Comprehensive Staging Research Articles

CTNNB1 p.D32A (c.95A > C) somatic mutation in stage I grade 1 endometrioid endometrial carcinoma with lung metastasis: a case report

BackgroundMost endometrial cancers are of low histological grade and uterine-confined, with a high 5-year survival rate. However, a small subset of women with low-grade and early-stage endometrioid endometrial cancer experience recurrence and death; thus, a more precise risk-stratification is needed.Case presentationA 29-year-old woman presented with abnormal vaginal bleeding and was diagnosed with FIGO grade 1 endometrioid endometrial carcinoma by curettage. Comprehensive cancer staging including pelvic and para-aortic lymphadenectomy was then performed. Postoperative pathological findings suggested an FIGO grade 1 endometrioid endometrial carcinoma infiltrating the superficial muscle layer. The patient did not receive adjuvant therapy. After 4 years of follow-up, the patient returned to our institution with lung metastasis. She underwent thoracoscopic resection of the affected lobes, followed by six cycles of combined chemotherapy of paclitaxel and carboplatin. Next-generation sequencing showed that the primary and lung metastatic tumors shared 4 mutations: PTEN (p.P248Lfs*8), CTNNB1 (p.D32A), BCOR (p.N1425S) and CBL (p.S439N). Immunohistochemistry revealed nuclear location of β–catenin in the primary and lung metastatic tumor samples, indicating abnormal activation of β–catenin.ConclusionCTNNB1p.D32A (c.95A > C) mutation may be related to lung metastasis in this patient with low-grade early-stage endometrioid endometrial carcinoma.

ОППОЗИЦИЯ В НАУЧНО-ПОЛИТИЧЕСКОМ ДИСКУРСЕ: КАТЕГОРИАЛЬНАЯ ОПРЕДЕЛЕННОСТЬ И ПОТЕНЦИАЛ ПЛЮРАЛИЗМА

In the presented work, not only specific representatives of the political opposition in Russia are considered, but also a number of factors describing their current state are studied. The author examines the political phenomenon of the opposition: the concept and essence, the factors that influenced the evolutionary nature of its formation, and also analyzes the opposition as a mechanism of political pluralism. The main approaches to the assessment of the opposition, three stages of comprehension are also presented, scientific approaches to the definition of this term are studied. An attempt has been made to solve an important scientific problem related to the analysis of the correlation of the types of opposition in Russia and its possible role in the short- and medium-term development of the political system of our country.

Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage ovarian cancer: A prospective multicentre study (SELLY).

e17579 Background: Comprehensive surgical staging of early epithelial ovarian cancer includes systematic paraaortic and bilateral pelvic lymphadenectomy but its therapeutic role is controversial and it is associated with potential severe morbidity. The feasibility of sentinel lymph-node (SLN) identification in early stage ovarian cancer has been shown only. We did a prospective multicenter study to assess the feasibility, detection rate and diagnostic accuracy of the SLN procedure in predicting the pathological pelvic-node status in patients with early stage ovarian cancer. Methods: This is a phase II single arm study (EUDRACT 2019-001088-58) including patients with presumed stage I-II epithelial ovarian cancer planned for immediate or delayed minimally-invasive comprehensive staging. The ovarian pedicle is injected with 2 mL of a 1.25 mg/mL indocyanine green (ICG) solution. The pelvic and lumbo-aortic retroperitoneum is then accessed and inspected to identify and remove SLNs. Staging is then completed including systematic pelvic and para-aortic lymphadenectomy and an histopathological examination of all nodes is performed. The primary endpoint was estimation of the sensitivity and sensibility of SLN in predicting nodal status. Assuming a sensitivity of 98.5% in predicting positive sentinel lymph nodes at histology, a pathological lymph node prevalence of 14.2%, a precision of estimate (i.e. the maximum marginal error) d=5%, a type I error α = 0.05, a sample size of 141 patients is needed to test the general hypothesis (i.e. to answer whether SLN(s) identified with ICG can accurately predict nodal status at histology of patients with apparently early EOC). Assuming a drop-out rate of 20%, a total of 176 patients will be enrolled in the study. Results: One-hundred and seventy-six patients were included with a drop-out rate of 22%. Sentinel node was identified in 102 patients (detection rate, 58%, [95% CI: 51-65]). There were no clinical differences between patients with successful or unsuccessful mapping. Both the infundibolopelvic ligament and the legamentum ovarii proprium were injected in 29.0% of cases. Twenty-one patients had positive nodes and 71% of them showed successful mapping. Among the latter, a negative sentinel node was identified in 3 patients (Sensitivity 78.6% [95% CI: 57-100]; Specificity 100%; Accuracy 97% [95% CI: 94-100]; PPV 100%; NPV 96,6% [95% CI: 93-100]). Twenty-two (12.5%) intra- and 25 (14.2%) postoperative complications occurred (12 G1; 9 G2; 2 G3, 2 G4). Clinical trial information: EUCTR2019-001088-58 .

Shaw in America (Bernard Shaw on the American Stage: A Chronicle of Premieres and Notable Revivals)

Shaw in America (Bernard Shaw on the American Stage: A Chronicle of Premieres and Notable Revivals)

A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery.

Neonates and infants undergoing cardiac surgery tend to receive high volumes of blood products. The use of rotational thromboelastometry (ROTEM®) has been shown to reduce the administration of blood products in adults after cardiac surgery. We sought to develop a targeted administration of blood products based on ROTEM® to reduce blood product utilization during and after neonatal and infant cardiac surgery. We conducted a retrospective review of data from a single center for neonates and infants undergoing congenital cardiac surgery using cardiopulmonary bypass (CPB) from September 2018-April 2019 (control group). Then, using a ROTEM® algorithm, we collected data prospectively between April-November 2021 (ROTEM group). Data collected included age, weight, gender, procedure, STAT score, CPB time, aortic cross-clamp time, volume, and type of blood products administered in the operating room and cardiothoracic intensive care unit (CTICU). In addition, ROTEM® data, coagulation profile in CTICU, chest tube output at 6 and 24 hours, use of factors concentrate, and thromboembolic complications were recorded. The final cohort of patients included 28 patients in the control group and 40 patients in the ROTEM group. The cohort included neonates and infants undergoing the following procedures: arterial switch, aortic arch augmentation, Norwood procedure, and comprehensive stage II procedure. There were no differences in the demographics or procedure complexity between the two groups. Patients in the ROTEM® group received fewer platelets (36±12 vs. 49±27 mL/kg, p 0.028) and cryoprecipitate (8±3 vs. 15±10 mL/kg, p 0.001) intraoperatively when compared to the control group. The utilization of ROTEM® may have contributed to a significant reduction in some blood product administration during cardiac surgery for infants and neonates. ROTEM® data may play a role in reducing blood product administration in neonatal and infant cardiac surgery.

Evolution of community health workers: the fourth stage.

Comprehensive primary care is a key component of any good health system. Designers need to incorporate the Starfield requirements of (i) a defined population, (ii) comprehensive range, (iii) continuity of services, and (iv) easy accessibility, as well as address several related issues. They also need to keep in mind that the classical British GP model, because of the severe challenges of physician availability, is all but infeasible for most developing countries. There is, therefore, an urgent need for them to find a new approach which offers comparable, possibly even superior, outcomes. The next evolutionary stage of the traditional Community health worker (CHW) model may well offer them one such approach. We suggest that there are potentially four stages in the evolution of the CHW - the health messenger, the physician extender, the focused provider, and the comprehensive provider. In the latter two stages, the physician becomes much more of an adjunct figure, unlike in the first two, where the physician is at the center. We examine the comprehensive provider stage (stage 4) with the help of programs that have attempted to explore this stage, using Qualitative Comparative Analysis (QCA) developed by Ragin. Starting with the 4 Starfield principles, we first arrive at 17 potential characteristics that could be important. Based on a careful reading of the six programs, we then attempt to determine the characteristics that apply to each program. Using this data, we look across all the programs to ascertain which of these characteristics are important to the success of these six programs. Using a truth table, we then compare the programs which have more than 80% of the characteristics with those that have fewer than 80%, to identify characteristics that distinguish between them. Using these methods, we analyse two global programs and four Indian ones. Our analysis suggests that the global Alaskan and Iranian, and the Indian Dvara Health and Swasthya Swaraj programs incorporate more than 80% (> 14) of the 17 characteristics. Of these 17, there are 6 foundational characteristics that are present in all the six stage 4 programs discussed in this study. These include (i) close supervision of the CHW; (ii) care coordination for treatment not directly provided by the CHW; (iii) defined referral pathways to be used to guide referrals; (iv) medication management which closes the loop with patients on all the medicines that they need both immediately and on an ongoing basis (the only characteristic which needs engagement with a licensed physician); (v) proactive care: which ensures adherence to treatment plans; and (vi) cost-effectiveness in the use of scarce physician and financial resources. When comparing between programs, we find that the five essential added elements of a high-performance stage 4 program are (i) the full empanelment of a defined population; (ii) their comprehensive assessment, (iii) risk stratification so that the focus can be on the high-risk individuals, (iv) the use of carefully defined care protocols, and (v) the use of cultural wisdom both to learn from the community and to work with them to persuade them to adhere to treatment regimens.

ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023*

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.

ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023*

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for...

ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.

D-14 | Atrial Septal Interventions During and After Hybrid Stage I Palliation

Hybrid stage I palliation (HS1P) is an alternative approach for single ventricle (SV) patients, particularly those with high-risk factors. Unlike surgical stage I palliation where atrial septectomy is standardly performed, the approach to atrial septal intervention (ASI) during HS1P is patient dependent. In this study, we aimed to describe the frequency of interventions on the atrial septum both at the time of the HS1P and during the interstage period and to determine factors associated with a need for ASI post-HS1P. A retrospective study was performed in all SV patients who underwent HS1P at our center in the past 12 years. Initial and subsequent interventions on the atrial septum were collected through either surgical Norwood or Comprehensive stage II. Patient factors, atrial septal characteristics by echo, and type of atrial septal intervention were also collected and compared to identify risk factors for ASI intervention post-HS1P. Of 50 SV patients included, about half of the patients (26/50) required an ASI post-HS1P; 23 (46%) had an ASI performed at the time of HS1P, and 7 (27%) of these patients required a subsequent ASI. Of the 27 patients who did not undergo an initial ASI, 19 (70%) required a subsequent ASI. Compared to static and cutting balloon septoplasty, balloon atrial septostomy and atrial septal stent placement were associated with a decreased risk of need for ASI post-HS1P (both p<0.05). There were no significant differences in patient characteristics, hospital course, or overall outcomes between patients who required ASI post-HS1P vs. those who did not. Atrial septal intervention after HS1P is common but has little impact on patient outcomes through the next stage of palliation. Although no patient or anatomic factors were identified risk factors for atrial septal intervention post-HS1P (besides having an intact atrial septum), intervention with either balloon atrial septostomy or atrial septal stent placement was associated with a lower need for atrial septal reintervention and therefore may be the preferred approach when anatomically feasible.

The clinico pathological features and survival in serous endometrial cancers

Background & IntroductionSerous cancers are a biologically aggressive variety of endometrial cancer (EC) with a high rate of recurrence and mortality among all the subtypes. Herein we describe our experience with serous endometrial cancer. ObjectiveThis study was conducted to identify the clinicopathological characteristics, treatment modalities and survival outcomes in women diagnosed with serous endometrial malignancies. MethodsThis was a retrospective descriptive analysis of data on patients diagnosed with serous endometrial tumours between January 2010 to September 2019 in our institute collected from electronic medical records. Descriptive statistics such as proportions, means and standard deviations and Cox regression hazards model on risk factors were performed. Survival was plotted by Kaplan-Meier curves. ResultsDuring the study period, 32 (5.7%) patients out of 564 diagnosed cases of endometrial cancer had serous histology. The mean age at diagnosis was 62.5 years (SD 7.6) while mean BMI was 26.4 kg/m2 (SD 4.6). Staging laparotomy was done in 27(84%) of the patients. Advanced stages (III and IV) were detected in 16 patients (50%) at primary surgery.Adjuvant chemo therapy and radiation was received by 21(65.6%) patients therapy. Out of 32 patients, 13 (40%) developed recurrence while another 13 expired. Stage at diagnosis and type of adjuvant therapy were important factors in determining the outcome. Median recurrence free and overall survival was 22(95% CI 1.4–42) and 36 months (95% CI 10.1–61.8) respectively. ConclusionSerous endometrial cancers are an intrusive subtype of EC. Comprehensive surgical staging with optimal cytoreduction should be aimed at. Adequate upfront molecular categorization of these tumors is mandated. Adjuvant therapy with chemotherapy and radiation is given in postoperative setting. Targeted therapies and immunotherapy could be considered in recurrences.

Clinical characteristics and survival outcomes in patients with primary ovarian carcinoid: A historical cohort study.

Primary ovarian carcinoids are extremely rare ovarian tumors, and there is limited data available on their clinical characteristics and survival outcomes. We conducted a historical cohort study of 56 patients to investigate their clinical characteristics. The overall survival, disease-specific survival, recurrence-free survival, and potential prognostic factors of these patients were also evaluated. The median age of these patients was 42.0 years (range: 20-71). The average mass and carcinoid size was 7.3 and 0.4 cm, respectively. Elevated tumor marker levels and ascites were observed in 15 and 10 patients, respectively. In 98.2% of the patients, tumors were confined to the ovary, while only one had metastatic disease. Surgery was the mainstay therapy: 37.5% of the patients underwent unilateral salpingo-oophorectomy, 25.0% underwent hysterectomy with bilateral salpingo-oophorectomy, 21.4% underwent ovarian cystectomy, 10.7% underwent comprehensive staging surgery, and 5.4% underwent bilateral salpingo-oophorectomy. Appendectomy and lymphadenectomy were performed in eight and five patients, respectively, but none showed tumor involvement. Chemotherapy was the only adjuvant treatment utilized, and was administered in four patients. Pathological analysis showed that strumal carcinoid was the most predominant subtype, occurring in 66.1% of the patients. The Ki-67 index was reported in 39 patients, 30 of which had an index of no more than 3%, with a maximum of only 5%. Only one relapse occurred after the initial treatment, and that patient experienced recurrences on two occasions, maintaining stable disease after surgery and octreotide therapy. After a median follow-up of 3.6 years, 96.4% of the patients achieved no evidence of disease, while 3.6% were alive with the disease. The 5-year recurrence-free survival rate was 97.9% and no death occurred. No risk factors for recurrence-free survival, overall survival, or disease-specific survival were identified. The Ki-67 indices were extremely low and prognoses were excellent in patients with primary ovarian carcinoids. Conservative surgery, especially unilateral salpingo-oophorectomy, is preferred. Individualized adjuvant therapy may be considered for patients with metastatic diseases.

Placenta accreta spectrum into the parametrium, morbidity differences between upper and lower location

Objective To demonstrate the surgical and morbidity differences between upper and lower parametrial placenta invasion (PPI). Materials and methods Forty patients with placenta accreta spectrum (PAS) into the parametrium underwent surgery between 2015 and 2020. Based on the peritoneal reflection, the study compared two types of parametrial placental invasion (PPI), upper or lower. Surgical approach to PAS follows a conservative-resective method. Before delivery, surgical staging by pelvic fascia dissection established a final diagnosis of placental invasion. In upper PPI cases, the team attempted to repair the uterus after resecting all invaded tissues or performing a hysterectomy. In cases of lower PPI, experts performed a hysterectomy in all cases. The team only used proximal vascular (aortic occlusion) control in cases of lower PPI. Surgical dissection for lower PPI started finding the ureter in the pararectal space, ligating all the tissues (placenta and newly formed vessels) to create a tunnel to release the ureter from the placenta and placenta suppletory vessels. Overall, at least three pieces of the invaded area were sent for histological analysis. Results Forty patients with PPI were included, 13 in the upper parametrium and 27 in the lower parametrium. MRI indicated PPI in 33/40 patients; in three, the diagnosis was presumed by ultrasound or medical background. The intrasurgical staging categorizes 13 cases of PPI performed and finds diagnosis in seven undetected cases. The expertise team completed a total hysterectomy in 2/13 upper PPI cases and all lower PPI cases (27/27). Hysterectomies in the upper PPI group were performed by extensive damage of the lateral uterine wall or with a tube compromise. Ureteral injury ensued in six cases, corresponding to cases without catheterization or incomplete ureteral identification. All aortic vascular proximal control (aortic balloon, internal aortic compression, or aortic loop) was efficient for controlling bleeding; in contrast, ligature of the internal iliac artery resulted in a useless procedure, resulting in uncontrollable bleeding and maternal death (2/27). All patients had antecedents of placental removal, abortion, curettage after a cesarean section, or repeated D&C. Conclusions Lower PAS parametrial involvement is uncommon but associated with elevated maternal morbidity. Upper and lower PPI has different surgical risks and technical approaches; consequently, an accurate diagnosis is needed. The clinical background of manual placental removal, abortion, and curettage after a cesarean or repeated D&C could be ideally studied to diagnose a possible PPI. For patients with high-risk antecedents or unsure ultrasound, a T2 weight MRI is always recommended. Performing comprehensive surgical staging in PAS allows the efficient diagnosis of PPI before using some procedures.

Abbreviated MRI for Comprehensive Regional Lymph Node Staging during Pre-Operative Breast MRI.

The detection of regional lymph node metastases (LNM), in particular significant LNM (≥N2), is important to guide treatment decisions in women with breast cancer. The purpose of this study was to determine whether a coronal pulse sequence as part of pre-operative breast MRI is useful to identify women without significant LNM. Retrospective study between January 2017 and December 2019 on 414 consecutive women with breast cancer who underwent pre-operative breast MRI on a 1.5 T system. For lymph node (LN) staging, a coronal pre-contrast non-fat-suppressed T1-weighted TSE sequence was acquired with the system's built-in body coil, covering the chest wall; acquisition time 3:12 min. Two radiologists rated the likelihood of LNM on a 3-point scale (absent/possible/present). Validation was obtained by histology from sentinel LN biopsy, axillary LN dissection, and/or PET/CT. 368/414 women were staged to have no or non-significant LNM (pN0 in 282/414, pN1 in 86/414), and significant LNM (≥pN2) in 46/414. For identification of women with significant LNM, MRI was true-positive in 42/46, false-negative in 4/46, true-negative in 327/368, and false-positive in 41/83, the latter mostly caused by women with N1-disease (38/41), yielding an NPV and PPV for significant LNM of 98.8% [95%-CI: 97.0-100%] and 50.6% [43.1-58.1%], respectively. A 3 min coronal T1-weighted pulse sequence covering the chest wall as part of pre-operative breast MRI is useful to rule out significant LNM with high NPV. Where MRI staging is positive for significant LNM, additional work-up is indicated to improve the distinction of N1 and N2 disease.

Presence of the Female Persona in the Poetry of Nizar Qabbani

This article revolves around the female poet's ego in the poetry of Nizar Qabbani, and we have concluded that the death of “Wesal,” the poet's sister, had an impact on him, as he became a supporter of women's rights, pushing them to control their lives, bodies and destiny, and making the cause of women the most loyal and important rank in his collections until 1967. Qabbani chose to speak for women and to be persuaded by her mask so that his poetry would have the strongest impact on people, to reflect many types of women's pains and issues in Eastern society, and to freely reveal the feelings, thoughts and anger in his chest that were considered forbidden at that time. The cause of freedom, which was adopted by Qabbani was limited in its first stage to women's freedom, and for this reason, the poems of the female poet ego abounded, so that we receive the voice of women who demand freedom in all its colors and spectrums and in various fields. Diary of an Indifferent Woman, published in 1968, was dedicated by the poet to the female poet's ego to speak with the voice of women, summarize all their issues, and declare a revolution against society in the face of all the injustices they face, summarizing a partial stage, which is the stage of the absolute women's freedom in order to move to a more comprehensive and broader stage, which is the stage of mankind at large. After the 1967 war, the issue of freedom expanded to the level of the Arab nation and the human being in general, male and female, so the voice of the female poet ego representing women decreased, and the voice of the masculine poet ego, which represents human beings at large aroused.

Research on the evolution and improvement of China's shadow education governance policy from the perspective of multiple streams theory.

From a global perspective, after-school tutoring education, also known as shadow education, has developed rapidly since the beginning of this century. However, shadow education has also brought many practical problems, such as the increased burden on parents and children, and the unfairness in education. At present, the Chinese government is vigorously implementing the double reduction policy and has achieved remarkable practical results. This study focuses on the evolution of the government policy of shadow education in China. First, it analyzed the four stages of shadow education governance policy experience: the acquiescent survival stage, the encouraging development stage, the preliminary regulation stage, and the comprehensive rectification stage. Python was used for text mining the policies from different periods and analyzing the focus of the policies in different stages by obtaining high-frequency vocabulary. Then, the multiple streams theory was used to explore the policy evolution process and change mechanism. Finally, relevant recommendations have been discussed to address the gaps in the current shadow education governance policies. The study found that the objectives, scope of adjustment, and protection of rights and interests of China's shadow education governance policies have undergone significant changes over time. Through the constant interaction and interweaving of the stream of problems, the stream of politics, and the stream of policy, the window of opportunity for policy change was jointly promoted. The innovations of this article mainly include the following: First, the evolution of China's shadow education governance policies was systematically reviewed using text mining methods to compare the differences of governance policies at different stages and second, multiple streams theory was used as the theoretical framework to analyze the reasons for the focus of shadow education governance policy changes.

From Participatory Governance to Collaborative Governance for Disaster-Tourism

This article aims to explain the need for changing the model from participatory governance to collaborative governance in disaster tourism management. This research utilized a descriptive qualitative approach. The findings revealed that sustainable tourism development is crucial and must receive careful attention within a comprehensive national development framework. In the current era, the government cannot carry out tourism development independently given the limited capacity and provide sufficient space for increasingly active private and public participation. Sustainable tourism development can be performed through a collaborative governance model involving various stakeholders. The development of a collaborative model can be conducted through the comprehensive participation stage of non-government stakeholders. With maximum participation, there will be a solid network to create partnerships as the final form of collaboration.

Analysis Of Mathematics Learning Difficulties In Solving Story Problems Based On Newman's Error Analysis

This study aims to analyze the difficulty of learning mathematics in solving story problems based on Newman's Error Analysis. A total of 22 students were selected by 6 students to be interviewed subjects. The method used in this study is descriptive qualitative with data collection techniques in the form of tests and interviews. Data were analyzed using miles and Huberman data analysis which included data collection, data reduction, data presentation, and conclusion. The results showed that subjects in the high category experienced difficulties at the Transformation, Process Skill, and Encoding stages. Meanwhile, subjects with moderate categories experience difficulties in the Reading, Comprehension, Transformation, Process Skill, and Encoding stages. As well as subjects in the low category also experience difficulties in the Transformation, Process Skill, and Encoding stages.

Land Consolidation in Rural China: Historical Stages, Typical Modes, and Improvement Paths

Land consolidation is an important means to optimize land-use structure and improve the level of intensive and economical use of land, and it is also a critical measure to coordinate economic and social development and promote cultivated-land protection. Therefore, the scientific advancement of land consolidation is of great significance to comprehensively promote rural revitalization and build a modern agricultural power. In this study, we explore the history of rural China’s land consolidation since 1949 and divide it into five stages: start-up stage (1949–1977), exploration stage (1978–1997), rapid development stage (1998–2007), quality improvement stage (2008–2018) and comprehensive consolidation stage (2019 to present). In different stages, there are obvious differences in national policy orientation on land consolidation. The differences in organization and implementation entities determine that government-led land consolidation, enterprise-driven land consolidation and villager-initiated land consolidation are the three main modes of rural land consolidation in China. To overcome the problems existing in current rural development and boost rural and agricultural modernization, it is urgent to adhere to planning-led and ecological priorities, build a diversified input pattern, innovate the public participation mechanism and strengthen full-process supervision, scientifically promoting the whole-region comprehensive land consolidation in rural China.

Imaging Recommendations for Diagnosis, Staging, and Management of Esophageal Cancer

AbstractEarly staging and treatment initiation affect prognosis of patients with esophageal and esophagogastric junction cancer; hence, it is imperative to have knowledge of proper choice of imaging modality for staging of these patients, to effectively convey relevant imaging findings to the treating physician/surgeon. It is also essential to be aware of pertinent imaging findings that need to be conveyed to the treating physician/surgeon at staging, and after treatment, including post-therapy complications (if any), so as to provide timely management to such patients. In this article, we have provided imaging guidelines for diagnosis, staging, post-therapy response evaluation, follow-up, and assessment of post-therapy complications of esophageal and esophagogastric junction cancer in a systematic manner. Besides, risk factors and clinical workup have also been elucidated. We have also attached comprehensive staging and post-therapy contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography-based synoptic reporting formats “ECI-RADS” and “pECI-RADS,” respectively, for esophageal and esophagogastric junction cancer in the supplement, for effective communication of imaging findings between a radiologist and the treating physician/surgeon.