Acupuncture and moxibustion (AM) is increasingly recommended in various clinical practice guidelines published in Japan. AM has pharmacological-like effects with fewer adverse events, and it can relieve various symptoms, including persistent physical symptoms (PPS) or symptoms with a clear cause that are difficult to treat with medications. In addition, AM may overcome the limitations of Kampo medicine by reproducing the effects of some Kampo drugs or reducing the severity of the clinical feature (termed "Sho"). AM has a strong focus on narrative medicine, including recording a patient's life history or conducting a physical exam (e.g., of tongue, pulse, facial color, or acupoints), which can detect pathological signs in PPS patients with no abnormal blood or imaging testing findings. This is important for certain diagnoses and treatments with AM. Moreover, although 80% of rheumatoid arthritis (RA) patients have been well controlled since the emergence of biologics, some RA patients continue their symptoms despite reducing inflammation. AM has the potential to help these patients through lifestyle changes, such as improved sleep or smoking cessation. Further research on the integration of AM into general medical care, or its application for early-phase chronic pain, is required.

PURPOSE : The purpose of this study was to clarify the effects of prolonged expiration (PE) on respiratory and cardiovascular responses and autonomic nervous activity during the exercise.METHODS : Twenty-five healthy men (22±1years) were classified according to the breathing mode during the exercise : 2-second inspiration and 4-second expiration in 1 : 2 group, 3-second inspiration and 3-second expiration in 1 : 1 group and normal breathing in control group. The 6-minute exercise was performed at anaerobic threshold (AT) and 60%AT using a cycle ergometer as an exercise protocol. Respiratory rate (RR) and tidal volume (TV) were measured by the expired gas analysis. The power of low- (LF) and high-frequency components (HF) was analyzed from a Holter electrocardiogram to assess the heart rate variability. RESULTS : RR and LF/HF were significantly lower, TV and HF were significantly higher during the exercise of 60%AT and AT in the 1 : 1 and 1 : 2 groups than in the control group (P<0.05 or P<0.01). The increase of HR was significantly lower and that of HF was significantly higher during the exercise at 60%AT in the 1 : 2 group than in the 1 : 1 group (P<0.05). CONCLUSION : PE activated the parasympathetic nervous activity and consequently restrained an excessive increase of HR during the exercise at 60%AT.

In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.

On 26 May 2024, the Panel Discussion 2 " Cooperation between medical doctors and acupuncturists: With a view to future medical care " was held at the 73rd Annual Meeting of the Japan Society of Acupuncture and Moxibustion was held in Sendai, Miyagi, Japan. Three panelists presented the attempts of cooperation between medical doctors and acupuncturists at medical institutions and medical field in Japan, including the fact that acupuncture and moxibustion have been successful in improving and alleviating patients' illnesses and symptoms in psychiatry, general internal medicine and palliative medicine, contributing to shorter hospital stays for patients, and the challenges for cooperation between medical doctors and acupuncturists at medical institutions and medical field in Japan. A designated speaker also presented on the development of highly specialized acupuncturists at the Japan Society of Acupuncture and Moxibustion to establish cooperation between medical doctors and acupuncturists, among others. Finally, we discussed issues and future prospects for cooperation between medical doctors and acupuncturists at medical institutions and medical field in Japan, with a view to future medical care where acupuncture and moxibustion will be utilized. One of the challenges in improving the utilization rate of acupuncture and moxibustion in Japan is the cooperation between medical doctors and acupuncturists at medical institutions and medical field. This report summarizes the contents of this panel discussion.

Patients with Behçet disease often develop postoperative valve detachment and pseudoaneurysm as a potentially fatal complication following aortic valve surgery, necessitating re-operation in a few cases. A 37-year-old man underwent 5 aortic valve and aortic root surgeries for the management of valve detachment after initial aortic valve replacement. Evaluation during the course of his disease revealed incomplete Behçet disease. He presented with high fever and Staphylococcus epidermidis bacteremia during the introduction of immunosuppressive therapy with infliximab. Contrast computed tomography revealed a pseudoaneurysm around the aortic root, and an aortic root replacement was performed using an aortic homograft after administration of a 6-week course of vancomycin. The patient is being observed at our outpatient clinic and has demonstrated no complications after 5 years from his last surgery.