In The 63rd Annual Congress of JSAM (Ehime 2014), the Committee for Safe Acupuncture of Research Department in the Japan Society of Acupuncture and Moxibustion (JSAM) conducted a workshop entitled "The Regional Anatomy Q&A for safety needling"which provided information on organ damage and neurological injuries that may occur after acupuncture treatments. This workshop stated the need for improvements in safe practices of acupuncture.
This workshop was divided into three parts:(1) results of questionnaire surveys conducted in Japan for acupuncturists on their clinical experience of adverse events and for orthopaedic doctors on their clinical experience of patients who suffered adverse events after acupuncture treatment;(2) a literature search of severe adverse events e.g., pneumothorax and neurological injuries, associated with acupuncture treatment in Japan;(3) the regional anatomy of the upper part of the body, which is based on several anatomical studies on acupoints.
The incidence of severe adverse events is considered to be very low during all acupuncture treatments;however, the real incidence is estimated to be higher than the number of case reports in the literature. In order to prevent severe adverse events, regional anatomical knowledge of needling points is very important, and furthermore, safe needling techniques are required.
We hope that this workshop can aid in enhancing the knowledge and techniques and contribute to safe practices of acupuncture.

We report a case of a dissecting brachiocephalic artery aneurysm that developed at the anastomotic site following surgery for acute aortic dissection ; and which was successfully treated by stent grafting. The patient, a 62-year-old man, had undergone total arch replacement for an acute Stanford type A aortic dissection that accompanied dissection of the brachiocephalic artery. In the early postoperative period, he complained of dull pain in the right arm and fatigue on exertion. The blood pressure in the patient's right arm was found to be significantly lower than in the left. Enhanced computed tomography (CT) performed 1 month postoperatively revealed leakage at the anastomotic site of the brachiocephalic artery, leading to the formation of a false lumen and the creation of a dissecting aneurysm with a maximum short diameter of 30 mm. No re-entry was seen, and the greatly expanded false lumen was exerting pressure on the true lumen, causing ischemia of the arm. Enhanced CT performed 3 months postoperatively showed that the maximum short diameter of the aneurysm had increased to 35 mm. Because ischemic symptoms of the arm were also present, surgery was considered to be indicated, and stent grafting was performed. A stent graft was inserted via the right axillary artery and positioned to close the entry to the false lumen of the dissecting aneurysm. Symptoms resolved without any complications, and the patient was discharged 7 days after the surgery. The false lumen of the dissecting aneurysm completely disappeared, and no complications have developed during the 3-year interval since stent grafting. In this patient, stent grafting enabled minimally invasive closure of the entry to the dissecting aneurysm that had developed at the anastomosis site. We conclude that stent grafting is very useful for treating dissecting aneurysms caused by anastomotic leakage and without re-entry, as seen in this case.

[Objective]We performed a questionnaire for the purpose of investigating the present conditions of infection control education in Japanese acupuncture schools and to discuss the problems.
[Methods]We conducted a postal survey by sending out questionnaires to 153acupuncture schools in Japan from December 2008 to March 2009.
[Results]Replies were obtained from 69.9%of the schools (107 out of 153schools). In their responses, 65%of the schools taught hand-washing with soap and alcohol-based hand rub as methods of hand hygiene. Moreover 58%of the schools used only single use needles (SUNs), 40%used both reusable and single use needles, and 2%used only reusable needles. However, single use was observed only at 25%of the schools that introduced SUNs.
Furthermore, we inquired whether the students were taught to use sterilized gloves and finger cots. The results illustrated that a proportion of schools provided the instruction;the proportion of constant instruction was 17%, that of the instructor's option was 35%, that of no requisite was 48%.
[Conclusion]From the above-mentioned results, it became clear that the direction for use of SUNs was not instructed adequately. In addition, this aseptic technique for puncture is not yet standardized in the school's education. It is necessary to realize the measures based on evidence and to employ them in educational programs at acupuncture schools.

Simultaneous pulmonary trunk and ascending aortic aneurysms are very rare, and the role of surgery in this entity is not well defined. We report a rare case of aneurysm of both the pulmonary trunk and the ascending aorta, associated with pulmonary and aortic valve insufficiency in a 17-year-old boy. Cardiac disease had been diagnosed at the age of 5, and at that time, pulmonary and aortic valve insufficiency were found by ultrasound cardiography (UCG). At regular follow-up, both cardiac valve regurgitation and the dilatation of the aneurysm gradually increased. A recent computed tomographic scan revealed that the ascending aortic aneurysm was 55 mm and the pulmonary trunk aneurysm was 60 mm. A UCG also showed severe aortic valve regurgitation and moderate pulmonary valve regurgitation with no pulmonary hypertension. Surgical repair was performed successfully. The aortic valve was replaced with a mechanical valve. The dilated ascending aortic aneurysm was excised and replaced with a Dacron graft. The pulmonary trunk aneurysm was incised longitudinally. The pulmonary valve was tricuspid, and no organic leaflets change was observed. Pulmonary valvuloplasty by commissure plication of the prolapsed cusps was performed. A large portion of the anterior pulmonary aneurysm wall was excised and plicated to reduce the radius diameter. The pathology of the aneurysm wall showed infiltration of inflammatory cells in the tunica media, fragmentation and decrease of elastic fiber, loss of muscular tissue, and increase in collagen fibers. No cystic medial necrosis was observed in the pathologic specimen. The postoperative course was uneventful, and there were no adverse events or complications at 2 years follow-up. The following image study revealed the normal size of the great vessels.

We report a case of graft infection long after femorofemoral crossover bypas grafting (FFBG), first presenting as septic distal emboli without any infective signs in the groin. A 71-year-old man who had undergone FFBG visited our hospital because of sudden pain in his right foot. No infective signs were found in the graft route from physical examination. However, computed tomography demonstrated perigraft fluid and graft thrombi. Graft excision and extra-anatomic revascularization were successfully done. Light micrography showed Staphylococcus aureus extensively infiltrating in the expanded polytetrafluoroethylene graft wall.

Cardiovascular surgery in situs inversus totalis (SIT) is unusual. We report a case of coronary artery bypass grafting (CABG) in SIT. A 67-year-old man with unstable angina pectoris was admitted to our hospital. Coronary arteriography demonstrated three-vessel disease in the mirror-image heart. CABG with 4 distal anastomosis was carried out with conventional methods. Careful observation based on complete understanding for preoperative images could minimize operative difficulties caused by mirror-image heart.