Cognitive apprenticeship and reflective practice are fundamental educational theories supporting postgraduate clinical training. Community hospital rotations provide ideal opportunities to apply these theories. However, community hospitals face challenges in securing educational time due to faculty shortages and heavy clinical workloads, leading to on-the-job training becoming the primary educational approach. Consequently, opportunities for structured instruction and reflection may be limited, potentially hindering the implementation of cognitive apprenticeship and reflective practice. To address this mismatch between educational needs and available resources, we implemented a remote educational conference focused on clinical questions (CQs) arising from residents' clinical experiences. Unlike traditional clinical conferences that focus on determining patient management, this initiative centers on reflective dialogue based on CQs formulated by residents themselves. By integrating experiential learning theory and reflective practice theory and focusing specifically on the latter three steps of cognitive apprenticeship, we successfully constructed an effective educational model for remote learning environments. This practice enables high-quality medical education that transcends geographical constraints and is considered valuable for future community-based medical education.

The role of academic journals evolves with the times. Academic publishing is diversifying, shifting from traditional paper-based formats to broader dissemination through open access. In response to these developments-and to contribute to ongoing progress in medical education-Medical Education (Japan) has undertaken a comprehensive revision of its submission guidelines. As of January 17, 2025, all submissions, peer reviews, and editorial processes are being conducted in accordance with the updated guidelines.　The Editorial Board convened a round-table discussion to explore recent developments, beginning with the revision of the submission guidelines. This discussion elaborates on the journal's role and its relevance to the academic community, including society members, authors, and readers. It features statements from participating editorial committee members and highlights the key issues discussed, including the criteria each member uses to evaluate manuscripts. The aim is to offer insight into the journal's editorial stance and decision-making process.

We organized salon activities in Kudoyama-cho, Wakayama Prefecture, that engaged pharmacy students in community health support activities. The project aimed to explore current health support initiatives and the potential contributions of the students to local communities. During the activities, the students engaged with participants through exercises, dances, and games. We found that students' participation enhanced interactions in the salon through their creative approaches. A system enabling pharmaceutical students to be continuously involved in the salon should be established through collaborations between universities and local governments.

This case involves a man in his 60s who was undergoing rituximab therapy and developed COVID-19 pneumonia and showed persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite treatments with dexamethasone, remdesivir, tocilizumab, and other drugs, the patient remained SARS-CoV-2 positive and ultimately died of respiratory failure. Patients receiving B-cell depletion therapy have an increased risk of persistent viral infections due to immunosuppression, underscoring the importance of early intervention with antiviral drugs and neutralizing antibodies in such cases.

Objective: This study evaluated the inflammatory response in lungs of EAE mice by immunohistochemistry and histochemistry. Methods: Eight adult C57BL/6 mice were injected with myelin oligodendrocyte glycoprotein 35-55 to induce the EAE. Lungs and spinal cords were sampled from the experimental mice at the time of sacrifice and used for the western blotting, histochemistry, and immunohistochemistry. Results: Histopathological examination revealed inflammatory lesions in the lungs of EAE mice, characterized by infiltration of myeloperoxidase (MPO)- and galectin-3-positive cells, as determined by immunohistochemistry. Increased numbers of collagen fibers in the lungs of EAE mice were confirmed by histopathological analysis. Western blotting revealed significantly elevated level of osteopontin (OPN), cluster of differentiation 44 (CD44), MPO and galectin-3 in the lungs of EAE mice compared with normal controls (p < 0.05).Immunohistochemical analysis revealed both OPN and CD44 in ionized calcium-binding adapter molecule 1-positive macrophages within the lungs of EAE mice. Conclusions and Relevance: Taken together, these findings suggest that the increased OPN level in lungs of EAE mice led to inflammation; concurrent increases in proinflammatory factors (OPN and galectin-3) caused pulmonary impairment.

A 32-year-old woman was diagnosed with Takayasu's arteritis 5 years ago and underwent aortic valve replacement for aortic regurgitation 1 year ago. She had been taking Prednisolone and Azathioprine for Takayasu's arteritis, but these drugs were switched to subcutaneous Tocilizumab 4 months ago. One month ago, she had dyspnea on exertion, and 2 days ago, chest discomfort appeared, and she came to our hospital. Blood tests showed CRP 0.02 mg/dl, and echocardiography and CT showed perivalvular leakage and aortic root pseudoaneurysm, which led us to suspect aortic root pseudoaneurysm due to Takayasu's arteritis and to perform emergency surgery. Although a circumferential pseudoaneurysm was observed at the aortic root, no destruction of the prosthetic valve was observed. The suture from the previous surgery was attached to the sawing cuff of the prosthetic valve, and the prosthetic valve was not fixed to the aortic annulus and could be easily removed. The Bentall operation was performed using a bioprosthetic valve. The histopathological diagnosis was subacute infective endocarditis, and the patient was diagnosed with a pseudoaneurysm of the aortic root due to infection. The patient had a good postoperative course and was discharged home on the 19th day. We report a case of Takayasu's arteritis with valve annular abscess after AVR, which was treated surgically during biologic drug administration.

Objective: When dopamine is administered using a syringe pump, the reduction in drug infusion volume due to syringe replacement can cause hemodynamic instability. To address this, several changeover methods have been developed. This study aimed to investigate the optimal syringe changeover method by comparing the time required for syringe replacement and the drug infusion volume during replacement across different methods. 　Methods: Experiment I. The time required for syringe replacement using the standard syringe changeover method and the flushing method was compared using the Mann-Whitney U test, and the volume of dopamine solution not infused during syringe replacement was estimated. Experiment II. At dopamine infusion rates of 3.6 ml/h (general initial rate) and 6.0 ml/h (standard rate), the dopamine infusion volume over 60 min after syringe replacement was compared between the on-off method or double pumping method and standard syringe changeover method. 　Results and Discussion: There was no significant difference in syringe replacement time between the standard syringe changeover method and the flushing method. The volume of uninfused dopamine solution during the syringe replacement period was less than 0.1 ml for both flow rates. At a flow rate of 3.6 ml/h, the volume of dopamine infused 10 min after the start of infusion was significantly larger with both the double pumping method and the on-off method compared with the standard method. At 30 min and between 50 to 60 min, only the on-off method showed a significantly larger infusion volume compared with the standard method. At a flow rate of 6.0 ml/h, no significant differences were observed at any time point. These findings suggest that higher flow rates may reduce the impact of frictional resistance.