[PURPOSE] To examine the safety of acupuncture treatment for breech presentation. [PARTICIPANTS AND METHODS] A retrospective study of cases in which acupuncture in the pelvic position was performed on hospitalized pregnant women with preterm labor in the pelvic position during the period March 1, 20XX-11 to December 28, 20XX was conducted. The survey items included maternal background, maternal and fetal status (including Non stress test), change in drug dosage for preterm labor, outcome of acupuncture treatment, and any adverse events due to acupuncture treatment. [RESULTS] There were 23 pregnant women who qualified for the study. All were receiving standard management of imminent preterm labor. The median number of acupuncture sessions was 7 per patient, for a total of 157 sessions. There was no significant increase in the number of uterine contractions within 24 hours of acupuncture treatment, and in no case was the fetal status assessed as non-reactive before delivery. There was no significant increase in drug dosage within 24 hours of acupuncture treatment. The rate of correction to the cephalic position was 39.1% (9/23 cases). Two adverse events (Grade 1) due to acupuncture treatment were observed, with a frequency of 1.3% (2 cases/157 sessions) per treatment. In addition, there were two cases in which ritodrine hydrochloride was increased within 24 hours of acupuncture treatment.[CONCLUSION] In our study population, there were no signs of fetal distress or worsening of uterine contractions. In the acupuncture treatment methods of our department, the possibility of adverse effects on the mother or fetus was considered low. However, there were two cases in which ritodrine hydrochloride was increased after acupuncture treatment. When providing acupuncture and moxibustion treatment to pregnant women, it is necessary to collaborate with obstetricians.

[Objective] To investigate effect on symptoms and safety of acupuncture and moxibustion for cancer-related fatigue.[Participants and methods] The subjects of the study were cancer patients hospitalized in palliative care who were treated with acupuncture for fatigue during the period from April 20XX-5 to October 20XX. Medical records were examined retrospectively. The main items investigated were changes in the symptom item of the STAS-J scores before and after the start of acupuncture treatment, and the frequency of adverse events.[Results] Thirty patients (14 women) were eligible for the study. All patients received standard palliative care. STAS-J improved within one week after the start of acupuncture treatment in 17 cases (56.7%), remained unchanged in 13 cases, and worsened in none of the cases. The number of acupuncture treatments was 14 per patient (median), for a total of 514 total treatments. No adverse events as defined by acupuncture safety guidelines were observed.[Conclusion] This report does not evaluate the impact of acupuncture alone because palliative care involves multidisciplinary care. However, the symptom item of the STAS-J improved in 56.7% of cases within one week after the start of acupuncture treatment, no cases worsened, and no adverse events were observed. Acupuncture and moxibustion is one of the methods worth trying in cases where symptoms of cancer-related fatigue do not improve with standard palliative care.

Background/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL. Methods: The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake. Results: In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2). Conclusions Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA– group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0% and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Conclusions Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

[PURPOSE] To evaluate the efficacy and safety of acupuncture and moxibustion treatments in breech presentation, we report correction rates and adverse events for correcting breech presentation in our department.[PARTICIPANTS AND METHODS] Subjects were pregnant women who were diagnosed with breech presentation in our obstetrics and gynecology department and started acupuncture and moxibustion treatment between April 1, 2009 and October 31, 2018. The target patients were retrospectively investigated by medical records. The main items investigated were the status of the pregnant women at the time of acupuncture and moxibustion initiation (presence or absence of threatened preterm labor), treatment position (sitting or lateral position), correction rates and occurrence of adverse events. Successful correction was defined as the rate of head position after acupuncture and moxibustion treatments. Adverse events were defined as "unfavorable medical events occurring during or after treatment, regardless of causation."[RESULTS] There were 371 pregnant women in the study; among them 57 women were diagnosed with threatened preterm labor at the start of acupuncture and moxibustion treatment, including 21 pregnant women who were in the hospital. The sitting position was used for treatment for 45.2% (168 cases) of subjects and lateral position was used for 54.7% (203 cases). The correction rates were 72.2% (268/371). In pregnant women with threatened preterm labor who were hospitalized at the time of acupuncture and moxibustion initiation, the correction rates were 28.6% (6/21 cases), which was significantly lower than that of outpatient pregnant women. There was no significant difference in the rate of correction by treatment position between sitting and lateral position. There were no adverse events of vagal reflexes when the left lateral position was treated. The frequency of adverse events per number of procedures was 1.1% (21/1916) and per number of cases was 5.7% (21/371 cases). There were two cases of rupture of membranes with no apparent causal relationship.[CONCLUSION] The safest position for treatment in pregnant women was considered to be the left lateral position. Most of the adverse events were minor or moderate, but there were two cases of rupture of membranes with no apparent causal relationship. When performing acupuncture and moxibustion for breech presentation, it is necessary to work closely with the patient's obstetrician.

[OBJECTIVE] In recent years, acupuncture treatment for cancer patients has spread worldwide. However, in Japan, there are few facilities where acupuncture and moxibustion treatment is being carried out in a hospital, and in introducing acupuncture treatment as part of palliative care is rare. In this study, we investigated the current situation at our hospital where acupuncturists are participating in the palliative care team of the hospital.[PARTICIPANTS AND METHODS] Subjects were patients with cancer in our hospital who were hospitalized to receive the best supportive care for their condition and who had started acupuncture treatment between April 8, 2011 and November 13, 2017. The target patients were retrospectively investigated by medical records. [RESULTS] Of the 75 patients, 72 (96%) were Performance Status 3 and 4. Thirty-seven (49%) had oxygen therapy. Fifty-five patients (73%) had pleural fluid or ascites during acupuncture and moxibustion treatment, and 50 patients (67%) had edema. In the treatment of acupuncture, Contact Needle Therapy was used to avoid the risk of infection and bleeding, and in the moxibustion treatment, scarring moxibustion was not used to avoid the risk of burns and infection. Fifty-nine patients (79%) had a positive opinion of the acupuncture treatment. Forty-five patients (66%) requested acupuncture within two days of their death. There were 3 adverse events, but all were mild and transient, .[CONCLUSION] In the acupuncture treatment at our hospital for patients in the terminal stage of cancer, treatment was performed taking into consideration the risks to the patient, and there were no serious adverse events. There were many positive feedbacks from patients who received acupuncture, suggesting that acupuncture may be useful for alleviating symptoms at the end stage of cancer.

In Japan, Nordic walking (NW) has two style walking method. For one thing, the poles are used to push against the ground towards the back of the body (diagonal style: DIA). The other one, the poles put on forward and using like a cane (defensive style: DEF). This study aims to clarify differences between the two Nordic walking (NW) styles. The subjects were 12 community-dwelling middle-aged and older adults (mean age: 62.4 ± 7.8 years). All of subjects were tested to perform NW in both style for 12 minutes walking around the park. Walking distance, speed, heart rate (HR), energy expenditure (EE) and electromyogram (EMG) amplitude of the upper and lower limbs using surface EMG were assessed. A pole with a built-in load cell measured force used to push the pole into the ground (pole force), pole contact time, and pole impulse. Distances and speed in DIA was significantly higher than DEF. Significant difference in muscle activity was observed between DIA and DEF in the triceps brachii only. EE of DEF was significantly higher than DIA. Poling force and pole impulse in DIA was significantly higher than DEF. These results indicate that when prescribing NW for health promotion, it should be done according to each characteristic in DIA or DEF.

[Objective]Although warm-tube moxibustion is easy-to-use in acupuncture therapy, the timing of moxa removal varies among practitioners. In the present study, we used near infrared spectroscopy (NIRS) to compare effects of different durations of moxibustion stimulation on improvement in local circulation as measured by changes in blood oxygenation dynamics in muscle tissue.
[Methods]Twelve healthy adults underwent warm-tube moxibustion with a single cone applied to the upper right shoulder region;measurements of tissue blood oxygenation dynamics (ΔOxy-Hb, ΔTotal-Hb) were obtained at intervals of 0.5 s. Control measurements were first taken for 15 min without intervention (Control);then, subjects received moxibustion 2 min after the start of measurement and had the moxa removed at the following time points: 30 s after patients experienced heat pain (Removal 30, moxibustion group); 45 s after heat pain (Removal 45, moxibustion group);or did not have the moxa removed (Continuous moxibustion group). These 4 different conditions were compared. Additionally, we determined the burning temperature of moxa and the skin temperature and intensity of heat pain sensation at the site of moxibustion.
[Results]Compared with the Control, the Removal 30, Removal 45, and Continuous moxibustion groups had significant increases in ΔOxy-Hb, ΔTotal-Hb, and skin temperature, with no significant differences among the moxibustion groups. No significant difference in the intensity of heat pain sensation was observed among the moxibustion groups. All moxibustion groups began to show rapid increases in both ΔTotal-Hb and ΔOxy-Hb around the time when subjects began to feel heat pain, suggesting that the axon reflex evoked by noxious stimuli of heat pain increased blood volume and arterial blood flow.
[Conclusion]Hemodynamic improvement in muscle tissue through the use of continuous warm-tube moxibustion for 30 s or longer after the occurrence of heat pain was confirmed.

The number of senile eye cataract cases increases year by year. Recent developments in new operation techniques have brought more safety and ease i.e. ultrasonic phacoemulsication and lens replacement. However, some complications of these techniques result in troublesome outcomes. In this paper the authors report a female patient aged 74 years old who suffered from severe photophobia after cataract surgery, which was successfully treated with the Kampo formulation, ryokeikansoto. Such troublesome cases tend to be neglected to in medical journal publications when the background of the complaint is unknown.