Introduction: This study examines the relationship between learning styles and outcomes of interprofessional education (IPE) through co-curricular learning for medical and welfare students.Method: To analyze changes over time, we utilized IPE evaluations of students from Nagasaki University School of Medicine and the Department of Comprehensive Community Care Services, Nagasaki Junshin Catholic University, who participated in either face-to-face or online classes.Results: The learning outcomes from medical and welfare perspectives in IPE significantly increased regardless of the learning style. As for the same perspective on students from each department, the value of many outcomes in face-to-face learning showed significant increases compared to online classes.Discussion: The learning outcomes of IPE in medical and welfare through online classes were considered to have achieved certain results. Additionally, differences in learning outcomes depending on the learning style were thought to be due to variations in understanding between the groups. It was suggested that long-term studies are necessary for effective co-curricular learning in the future.

Introduction・Purpose: We conducted qualitative research to explore the psychosocial processes by which dental trainees overcome difficulties during clinical training. Our focus was on their resilience.　Methods: Semi-structured interviews with nine trainee dentists were conducted. For the data analysis, we used Modified Grounded Theory Approach.　Results: The three factors, namely, “relationships with others” , “inner strengths” , and “acting autonomously” , contributed to the processes by which negative effects of trainee dentists changed into positive ones.　Discussion: It was suggested that these factors could provide clues to understanding the psychological burden of dental trainees and how to support them in gaining self-confidence.

A 79-year-old man, who had a history of intravesical instillations of bacillus Calmette-Guérin (BCG) therapy for urinary bladder cancer, developed bloody sputum 4 years after BCG therapy. BCG was detected from the sputum by detailed examination. Medical therapy for tuberculosis (TB) was started, but bloody sputum continued. Computed tomography (CT) for the chest was performed to evaluate the state of TB, and surprisingly, found impending rupture of tuberculosis mycotic thoracic aneurysm. He was emergently transferred to our hospital. CT revealed that the aneurysm made a lump with surrounding lung and lymph nodes. It seemed to be quite difficult to dissect and to be quite high risk to perform graft replacement with pneumonectomy. On the other hand, TB infection was controlled with antibiotic therapy. Thus we chose debranch TEVAR for this complicated situation. His bloody sputum regressed soon after the procedure and disappeared during his hospitalization. He was discharged home on POD 13 without serious complication and continued to have antibiotic therapy under the instruction of his primary physician.

Endovascular treatment for chronic aortic dissection in patients with Marfan syndrome is still controversial. A 60-year-old man developed an extended chronic type B dissection involving the aortic arch and thoraco-abdominal aorta with a large entry at the distal aortic arch and patent false lumen. He had undergone David procedure for type A aortic dissection at age 42, and aortic valve replacement for recurrent aortic valve insufficiency at 58, which was complicated with mediastinitis. He also suffered drug-induced interstitial pneumonitis. Considering his complicated surgical history and impaired pulmonary function, conventional graft replacement of thoraco-abdominal aorta was thought to be quite a high risk. Thus, we chose debranch TEVAR with a staged approach. First, debranching and Zone 0 TEVAR with the chimney technique were performed. Then, 4 months later, abdominal debranching and TEVAR was performed. The patient tolerated both procedures well and was discharged home. Two years after last procedure, he is in good condition and computed tomography shows that complete entry closure and false lumen had thrombosed. This strategy may be worthy to be considered even for a patient with Marfan syndrome, in case the patient's condition is unsuitable for conventional surgery.

Histiocytic sarcoma in the liver is an extremely rare hematological malignancy. Herein, we reported the case of a 68-year-old woman who presented with characteristic wedge-shaped abnormality bounded by hepatic veins on computed tomography and magnetic resonance imaging of the liver. In the wedge-shaped area, decreased portal flow and the deposition of iron were observed. These imaging findings are consistent with intrasinusoidal tumor cell infiltration. A liver biopsy was performed, and histiocytic sarcoma was confirmed histopathologically.
Aged ; Biopsy ; Female ; Hematologic Neoplasms ; Hepatic Veins ; Histiocytic Sarcoma* ; Humans ; Iron ; Liver ; Magnetic Resonance Imaging*

A 74-year-old woman was referred to our unit with a chief complaint of dysphagia. Enhanced CT showed a Kommerell diverticulum with a maximum diameter of 46 mm, associated with a right-sided aortic arch and aberrant left subclavian artery. We performed two-staged operations : left subclavian-common carotid artery bypass followed by total arch, and descending aortic replacement by an antero-lateral thoracotomy with partial sternotomy (ALPS). The postoperative course was uneventful. Total arch and descending aortic replacement for a Kommerell diverticulum by an ALPS approach is rare. ALPS approach for Kommerell diverticulum achieves safe surgery with good exposure.

A tutorial education system for medical students was introduced at Kinki University in 1998. To evaluate the efficacy and to identify problems of the system, questionnaires were given to both students and tutors. Many students (approximately 80%) enjoyed the system and felt that tutorial lectures were effective. Many students believed that their selflearning time had increased and that they had developed the ability to think scientifically. However, they also thought that the material for tutorials was insufficient and that some tutors lacked teaching ability. Tutors thought that students had developed motivation (52%), problem-solving ability (58%), and debating skills (77%). Tutors also pointed out several problems, e.g., that some students had not developed self-leaning ability. Also, some tutors were poorly motivated. These findings suggest that we need to improve tutorial materials and the quality of tutors as well as fostering the self-learning ability of students.