Eight years ago the problem-based learning tutorial system was introduced for premedical education at Kinki University School of Medicine. We evaluated this unique education system with questionnaires for students in 1997 and 2000. The suitability of the problem-based learning tutorial system for medical education was 72% in 1997 and 92% in 2000. Approximately 90% students were satisfied with the tutorial system in both years, indicating that this system was widely accepted by even first-year students. However, group differences and differences due to tutors were still observed in the activities of students or the achievement of general instructional objectives or both. The content of the tutorial system and tutor training should be continuously evaluated.

Remedial education in the basic sciences (biology, physics, and chemistry) for medical students was introduced at Kinki University in 1993. The effects and problems of premedical education were examined on the basis of a questionnaire to students and of scores on biology examinations at the time of university entrance and at the end of the first academic year. From 1999 through 2002, the average percentage of incoming freshmen who had not taken a biology course in senior high school ranged from 45.8% to 61.6%. The average score of these students on biology examinations was 23.2 to 29 points higher at the end of the first academic year than at university entrance. Thus, we found that remedial education helped improve these results. However, according to the questionnaire 26.4% of students who received remedial education felt that it had had no effect. Even at the end of the first academic year, the difference in the average score between students who had studied biology in high school and those who had not was 17 points.

It is known that lactic anions and hydrogen ions (H⁺) produced during intense exercise are partly transported or diffused from muscle to blood resulting in the production of non-metabolic CO₂ through the bicarbonate buffering system. The purpose of the present study was to examine the reliability of the estimation of non-metabolic CO₂ output using respiratory gas analysis during incremental exercise. Six healthy subjects underwent an incremental pedaling exercise test accompanied by respiratory gas and arterial blood sampling. The rate of non-metabolic CO₂ output (VCO₂-NM) was calculated by subtracting projected metabolic VCO₂ from actual VCO₂ after CO₂ threshold (CT) . CT was determined using a modified V-Slope method. Bicarbonate (HCO₃^-), pH, CO₂ partial pressure and lactate concentration were measured from arterial blood samples using automatic analyzers. The kinetics of VCO₂-NM and HCO₂^- were compared throughout the exercise test. VCO₂-NM was significantly correlated with HCO₃^-decrease after CT (r=0.976, p<0.001) and the kinetics of VCO₂-NM and HCO₃^- decrease were similar during exercise. Furthermore, the amount of non-metabolic CO₂ output (NM-CO₂) calculated integrating VCO₂-NM above CT was significantly correlated with the difference in HCO₃^-between CT and exhaustion (r=0.929, p<0.01) and with the difference in arterial blood pH between rest and exhaustion (r=0.863, p<0.05) . However, NM-CO₂ was not significantly related to maximum ventilation (r=0.111, ns) . These results suggest that the estimation of non-metabolic CO₂ output during incremental exercise proposed in the present study is reliable. It was also suggested that the primary factor which influenced nonmetabolic CO₂ output during incremental exercise was the addition of H⁺ into blood and not hyperventilation.