Objective : The study of synchronous multiple gastric carcinoma is of the utmost importance in the management of carcinoma of the gastric remnant and in the epidemiology and histogenesis of gastric carcinoma. We compared the clinicopathologic features and outcome of patients with synchronous multiple gastric carcinoma (SMGC) to those of patients with single gastric carcinoma. Methods : Of the 3,320 patients diagnosed with gastric carcinoma who underwent surgery in our hospital, 188 patients (5.7%) were diagnosed with SMGCs. Results : Early carcinomas were more frequently observed in patients with SMGCs than in patients with single gastric carcinoma (p < 0.001). In addition, lymph node metastasis was less common in patients with SMGCs than in patients with single gastric carcinomas (p < 0.05). Regarding the operative procedures, total gastrectomy was more frequently performed in patients with SMGC (32.5 vs. 20.2%; p < 0.001). The 5-year survival rate of patients with SMGCs was higher than that of patients with single gastric carcinoma (69.3% vs. 54.1%, p < 0.001). Multivariate analysis showed that lymph node metastasis, serosal invasion, and curative resection were significant prognostic factors for the survival of patients with SMGCs. Conclusion : More recently, endoscopic or laparoscopic resection for early gastric carcinoma has frequently been performed. Careful preoperative and intraoperative evaluation and postoperative follow-ups are essential to detect any missed lesions in the remnant stomach, particularly in elderly patients with early gastric carcinoma.

Educational video podcasts are increasingly used in higher education, yet the cognitive mechanisms underlying their effectiveness remain underexplored. This experimental study examined how working memory capacity and additive contextual features influence situational interest, cognitive load, and learning from educational video podcasts. Sixty-two university students viewed video podcasts on lightning with standard narration with visuals (control), elaborative details, or seductive details. Working memory did not significantly predict learning outcomes or moderate the effects of additive features, and no differences were observed across conditions for cognitive load or situational interest. In free recall, the control condition outperformed the seductive details condition (p = .004, g = 1.03), though this difference was not significant when controlling for working memory. Transfer did not differ across conditions. Follow-up interviews revealed that students across conditions emphasized visuals as critical for comprehension, while those in additive conditions reported feeling overwhelmed despite similar cognitive load ratings. These findings suggest that well-designed multimedia environments may stabilize learning outcomes across differences in working memory capacity, extending cognitive theory of multimedia learning. Designers of educational video podcasts should prioritize narration aligned with supportive visuals over additive contextual features.

The split-attention principle suggests that separating onscreen information sources can overburden working memory and impede learning. While research has traditionally focused on the separation of images and text, relatively little is known about the impact of multiple simultaneous visual inputs. This study examined the split-attention principle in a multimedia environment featuring a pedagogical agent performing gestures, with hologram-like images either integrated centrally with the agent or spatially separated. A within-subjects design (N = 80) investigated the impact on satisfaction, cognitive load, and cued recall. The quantitative findings revealed no significant differences between the two spatial conditions. Preliminary qualitative insights from a limited sample of six individual interviews suggested that some participants may employ strategies to simplify complex designs and manage perceived cognitive load. Based on these limited qualitative observations, this research tentatively proposes the “pruning principle”, a metacognitive strategy where learners actively “prune” extraneous information to optimize cognitive resources. These findings underscore the importance of considering individual differences and metacognitive strategies in multimedia design.