[in Japanese]

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[in Japanese]

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[in Japanese]

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The Ministry of Health and Welfare inaugurated an official recognition system for spa-based health promotion facilities in 1988 as part of its health promotion program. As a result, those facilities gradually increased across the country until the number of the recognized facilities reached 17 by February 1995.
The Japan Health & Research Institute has performed factfinding surveys on the use of these recognized spa-based health promotion facilities every year from the beginning of the recognition system. This paper reports the survey results obtained during these 5 years.
During the past 5 years, 275 males and 138 females used these spa-based health promotion facilities (with tax deductions applied to madical expenses). The number of male patients was about twice as large as that of female patients. Most males used the facilities because of diseases in the field of internal medicine, and most females, because of diseases in the field of orthopedic surgery.
We are planning to prepare a manual for evaluating the effects of spa therapy and assess the efficacy of spa therapy by including a new survey item of “clinical effects of spa therapy” in a questionnaire for a nationwide survey.

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Rheumatoid arthritis (RA) is a systemic inflammatory disease with a main symptom of chronic polyarthritis. Migration of T lymphocytes to synovium, which is mediated by the adhesion molecules expressed in both lymphocytes and vascular endothelial cells, play a key role in the synovial imflammation.
To investigate the mechanism of therapeutic effect of low powar laser irradiation to RA Joint, adhesion molecules in synovial tissue were studied.
Nine knee joints of 8 RA cases were irradiated with a Ga-Al-As laser (790nm in wave length and 20mW of output power) at 6 points on the lateral aspect of joint prior to the replacement surgery. Several pieces of synovial tissue from the lateral irradiated area and from the medial nonirradiated area as a control were resected for study at surgical operation. Frozen sections were immunohistochemically studied using monoclonal antibodies to the adhesion molecules. In 5 of 9 knee joints, immunohistochemical studies for adhesion molecules of cultured synovial tissue and ELISA for soluble adhesion molecules in culture fluid were performed. Moreover, in 5 of 9 knees, electron microscopic observation of synovial tissue irradiated with low power laser were carried out.
Expression of ICAM-1, VCAM-1 and fibronectin in the synovial tissue was suppressed in the irradiated area comparing with that in the nonirradiated area. ELAM-1 staining of the endothelial cells was also decreased, although the staining was weak even in nonirradiated area. LFA-1 staining of lymphocytes was markedly decreased in the perivascular area, on the other hand it was almost unchanged in the sublining area of irradiated synovium. Staining of ICAM-1, VCAM-1 and ELAM-1 also decreased in the cultured synovial cells irradiated with low power laser, but soluble adhesion molecules in the culture fluid of synovial cells showed no significant change with low power laser irradiation.
Electron microscopically, markedly dilated rough endoplasmic reticulum of fibroblast like cells and flattening of vascular endothelial cells were observed in the irradiated synovial tissue.
These morphological changes of cells in the synovial tissue irradiated with low power laser would be related to the decreased cytokine production, resulting suppression of adhesion molecule expression and improvement of synovial inflammation.

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This study was conducted to assess the effects of bathing in still water and in flowing water on the heart rate variability. Eight healthy young males (age 20 to 28) bathed in still water at temperatures of 34°C, 38°C, and 41°C for 20 minutes each. The other eight healthy young males (age 22 to 28) bathed in flowing water at a temperature of 36°C for 30 minutes. Electrocardiograms were recorded before, during, and after the bathing. Subjects sat still for 20 minutes before bathing, and then bathed in water to the axilla in a sitting position. Subjects breathed freely during the experiment. Heart rate variability was estimated with the power spectral analysis using FFT. The power densities in the high frequency (0.15 to 0.50Hz) and low frequency (0.04 to 0.15Hz) areas as obtained from this frequency analysis (HF and LF) as well as the ratio of LF/HF were calculated, and HF was used as index of cardiac parasympathetic activity, LF as index of sympathetic activity with parasympathetic modulation, and LF/HF as index of sympathetic activity.
During bathing in still water at 34°C and 36°C, no significant change from the value before the bathing was found in heart rate, HF, LF, or LF/HF. HF and LF significantly decreased during the bathing in still water at 38°C and 41°C, LF/HF significantly increased during the bathing in still water at 38°C, During the bathing in still water at 41°C, we could not calculate LF/HF for many subjects because HF disappeared. During the bathing in water flowing at a moderate speed (1.0m/sec), LF/HF increased significantly. During the bathing in water flowing at a high speed (2.0m/sec), heart rate and LF/HF increased significantly while LF decreased significantly.
These results suggest that parasympathetic nervous activities are suppressed and sympathetic nervous activities are enhanced during bathing in still water at temperatures higher than the neutral temperature (34°C), and sympathetic nervous activity is enhanced during the bathing in flowing water at 36°C, However, the effects of respiration rate and tidal-volume on HF, and the validity of the HR variabilities as an index of autonomic nervous activities should be examined in further detail.

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We studied the effects of transcutaneous electrical nerve stimulation (TENS) of Baxie on local cold tolerance as an index of cold induced vasodilatation (CIVD). The subjects consisted of 22 healthy adult volunteers.
The skin temperature and skin blood flow in the middle finger were measured simultaneously before, during, and after immersing the finger in cold water. TENS at 1Hz with 100-V intensity was applied for 5 minutes before immersion of the finger.
Experiments were conducted with no stimulation and with TENS on the same subjects on different days.
The results revealed the following:
1. The minimum skin temperature and minimum skin blood flow during immersion of the finger in cold water were higher in the TENS group than in the control (no stimulation) group.
2. The maximum skin temperature, mean skin temperature, and increase and decrease of skin blood flow rate during immersion of the finger in cold water and in the rising phase of skin temperature were higher in the TENS group than in the control group.
3. The index of resistance to frostbite was higher in the TENS group than in the control group.
4. The number of fluctuations in skin temperature during immersion of the finger in cold water was significantly higher in the TENS group than in the control group.
5. The incidence of abnormal perception during immersion of the finger in cold water was lower in the TENS group than in the control group.
These results suggest that TENS enhances the local cold tolerance of fingers by suppressing SSA in the initial falling phase on skin temperature and increasing the motion of skin blood vessels in the rising phase of skin temperature.

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