Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study)

AIM: As a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double-flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single-center studies with a limited number of cases. METHODS: We conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1-year after surgery, and secondary endpoint was incidence of anastomosis-related complications. RESULTS: Of 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1-year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra-thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44-10.9, P = 0.0109). Total incidence of anastomosis-related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis-related complications (OR: 3.93, 95% CI: 1.93-7.80, P = 0.0003). CONCLUSION: Double-flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well-prepared for

New Approach to Teaching Japanese Pronunciation in the Digital Era - Challenges and Practices

Pronunciation has been a black hole in the L2 Japanese classroom on account of a lack of class time, teacher\u2019s confidence, and consciousness of the need to teach pronunciation, among other reasons. The absence of pronunciation instruction is reported to result in fossilized pronunciation errors, communication problems, and learner frustration. With an intention of making a contribution to improve such circumstances, this paper aims at three goals. First, it discusses the importance, necessity, and e ectiveness of teaching prosodic aspects of Japanese pronunciation from an early stage in acquisition. Second, it shows that Japanese prosody is challenging because of its typological rareness, regardless of the L1 backgrounds of learners. Third and finally, it introduces a new approach to teaching L2 pronunciation with the goal of developing L2 comprehensibility by focusing on essential prosodic features, which is followed by discussions on key issues concerning how to implement the new approach both inside and outside the classroom in the digital era