A 76-year-old man who underwent thoracic endovascular aortic repair (TEVAR) of an early chronic phase of Stanford type B dissection developed a 71 mm distal aortic arch aneurysm in conjunction with the migration of its proximal end over 9 years of follow-up. The proximal end of the graft had migrated 7 cm distal to the takeoff of the left subclavian artery. The patient underwent total arch replacement with an open stent graft which was connected with the TEVAR graft. He was discharged home 15 days after surgery without complications.

Aim of the present study was to statistically evaluate the examination rule with use of a questionnaire obtained from physicians regarding treatment for chillness of the limbs, and to prove the clinical usefulness of the database. The database showed that tokishigyakukagoshuyushokyoto was the most frequently used to treat chillness of the limbs, and subsequently keishikajutsubuto, hachimijiogan, and tokishakuyakusan were ranked as drugs with wide use. When physicians determined a kampo formulation suitable for each patient, they used findings specific for the kampo formulation, but not uniform findings obtained from the four traditional examination methods (i.e., inspection, listening and smelling, interviewing, palpitation). There was a statistical difference in the selection mode of drugs among physicians. In a simulation obtained from a questionnaire, there was a positive association between time (time X) to the start of becoming physically warm in the limbs, and time (time Y) to remission (R² = 0.971, P = 0.014). The formula (Y = 4.379 X−0.519), which could predict time Y on the basis of information on time X, was able to accurately monitor the clinical courses of 7 responders to treatment for chillness of the limbs. Taken together, these results strongly suggest that the database constructed in the present study may be useful for evaluation of traditional Kampo medicine, and might allow us to perform more fittingly personalized Kampo medicine in the near future.

During the coronavirus pandemic, we focused on Hypothesis-Driven Physical Examination (HDPE), which is performed while considering physical examination and differential diagnosis as issues that can be learned without directly having contact with patients. We created HDPE scenarios with students who elected general medicine in Clinical Clerkship 2, and we implemented HDPE using that scenario on the last day of the clerkship. The scenario was created online and HDPE was conducted face-to-face. Students could learn correct medical examination techniques and manners through mutual learning. In addition, they could acquire communication and lifelong learning abilities through cooperative learning. We were able to enhance the learning effect through mutual learning that works on the students’ own intrinsic motivation in terms of both creating scenarios for the framework of cognitive apprenticeship and implementing HDPE.