Methods: Finite element models of T12 and L1 were constructed from computed tomography images of osteoporotic patients. Three analyses were conducted: (1) the impact of various screw diameters with DEPST, (2) a comparison of fixation strength between short DEPST (S-DEPST), which penetrates the posterolateral endplate, and conventional DEPST (C-DEPST), and (3) a comparison between conventional cancellous thread screws (CTS) and endplate screws (ETS). Pullout strength (POS) was measured in all analyses. Vertebral motion angle (VMA) of the lower instrumented vertebra (LIV) was measured in analyses (2) and (3), and the four-directional load test (4DLT) was performed in analysis (2). Results: Larger screw diameters with DEPST correlated with elevated POS. S-DEPST demonstrated significantly better fixation strength with a POS 1.46 times higher than C-DEPST and 2.5 times higher than traditional trajectories. S-DEPST also demonstrated higher fixation in all directions in 4DLT. However, no significant difference was observed in the VMA of LIV. ETS demonstrated slightly higher fixation than CTS, but the difference was not statistically significant. Conclusions Fixation strength improved with larger screw diameters in DEPST. S-DEPST provided additional fixation due to rim penetration. ETS may offer a higher fixation strength and warrants further validation.

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.