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The online learning in English language has been going along with the rapid development and diffusion of the information and communication techologies and shifted from being merely marginal trend to become popular, where the number of higher education institutions has dramatically increased to offer and led to extremely changes many aspect in learning societies. This study explores the technical abilities, technology accessibility and self-directed learning that contribute to student attitudes towards online English learning in predicting the continuance intention of the online learning. This study employed quantitative approach. There were 10 tertiary students interviewed as preliminary study, then 36 students were surveyed through questionnaire in a pilot test. The validated questionaire were used in this study on the 102 students. Rasch measurement model was utilized to validate the 25 items of questionnaire, meanwhile the Smart PLS ver. 2.0 was used to assess the regression of exogen to endogen variables. The study concluded that self- directed learning contributed to the attitude towards online English language learning as mediator to continuance intention of online learning. The ability and positive attitude in using digital technology must be present to support English learning current and forthcoming. The next research can focus more on how students adapt to a variety of rapidly changing technologies to support their English skills.

Summary Deep lobe of the parotid gland is a rare localisation of head and neck tumors and most of them are pleomorphic adenoma. We encountered a 76-year-old woman with deep lobe parotid gland oncocytic neoplasms (synchronous oncocytoma and multifocal nodular oncocytic hyperplasia), but without any complaints. The patient was operated for larynx carcinoma four years ago. A deep lobe parotid gland lesion was detected during radiological evaluation of her middle ear cholesteatoma. A near total parotidectomy was performed. Oncocytoma is an uncommon salivary gland tumor and generally occurs in the superficial lobe of parotid gland of older patients. Multifocal nodular oncocytic hyperplasia is an unusual parotid gland lesion that accounts for 0.1% of parotid tumors. Computed tomography, magnetic resonance imaging, FNA and sialoscintigraphy may be helpful for evaluating parotid gland oncocytomas. Acinic cell carcinoma and clear cell carcinoma were the main differential diagnosis of oncocytoma. Surgical removal is the treatment of choice and total parotidectomy is suggested for deep lobe parotid gland oncocytomas. Recurrences are unusual for oncocytoma. Long-term follow up is necessary for multinodular cases. Parotid gland space occupying lesions may necessitate further emphasis regarding the fact that either second primary or a metastatic lesion may be found in especially a previously noted head and neck carcinoma patient.

Sixty five years old man presented with epigastrium pain unrelated to eating and weight-loss. Upper gastrointestinal endoscopy revealed an ulcerovegetan mass lying from gastric fundus to antrum, abdominal computerized tomograpy showed polypoid solid mass in the gastric lumen and a heterogenous mass in the right kidney. Endoscopic biopsy specimen indicated adenocarcinoma. The patient had taken to surgery and a mass in the stomach penetrated serosa, invased to pancreas at posterior and porta hepatis was found with perigastric lymph nodes. There was no invasion in perigastric soft tissue and lymph nodes. The pathologic diagnosis of renal mass was renal cell carcinoma, cytokeratin and vimentin positive. The patient's performance status was poor, paliative treatment was given. He died at seventh month of diagnosis.