To investigate the effect of teeth clenching on isokinetic knee extension at various velocities, isokinetic muscle strength during knee extension was measured in association with teeth clenching at 30, 60, 150, 300 and 450 degrees per second (deg/s) using the Cybex 6000 isokinetic dynamometer. The volunteer subjects were 9 healthy males (26.2±0.97 years) . The peak torque per body weight and average power per body weight were statistically analyzed. Our results demonstrated that the peak torque per body weight with teeth clenching at 30, 60 and 150 deg/s significantly increased by 7.0%, 7.4% and 4.9%, respectively (p<0.05), but no significant differences were found at 300 and 450 deg/s. While the average power per body weight with teeth clenching at 30, 60 and 150 deg/s significantly increased by 6.5%, 6.1% and 6.9%, respectively (p<0.05), no sig-nificant differences were found at 300 and 450 deg/s. A significant negative correlation was shown between the isokinetic angular velocity and the difference in peak torque per body weight derived from with and without teeth clenching (r=-0.699; p<0.05) . These findings suggested that the effect of teeth clenching on isokinetic muscle strength of knee extension was dependent on the angular velocity, and at lower angular velocities teeth clenching had the effect of increasing the isokinetic muscle strength during knee extension.

We have been utilized acupuncture and moxibustion in our department of internal medicine at Meiji University of Integrative Medicine since its investment in 1987. In the department, various kinds of symptoms in the field of internal medicine have been managed with acupuncture and moxibustion. In this article, I would like to introduce our activities regarding acupuncture treatment in the department of internal medicine and some remarkable results of our clinical studies which evaluated effects of acupuncture and moxibustion as well as relationship between acupuncture therapists and the staff of our department. In the field of respiratory disorders such as COPD or bronchial asthma, usefulness of acupuncture have been proved through a controlled clinical trial which involved COPD patients who had not been able to control with standard care. Also, acupuncture was found to be useful in the management of bronchial asthma in a case series study in which acupuncture treatment was repeatedly applied with intervals without acupuncture. We have also demonstrated that acupuncture was useful for gastrointestinal disorders such as irritable bowel syndrome (IBS). Results of a case series with n-of-1 study design showed significant reduction in the symptoms during acupuncture treatment, while those in the period without acupuncture had been aggravated. Data from studies on diabetic complications such as peripheral neuropathy or gastropathy also showed usefulness of acupuncture. We considered that it is valuable to explore unknown usefulness of acupuncture in the field of internal medicine and prove effectiveness of acupuncture with appropriate scientific manner.

[Objective]The aim of this study was to prevent accidental burns caused by touching a heated needle shaft or by a burning moxa ball falling from a moxa needle. Therefore, we measured the central temperature (Tc) of a burning moxa ball and the temperature at the landing point (Td) of a falling moxa ball.
[Methods]Stainless steel acupuncture needles and unrefined moxa for moxa needles were used. The moxa balls weighed 0.15 g (diameter, 13± 1mm), 0.30 g (diameter, 16 ± 1mm), and 0.60 g (diameter, 24 ± 1mm). To measure the Tc of a moxa ball, a K-type thermocouple temperature probe was inserted into the centre of the ball. The Td of a moxa ball was measured by placing the probe 2 mm directly below the moxa ball. At each point in time, the moxa ball was forced to drop after ignition. Each measurement was repeated 5 times. The data were expressed as mean ±standard deviation.
[Results]The maximum Tc of the 0.15, 0.30, and 0.60 g moxa balls was 569 ± 26°C at 72 ± 8s after ignition, 606 ± 26°C at 109 ± 4s, and 624 ± 48°C at 167 ± 14 s, respectively. Tc of each ball decreased to less than 45°C at 180 ± 8s, 225 ± 4s, and 345 ± 13s after ignition, respectively. When a 0.15 g moxa ball was dropped 30 s after ignition, Td measured 1, 5, and 10 s after the drop was 60 ± 6°C, 97 ± 7°C, and 137 ± 31°C, respectively. Td was less than 45 degrees 120 seconds after ignition. When a 0.30 g moxa ball was dropped 120 s after ignition, Td measured 1, 5, and 10 s after the drop was 66 ± 7°C, 96 ± 6°C, and 129 ± 2°C, respectively. Td was less than 40 degrees 120 seconds after ignition. Td was less than 45 degrees 180 seconds after ignition. When a 0.60 g moxa ball was dropped 180 s after ignition, Td measured 1, 5, and 10 s after the drop was 69 ± 3°C, 96 ± 14°C, and 135 ± 20°C, respectively. Td was less than 45 degrees 270 seconds after ignition.
[Conclusion]For 0.15, 0.30, and 0.60 g moxa balls, if Tc, that is the temperature of the probe, is considered to be the temperature of the needle shaft, burns may be caused by touching the heated shaft up until about 180, 240, and 360 s after ignition, respectively. Furthermore, there is a risk of burns caused by dropping a burning 0.15, 0.30, or 0.60 g moxa ball before 120, 180, or 270 s after ignition, respectively.

[Objective]To survey the current situation of infection control in clinical practice of acupuncture and to discuss the problems and strategy.
[Methods]The subjects were 1,000 acupuncture clinics enrolled in iTownPage in the Chubu region. The questionnaire was sent to them by mail in November 2008. The questions were the following; 1) Profile of respondent, 2) Hand hygiene, 3) Preparation of needling sites, 4) Sterilization and storage of needles and equipment and disposable products, 5) Disposable needle, 6) Hand-pressing (Oshi-de), 7) Infectious waste, 8) Awareness, efforts and self-evaluation of practitioner for infection control, and 9) Comments of this survey.
[Results]The collection rate was 22.2%. Washing time for less than 30 sec was 31.1%, Usage rate of a cloth towel was 67.7%, Hand antisepsis by the basin method was 18.9%, Usage rate of 50 %isopropyl alcohol was 19.8%, etc. 26.6%of all respondents answered that the possibility of infection in acupuncture and moxibustion therapy was very low and 50.9%of those responded that it was low. However, only 27.0%of the responders answered that infection control in their own clinics was appropriate. In addition, 72.5%of the responders belonged to the Japan Acupuncture and Moxibustion Association (JAMA) or the Japan Society of Acupuncture and Moxibustion (JSAM).
[Conclusion]Although some infection controls have been improved, many problems became clear. These problems are suggested to be caused by poor acknowledge, previous experience and wishful thinking of practitioners. It is necessary to continue activities to raise practitioner's awareness for infection control.

PURPOSE: This study aimed to create a digitized database of fabricated obturators to be kept for patients' potential emergency needs. MATERIALS AND METHODS: A chairside intraoral scanner was used to scan the surfaces of an acrylic resin obturator. The scanned data was recorded and saved as a single standard tessellation language file using a three-dimensional modeling software. A simulated obturator model was manufactured using fused deposition modeling technique in a three-dimensional printer. RESULTS: The entire obturator was successfully scanned regardless of its structural complexity, modeled as three-dimensional data, and stored in the digital system of our clinic at a relatively small size (19.6 MB). A simulated obturator model was then accurately manufactured from these data. CONCLUSION: This study provides a proof-of-concept for the use of digital technology to create a digitized database of obturators for edentulous maxillectomy patients.
Emergencies ; Humans ; Maxillofacial Prosthesis* ; Pilot Projects*

The purpose of this study was to investigate the effect of teeth clenching on isokinetic knee extension force during repeated voluntary contractions. We assessed isokinetic muscle strength in association with teeth clenching during 100 consecutive knee extensions at 60 degrees per second (deg/s) using a Cybex 6000 isokinetic dynamometer. In this study, 8 healthy male volunteers (28.4 ± 3.89 years) were asked to perform isokinetic contractions in an extended cycle of five contractions without teeth clenching followed by five contractions with the teeth clenching. The peak torque per body weight was statistically analyzed. In our results, the peak torque per body weight with teeth clenching were significantly greater than those without teeth clenching in the first 70 cycles; however, no significant differences were shown at 71-100 cycles. There was a significant negative correlation between the number of knee extensions and the difference in peak torque per body weight derived from with and without teeth clenching (r=-0.475, p<0.0001) . Our findings reveal that the effect of teeth clenching on the isokinetic muscle strength of knee extension is dependent on muscular fatigue, and that the improving effect of teeth clenching on isokinetic muscle strength declines with increasing muscular fatigue.

Previous research has demonstrated that the concentric muscle strength of knee extension exerted at slow to medium angular velocities is increased by teeth clenching. This study evaluated the isokinetic eccentric strength of knee extensors at 4 angular velocities (60, 120, 180 and 240 degrees per second) with and without teeth clenching on the Cybex 6000 Extremity Testing and Rehabilitation System. Twelve healthy adult male (26.8±1.8 years) volunteered for the study. Peak torque per body weight and average power per body weight were analyzed. The results demonstrated that peak torque per body weight accompanied by teeth clenching was significantly increased at 60, 120, 180 and 240 deg/s by 9.5%, 8.2%, 8.2% and 9.8%, respectively (p<0.01) . Similarly average power per body weight during teeth clenching was significantly higher at 60, 120, 180 and 240 deg/s by 9.1%, 9.5%, 9.4% and 7.7%, respectively (p<0.05) . These findings suggest that teeth clenching is a factor that leads to augmented eccentric strength of knee extensors. Its effect appears to be independent of angular velocity.

[Objective]The aim of this study was to survey the current status of adverse events (malpractice and side-effects) in clinical practices of acupuncture (Acp) and moxibustion (Mox), to discuss the problems, and to suggest corrective strategies.
[Methods]The survey was sent by mail in October 2009 to 6,000 Acp clinics (including Mox) selected at random from the i-Town-Page telephone directory. The questions addressed the following issues:(1) respondent profile;(2) Acp adverse events;(3) Mox adverse events;(4) complaints and litigation;(5) informed consent regarding these adverse events;(6) subscriptions to publications that address the safety issues of Acp and Mox;and (7) access to free safety resources. Note that we inquired about the experiences of adverse events but did not inquire about their frequency.
[Results]The response rate was 21.6%. The top three adverse events for Acp were subcutaneous hemorrhage (65.8%), micro-hemorrhage (62.0%), and needle pain (52.9%). The top malpractice event was forgotten needles (32.7%). Needle breakage and pneumothorax, which are severe malpractice events, were reported by 2.2%and 2.0%of the clinics, respectively. The top three adverse events for Mox were accidental and unintentional burn injury (24.0%), singed hair (15.5%), and singed clothes (15.0%). The most severe malpractice event was suppuration of the Mox point (10.8%). The top adverse events associated with complaints and litigation were symptom exacerbation (21.8%) and pneumothorax (36.4%). Only 74.8%of respondents obtained informed consent, but of those, 61.0%reported providing adverse affect warnings orally. Subscriptions to books and periodicals on the safety of Acp and Mox were reported by less than 30.0%of the respondents.
[Conclusion]The most common adverse events associated with Acp were side effects caused by excessive stimulation. With Mox adverse events were more commonly attributable to negligence. The low subscription rate to safety periodicals suggests that safety information is not presently widely distributed. It is necessary to transmit safety information via the Internet as well as in books and other periodicals.

[Objective]The purpose of this study was to gain a clear understanding of adverse events associated with acupuncture (Acp) and moxibustion (Mox) therapies. Thus, we administered questionnaires to orthopedists in order to understand the clinical experience of patients who suffered adverse events.
[Materials and Methods]For this study, 6,000 orthopedic hospitals and clinics were randomly selected from 13,225 hospitals and clinics listed in the telephone directory iTown Page (http://itp.ne.jp). In October 2011 and July 2012, 3,500 and 2,500 questionnaires, respectively, were sent by mail. The questions addressed the following:(1) the respondent's profile (e.g., years of experience as a licensed orthopedist);(2) adverse events associated with Acp, including electroacupuncture;(3) adverse events associated with Mox;(4) use of Acp and Mox therapies in the orthopedist's hospital or clinic;(5) comments on the safety of Acp and Mox therapies. The identity of respondents remained secret.
[Results]The questionnaire response rate was 10.7%. The respondents were licensed orthopedists for 30 ± 11 years (mean ±standard deviation). Adverse events associated with Acp included retained needles and needle breakage (n ≥148), hemorrhages (n ≥ 64), infections (n ≥ 40), organ injuries (n = 28), and so on. Retained needles (≥ 145 out of 148), subcutaneous hemorrhages (63out of 64), arthritis (17 out of 40), and pneumothorax injuries (27 out of 28) occurred most frequently. The adverse events associated with Mox were burn injuries (n ≥ 121), infections (n ≥ 16), and other adverse events (n = 2). Second-degree burn injuries (n ≥ 48 out of 121) and suppuration infections (11 out of 16) occurred most frequently. These were the most common adverse events associated with Acp and Mox. The usage rate of Acp and Mox therapies in the orthopaedist's hospital or clinic was 18.6%. There were many comments on infection control by acupuncturists (n = 27), education and technical levels of Acp and Mox (n = 13), and retained needles and needle breakages (n = 13).
[Conclusion]These survey results reveal that the occurrence of severe adverse events associated with Acp and Mox was higher than our expectation. In order to improve the safety of Acp and Mox therapies, various educational activities to disseminate information about existing safety measures to acupuncturists are needed. Further studies on new preventive measures, continuous surveys, and feedback to acupuncturists are also required.

[Objective]The purpose of this study was to investigate the effects of manual acupuncture stimulation (MA) on motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS).
[Methods]The subjects were 10 healthy volunteers who gave oral and written informed consent. Experiment 1. MEPs were induced from the right abductor digiti minimi muscle (rADM) by TMS with a circular coil to the left cortex motor area and were measured before and after MA to the right LI4 (right Hoku point), left LI4 (left Hoku point), right LR3(right Taichong point) or left LR3(left Taichong point). A sparrow pecking technique (1 Hz for 1 minute) with a stainless steel needle (40 mm long, 0.18 mm in diameter, Seirin co., Inc, Shizuoka) was used for MA. The subjects received the same experiments four times with MA to different acupoints on a different day. Experiment 2. MEPs were measured during imaging of rADM and lADM contraction and immediately after noxious pinch stimulation to the skin on the right LI4 and left LI4 and right LR3and left LR3respectively. Repeated measure two-way ANOVA was used for statistical analysis to compare between all groups. Repeated measure one-way ANOVA and multiple comparison (Dunnett's test) were applied to time point data in each group.
[Results]MA to the left LI4 or right LR3was significantly decreased MEP (P < 0.01, respectively). In the right LI4, there was a tendency to decrease of MEP, but not significantly (P = 0.26). Most subjects answered feeling severe or strong acupuncture needle sensation. MEPs were significantly increased by imaging of contraction and noxious stimulation (P < 0.001 and P < 0.01, respectively).
[Conclusion]These results suggested a possibility that distant acupuncture stimulation would suppress motor activity via several roots and that an acupuncture inhibited effect was compensated by facilitation arising from the concentration to the stimulated hand.