Objective: The practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management. Methods: A Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC. Results: A total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities. Conclusion Gynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.

Usually, chronic pain is difficult to treat because this is often accompanied by none-organic factors such as psychiatric symptoms, which complicate the pathological condition. For this reason, the guidelines also call for coping with peripheral symptoms except pain. This time, we report that facial pain as well as peripheral symptoms such as mental anxiety gradually improved by a combination of decoction extract and acupuncture and moxibustion. The case was a man in his 60s, who received all kinds of treatments such as taking Western medicines and blocking trigger points for chronic facial pain of unknown cause with mental anxiety. However, even after one year the side effects were strong and the treatment was ineffective. Acupuncturists and Kampo specialists made the diagnosis and treatment based on a common concept of Kampo medicine. Treatment focused on shin abnormalities and oketsu suppressed the vicious cycle of pain and improved psychiatric symptoms and QOL. It was suggested that Kampo medicine based on the idea “the same in mind and body” is effective for chronic pain in which various symptoms are intricately intertwined.

The number of acupuncturists and moxibustion therapists has rapidly increased since around 2000. If they can be regarded as new healthcare resource investments, it is of great significance to evaluate their social impact. Here, we conducted a regional correlation study in different prefectures by using the extension of average life expectancy as an evaluation index. The results revealed an increase in “acupuncturists (human healthcare resources)” and in “facilities for performing acupuncture and moxibustion therapy (physical healthcare resources)” to show a weak but statistically significant positive correlation with the extension of average life expectancy for elderly men. Due to methodological limitations, however, this study cannot confirm a causal relationship between them. The author strongly hopes that public service corporations involved in the provision of acupuncture and moxibustion will henceforth serve as a bridge to allow researchers, acupuncturists, and moxibustion therapists to collaborate and conduct multicenter joint studies, in order to create an even greater social impact of acupuncture and moxibustion.

Patients with the best supportive care often get worse and worse, and it is very difficult to improve their symptoms. As cancer is currently a leading cause of death in Japan, and adequate control of the cancer-associated pain is important to improve the quality of life (QOL) in cancer patients. Pain caused by bone metastasis is particularly difficult to control, and the strong analgesic medication which it requires is generally difficult to control. Such metastases result in reduced mobility and markedly reduced activities of daily living (ADL) and the QOL of patients. Our patient was a 67-year-old man who had been treated for metastasis from the left kidney to cancer of the right pelvic bone ; palliative chemotherapy and mild treatment were provided for his sharp pain, but control of his sharp pain was insufficient. Here we expand on our experience in a patient with bone metastasis caused by renal cell carcinoma successfully treated with Kampo medicine, using acupuncture and decoction extract.

In recent years, due to the rapid changing social structure, thedemands for medical services are also changing. There is a need to explore the future direction of acupuncture and moxibustion. Therefore, using the keyword "patient"as the focus of medicalservices, we discussed the question, "What is meant by 'patient-centered'Acupuncture and Moxibustion?"
Our results indicate that the numerous clinical treatments, education, and research that occurred throughout the long history of acupuncture and moxibustion in Japan were in fact all done "for the patient."However, we note that there is still room for improvement in verification method and cooperation between each field, and we confirmed that there is a need to build Acupuncture and Moxibustion methods that truly represent "patient-centered medicine."

Since ancient times, acupuncture and moxibustion have been widely administrated for any emergency case. In this country, they have been endeavored at establishing the harmony between Kampo and Modern medicine. Based on such background, we report two cases of colic pain attack of lithiasis successfully treated with contact needle therapy established by Bunkei Ono.In case one, ureterolithiasis brought colic back pain. Symptoms were improved with satisfaction for one session and the stone discharged via following Kampo-medication.In case two, the patient suffered from colic epigastralgia of choledocholithiasis complicated by severe appetite loss. Although one session successfully extinguished the symptoms, blood chemistry revealed implying signs of cholangitis. A laparotomy with T-tube drainage was performed eventually.These cases pronounced the efficacy of contact needle therapy in the treatment of colic pain and invited deliberate estimation with Modern medicine. The harmony between Kampo and Modern medicine was considered as a prerequisite for clinical practice.

Recently, the number of athletes who receive acupuncture therapy is increasing. However, most of these athletes receive acupuncture therapy with single-acupuncture and/or electro-acupuncture to a local point, or a trigger point. We experienced two water polo athletes who were improved using acupuncture and moxibustion therapy with “zuisho” therapy. Case 1 was 16 year old man. He became aware of pain in his right thumb after training, which continued with extended training time, a numbness in his left hand appeared more, and he received acupuncture and moxibustion therapy. These symptoms disappeared immediately with acupuncture and moxibustion therapy using the standard traditional methods, such as contact needling to a yuan point, and in situ acupuncture to a back shu point, etc. Case 2 was 17 year old man. He received acupuncture and moxibustion therapy for lumbago and stiffness of the neck. These symptoms disappeared immediately after acupuncture and moxibustion therapy using the standard traditional methods such as contact needling to a yuan point, and inserting needles into a back shu point, an extra meridian, etc. In these two cases, symptoms were improved with “zuisho” therapy, and both could continue with longer and more strenuous training. This suggests that acupuncture and moxibustion therapy using the standard traditional methods are useful for athletes.
Acupuncture ; Therapeutic procedure ; symptoms <1> ; Training ; Water

During the perioperative period after total hip arthroplasty (THA), much attention has been recently paid to deep venous thrombosis, yet there are few reports concerning stroke after THA and there is no such data at all in Japan at present. The purpose of this retrospective study was to elucidate the occurrence rate and the characteristics of stroke cases during the THA perioperative period. A total of 1,551 primary THAs performed between January 1999 and December 2008 were investigated. Cerebral infarction occurred in three patients (0.19%) during three weeks after THA. Concerning the related factors, one male had foramen ovale, one female had untreated diabetes and atrial fibrillation, and one female had severe stenosis of the internal carotid artery. Cerebral infarction occurred at Day 1 in one male, at Day 2 in one female, and at Day 5 in the other female, and they underwent anticoagulant therapy just after their diagnosis. In all three patients, motor paralysis fully improved and they came back to the THA rehabilitation program within Day 9. One male was discharged at 4 weeks, and another two females were discharged at 8 weeks. Because many people eating a more European diet are now getting older in Japan, prophylaxis for not only DVT but also stroke after THA should be emphasized.

Case1was a 91-year old man diagnosed with multiple cerebral infarctions. He had undergone percutaneous endoscopic gastrostomy in the same year. One year later, we initiated acupuncture treatment because of recurrent respiratory tract infections. The acupuncture points selected were LU 5, Chize and KI 13, Taixi. Before acupuncture, the frequencies of antibiotics-use and feverish days were 6.3 days and 2.7 days per month on average. During acupuncture therapy, these frequencies were reduced to 1.2 days and 0.6 days per month, respectively.Case 2 was an 81-year old man diagnosed with right thalamic hemorrhage. He underwent percutaneous endoscopic gastrostomy in the same year. After 6 months, we began acupuncture treatment, also because of recurrent respiratory tract infections. The acupuncture points were the same as in Case 1.Prior to acupuncture, antibiotics-use and feverish days were 8 days and 4.5 days per month, which were then reduced to1and 0.6 days per month, respectively.Case 3 was a 93-year old man diagnosed with dementia. He was being fed via nasoenteric tubes. After 3 months, again because of recurrent respiratory tract infections, acupuncture treatment was begun. The acupuncture points were the same as in Cases 1 and 2.His use of antibiotics and feverish condition were 9 days and 10 days per month on average before acupuncture, but with acupuncture therapy these were improved to 2 days and 1.3 days per month.Based on this experience, it is suggested that acupuncture be considered for the treatment of recurrent respiratory tract infections in elderly, tube-fed patients.
Acupuncture ; days/month ; Respiratory ; therapeutic aspects ; Cases