The implementation status of problem–based learning （PBL） tutorial systems was surveyed in 2008, 2011, and 2012. The 2008 survey showed that the content of PBL tutorial systems differed greatly among universities.
  In response to a question in the 2011 survey of whether the PBL tutorial system would last for 5 years or more, more than 80% of universities agreed that the systems would likely last that long.
  In response to a question of whether PBL tutorial system had been changed around 2012, more than 80% universities said the system had not been unchanged. Furthermore, regarding the evaluation of tutors, the motivation of tutors as a whole did not increase. In the future, the implementation status might not be changed.

Plasmin/plasminogen activators (PA) are the serine enzyme which digests fibrin and/or fibrinogen. Plasmin is produced by the cleavage of its precursor, plasminogen by PAs (urokinase-type PA and tissue-type PA). These events are expected in the thrmbolytic therapy for thromboembolic deseases. Apart from the blood fibrinolysis mentioned above, new role of plasmin/plasminogen activators has been extensively investigated in the field of cellular biology. On the cell surface, the receptor for urokinase-type PA (u-PAR) was found (that for t-PA has not cloned yet). Then, plasmin as well as u-PA itself activates pro-form of matrix metalloproteinases (MMPs) around the pericellular space. These proteolytic activities by u-PA, plasmin and MMPs induce the degradation of extracellular matrix (ECM), affording the cells certain enviroment for their biological function. Further, the coupling of u-PA/u-PAR system and integrins can generate intracellular signal transductions which take part in the regulation of cell proliferation, attachment or migration followed by various physiological and pathophysiological functions. These serial mechanisms are the principle of pericellular proteolytic cascade.

1) For the future selection after 2-year primary clinical training program, most of the doctor do not desire to be a researcher in basic medicine as well as in public medicine.
2) In order to educate medical students to experience the research with joy, curriculum for integrated laboratory practice and/or assignment to basic medical department may be a good candidate in poor situation.
3) If a benefit to give favorable conditions to basic medical researcher may be legally provided, many residents assume attractive life in basic medicine.

1) We attended the 14th annual meeting of the International Association of Medical Science Educators. Findings of research in medical education were presented.
2) Topics of the meeting included: assessment, curriculum, instructional methods, professional development/student support, team-based learning and problem-based learning/clinical skills, and technology/e-learning.
3) Preconference workshops, concurrent focus sessions, poster discussions by category, and other events were cleverly integrated into the program of this meeting. We obtained useful and applicable information for the management of meetings on education.

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.

Cardiac surgery for very-low-birth-weight infants is rarely reported, especially for a triplet. We herein report the successful staged repair of a premature triplet accompanied with transposition of the great arteries. During pregnancy, the fetuses were diagnosed as dichorionic diamniotic triplets, and the mother entered a hospital for maternal protection and health care from 25 weeks' gestation. The triplets were delivered by Caesarean section at 33 weeks and 5 days of gestation because of intrauterine growth retardation. One of the infants, weighing 1,336 g, was diagnosed with transposition of the great arteries (type II). Since he was deemed unable to endure an intracardiac repair, he received balloon atrial septostomy on the 27th day of life and then bilateral pulmonary artery banding on the 29th day of life. However, further balloon atrial septostomy on day 69 and left pulmonary arterial de-banding on day 73 post-birth were needed because of the progression of hypoxia. He received prolonged intubation and inotropic support after temporary cardiopulmonary stability, and we ultimately decided to perform arterial switch operation on day 110, when he weighed 1,838 g. The patient showed a good recovery. In the field of pediatric cardiac surgery, we occasionally select staged strategies for patients who cannot undergo radical operations all at once because of their general condition or low body weight. However, there are no established guidelines concerning the timing of palliative or radical operations in low-birth-weight infants. At present, we select medical strategies ourselves, on a case-by-case basis. In the present case, although our medical strategy had to be adapted, we still obtained a good recovery for this triplet with extremely low birth weight. We herein report this case with some references from the literature.

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