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.

There are various diseases of the gallbladder and cystic duct, and imaging diagnosis is challenging for the rare among them. However, some rare diseases show characteristic imaging findings or patient history; therefore, familiarity with the imaging presentation of rare diseases may improve diagnostic accuracy and patient management. The purpose of this article is to describe the imaging findings of rare diseases of the gallbladder and cystic duct and identify their pathological correlations with these diseases.

  Strength training performed while restricting blood flow is believed to cause the secretion of growth hormones under low load intensities and allow for muscle hypertrophy and increased muscle strength. This has potential clinical applications for elderly individuals and people with existing conditions. However, previous research has been performed on land, with hemodynamics and growth hormone secretion trends for training performed underwater unclear. Against this background, we investigated the effects of blood flow restriction training underwater on hemodynamics and plasma growth hormone (GH) levels. Twelve healthy university students were divided into two groups: a localized immersion group where only the upper limb of the dominant hand was submerged, and a whole-body immersion group where participants were submerged to the xiphoid process. Immersed according to respective group protocols, both groups performed flexion and extension of the shoulder joint for 10 minutes with a pressurized cuff at the base of the upper arm under both 0 mmHg and 50 mmHg cuff pressures. Measured hemodynamics were heart rate, systolic blood pressure, and diastolic blood pressure. Plasma GH levels were measured from blood samples. This study revealed that underwater blood flow restriction strength training induced plasma GH level secretion under 50 mmHg conditions. In addition, high levels of GH secretion were shown in the localized immersion group for strength training even when the cuff was not pressurized. Conversely, no significant differences were evident in any measured hemodynamic categories. Results suggest that, in addition to cuff pressure, blood flow restriction training is affected by the body part immersed in water.

  Aquatic walking, which is influenced by the physical characteristics of water such as buoyancy, resistance, water pressure, and water temperature, is known to be effective for reducing stress on joints and increasing muscular strength. However, there is no consensus on its influence on blood pressure changes in elderly people. To address this uncertainty, we researched the effects of aquatic walking on the blood pressure of elderly people. Study participants were 48 females enrolled in a class to prevent the need for nursing care. In accordance with the diagnostic criteria for hypertension, participants were divided into two groups based on initial blood pressure measurements: a “high blood pressure group” with 27 people and a control group with 21 people. Both groups did the following program once a week for five weeks: 10 minute warmup, 15 minutes of aquatic walking (forward, backward, and sideways walking), 10 minute break, and additional 10 minutes of aquatic walking. Systolic blood pressure, diastolic blood pressure, heart rate, and average blood pressure of the participants were recorded. Results showed that the high blood pressure group showed significant decreases in systolic blood pressure after one week, and significant decreases in both diastolic blood pressure and average blood pressure from three weeks onward. No significant change was evident in the control group. However, comparing values measured immediately before and after aquatic walking showed that the control group had a significant post-aquatic walking increase in both systolic and diastolic blood pressures as well as a significant decrease in heart rate. Similar significant post-aquatic walking increases in systolic and diastolic blood pressures as well as a significant decrease in heart rate was also evident in the high blood pressure group from five weeks onward, once their measured values had improved. These results suggest that continuing an aquatic walking program will lower the blood pressure of elderly individuals meeting the diagnostic criteria for hypertension, but it is necessary to be attentive to physical condition because blood pressure increases immediately after aquatic walking in non-hypertensive individuals.