Purpose: Surgical resection of remnant gastric cancer (RGC) is technically challenging and difficult. Minimally invasive surgery (MIS) has been adopted for various procedures, but reports of MIS for RGC remain limited. Herein, we report the surgical techniques and short-term outcomes of MIS for RGC. Methods: We conducted a retrospective cohort study involving 61 consecutive RGC patients who underwent open or minimally invasive (laparoscopic or robotic) total gastrectomy for potentially curable RGC at our institution (January 1999–August 2025). A propensity scorematched cohort was used for an exploratory evaluation of the safety and efficacy of MIS for RGC, focusing on feasibility rather than superiority over open surgery. Results: Of these 61 patients, 53 underwent open surgery and eight underwent MIS gastrectomy for RGC. The median age was 70 years. The cohort comprised 53 men and eight women. The initial procedure was open surgery in 58 patients and MIS in three patients.Propensity score matching showed significantly reduced intraoperative blood loss in the MIS group compared with the open surgery group (39 mL vs. 576 mL, p < 0.05), and significantly longer operation time in the MIS group (352 minutes vs. 297 minutes, p < 0.05). Postoperative hospital stay was significantly shorter in the MIS group (12 days vs. 17 days, p < 0.05). The incidence of postoperative pancreatic fistula was lower in the MIS group, although not significantly different (0% vs. 16.7%). Conclusion MIS, including robotic gastrectomy, is feasible and safe for RGC, with potential perioperative benefits requiring multicenter validation.

Sports medicine requires a multidisciplinary and comprehensive approach, making it highly compatible with primary care. Internationally, there are many primary care physicians in the field of sports medicine; however, there are few in Japan. Although the demand for learning about sports medicine is high, there are few facilities where primary care physicians can undergo training. This report discusses the initiatives and prospects of the Kameda Family Clinic Tateyama Primary Care Sports Medicine Fellowship Program, which was established in 2009 and revised and implemented in 2022.

Sports medicine requires a multidisciplinary and comprehensive approach, making it highly compatible with primary care. Internationally, there are many primary care physicians in the field of sports medicine; however, there are few in Japan. Although the demand for learning about sports medicine is high, there are few facilities where primary care physicians can undergo training. This report discusses the initiatives and prospects of the Kameda Family Clinic Tateyama Primary Care Sports Medicine Fellowship Program, which was established in 2009 and revised and implemented in 2022.

  Background: The STarT (Subgrouping for Targeted Treatment) Back Screening Tool (SBST) is an established clinical evaluation tool that easily assesses the risk of chronic or refractory low back pain. This study aimed to examine the usefulness of acupuncture in patients with low back pain.  Methods: A total of 71 outpatients with low back pain who underwent acupuncture and moxibustion at the Center for Integrative Medicine, Tsukuba University of Technology, between 2019 and 2022 were included in this study, regardless of the specific medical condition causing the pain. Survey items included the SBST and lumbar pain intensity visual analog scale (VAS). Demographic factors and contents of acupuncture treatment were collected from the medical charts. The VAS score 4 weeks after the start of treatment was used as an index of clinical outcome and was analyzed using repeated measures analysis of variance (ANOVA) and hierarchical multiple regression analysis.   Results: Classification using the SBST at the first visit resulted in 36, 30, and 15 patients in the low-, medium-, and high-risk groups, respectively. Repeated-measures ANOVA showed statistically significant differences in the mean VAS values with respect to differences in time point (P < 0.01), group (P < 0.01), and interaction (P < 0.05). The VAS values after 4 weeks in the high-risk group were significantly higher than those in the other two groups (both P < 0.01). In the hierarchical multiple regression analysis, with VAS as the dependent variable, the relationship between SBST classification and VAS maintained a significant positive relationship in all models, including adjustments for interaction terms and patients’ background items. A simple slope analysis indicated that this relationship was more evident in patients with lower limb symptoms than in those without symptoms.  Conclusion: The SBST could be a simple and useful tool for predicting the clinical outcomes of acupuncture.

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.

  Background: The STarT (Subgrouping for Targeted Treatment) Back Screening Tool (SBST) is an established clinical evaluation tool that easily assesses the risk of chronic or refractory low back pain. This study aimed to examine the usefulness of acupuncture in patients with low back pain.  Methods: A total of 71 outpatients with low back pain who underwent acupuncture and moxibustion at the Center for Integrative Medicine, Tsukuba University of Technology, between 2019 and 2022 were included in this study, regardless of the specific medical condition causing the pain. Survey items included the SBST and lumbar pain intensity visual analog scale (VAS). Demographic factors and contents of acupuncture treatment were collected from the medical charts. The VAS score 4 weeks after the start of treatment was used as an index of clinical outcome and was analyzed using repeated measures analysis of variance (ANOVA) and hierarchical multiple regression analysis.  Results: Classification using the SBST at the first visit resulted in 36, 30, and 15 patients in the low-, medium-, and high-risk groups, respectively. Repeated-measures ANOVA showed statistically significant differences in the mean VAS values with respect to differences in time point (P < 0.01), group (P < 0.01), and interaction (P < 0.05). The VAS values after 4 weeks in the high-risk group were significantly higher than those in the other two groups (both P < 0.01). In the hierarchical multiple regression analysis, with VAS as the dependent variable, the relationship between SBST classification and VAS maintained a significant positive relationship in all models, including adjustments for interaction terms and patients’ background items. A simple slope analysis indicated that this relationship was more evident in patients with lower limb symptoms than in those without symptoms.  Conclusion: The SBST could be a simple and useful tool for predicting the clinical outcomes of acupuncture.

Low back pain is ranked number one burden of disease and a symptom that afflicts people worldwide. Although many cases of low back pain are considered non-specific, there is no unified agreement on the classification method. Furthermore, the biopsychosocial model is used as an interpretation model for understanding low back pain. Therefore, the effectiveness of acupuncture treatment for low back pain must be verified while clearly identifying the perspective from which low back pain is viewed and considering psychological factors. In this symposium, lectures were given by Akasaka, Inoue, Kikuchi, and Kondo. Akasaka explained specific and non-specific low back pain from the perspective of a physical therapist. Specifically, he presented the classification of low back pain based on structural anatomy of the musculoskeletal system such as facet joint, myofascial, and intervertebral discogenic pain as non-specific low back pain, and explained about the effectiveness of physical therapy. Inoue presented the results of randomized controlled trials of acupuncture treatment in patients with low back and lower limb pain that he had conducted. He also discussed the importance of needling at specific points such as the erector spinae group of muscles after carefully palpating these points. Furthermore, Inoue outlined the effects of needling along nerve pathways in patients with lower limb symptoms. Kikuchi reported the results of a retrospective observational study on the effectiveness of acupuncture in treatment of low back pain by classifying patients according to their movement reproducibility. He well stated that patients with movement reproducibility showed more improvement in low back pain-related quality of life. Kondo elaborated on how psychosocial factors in patients with low back pain could affect the effectiveness of acupuncture treatment. He also reported that the less catastrophic thinking about pain was, the greater effectiveness of acupuncture treatment was. In addition, Kondo also indicated that the lower risk on the Subgrouping for Targeted Treatment Back Screening Tool was, the more easily reduced pain was.We hope that the content of this symposium would serve as a valuable resource for clinical, research, and educational activities starting tomorrow.

The faculty development for clinical supervisor teaching residents (FD) was held for two nights on site in Japan. However, corona pandemic made it difficult to conduct the FD on site, thus we conducted it completely online. To avoid participants’ burden of long hours of synchronous online learning, we adopted a flipped classroom in which assignments in asynchronous online learning was used in discussion in synchronous learning. Assignments were issued sequentially five weeks prior to the synchronous session, and the synchronous session was held from 5:00 p.m. on Friday, November 13, 2020 to Saturday, November 14, 2020 for 45 participants. All participants completed the course by submitting all the assignments. The online flipped classroom utilizing assignments has a potential to significantly reduce the time constraints on busy clinicians.

[Objective]To investigate the effects of acupuncture on sports activities of athletes[Methods]A total of 1,804 athletes were targeted. The method used was a collective survey. Questionnaires were administered after obtaining consent from the participants; online questionnaires were also provided. The questionnaire evaluated profile (sex, age); sensation immediately after acupuncture treatment, duration of stimulus sensation, stimulus intensity, stimulus sensation, and therapeutic effect; timing of acupuncture treatment; and questions related to acupuncture as to whether the acupuncture caused any adverse effects on play (movement) or showed any positive effects.[Results]In total, 1,525 (84.5%) valid responses were obtained. The survey analyzed 841 subjects (55.1%) who underwent acupuncture. The most common response after acupuncture treatment was that the subjects felt lighter and were able to move more easily; 43.9% of subjects gave this response. In addition, 10.6% of respondents said that they continued to feel pain similar to the sensation during acupuncture treatment and 7.7% said they felt weak. The most common response at 59.8% was that the sensation felt during acupuncture disappeared quickly after treatment was ended, 58.6% of subjects said that the sensation felt after acupuncture was optimal, and 48.3% responded that the sensation from treatment remained and a positive effect was observed. The most common timing for receiving acupuncture for 21.8% of subjects was after practice or a match: [Discussion and Conclusion]Acupuncture for athletes should be performed according to the guidelines, taking into account the competition schedule and type of competition and the appropriate amount of acupuncture stimulation, thereby preventing problems during competition.