Currently, it is difficult to say that young acupuncturists and athletic trainers (ATs) in Japan are advancing smoothly in their clinical practice, fieldwork, and research activities. This symposium aims to report on the current state and challenges faced by these professionals, along with discussing possible solutions for improvement. Kawaguchi introduced the implementation of the Acute: Chronic Workload Ratio for managing training loads in a university American football team, highlighting that maintaining player loads within the "Sweet Spot" could enhance injury prevention. However, he pointed out that insufficient data from players posed a significant challenge to data collection and consistent monitoring. Murakoshi presented on the sports acupuncture support project at Niigata University of Health and Welfare, which establishes a treatment framework for student-athletes, but noted that a lack of understanding among coaches has hindered widespread adoption. Saito discussed condition monitoring in Japan's national hockey team, emphasizing the utility of sleep data and self-reported fatigue in player health management, while stressing that communication with athletes is as crucial as data collection. Hosoi, drawing on his experience in sports settings, underscored the need to improve the status and treatment of acupuncturists due to the shortage of evidence-based approaches, and highlighted the disparity in treatment between Japan and overseas, advocating for an elevated status for acupuncturists in sports environments. Additionally, he presented various sports field activities, particularly focusing on Japan's national soccer team (SAMURAI BLUE), to illustrate the high demand for acupuncturists and ATs. Tamai described his research on salivary biomarkers for fatigue assessment, suggesting the potential of viral nucleic acids as new indicators in the face of limitations in conventional fatigue assessment methods. These five reports emphasized the importance of training load management and acupuncture care in sports settings, underscoring the need for establishing evidence, introducing scientific methods for fatigue evaluation, and implementing reforms to improve the status and working conditions of these professionals.

We report a case of mitral valve replacement without aortic cross clamp in a patient with MitraClip failure. The patient is an 83-year-old man with a history of coronary artery bypass surgery 31 years earlier. He developed heart failure due to severe mitral regurgitation. He underwent MitraClip, but it caused mitral stenosis and hemodynamic instability. Considering the severe calcification of the ascending aorta and previous bypass grafts, typical median sternotomy surgery with cross clamp had to be avoided. We performed mitral valve replacement via right thoracotomy under ventricular fibrillation. The postoperative course was favorable. Mitral valve surgery with ventricular fibrillation could be undertaken safely for a patient with difficulty in aortic cross clamp.