Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) of superficial esophageal cancer has been increasingly used as an alternative to surgery because it is minimally invasiveand has a high rate of en bloc resection. However, a high rate of esophageal stricture is observed after ESD for large lesions, which can dramatically decrease the patient's quality of life. Stricture prevention is necessary to allow for endoscopic therapy to expand. We, herein, review the most recent evidence and discuss the role of the metallic self-expandable stent and the biodegradable stent in esophageal stricture prevention. Limited studies suggested that prophylactic stenting could reduce the stricture rate without increasing the number of complications. In addition, the number of bougie dilation procedures was significantly lower with stent placement. Esophageal stenting is a promising option for post-ESD stricture prevention. However, current evidence is too preliminary to formulate practice standards. Future studies are needed to further validate the efficacy and safety of prophylactic stenting and determine the best strategy for stricture prevention. Stent migration is the most common complication. A new stent that has advantages of a low migration rate and minimal tissue reaction will need to be developed. Therefore, randomized controlled trials with long-term follow-up periods are required before prophylactic stenting could be considered a valid option to prevent post-ESD stricture.

Gastric adenocarcinoma of fundic gland type spreading to heterotopic gastric glands

Herein, we present a case of gastric adenocarcinoma of fundic gland type(GA-FG) spreading to heterotopic gastric glands(HGG) in the submucosa. A 58-year-old man with epigastric pain was referred to our hospital and underwent an esophagogastroduodenoscopy. A Borrmann type II gastric cancer at the antrum and a 10 mm submucosal tumor-like lesion in the lesser curvature of the upper third of the stomach were detected. Histological examination of the biopsy specimens obtained from the submucosal tumorlike lesion suggested a GA-FG. Therefore, endoscopic submucosal dissection was performed as excisional biopsy, and histopathological examination of the resected specimen confirmed a GA-FG and HGG proximal to the GA-FG. Although the GA-FG invaded the submucosal layer slightly, the submucosal lesion of the GA-FG had a poor stromal reaction and was located just above the HGG in the submucosa. Therefore, wefinally diagnosed the lesion as a GA-FG invading the submucosal layer by spreading to HGG.

The Research On The Control Self- Assessment-Base On The Assessment Report

Internal control self-assessment is an internal control audit method which consists of the auditors＇ audit and entity managers together constitute an evaluation team. then result in a report of CSA which include the defects finding and improvement plan. As the product of it. research on the CSA report is very important. In this research base on the real data to study, and analysis shows that the quality of report in Chinese CSA were not high.

A Comparative Study on the Education of Elderly University between China and Britain

The UK is one of the earliest countries in the world to set up an elderly university. There are many similarities and differences between Chinese and British elderly university. This paper makes a comparative study on the educational goals, curriculum, content and activities of elderly university in China and Britain, which is beneficial to the elderly university of our country for reference to the development experience of the elderly university in Britain. The elderly university in our country should also adhere to the value orientation of social adaptation and self-realization theory, further update the curriculum content, carry out diversified teaching activities, meet the diversified needs of the elderly for entertainment, learning and development, and ultimately improve the quality of life of the elderly.

Study on the Scaffolding Teaching of Three-dimensional Animation Foundation based on Modularization

In this paper, the teaching of course Three-dimensional Animation Foundation is designed mainly based on teaching content modularization and scaffolding teaching model. The modularized content design for Three-dimensional Animation Foundation is specifically expounded, and also the ideas for developing the scaffolding teaching model are analyzed. How to integrate the scaffolding teaching model into course teaching is introduced in details. Finally, new methods for guiding students to think independently in course teaching and improve students＇ self-awareness and self-learning ability are proposed.

Predictive factors for the failure of endoscopic stent-instent self-expandable metallic stent placement to treat malignant hilar biliary obstruction

AIM To investigate the factors predictive of failure when placing a second biliary self-expandable metallic stents(SEMSs). METHODS This study evaluated 65 patients with an unresectable malignant hilar biliary obstruction who were examined in our hospital. Sixty-two of these patients were recruited to the study and divided into two groups: the success group, which consisted of patients in whom a stent-in-stent SEMS had been placed successfully, and the failure group, which consisted of patients in whom the stent-in-stent SEMS had not been placed successfully. We compared the characteristics of the patients, the stricture state of their biliary ducts, and the implemented endoscopic retrograde cholangiopancreatography(ERCP) procedures between the two groups.RESULTS The angle between the target biliary duct stricture and the first implanted SEMS was significantly larger in the failure group than in the success group. There were significantly fewer wire or dilation devices(ERCP catheter, dilator, or balloon catheter) passing the first SEMS cell in the failure group than in the success group. The cut-off value of the angle predicting stent-in-stent SEMS placement failure was 49.7 degrees according to the ROC curve(sensitivity 91.7%, specificity 61.2%). Furthermore, the angle was significantly smaller in patients with wire or dilation devices passing the first SEMS cell than in patients without wire or dilation devices passing the first SEMS cell. CONCLUSION A large angle was identified as a predictive factor for failure of stent-in-stent SEMS placement.

The Narrative Perspectives Manifested in AI-Kharrat＇s Novels

This study deals with two novels of Eduar AI-Kharrat： Rama wal-Tinnin （Rama and the Dragon, 1979） and al-Zaman al-Akhar （The Other Time, 1985）. The text in both novels is of the pluralist, polyphonic and modernistic type and the real and the imaginary are juxtaposed. The narrative imitates at its diverse levels the internal conflict, argument, and uncertainty of the protagonist Michael, who finally finds his self-realization in an imaginary time, ＂the other time＂, which is also the title of one of the novels. The present study focuses on the transformation and alternation of the perspectives and the narrative vision through the destruction of the narrator＇s identity and the text itself, the analysis of the narrative shift between the first and third person, the fragmentation of the self, the ambiguity of the signs, the severity of the crisis, and the psychological conflict at its diverse levels and multiplicities. Toward this plurality and shift, it is necessary to systematically depend upon what the theories of Bakhtin and Genette have to offer in order to cover the narrative levels and multiple voices prevailing in the texts.

Intrinsic and Extrinsic Value for English Learning: Mediation Effects of SelfEfficacy in Chinese EFL Context

The present study examined how students＇ intrinsic and extrinsic value promotes their foreign language proficiency via the mediation effect of self-efficacy beliefs. A total of 1,036 Chinese eighth graders answered an English proficiency test and questionnaires assessing motivational beliefs. Structural equation modelling results with bootstrapping procedures revealed that intrinsic value can directly and indirectly influence foreign language proficiency via partial mediation effect of self-efficacy while extrinsic value can only directly influence foreign language proficiency with a small magnitude. Moreover, there is no gender difference in the mediation model. Our findings suggested that intrinsic value can help students improve foreign language proficiency by improving their self-efficacy beliefs. The findings contribute to the documents of self-determination theory and hold substantive theoretical and practical implications for foreign language teachers.