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The Case Study of Vanitas

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The Case Study of Vanitas (ヴァニタスの 手記 ( カルテ ) , Vanitasu no Karute ) is the second main manga series by mangaka Jun Mochizuki following the completion of her one-shot Crimson-Shell and her first main series Pandora Hearts . The series launched on December 22nd 2015 and is being published monthly in Gangan Joker magazine. Yen Press publishes the official English localization, translated by Taylor Engel. In Japanese, it is marketed as part of the "shounen" demographic. In English, it is marketed as "older teen."

On March 28, 2021, Studio BONES announced an anime adaptation , which aired from the summer of 2021 to the spring of 2022.

• 2.1 Vampires
• 2.2 The Book of Vanitas
• 2.3 Malnomen
• 3.3 Stage Play
• 6 Navigation

Centuries prior to the French Revolution, the " World Formula " theory was proposed by Paracelsus which posited that the world was governed by mathematical formulas whose variables could be identified and altered. He aspired to change these variables in an attempt to erase suffering and bring happiness to humanity, which resulted in the event known as " Babel ." Innumerable calamities rocked the world to its core, causing massive amounts of death, and once it subsided new entities came into being in the world, primely the Vampire species . Deemed abominations before God, normal humans attempted to wipe out these new beings, and a race war ensued. This attempted genocide failed and Vampires began to hide their existences which came to be believed as no more than myth and legend, despite dwelling only one step beyond the human world.

Noé Archiviste , a young vampire living in late 19th century France, is sent by his Teacher to Paris to find the Book of Vanitas and discover its true nature. Supposedly, the Book of Vanitas is a cursed grimoire created by the Vampire of the Blue Moon from which the incurable disease Malnomen originates. Noé successfully discovers the Book on his way to Paris, as well as the person possessing it—a human calling himself Vanitas who uses the grimoire to cure Malnomen. Vanitas declares his goal to be the salvation of the entire race of Vampires, and Noé accompanies him for his entire journey, wishing to understand the true nature of not only the Book but also the enigmatic owner who wields it.

The story consists of Noé's memoirs on how he would come to eventually kill Vanitas with his own hands.

Terminology [ ]

Vampires [ ].

Though referred to as "vampires," the Vampire race within The Case Study of Vanitas are distinct from mythical vampires, and were in fact named after them for having certain similarities. The main distinguishing feature between Vampires and humans is the ability of Vampires to see and interact with the World Formula , allowing them certain superhuman abilities. Unlike mythical vampires, Vampires within The Case Study of Vanitas do not have to drink blood or harm others to survive, and the vast majority go their entire lives without harming humans. While most (but not all) Vampires do enjoy the taste of blood, it is not a biological need, and is compared to alcohol, smoking, or sex. Compulsive blood drinking only occurs in the case of blood addiction or Malnomen .

Most Vampires are born under the Crimson Moon, and have a natural fear of the Blue Moon. Those who are born under the Blue Moon, as in the case of Vanitas of the Blue Moon , are scorned and ostracized by other Vampirekind.

The Book of Vanitas [ ]

A cursed grimoire supposedly passed on to Vanitas by Vanitas of the Blue Moon themself. It is the originator of the disease Malnomen, created in revenge against Vampires for their prosecution of those born under the Blue Moon. The human Vanitas now has the Book of Vanitas within his possession and is the only person capable of using it. However, contrary to the Book's original purpose, Vanitas uses it to cure cases of Malnomen and desires to save the Vampire race.

Malnomen [ ]

A disease created by Vanitas of the Blue Moon . It attacks the True Name of vampires, causing their bodies and souls to warp. Those infected with Malnomen, usually called curse bearers, gradually grow insane and begin to obsessively search for blood, escalating until they assault and even kill others without hesitation. In addition, their bodies will corrupt, though the onset of physical symptoms appear to happen rapidly in the final stages of the disease. Once warping of the body occurs, the curse bearer will continue to attack others until it dies. Until very recently, there was no possible way to cure those infected with Malnomen, and thus all curse bearers would be sentenced to execution by decapitation once their condition was discovered. The human Vanitas reverse engineers the different forms of Malnomen to find and restore the curse bearer's True Name, curing them.

The Case Study of Vanitas is written and illustrated by Jun Mochizuki and began serialization in Square Enix's monthly shōnen magazine Monthly Gangan Joker on December 2015. There are currently nine tankōbon volumes collecting serial chapters released in Japanese. The series is licensed in English by Yen Press and published simultaneously with its Japanese release.

The Case Study of Vanitas is an anime television series adaptation of the manga written and illustrated by Jun Mochizuki. On March 28, 2021, Aniplex announced at AnimeJapan an anime adaptation for the manga, animated by the studio BONES. It started broadcasting on July 2, 2021.

Stage Play [ ]

Stage "Vanitas no Carte" is a stage play adaptation of the manga written and illustrated by Jun Mochizuki. Announced by the official Twitter account on October 28, 2021. The show was initially scheduled from January 21st to January 30th, 2022 at the THEATRE1010 (シアター1010), in Tokyo, Japan. An encore was performed from March 10th to March 12th, 2023 at the Sunshine Theater (サンシャイン劇場), in Tokyo, Japan.

Gallery [ ]

• Vanitas first appeared in the final Pandora Hearts artbook 「There is.」 , shown waving to the main cast of Pandora Hearts as he passed by alongside Noé with his back turned so that he remained unidentifiable at the time.

Navigation [ ]

• 2 List of Characters (The Case Study of Vanitas)
• 3 Noé Archiviste

• Cast & crew
• User reviews

The Case Study of Vanitas

• A human wields a magic book that can cure vampires of their bloodlust, and sets out to find vampires to cure with the book.
• There once lived a vampire known as Vanitas, hated by his own kind for being born under a blue full moon, as most arise on the night of a crimson one. Afraid and alone, he created the "Book of Vanitas," a cursed grimoire that would one day take his vengeance on all vampires; this is how the story goes at least. Vanitas no Carte follows Noé, a young man travelling aboard an airship in 19th century Paris with one goal in mind: to find the Book of Vanitas. A sudden vampire attack leads him to meet the enigmatic Vanitas, a doctor who specializes in vampires and, much to Noé's surprise, a completely ordinary human. The mysterious doctor has inherited both the name and the infamous text from the Vanitas of legend, using the grimoire to heal his patients. But behind his kind demeanor lies something a bit more sinister. — MAL Rewrite

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Manga / The Case Study of Vanitas

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" I'll do as I please, use methods I choose, and, no matter what you people want... I will save you without fail! " — Vanitas

Stories tell of a mysterious clockwork grimoire called The Book of Vanitas which, once opened, is said to place a curse upon the reader that is worse than death itself. Drawn to Paris on rumors of the book's existence, Noé, a vampire, boards the airship La Baleine to confirm it for himself. There, he's suddenly attacked by a fellow vampire who loses control of herself after her true name , the foundation of a vampire's self, is corrupted.

In steps the enigmatic, self-professed "vampire doctor" Vanitas wielding his namesake tome , which he uses not to curse but to cure. Claiming he inherited the book as well as his name from the original Vanitas , a vengeful vampire born under the ill-fated blue moon, he cheerfully recruits Noé to work with him in eradicating the malady that's robbing vampires of their true names — and their sanity .

The Case Study of Vanitas ( Vanitas no Carte , or The Memoirs of Vanitas ) is an ongoing 2015 Steampunk fantasy manga by Jun Mochizuki of PandoraHearts fame. It runs in Square Enix's monthly Gangan Joker magazine and is simulpublished in English by Yen Press . An anime adaptation by Studio Bones began airing in July 2021.

Contains examples of:

• Adaptation Distillation : The anime adaptation maintains the basic story, but excludes explanations of world building, several action sequences, dialogues, some foreshadowing and minor characters.
• Adaptation Explanation Extrication : In the beginning of the Bal Masque arc in the manga, Dominique has her two attendants chain Vanitas to a giant wooden wheel so she can interrogate him about what he really wants with Noe and his Archiviste powers. For some reason, the anime adaptation cuts out her attendants, showing Vanitas still being chained to the wheel, but it creates some confusion as to how a girl of Dominique's stature and size could possibly be capable of putting him, a grown man, on there without help. It also creates some confusion as to why Vanitas would even let Dominique chain him to a giant wheel, since he doesn't seem like the type of person who would just let some girl do that to him. Possibly subverted: Dominique as a vampire is physically stronger than the average human so it could be feasible she can overpower Vanitas by herself, though that’s still debatable.
• Alternate History : The series takes place in a world where the 16th century's alchemist Paracelsus altered the World Formula with the Tower of Babel and created those that are known as vampires. The manga starts around 300 years after the incident, in a version of 1889 Paris where the Tower of the Sun was built instead of the Eiffel Tower.
• Amusement Park : The fifth arc of the series takes place at an amusement park where Mikhail is keeping Dominique hostage by threatening to make her jump from a Ferris wheel if Noé doesn't drink Vanitas' blood .
• Ancient Tomb : The Catacombs of Paris appear as the setting of the third arc, as well as the secret lair of the Chasseurs.
• The anime's first opening sequence, played over the upbeat song "Sora to Utsuro," features the two protagonists, Noé and Vanitas, going on a tour around Paris where they visit the many attractions in the city and Vanitas plays babysitter for an excited Noé. This makes the anime look like a happy-go-lucky Bromantic Comedy set in a mundane France. The series is actually a vampire story taking place in a Steampunk version of 1889 Paris, containing plenty of drama, action, horror, and tragedy that wouldn't be expected from that carefree opening.
• The second opening sequence also shows nothing but Vanitas and Noé walking around Paris, but this time separately until they find each other. Most of the second half of the anime doesn't even take place in Paris.
• Bathos : Moments of drama and angst are frequently juxtaposed with slapstick, snarky banter or chibi antics.
• The Beautiful Elite : As typical of a Jun Mochizuki work, a lot of the characters in Vanitas are gorgeous beyond compare.
• Bookcase Passage : In Mémoire 6, Dominique and Noé go to a shop where they go through a hidden passage behind a bookcase that leads them to Altus Paris, the Pocket Dimension of Paris where vampires live.
• Breather Episode : Episode 7, which adapts Mémoire 12 from the manga, is a much-needed break from all the action and angst from the episodes so far. It focuses on the main characters just eating and dancing together at a restaurant to have a good time for once. As well as a good delivery of Ship Tease for all the potential couples, both the opposite-sex and same-sex ones.
• Bridal Carry : In Mémoire 53, Jeanne carries Dominique bridal-style after saving her from her own suicide attempt . Funny as Jeanne had fantasized about a similar scenario with Vanitas a few chapters back.
• Buddy Picture : Vanitas and Noé's relationship is consistently central in the story. The first chapter has Noé himself state that the plot is about his journey with Vanitas, which will end with the latter's death at his hands .
• Cast Full of Pretty Boys : Most of the male characters are either very handsome or incredibly pretty. An omake makes a joke about it by showing several of the guys working at a Host Club .
• In the first chapter, Vanitas falls off of a Cool Airship and Noé jumps right after him to catch his leg. Somehow, both survive the landing without a parachute.
• At the start of Mémoire 53, Jeanne saves a suicidal Dominique who had jumped off a Ferris wheel, catching her in the air before she hits the ground.
• Childhood Friend Romance : Noé's childhood friend Dominique has been in love with him since they were children, but the death of her brother Louis makes it hard for Dominique to progress her feelings for Noé. Meanwhile, Noé's exact feelings for Dominique are unknown aside from being very close with her and wanting to protect her to not lose another loved one after what happened to Louis.
• Children Do the Housework : Two orphaned human boys got adopted by the vampire known as Vanitas, later renamed Luna. To the concern of the boys, Luna sucked at cooking and cleaning. The older boy happened to be very good at both things, so Luna left those responsibilities to him.
• Church Militant : The church is the main human organization in charge of hunting and killing vampires. The Chasseurs are soldiers of the church who have been trained to fight vampires with weapons, aided by a Super Serum to match a vampire's strength.
• Noe is purple, representing his curiosity, nobility of spirit, and the mystery surrounding his past.
• Vanitas is dark blue, representing his confidence, melancholy and strong integrity.
• Dominique is red, symbolizing passion, aggression, and a desire for love.
• Jeanne is yellow and pink, symbolizing idealism, love, joy, and jealousy.
• Luca is green, symbolizing youth, jealousy, generosity and vigor.
• Compressed Adaptation : The anime's first half was fairly faithful to the manga, only cutting some minor scenes for faster pacing. However, the second half was significantly condensed in order to adapt the Gévaudan arc's three and a half manga volumes and the amusement park arc's two and a half manga volumes into a 12-Episode Anime . As a result, it eliminated a chunk of Chloé's backstory as well as the scenes related to the vampire senate and the extremist faction of the church that set up future arcs.
• Cool Airship : Noé and Vanitas first meet at La Baleine, a giant airship designed to look like a flying Gothic palace.
• Corrupt Church : The Catholic Church carried out a big massacre in Gévaudan, killing hundreds of women and children, under the delusion of exterminating vampires hiding among humans. They then used the "Beast" and curse-bearers as a cover story.
• Subverted in the belltower scene of Mémoire 11/Episode 6. Noé chooses to join Vanitas' journey by his own will and he makes a vow to stay together with Vanitas to the end as the sun rises to symbolize the start of their companionship. Sadly, Noé's narration from the future immediately reminds the audience that his relationship with Vanitas will end in tragedy.
• Played straight in Mémoire 55/Episode 24. In the aftermath of their big fight at the amusement park, Vanitas and Noé reconcile and reaffirm their bond to each other. The arc ends with Vanitas looking out at the sun rising through the clouds as he takes Noé's hand and goes to eat breakfast with him.
• Dance of Romance : Mémoire 12/Episode 7 has one big Ship Tease moment for those who are into the potential same-sex couples as NoéxVanitas and DominiquexJeanne dance a waltz while surrounded by Love Bubbles and Bishie Sparkle . Dominique takes Jeanne to dance with her (to tease Noé as she thinks he likes Jeanne) and both enjoy it so much that they immediately become good friends. While the girls dance, Noé asks Vanitas to dance with him, using that he wants to teach him as an excuse. Noé takes the chance to ask Vanitas what love is, but both are just left wondering as neither know the answer.
• Dark and Troubled Past : Noé who is the last remaining survivor of his clan and was a slave on the black market before Dominique's family bought him; Vanitas whose parents were murdered by vampires and became an experimental subject.
• Date Peepers : Domi spies on the date she set up between Jeanne and Vanitas, disguised as a man . Dante ends up stumbling across her and then tagging along for the rest of the date.
• Daywalking Vampire : None of the vampires in the setting have any problem with sunlight.
• Dysfunction Junction : As it's to be expected from a manga made by Jun Mochizuki, almost all the characters have a terribly traumatic backstory, are mentally unstable, or both.
• Everyone Is Bi : Although none of the main characters' sexualities have been explicitly confirmed, everyone in the main cast gets Ship Tease with people of both genders. Vanitas enjoys making unwanted sexual advances at Jeanne and lets her drink his blood several times. Meanwhile, Vanitas is all but stated to feel curious about how would it feel like to let Noé bite him and drink his blood too (even thinking about Noé biting Dominique when pressing Jeanne into doing it with him). Noé repeatedly drinks blood from Dominique and likes it, but he also drools at the mere thought of having a taste of Vanitas's blood. Dominique has an obvious crush on Noé since childhood, not that it stops her from flirting with women for fun and later forming a very affectionate friendship with Jeanne who often blushes at Dominique.
• Fantasy Metals : In this world, almost all machines are powered by Astermite, a mineral with miraculous properties that doesn't produce smoke that pollutes the air and has made it possible to build giant airships.
• Ferris Wheel of Doom : In the amusement park arc, because of Mikhail's Book of Vanitas going out of control, a Ferris wheel collapses and almost crushes Vanitas and Noé. They're saved by Dominique who creates an ice barrier to protect them.
• First-Episode Twist : The start of the first chapter/episode introduces Noé, a young man traveling to Paris in order to search for a legendary grimoire named the Book of Vanitas. While boarding an airship, Noé meets a sickly woman who is seemingly attacked by a suspicious man. Noé reveals himself to be a vampire and fights the man to protect the woman only for the woman to bite Noé as she's actually a curse-bearer, a vampire who went mad after having their true name stolen. Vanitas, the man who Noé fought, then reveals he's the possessor of the Book of Vanitas and uses its power to restore the curse-bearer's sanity.
• Flames of Love : In Mémoire 27, Vanitas and Jeanne take shelter from the snow at an abandoned cabin. After Jeanne orders to undress themselves to warm their bodies up together, they cuddle in front of a fireplace. The icing on the cake is Jeanne giving water to Vanitas mouth-to-mouth as the flames burn behind them.
• Flowers of Romance : In Mémoire 42, Jeanne has a passionate moment with Vanitas in a field of astérisque flowers, where she pins him down to drink his blood and kiss him on the cheek.
• Foregone Conclusion : The first manga chapter and anime episode close on some narration from a future version of Noé, who muses on the journey he went on alongside the titular Vanitas and reveals how the story will end: with Vanitas dying by his hand .
• If you look carefully, Vanitas never touches his book barehanded... or anyone for the matter. The one time he touches a vampire with his bare hand, her strength vanishes and she becomes unable to even stand.
• One of the covers shows the arms of Vanitas and Noé wrapped by chains... At the same emplacement as Vanita's scars. The Book of Vanitas has a silver chain, and he never touches it bare-handed. Do the math.
• In the first chapter/episode, as Noé narrates the fairy tale of the Vampire of the Blue Moon, the audience can see the Book of Vanitas... and the silhouette of another book behind it. There are, in fact, two books. When Vanitas' younger brother Misha introduces himself to Noé, he reveals he also has his own Book of Vanitas.
• Formulaic Magic : The World Formula, a mathematical equation originally written by Paracelsus in the 16th Century, is reality, and any changes to the formula also changes reality. It's believed that vampires resulted from the formula for humans being changed, and Astermite resulted from the formula for coal being changed. Vampires are able to see the World Formula and change it on the fly, giving them magical powers like Playing with Fire and so on. In turn, Chasseurs have developed technology to blind a vampire's ability to see the Formula, thus disorientating and weakening them.
• French Accordion : The setting is France (mostly in Paris) and fittingly, Yuki Kajiura used a lot of accordion for the anime's soundtrack.
• Gaslamp Fantasy : Though it has very strong Steampunk influences, the series's inclusion of magic, the supernatural, and many Gothic Horror tropes sets it as one of these as well.
• Gothic Horror : Like PandoraHearts , Vanitas has big elements of the gothic genre such as vampires, the late 19th century European setting, old castles, symbolism, and physical as well as psychological torture.
• Gratuitous French : The series is Japanese, but the characters occasionally speak French words to remind the audience that the work's setting is France. For example, the word vampire is spelled in French, the Vampire Hunters are called Chasseur, and vampire executioners are called Bourreau. The first scene of the first anime episode has news titles in correct, understandable French, but if you squint, you can read the text below... Which is some text about an archeological finding made in 1901, and rediscovered in 2021, obviously google-translated from the English.
• Great Offscreen War : Between the 16th and 17th centuries, humans and vampires were in a great war as both races tried to exterminate each other. By the time of the late 19th century in which the story takes place, humans and vampires have long stopped having anything to do with each other. Although, there's danger that another war might break out if Curse-Bearers continue attacking humans.
• Half-Breed Discrimination : Dhampirs are heavily discriminated against by humans and vampires. Their hybrid heritage causes them to be abandoned by their parents and hunted by vampires and/or the church, unless they're under the protection of a high-ranking vampire like Marquis Machina.
• Half-Identical Twins : Louis and Dominique de Sade are actually fraternal twins and they look very alike, especially after Dominique started dressing like a boy to cope with Louis' death.
• Hemo Erotic : Having one's blood drunk by a vampire is noted to be pleasurable for many, and in fact many Vampires will drink each other's blood as an act of affection between friends and loved ones, as demonstrated by Noé and Dominique. It's explained that this reaction is because there's a biologic response that anesthetizes the bitten individual through a substance that is apparently similar to... an aphrodisiac . However, the degree which this is pleasurable runs on a sliding scale, with some just becoming numb or drowsy, and not feeling any pleasure at all. The individuals involved also seem to matter, possibly on a biological level, as Vanitas comments that he feels particularly euphoric when being fed upon by Jeanne compared to other times he's been bitten. Also, apparently, drinking someone's blood without consent is considered a crime .
• High School AU : The omake of Volume 7 is about an AU where the characters are high school students and teachers. The premise is Vanitas infiltrating the academy while Disguised in Drag and gets found out by Jeanne who also is disguised as a man to be Luca's bodyguard. The omake later got an Audio Adaptation with a couple of Drama CD for the anime's Blu-ray release.
• I Know Your True Name : A vampire's true name is linked to their destiny and is as important as life itself.
• "Le Formidable!" for Vanitas and Noé, sung by Natsuki Hanae and Kaito Ishikawa .
• "Blooming in the Sun～mon trésor～" for Jeanne and Luca, sung by Inori Minase and Shino Shimoji .
• "Nameless Road" for Roland and Olivier, sung by Kengo Kawanishi and Tomoaki Maeno .
• "Snow Flower" for Chloé and Jean-Jacques, sung by Rie Kugimiya and Daiki Hamano .
• Louis begged his beloved friend Noé, to kill him when he was going out of control, fearing that he would kill Noé if he wasn't terminated. Noé's inability to fulfill Louis's last wish continues to haunt Noé to this day, and is in fact part of what drew him to Vanitas since Vanitas 's abilities represented a hope that Louis could have been saved.
• When Chloé was in despair over how miserable her existence was, outliving generation after generation of her human family and being hated by the townspeople she had been brought up to love, she desired to be killed by Jeanne who she loved like a little sister. Jeanne was actually directed to do so, but was unable to carry it out.
• Layered World : One of the effects of the Babel Incident was the creation of secluded dimensions, named "Altus," that are connected to the original world, but are only accessible to vampires and humans who cross the border while touching a vampire. After the war, most vampires are living at Altus, although there's still some vampires who live at the original world along with humans.
• Legacy Character : The current Vanitas claims he's the inheritor of the original, though he's only an average human rather than a vampire.
• Masculine Girl, Feminine Boy : Jeanne and Vanitas are turned into this in the High School AU where both go to the academy Disguised in Drag . Jeanne also behaves like a flirt who calls Vanitas her food property because of all the shoujo manga Dominique made her read.
• Masquerade Ball : The second arc of the series has our heroes attend a Bal Masque full of vampire aristocrats.
• Mass Super-Empowering Event : The renowned alchemist Paracelsus built the Tower of Babel as part of an experiment to rewrite the World Formula, resulting in a disaster known as the Babel Incident. The formula that constituted coal was altered to become the blue mineral, Astermite, from which power could be produced without almost any environmental pollution, a flora formula was altered to create bioluminescent flowers, and most importantly, the human formula had been altered and given way to the existence of vampires.
• Matricide : In a disturbing example, Catherine, a young girl vampire attacks her mother after being affected by the curse. She then begs Vanitas to kill her before she hurts her sister. He obliges
• "Vanitas" can mean "vanity" (exhibited in the self-serving way he talks about saving the vampires) or "emptiness" (a possible allusion to Noé's statement at the end of chapter 1 that he would kill him with his own two hands). A vanitas is also a particular style of painting, a reminder of death and the frailty of life which demands that we cannot be obsessed with trivial things. This may also be a factor in the meaning of Vanitas' name.
• Noé's name. Vanitas calls him "Child of the Ark" and he is an Archivist, a clan of vampires believed to have died out. Noé is the French version of "Noah" from Noah's Ark, a famous Bible story where two (a male and a female) of every animal is brought upon a boat to survive extinction...
• A vampire's true name seems to be this in general.
• Mercy Kill Arrangement : Vanitas promises Jeanne to kill her if there ever comes a time that she's 'no longer herself'.
• Mind Virus : The malady afflicting vampires that Vanitas is aiming to eradicate. It takes possession of the victim's true name and endows them with an unquenchable thirst for blood.
• Mutual Pining : In the aftermath of the Gévaudan arc, Vanitas and Jeanne find themselves pining for each other, leading people around them to point out Vanitas has fallen for Jeanne and vice versa. Vanitas is highly uncomfortable with catching feelings for Jeanne because his self-loathing keeps him in denial about being deserving of love. Meanwhile, Jeanne is happy to be in love with Vanitas, but since he claims he doesn't feel attraction to someone who can love him, she plans to not let him know her true feelings.
• Mythology Gag : When Vanitas and Noe are initially caught by Roland, Vanitas introduces themselves as Vincent and Gilbert. These are the names of two brothers from the author's previous manga, PandoraHearts .
• Myth Prologue : The manga begins with Noe narrating the story of the Vampire of the Blue Moon and how they were exiled for being a bad omen while swearing revenge. It later turns out that this story isn't as accurate as other vampires believed as it turns out that the Vampire of the Blue Moon was actually a nice guy with no interest in revenge.
• Not the Fall That Kills You… : In the first chapter/episode, Noé and Vanitas fall off of a Cool Airship . Not only do they survive the fall and landing (without a parachute!), they come out unharmed even though they crashed against a cathedral and made a hole in the ceiling.
• Off with His Head! : Decapitation is the only certain way to kill vampires. Louis, who was Dominique's older brother and one of Noé's first friends, was decapitated by his grandfather in order to protect Noé when Louis became a Cursebearer.
• Oh, and X Dies : The first chapter ends with Noé's narration stating that he will kill Vanitas at the end of their journey.
• One Cast Member per Cover : There's a different character on each volume cover, with the occasional exception of pairs (Vanitas and Noé in every cover featuring them since Volume 3, Chloé and Jean-Jacques in Volume 7). Only the two protagonists, Vanitas and Noé, have more than one cover.
• One Twin Must Die : Twins are a symbol of bad luck to vampires, which is why some families kill one of the twins at birth. This was supposed to be Dominique's twin brother Louis' fate as giving birth to twins would have been a disgrace to the noble house of de Sade. Louis was only spared because his grandfather wanted to use him for some sort of experiment involving his transformation into a Curse-Bearer, so he could live up to his teens.
• Our Vampires Are Different : Vampires are closer to a Mage Species that drinks blood to gain strength. Because of their direct connection to the World Formula, they have abilities similar to magic that allow them to increase their physical strength and stamina, and in the case of more powerful vampires, use Elemental Powers and such. They apparently won't die unless directly killed via decapitation and their bodies instantly turn to dust after losing their head. Drinking blood is not a necessity for them and they can easily suppress their blood cravings unless they become Curse-Bearers, vampires who went insane after their true name was corrupted.
• Over-the-Shoulder Carry : Jeanne carries Vanitas over her shoulder when she needs to take him away for a private conversation about her blood cravings.
• Pink Girl, Blue Boy : There's the pink-haired Jeanne often paired with Vanitas who is blue-eyed and dresses in blue clothes.
• P.O.V. Boy, Poster Girl : A male-male variation; Vanitas is the titular character and poster boy while Noé is the viewpoint character.
• The Power of Friendship : A recurring theme is Vanitas and Noé growing stronger together and overcoming obstacles by learning to trust and help each other as friends. A notable example is Noé managing to stop a hypnotized Vanitas' attempt to murder him by swearing he will never let him be "free" (i.e. alone) .
• Real Event, Fictional Cause : Between 1764 and 1767, there was an incident of serial murders in the former French province of Gévaudan that were attributed to a man-eating wolf-like animal that was called The Beast of Gévaudan. In this manga, the murders were supposedly committed by a Curse-Bearing vampire. In reality, that was just a cover. The real cause of the murders was an illegal vampire hunt of the church that indiscriminately killed everyone in Gévaudan that could be, become, or give birth to a vampire.
• Red Eyes, Take Warning : Vampires' eyes turn red when they display their superhuman powers that allow them to rewrite the World Formula. They also turn red when they're feeling strong emotions or are thirsty for blood.
• Reluctant Psycho : Many curse bearers are unwillingly turned into feral animals due to having their true names tampered with. Only a handful trade their names willingly for power. Even then, eventually their curse will leave their control and devolve into violent rage. Even fully in control, Chloé had difficulty resisting Noé's blood.
• Revenge : Vanitas' whole motive for saving the vampires; not to help them out of genuine good will but as revenge against the Vampire of the Blue Moon.
• Roundabout Shot : The anime opening sequence has one of these with Noé grabbing Vanitas by the hands and spinning him around in the air until they fall into a fountain.
• Rule of Symbolism : In an art illustration Jun Mochizuki did for Vanitas shows him falling, blue butterflies all around him. The only butterflies that are not blue are the purple ones on his arm where the mark of possession by the original Vanitas of the Blue Moon gave him.
• Scars Are Forever : Vanitas' left arm is scarred since he was bitten by the Vampire of the Blue Moon (or claims that he was).
• Scenery Porn : As expected from Jun Mochizuki's work. Just look at Chapter 1's scenery of Paris as Noé and Vanitas fall out of the airship. It's breathtaking.
• Ship Tease : The series has teasing moments for all the potential couples of the main cast, mainly VanitasxNoé (unusual partnership with lots of Homoerotic Subtext and Noé's strong interest for drinking Vanitas' blood), VanitasxJeanne ( Forceful Kiss from Vanitas, very sexually-charged blood drinking scenes, and a persistent Unresolved Sexual Tension ), NoéxDominique (childhood friends who like drinking blood from each other and are very protective of each other), and DominiquexJeanne ( Pseudo-Romantic Friendship where both girls admit to love each other).
• Spell Book : The Book of Vanitas has the power to interfere with the World Formula and restore the names of vampires that had them stolen.
• Steampunk : The series takes place in a steam-powered Paris as opposed to the Gaslamp Fantasy of PandoraHearts , though Vanitas also qualifies as that as well.
• Take Away Their Name : Naenia strips vampires from their true names, which causes them to become curse-bearers. The only known way to cure them is using the Book of Vanitas to bring their true name back.
• Technically-Living Vampire : Vampires are an advanced Human Subspecies that came into existence because of a disaster known as the Babel Incident. Some humans gained the supernatural ability to use their eyes to rewrite the World Formula. Vampires drink blood if they want to (although the urge is easy to suppress) and are Long-Lived , but they're just like humans in every other aspect.
• Unresolved Sexual Tension : After a very weird and rough start, Vanitas and Jeanne have developed a very strong mutual attraction since the Gévaudan arc, with Vanitas having become increasingly flustered around her with their interactions.
• Void Between the Worlds : Between the human world and the vampire world, there's a void known as the "Border" that only vampires are able to cross. It's said that if a human were to step into the Border without touching a vampire, they would fall into nothingness and be lost between worlds forever.
• Wall Pin of Love : Vanitas has Jeanne cornered after tricking Noé into taking Jeanne's master Luca as a hostage. As Jeanne begs for Luca's life, Vanitas pins her against the wall, does something to her that makes her lose her power, and forces a kiss on her before asking her to marry him as he has fallen "in love" with her.
• Watching the Sunset : A variation happens in the belltower scene at the end of Mémoire 11/Episode 6. Noé makes the declaration that he wants to understand Vanitas and has decided to stay by his side. Vanitas concedes and the two men watch the sunrise, a symbol of the true start of their partnership.
• Witch Hunt : After the Babel Incident caused some humans to be transformed into vampires, they became hunted by regular humans who viewed them as unholy monsters. The original Beast of Gévaudan incident happened because paranoid members of the church were hunting hidden vampires in Gévaudan and killed any women and children they came across.
• The X of Y : The title is "The Case Study of Vanitas".

Video Example(s):

Vanitas and Jeanne

When Vanitas finds out that Jeanne apparently gets random cravings for blood, but can't figure out if she's a curse-bearer or not, he decides to entice her to drink his blood. It works, and he winds up enjoying it to the point where, in a later episode, he offers to give Jeanne exclusive bloodsucking rights to him in exchange for keeping the fact that she bit him a secret from her master Luca.

Example of: Voluntary Vampire Victim

Noe Archiviste

Vanitas and Ast...

Jeanne The Hell...

Vanitas Takes M...

Vanitas [Bats]

The Book of Van...

The Case Study ...

Noe Asks Vanita...

The Vampire of ...

Vanitas Hates R...

Dominique de Sade

Dominique Threa...

Jeanne Loves Va...

Jeanne Carries ...

Noe Throws Vanitas

Noe Takes Vanit...

Jeanne and Vanitas

Vanitas Kisses ...

Vanitas' Declar...

Noe's Slow Reac...

Noe Loves Tarte...

Murr Scratches Noe

Vanitas Makes F...

Astolfo Granatum

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THE CASE STUDY OF VANITAS

Vanitas no carte.

There once lived a vampire known as Vanitas, hated by his own kind for being born under a blue full moon, as most arise on the night of a crimson one. Afraid and alone, he created the “Book of Vanitas,” a cursed grimoire that would one day take his vengeance on all vampires;

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Vanitas no Karte Part 2

The Case Study of Vanitas Part 2

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The Case Study of Vanitas: What Fans Can Expect From Season 2

The Case Study of Vanitas was one of the best summer anime of 2021. With the premiere of Season 2, here's what fans can expect from Vanitas and Noe.

Vampire stories in the anime world are well received and are considered a trendy genre. These stories are unique, often blending a variety genres together to craft unique fantasy stories. While names like One Piece and Demon Slayer have dominated the anime scene since last year, a surprise summer breakout vampire story managed to climb its way into the top anime of 2021.

The Case Study of Vanitas is not a typical human-meets-vampire story. On the contrary, the series is an elaborate fantasy world with elements of steampunk and gothic aesthetics topped with compelling vampire lore. The series takes place in 19th century Paris, where, miraculously, vampires can survive without consuming human blood.

Related: In/Spectre Season 1's Biggest Unanswered Questions

In Season 1, the two leads -- Noe Archiviste and Vanitas -- set out in search of "the Beast", a rogue vampire that has been slaughtering innocent people. The duo is determined to find the one responsible for budding impurity in the vampires’ hearts. The twelve episode series immediately stuck out to anime fans, so much so that it didn’t take long to renew the series for a second season.

Fortunately, Season 2 has already begun airing, and viewers are excited to see if their fan theories will be confirmed. The Case Study of Vanitas Season 2 picks up directly. With ten episodes already released, and the tale of the Beast of Gevaudan explored in detail, the plot has begun focusing on Chloe, Jean-Jacques, and Astolfo’s backstories. Mystery still surrounds Ruthven, who failed to kill Noe, hinting at a greater conflict in the future.

The Case Study of Vanitas continues to excell in developing its characters. Season 2 has stayed devoted to developing existing cast members while introducing new characters that stay true to the gothic aesthetic. In terms of character writing, even minor cast members are able to captivate viewers and make their presence known.

Related: The Case Study of Vanitas’ Complex Shipping Situation

That being said, the spotlight still shines on Vanitas and Noe’s turbulent friendship . However, their complicated relationship is what makes The Case Study of Vanitas so entertaining. Without any major spoilers -- the way Noe managed to rescue Vanitas and teach him how to trust again feels genuine and satisfying to the audience. Their relationship feels stronger than ever before.

Speaking of relationships, The Case Study of Vanitas has continued to hint at multiple romantic prospects amongst its cast members. Even though Vanitas and Jeanne make a promising couple, their current status is difficult to place. All in all, the second season of The Case Study of Vanitas will make an excellent watch for fans, and with how well the series has been received by audiences, many are confident for a prospective third season.

Strongest Characters in The Case Study of Vanitas: Vanitas, Noe, & More

T he Case Study of Vanitas is a story based in a fictional 19th-century Paris where humans and vampires share the city. The story revolves around Vanitas and his companion, Noe Archiviste. They are on a quest to heal cursed vampires through the Book of Vanitas. It goes into detail about the Vampire born under the Blue Moon. He was isolated because of their fear, and thus, he swore vengeance against the vampires born under the Red Moon. His name was none other than Vanitas. The narrative is a memoir from the eyes of Noe Archiviste. He delves into how he came to meet Vanitas, their journey together, and how it eventually ends.  

Vanitas 

While he derives his name from an old vampire and uses his grimoire The Book of Vanitas. One wouldn't be harshly criticized if they had mistaken Vanitas for a vampire. And that speaks for Vanitas himself, who is a human first and foremost. While he isn't physically weak, he compensates for his lack of strength with his intelligence and grimoire. A combination of these two allows him to manipulate the actual names of vampires, making him a formidable presence within the series.

Noe Archiviste 

The sole survivor of the Archiviste clan, Noe is the narrator of the series and accompanies Vanitas on his journey of curing Vampires. While one may argue that Noe has been defeated several times within the series. It might be accurate, but his compassion and kindness prevent him from having a severe physical altercation.

Despite being a vampire himself, Noe treats vampires and humans as equally good creatures. It’s this good virtue that pulls him down from time to time. But make no mistake, with his ability to relive memories just by drinking the respective person's blood. It is safe to say one wouldn't want to get on his wrong side.

Lucius Oriflamme

He is one of the most powerful and influential characters in The Case Study of Vanitas. Despite his young age, he serves as the Grand Duke to the Vampire Queen herself. He's an aristocrat through and through.

Despite his childlike demeanor, he's quite skilled at manipulating others with his strategic ploys and engagement in political scenarios to further his motive and maintain his clan's position of power. To top it off, he holds Jeanne as his Chevalier.

Prolific, Revered, and the guardian of Lucius Oriflamme, Ruthven is often considered one of the most essential characters in The Case Study of Vanitas. Playing a pivotal role in ending the war between humans and vampires, he now finds himself as a member of the Senate and is well-known amongst humans as well.

He sought peace between humans and vampires during the war, even acting as a peacemaker. Having been betrayed by his students, he no longer shares the same passion and is ready to use any means to seek his desires. Cold, ruthless, and feared by vampire society, with his powers yet to be showcased, he's just a testament to the man that is Ruthven.

Jean-Jacques Chastel

Chastel is the protector and longtime companion of Chloe d'Apchier and the last surviving member of the d'Apchiers. His loyalty knows no bounds, as he goes on to sign a contract with the devil itself just to realize Chloe's wish. He turns himself into the very beast the village feared in exchange for his actual name. He wreaks havoc on anyone who tries to hurt Chloe, a symbol of his genuine and sincere feelings towards her.

The post Strongest Characters in The Case Study of Vanitas: Vanitas, Noe, & More appeared first on ComingSoon.net - Movie Trailers, TV & Streaming News, and More .

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Case study definition

Case study, a term which some of you may know from the "Case Study of Vanitas" anime and manga, is a thorough examination of a particular subject, such as a person, group, location, occasion, establishment, phenomena, etc. They are most frequently utilized in research of business, medicine, education and social behaviour. There are a different types of case studies that researchers might use:

• Collective case studies

• Descriptive case studies

• Explanatory case studies

• Exploratory case studies

• Instrumental case studies

• Intrinsic case studies

Case studies are usually much more sophisticated and professional than regular essays and courseworks, as they require a lot of verified data, are research-oriented and not necessarily designed to be read by the general public.

How to write a case study?

It very much depends on the topic of your case study, as a medical case study and a coffee business case study have completely different sources, outlines, target demographics, etc. But just for this example, let's outline a coffee roaster case study. Firstly, it's likely going to be a problem-solving case study, like most in the business and economics field are. Here are some tips for these types of case studies:

• Your case scenario should be precisely defined in terms of your unique assessment criteria.

• Determine the primary issues by analyzing the scenario. Think about how they connect to the main ideas and theories in your piece.

• Find and investigate any theories or methods that might be relevant to your case.

• Keep your audience in mind. Exactly who are your stakeholder(s)? If writing a case study on coffee roasters, it's probably gonna be suppliers, landlords, investors, customers, etc.

• Indicate the best solution(s) and how they should be implemented. Make sure your suggestions are grounded in pertinent theories and useful resources, as well as being realistic, practical, and attainable.

• Carefully proofread your case study. Keep in mind these four principles when editing: clarity, honesty, reality and relevance.

Are there any online services that could write a case study for me?

Luckily, there are!

We completely understand and have been ourselves in a position, where we couldn't wrap our head around how to write an effective and useful case study, but don't fear - our service is here.

We are a group that specializes in writing all kinds of case studies and other projects for academic customers and business clients who require assistance with its creation. We require our writers to have a degree in your topic and carefully interview them before they can join our team, as we try to ensure quality above all. We cover a great range of topics, offer perfect quality work, always deliver on time and aim to leave our customers completely satisfied with what they ordered.

The ordering process is fully online, and it goes as follows:

• Select the topic and the deadline of your case study.

• Provide us with any details, requirements, statements that should be emphasized or particular parts of the writing process you struggle with.

• Leave the email address, where your completed order will be sent to.

• Select your payment type, sit back and relax!

With lots of experience on the market, professionally degreed writers, online 24/7 customer support and incredibly low prices, you won't find a service offering a better deal than ours.

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News The Case Study of Vanitas Manga Takes 2-Month Break

The manga went on hiatus in June 2022, and resumed in May 2023.

Yen Press has been publishing the manga simultaneously in English since its debut, and it describes the first volume:

Rumors revolving around The Book of Vanitas, a clockwork grimoire of dubious reputation, draw Noé, a young vampire in search of a friend's salvation, to Paris. What awaits him in the City of Flowers, however, is not long hours treading the pavement or rifling through dusty bookshops in search of the tome. Instead, his quarry comes to him...in the arms of a man claiming to be a vampire doctor! Thrust into a conflict that threatens the peace between humans and vampires, will Noé cast in his lot with the curious and slightly unbalanced Vanitas and his quest to save vampirekind?

Mochizuki ( Pandora Hearts , Crimson-Shell ) launched the manga in Gangan Joker in December 2015. Square Enix published the 11th volume on April 22.

BONES ' television anime of the manga premiered in July 2021. The anime's second part premiered in January 2022. Funimation streamed the first part, and it also streamed an English dub. Both Funimation and Crunchyroll streamed the second part as it aired, and Crunchyroll also added the first part.

Source: Gangan Joker 's X/Twitter account

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• Open access
• Published: 24 May 2024

Integration of case-based learning and three-dimensional printing for tetralogy of fallot instruction in clinical medical undergraduates: a randomized controlled trial

• Jian Zhao 1   na1 ,
• Xin Gong 1   na1 ,
• Jian Ding 1 ,
• Kepin Xiong 2 ,
• Kangle Zhuang 3 ,
• Rui Huang 1 ,
• Shu Li 4 &
• Huachun Miao 1  

BMC Medical Education volume  24 , Article number:  571 ( 2024 ) Cite this article

Metrics details

Case-based learning (CBL) methods have gained prominence in medical education, proving especially effective for preclinical training in undergraduate medical education. Tetralogy of Fallot (TOF) is a congenital heart disease characterized by four malformations, presenting a challenge in medical education due to the complexity of its anatomical pathology. Three-dimensional printing (3DP), generating physical replicas from data, offers a valuable tool for illustrating intricate anatomical structures and spatial relationships in the classroom. This study explores the integration of 3DP with CBL teaching for clinical medical undergraduates.

Sixty senior clinical medical undergraduates were randomly assigned to the CBL group and the CBL-3DP group. Computed tomography imaging data from a typical TOF case were exported, processed, and utilized to create four TOF models with a color 3D printer. The CBL group employed CBL teaching methods, while the CBL-3DP group combined CBL with 3D-printed models. Post-class exams and questionnaires assessed the teaching effectiveness of both groups.

The CBL-3DP group exhibited improved performance in post-class examinations, particularly in pathological anatomy and TOF imaging data analysis ( P  < 0.05). Questionnaire responses from the CBL-3DP group indicated enhanced satisfaction with teaching mode, promotion of diagnostic skills, bolstering of self-assurance in managing TOF cases, and cultivation of critical thinking and clinical reasoning abilities ( P  < 0.05). These findings underscore the potential of 3D printed models to augment the effectiveness of CBL, aiding students in mastering instructional content and bolstering their interest and self-confidence in learning.

The fusion of CBL with 3D printing models is feasible and effective in TOF instruction to clinical medical undergraduates, and worthy of popularization and application in medical education, especially for courses involving intricate anatomical components.

Peer Review reports

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease(CHD) [ 1 ]. Characterized by four structural anomalies: ventricular septal defect (VSD), pulmonary stenosis (PS), right ventricular hypertrophy (RVH), and overriding aorta (OA), TOF is a focal point and challenge in medical education. Understanding anatomical spatial structures is pivotal for learning and mastering TOF [ 2 ]. Given the constraints of course duration, medical school educators aim to provide students with a comprehensive and intuitive understanding of the disease within a limited timeframe [ 3 ].

The case-based learning (CBL) teaching model incorporates a case-based instructional approach that emphasizes typical clinical cases as a guide in student-centered and teacher-facilitated group discussions [ 4 ]. The CBL instructional methods have garnered widespread attention in medical education as they are particularly appropriate for preclinical training in undergraduate medical education [ 5 , 6 ]. The collection of case data, including medical records and examination results, is essential for case construction [ 7 ]. The anatomical and hemodynamic consequences of TOF can be determined using ultrasonography, computed tomography (CT), and magnetic resonance imaging techniques. However, understanding the anatomical structures from imaging data is a slow and challenging psychological reconstruction process for undergraduate medical students [ 8 ]. Three-dimensional (3D) visualization is valuable for depicting anatomical structures [ 9 ]. 3D printing (3DP), which creates physical replicas based on data, facilitates the demonstration of complex anatomical structures and spatial relationships in the classroom [ 10 ].

During the classroom session, 3D-printed models offer a convenient means for hands-on demonstration and communication, similar to facing a patient, enhancing the efficiency and specificity of intra-team communication and discussion [ 11 ]. In this study, we printed TOF models based on case imaging data, integrated them into CBL teaching, and assessed the effectiveness of classroom instruction.

Research participants

The study employed a prospective, randomized controlled design which received approval from the institutional ethics committee. Senior undergraduate students majoring in clinical medicine at Wannan Medical College were recruited for participation based on predefined inclusion criteria. The researchers implemented recruitment according to the recruitment criteria by contacting the class leaders of the target classes they had previously taught. Notably, these students were in their third year of medical education, with anticipation of progressing to clinical courses in the fourth year, encompassing Internal Medicine, Surgery, Obstetrics, Gynecology, and Pediatrics. Inclusion criteria for participants encompassed the following: (1) proficient communication and comprehension abilities, (2) consistent attendance without absenteeism or truancy, (3) absence of failing grades in prior examinations, and (4) capability to conscientiously fulfill assigned learning tasks. Exclusion criteria were (1) absence from lectures, (2) failure to complete pre-and post-tests, and (3) inadequate completion of questionnaires. For their participation in the study, Students were provided access to the e-book “Localized Anatomy,” authored by the investigators, as an incentive for their participation. Voluntary and anonymous participation was emphasized, with participants retaining the right to withdraw from the study at any time without providing a reason.

The study was conducted between May 1st, 2023, and June 30, 2023, from recruitment to completion of data collection. Drawing upon insights gained from a previous analogous investigation which yielded an effect size of 0.95 [ 10 ]. Sample size was computed, guided by a statistical consultant, with the aim of 0.85 power value, predicated on an effect size of 0.8 and a margin of error set at 0.05. A minimum of 30 participants per group was calculated using G*Power software (latest ver. 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany), resulting in the recruitment of a total of 60 undergraduate students. Each participant was assigned an identification number, with codes placed in boxes. Codes drawn from the boxes determined allocation to either the CBL group or the CBL-3DP group. Subsequently, participants were randomly assigned to either the CBL group, receiving instruction utilizing the CBL methodology, or the CBL-3DP group, which received instruction integrating both CBL and 3D Printed models.

Printing of TOF models

Figure  1 A shows the printing flowchart of the TOF models. A typical TOF case was collected from the Yijishan Hospital of Wannan Medical College. The CT angiography imaging data of the case was exported. Mimics Research 20.0 software (Mimics Innovation Suite version 20, Materialize, Belgium) was used for data processing. The cardiovascular module of the CT-Heart tool was employed to adjust the threshold range, independently obtain the cardiac chambers and vessels, post-process the chambers and vessels to generate a hollow blood pool, and merge it with the myocardial volume to construct a complete heart model. The file was imported into Magics 24.0 software (version 24.0; Materialize, Belgium) for correction using the Shell tool page. After repairs, the model entered the smoothing page, where tools such as triangular surface simplification, local smoothing, refinement and smoothing, subdivision of components, and mesh painting were utilized to achieve varying degrees of smoothness. Finally, optimized data were obtained and exported as stereolithography (STL) files. An experienced cardiothoracic surgeon validated the anatomical accuracy of the digital model.

The STL files were imported into a 3D printer (J401Pro; Sailner 3D Technology, China) for model printing. This printer can produce full-color medical models using different materials. The models were fabricated using two distinct materials: rigid and flexible. Both materials are suitable for the observational discussion of the teaching objectives outlined in our study. From the perspective of observing pathological changes in the TOF, there is no significant difference between the two materials.

Experimental flow chart of this study. A TOF model printing flow chart. B The instructional framework

Teaching implementation

Figure  1 B illustrates the instructional framework employed in this study. One week preceding the class session, all the students were tasked with a 30-minute self-study session, focusing on the theoretical content related to TOF as outlined in the Pediatrics and Surgery textbooks, along with a review of pertinent academic literature. Both groups received co-supervision from two basic medicine lecturers boasting over a decade of teaching experience, alongside a senior cardiothoracic surgeon. Teaching conditions remained consistent across groups, encompassing uniform assessment criteria and adherence to predefined teaching time frames, all conducted in a Project-Based Learning (PBL) classroom at Wannan Medical College. Additionally, a pre-course examination was administered to gauge students’ preparedness for self-study.

In adherence to the curriculum guidelines, the teaching objectives aimed to empower students to master TOF’s clinical manifestations, diagnostic modalities, and differential diagnoses, while acquainting them with treatment principles and surgical methodologies. Additionally, the objectives sought to cultivate students’ clinical reasoning abilities and problem-solving skills. the duration of instruction for the TOF theory session was standardized to 25 min. The didactic content was integrated with the TOF case study to construct a coherent pedagogical structure.

During the instructional session, both groups underwent teaching utilizing the CBL methodology. Clinical manifestations and case details of TOF cases were presented to stimulate students’ interest and curiosity. Subsequently, the theory of TOF, including its etiology, pathogenesis, pathologic anatomy, clinical manifestations, diagnostic methods, and therapeutic interventions, was briefly elucidated. Emphasis was then placed on the case, wherein selected typical TOF cases were explained, guiding students in analysis and discussion. Students were organized into four teams under the instructors’ supervision, fostering cooperative learning and communication, thereby deepening their understanding of the disease through continuous inquiry and exploration (Fig.  2 L). In the routinely equipped PBL classroom with standard heart models (Fig.  2 J, K), all students had prior exposure to human anatomy and were familiar with these models. Both groups were provided with four standard heart models for reference, while the CBL-3DP group received additional four 3D-printed models depicting TOF anomalies, enriching their learning experience (Fig.  2 D, G). After the lesson, summarization, and feedback sessions were conducted to consolidate group discussions’ outcomes, evaluate teaching effectiveness, and assess learning outcomes.

Heart models utilized in instructional sessions. A External perspective of 3D digital models. B, C Cross-sectional views following trans-septal sagittal dissection of the 3D digital model (PS: Pulmonary Stenosis; OA: Overriding Aorta; VSD: Ventricular Septal Defect; RVH: Right Ventricular Hypertrophy). D External depiction of rigid 3D printed model. E, F Sagittal sections of the rigid 3D printed model. G External portrayal of flexible 3D printed model. H, I Sagittal sections of the flexible 3D printed model. J, K The normal heart model employed in the instruction of the CBL group. L Ongoing classroom session

Teaching effectiveness assessment

Following the instructional session, participants from the two groups underwent a theoretical examination to assess their comprehension of the taught material. This assessment covered domains such as pathological anatomy, clinical manifestations, imaging data interpretation, diagnosis, and treatment relevant to TOF. Additionally, structured questionnaires were administered to evaluate the efficacy of the pedagogical approach employed. The questionnaire consisted of six questions designed to gauge participants’ understanding of the teaching content, enhancement of diagnostic skills, cultivation of critical thinking and clinical reasoning abilities, bolstering of confidence in managing TOF cases, satisfaction with the teaching mode, and satisfaction with the CBL methodology.

The questionnaire employed a 5-point Likert scale to gauge responses, with 5 indicating “strongly satisfied/agree,” 4 for “satisfied/agree,” 3 denoting “neutral,” 2 reflecting “dissatisfied/disagree,” and 1 indicating “strongly dissatisfied/disagree.” It comprised six questions, with the initial two probing participants’ knowledge acquisition, questions 3 and 4 exploring satisfaction regarding enhanced competence, and the final two assessing satisfaction with teaching methods and modes. Additionally, participants were encouraged to provide suggestions at the end of the questionnaire. To ensure the questionnaire’s validity, five esteemed lecturers in basic medical sciences with more than 10 years of experience verified its content and assessed its Content Validity Ratio and Content Validity Index to ensure alignment with the study’s objectives.

Statistical analysis

Statistical analyses were conducted utilizing GraphPad Prism 9.0 software. Aggregate score data for both groups were presented as mean ± standard deviation (x ± s). The gender comparisons were analyzed with the chi-square (χ2) test, while the other variables were compared using the Mann-Whitney U test. The threshold for determining statistical significance was set at P  < 0.05.

Three-dimensional printing models

After configuring the structural colors of each component (Fig.  2 A, B, C), we printed four color TOF models using both rigid and flexible materials, resulting in four life-sized TOF models. Two color TOF models were created using rigid materials (Fig.  2 D, E, F). These models, exhibiting resistance to deformation, and with a firm texture, smooth and glossy surface, and good transparency, allowing visibility of the internal structures, were deemed conducive to teaching and observation. We also fabricated two color TOF models using flexible materials (Fig.  2 G, H, I), characterized by soft texture, opacity, and deformability, allowing for easy manipulation and cutting. It has potential utility beyond observational purposes. It can serve as a valuable tool for simulating surgical interventions and may be employed to create tomographic anatomical specimens. In this study, both material models were suitable for observation in the classroom. The participants were able to discern the four pathological changes characteristic of TOF from surface examination or cross-sectional analysis.

Baseline characteristics of the students

In total, 60 students were included in this study. The CBL group comprised 30 students (14 males and 16 females), with an average age of (21.20 ± 0.76) years. The CBL-3DP group consisted of 30 students (17 males and 13 females) with an average age of 20.96 years. All the students completed the study procedures. There were no significant differences in age, sex ratio, or pre-class exam scores between the two groups ( P  > 0.05), indicating that the baseline scores between the two groups were comparable (Table  1 ).

Theoretical examination results

All students completed the research procedures as planned. The post-class theoretical examination encompassed assessment of pathological anatomy, clinical presentations, imaging data interpretation, diagnosis, and treatment pertinent to TOF. Notably, no statistically significant disparities were observed in the scores on clinical manifestations, diagnosis and treatment components between the cohorts, as delineated in Table  2 . Conversely, discernible distinctions were evident whereby the CBL-3DP group outperformed the CBL group notably in pathological anatomy, imaging data interpretation, and overall aggregate scores ( P  < 0.05).

Results of the questionnaires

All the 60 participants submitted the questionnaire. Comparing the CBL and CBL-3DP groups, the scores from the CBL-3DP group showed significant improvements in many areas. This included satisfaction with the teaching mode, promotion of diagnostic skills, bolstering of self-assurance in managing TOF cases, and cultivation of critical thinking and clinical reasoning abilities (Fig.  3 B, C, D, E). All of which improved significantly ( P  < 0.05 for the first aspects and P  < 0.01 for the rest). However, the two groups were not comparable ( P  > 0.05) in terms of understanding of the teaching content and Satisfaction with the CBL methodology (Fig.  3 A, F).

Upon completion of the questionnaires, participants were invited to proffer recommendations. Notably, in the CBL group, seven students expressed challenges in comprehending TOF and indicated a need for additional time for consolidation to enhance understanding. Conversely, within the CBL-3DP group, twelve students advocated for the augmentation of model repertoire and the expansion of disease-related data collection to bolster pedagogical efficacy across other didactic domains.

Five-point Likert scores of students’ attitudes in CBL ( n  = 30) and CBL-3DP ( n  = 30) groups. A Understanding of teaching content. B Promotion of diagnostic skills. C Cultivation of critical thinking and clinical reasoning abilities. D Bolstering of self-assurance in managing TOF cases. E Satisfaction with the teaching mode. F Satisfaction with the CBL methodology. ns No significant difference, * p  < 0.05, ** p  < 0.01, *** p  < 0.001

TOF presents a significant challenge in clinical practice, necessitating a comprehensive understanding for effective diagnosis and treatment [ 12 ]. Traditional teaching methods in medical schools have relied on conventional resources such as textbooks, 2D illustrations, cadaver dissections, and radiographic materials to impart knowledge about complex conditions like TOF [ 13 ]. However, the limitations of these methods in fully engaging students and bridging the gap between theoretical knowledge and practical application have prompted a need for innovative instructional approaches.

CBL has emerged as a valuable tool in medical education, offering students opportunities to engage with authentic clinical cases through group discussions and inquiry-based learning [ 14 ]. By actively involving students in problem-solving and decision-making processes, CBL facilitates the application of theoretical knowledge to real-world scenarios, thus better-preparing students for future clinical practice [ 15 ]. Our investigation revealed that both groups of students exhibited comparable levels of satisfaction with the CBL methodology, devoid of discernible disparities.

CHD presents a formidable challenge due to the intricate nature of anatomical anomalies, the diverse spectrum of conditions, and individual variations [ 16 ]. Utilizing 3D-printed physical models, derived from patient imaging data, can significantly enhance comprehension of complex anatomical structures [ 17 ]. These models have proven invaluable in guiding surgical planning, providing training for junior or inexperienced pediatric residents, and educating healthcare professionals and parents of patients [ 18 ]. Studies indicate that as much as 50% of pediatric surgical decisions can be influenced by the insights gained from 3D printed models [ 19 ]. By providing tangible, anatomically accurate models, 3D printing offers a unique opportunity for people to visualize complex structures and enhance their understanding of anatomical intricacies. Our study utilized full-color, to-scale 3D printed models to illustrate the structural abnormalities associated with TOF, thereby enriching classroom sessions and facilitating a deeper comprehension of the condition.

Comparative analysis between the CBL-3DP group and the CBL group revealed significant improvements in post-test performance, particularly in pathological anatomy and imaging data interpretation. Additionally, questionnaire responses indicated higher levels of satisfaction and confidence among students in the CBL-3DP group, highlighting the positive impact of incorporating 3D printed models into the learning environment, improving the effectiveness of CBL classroom instruction. Despite the merits, our study has limitations. Primarily, participants were exclusively drawn from the same grade level within a single college, possibly engendering bias owing to shared learning backgrounds. Future research could further strengthen these findings by expanding the sample size and including long-term follow-up to assess the retention of knowledge and skills. Additionally, the influence of the 3D models depicting a normal heart on the learning process and its potential to introduce bias into the results warrants consideration, highlighting a need for scrutiny in subsequent studies.

As medical science continues to advance, the need for effective teaching methods becomes increasingly paramount. Our study underscores the potential of combining active learning approaches like CBL with innovative technologies such as 3D printing to enhance teaching effectiveness, improve knowledge acquisition, and foster students’ confidence and enthusiasm in pursuing clinical careers. Moving forward, further research and integration of such methodologies are essential for meeting the evolving demands of medical education, especially in areas involving complex anatomical understanding.

Conclusions

Integrating 3D-printed models with the CBL method is feasible and effective in TOF instruction. The demonstrated success of this method warrants broad implementation in medical education, particularly for complex anatomical topics.

Data availability

All data supporting the conclusions of this research are available upon reasonable request from the corresponding author.

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Acknowledgements

We extend our sincere appreciation to the instructors and students whose invaluable participated in this study.

This paper received support from the Education Department of Anhui Province, China (Grant Numbers 2022jyxm1693, 2022jyxm1694, 2022xskc103, 2018jyxm1280).

Author information

Jian Zhao and Xin Gong are joint first authors.

Authors and Affiliations

Department of Human Anatomy, Wannan Medical College, No.22 West Wenchang Road, Wuhu, 241002, China

Jian Zhao, Xin Gong, Jian Ding, Rui Huang & Huachun Miao

Department of Cardio-Thoracic Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, China

Kepin Xiong

Zhuhai Sailner 3D Technology Co., Ltd., Zhuhai, China

Kangle Zhuang

School of Basic Medical Sciences, Wannan Medical College, Wuhu, China

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Contributions

Jian Zhao and Huachun Miao designed the research. Jian Zhao, Xin Gong, Jian Ding, Kepin Xiong designed the tests and questionnaires. Kangle Zhuang processed the imaging data and printed the models. Xing Gong and Kepin Xiong implemented the teaching. Jian Zhao and Rui Huang collected the data and performed the statistical analysis. Jian Zhao and Huachun Miao prepared the manuscript. Shu Li and Huachun Miao revised the manuscript. Shu Li provided the Funding acquisition. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Shu Li or Huachun Miao .

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This investigation received ethical approval from the Ethical Committee of School of Basic Medical Sciences, Wannan Medical College (ECBMSWMC2022-1-12). All methodologies adhered strictly to established protocols and guidelines. Written informed consent was obtained from the study participants to take part in the study.

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Zhao, J., Gong, X., Ding, J. et al. Integration of case-based learning and three-dimensional printing for tetralogy of fallot instruction in clinical medical undergraduates: a randomized controlled trial. BMC Med Educ 24 , 571 (2024). https://doi.org/10.1186/s12909-024-05583-z

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Received : 03 March 2024

Accepted : 21 May 2024

Published : 24 May 2024

DOI : https://doi.org/10.1186/s12909-024-05583-z

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