundering, and concealing them without operating the Automatic Identification System (AIS) at sea. The DPRK’s Illicit trade cases have been divided into two types of transactions: those that violate customs clearance procedures by providing false information to customs through disguise or concealment, and those that do not go through normal customs procedures, such as smuggling. To block customs violations, technical measures such as increasing the number of inspections of container ships or improving the accuracy of inspections are required, while to block smuggling, since it does not go through physical inspections, there are ways to monitor it through satellite images or strengthen border enforcement such as airport bays and land routes. As a result, DPRK’s nuclear items are designated as sanctioned items under UN resolutions, and it is assumed that DPRK and its networks will attempt to trade illegally through a combination of customs clearance violations and non-customs clearance violations, depending on the circumstances. Furthermore, since DPRK is subject to extensive sanctions from the international community, including the UN, in connection with its nuclear weapons program, illegal trade continues, and efforts should be made to block illegal trade through physical inspection at customs clearance.

Lactococcus garvieae is a Gram-positive cocci that has been known to be a fish pathogen, and considered as a low virulence organism rarely associated with human infection. We report a case of acute cholangitis with common bile duct (CBD) stone and bacteremia by L. garvieae bacteremia in a 70-year-old male. The patient presented with epigastric pain and was diagnosed with two CBD stones. Blood culture obtained prior to empiric antimicrobial therapy with ceftizoxime sodium showed growth with Escherichia coli and L. garvieae. The bacteria were confirmed by matrix-assisted desorption/ionization time-of-flight mass spectrometry. Initial attempt at endoscopic biliary drainage failed, and the patient underwent percutaneous transhepatic biliary drainage and subsequent stone removal. He occasionally ingested raw fish and had a history of gastric ulcer with acid suppression therapy, which could be possible risk factors for L. garvieae infection. This is the first case of L. garvieae bacteremia in acute cholangitis.

Gallbladder cancer is the most common cause of hilar biliary obstruction; however, it rarely causes combined biliary, duodenal, and colon triple obstruction. In this case, the quality of life for a patient with recurrent gallbladder cancer with combined duodenal, colonic, and biliary obstruction was improved by endoscopic and endosonographic palliation, despite its technical difficulty and complexity. Seven metal stents were implanted one by one using only endoscopic methods. Successful stent-in-stent placement and endoscopic ultrasound-guided stenting after failed ERCP improved the patient’s quality of life to the extent that there was no need for any external drainage.

본 연구는 제주특별자치도에 유입된 Myocastor coypus Molina, 1782 (Nutria)의 퇴치를 위해 이루어졌다. 서식확인 및 퇴치는 2013년 9월부터 2013년 11월까지 이루어졌고, 그후 퇴치 성공여부를 확인하기 위해 2022년 6월까지 조사가 이루어졌다. 서식 확인 및 포획은 무인카메라, 청문조사, 문헌조사, 먹이유인을 통한 트랩 포획법을 사용하여 진행하였다. 후속조사는 Nutria의 행동반경을 감안하여 조사범위를 비교적 넓게 설정하여 서식지역(퇴치지역)을 중심으로 4.0㎢ 내 습지 및 하천 조사를 진행하였다. 그 결과 서식 확인지역은 제주특별자치도 제주시 구좌읍 송당리 소재의 송당목장에 서만 발견되었으며, 방목장 내 수로와 연못에서 서식흔적(족적, 배설물, 굴)이 확인되었다. 포획개체는 총 8개체였으며, 암컷 4개체, 수컷 3개체였다. 1개체는 서식확인 시 확인되어 부패 정도가 심해 암·수의 구별이 어려웠다. 후속조사는 설정한 조사범위 내 항시 물이 있는 성읍저수지, 천미천, 몰순이못을 중심으로 서식지와 그 주변을 정밀조사하였으나 서식흔적이 확인되지 않았다. 따라서, 제주도에 서식하는 Nutria는 완전히 퇴치된 것으로 판단된다. 제주특별자치도에서 Nutria의 퇴치가 성공적으로 이루어진 것은 Nutria의 서식 확인 후 빠른 포획을 통해 정착단계 초기에 퇴치가 이루진 것과 제주도 지질 특성상 물이 항시 고여있는 습지가 드물어 확장의 시기가 늦어진 것이 시너지 효과를 일으켜 성공적인 퇴치가 이루어진 것으로 판단된다. 이 결과들은 외래종의 유입에 대한 대처는 그 종의 생태특성을 신속하게 파악하고, 올바른 대처를 통해 확장단계 이전 정착 초기 단계에서 관리 및 퇴치를 통해 교란이 일어나기 전 또는 교란 초기에 차단하는 것이 매우 효과적인 방법임을 시사한다.

Pseudo-pheochromocytoma is defined as an adrenal tumor that has the typical characteristics of pheochromocytoma likely hypertension but is histopathologically diagnosed to other types of adrenal tumors. 11-year-old, castrated male Maltese presented for a left adrenal mass with hypertension. According to clinical signs and radiological features, a temporary diagnosis was made of pheochromocytoma. The adrenalectomy was performed and the histopathological examination of the resected adrenal gland was diagnosed as cortical adenocarcinoma. This report describes the case of pseudo-pheochromocytoma in a dog and implies the salience that even if pheochromocytoma is diagnosed based on all test results, pseudo-pheochromocytoma should not be excluded.

Chronic fibroinflammatory pancreatitis causes irreparable damage to the pancreatic parenchyma. This frequently results in food restrictions, painkiller addiction, and serious quality of life impairment in children. We observed a 13-year-old girl who had previously been hospitalized multiple times and had undergone acute pancreatitis arrived with excruciating abdominal pain and recurrent hematemesis. A chronic intra-pseudocyst bleed and an ampulla of Vater hemorrhage were discovered during an upper gastrointestinal endoscopy. A 3×2×1 cm pancreatic head pseudocyst was discovered on the magnetic resonance cholangiopancreatography, however the computed tomography scan revealed a pancreatic head pseudocyst, pancreatic duct stones, and substantial peripancreatic inflammation. The multidisciplinary team determined that Frey’s surgery was the most efficient method to minimize her suffering. No complications occurred during the healing phase following surgery, and two years later, neither recurrence bleeding nor abdominal pain appeared. In summary, Frey’s method is a secure and efficient intervention when applied by a multidisciplinary team.

췌석은 만성췌장염에서 흔히 동반되는 소견으로 반복되는 복통과 췌장염의 원인이 될 수 있다. 췌석은 췌관 협착과 자주 동반되고 췌관내 박혀 있는 경우가 많아 바스켓을 이용하여 제거하기 어렵다. 체외충격파쇄석술(ESWL)로 치료하기도 하나 반복 시술이 필요하고 성공률도 높지 않았다. 최근에 개발된 SpyGlass™ DS II (Boston Scientific, Marlborough, MA, USA)는 직경이 3.5 mm로 가늘어 췌관이 확장되어 있을 때 안으로 삽입이 가능하게 되었다. 그리고 직접 췌석을 보면서 전기수압쇄석술(EHL)이나 레이저 유도 쇄석술(laser lithotripsy)를 시행하며 췌석을 제거해 볼 수 있게 되었다. 본고에서는 SpyGlass™ DS II와 EHL을 이용하여 10 mm 이상의 다발성 췌석을 제거하는 방법을 소개하고자 한다.

상피하종양은 위내시경 중 우연히 발견되고 특히 위에서 자주 발견된다. 십이지장에서도 발견될 수 있는데, 특히 유두부 주위에 융기된 병변이 관찰되면 총담관이나 췌장과의 관계를 평가해야 하며 상피하종양뿐만 아니라 암이나 자가면역질환도 감별 진단에 고려하여야 한다. 이 증례의 환자는 내시경 검사 중 우연히 유두부 주위에서 상피하종양으로 의심되는 병변이 발견되어 진료 의뢰되었다. 환자는 무증상이었고, 신체 진찰 및 혈액 검사 소견은 정상이었다. 내시경적 조직 검사 결과에는 특이 소견은 없었으나 영상 검사 등을 종합하였을 때 악성 가능성을 완전히 배제할 수 없었다. 따라서 수술로 팽대부 절제술을 시행하였고, 조직 검사 결과 IgG4 연관 팽대부염으로 진단되었다.

Sarcoma is rare malignant tumors that develop from mesenchymal cells. Metastasis to the oral cavity is a rare occurrence. Undifferentiated Pleomorphic sarcoma(UPS), formerly known as Malignant fibrous histiocytoma(MFH), is rare spindle cell neoplasm that can have poorly prognosis with metastasis and local recurrence. This report describes a case of a 77-year-old man who was diagnosed with Undifferentiated Pleomorphic Sarcoma of the chest wall and underwent adjuvant radiation therapy after surgical resection. Although there was success of wide excision, two years later, he presented with metastasis to the several organs including tongue. We retrospectively analyzed results of Next Generation Sequencing(NGS), and we figured out RB1 gene mutation. Until now targeted therapy of RB1 gene mutation is not established. Surgeon needs to consider metastatic tumors through identifying patients’ chief complaints and past medical & dental history. We need to research through NGS, and take a step closer to find targeted therapy for tumors.

Malignant melanoma is a highly malignant tumor derived from melanocyte. Malignant melanoma of the oral cavity occurs mainly in the palatine mucosa and the maxillary gingiva in men in their 50s. Malignant melanoma can be divided into pigmented and non-pigmented(amelanotic). Among them, non-pigmented malignant melanoma accounts for 2-8% of all malignant melanomas. Pigmented malignant melanoma is detected through changes in pigmentation, whereas non-pigmented malignant melanoma is characterized by no pattern of color change. In this study, at the initial visit, a malignant lesion was suspected and a biopsy was performed. According to the biopsy results, it was diagnosed as polymorphic sarcoma, but the histological examination performed during the operation revealed that it was amelanotic melanoma. As such, the differential diagnosis is important because there is no clinical change in non-pigmented malignant melanoma. Diseases to be differentially diagnosed when non-pigmented malignant melanoma occurs in the oral cavity include squamous cell carcinoma, lymphoma, sarcoma, inflammation, and osteomyelitis. In this study, we report a case that showed the histopathological characteristics of malignant melanoma without superficial pigmentation.

The forty-nine cases of psittacine birds were submitted for disease diagnosis to the Avian Disease Division of the Animal and Plant Quarantine Agency (APQA) of Korea from 2012 to 2021. On the basis of clinical manifestations and the presence of gross lesions, necropsy, bacteriological culture, virus detection and histopathological examination were performed according to an APQA diagnostic protocol. Bacterial diseases like chlamydiosis, colibacilosis, viral disease like proventricular dilatation disease, budgerigar fledgling disease (BFD), psittacine beak and feather disease and fungal infection and parasitic diseases like blackhead disease and coccidiosis were confirmed in forty-nine cases. We present here five cases report diagnosed fungal pneumonia, blackhead disease, BFD-fungal infection, BFD and psittacosis-bacterial enteritis in psittacine. Since the pathogen can be detected even in healthy parrots, histopathological diagnosis is necessary to determine the cause of death, and clinical symptoms and gross lesions must be fully considered. In addition, zoos and aviaries where large quantities of parrots are reared, these diseases can be reduced through sanitary management of the breeding environment.

Plunging ranula is a mucous retention cyst with extension below to the mylohyoid muscle. It can occur by an extravasation of saliva from the salivary gland due to trauma or obstruction of the duct. Fluid from the obstructed gland penetrate through the defect of mylohyoid muscle or through the posterior edge of mylohyoid muscle, and spreading to the cervical area. The “tail sign” has been widely reported as pathognomonic for their diagnosis. It indicates the communication between the collapsed sublingual and submandibular space over the posterior edge of the mylohyoid muscle. In this case, in addition to simple ranula in the right floor of mouth, MRI findings showed homogeneous contrast enhancement in front of the right cervical carotid artery and in the deep part of sternocleidomastoid muscle, but tail sign was not observed. Therefore it was clinically diagnosed as a branchial cleft cyst and was removed through surgical procedure. As a result of the final pathologic biopsy, the lesion, which has been suggested to be simple ranula in the floor of mouth, was diagnosed as reactive pyogenic granuloma, and the cervical lesion was diagnosed as a plunging ranula. This is a case report in which these two lesions are decided to have been separated from one before surgery. This report indicate that plunging ranula can be observed without tail sign and how to make an accurate diagnosis of plunging ranula by reporting misdiagnosis case.

Telangiectatic osteosarcoma(TAEOS) is a rare subtype of osteosarcoma(OS) composed of blood-filled or empty cystic architecture simulating aneurysmal bone cyst. TAEOSs account for 2-12% of all OSs. TAEOSs mostly develop around knee and proximal humerus, but TAEOSs of the jaws are rare. To the best of my knowledge, this is the fourth case of primary TAEOS affecting the jaws. A 36-year-old female who had been previously diagnosed osteosarcoma by biopsy reported with a chief complaint of throbbing and swelling of the right mandible. The patient received neoadjuvant chemotherapy followed by hemi-mandibulectomy. After surgery, patient received adjuvant chemotherapy. The patient is free of disease for 6 months after surgery. TAEOSs are mimicking other benign entities, such as aneurysmal bone cyst and central giant cell granuloma. Thus, careful diagnosis through thorough radiographic and histopathologic evaluation is important to establish a treatment plan, prognosis, prediction and management strategy.

The restraints are used in the intensive care unit as a way to restrict the movement of the whole body or part of the body for the safety of the patient, such as maintaining medical equipment, preventing falls and patient self tube removal through regulating the patient's behavior. However, the physical restraints are used for the physical safety of the patient, but that is cause a variety of physical and psychological complications. Thus, nurses in intensive care units who apply restraint on face an ethical dilemma in the confrontation between the nurse's duty to improve the patient's health and protect the patient's safety and the value of the patient's autonomy and dignity. We have two examples are proposed to identify the ethical dilemma situation faced by nurses, to induce an active attitude towards elimination by establishing exactly restraint - removal criteria. In addition, it is proposed to seek a balance of individual values through active communication between the patient and the medical staff regarding the application of the restraint.

With the enforcement of the “Act on decisions on life-sustaining treatment for patients at the end of life” in February 2018, discussion on advanced care planning (ACP) has increased. However, as decisions on life-sustaining treatments are still made in the intensive care unit, deaths related to the suspension of life-sustaining treatment account for a large proportion of deaths in the intensive care unit. The nurses encounter challenges in supporting the patient's dignified death; they experience an ethical dilemma in the ambiguity due to a lack of guidance on legal responsibilities regarding decisions on life-sustaining treatment. In order for the nurses to perform as a supporter providing care to the patients and as a advocate during the process of decision-making on life-sustaining treatment, there should be a systemic change to ensure the nurses' participation. In addition, an open and continuous discussion should be proposed to cultivate nurses’ ethical sensitivity and moral courage. This paper reports two ethical examples related to the decisions on life-sustaining treatment occurred in intensive care units of a tertiary hospital.