The main mechanisms by which acupuncture/moxibustion treatment exerts its effects are "activation of the pain inhibitory system", "influence on tissue perfusion" and "relaxation of hypertonic muscles". Basic research has been conducted on these effects in various fields, and substantial knowledge has been obtained. Furthermore, in clinical studies based on the results of such research, these key expressions are often used to discuss outcomes. As can be seen from this, in most cases, acupuncture/moxibustion treatment is used to cause functional changes rather than organic changes. On the other hand, "regenerative medicine" is a field that requires clear organic changes. The theme of "regenerative medicine and acupuncture/moxibustion" discussed in this symposium is a challenge to enter a new area of medicine that differs from conventional acupuncture/moxibustion treatment. In this presentation, "peripheral nerves", "bones", "tendons" and "muscles" are the focus, and the results of previous research on each are introduced. This paper summarizes the details.

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study. Methods: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD. Results: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4). Conclusions Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.

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.

Introduction  The objective of this study was to identify measures Japan should take to achieve health (goal 3) and gender (goal 5) goals of the Sustainable Development Goals (SDGs) in synergy by comparing the status of health and gender in Japan and the United Kingdom based on gender analysis.Methods  In-depth interviews were conducted with 8 gender experts and 2 obstetrician/gynecologists in Japan and 9 informants in government, civil society and academia in the UK. The status of sexual and reproductive health and rights (SRHR) and measures against gender-based violence were elaborated. Qualitative content analysis was conducted on the transcripts of the interview audio-records.Results  We have compared contraception and abortion, control of sexually transmitted infections, sexuality education, measures against breast and cervical cancers and measures against gender-based violence in Japan and the UK. Significant differences were noted in contraception and abortion, sexuality education and measures against gender-based violence. There were four areas where the UK applied gender-transformative measures (measures that address not only the condition of women but also the gender relations between men and women and social status of women) whereas Japan has not yet applied such measures: 1) Ensuring selection of a wide range of contraceptive methods with low price, 2) Enabling abortion solely based on the decision by women, 3)Comprehensive sexuality education that includes gender and human relationship, and 4) Setting an integrated strategy against gender-based violence. Conclusion  Japan can strive for both health and gender goals of the SDGs by addressing above four aspects. Promotion of civil society participation in policy decision and increased proportion of female parliamentarians will help address these aspects.

BACKGROUND/AIMS: Reliable diagnostic instruments for measuring the presence of functional gastrointestinal disorders based on the Rome III criteria have been lacking in Japan. The aims of the present study were to translate and validate the Rome III diagnostic questionnaire which was widely used in Western countries. METHODS: The original version of Rome III diagnostic questionnaire was translated from English into Japanese through 3 independent forward translations, resolution, back translation and reconciliation of the differences. Forty-nine patients with irritable bowel syndrome (IBS), 32 patients with functional dyspepsia (FD) and 56 subjects without any current GI symptoms as controls were recruited from three hospitals located in different regions of Japan and completed the IBS and FD diagnostic modules twice within 14 days. Kappa statistic was used to assess test-retest reliability. The sensitivity and specificity of each diagnostic module for distinguishing IBS or FD patients from controls was tested. RESULTS: Median kappa statistics were 0.63 for the translated IBS diagnostic module and 0.68 for the FD module. The sensitivity, specificity, and positive predict value of the IBS module against physician diagnosis was 61.2%, 100%, and 100% and those of the FD module was 53.2%, 98.2%, and 94.4%, respectively. Meanwhile, IBS patients were significantly more likely to report blood in stools compared to controls (18.4% vs 1.8%, P < 0.01). CONCLUSIONS: The IBS and FD diagnostic modules on the Japanese version of the Rome III diagnostic questionnaire are valid and reliable. Further studies are warranted to elucidate the diagnostic utility of the red flag questionnaire.
Asian Continental Ancestry Group* ; Diagnosis ; Dyspepsia* ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome* ; Japan ; Reproducibility of Results* ; Sensitivity and Specificity ; Translations

Background: The relaxing phenomenon induced by acupuncture on hypertonic muscle has not clearly been demonstrated. We studied whether acupuncture stimulation on the hypertonic muscle model induce relaxation. Methods: A rat model of hypertonia was created by inducing tetanic contraction in the triceps surae muscles of 21 Wistar rats (male, 12 weeks) with four electrical stimulations (80 Hz, 5 mA, 5 min.), with a 2 min. interval between each stimulation. The rats were randomly divided into two test groups: 1. Untreated group (N = 12), 2. Group treated with acupuncture stimulation of the triceps surae muscle (N = 9). Rats in the untreated group received no therapeutic treatment after the model was created. Acupuncture was performed within 5 min. after the model was created. Evaluations were taken before and 5 min., 1, 2 and 3 days after tetanic contraction was induced. The rats were anaesthetized and a tension sensor for measuring static and dynamic muscle tension was used to determine triceps surae muscle stretching tension during passive dorsal flexion of the foot (30°, 40°, 50°). Results: In both groups, at each of the angles of passive dorsal flexion, there was a significant increase in stretching tension 5 min. after inducing tetanic contraction compared to before induction, and statistics showed recovery to pre-induced tetanic contraction values after 1 day and thereafter. Compared to the untreated group, however, values 5 min. after induced tetanic contraction tended to be lower in the group treated with acupuncture stimulation. Conclusions: Compared to the untreated group, stretching tension values 5 min. after inducing tetanic contraction tended to be lower in the acupuncture group. This could be due to acupuncture stimulation causing changes in blood flow in the lower leg, including muscle tissue, resulting in reuptake of calcium by the sarcoplasmic reticulum, and/or the influence acupuncture on reducing lower leg edema. Acupuncture stimulation could also have an action on the γ fibers and Ib fibers associated with continuous muscle tonus and muscle relaxation.

Objective: The purpose of this study was to compare the effects of superficial and deep insertion of acupuncture needles in the treatment of patients with neck-shoulder pain and to search for more effective acupuncture methods. Methods: The subjects were patients seen at the Meiji University of Integrative Medicine’s Department of Orthopedic Surgery Clinic. A randomized controlled clinical trial was conducted in which 20 patients with neck-shoulder pain were randomly allocated to either a superficial acupuncture group (n=10) or a deep acupuncture group (n=10). Treatment was applied to points where patients experienced the most pain. The maximum number of stimulation points for both groups was 10. In the superficial acupuncture group, the needle was only inserted to a depth of 5 millimeter. In the deep acupuncture group, the needle was inserted to a depth of 15 to 20 millimeter. Both groups were manually stimulated using a sparrow pecking method over 20 seconds, after which the needle was removed. Both groups were treated weekly for four weeks. The primary outcome measurement was intensity of pain evaluated using a Visual Analogue Scale (VAS). The secondary outcome measurement was the Neck Disability Index (NDI) for the purpose of evaluating the grade of disability in daily life due to neck-shoulder pain. Results: There were no significant differences in age, male-female ratio, disease duration, or the initial scores of VAS and NDI between the two groups. VAS and NDI scores indicated significant differences between the groups (VAS: <0.0001, NDI: p<0.0001) in change over time, with the deep acupuncture group having more favorable results than the superficial acupuncture group. The degree of change from the baseline at the time of each evaluation was calculated, and results for the two groups were compared. The deep acupuncture group showed significantly better improvement in the sustained effects after completion of treatment (VAS: p<0.05). There were no significant differences directly after the first treatment (VAS: p=0.72) or in cumulative effect after repeated treatment (VAS: p=0.24). Discussion and Conclusion: The results of this study suggested it would be more efficient to insert the needle to deep tissues when performing acupuncture treatment on subjective pain sites. The difference in the effects between the two acupuncture methods may be due to the difference in tissue stimulation received. The difference in effect is thought to be due to the differing influence of treatment on pain threshold, muscle blood flow, and muscle tones.

Background: The authors, in collaboration with a nursing college and healthcare organizations, initiated a project, "Tama District (a suburban area in Tokyo) End-of-life Care Networking" for nurses, in order to provide networking opportunities for nurses who would like to work together in their local community. A survey was conducted to identify those nurses' needs before initiating this project. Result: The first networking meeting was held based upon the survey results, and 39 nurses participated. The participants were from 14 hospitals, six home-visit nursing stations, and one home care support office in a northern area of Tama District and its surrounding areas in Tokyo. After having this meeting, it was identified that these nurses were highly motivated in providing better end-of-life care, and they had strong desires to network together and to exchange information about challenges and opportunities in their practice. Conclusion: Future issues and implications included the following: (1) Providing continuous opportunities for nurses with such meetings, and refining and updating programs to meet their needs; (2) Facilitating face-to-face relationships among individual nurses in this local community in order to facilitate better collaboration; (3) Initiating local activities that may improve and enhance nursing practice for patients and families who have health issues in their daily life.

BACKGROUND AND OBJECTIVES: Reactive oxygen species (ROS) mediate various signaling pathways that underlie vascular inflammation in atherogenesis and cardiovascular diseases. Cardiac rehabilitation (CR) has a variety of multiple beneficial effects, including anti-inflammatory effects. The purpose of the present study was to investigate the effects of CR on ROS in patients with cardiovascular diseases. SUBJECTS AND METHODS: The serum level of derivatives of reactive oxidative metabolites, an index of oxidative stress, was measured in 100 patients with cardiovascular diseases before, and, subsequently, 3 and 6 months after, CR. A biological antioxidant potential (BAP) test was applied to assess the antioxidant power of the serum. RESULTS: The resting reactive oxidative metabolite levels decreased 3-6 months after CR {pre: 351+/-97 Carratelli unit (CARR U), 3 months: 329+/-77 CARR U, 6 months: 325+/-63 CARR U, all p<0.01} with the increase of the percentage of the predicted values of VO2 peak and the percentage of the predicted values of VO2 at the anaerobic threshold (VO2 AT) and the decrease of the B-type natriuretic peptide (BNP). The BAP test and antioxidative/oxidative stress ratio increased 6 months after CR. The % changes of the antioxidative/oxidative stress ratio was positively correlated with the % changes of VO2 AT, and negatively correlated with the % changes of the BNP. CONCLUSION: These results suggest that intensive supervised CR significantly improved exercise capacity, which may be attributable to an adaptive response involving more efficient oxidative metabolites or the increased capacity of endogenous anti-oxidative systems in patients with cardiovascular diseases.
Anaerobic Threshold ; Antioxidants ; Atherosclerosis ; Cardiovascular Diseases ; Exercise Therapy ; Humans ; Inflammation ; Natriuretic Peptide, Brain ; Oxidative Stress ; Oxygen Consumption ; Reactive Oxygen Species

Objective: We applied acupuncture to the cervical region of patients suffering from upper extremity radicular symptoms due to cervical spondylotic radiculopathy (CSR) and verified clinical efficacy. Methods: 16 extremities of 15 patients were selected as subjects diagnosed with CSR and suffering from upper extremity pain and/or dysaesthesia. All of the patients were treated with acupuncture once a week for four weeks, on up to ten sites where tension/induration was recognized in the cervical paraspinal region centered around the affected area. A stainless steel needle 0.18mm in diameter was inserted 10 to 20mm, manipulated using the sparrow pecking method (1Hz, 20sec) and removed. The severity of symptoms was recorded before each treatment and one month after the completion of the treatments using a Visual Analogue Scale (VAS) and evaluated. In addition, a Quality of Life (QOL) evaluation was conducted before treatment, after four treatments, and one month after the completion of the treatments using the Neck Disability Index (NDI) and CSR treatment effectiveness metrics. Results: VAS plots show a significant change in pattern over time in all cases (Neck-shoulder pain: p<0.0001, upper extremity pain: p<0.0001, upper extremity dysaesthesia: p<0.001). Furthermore, in QOL evaluation, both NDI and CSR treatment effectiveness metrics similarly showed a significant change (NDI: p<0.0001, CSR treatment effectiveness metrics: p<0.0001). Because there was a significant difference (p<0.001) between symptoms before treatment and before the fourth treatment, the efficacy of continued treatments was verified. Meanwhile, there was no significant difference between the symptoms at the completion of the treatments and the symptoms one month after the completion of the treatments; thus, the sustained efficacy of treatments over a certain period was verified (p=0.52). Discussion and Conclusion: These results verified that acupuncture treatment to the cervix has continued and sustained efficacy not only on the symptoms of neck and shoulders due to CSR, but also on upper extremity pain and/or dysaesthesia; therefore, we think this is a promising treatment as the first choice for conservative therapy. The mechanism that alleviates upper extremity pain and/or dysaesthesia through acupuncture treatment to the cervix via the stimulation of the posterior branch of the spinal nerve dominating the cervical paraspinal muscle creates a reflex effect in the anterior branch of the same nerve; as a result, it is beneficial for suppressing upper extremity pain dominated by the anterior branch as well as improving nerve blood flow.