This study reports the efforts of acupuncturists to promote multidisciplinary cooperation in our laboratory. We conducted a questionnaire survey involving all employees of our laboratory in December 2013 to investigate problems regarding multidisciplinary cooperation, and identified a lack of information and problems concerning treatment plans and costs. After implementing measures to tackle these problems between January and November 2014, we conducted the questionnaire survey again. As the results, 79% of the employees responded that they had gained more information about acupuncture compared to the previous year, and 72% of them responded that treatment plans and costs were appropriate. Compared to the number of new patients who sought acupuncture treatment between January and November 2013 (n = 273), there was an increase of 40% in the same period of 2014 (n = 385). These results showed that employees' understanding of acupuncture and multidisciplinary cooperation were promoted.

In Japan, controlled devices for medical professionals have been often purchased by people other than acupuncturists or doctors, using the Internet sales system. Press Tack Needle (PYONEX^®) allows easy handling by combining a plastic part with an adhesive tape. Since it has been reported to be relatively safe with limited adverse events such as adhesive-related dermatitis or similarly mild disorders, it is widely used. We report a case that when the patient removed a PYONEX^® which applied by himself, the needle tip was broken and remained in his body. It might lead to an accident such as injury due to a broken needle left in the body. The patient had purchased the PYONEX^® on his own judgments, storing it for a long period of time, applied it to his body 10 months after its expiration date and kept it attached for approximately 3 weeks. Plastics are characterized by deterioration and can be damaged by environmental factors including ultraviolet rays, water, and shocks. In this paper as an urgent issue, we note that when using these products, in addition to paying attention to their expiration dates, precautions should be considered since deterioration may also progress due to prolonged attachment.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis, by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the QOL of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of rheumatoid arthritis, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males, 2dropped) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2×2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire: Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.

BACKGROUND/AIMS: There is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients. METHODS: The study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment. RESULTS: The OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL). CONCLUSIONS: The study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.
Balloon Occlusion ; Bilirubin ; Endoscopy ; Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation ; Liver Cirrhosis ; Liver ; Prognosis ; Risk Factors ; Sclerotherapy ; Varicose Veins

Our institute performs retained acupuncture for cold-related symptoms using planar electric heaters. After placing retained acupuncture needles at 8 points on the lower back, the site is covered with a planar electric heater and heated for 20 minutes, with the 6-channel dial of the device set at 5, the second highest temperature. Using this method, we treat and examine patients with cold-related symptoms. If patients feel discomfort during the heating process, the procedure is continued when heat is used for treatment and immediately terminated in the case of examination. On examining related adverse events in 75 cases (224 sessions) within the 8-month period between March and October 2016, there was soreness/irritation of the skin surface in 5 (2.2%), itching in 3 (1.3%), and physical deconditioning in 1 (0.4%). However, all of these events were mild and temporary, supporting the safety of the method. As a future challenge, it may be necessary to expand this study to clinical research on traditional Chinese medicine and acupuncture/moxibustion.

The patient was a 44-year-old man with right facial paralysis as the main complaint. Upon resection of a be­nign parotid gland tumor (6 cm in diameter), one of the buccal branches of the right facial nerve was severed. Immediately after the surgery, facial nerve paralysis occurred in the areas innervated by the buccal and marginal mandibular branches. Therefore, on the 5th day after the surgery, acupuncture was started. The paralyzed facial site was treated weekly for 15 minutes by inserting a disposable acupuncture needle (40 mm in length and 0.16 mm in thickness) about 5 mm deep into the site. As a result, the discomfort around the right ear was alleviated and the right facial nerve paralysis was gradually improved and cured in 6 months after the onset. Acupuncture may have prevented secondary changes such as tissue scarring and atrophy after the surgery, and promoted healing. The paralysis of the areas innervated by the buccal branches may have been improved through re­rooting from the other branches in the periphery region of the neurectomy site. The present case is informative in considering the indications of acupuncture.

To help medical doctors practicing Kampo medicine suggest appropriate acupuncture treatments for individ­ual patients, a study group made up of 7 acupuncturists and 5 medical doctors developed an acupuncture cur­riculum. The group provided a learning program based on the curriculum for 16 medical doctors in charge of outpatient Kampo services in a research institute. The learning program consisted of a lecture and practical training, and a total of 4 sessions were held. At the end of each session, a test was conducted to examine the participants' level of understanding. After the completion of the learning program, a questionnaire survey was conducted to confirm the usefulness of the acupuncture curriculum for the practice of Kampo medicine. The mean number of participants per session was 10.8 ± 1.3. The mean test score was 9.3 ± 0.5 (full score : 10). In the questionnaire, 14 out of the 16 (88%) answered that the acupuncture curriculum was useful or relatively useful for the practice of Kampo medicine. On comparing the numbers of new acupuncture patients with a his­tory of outpatient Kampo service use before and after the acupuncture curriculum, there was a 1.8-fold increase after it. The results support the usefulness of the acupuncture curriculum to understand acupuncture and practice Kampo medicine. Further evaluation is necessary.