Vibration applied to the human palm or sole skin induces the tonic finger or toe flexion reflex. This reflex occured merely in 30per cent of the subjects, however the toe flexion reflex was induced in almost all subjects by increase of voluntary flexion of the toe or upward rotation of the ancle joint. This reflex was used as an indicator of the effectiveness of acupuncture stimulation (AS). Electroacupuncture stimulation was mainly applied to the skin with the intensity of perception threshold. AS sites used were Ho-ku, Wai-kuan, etc As a rule, this reflex was inhibited strongly and the inhibitory effect continued for 30min or more. AS applied simultaneously to the acupuncture point and its neighboring area showed summation of the inhibitory effect on the reflex. There was no difference between the effects of AS applied to the same or neighboring dermatome. AS to periphery of limbs was effective but AS to the body was almost ineffective. These results suggest that there is no specificity of the acupuncture point and there are both segmental and nonsegmental mechanisms participate in this inhibitory of AS on vibration-induced flexion reflex.

It is said that the key to effective acupuncture is to perform appropriate stimulation of the best combinations of meridian points which directly or indirectly affect the disease.
In order to determine the difference in the efficacy between combinations of clinically important meridian points, this study examined the effect of two-point acupuncture stimulation on the exteroceptive vibration-induced finger flexion reflex (Eklund et al., 1978).
METHOD
Subjects were six healthy adults of both sexes between 20 and 35 years of age. Two-point combinations were made of IC₄ Hegu (standard point) with each of the following points: IC₆ Pianli, P₇ Lieque, C₃ Shaohai, TM₂₀ Baihui, VU₁₃ Feishu, VU₂₅ Dachangshu, G₃₆ Zusanli. Perception threshold electrical stimulation of each combination was performed at 45Hz for 5min. using subcutaneous needles. The finger flexion reflex was induced by a tapping vibrator applied to the palm and recorded through a pressure transducer.
RESULTS
1) The combination of adjacent points on the hand: Stimulation of Hegu together with Pianli, both of which are on the Large Intestine meridian, caused a strong inhibition of the reflex. The inhibition lasted about twice as long as that caused by stimulation of Hegu alone. However, neither Hegu and Lieque not Hegu and Shaohai stimulation caused prolongation of the inhibition.
2) The combination of the hand and the back: Neither Hegu and Feishu nor Hegu and Dachangshu stimulation caused any prolongation of the inhibition.
3) The combination of the hand and the leg: Hegu and Zusanli stimulation caused marked inhibition, which lasted about four times as long as that caused by Hegu-alone stimulation.
4) The combination of the hand and the head: Hegu and Baihui stimulation caused no or much less inhibition that caused by Hegu-alone stimulation.
5) Examination of difference among stimulating methods: Electrical stimulation through surface electrodes (A), Retained subcutaneous needles (B), Electrical stimulation between a subcutaneous needle and the indifferent electrode. (C), Electrical stimulation between subcutaneous needles (D). The intensity of the inhibition effect of these methods can be expressed as follows:
D>C>B>A
DISCUSSION and CONCLUSION
The reflex inhibition caused by the standard point stimulation was strengthened or weakened by simultaneous stimulation of an additional point. Based on our examination of the characteristics of the inhibition, it was thought that not only mutual interference of impulses at the spinal level but also humoral factors and some polysynaptic reflex mechanism in the higher center level participate in this effect.

We report 18 cases of thoracoabdominal aortic aneurysm repair. Most causes of the thoracoabdominal aortic aneurysm were atherosclerotic lesions (56%) or inflammatory changes (39%), such as Takayasu's aortitis and Behçet's disease. The Crawford procedure was performed in 13 patients, patch aortoplasty in 3, the Hardy procedure in 1 and extra-anatomic bypass in 1. As an adjunct, temporary bypass was employed in 8 patients and F-F bypass in 7 patients. Visceral arteries were perfused selectively during aortic cross-clamp. A total of 39% of all patients required emergency surgery for rupture, and among inflammatory aneurysms 86% of them ruptured. The early mortality rate was 0% in non-ruptured thoracoabdominal aneurysms, 42.9% in ruptured and 16.7% overall. There were 3 severe post-operative complications including one each of paraplegia, non-occlusive intestinal ischemia and rupture. All of them turned resulted in in-hospital death and the in-hospital mortality rate was 33.3%. There was no late death among atherosclerotic thoracoabdominal aortic aneurysms. However both Behçet's disease cases required re-operation for rupture at the anastomotic site in the late postoperative period and one patient died. One Marfan's syndrome patient also died 3 years postoperatively. We conclude that the Crawford procedure with F-F bypass is an effective and safe approach to thoracoabdominal aortic aneurysm repair and yields good clinical results.

Nine patients with type IIIb dissecting aortic aneurysm underwent graft replacement of the thoracic and abdominal aorta between 1988 and 1992. The spiral opening method was used to expose the thoracic and abdominal aorta. Temporal bypass was employed in 2 patients and F-F bypass in 7 patients. Visceral arteries were perfused selectively during aortic cross-clamp. The entire descending thoracic aorta and abdominal aorta was reconstructed in 6 patients and the proximal descending thoracic aorta to renal arteries in 3 patients. The Crawford graft inclusion technique was used in all cases. Three patients required emergency surgery for rupture in one and impending rupture in 2. Operative deaths occurred in 2 patients (22.2%). Morbidity included renal failure (2), bleeding requiring reoperation (2), arrythmia (1), paraplegia (1), paraparesis (1), respiratory failure (1) and ileus (1). In the past two years, we operated on 5 cases of type IIIb dissecting aneurysms and there was neither operative death nor paraplegia.

Introduction: It is important to educate undergraduates about communication errors in clinical sites, but it is difficult for clinically inexperienced students to imagine those errors. Therefore, in this study, a board game (BG) was developed and put into practice to encourage students' understanding.　Methods: The BG consists of a board on which the patient's name is written and cards on which drug names are written. Students place cards on the board according to the teacher's instructions. These instructions include multiple traps based on actual incident cases. Through the game, students experienced errors.　Reflection: This BG contains gamification elements that make learning contents simple and fun and simulation elements that reproduce errors with high fidelity. By combining these elements, it is possible for each aspect of the ARCS model to be provided in a well-balanced manner, even in patient safety education for clinically inexperienced students.

Introduction: Recently, Escape Rooms have been included in educational content.　Method: An Escape Room style class was conducted for first-year medical students to review previously learned content and to learn how to collaborate with others. The class was 70 minutes in total, 45 minutes of that was spent playing games. These included not only puzzles and riddles but also simulation-based tasks such as BLS. Multi-ending style was also used to motivate students.　Result: In addition to the difficulty of making stories and puzzles, the management of staff and organizing of the games were also challenging for the class.　Discussion: There are few comprehensive studies on educational practices using escape rooms. Research is necessary to consider effective and practical training methods.

The novel coronavirus infection (COVID-19) has significantly impacted medical education and the need to respond to rapidly changing and uncertain situation. In addition, with the decision to hold this year’s annual meeting, it was deemed necessary to have a forum for information sharing and discussion. Therefore, a special committee was formed to organize a cyber-symposium on medical education, and four symposia were held every two weeks, starting May 2020, under the themes of ‘Future Clinical Clerkship’, ‘Examinations’, ‘Post-graduate Education’ and ‘Medical Education with Corona’. This paper reports these symposia and provides an overview and future considerations.

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.