[Introduction] What is a medical-like practice as defined in Article 12 of the Act on Anma, Massage, Shiatsu, Acupuncture, and Moxibustion Practitioner, etc.? Are Anma, Massage, Shiatsu, Acupuncture, and Moxibustion included in the medical practice? This article examines medical-like practice based on the above questions.[Objective & Method] First, the medical practice, which is the premise for practice similar to the medical practice, was clarified. Next, we interpreted the wording of the articles of the law. We then organized the literature, Ministry of Health and Welfare notifications, and judicial precedents to depict the contours of medical-like practice. Finally, we examined how medical-like practice are positioned in the medical care system, in relation to the Medical Practitioners Law, and in comparison with the medical practice.[Result] Regarding the medical practice, medical practice could be defined as an act that "may cause health hazards unless it is performed by a physician" based on the assumption that it is now "an act with medical relevance" based on notifications and judicial precedents. From the interpretation of the wording of the relevant articles of the law, it was concluded that the natural interpretation is that kind of practice is included in acts similar to medical practice. Through the literature, notifications, and judicial precedents, the content and direction of the understanding and interpretation of the medical profession-like practice have been clarified and refined over time, and the latest Ministry of Health and Welfare notifications and judicial precedents confirm that the law is currently being applied as a medical profession-like practice. The study examined the medical profession-like practice in relation to the Medical Practitioners Act and in comparison with the medical practice, and concluded that although the medical practice is performed by medical doctor, if one focuses only on the act, the medical profession-like act can be said to be part of the medical profession, albeit to a limited extent.[Discussion] However, it is extremely limited compared to treatment performed by medical doctor, and is different from medical practice in terms of the interpretation of the article, the Ministry of Health and Welfare's opinion, and judicial precedents. However, if that practice is to play a role in the advancement of medical treatment, the practitioner as a "medical-like practice" must keep pace with the progress of the "medical practice" and have progress and deep medical insight.

[Objectives]The purpose of this study is to clarify the effect of acupuncture sensation on the body sway during a one-legged stance.[Methods] The study participants were 16 healthy adults (mean age 21.8±1.6 years). The study design was a crossover method, wherein the same individuals participated in the acupuncture stimulation condition and the control condition at intervals of more than one week. Evaluation was performed before and after each intervention by holding a one-legged stance for 40 seconds on a force plate. A total of six items of body sway were measured, including: circumferential area, rectangular area, effective value area, total trajectory length, unit trajectory length, and unit area trajectory length. In addition, Visual analog scale (VAS) was used to evaluate the ease with which the lower leg was subjected to force during measurement. In the acupuncture stimulation condition, single acupuncture was performed on the lower limb muscle group of the measuring leg, and the VAS of the acupuncture sensation was evaluated at the time of stimulation and at the end of measurement. Stainless steel disposable acupuncture needles (length: 50 mm, diameter: 0.20 mm.) were used for stimulation. The stimulation sites were the ST32, ST37, BL37, BL57, and GB37 of the test leg, and acupuncture needles were inserted to the desired depth and removed when sensation was felt. The control condition was the supine position for five minutes. Comparisons were made between the pre- and post-acupuncture stimulation conditions and the pre- and post-control conditions(body sway, lower leg VAS, acupuncture sensation VAS). [Results] There was no significant difference between the two conditions in terms of body sway. However, the VAS of lower limb effort was significantly lower, from 78.0±14.9 mm to 63.1±17.0 mm before and after the intervention (p<0.05). On the other hand, in the control condition, there was no significant difference from 79.5±12.3 mm to 75.2±12.7 mm before and after rest. The VAS of acupuncture sensation was 50.4±14.3 mm during stimulation and 9.8±9.0 mm at the end of measurement, which was significantly lower (p<0.05). [Conclusion] Acupuncture sensation did not affect the body sway before and after acupuncture stimulation. However, the subjective sensation of weakness appeared, suggesting that acupuncture stimulation may cause a transient sensation of weakness.

[Objective] This study aimed to investigate the awareness and perceptions of cosmetic acupuncture among ordinary women.[Method] A questionnaire method was adopted, with a target population of 1,000 ordinary women living in Shizuoka prefecture, which is considered a suitable location for test marketing in Japan.Questionnaires were distributed through the Chambers of Commerce in the prefecture by age group, according to the population ratio, and responses were obtained. The items included (1) basic information; (2) presence and type of facial cosmetic concerns; (3) experience of acupuncture, awareness of cosmetic acupuncture, the medium through which they learned of it, perception of effects, and experience of cosmetic acupuncture; (4) effects and types of cosmetic acupuncture, presence or absence of adverse effects, current treatment status, desired treatment outcomes and reasons for seeking treatment, wishes from treatment clinics, and wishes from practitioners; and (5) 1 month's investment in beauty.[Result] The response rate was 56.2%, and 91.8% of the participants perceived that they had facial cosmetic concerns; 28.8% had experience with acupuncture, whereas 42.0% had knowledge regarding cosmetic acupuncture. Television (45.3%) was the primary source of information regarding this. The most prevalent perception of the effects of cosmetic acupuncture was lifting (44.8%), and 43.2% of the 521 participants inexperienced with cosmetic acupuncture consented to treatment. Participants mostly reported being somewhat interested in the procedure as their reason for wanting to receive treatment (45.3%). The most common reason for opting out of treatment was due to pain (52.6%). Of those who experienced cosmetic acupuncture, 60.0% said they experienced positive effects, and lifting (62.5%) is the most frequently perceived outcome, which matched the commonly held perception. However, among the participants, 45.0% reported negative effects, while 47.5% received the treatment two or more times in the past but did not continue. Participants mainly wanted clean treatment centers and skilled practitioners. The most common monthly investment in beauty was between 3,000 yen and 5,000 yen (28.5%).[Discussion/Conclusion] The results suggest that many women have cosmetic concerns regarding their faces and expect lifting from cosmetic acupuncture. The low treatment rate among women and their reasons for not seeking re-treatment were elucidated in this study, despite their degree of awareness. Further, the problems associated with the development of cosmetic acupuncture were clarified.

[Aim] We compared the effects of acupuncture and press tuck needle (PTN) acupuncture in office workers with physical and psychological fatigue.[Design] A randomized, open-label, parallel-group, comparison study.[Setting] An acupuncture room in the A Clinic within the Kanto Metropolitan Area.[Patients] Clinic workers. The inclusion criteria were 20-45 years of age and awareness of physical and psychological fatigue. The exclusion criteria were fatigue-related diseases and symptoms, medical abnormalities, and history.[Intervention] The subjects were randomly allocated to either the acupuncture treatment group (ACP group) or PTN acupuncture treatment group (PTN group). The interventions were based on acupoints for fatigue symptoms as per previous reports and individualized treatment for physical symptoms, including neck and lower back pain, among others, and were performed twice a week for one month.[Evaluation methods] The visual analog scale (VAS) scores were the primary method for evaluating for physical and psychological fatigue at four weeks post-treatment. Other forms of measurement used were the VAS scores within groups immediately after treatment and to evaluate physical health, the Health Perceptions Questionnaire, General Health Questionnaire-12, and Short Form-36 responses; and salivary amylase levels were used.[Results] Thirteen of 14 subjects in the ACP group and 13 of 15 in the PTN group were included in the analysis. There was no significant difference between the groups for VAS scores. Evaluation, immediately before and after the intervention showed a significant decrease in VAS scores for physical fatigue in both groups. The ACP group showed a greater immediate change than the PTN group. In a comparison within each group, the VAS of psychological fatigue in the PTN group showed significant decrease after the eighth treatment.[Conclusions] Acupuncture may immediately improve physical fatigue in office workers. Moreover, the frequency of using PTN acupuncture may eventually decrease physical fatigue. Therefore, acupuncture and PTN acupuncture can help office workers' health.

Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery.Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae.Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided.Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.

Objective : In 2011, the Ishikawa Prefectural Joint Committee of Blood Transfusion Therapy was organized in Ishikawa Prefecture. Since 2012, pharmacists have promoted educational activities regarding the appropriate use of albumin products for different occupations based on a survey involving all medical institutions in Ishikawa Prefecture. We examined the effects of these activities with respect to the usage of albumin products. Methods : A questionnaire survey regarding blood transfusion therapy, including the total usage of albumin products, departments responsible for the management of albumin products, and health care professionals’ awareness of issues on the appropriate use of albumin products, was conducted from 2011 until 2014 involving all medical institutions where blood transfusion preparations were used in Ishikawa Prefecture. Results : The questionnaire collection rate was ≥70%. The results showed that, in middle- or small-scale medical institutions, departments/physicians other than the Department of Pharmacy were responsible for the management of albumin products. Furthermore, some health care professionals did not recognize/understand problems regarding the appropriate use of albumin products. Pharmacists newly increased educational activities by study meetings for various occupations or panel discussions involving participants. The participants’ occupations varied, and the number of institutions to which they belonged was 20 to 24. The total usage of albumin products in Ishikawa Prefecture decreased by approximately 20% between 2011, when these attempts were started, and 2014. Discussion : This study suggests that the educational activities by pharmacists and other health care professionals at the prefectural level reduced the total usage of albumin products.

Headaches caused by metastatic brain tumors result from dural tension and traction of the sites of nociceptive nerves that originates from displacement of cerebral vessels and intracranial hypertension caused by the tumor. Causes of such headaches also include meningeal irritation resulting from intrathecal dissemination of tumor and carcinomatous meningitis.Treatment of headaches resulting from intracranial hypertension involves alleviation of cerebral edema and reduction of intracranial pressure using hyperosmolar therapy and steroid administration, but treatment is often complicated by a lack of pressure reduction. We encountered 2 cases of headaches with intracranial hypertension that did not improve following hyperosmolar therapy and steroid administration, but resolved with increased opioid dose.In cases where intracranial pressure does not decrease, or for headaches attributed to direct stimulus of intracranial nociceptive nerves rather than intracranial hypertension, attempts to treat the patient with initiation or increased dosage of opioids may prove effective from a clinical standpoint.

[Objective]The purpose of this study was to gain a clear understanding of adverse events associated with acupuncture (Acp) and moxibustion (Mox) therapies. Thus, we administered questionnaires to orthopedists in order to understand the clinical experience of patients who suffered adverse events.
[Materials and Methods]For this study, 6,000 orthopedic hospitals and clinics were randomly selected from 13,225 hospitals and clinics listed in the telephone directory iTown Page (http://itp.ne.jp). In October 2011 and July 2012, 3,500 and 2,500 questionnaires, respectively, were sent by mail. The questions addressed the following:(1) the respondent's profile (e.g., years of experience as a licensed orthopedist);(2) adverse events associated with Acp, including electroacupuncture;(3) adverse events associated with Mox;(4) use of Acp and Mox therapies in the orthopedist's hospital or clinic;(5) comments on the safety of Acp and Mox therapies. The identity of respondents remained secret.
[Results]The questionnaire response rate was 10.7%. The respondents were licensed orthopedists for 30 ± 11 years (mean ±standard deviation). Adverse events associated with Acp included retained needles and needle breakage (n ≥148), hemorrhages (n ≥ 64), infections (n ≥ 40), organ injuries (n = 28), and so on. Retained needles (≥ 145 out of 148), subcutaneous hemorrhages (63out of 64), arthritis (17 out of 40), and pneumothorax injuries (27 out of 28) occurred most frequently. The adverse events associated with Mox were burn injuries (n ≥ 121), infections (n ≥ 16), and other adverse events (n = 2). Second-degree burn injuries (n ≥ 48 out of 121) and suppuration infections (11 out of 16) occurred most frequently. These were the most common adverse events associated with Acp and Mox. The usage rate of Acp and Mox therapies in the orthopaedist's hospital or clinic was 18.6%. There were many comments on infection control by acupuncturists (n = 27), education and technical levels of Acp and Mox (n = 13), and retained needles and needle breakages (n = 13).
[Conclusion]These survey results reveal that the occurrence of severe adverse events associated with Acp and Mox was higher than our expectation. In order to improve the safety of Acp and Mox therapies, various educational activities to disseminate information about existing safety measures to acupuncturists are needed. Further studies on new preventive measures, continuous surveys, and feedback to acupuncturists are also required.