CONCLUSION Female gender significantly predicted lower salary among VAMC surgeons, however within each surgical specialty, there was no significant gender pay gap. SENTENCE SUMMARY Independent predictors of salary included gender, surgical specialty, experience, h-index, and geographic location. Although female surgeons had lower overall salaries compared to male surgeons in the Veterans Health Administration (VHA), there were no significant gender differences in salary among each surgical specialty. Pay transparency, unique to the VHA, along with the use of rational and objective criteria to establish and adjust salaries, may play a role in reducing the gender pay gap among VHA surgeons. Published by Elsevier Inc.BACKGROUND To investigate whether the use of Pecs II block benefit patients with the respect to the immune functions. METHODS Totally 196 patients were included in this study. These patients were randomized to two groups, general anesthesia alone group (G group) and Pectoral nerve (Pecs) II block under general anesthesia group (PG group). RESULTS It was found that remifentanil consumption was less in PG group than it in G group. PG group showed a higher proportion of NK cells in peripheral blood mononuclear cell (PBMC) and an improved killing activity than G groups after surgery. We also found that postoperative interleukin (IL)-2 concentration in the plasma of PG group was dramatically higher than it of G group. Interestingly, there was even no significant change between preoperative and postoperative IL-2 levels in PG group, suggesting the less inhibitory effect of Pecs II block on immune system of those patients. CONCLUSIONS In conclusion, these results indicate that Pecs II block use in patients may have an enhanced immunity compared with general anesthesia method. Increased abdominal pressure is common in obese patients and predisposes them to gastroesophageal regurgitation (GER). To drain GER and prevent aspiration, nasogastric (NG) tubes are frequently inserted in obese patients undergoing general anesthesia. However, whether gastric drainage actually decreases the occurrence of GER remains to be elucidated. In this study, increased abdominal pressure was simulated with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning, while the retained NG tube was replaced by a pre-inserted esophageal multichannel intraluminal and pH (MII-pH) monitoring. Fifteen patients undergoing elective gynecologic laparoscopy were enrolled in this study.  https://www.selleckchem.com/products/acetylcysteine.html  Thirteen patients (86%) developed GER while in the LPT position. With the high occurrence of GER, pre-inserted NG tubes under general anesthesia are not likely to be protective in obese patients. V.AIM To assess the predictive value of the U classification and the significance of follow-up ultrasound in those managed conservatively. MATERIALS AND METHODS A retrospective observational study was carried out among 1,465 patients who underwent thyroid ultrasound in 2016 at a teaching hospital in UK. Details regarding U classification of nodules, cytology, histology in patients who underwent surgery, and follow-up ultrasound in those managed conservatively were obtained. RESULTS Thyroid surgery was performed in 129 patients of which malignancy was seen in 35 (27.1%). The proportion of patients with cancer in U1-U5 categories were 0%, 13.6%, 30.4%, 40%, and 100%, respectively (Fisher's exact test p=0.001). There was no significant difference in U stage, cytology, or histology between incidental and symptomatic nodules. Among patients who did not undergo surgery 5% of U1, 14.6% of U2, 75% of U3, and 71.4% of U4 underwent repeat ultrasound. Radiological progression in nodule size was seen in 4.2% of U1, 1.9% of U2, 0% of U3, and 40% of U4 nodules at median duration of 306, 439, 274, and 748 days, respectively. CONCLUSIONS U classification is reliable in risk-stratifying thyroid nodules. Patients with benign nodules without high-risk features do not require follow-up. The interval between scans in patients with indeterminate nodules can be extended to a period of 6-12 months. The clinical director (CD) is responsible for delivering high-quality patient-focused clinically effective healthcare services, which support the core principles of patient safety, and also serves as a conduit transmitting the trust's vision and objectives to clinical staff. The CD has to have a strategy to ensure that this is delivered without compromising patient care. He/she has to speak for all staff and ensure that the directorate strategy is aligned with the vision and strategy of the trust. In the opposite direction, the CD acts as a conduit through implementation of the departmental vision and strategy. To achieve these objectives, the CD works in close collaboration with the divisional triumvirate (executive [senior management team], divisional team [mid-level], directorate/departmental team), service manager, specialty leads, and senior nurses in addition to frontline consultant radiologists to ensure planning and delivery of robust clinical services within their areas and the entire trust. The role of the CD inherently requires "out-of-the-box" strategies, innovation, and influential communication skills for continuous service improvement and effective patient management pathways and flow. The CD ensures that appropriate medical workforce is available in the department to deliver high-quality care and maximise clinical efficiencies through effective deployment of available resources. AIM To investigate whether the long-held view that the hand is the commonest site for an enchondroma is actually correct in light of more sensitive imaging techniques that are able to demonstrate small enchondromas at other skeletal sites. MATERIALS AND METHODS A two-part retrospective study was undertaken. Part 1 comprised a review of the hand radiographs obtained in two major teaching hospitals over a 10-year period to establish the incidence of enchondroma in the hand. Part 2 was a review of a series of enchondromas of the proximal humerus, distal femur, and proximal tibia less then 4 cm in length on magnetic resonance imaging (MRI) to see which cases were visible or not on corresponding radiographs. RESULTS Part 1 84 enchondromas were identified on 116,354 trauma radiographs to give an incidence of 0.07%. Part 2 157 patients with an enchondroma on MRI less then 4 cm were reviewed. Only 17% of lesions less then 2 cm in length were visible on the contemporaneous radiographs. In lesions that were 2-2.9 and 3-3.