At the Showa University School of Medicine, an innovative curriculum was introduced beginning in the academic year 2020, aiming to keep medical education in step with societal progress. The curriculum enables the acquisition of fundamental clinical skills from the first year. It then integrates an observational clinical practice scheme for one day per week from the second half of the second year to the first half of the fourth year. After successful completion of the “Common Achievement Test” during the summer of their fourth year, students begin participating in clinical practice for approximately two years, culminating in the summer of their sixth year. Following the foundational medical instruction, the curriculum advances to incorporating an integrated education model, combining basic and clinical sciences with an emphasis on active learning strategies. The curriculum’s structure has been reformed, reducing the length of each class session from 90 to 65 minutes and making attendance optional. Moreover, before class participation, students are required to engage with on-demand lectures, each spanning 20 minutes, to prepare for the class interactive learning sessions. The educational framework is based on a foundational trust in the students and the educators’ resolute commitment to delivering medical education that meets international standards. Consequently, it has engendered highly motivated students and the development of responsible and autonomous learners.
Thus, the students and educational staff of Showa University School of Medicine are esteemed to be unparalleled within the Japanese context.

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As a major reform to the medical education at Showa University, a new curriculum was introduced for second-year medical school students in 2021, to provide a wide range of basic medical knowledge and skills applicable to clinical practice. The curriculum has been reorganized to integrate traditional basic medical education, diverse practical knowledge, and exercises conducted by clinicians. The first half of the second year focuses on the structure and function of the normal human body “The Structure and Function of the Human Body”; the curriculum’s units are arranged in order based on the organ, and each unit integrates anatomy, physiology, and biochemistry. We have created a curriculum that appropriately incorporates integrated learning, exercises, and practical training. In the second half, the “General Pathology” course concentrates on the basics of pathological conditions of the human body. The students gain an understanding of pathological conditions through an integrated learning of pathology and microbiology, as well as hands-on exercises and practice. To sum up, this review outlines the features of the new curriculum’s learning content and schedule regarding basic medicine.

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Active learning is a comprehensive term encompassing educational and instructional techniques that aim to elicit proactive learning from students; it does not refer to simple self-study or passive learning. Unlike the conventional cramming-style education that is prevalent in Japan, which has limitations in cultivating versatile skills and problem-solving abilities, active learning has been adopted globally, including in the United States. Students are expected to not only actively respond to a given task but also constantly contemplate and explore answers. Active learning is promoted by facilitating such activities among teachers and talented students. Japan’s Ministry of Education has redefined universities as institutions for higher education where students continuously learn throughout their lives and cultivate the ability to think independently. This definition anticipates graduates with high levels of bachelor’s competence, meaning individuals with outstanding international competitiveness. To this end, instructors need to create curricula that sustain students’ motivation for goal-setting and learning and stimulate intellectual curiosity. At medical schools, acquiring comprehensive abilities through active learning and a background in medical art are needed to cultivate professionalism in addition to the accumulation of knowledge. Finally, sincerity to patients is the most important attitude for medical professionals. That is what Showa University’s policy of “Shisei-Ikkann” means. For this purpose, the authors designed and constructed a new curriculum that provides opportunities for learning the abovementioned aspects while having fun. With respect to active learning, the most important point in promoting medical education is increasing learning engagement and the time for “out-of-class learning,” Leading educational institutions prioritize constructive discussions and creative group work as pillars of educational concepts with the concept of the physical classroom as a location in which vast amounts of knowledge are unilaterally accumulated gradually disappearing. By actively adopting the latest and most effective educational methods, such as flipped classrooms and gamification, and leveraging information and communications technology and the Internet of Things, the Showa University School of Medicine has implemented an advanced, sustainable curriculum compared with those of other medical schools. Various mechanisms have been developed to enhance students’ motivation; moreover, effective debriefing and peer teaching ensure a deep and long-term understanding of learned contents.

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In 2020, Showa University School of Medicine implemented a new curriculum, particularly emphasizing clinical training. The curriculum introduces clinical training from the first year and a 19-month extensive clinical participation program to enrich students’ knowledge, skills, and attitudes. This framework ensures that medical students develop practical clinical capabilities and professionalism and stay motivated. Herein, we aimed to describe the deliberation process for the introduction of clinical training in the new curriculum, the improvements made, and the specific clinical training operations. The curriculum at Showa University School of Medicine is expected to undergo continuous enhancements to cultivate competent physicians who can actively participate as members of a medical team.

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The curriculum and diploma policy of Showa University retail undergraduate medical students to gain an international medical perspective and have the spirit and mindset to acquire the latest international medical knowledge and skills. Thus, elective training at overseas medical institutes have been established by International Exchange Center, and medical English education programs have been implemented in the six-year curriculum. However, it could not be ascertained whether these trainings and programs have necessarily achieved the standard level of medical English education being aimed for in Japan. To align our medical English education to the international medical standard, we established the “Internationalization and Medical English Education Committee,” and introduced multiple achievement goals in the revised competency-based milestone and regular educational programs to foster and enhance the students’ awareness of international medical care during their 6-year medical education in Showa University.

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The global coronavirus disease 2019 （COVID-19） pandemic has raised concerns on the risk of aerosol transmission in the dental care setting. Given the inevitability of aerosol generation and direct contact with the patient’s oral mucosa and saliva during dental procedures, early directives from the World Health Organization and government organizations emphasized minimizing aerosol-generating dental practices. Subsequently, clear guidelines were established and risk assessments were conducted based on a comprehensive characterization of the COVID-19 infection risk in dentistry. However, despite advancements in the past 3 years, achieving a consensus on COVID-19 aerosol transmission remains challenging. This review outlines the infection risks in dental practice, explores measurement methodologies, and discusses the future of infection control in dentistry. This article offers insights into the countermeasures for various infections, particularly COVID-19, and may help guide dental practitioners implement robust infection control measures.

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CD71/transferrin receptor 1, a crucial type Ⅱ transmembrane glycoprotein, plays a vital role in regulating iron uptake and cell proliferation, and it is commonly found in various cancer cells. This study aimed to assess CD71 expression through immunohistochemistry in colorectal tubular adenoma, tubular adenocarcinoma, and carcinoma in adenoma, with the objective of determining the usefulness of CD71 immunohistochemistry in diagnosing colorectal cancer histopathologically. Subjects and Methods: The study included 28 colorectal tubular adenomas and 34 tubular adenocarcinomas obtained through endoscopic resection. Among the tubular adenocarcinomas, 16 （47％） were categorized as intra-adenoma carcinomas, and the adenoma and adenocarcinoma sections were evaluated separately. CD71 expression was evaluated across five grades: Grade 0 indicated no staining, Grade 1 denoted positive staining limited to the cellular membrane, Grade 2 represented weak and focal cytoplasmic positivity, Grade 3 indicated diffuse cytoplasmic positivity in portion of the tumor, and Grade 4 indicated intense and diffuse cytoplasmic positivity throughout the tumor. Statistical analysis involved the χ-square test and Fisher exact test for independence to compare differences between groups. Results: CD71 expression in adenoma was Grades 0, 1, 2, and 3 in 12, 13, 2, and 1 cases, respectively, with the majority falling into Grade 0-1 （n＝25） and no Grade 4 cases observed. Conversely, CD71 expression in adenocarcinoma was Grades 1, 2, 3, and 4 in 6, 6, 9, and 13 cases, respectively, with diffuse positivity being predominant and no Grade 0 cases identified. Among the 16 cases of carcinoma in adenoma, the adenoma portion exhibited low CD71 expression （Grades 0, 1, or 2） in all instances, whereas 10 of these cases showed elevated CD71 expression （Grades 3 or 4） in the adenocarcinoma portion. Conclusions: CD71/transferrin receptor 1 expression levels were notably lower in colorectal tubular adenomas compared to tubular adenocarcinomas. Moreover, CD71 demonstrated differential expression patterns between the adenoma and adenocarcinoma portions of carcinoma in adenoma originating from the same tumor clone, indicating that CD71 immunohistochemistry might serve as an additional tool in the histopathological diagnosis of colorectal tumors.

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This report presents case of a 13-year-old boy with refractory ulcerative colitis who experienced a remission after ustekinumab therapy. The patient was diagnosed through lower gastrointestinal endoscopy at our institution. The standard treatment with steroids did not result in remission. Therefore, the patient was treated with adalimumab, a biological agent. Despite some improvements in the symptoms, the patient did not attain full remission until ustekinumab was introduced. After introducing ustekinumab, the patient maintained remission for eight months. Therefore, timely introduction of biological agents is considered important for achieving early remission in refractory ulcerative colitis cases.

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Horner syndrome （HS） is an oculosympathetic neuropathy characterized by miosis, ptosis, and anhidrosis. Although retropharyngeal abscesses in children are sometimes encountered clinically, HS is rare. Herein, we report a case of HS associated with a retropharyngeal abscess in a girl aged 3 years and 11 Months; the patient had a history of cervical pain, fever, and ptosis. Contrast-enhanced computed tomography （CT） confirmed retropharyngeal abscesses; thus, sulbactam sodium/ampicillin sodium therapy was started. On treatment day 3, the patient underwent incisional drainage of the posterior pharyngeal abscess. On postoperative day 1, the patient’s eyelid drooping improved. The patient’s continued to improve. On day 8, the abscess cavity disappeared, as confirmed by contrast-enhanced CT. On day 9, the patient was discharged. The oculosympathetic pathway has a circuit comprising three neurons. The first-order neuron originates in the hypothalamus and descends to make synapses in the spinal cord. The second-order neuron leaves the cord and forms synapses in the upper cervical ganglion. The third-order neuron is divided into two branches: 1） on the one hand they ascend along the inner carotid artery, cross the cavernous sinus, and innervate the Müller and iris dilator muscles and 2） On the other hand, the fibers that regulate sweating ascend along the outer carotid and inner maxillary arteries toward the face. In the current case, the patient presented with ptosis caused by damage to the internal carotid plexus; nonetheless, the external carotid plexus remained intact, and no sweating disorder occurred. Although rare, HS resulting from retropharyngeal abscess does exist. Therefore, neurological symptoms should be assessed in suspected patients.

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We present a case of bilateral simultaneous idiopathic facial nerve palsy. A 64-year-old man presented with peripheral facial palsy on both sides of the face, concurrently, following the onset of a fever of unknown origin. The diagnosis was bilateral simultaneous Bell’s palsy, as there was no evidence of systemic disease. After approximately 2 months of conservative treatment, the patient achieved complete recovery. Simultaneous cases of facial nerve palsy typically have a relatively good prognosis. Therefore, avoiding systemic administration of steroids may be preferable, particularly if an underlying disease is suspected.

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