The Evolution of Medical Education

Education about medicine has an ancient history. It seems to me that it is probably the oldest part of the history of education. In the time of the ancient Greeks, Hippocrates gathered his disciples, taught them medicine, and wrote books on the subject. In Japan as well, medicine was introduced from China and other continents in ancient times, and in the Heian period（７９４‐１１８５）, Tamba Yasuyori wrote “Ishinpo”, which was a systematic form of medicine. During the Edo period （１６０３‐１８６８）, people learned medical science through apprenticeship with prominent doctors. From the end of the Edo period to the Meiji era, the Western style of medical schools came in, where several doctors with different educational abilities with different specialties came together to systematically teach medicine to a large number of students. The ２０th century saw an accelerated fragmentation of medical specialties and an exponential increase in the amount of information about medicine. This trend has continued at an accelerated pace today and will continue for many years to come. On the other hand, the length of medical schooling has remained basically unchanged. It is unlikely to change much in the future ; until the first half of the ２０th century, lectures still seemed to be exhaustive. The lecture notes of medical students at that time tell the story of dictation that rivaled the textbooks of the time ; in the second half of the ２０th century, such exhaustive lectures gradually diminished and the style of teaching began to change. Audio-visual materials were also introduced to increase the amount of information conveyed per credit hour. In addition, bedside teaching was introduced, and clinical practice began to be substantiated. In the late １９８０s, new educational methods such as the New Pathway at Harvard University in the U. S. were introduced, and in the １９９０s, some universities in Japan began to introduce these methods, which accelerated at the beginning of this century. In the １９９０s, universities began to introduce a new method of teaching, such as the small-group tutorial format, in which learners learn mainly by discussion, and faculty members take the role of supporting them. Students who had been fed cooked medical information through spoon feeds are now required to acquire the ability to prepare and eat the ingredients themselves. We have entered an era in which students are expected to develop the ability to make the best use of the vast amount of medical information that is available. In addition, it is no longer important to assess “how well the faculty taught the students” but rather “how well the students were able to do what they were able to do”. Quality and quantity are now being assessed in clinical practice, and students are now expected to participate in the practice team. It is a deeper, more practical learning（deepening）, a style of learning that would have been done after graduation in the past. And it became common sense to organize the curriculum around a core of what students should have acquired after graduating from medical school（coring）. Seamless connections between undergraduate education and post-graduate clinical training will be even more sought after in the future. They must be connected to specialty training and postgraduate education. The fundamental driving force behind this evolution of medical education has been medical research, which has led to an increase in medical information. There is no doubt about it. With the times, the true value of medical education is being questioned. Ars longa, vita brevis-Hippocrate

Homology of the adductor pollicis and contrahentes muscles: a study of monkey hands.

The deep palmar muscles in monkey hands were studied. The contrahentes muscles mainly arose from the capitate bone, descended palmar to the deep palmar branch of the ulnar nerve and the palmar metacarpophalangeal nerves, and attached to the proximal phalanges or wing tendons of the second, fourth and fifth fingers. In relation to the deep palmar branch of the ulnar nerve and the palmar metacarpophalangeal nerves, the contrahentes muscles are homologous with the adductor pollicis and flexor indicis radialis muscles. The contrahentes muscles occasionally gave off some accessory slips which blended with the interosseous muscles. These findings suggest that the human adductor pollicis muscle is a well-developed remnant of a contrahens muscle, and that the human interosseous muscles contain some remnant of the contrahentes muscle. In fact, a well-developed remnant of a contrahens muscle was found in the fourth finger of a human hand. It is further considered that the human adductor pollicis muscle contains an element of the interosseous muscle of the thumb.</p

Stereoscopic Three-Dimensional Images of an Anatomical Dissection of the Eyeball and Orbit for Educational Purposes

The purpose of this study was to develop a series of stereoscopic anatomical images of the eye and orbit for use in the curricula of medical schools and residency programs in ophthalmology and other specialties. Layer-by-layer dissection of the eyelid, eyeball, and orbit of a cadaver was performed by an ophthalmologist. A stereoscopic camera system was used to capture a series of anatomical views that were scanned in a panoramic three-dimensional manner around the center of the lid fissure. The images could be rotated 360 degrees in the frontal plane and the angle of views could be tilted up to 90 degrees along the anteroposterior axis perpendicular to the frontal plane around the 360 degrees. The skin, orbicularis oculi muscle, and upper and lower tarsus were sequentially observed. The upper and lower eyelids were removed to expose the bulbar conjunctiva and to insert three 25-gauge trocars for vitrectomy at the location of the pars plana. The cornea was cut at the limbus, and the lens with mature cataract was dislocated. The sclera was cut to observe the trocars from inside the eyeball. The sclera was further cut to visualize the superior oblique muscle with the trochlea and the inferior oblique muscle. The eyeball was dissected completely to observe the optic nerve and the ophthalmic artery. The thin bones of the medial and inferior orbital wall were cracked with a forceps to expose the ethmoid and maxillary sinus, respectively. In conclusion, the serial dissection images visualized aspects of the local anatomy specific to various procedures, including the levator muscle and tarsus for blepharoptosis surgery, 25-gauge trocars as viewed from inside the eye globe for vitrectomy, the oblique muscles for strabismus surgery, and the thin medial and inferior orbital bony walls for orbital bone fractures

Typology of Abdominal Arteries, with Special Reference to Inferior Phrenic Arteries and their Esophageal Branches

Origins and distribution of the human inferior phrenic arteries were studied by dissecting 68 Japanese adult cadavers. The inferior phrenic arteries were usually observed as paired (left and right) vessels. Their origins were summarized as follows: a) the aorta itself (85/138 cases, 61.6%), b) the ventro-visceral arteries (celiaco-mesenteric system of the aorta) including the celiac trunk (39/138 cases, 28.2%) and the left gastric artery (4/138 cases, 2.9%), and c) the latero-visceral arteries (adreno-renal system of the aorta) including the middle adrenal artery (4/138 cases, 2.9%) and the renal artery (6/138 cases, 4.3%). The left and right arteries occasionally originated in common trunk from the aorta, celiaco-mesenteric system or adreno-renal system (22/138 cases, 15.9%). A typological diagram explaining these variations is given. The inferior phrenic arteries, especially the left ones, sometimes issued visceral or esophageal branches. This fact indicates that the inferior phrenic arteries are homologous with the celiac trunk and mesenteric arteries. It is further discussed that the celiac trunk and mesenteric arteries are originally paired vessels, through introduction of our previous typological diagram of the abdominal arteries.</p

Glycocalyx Degradation in Retinal and Choroidal Capillary Endothelium in Rats with Diabetes and Hypertension

Endothelial glycocalyx (GCX) has been reported as a protective factor for vascular endothelial cells (VEC) in diabetes and hypertension. However, the involvement of GCX impairment in ocular vasculopathy remains unclear. We evaluated the changes in the GCX thicknesses of the retinal and choroidal capillaries in rats with diabetes and hypertension by cationic colloidal iron staining using a transmission electron microscope. In the control group, the mean (standard error of the mean) thicknesses of retinal and choroidal GCX were 60.2 (1.5) nm and 84.3 (3.1) nm, respectively. The diabetic rats showed a significant decrease of GCX thickness in the retina, but not in the choroid, compared to controls (28.3 (0.3) nm, p＜0.01 and 77.8 (1.4) nm, respectively). In the hypertensive rats, both retinal and choroidal GCX were significantly decreased compared to the control values (10.9 (0.4) nm and 13.2 (1.0) nm, respectively, both p＜0.01). Moreover, we could visualize the adhesion of leukocytes and platelets on the luminal surface of VEC, at the site where the GCX was markedly degraded. These findings suggest that the GCX prevents adhesion of leukocytes and platelets to the VEC surface, and this impairment may lead to ocular vasculopathy in diabetes and hypertension

Biomechanical Evaluation of the Fixation Methods for Transcondylar Fracture of the Humerus:ONI Plate Versus Conventional Plates and Screws

We biomechanically evaluated the bone fixation rigidity of an ONI plate (Group I) during fixation of experimentally created transcondylar humerus fractures in cadaveric elbows, which are the most frequently observed humeral fractures in the elderly, and compared it with the rigidity achieved by 3 conventional fixation methods:an LCP reconstruction plate 3.5 using a locking mechanism (Group II), a conventional reconstruction plate 3.5 (CRP) with a cannulated cancellous screw (Group III), and a CRP with 2 cannulated cancellous screws (CS) in a crisscross orientation (Group IV). In the axial loading test, the mean failure loads were:Group I, 98.9+/-32.6;Group II, 108.5+/-27.2;Group III, 50.0+/-7.5;and Group IV, 34.5+/-12.2 (N). Group I fixations failed at a significantly higher load than those of Groups III and IV (p0.05). In the extension loading test, the mean failure loads were:Group I, 34.0+/-12.4;Group II, 51.0+/-14.8;Group III, 19.3+/-6.0;and Group IV, 14.7+/-3.1 (N). Group IV fixations showed a significantly lower failure load than those of Group I (p0.05). The fixation rigidities against mechanical loading by the ONI plate and LCP plate were comparable. These results suggested that an ONI system might be superior to the CRP and CS method, and comparable to the LCP method in terms of fixation rigidity for distal humerus fractures.</p

Absence of scalenus anterior muscle.

A rare anomaly of the scalenus muscles is described. In this case, the right scalenus anterior muscle was absent. As a substitute for this muscle, some aberrant muscle slips arose from the lower vertebrae and descended in front of the ventral rami of the lower cervical nerves. These aberrant slips then ran between the ventral rami of the the eighth cervical and first thoracic nerves, and were fused with the right scalenus medius muscle. Thus, the subclavian artery and vein ran in front of the aberrant slips, together with the ventral ramus of the first thoracic nerve. The aberrant muscle slips issued 2 accessory bundles. One bundle ran between the ventral rami of the fourth and fifth cervical nerves and was fused with the scalenus medius muscle; the other bundle ran between the ventral rami of the fifth and sixth cervical nerves and was fused with the scalenus medius muscle.</p

Perineuronal Sulfated Proteoglycans in the Adult Rat Brain: Histochemical and Electron Microscopic Studies

Neurons of cerebellar nuclei in the rat brain had a marked surface coat which was stained with cationic iron colloid or aldehyde fuchsin. Neurons with a similar surface coat were also noted in the retrosplenial cortex. The surface coat was stained doubly with cationic iron colloid and aldehyde fuchsin. Digestion with hyaluronidase eliminated the stainability of the surface coat to both agents. Combined digestion with chondroitinase ABC, heparitinase and keratanase eliminated the cationic iron colloid staining but did not interfere with the aldehyde fuchsin staining. Electron microscopy of ultrathin sections revealed that the iron particles were deposited in the perineuronal tissue spaces. These findings indicate that the surface coat consists of sulfated proteoglycans which occupy, as the extracellular matrix, the perineuronal tissue spaces. Many neurons in the retrosplenial cortex were labeled with lectin Vicia villosa agglutinin. Double staining revealed that these lectin-labeled neurons are usually reactive to cationic iron colloid. Few neurons in the cerebellar nuclei were labeled with lectin V. villosa agglutinin.</p

Blood microvascular organization of the nasal-associated lymphoid tissue of the guinea pig: a scanning electron microscopic study of corrosion casts.

It has previously been confirmed that the guinea pig has aggregations of 10-20 lymphoid follicles at the junction of the nasal cavity and the nasopharyngeal duct. The vascular architecture of this nasal-associated lymphoid tissue (NALT) was studied by the corrosion cast/scanning electron microscope method. The NALT was supplied by branches of the inferior nasal artery. These afferent arterial branches gave off arterioles to the follicles and the interfollicular regions, where the arterioles ramified into capillaries. Some of these arterioles reached the subepithelial region to form a single-layer dense capillary network. The subepithelial capillaries gathered into short collecting venules, which in turn drained into high endothelial venules (HEV) in the interfollicular region. The HEV, which also receives tributaries from the follicular and interfollicular capillary plexuses, descended in the interfollicular regions and finally flowed into the efferent veins at the bottom of the NALT. Indentations impressed by high endothelial cells (HEC) were prominent on the surface of the HEV casts, and their frequency was larger in the upper course or segments than in the lower. This suggests that the incidence of HEC in the upper segments is higher than in the lower segments, and these findings are consistent with the hypothesis that some substances which are taken up into the subepithelial capillaries and transported to the venules induce differentiation and maintain of HEVs.</p

The occurrence of neurons with strongly negatively charged surface coats in mammalian, avian, reptilian, amphibian and piscine brains.

Neurons with strongly negatively charged surface coats were recognized in mammalian, avian, reptilian, amphibian and piscine brains. Many large-sized neurons had strongly negatively charged surface coats in the visual cortex and brain stem of the cow, cat, guinea pig, mouse, quail and parakeet. Such neurons were also seen in the brain stem of the lower vertebrates such as the house lizard, Japanese terrapin, bullfrog, newt, carp and sweetfish.</p