[Introduction] The effects of combining acupuncture and kampo medicine on in vitro fertilization (IVF) outcomes is unclear. Therefore, we aimed to investigate their combined effects on promoting conception in patients with multiple IVF attempts.[Methods] Participants with at least two IVF attempts who gave informed consent were included in this study. Administering acupuncture and kampo medicine, the study was conducted across three facilities from 2013 to 2017 using a case series design． Case 1: A 40-year-old woman presented after 13 months of infertility, having experienced a natural conception and subsequent miscarriage 10 months prior, which led to IVF. After a second embryo transfer, she miscarried again 3 months before visiting. She began kampo medicine and acupuncture for support in our department. Case 2: A 46-year-old woman with a 36-month infertility history did not achieve pregnancy after three IVF cycles． Case 3: A 37-year-old woman with a 20-month infertility history failed to conceive after two IVF attempts． Case 4: A 26-year-old woman, new to infertility treatment, received acupuncture for fertility preservation, experiencing headache, shoulder stiffness, and widespread pain. Case 5: A 38-year-old woman with a 108-month infertility history suffered from shoulder stiffness due to prolonged IVF therapy. The main outcome measured was pregnancy. Standard acupuncture points utilized included L14 (Hegu), CV12 (Zhongwan), CV7 (Yinjiao), ST27 (Daju), ST29 (Guilai), BL18 (Ganshu), BL20 (Pishu), BL23 (Shenshu), BL33 (Zhongliao), SP10 (Xuehai), ST36 (Zusanli), and SP6 (Sanyinjiao)． [Results] Four out of five participants achieved pregnancy． [Discussion] Our findings reveal a positive effect of combining acupuncture and kampo medicine on enhancing pregnancy rates in patients undergoing multiple IVF treatments, suggesting clinical effectiveness in fostering an appropriate environment for conception．

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.

Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.
Abdominal Abscess ; Abscess ; Anastomotic Leak ; Drainage ; Gastrectomy ; Humans ; Needles ; Pancreatic Fistula ; Punctures ; Stomach Neoplasms ; Ultrasonography