Background: Previous studies that have focused on the challenges faced by female surgeons, such as the gender pay gap, gender biases, lower likelihood of promotion, and gender differences in the perception of discrimination against women, are reviewed. A more comprehensive understanding of explicit and implicit gender discrimination and experiences and perceptions of discrimination is needed. This study aims to determine the current prevalence and degree of gender discrimination in the Korean Surgical Society and to compare the experiences and perceptions of gender discrimination between male and female surgeons. Methods: We analyzed 400 responses from a survey sent to all members of the Korean Surgical Society. This electronic survey included 16 items on experiences of gender discrimination and 17 items on perceptions of gender discrimination. We conducted χ2 tests and binary logistic regression on the data regarding these experiences and perceptions of gender discrimination. Results: Adjusted analyses found that female surgeons were more likely to experience gender discrimination than their male counterparts across all categories of discrimination. Further, adjusted analyses showed that female surgeons were more likely to confirm the presence of gender discrimination than male surgeons. Conclusion Female surgeons were more likely to experience implicit and explicit gender biases and discrimination throughout all stages of their career progression. We also discovered significant gender differences in the perception of gender discrimination, as well as the experience of it. Changing the male-dominated culture and raising awareness of gender biases and discrimination among male surgeons are crucial steps toward addressing gender discrimination in surgery.

BACKGROUND: The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. METHODS: Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. RESULTS: Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. CONCLUSIONS: The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Eyelids ; Humans ; Incidence ; Intention ; Myocutaneous Flap ; Skin ; Surgical Flaps ; Tendons ; Tissue Donors ; Transplants

OBJECTIVE: Mid-sized hospital websites were assessed to examine how their attributes influence outcome indicators as a potential marketing strategy. Specifically, the website attributes considered were accessibility, content sufficiency, and layout design, while outcome indicators were evaluated, based on satisfaction with the website, intention to revisit the website, and intention to recommend the hospital. METHODS: Five representative websites were selected according to their ranks derived from major ranking sites. The diversity of the websites were emphasized. Then, a questionnaire survey was conducted on 74 respondents. Collected data was analyzed, using frequency, correlation, and repeated measures analysis of variance. RESULTS: All three attributes were related to satisfaction with the website; in addition, both content sufficiency and layout design were significantly related to the intention to revisit. As for the intention to recommend the hospital, only the content sufficiency was significant. In particular, the sufficiencies on 'disease or symptoms' and 'question and answer' were important to all three outcome indicators. CONCLUSION: The websites serve as a marketing tool in managing mid-sized hospitals. Well-designed websites containing sufficient contents facilitate visitor's satisfaction and intention to revisit the website, as well as furthering their intention to recommend the hospital.
Surveys and Questionnaires ; Hospital Administration ; Intention ; Internet ; Marketing ; Personal Satisfaction

No abstract available.
Nitrous Oxide* ; Subacute Combined Degeneration*

PURPOSE: We aimed to determine the demographic and epidemiologic variables that are associated with no treatment in lung cancer patients. MATERIALS AND METHODS: Patient data were collected from the Korean National Health Insurance Database. The lung cancer group included patients with an initial diagnosis of lung cancer between January 2009 and December 2014. Treated cases were defined as those that underwent surgery, radiation, or chemotherapy until death, after the diagnosis of lung cancer. Risk of no treatment was calculated by multiple logistic regression analysis. RESULTS: Among the 2,148 new cases of lung cancer from 2009 to 2104, 612 (28.4%) were not treated. Risk of no treatment was higher in the following patients: patients in their 60s (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.75 to 1.84), 70s (OR, 3.64; 95% CI, 2.41 to 5.50), and >80 years old (OR, 16.55; 95% CI, 10.53 to 25.03) than those in their 50s; patients with previous myocardial infarction (OR, 2.07; 95% CI, 1.01 to 4.25) or chronic kidney disease (OR, 2.88; 95% CI, 1.57 to 5.30); and patients diagnosed at a non-referral hospital (OR, 1.40; 95% CI, 1.01 to 1.92) or primary care provider (OR, 1.81; 95% CI, 1.43 to 2.29) compared with referral hospital. Low-income patients receiving Medicaid were 1.75 times (95% CI, 1.14 to 2.68) more likely to forgo treatment than high-income patients (upper 20%). Risk was not associated with sex or the year in which the lung cancer was diagnosed. CONCLUSION: Age predominantly determines whether patients with lung cancer undergo anti-cancer treatment.
Diagnosis ; Drug Therapy ; Humans ; Logistic Models ; Lung Neoplasms ; Lung ; Medicaid ; Myocardial Infarction ; National Health Programs ; Primary Health Care ; Referral and Consultation ; Renal Insufficiency, Chronic

Background/Aims: The treatment of epidermal growth factor receptor (EGFR)-mutated lung cancer cases has shown remarkable development in the past two decades. However, there have been limited studies comparing the prognostic effects of EGFR-tyrosine kinase inhibitor (TKI) and other treatment modalities. Therefore, we compared the survival outcomes of patients treated with EGFR-TKIs versus those treated with other treatment modalities. Methods: Patient data were collected from the Korean National Health Insurance Database, National Health Insurance Service- National Sample Cohort 2002 to 2015, which was released by the Korean National Health Insurance Service in 2015. The lung cancer group included patients (n = 2,003) initially diagnosed with lung cancer between January 2010 and December 2013. The main outcome was all-cause mortality. A Cox proportional hazard regression analysis was used to calculate the relative risk of mortality. Results: Among the newly diagnosed lung cancer cases, 1,004 (50.1%) were included in the analysis. A 15.1-month median survival benefit was observed in the EGFR-TKI group than that of the multimodality therapy group. The risk of mortality was as follows: EGFR-TKI treatment group (n = 142; hazard ratio [HR], 5.29; 95% confidence interval [CI], 3.57 to 7.86) and multimodality therapy group (n = 326; HR, 7.42; 95% CI, 5.19 to 10.63) compared to surgery only (n = 275). Conclusions Patients with advanced lung cancer harbouring EGFR mutations treated with EGFR-TKIs showed better median survival and lower risk of mortality than those in the multimodality therapy group. In the case of EGFR-mutated advanced lung cancer, there is room for downstaging in the TNM classification.

Background/Aims: HDL cholesterol (HDL-C) may have anti-tumor effects; however, the effects remain unclear. Thus, this study aimed to investigate sex- and tumor stage-specific association of hyperglycemia and HDL-C with gastric cancer. Materials and Methods: We used the National Health Insurance Service data. All participants underwent gastric cancer screening between January and December 2011. Hyperglycemia and HDL-C levels were categorized according to the World Health Organization guideline and Adult Treatment Panel III. Adjusted regression analysis was performed using ORs and 95% CIs. Results: Gastric cancer was detected in 10,417 of 5.49 million individuals (2.43 million men). Hyperglycemia (OR, 1.28; 95% CI, 1.20~1.36) and low HDL-C levels (OR, 1.41; 95% CI, 1.35~1.48) were associated with gastric cancer. In the sub-analysis by sex, hyperglycemia (≥126 mg/dL) was associated with gastric cancer in both men (OR, 1.26; 95% CI, 1.18~1.36) and women (OR, 1.32; 95% CI, 1.17~1.49). Low HDL-C levels were associated with gastric cancer in both men (OR, 1.49; 95% CI, 1.40~1.58) and women (OR, 1.32; 95% CI, 1.27~1.42). In the sub-analysis by tumor stage, hyperglycemia was associated with both early (OR, 1.14; 95% CI, 1.08~1.20) and advanced gastric cancer (OR, 1.39; 95% CI, 1.26~1.55). Low HDL-C levels were also associated with early (OR, 1.34; 95% CI, 1.27~1.41) and advanced gastric cancer (OR, 1.92; 95% CI, 1.74~2.13). Conclusions Hyperglycemia and low HDL-C levels are consistently associated with gastric cancer regardless of sex or tumor stage.

Background: The mechanisms leading to lung fibrosis are still under investigation. This study aimed to demonstrate whether antacids could prevent the development of interstitial lung disease (ILD). Methods: This population-based longitudinal cohort study was conducted between January 2006 and December 2010 in South Korea. Eligible subjects were ≥40 years of age, exposed to proton pump inhibitors (PPI)±histamine-2 receptor antagonists (H-2 blockers) or H-2 blockers only, and had no history of ILD between 2004 and 2005. Exposure to antacids was defined as the administration of either PPI or H-2 receptor antagonists for >14 days, whereas underexposure was defined as antacid treatment administered for less than 14 days. Newly developed ILDs, including idiopathic pulmonary fibrosis (IPF), were counted during the 5-year observation period. The association between antacid exposure and ILD development was evaluated using adjusted Cox regression models with variables, such as age, sex, smoking history, and comorbidities. Results: The incidence rates of ILD with/without antacid use were 43.2 and 33.8/100,000 person-years, respectively and those of IPF were 14.9 and 22.9/100,000 person-years, respectively. In multivariable analysis, exposure to antacid before the diagnosis of ILD was independently associated with a reduced development of ILD (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.45 to 0.71; p<0.001), while antacid exposure was not associated with development of IPF (HR, 0.88; 95% CI, 0.72 to 1.09; p=0.06). Conclusion Antacid exposure may be independently associated with a decreased risk of ILD development.

Streptococcus pneumoniae (pneumococcus) has been known to cause pneumonia, sinusitus, otitis media, meningitis, endocardiditis, myelitis and arthritis. Spinal epidural abscess by S. pneumoniae has been diagnosed rarely among the patients with spinal trauma, intravenous drug abuse, alcoholism, diabetes mellitus, long term steroid use, chronic renal failure, and acquired immune deficiency syndrome. We experienced a case of pneumococcal spinal epidural abscess occurred in 75-year-old female with L1 compression fracture since 4 years ago. Her spine magnetic resonance imaging revealed epidural abscess at the level from L3 to S1. S. pneumonia was identified on blood which was susceptible to penicillin. She was immediately treated with antibiotics and surgical exploration. The pneumococcal spinal epidural abscess is very unusual. Therefore, we report here this case with a brief review of the literature.
Acquired Immunodeficiency Syndrome ; Aged ; Alcoholism ; Anti-Bacterial Agents ; Arthritis ; Bacteremia ; Diabetes Mellitus ; Epidural Abscess ; Female ; Fractures, Compression ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Meningitis ; Myelitis ; Otitis Media ; Penicillins ; Pneumonia ; Spine ; Streptococcus pneumoniae ; Substance Abuse, Intravenous

PURPOSE: Reduced brain glucose metabolism and basal forebrain cholinergic neuron degeneration are common features of Alzheimer's disease and have been correlated with memory function. Although regions representing glucose hypometabolism in patients with Alzheimer's disease are targets of cholinergic basal forebrain neurons, the interaction between cholinergic denervation and glucose hypometabolism is still unclear. The aim of the present study was to evaluate glucose metabolism changes caused by cholinergic deficits. MATERIALS AND METHODS: We lesioned basal forebrain cholinergic neurons in rats using 192 immunoglobulin G-saporin. After 3 weeks, lesioned animals underwent water maze testing or were analyzed by 18F-2-fluoro-2-deoxyglucose positron emission tomography. RESULTS: During water maze probe testing, performance of the lesioned group decreased with respect to time spent in the target quadrant and platform zone. Cingulate cortex glucose metabolism in the lesioned group decreased, compared with the normal group. Additionally, acetylcholinesterase activity and glutamate decarboxylase 65/67 expression declined in the cingulate cortex. CONCLUSION: Our results reveal that spatial memory impairment in animals with selective basal forebrain cholinergic neuron damage is associated with a functional decline in the GABAergic and cholinergic system associated with cingulate cortex glucose hypometabolism.
Acetylcholine/metabolism ; Alzheimer Disease ; Animals ; Antibodies, Monoclonal/*pharmacology ; Basal Forebrain/*drug effects/metabolism ; Cholinergic Agents/administration & dosage/*pharmacology ; Cholinergic Neurons/*drug effects/metabolism ; Fluorodeoxyglucose F18 ; GABAergic Neurons/*drug effects/metabolism ; Glucose/*metabolism ; Gyrus Cinguli/*drug effects/metabolism ; Humans ; Injections ; Maze Learning ; Motor Activity/physiology ; Positron-Emission Tomography ; Rats ; Ribosome Inactivating Proteins, Type 1/*pharmacology