It is said that the R-R interval on an ECG, showing the period of the cardiac cycle, reflects the activity of the vagus.
In this paper, the changes in the R-R interval brought by acupuncture and moxibustion were investigated by using Ximen (P-4) and Shenmen (H-7).
In the case of acupuncture and/or moxibustion to Ximen as well as Shenmen, the prolonged R-R interval was noted, while the increased coefficient of alteration of R-R interval was showed in the case of acupuncture. The coefficient of the alteration showed a decrease, however, in the case of moxibustion to Shenmen. Remarkable reduction in the coefficient of the alteration were observed immediately after acupuncture to Ximen under administration of atropine, but moxibustion did not produce any remarkable fluctuations. On the other hand, acupuncture to Ximen under administration of propranolol produced no remarkable fluctuation, while moxibustion brought an increased coefficient of the alteration.
The results suggested that there were considerable variations in the influence on the autonomic nervous system which participated with the cardiac rhythm by different stimulation to the same meridian point.

Radioisotope renography, which is a technique for extracorporeal examination of kidney utilizing radionuclides, can provide the data of renal dynamics such as blood flow and excretion of urine about individual kidney. Since this technique allowes simple and noninvasive examination of renal functions, it is now commonly used clinically.
The present study was designed to elucidate a relationship between renal function and meridian point by using radioisotope renography. In this paper the effect of acupuncture applied placing-needle wlth low frequency wave to Shenshu (UB-23) of the urinary bladder channel of foot-taiyang on renal function, especially excretion of urine, was observed.
It was found that urinary elimination of radioisotope after acupuncture increased, although no marked change was noted on the pattern of renogram curve.

A 67-year-old man receiving treatment for choledocholithiasis was found to have an abdominal aortic aneurysm on CT. The maximum diameter of the aneurysm was 60mm, and the isthmus of a horseshoe kidney was also observed. A total of four renal arteries, two each on the right and left sides, was detected by angiography and helical CT. Two of four arteries bifurcated from the aneurysm. Laparotomy confirmed the presence of a fifth renal artery, which extended from the left common iliac artery to the isthmus. It was not difficult to free the isthmus from the aneurysm. A Y-shaped prosthesis was placed between the normal portion of the aorta and the common iliac arteries without severing the isthmus. The left renal artery arose from the aneurysm and was reconstructed with 6mm knitted Dacron. The right renal artery, which was located below the isthmus, was ligated. The absence of postoperative renal dysfunction confirmed the patency of the reconstructed renal artery. Eleven such cases have been reported in Japan, including the present case. In 5 cases, renal artery reconstruction was performed, and the isthmus was preserved in 8 cases. However, the sites of renal artery bifurcation were correctly detected preoperatively in only 3 of these patients. It appears that accurate preoperative imaging is very important, along with renal artery reconstruction.

In order to avoid the risk of COVID-19 among our clinic staffs, remote medical care using tablet-type devices was conducted in our fever outpatient clinic. In about 5 months, there were 87 patients with COVID-19 diagnosed by PCR test. Among them, 24 patients (15 men and 9 women, average age 36.2 years) were treated with Kampo medicine. Four of 24 patients required hospitalization. All patients, including those hospitalized cases, improved their symptoms during the observation period. We believe that Kampo medicine is effective in the early treatment of COVID-19. In addition, we consider that remote medical care using tablet-type devices is one of the useful methods in the treatment of highly contagious infectious diseases.

The effectiveness of acupuncture in treating rhinitis due to allergic reaction to housedust and mites was tested by inducing an allergic response through a nasal mucosa test and observing the influence of acupuncture stimulation in the stellate ganglion. Stimulating the ganglion of the same side as that nasal passage which was most strongly blocked obtained suppression of nasal drip on that side with improvement in clearance of the nasal air passage in four out of five subjects. This is thought to be due to the excitation of the sympathetic nervous system in the cervical region.
Next, acupuncture therapy was coupled with conservative therapy to test their usefulness in combination. Seven subjects were treated for allergic rhinitis and of these, six subjects' subjective symptoms (such as nasal obstruction) improved immediately after the acupuncture stimulation. Of these six subjects, two subjects' improved condition continued while the other four subjects' relief lasted only one day.
Then five of the subjects were given long term acupuncture treatment with all five subjects having a complete improvement of their nasal allergy symptoms to housedust and mites.

The lower one-third point of a line connecting the posterior superior iliac spine and the middle of the lower margin of the ischial tuberosity is used as the acupuncture point to the pudendal nerve. The present study anatomically examined the positional relation between a needle inserted in the acupuncture point and the pudendal nerve as well as examined the projection region of the nerve to the body surface, using the bilateral pudendal nerves of 18 Japanese cadavers.
The needle inseted in the acupuncture point to the pudendal nerve missed the nerve caudally or laterocaudally in many cases, but with twelve cases directly pricking the caudal portion of the nerve. The pudendal nerve lying on the sacrospinous ligament was projected just on or lateral to a line connecting the posterior superior iliac spine and the medial edge of the lower margin of the ischial tuberosity, and in rostro-caudal direction the pudendal nerve was situated in a range 50 to 60% from the top of that line. The height of the sacral cornua corresponded to that of the rostral half of the pudendal nerve lying on the sacrospinous ligament or that more rostral than the rostral tip of the nerve, and the height of the lower tip of the coccyx corresponded to that more caudal than the caudal tip of the nerve.

OBJECTIVE: Our goal was to develop a system using virtual reality (VR) technology to test the haptic skills of medical students. Currently, surgical skills are learned on live patients in a clinical environment in which the student practices under the close supervision of an experienced surgeon. We are interested in using haptic feedback devices to enhance surgical skills, because simulated touch in a virtual world improves the performance of trainee surgeons. In this study, we evaluated the efficacy of a test that evaluates the surgical skill of medical students by using a VR simulator.
METHODS: We used a microsurgical simulator with a force-feedback system. Its effectiveness in helping 36 medical students to acquire the tactile skills used in microscopic surgery was evaluated experimentally. Operating time and the number of sites of hemorrhage were measured to evaluate surgical aptitude. We also evaluated system performance with respect to reality, immersiveness, and operability as secondary measures. Data were analyzed using descriptive methods.
RESULTS: The operating time and number of hemorrhagic sites were positively correlated. Subject students were clustered into three groups: dexterous, awkward, or clumsy. The relation between the number of hemorrhages in the retina and immersion and operability differed between the group of would-be surgeons and those of would-be internists and pediatricians. All the students commented that the simulator was a useful tool for medical education.
CONCLUSIONS: The VR simulator can be used not only to teach and evaluate subtle tactile and surgical skills relevant to the surgical profession, but also to test the aptitude of medical students. The training transfer from a haptic simulator to actual practice methodology should be quantifiable in the near future. This work has steered medical informatics research into a new type of medical education.

Objective: Incidents, such as disturbance of consciousness due to adverse reactions of medications during automobile driving, could cause a serious accident.  Although automobile driving is indicated to be “prohibited” in the package inserts of many drugs, no explicit guidelines are available in Japan on specific guidance to patients.  Therefore, we attempted to prepare guidelines for medication guidance regarding automobile driving.
Methods: We investigated the number of incidents involving traffic accidents and the disturbance of consciousness cases reported in “Japanese Adverse Drug Event Report” database by “Pharmaceuticals and Medical Devices Agency (PMDA).”  We also analyzed descriptions regarding automobile driving found in package inserts and guidelines to determine a risk level for each medication.
Results: Guidelines for medication guidance were prepared based on four-level classification of drugs for which “prohibition” of automobile driving was indicated in their package inserts; these levels are “conform to pertinent guidelines,” “strictly prohibited,” “prohibited,” and “conditionally prohibited.”  The contents of the guidance prepared for some drugs were different from their package inserts.
Conclusions: The guidelines prepared in this study can be expected to become a support tool to ensure close attention to cautions regarding automobile driving.  Because some contents of the guidance are different from that described in the package inserts, it is desirable to obtain agreement with physicians in hospitals adopting these guidelines.  In addition, guidelines based on a broader range of information should be prepared in the future.

Objective: When vehicular accidents occur as a result of impaired consciousness etc., because of adverse drug reactions, there is a risk that third parties may be harmed.  Till date, at Nagoya City East Medical Center (hereinafter, our hospital), the warnings about driving motor vehicles while taking drugs has varied depending on the doctor or pharmacist who provides the guidance.  Therefore, throughout our hospital, we aimed to standardize these warnings and to introduce measures to strictly enforce them.
Methods: Among all the drugs used at our hospital, we identified those with warnings on the package insert about driving motor vehicles and classified them in accordance with “The Drug Administration Guidance Criteria Regarding the Driving of Vehicles,” created by our hospital on the basis of descriptions on the package insert and the level of risk of taking drugs.  We then standardized the warnings about driving motor vehicles while taking drugs, throughout our hospital.
Results: Of the 1,416 drugs used at our hospital, we identified 294 (21%) with warnings about driving motor vehicles on the package insert, and more than half of these (158 drugs) had warnings about the prohibition of driving motor vehicles on the package insert.  As a result of classifying the drugs according to “The Drug Administration Guidance Criteria Regarding the Driving of Vehicles,” we identified 53 drugs with warnings about the prohibition of driving motor vehicles.  By the classification of the level of risk of taking drugs while driving motor vehicles and the hospital-wide standardization of the warnings about driving motor vehicles while taking drugs, we are now able to provide drug administration guidance in the form of warnings that are customized to the level of risk of using each drug.
Conclusion: These measures have clarified the level of risk of taking each drug and warnings about driving motor vehicles while taking them.  In the future, we intend to cooperate with local pharmacies to intervene in the prescription of drugs outside well as inside hospitals.

A 23-year-old woman with mitral valve infective endocarditis complicated by embolism of the right common iliac artery underwent transfemoral embolectomy by a Fogarty catheter and mitral valve replacement. She developed occlusion of the right internal iliac artery, that was revealed by computed tomography on the 9th postoperative day. The occlusion was considered to result from migration of a part of the emboli from the right common iliac artery into the right internal iliac artery during the procedure of embolectomy. On the 16th postoperative day, she underwent repeat mitral valve replacement because of perivalvular leakage. Furthermore, after 2 weeks from the diagnosis of embolism of the right internal iliac artery, the embolic site showed aneurysmal formation finally requiring aneurysmectomy. Her recovery was uneventful. Our case is considered to be rare in that serial observations on computed tomography indicated the development of mycotic aneurysm at the site of septic embolism. In addition, care must be taken to prevent migration of emboli into branched arteries during the procedure of embolectomy for peripheral arterial septic embolism caused by infective endocarditis.