The purpose of this study was to systematically review non-randomized controlled trials of balneotherapy effects on locomotorium diseases in order to assess their quality and organize the evidence.
 We searched the databases of PubMed, CINAHL, Web of Science, JDream ll, and lchushi-Web forpapers published from 1990 to December 2, 2008. Eligible studies were non-randomized controlled trials in which balneotherapy exclusive of underwater exercise was the primary intervention. There was no limitation on the language in which the paper was written.
 We found only 4 papers (2 in English, 1 in Croatian, and 1 in Japanese) that fulfilled the eligibility criteria. These papers differed in the type of diseases studied, so a meta-analysis could not be applied. Their individual results showed that hot springs treatment in combination with a comprehensive fitness class was more effective than hot springs treatment alone, and that balneotherapy had therapeutic effects on arthrosis deformans, psoriatic arthritis, and lumbago. However, it was difficult to accurately interpret the effects because these papers were deficient in providing descriptions of important details of the studies.
 To improve the quality of future investigations performed with non-randomized controlled trials, we suggest that investigators design a study based on various checklists, implement interventions, conduct evaluations, finally write papers summarizing their findings.

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 Shoulder hand syndrome was one of the severe complications in stroke patients and often disturbed the QOL and the rehabilitation therapy. The reflex sympathetic dystrophy (RSD) was considered as the pathogenesis of shoulder hand syndrome, but the therapy had been not established. We analyzed the sympathetic nerve function of thermotherapy of shoulder-neck or passive exercise of limbs in stroke patients. ‹methods› In stoke patients suffering from shoulder hand syndrome, we set the thermisters (Terumo.Co. CMT-205) and local perspiration meters (Skinos Co. SKD 2000) on both forefingers and set the accelerated photoplethysmography (Tokyo Iken Co. SA.3000P). We analyzed the blood vessel tension (BVT) and the wave type. ‹results› The temperature of the paralytic fingers and hands was significantly higher than the temperature of the normal sides. The pulse wave patterns and blood vessel tension in paralytic fingers were more disturbed than those of intact fingers. The perspirations of paralytic hands were significantly correlated with duration and systolic blood pressures and the sympathetic nerve function was considered to concern to the disorders in early stage of stoke.

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 In this study, we investigated the effects of L-Arginine, which increases the production of nitricoxide (NO) with vasodilative actions, on forearm bathing. The subjects were 12 healthy adult males with 24±1 years old. We compared the changes of blood pressure, heart rate, deep/superficial temperatures, and dermal blood flow by forearm batlmg with or without the oral ingestion of 2000mg L-Arginine. After a 30-minute rest following ingestion, the subjects took a forearm bathing ; immersion of the right forearm below the elbow in 41°C hot water for 15 minutes. There were no significant differences neither in blood pressure, heart rate, nor sublingual temperature between the changes by L-Arginine and water ingestion. Although the superficial temperature of the left toe was significarttly increased 15 minutes after the start of bathing regardless of the presence or absence of L-Arginine (p<0.01), the increase with L-Argilline ingestion was significantly greater (p<0.01) than that without L-Arginine. Furthemore, an increase in left dorsal skin blood flow after 10 to 15 minutes bathing with L-Arginine was more marked than that without L-Arginine. The increasing ratio of blood flow after 15 minutes of right forearm bathing against pre-bathing value was significantly higher (p<0.05) in case with L-Argitme than that in its absence. These results suggest that the oral administration of L-Arginine accelerates thermal vasodilative effects during forearm bathing.

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Purpose
 Electrodermal activity (EDA) is well known to be influenced by sympathetic activity. Although spa bathing alters autonomic nervous function, the effects of spa bathing on EDA have not been determined. We therefore examined the influence of spa bathng on EDA and autonomic nervous function.
Method
 When a gold electrode in test solution and another electrode on the palm were connected to a voltmeter and the index finger was inserted into the test solution, the maximum change of potential shown on the voltmeter was considered as EDA. Several kinds of spa water, tap water, refined water and alkaline ion water were used as test solutions. Electric conductivity, pH, oxidation reduction potential (ORP) and temperature were also measured. Five adult women participated in these tests.
To examine influences on the autonomic nervous system, Fourier analysis of the RR interval of heart rate was perforrned for three volunteers using electrocardiography before and after bathing in sulfur spa or tap water.
Results
 EDA displayed an extremely positive correlation to ORP, a weak negative correlation to pH and barely any relationship to electric conductivity of test solutions. Spectrum density at 0.04-0.15 Hz under Fourier analysis (LF) increased after sulfur bathing, but decreased after tap water bathing.
Discussion and conclusion : As EDA strongly correlated to ORP of solutions, epidermal cells may generate electric potential by extracellular ORP which may also produce intracellular electric potential altering membrane potential and consequently autonomic nervous functions might be influenced by the changed EDA.
 Since LF is consider to mainly comprise a parasympathetic component in resting state, the results of LF may indicate that the balance of autonomic nervous activity of the heart becomes more parasympathetic dominant after sulfur bathing and more sympathetic dominant after tap water bathing.
From above mentioned, bathing may have an electric influence on the human body by the ORP of bathing water.

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 The clinical utility of CO₂-enriched baths for athletes as well as patients has been ascribed to direct vasodilative actions of CO₂ on the bathed skin or muscles through NO production via the activated NO-cGMP system based on the local tissue acidosis by CO₂. The systemic as well as localized physiological changes induced by the carbonated bath were studied when it was applied locally for 30 minutes, comparing with freshwater footbath.
 Fifteen healthy adult males (32+/-10 years old) took carbonated footbath (by Module mixture type artificial carbonated bath, at CO₂ concentration 1100+/-100 ppm, pH 4.8), and freshwater footbaths (pH 7.4)at 38°C, and assumed a control sitting position following a randomized controlled design. Each footbath had a 5-minute rest in a sitting position, and a 30-minute bathing, followed by a 10-minute rest. They took 3 kinds of experiments (freshwater and carbonated footbaths, and control sitting position), 1 week apart from each other. The blood pressure, heart rate variability, and laser Doppler flowmetric findings as well as sublingual temperature were monitored.
 The results showed that the carbonated footbath brought about initial parasympathetic activation (higher HF/(LF+HF)) at 5 min after starting footbath according to the heart rate variability analysis, comparing with freshwater footbath. From 10 rninutes after starting carbonated footbath, significantly larger vasodilation occurred comparing with the freshwater footbath, and this vasodilatien was kept until last 30 minutes. In both carbonated and freshwater footbaths, increases in sublingual temperature occurred in the last 30-minute stage of footbaths. Along with the increase in body temperature, heart rate variability showed sympathetie activation only in the freshwater footbath over the control sitting position, while there was no change in the carbonated footbath.
 Taken together, 38°C and 1100ppm carbonated footbath induced localized additional vasodilation of the immersed skin from 10 minutes after starting carbonated footbath over the changes in the freshwater footbath, which would be due to the NO production induced by the local tissue acidosis. However, the immediate parasympathetic activation just after starting carbonated footbath would not be due to the systemic thermal effect, but due to the somato-autonomic and axon reflex induced by the nociceptive ion channels such as TRP-V1 (Transient receptor potential-vanilloid) for thermal stimulation, and ASICs (Acid sensitive ion channels) for the acidic carbonated bath (pH 4.8).

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