Systolic anterior motion (SAM) is a common complication of mitral valve repair surgery and occasionally requires further treatment. A 56-year-old woman with severe mitral regurgitation accompanied by posterior leaflet prolapse underwent mitral valve plasty including hour-glass-shaped resection, chordal replacement, and interrupted commissural band annuloplasty. The mitral valve was exposed via a right-sided left atriotomy. We found a large thick P2-3 scallop (27 mm in height) with ruptured and elongated chordae. After repair, transesophageal echocardiography (TEE) revealed SAM of the anterior mitral leaflet and severe mitral regurgitation upon weaning from the cardiopulmonary bypass. Although catecholamine was discontinued and volume loading applied, the SAM did not improve. We decided to revise the mitral plasty. Therefore, although the height of the P3 scallop after resection remained 17 mm, neochordae were placed once more on the basal side of the posterior leaflet, and the leaflet was shortened by placing a continuous suture near the annulus. This reduced the height of the posterior leaflet and moved the co-aptation line posteriorly. After this repair, TEE showed that the SAM had disappeared. Thus, repositioning the neochordae and shortening the posterior leaflet by applying a continuous suture effectively and rapidly eliminated the problem.

[Objective] We examined whether the meridian test is useful for diagnosis and assessment, other than treatment.
[Method] Participants were patients and therapists in acupuncture and moxibustion facilities. We gave them the meridian test before and after treatment, and carried out the questionnaire survey for the test time, impressions and others.
[Results and Discussion] The time of the meridian test was suitable for the patients and therapists. This test detected unconscious disorders in locomotive organs. It also clarified unconscious therapeutic effects. Furthermore, we obtained affirmative answers on the test from patients and therapists. From these results, it was suggested that the meridian test is a useful method in addition to treatment.

Background : Aortic valve stenosis may be complicated by atherosclerotic lesions in the ascending aorta, which may cause cerebral infarction due to intraoperative dispersion of atheromas. We describe herein a safe aortic cross-clamping technique after removal of the sclerotic lesion in the ascending aorta during short-term unilateral selective cerebral perfusion and mild hypothermic circulatory arrest. Methods : From January 2006 to March 2014, a total of 144 patients underwent aortic valve replacement (AVR) for treatment of aortic valve stenosis. Patients who required ascending aorta replacement surgery, had infective endocarditis, or required emergency surgery were excluded. Five patients underwent AVR using unilateral selective cerebral perfusion and mild hypothermic circulatory arrest due to the presence of atherosclerotic plaques or severe calcification of the ascending aorta (Compromised Aorta group), and 139 patients underwent AVR using ascending aortic perfusion and clamping (Control group). Cardiopulmonary bypass using the right axillary and femoral arteries was started and cooled to a pharyngeal temperature of 34°C in the Compromised Aorta group. During hypothermic circulatory arrest, the brachiocephalic artery was clamped and unilateral selective cerebral perfusion was administered from the right axillary artery. The perfusion volume was adjusted to 500 to 800 ml while using the cerebral oxygen saturation monitor. After transection of the ascending aorta, the atheroma and suture line calcification were removed. A suitable site for cross-clamping was identified under direct vision, and the aorta was carefully cross-clamped. Results : The patients in the Compromised Aorta group required a mean circulatory arrest period of 3.8 min (range, 3.0-5.5 min). The mean minimum value of the left-side cerebral oxygen saturation was 52.0% (range, 45-58%). No patients in the Compromised Aorta group died or developed cerebral complications (95% confidence interval (CI) 0.000-0.522). Complications in the Control group included in-hospital mortality (3/140, 2.2% ; 95%CI : 0.003-0.046 ; p=0.899), stroke (2/139, 1.4% ; p=0.932), transient neurologic deficits (4/139, 2.9% ; p=0.867), and total cerebral complications (6/139, 4.3% ; 95%CI : 0.009-0.077 ; p=0.806). Additionally, there were no significant differences between the Compromised Aorta and Control groups in the operative time (345.8±71.8 vs. 333.6±85.4 min, respectively ; p=0.754), cardiopulmonary bypass time (196.4±63.6 vs. 199.2±50.0 min, respectively ; p=0.902), and aortic cross-clamp time (132.0±44.1 vs. 124.8±36.3 min, respectively ; p=0.666). Conclusion : Short-term unilateral selective cerebral perfusion and mild hypothermic circulatory arrest is a safe strategy in patients undergoing AVR with a severely atherosclerotic aorta. The outcomes of this strategy were equivalent to those in the Control group, which had fewer atherosclerotic lesions in the ascending aorta.

Introduction : We investigated the effects of skin stimulation with noninvasive microcones on constipation in university students.
Methods : 17 university students with constipation were studied. Students were randomly assigned to either Group S (n=9) that received skin stimulation of the auricle using microcones, or Group P (n=8) that were given placebo treatment. Both groups received 4 weeks of treatment.
Results : There were no significant differences in the mean baseline CAS-J (Japanese Version of Constipation Assessment Scale) values between the two groups. After 4 weeks, subjects in Group S had significantly lower CAS-J values compared with baseline (P=0.02). No significant changes were noted in the values for Group P.
Conclusion : These results suggested that skin stimulation with noninvasive microcones improved constipation in university students, and may be a viable option for self-care of this condition.

[Objective] The understanding and cooperation of dialysis medical staff are indispensable for the widespread introduction of acupuncture treatment in maintenance dialysis medical treatment. In this study, we tried to clarify the level of understanding of acupuncture of dialysis medical staff We also tried to examine change in their opinion of acupuncture after experiencing it. We discussed the possibility of using acupuncture treatment in maintenance dialysis medical treatment.
[Method] At first, we distributed the questionnaire concerning the level of understanding of the acupuncture of dialysis medical staff (n=105) who visited the experience corner. Next, we investigated whether the staff who had experienced acupuncture treatment changed their opinion of it. We also investigated the method and effect of acupuncture.
[Results & Conclusion] Few staff had experienced acupuncture previously. They had fears regarding acu- puncture regardless of their experiences, but these fears were alleviated after acupuncture experience. From these results, it is believed that dialysis staff have an insufficient understanding acupuncture. On the other hand, we considered the possibility that acupuncture could positively contribute to dialysis medical treatment because many staff approved the safety and hygiene levels of acupuncture. It will be necessary to educate staff concerning the effect of acupuncture on maintenance dialysis patients in order that they may be able to effec- tively administer acupuncture in the future.

We employed the Meridian Test to study the effects of acupuncture on m otor organ diseases and medical expenses of workers in a company, where health promotion is a priority. Our two-month trial was done at one factory which employs mainly physical labor workers. Acupuncture treatments were given for pain in the neckshoulder, knee and lumbar regions. After 8 weeks of our treatment, 83% of neck-shoulder pain cases, 77% of lumbar pain cases, and 88% of knee pain cases reported that their pain was reduced more than 50%. The results of a mental test (POMS test) showed a significant decrease in tension, depression, anger, fatigue and mental confusion. In terms of acupuncture treatment, numbers of visits to conventional hospitals were significantly decreased and average medical expenses were reduced to about 30%. These reductions continued for the next 3 months. Acupuncture treatment using the Meridian Test could benefit corporations where health promotion of workers is an urgent priority.

Objective : To research reports of economic analysis of acupuncture therapy.
Method : Searches were performed in Medline for reports of cost description, economic, randomized controlled trial, cost effectiveness, or cost benefit. Studies were included if they reported original data from any form of standard economic analysis.
Results : A total of 15 papers was found. These studies were investigated as follows : angina pectoris, carpal tunnel syndrome, stroke, knee osteoarthrosis, low back pain, musculoskeletal disease, migraine, acupuncture analgesia. On the other hand, only one paper was found in Japan.
Conclusion : Almost studies were noncntrolled trial, non-rigorous and retrospective studies. In future there is a need for high quality and rigorous studies of the cost and benefits of acupuncture.

Nobody studies economic evaluation of acupuncture and moxibustion in Japan. To establish a method of economic evaluation of acupuncture and moxibustion, we introduced case study of economic evaluation of acupuncture and moxibustion at work. In addition, we examined a course of study that annex economic evaluation to a study of acupuncture and moxibustion. This manuscript introduces two case studies of economic evaluation and essential points of economic evaluation.