Purpose: Understanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function. Methods: In this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated. Results: Treitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal. Conclusion In summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

  Introduction: Stainless steel needles are mainly used in acupuncture treatment, but material considerations are crucial for patients with metal allergies. This report presents a case of acupuncture treatment administered without inducing allergic symptoms in the patient, achieved through effective collaboration with medical specialists.  Case: The patient was a 35-year-old woman. Complaints were menstrual symptoms, neck and lumbar pain, the former appeared after the birth of her second child at the age of 24, and the latter was felt chronically. She visited our department because she wanted to receive kampo medicine and acupuncture treatment. It was also reported that she had metal allergy symptoms. Therefore, after consultation with the allergist of our department, a full examination was requested at the dermatology department. In the meantime, our department suspected PMS, PMDD, and muscular or joint pain. First, we started acupuncture treatment using titanium press tack needles and resin contact needles to address muscular or joint pain, taking metal allergies into consideration. The frequency was once every two weeks. One month later, a patch test result was positive for nickel. Nevertheless, she still requested acupuncture treatment, and we consulted with the allergist regarding her case. Then, with her consent, the silicone-coated stainless steel acupuncture needles were inserted into the distal part of the limbs and remained in place for 15 min. During this time, we observed her skin and instructed her to closely monitor it and report any changes at her next visit. From the fifth treatment onward, additional acupuncture needles were placed in the neck and lumbar region, all without any allergic symptoms being observed.  Discussion and Conclusion: In this case, acupuncture treatment was performed safely in the medical cooperation. In the future, we would like to further examine the establishment of acupuncture treatment with high safety for patients with metal allergy symptoms and collaboration with medical specialists.

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.

[Objective] The aim of this study was to investigate the therapeutic effects of acupuncture in patients with chronic primary musculoskeletal pain. First, factors influencing treatment outcomes were identified using multiple regression analysis. Second, factors related to treatment selection were identified using logistic regression analysis. Third, the effects of non-electroacupuncture and electroacupuncture were compared using propensity score matching. [Subjects and Methods] This study utilized a retrospective observational design, enrolling participants based on the International Classification of Diseases, 11th Revision. In the multiple regression analysis, the dependent variable was the change in Visual Analogue Scale score before and after treatment, and in the logistic regression analysis, the dependent variable was the presence or absence of electroacupuncture. To compare the therapeutic effects of the non-electroacupuncture group and the electroacupuncture group, propensity scores were calculated based on factors related to treatment selection, and matching was performed to adjust the background characteristics of the two groups. The change in pain intensity was compared between the two groups using a two-sample t-test. [Results] First, in the multiple regression analysis, the initial Visual Analogue Scale score, Body Mass Index, and Undergoing electroacupuncture treatment were significantly associated with the change in pain before and after treatment. Second, the logistic regression analysis indicated that previous acupuncture experience and gender were related to treatment selection. Third, the comparison between the two groups revealed that the change in pain intensity was significantly greater in the electroacupuncture group (p = 0.03). [Discussion] The influence of initial Visual Analogue Scale score and Body Mass Index on treatment outcomes was consistent with previous studies. Regarding treatment selection, it was suggested that there is a tendency to avoid high-intensity treatments such as electroacupuncture for patients without prior acupuncture experience. The comparison between the non-electroacupuncture and electroacupuncture groups showed that both treatments resulted in a reduction in pain exceeding the minimum clinically important difference, indicating that both methods may be effective for pain management. [Conclusion] In patients with chronic primary musculoskeletal pain, electroacupuncture may be more effective than non-electroacupuncture, suggesting a greater therapeutic effect.