The concept of "patient's satisfaction"has become increasingly important among healthcare providers during the past decade. Acupuncture and moxibustion therapists have relatively longer contact time with patients, and a certain proportion of users of these remedies seek care for conditions that had not been satisfactorily managed with conventional care. Also, the comfortable process of the treatment is one of its beneficial characteristics. However, the characteristics and opinions of the users of acupuncture and moxibustion in Japan have long remained unclear. We have conducted a series of nation-wide surveys between 2003-2007 with grants from the Foundation for Training and Licensure Examination in Anma-Massage-Acupressure, Acupuncture and Moxibustion. The questions in these surveys included utilization rates, patient satisfaction, reasons for discontinuation, opinions on costs, and so on. The results of these surveys are provided along with some discussion in this article.

Background
Although there are several reports that electroacupuncture (EA) in the abdomen reduces fasting blood glucose and improves insulin sensitivity, the effects under a glucose load or hyperinsulinemic conditions have not yet been studied. In this study, we investigated the effect of EA at Zhongwan (CV12) under the conditions of an intravenous glucose tolerance test (IVGTT) and a hyperinsulinemic euglycemic clamp in normal Sprague-Dawlay (SD) rats.
Methods
Male SD rats were anesthetized with pentobarbital (40mg/kg i. p.) and then maintained by continuous infusion through a tail vein. Blood samples were drawn from the ventral tail artery during the fasting stage (baseline and 30min after), and at 2, 5, 10, 20, 30, 45, 60min after a glucose load (0.5g/kg). EA was performed for 30min (EA30, n=8) during the fasting stage and for 90min (EA90, n=8) during both the fasting and IVGTT periods. In the hyperinsulinemic euglycemic clamp experiments, insulin (2mU/kg/min) was infused through the tail vein, followed by infusion of 20% glucose at variable rates to maintain fasting blood glucose levels. EA was performed for 40min after a steady-state was achieved.
Results
Significant decreases in fasting blood glucose and increase in plasma insulin concentration were observed during the fasting period in rats in both the EA30 and EA90 groups, whereas rats in the control group (n=8) which did not receive any EA stimulation showed no such changes. Total glucose levels during the IVGTT were lower in the EA30 and EA90 groups compared to controls, with a significantly higher level of relative insulin secretion. During the hyperinsulinemic euglycemic clamp, glucose consumption was increased significantly by EA stimulation with a marked increase in both insulin concentration and sensitivity.
Conclusion
EA at CV12 accelerates glucose consumption during IVGTT and hyperinsulinemic conditions probably as a consequence of increased insulin sensitivity and/or increased plasma insulin concentration.

As a preparatory study for treating diabetic neuropathy by acupuncture, we investigated the effect of electroacupuncture on the sciatic blood flow in rats. Nerve blood flow was measured with a laser doppler flowmeter. Different treatments were applied to three groups of rats as follows:
1) those stimulated with low-frequency (1Hz, 5Hz) electroacupuncture,
2) those stimulated with high-frequency (20Hz, 100Hz) electroacupuncture and
3) those stimulated by pinching in the tails.
In the electroacupuncture groups, stimulation was applied to the plantae. While little change was observed in the rats stimulated with low-frequency electroacupuncture, temporary increases in both blood flow and blood pressure were observed in the rats stimulated with high-frequency electroacupuncture and in the rats subjected to pinch stimulation.
These reactions were all inhibited by the administration of phentolamine (α receptor blocker).
These results suggest that the increase in sciatic blood flow induced by high-frequency electroacupuncture and pinch simulation are dependent on the blood pressure.

A WFAS meeting for a standard for acupuncture needles was held in Suzhou, China on September 16, 2010. A delegate from the Department of International Affairs of JSAM accompanied by three experts from an acupuncture needle manufacture (Seirin Corporation) attended the meeting with the purpose of requesting modifications of the draft.
Suggestions from Japan included;(1) clearly define type of needle as 'Sterile filiform acupuncture needles for single-use', (2) not to limit the materials used for the needle body, (3) not to define upper/lower limitations in the size of the needle, (4) add some tests to guarantee safety such as limits for acidity or alkalinity and limits for extractable metals and an endotoxin test, (5) elimination of unnecessary tests regarding needles including hardness, puncture performance, strength, (6) change the term 'normative'in the quality testing method to 'informative'.
According to the suggestions from Japan, modifications in the 'Scope'(defining type of needle as 'filiform') and in the 'Material'section (any kind of materials in accordance with ISO/TS 15510:2007) were annexed to the resolution. However, there is still a need to continue requesting modification of other issues to develop a better draft of the WFAS standard, which will be submitted to an ISO/TC 249 meeting in the near future.

The World Federation of Acupuncture and Moxibustion Societies (WFAS) 2010 International Acupuncture Conference was held in San Francisco USA on November 6 - 7, 2010. The theme was "Acupuncture Research, Education and Clinical Practice."
At the conference, the Society for Acupuncture Research (SAR), which was one of the organizers of the NIH Consensus Conference 1997, was one of the co-sponsors and also the National Center for Complementary and Alternative Medicine (NCCAM) presented as one of the keynote speakers.
In recent years the international standardization of acupuncture related issues are moving to the forefront. WFAS is developing various standardization drafts related to acupuncture, starting with acupuncture needle regulations, which appear to be acting as a working unit of mainly Chinese ideas. WFAS has a plan to settle them as world standards through ISO, etc. However, the process of developing standard drafts does not appear democratic or fair. WFAS is indeed not democratically organized as inaccurate minutes for the executive committee meeting held at the conference contain crucial differences between the English version and the Chinese version.
We need to correspond firmly to WFAS that has a formal relationship with WHO and acts high-handedly, as it leads to obstruction of fair recognition and further development of a variety of acupuncture and moxibustion medicine that has been developed in diversity in each country.

The 2012 WFAS International Congress and Workshop on Acupuncture were held at Mason Pines Hotel in Bandung, Indonesia on November 16-18, 2012. The last congress held in Indonesia was in 2006 in Bali. This was the second congress held in Indonesia since the establishment of the WFAS in 1987.
The number of participants in the workshop and in the congress were 109 and 260, respectively, from 24 countries. There were seven keynote lectures and 51 oral presentations, including 5 by Japanese scientists.
In addition, the 4th session of the 7th Executive Committee of WFAS was held on November 16, 2012 from 10 a.m. to 6 p.m. at Mason Pines Hotel.
In this report, the agenda, a discussion of the WFAS Executive Committee meeting, and an outline of the oral presentations are introduced.

To investigate the effect of electro-acupuncture stimulation (EAS) on insulin sensitivity in rats, we performed several stimulations on Otsuka Long Evans Tokushima Fatty (OLETF) rats, during euglycemic clamp. We divided OLETF rats into five groups according to the kind of the stimulation: EAS at vagal innervated region of the auricle (AVA), EAS at non-vagal innervated region of the auricle (ANVA), EAS on the back of the body (AB), pinching on the back of the body (PB), and no stimulation on the body (NS). These procedures were also applied on Long Evans Tokushima Otsuka (LETO) rats as a control study.
Furthermore, we performed long-term stimulation (from six to 24 weeks of age) on OLETF rats to assess the preventive effect of those stimulations on the formation of the insulin resistance. EAS of pulse duration 300ms, 1.5V, 1Hz was applied for 10 or 15minutes. As a result, the glucose infusion rate (GIR) showed significantly higher levels during stimulation of PB group in LETO rats. On the other hand, the GIR of AVA group in LETO rats and PB group in OLETF rats were decreased by stimulation. The GIR in AVA group and AB group after long-term stimulation were significantly higher than those of NS group in OLETF rats. These results suggested that EAS at the auricle and the back is useful for the prevention of the formation of insulin resistance when it's applied before onset of the symptoms in OLETF rats.

Recently, the importance of patient satisfaction emerged in the context of providing high-quality health care. However, the level of patient satisfaction with acupuncture treatment and the factors that influence satisfaction have not been investigated. We conducted a cross-sectional survey on the satisfaction of patients who consult acupuncture clinics and investigated factors that have a certain influence on the level of satisfaction using multivariate analysis.
Subjects in the present study consisted of 2210 patients who consulted acupuncture clinics that were randomly selected from the alumni association of Meiji University of Oriental Medicine. The survey was conducted between July 10 through July 23, 2000 using our original questionnaire which consists of questions about health state and basic information about the patient, environment of the clinic, assessment of the practitioner by the patient and overall patient satisfaction with the clinic. Sampling of the subject was made using stratified random sampling method and the questionnaires were returned directly from the patient by mail.
Of 2210 patients given the questionnaire, 1, 319 (59.7%) responded. Mean (SD) level of the total satisfaction with the clinic evaluated using 100 mm visual analogue scale (VAS) was 81.4 (13.8). Simple linear regression analysis showed that the degree of explanation given by the practitioner was significantly related to patient satisfaction, while multiple regression analysis showed that the effect of treatment, treatment skill of the practitioner, patient's reliance on the practitioner, clean environment of the consultation room, depth of the practitioner's understanding of the patient and willingness of the practitioner to answer questions were factors significantly related with the patient's satisfaction.
In the present study, there was high overall satisfaction among patients consulting acupuncture clinics and the factors influencing satisfaction could be classified into three kinds : factors relating to the quality of treatment, communication factors between the patient and practitioner, and environmental factors related to the clinic.