• Journal of Gastric Cancer
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• v.21 no.4
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• pp.392-402
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• 2021

Purpose: Type 4 gastric cancer (GC) has a very poor prognosis even after curative resection, and the survival benefit of splenectomy for splenic hilar lymph node (LN; #10) dissection in type 4 GC remains equivocal. This study aimed to clarify the clinical significance of splenectomy for #10 dissection in patients with type 4 GC. Materials and Methods: The data of a total of 56 patients with type 4 GC who underwent total gastrectomy with splenectomy were retrospectively analyzed. Postoperative morbidity, state of LN metastasis, survival outcomes, and therapeutic value index (TVI) of each LN station were evaluated. TVI was calculated by multiplying the incidence of LN metastasis at each nodal station and the 5-year overall survival (OS) of patients who had metastasis to each node. Results: Overall, the postoperative morbidity rate was 28.6%, and the incidence of #10 metastasis in the patients was 28.6%. The 5-year OS rate for all patients was 29.9%, and most patients developed peritoneal recurrence. Moreover, the 5-year OS rates with and without #10 metastasis were 6.7% and 39.1% (median survival time, 20.4 vs. 46.0 months; P=0.006). The TVI of #10 was as low as 1.92. Conclusions: The clinical significance of splenectomy in the dissection of #10 for type 4 GC is limited and splenectomy for splenic hilar dissection alone should be omitted.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.617-632
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• 2022

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1-13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1-43%), 7% (95% CI < 1-34%) for dermal graft interposition, < 1% (95% CI < 1-37%) for radial forearm free flap, < 1% (95% CI < 1-52%) for ligation of the fistula, 17% (95% CI < 1-64%) for interposition of a deltopectoral flap, 9% (95% CI < 1-28%) for primary closure, and 2% (95% CI < 1-20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.415-421
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• 2022

Objective : Seizure recurrence after the first-ever seizure in patients with a supratentorial cerebral cavernous malformation (CCM) is almost certain, so the diagnosis and treatment of epilepsy is justified. The optimal method of management of these patients is still a matter of debate. The aim of our study was to identify factors associated with postoperative seizure control and assess the surgical morbidity rate. Methods : We retrospectively analysed 45 consecutive patients with a supratentorial CCM and symptomatic epilepsy in a single centre. Pre- and postoperative epidemiological data, seizure-related patient histories, neuroimaging results, surgery details and outcomes were obtained from hospital medical records. Seizure outcomes were assessed at least 12 months after surgery. Results : Thirty-five patients (77.8%) were seizure free at the long-term follow-up (Engel class I); six (13,3%) had rare, nocturnal seizures (Engel class II); and four (8.9%) showed meaningful improvement (Engel class III). In 15 patients (33%) in the Engel I group; it was possible to discontinue antiepileptic medication. Although there was not statistical significance, our results suggest that patients can benefit from early surgery. No deaths occurred in our study, and mild postoperative neurologic deficits were observed in two patients (4%) at the long-term follow-up. Conclusion : Surgical resection of CCMs should be considered in all patients with a supratentorial malformation and epilepsy due to the favourable surgical results in terms of the epileptic seizure control rate and low postoperative morbidity risk, despite the use of different predictors for the seizure outcome.

• Health Policy and Management
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• v.33 no.4
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• pp.457-478
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• 2023

Background: This study aims to contribute to the adjustment of the appropriate doctor manpower by analyzing the distribution, supply and demand, and estimation of the doctor manpower. Methods: This study utilized the medical personnel data of the Ministry of Health and Welfare, population trend data of the National Statistical Office, and health insurance benefit performance data of the National Health Insurance Service. Based on 2021, we compared the number of doctors in actual supply and the number of doctors in demand according to the amount of medical use by gender and age for 250 regions. Logistic regression analysis and scenario analysis were performed to estimate the future medical workforce by considering the demand for doctors according to the future demographic structure, the size of the quota in medical schools, and the retirement rate. Results: There were 186 regions in which the supply of doctors was below average, and the average ratio of the number of doctors in supply to demand in the region was 62.1%. Conclusion: In order to increase the number of active doctors nationwide to at least 80%, 7,756 people must be allocated. The number of doctors in demand is estimated to decrease after increasing to 1.492 times in 2059. The future projected number of doctors is expected to increase to 1.349 times in 2050 and then decrease taking into account the doctor quota and the retirement rate.

• IMMUNE NETWORK
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• v.20 no.3
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• pp.27.1-27.11
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• 2020

Although various studies on predictive markers in the use of PD-1/PD-L1 inhibitors are in progress, only PD-L1 expression levels in tumor tissues are currently used. In the present study, we investigated whether baseline serum levels of IL-6 can predict the treatment response of patients with advanced non-small cell lung cancer (NSCLC) treated with PD-1/PD-L1 inhibitors. In our cohort of 125 NSCLC patients, the objective response rate (ORR) and disease control rate (DCR) were significantly higher in those with low IL-6 (<13.1 pg/ml) than those with high IL-6 (ORR 33.9% vs. 11.1%, p=0.003; DCR 80.6% vs. 34.9%, p<0.001). The median progression-free survival was 6.3 months (95% confidence interval [CI], 3.9-8.7) in the low IL-6 group, significantly longer than in the high IL-6 group (1.9 months, 95% CI, 1.6-2.2, p<0.001). The median overall survival in the low IL-6 group was significantly longer than in the high IL-6 group (not reached vs. 7.4 months, 95% CI, 4.8-10.0). Thus, baseline serum IL-6 levels could be a potential biomarker for predicting the efficacy and survival benefit of PD-1/PD-L1 inhibitors in NSCLC.

• Asia pacific journal of information systems
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• v.23 no.2
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• pp.1-20
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• 2013

Social commerce has been gaining explosive popularity, with typical examples of the model such as Groupon and Level Up. Both local business owners and consumers can benefit from this new e-commerce model. Local business owners have a chance to access potential customers and promote their products in a way that could not have otherwise been easily possible, and consumers can enjoy discounted offerings. However, questions have been increasingly raised about the value and future of the social commerce model. A recent survey shows that about a third of 324 business owners who ran a daily-deal promotion in Groupon went behind. Furthermore, more than half of the surveyed merchants did not express enthusiasm about running the promotion again. The same goes for the case in Korea, where more than half of the surveyed clients reported no significant change or even decrease in profits compared to before the use of social commerce model. Why do local business owners fail to exploit the benefits from the promotions and advertisements through the social commerce model and to make profits? Without answering this question, the model would fall under suspicion and even its sustainability might be challenged. This study aims to look into problems in the current social commerce transactions and provide implications for the social commerce model, so that the model would get a foothold for next growth. Drawing on justice theory, this study develops theoretical arguments for the effects of transaction characteristics on consumers' distributive justice and purchase intention in the social commerce. Specifically, this study focuses on two characteristics of social commerce transactions-the discount rate and the purchase rate of products-and investigates their effects on consumers' perception of distributive justice for discounted transactions in the social commerce and their perception of distributive justice for regular-priced transactions. This study also examines the relationship between distributive justice and purchase intention. We conducted an online experiment and gathered data from 115 participants to test the hypotheses. Each participant was randomly assigned to one of nine manipulated scenarios of social commerce transactions, which were generated based on the combination of three levels of purchase rate (high, medium, and low) and three levels of discount rate (high, medium, and low). We conducted MANOVA and post-hoc ANOVA to test hypotheses about the relationships between the transaction characteristics (purchase rate and discount rate) and distributive justice for each of the discounted transaction and the regular-priced transaction. We also employed a PLS analysis to test relations between distributive justice and purchase intentions. Analysis results show that a higher discount rate increases distributive justice for the discounted transaction but decreases distributive justice for the regular-priced transaction. This, coupled with the result that distributive justice for each type of transaction has a positive effect on the corresponding purchase intention, implies that a large discount in the social commerce may be helpful for attracting consumers, but harmful to the business after the promotion. However, further examination reveals curvilinear effects of the discount rate on both types of distributive justice. Specifically, we find distributive justice for the discounted transaction increases concavely as the discount rate increases while distributive justice for the regular-priced transaction decreases concavely with the dscount rate. This implies that there exists an appropriate discount rate which could promote the discounted transaction while not hurting future business of regular-priced transactions. Next, the purchase rate is found to be a critical factor that facilitates the regular-priced transaction. It has a convexly positive influence on distributive justice for the transaction. Therefore, an increase of the rate beyond some threshold would lead to a substantial level of distributive justice for the regular-priced transaction, threrby boosting future transactions. This implies that social commerce firms and sellers should employ various non-price stimuli to promote the purchase rate. Finally, we find no significant relationship between the purchase rate and distributive justice for the discounted transaction. Based on the above results, we provide several implications with future research directions.

• The Korean Journal of Applied Statistics
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• v.28 no.4
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• pp.741-762
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• 2015

This study examines the long-term prospects for a minimum living guarantee by public pensions for the elderly using a dynamic micro-simulation model. "Elderly poverty" here is an estimate calculated by considering only the public pension income and it means how public pension affects the minimum living guarantee for the elderly. The main results are: First the impact of the public pension system on elderly poverty can be decomposed into economic growth and institutional effect. When considering both effects, the absolute poverty rate of the elderly will be reduced to 20% by the year 2040. But when considering the institutional effect(except economic growth effect), that rate is expected to be a long-term level of around 90%. Second, even if the Basic Pension is indexed to 10% of A-value, the elderly poverty rate is only about 10%p to be reduced further, compared to the current CPI-indexed system. Third, current benefit formula for National Pension does not consider the actual correlation of income level and insured period; consequently, the reversal possibility of the replacement rate appears likely. Fourth, the reform of 2007 improves the sustainability of the National Pension; however, it deteriorates the adequacy of the pension policy, i.e., the past system would be better than the current system in regards to a reduction in elderly poverty. Further discussion is needed on aspects of correct pension reform assessments which is difficult to achieve without understanding the comprehensive benefits and costs to society.

• Radiation Oncology Journal
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• v.13 no.1
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• pp.55-61
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• 1995

Purpose : Despite a development of therapeutic machines and advance in modern radiation therapy techniques, locally advanced cervical carcinoma has shown high rate of local failure and poor survival rate, Combination of chemotherapy and radiotherapy demonstrated benefit in improving local control and possibly the overall survival. Our study was performed to evaluate effect of concurrent chemoradiation on locally advanced uterine cervical cancer. Methods and Materials : Twenty six patients with locally advanced stage(FIGO stage IIB with ${\geq}5cm$ in diameter, III, IVA) were treated with combination of radiation therapy and concurrent cisplatinum between May of 1988 and September of 1993 at our hospital. Radiation therapy consisted of external irradiaton and 1-2 sessions of intracavitary irradiation. Cisplatinum was administered in bolus injection of 25mg/$m^2$ at weekly intervals during the course of external radiation therapy. Results : Of the 26 Patients, twenty-five patients were evaluable for estimation of response. Median follow-up period was 25 months with ranges from 3 to 73 months. Stage IIB, III, and IVA were 16, 5, 4 patients, respectively, Twenty patients were squamous cell carcinoma. Response was noted in all 25 patients: complete response(CR) in 17/25($68\%$), Partial response(PR) in 8/25($32\%$). Of the 24 patients except one who died of sepsis at 3 months follow-up, seventeen patients($70.8\%$) maintained local control in the pelvis: 16/17($94.1\%$) in CR, 1/17($14.3\%$) in PR. Fourteen of the 17 patients with CR are alive disease free on the completion of follow-up. Median survival is 28 months for CR and 15 months for PR. Analysis of 5-year survival by stage shows 11/16($59.8\%$) in IIB, 3/5($60.0\%$) in III, and 1/4($25.0\%$) in IVA. Overall 5-year survival rate was $55.2\%$. Ten patients recurred: 4 at locoregional, 3 in distant metastasis and 3 with locoregional and distant site. Toxicity by addition of cisplatinum was not excessive. Conclusion : Although the result of this study was obtained from small number of patients, it is rather encouraging in view of markedly improved response rate compared with the results of historical group.

• Korean Journal of Soil Science and Fertilizer
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• v.18 no.2
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• pp.201-207
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• 1985

The experiments were conducted in order to evaluate the effect of a compound fertilizer for application of potato plants (Sumi) which were prepared by the Kyonggj Chemical LTD. The results were summarized as follows; 1. Comparing with the plot of 12kg/10a muriate of potash plot, the potato yield of compound fertilizer, double rate of potassium sulfate and normal rate of potassium sulfate plots were increased in order to 44%, 7% and 6% respectively. The yield of potato at the compound fertilizer were significantly higher than that of double rate of potassium sulfate, but the latter yield was lower that of control. 2. The yield of potato were to exeeding of final tuber on June 25, which was twelve day earlier than the actual harvest the application of the compound fertilizer may make possible to harvest potato eariler than normal season and benefit fammers which better economic return. 3. Manufacturing it with granular form at diammonium phosphate, ammonium sulfate and potassium sulfate as majour source materials and having little urea contents, the compound fertilizer raised higher the emergence rate of potato plant than the other fertilizer were promoted the early plant growth, and kept potato plants comparatively healthier than the other fertilizer even at later stage of plant growth.

• Journal of Yeungnam Medical Science
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• v.9 no.2
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• pp.312-320
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• 1992

Radiotherapeutically, nasopharyngeal cancer is an important disease in korea. Because of its blind anatomic location, early detection is relatively uncommon. Clinically, most of cases are locally advanced and nodal involvement are common. Recently better understanding of nature of the disease and improvement of radio-therapy technique permit better treatment results, including locoregional control and survival rate, and minimal normal tissue damages comparing with previously published data. We analyzed 31 patients of pathologically proven and previously untreated naso-pharyngeal carcinoma with different treatment techniques, retrospectively. Minimal and maximal follow up period of the survuor is 6 months and 68 months, respectively. Thirteen patients with squamous cell carcinoma are included in this analysis. The median age is 49 years(range from 20 to 64 years). Twenty two patients are stage III. Eleven patients are treated with radiotherapy alone and 20 are treated with comblined modalities treatment. The degree of responses after radiotherapy are categorized by 3-classes, i.e. complete response, partial response. In spite of simioarities of complete response rate and 1-year survival rate between two different treatment techniques, those patients with undifferentiated carcinoma appear to benefit from the adjuvant chemotherapy. In addition, systemic failure is more prominant in radiotherapy alone group than in combined modalities treatment group. These results suggest that adjuvant therapy in the radiotherapeutic management of nasopharyngeal cancers needs additional research according to histologic types and future extensive clinical trials.