Introduction: We examined whether an intervention in students’ self-assessment causes behavioral changes in how they make their assessments.
Method: Students taking part in problem-based learning were divided into 2 groups. The students of Group 1 were asked to evaluate themselves with a four-step process, whereas the students of Group 2 students were asked to evaluated themselves and to indicate how confident they were that their self-assessments were consistent with assessments by their instructors.
Results: We observed a significant difference in self-assessment patterns between the groups. Students in Group 1 overestimated their abilities, whereas students in Group 2 underestimated their abilities. However, when we compared students’ self-evaluations and their grades in lecture courses, we found that students with low grades were more likely to overestimate their ability than were students with high grades, regardless of whether they had stated how confident they were in their assessments.
Discussion: By considering their degree of confidence that their self-assessments agreed with assessments by their instructors, students might show more careful assessment behavior. However, students with low grades require a greater degree of individual guidance before exhibiting behavioral changes.

“Depolarized arrest”, induced by hyperkalemic (moderately increased extracellular potassium) cardioplegia is the gold standard to achieve elective temporary cardiac arrest in cardiac surgery. Hyperkalemic cardioplegic solutions provide good myocardial protection, which is relatively safe, and easily and rapidly reversible. However, this technique has detrimental effects associated with ionic imbalance involving sodium and calcium overload of the cardiac cell induced by depolarization of the cell membrane. Hence, the development of an improved cardioplegic solution that enhances myocardial protection is anticipated as an alternative to hyperkalemic cardioplegia. In this review, we assess the suitability and clinical potential of cardioplegic agents to induce “non-depolarized arrest” from the viewpoint of rapid cardiac arrest, myocardial protection, reversibility, and toxicity. “Magnesium cardioplegia” and “esmolol cardioplegia” have been shown to exert superior protection with comparable safety profiles to that of hyperkalemic cardioplegia. These alternative techniques require further examination and investigation to challenge the traditional view that hyperkalemic arrest is best. Endogenous cardioprotective strategies, termed “ischemic preconditioning” and “ischemic postconditioning”, may have a role in cardiac surgery to provide additional protection. The elective nature of cardiac surgery, with the known onset of ischemia and reperfusion, lends it to the potential of these strategies. However, the benefit of preconditioning and postconditioning during cardiac surgery is controversial, particularly in the context of cardioplegia. The clinical application of these strategies is unlikely to become routine during cardiac surgery because of the necessity for repeated aortic crossclamping with consequent potential for embolic events, but offers considerable potential especially if “pharmacological” preconditioning and postconditioning could be established.

A 26-year-old man with Marfan's syndrome suffered aortic dissection repeatedly during hospitalization. He was admitted with a diagnosis of annuloaortic ectasia with severe aortic regurgitation. A type A aortic dissection occurred after diagnostic angiography. Three weeks after the onset of the dissection, an aortic root replacement in combination with a total arch replacement was performed. Eight months later, residual dissection in the descending thoracic aorta was replaced with distal perfusion by a temporary bypass from the left subclavian artery to the descending thoracic aorta. At the termination of the operation, abdominal aortic dissection occurred with acute bilateral limb ischemia, which was treated with abdominal aortic intimal fenestration. He recovered uneventfully and was discharged 3 weeks after operation. In light of our experience, because of vascular fragility, great care should be taken in treating patients with Marfan's syndrome to avoid iatrogenic aortic dissection.

1) The clinical training system in our hospital was evaluated with a questionnaire by 49 trainees.
2) Overall, our clinical training system received high scores, but the scores varied significantly depending on the clinical department.
3) The scores of clinical departments did not correlate with the ratios of supervising physicians to trainees.
4) To provide the best training system possible, the current system must be evaluated and improved.