Objective: The objectives of this study were to compare medical expenses for the aged, the index of inter-government differences, nursing care expenses, the percentage of advanced nursing care, life expectancy, and the spa-related variables among rural governments in the same class based on the national criteria, in order to clarify the factors that affect nursing care and medical expenses.
 Methods: The Ministry of National Affairs and Communications classifies rural governments into 35 categories based on their population and industry. The subjects of this study were from the category III-0 (population between 100,000 and 150,000, percentage of tertiary industry below 55%) and 11 towns and villages met the eligibility criteria. We used statistical data open to the public in 2007, and calculated the correlation coefficients and multiple regression coefficients using medical expenses for the aged and nursing-care expenses as dependent variable.
 Results: Variables that had a significant correlation with medical expenses for the aged were percentage of medical expenses for the aged (r=-0.61, p<0.05), hospital expenses (r=0.88, p<0.05), the index of inter-government differences (r=0.75, p<0.05), and number (per 1,000 people) of spa hotels (r=-0.61, p<0.05). Variables that had significant correlation with nursing care expenses were percentage of people insured (r=-0.65, p<0.05), percentage of people insured who resigned from job(r=0.66, p<0.05), the average life span (r=0.82,p<0.05). Variables that had a significant effect on medical expenses for the aged were hospital expenses (β=0.618, p<0.05), the index of inter-government differences (β=0.334, p<0.05), and (per 1,000 people) of spa hotels (β=-0.210, NS). There was no spa-related variable that had a significant correlation with nursing care expenses, and we did not conduct multiple regression analysis for them.
 Conclusion: Although the correlations with the indices for spa among medical expenses for the aged and nursing care expenses were very low, the necessity of clarifying the numerical value of people who used spa actually was shown.

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 To clarify present status of outpatients related to bathing in the emergency critical center located in the hot spring area, medical records at the emergency room were analysed.
 In last year, 162 cases (1.2%) related to bathing of 13,386 patients who visited our emergency critical center from April, 2009 to March, 2010.
 There were limited because of poor records related to past history and hot spring, our data showed as follows: ①cases related to bathing were only 1.2% (162/13,386 patients), ②incidence of patients related to bathing was peaked December, ③two peaks were showed both 0-10 years old and 60-90 years old, ④males were dominant, ⑤physical diseases were accounted for 75% of diseases related to bathing, ⑥physical diseases mainly included cardiopulmonary arrest were suspected by drowned, syncope, and acute coronary syndrome, ⑦trauma mainly included hits and contusions treated by orthopedic surgery and neurosurgery, ⑧transportation was performed by ambulance account for 66%, ⑨outcome at discharge of emergency room were mainly stable condition including 69% of patients who returned home, and only cardiopulmonary arrest cases were dead.
 Although children and older people who had past medical history regarding cardiology and neuroloy suffered from diseases related bathing, self checking system was not sufficient to prevent all sickness except for sudden death. It had better not take a bath alone.

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Purpose
 In a series of our recent studies, systematic mild hyperthermia treatments, such as sauna, hot spring and a special bath for medical treatment, were found to activate leucocytes and to enhance immunity. Although they are known to be effective for health promotion, it is not easy for general people to regularly take these conventional hyperthermia. It would be advantageous for elderly persons, sick people and pregnant women as well as pressed business persons if it is able to minimize stress which might be induced by the conventional hyperthermia, such as high temperature heat, water pressure and humidity. To pursue a further study of the effect of hyperthermia itself, in this research, we utilized nano-mist sauna (NMS), a new hyperthermia treatment. NMS, a new type sauna, is characterized by the ability to produce ultra small fog-shaped hot water called nano-mist, which hardly condenses dew. And we studied the effect of NMS on body temperature, leukocytes, autonomic nerve function and energy production.
Method
 We obtained peripheral blood from six healthy male volunteers (age, 46.5±8.5 years) before and after NMS hyperthermia (20min, 40°C, 100%RH) for lactate and blood glucose measurement and flowcytometric analysis. Body temperature (hypoglossal) and pulse rates were also measured. The statistical analysis difference between the values was determined by paired t-test and Kruskal-Wallis test.
Result
 After NMS hyperthermia body temperature and the level of PO₂ rose (36.8→37.2°C), (52→61mmHg) (p<0.05). On the other hand, the level of lactate showed decrease in all subjects. The ratio and the numbers of NK cells decreased (21.8→17.7%, 498→436/μL) (p<0.05) while those of B cells increased (9.5→12.1%, 261→349/μL) (p<0.05).
Discussion
 Several investigators report that the conventional hyperthermia enhances the primordial immune system (i.e. extrathymic T cells, NK cells, NKT cells and granulocytes) via dominance of sympathetic nerve system function (SNS) . Conversely, in our study, those of the conventional immune system (i.e. T and B cells) was enhanced, suggesting suppression of SNS function. It is reported that the expression level of HLA-DR on the B cells was elevated during hyperthermia (body temperature rose). SNS function (hypothermia) is stimulated by stress and it is suppressed by relaxing (hyperthermia) in the opposite. And it is considered that NMS hyperthermia suppressed SNS and that it was also consistent with our result of lactate decrease. It is possible to consider that NMS hyperthermia may impact on autonomic nerve activating leucocytes. Therefore NMS may be a kind of effective health promotion for valetudinarian (ie an infant, a female) and both a caregiver and a caretaker.

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 Electroacupuncture (EA) is an acupuncture technique that is stimulated by acupuncture needles with low-frequency microcurrent. The aim of this study is to elucidate the effect of EA and it's molecular mechanism on muscle atrophy by using an animal model: hindlimb-suspended (HS) mice in the disuse muscle atrophy model. To compare the effects of EA in HS mice and HS mice treated with EA (EA/HS), soleus muscle mass and soleus myofiber diameter were measured. We then used real-time quantitative RT-PCR to analyze the expression of myostatin and ubiquitin ligase genes in atrophic muscles of HS mice and in muscles of EA/HS mice. We found that EA/HS mice maintained a soleus muscle mass that was not significantly different from that of wild mice (WT), whereas HS mice had significantly reduced muscle mass. Also, the diameters of myofibers in EA/HS mice, which were not significantly different from wild values, were significantly larger than those in HS mice. Repeated EA treatment suppressed gene expression of myostatin and ubiquitin ligase genes in skeletal muscle of EA/HS mice but induced expression of these genes in HS mice. These findings suggest the molecular mechanism by EA: suppression of myostatin and ubiquitin ligase gene may be a key reaction of inhibiting the disuse muscle atrophy.

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 The effects of hot springs have been described in many studies. However, few studies have reported the use of hot springs by patients. This study aimed to elucidate the use of hot springs by ambulatory orthopaedic patients. We prepared paper questionnaires on the use of hot springs by patients; these questionnaires were administered to ambulatory orthopaedic patients in our general hospital. The questions were as follows: (Q1) Is (Are) there any hot spring(s) near your residence? (Q2) Do you think hot springs are effective for improving your health? (Q3) Have you ever visited a hot spring in the past 1 year? If yes, what was the reason for visiting the hot spring? (Q4) If you did not visit any hot spring, what was the reason for not going? When you are unable to visit hot springs, do you use any alternative methods? (Q5) Do you want hot springs near your residence? The results were as follows: (Q1) Yes, 33 (61%); No, 20 (37%); and No answer, 1 (2%) (Q2) Yes, 15 (28%); Yes (a little), 29 (54%); Neutral, 7 (13%); and No, 3 (6%) (Q3) 1-2 times per year, 18 (33%); 3-4 times per year, 6 (11%); More than 5 times per year, 13 (24%); and No, 17 (31%) (Q4) Bear, 13 (24 %); Alternative, 23 (43%); Use spa, 8 (15%); and Others, 10 (19%) (Q5) Yes, 30 (56%); Yes (a little), 14 (26%); Neutral, 7 (13%); No, 1 (2%); and No answer, 2 (4%). The results of this study suggest that ambulatory orthopaedic patients have a good opinion about the effects of hot springs. Further, these patients visited hot springs. Orthopaedic surgeons must be well informed about the therapeutic use of hot springs.

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 The experience of the thermal spa lake "Blue Lagoon" in Iceland was reported. The plenty of geothermal seawater was supplied from the Svartsengi geothermal power plant to the Blue Lagoon. It was utilized not only as the spa for the public but also for the treatment of psoriasis at the annex clinic. The well-organized project supplying electric power to the community and hot water for the heating system of the public and home use was supposed to be the advanced model to answer to the increasing demand for carbon offset with ecological purposes.

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