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.

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.

Background: New methods are needed to assist medical students with active learning during histopathology classes. The built–in digital cameras of cell phones and smart phones have recently been used to capture histopathological images during histopathology classes. We examined how the use of the cameras affected students’ attitudes to classwork.
Method: The students were encouraged to capture histopathological images with the digital cameras of cell phones and smart phones. We observed and recorded changes in their learning attitude.
Result: The students captured many histopathological images with their digital cameras. They discussed the pathology of the diseases with their instructors while viewing captured images on the phones’ screens. Some students sorted the image files and used them for self–study after class.
Conclusion: Active learning is encouraged by allowing medical students to record histopathological images with the built–in digital cameras of cell phones and smart phones during histopathology classes.