Very hot hot-spring is loved by the Japanese, although it might cause thrombotic events. It causes addiction to hyperthermia possibly because of an increase in the production of morphine-like substance. Increases in platelet activation, adhesion molecules on the platelet surface, platelet-derived microparticles, and blood viscosity as well as decreases in fibrinolytic capacity and blood pressure were observed after bathing in very hot hot-spring. Bathing in very hot hot-spring is not recommended for the elderly in view of age-related changes in endothelial function, fibrinolytic capacity, dehydration, and dysregulation of blood pressure. Instead, hydrotherapy or bathing in hot-spring in temperatures under 42°C is beneficial with little risk regarding hemostasis and thrombosis.

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Background: The relaxing phenomenon induced by acupuncture on hypertonic muscle has not clearly been demonstrated. We studied whether acupuncture stimulation on the hypertonic muscle model induce relaxation.
Methods: A rat model of hypertonia was created by inducing tetanic contraction in the triceps surae muscles of 21 Wistar rats (male, 12 weeks) with four electrical stimulations (80 Hz, 5 mA, 5 min.), with a 2 min. interval between each stimulation. The rats were randomly divided into two test groups: 1. Untreated group (N = 12), 2. Group treated with acupuncture stimulation of the triceps surae muscle (N = 9). Rats in the untreated group received no therapeutic treatment after the model was created. Acupuncture was performed within 5 min. after the model was created. Evaluations were taken before and 5 min., 1, 2 and 3 days after tetanic contraction was induced. The rats were anaesthetized and a tension sensor for measuring static and dynamic muscle tension was used to determine triceps surae muscle stretching tension during passive dorsal flexion of the foot (30°, 40°, 50°).
Results: In both groups, at each of the angles of passive dorsal flexion, there was a significant increase in stretching tension 5 min. after inducing tetanic contraction compared to before induction, and statistics showed recovery to pre-induced tetanic contraction values after 1 day and thereafter. Compared to the untreated group, however, values 5 min. after induced tetanic contraction tended to be lower in the group treated with acupuncture stimulation.
Conclusions: Compared to the untreated group, stretching tension values 5 min. after inducing tetanic contraction tended to be lower in the acupuncture group. This could be due to acupuncture stimulation causing changes in blood flow in the lower leg, including muscle tissue, resulting in reuptake of calcium by the sarcoplasmic reticulum, and/or the influence acupuncture on reducing lower leg edema. Acupuncture stimulation could also have an action on the γ fibers and Ib fibers associated with continuous muscle tonus and muscle relaxation.

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  Pesticides are used in agriculture and in public health. Toxicity to humans include chronic and acute effects.. Therefore, knowledge of their concentration in drinking water treatment seems to be very important. The aim of this study was based on the literature indicating the presence of certain pesticides and pesticide metabolites in selected drinking water coming from the ground and deep-ground. The selected papers indicate that pesticides and metabolites of pesticides pollute water sources, underground water and deep-water. Concentrations of pesticides in most cases are lower than the 0.1μgl⁻¹, which is the general limit concentrations of pesticides, and pesticides metabolites in drinking water.
  Only in the case of the pesticide azinphos methyl was found overvaluation concentration of 3.22μgl⁻¹, which realizes the necessity identification concentrations of pesticides and their metabolites in mineral and spring waters

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  Vanadium, depending on the consumed dose may be toxic or health-promoting. Therefore, the knowledge of its concentration in the drinking therapeutic water, in particular in the medicinal mineral sources seems to be very important. This study was based on literature giving vanadium concentrations in some drinking waters derived from the ground and deep ground water.
  The concentration of vanadium in ground water shown varies in the range from 1-138μgl⁻¹. In volcanic regions of Italy vanadium concentration increases in relation to the water of a river as much as 100 fold. The concentration of vanadium in the mineral waters ranges from 1-93μgl⁻¹. The problem of acceptable and desired concentration of vanadium in natural waters in the mineral remains open, but it seems that this concentration in the tested samples is not too high.

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  In fall 2012, we renovated the grounds surrounding our hospital and constructed a “rehabilitation promenade,” along which patients could stroll and be in touch with the natural environment. The course is 500m long and includes pathways through a wood and along a pond. Using the promenade, patients can go for a stroll, exercise, or interact with other people.
In our ambulatory rehabilitation center, the promenade has been incorporated in one of the center’s programs since last year. This time, we herein report a survey on the changes in the mental and physical function over a 6-month period from May 2013 and their satisfaction level with the use of the promenade by a questionnaire in December 2013.
  22 subjects with a mean age of 77.5 ± 6.8 years were included in the survey on the mental and physical functions. Also, in satisfaction survey, valid responses were received from 58 individuals (mean age, 78.2 ± 8.2 years; 25 men and 33 women).
  As a result, in terms of the 6-month changes in mental and physical functions were generally maintained.
  In the questionnaire, more than 90% of users were satisfied with their use of the promenade, and the statistical analysis revealed that the highest level of satisfaction concerned going outside (p<0.01). For example, “I could feel the fresh air and the seasons” and “I could see a range of scenery.”
  In addition, compare the results for each category according to sex, the women chose significantly more answers that were related to interacting with other people, whereas the men chose significantly more answers that were related to exercise.
  From this survey, utilizing the surrounding environment may enable the development of more varied and satisfying forms of rehabilitation. We will continue with initiatives that utilize the promenade to help improve the QOL of those who use it.

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Objective: The purpose of this study was to compare the effects of superficial and deep insertion of acupuncture needles in the treatment of patients with neck-shoulder pain and to search for more effective acupuncture methods.
Methods: The subjects were patients seen at the Meiji University of Integrative Medicine’s Department of Orthopedic Surgery Clinic. A randomized controlled clinical trial was conducted in which 20 patients with neck-shoulder pain were randomly allocated to either a superficial acupuncture group (n=10) or a deep acupuncture group (n=10). Treatment was applied to points where patients experienced the most pain. The maximum number of stimulation points for both groups was 10. In the superficial acupuncture group, the needle was only inserted to a depth of 5 millimeter. In the deep acupuncture group, the needle was inserted to a depth of 15 to 20 millimeter. Both groups were manually stimulated using a sparrow pecking method over 20 seconds, after which the needle was removed. Both groups were treated weekly for four weeks. The primary outcome measurement was intensity of pain evaluated using a Visual Analogue Scale (VAS). The secondary outcome measurement was the Neck Disability Index (NDI) for the purpose of evaluating the grade of disability in daily life due to neck-shoulder pain.
Results: There were no significant differences in age, male-female ratio, disease duration, or the initial scores of VAS and NDI between the two groups. VAS and NDI scores indicated significant differences between the groups (VAS: <0.0001, NDI: p<0.0001) in change over time, with the deep acupuncture group having more favorable results than the superficial acupuncture group. The degree of change from the baseline at the time of each evaluation was calculated, and results for the two groups were compared. The deep acupuncture group showed significantly better improvement in the sustained effects after completion of treatment (VAS: p<0.05). There were no significant differences directly after the first treatment (VAS: p=0.72) or in cumulative effect after repeated treatment (VAS: p=0.24).
Discussion and Conclusion: The results of this study suggested it would be more efficient to insert the needle to deep tissues when performing acupuncture treatment on subjective pain sites. The difference in the effects between the two acupuncture methods may be due to the difference in tissue stimulation received. The difference in effect is thought to be due to the differing influence of treatment on pain threshold, muscle blood flow, and muscle tones.

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Background: In one series of studies, we observed the effects of acupuncture treatment (AT) on the autonomic nerve system (ANS). We experimented from various view-points. At last, we discovered a specific pattern for modifying ANS status, which showed that functions of the parasympathetic nerve increased while those of the sympathetic nerve decreased. To further study systematic modification of ANS balance, we focused on the lower body (feet). Moreover, two kinds of stimuli, tapping and vibration, were applied while measuring the value of finger floor distance (FFD) and heart rate (HR). Finally, the effects on ANS were discussed.
Methods: Twenty healthy subjects participated in this study, and they were divided into two groups; the tapping group and the vibration group. The former received 50 taps on the feet, and the latter received vibrations for two minutes. In order to indicate ANS status the effects of these stimuli were evaluated by FFD values and a kinetic record of changes in HR.
Results: Both groups showed improvement in FFD values, which was the same as the results for AT via modification of ANS. However, changes in HR showed a different pattern from AT; in this study sympathetic nerve) dominantly showed an increase without a decrease in parasympathetic nerve.
Discussion and Conclusions: The reasons for differences in ANS modification may be found in the role, especially in an emergency, of the lower body. The lower body is heavy in skeletal muscles, which needs energy and blood to react during acute stress. The ANS, which controls blood distribution, may shift and concentrate system blood from the smooth muscles of the stomach (controlled by parasympathetic nerve) to the skeletal muscles of the legs and feet (controlled by sympathetic nerve). Thus, this study indicated that local stimuli of the foot induced systematic ANS modification.

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Introduction: Prevention of the onset of cardio/cerebrovascular diseases, which represent circulatory system diseases, is now emphasized. It requires ensuring good arterial distensibility, which has been demonstrated to be reduced by life environments such as the lack of exercise or overnutrition but improved by aerobic exercise. Even if implementation of such exercises is possible, it increases the risks of the frail elderly with declined cardiopulmonary function and those with other diseases. This study aimed to focus on plantar flexion and dorsiflexion exercises of the ankles as a type of effective, low-load exercise that can induce dynamic stimulation associated with increased blood flow, using muscle pumping of the triceps surae and footbath, which could potentially increase overall blood flow via hyperthermic action. We then investigate the benefits of the combined effects of these two exercises on arterial distensibility.
Methods: We selected 25 physically and mentally healthy adult men and women (17 men and eight women; mean ± SD age, 25.7 ± 3.3 years) as study subjects.
  All the 25 subjects performed each of three exercises, namely footbath, ankle exercise, and ankle exercise in footbath, in a sitting position for 15 minutes. Ankle-brachial index (ABI), brachial-ankle pulse wave velocity (PWV), systolic blood pressure, diastolic blood pressure, and heart rate were measured using form PWV/ABI before and after the exercise for the evaluation of arterial distensibility.
Results: No significant differences were observed in the PWVs, ABIs, systolic/diastolic blood pressures, and heart rates before and after exercise in the footbath and exercise groups. However, for the footbath exercise group, a significant reduction in PWV was observed from before to after exercise.
Discussion: In this study, we focused our attention on the ankle exercise in footbath as a low-load exercise that could improve arterial distensibility. The results indicated a significant reduction in PWV, an index used to show the level of arterial distensibility, only for the footbath exercise group, which performed the combination of ankle exercise and footbath. We can infer that the improvement of arterial distensibility is attributed to the synergistic effect of the muscle pump and hyperthermic actions, which result in further increases and facilitation of cardiac output.
Conclusions: This study demonstrated that the ankle exercise in footbath was beneficial for the improvement of arterial distensibility.

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Background: To investigate the effect of high-voltage alternating current (AC) electric field exposure on muscle extensibility.
Methods: The study design was a crossover comparison. Fifteen healthy men were randomly divided into two groups. The interventions were exposure and no exposure to a high-voltage AC electric field (18 kV, 30 min). Subjects then performed bilateral self-stretching of the trapezius, hamstrings, and rectus femoris. Skin temperature, blood flow rate, blood pressure, heart rate, muscle rigidity, and muscle extensibility were measured before and after the intervention, and muscle rigidity and muscle extensibility were measured again after stretching. Skin temperature was measured bilaterally on the palms, shoulder girdle, anterior thigh, and dorsum of foot. Blood flow rate was measured in the right radial artery and dorsal artery of the foot. Muscle rigidity was measured bilaterally in the trapezius, rectus femoris, and biceps femoris. Muscle extensibility indices were determined for the left and right angle of lateral neck flexion, heel-buttock distance, straight leg raise angle, and sit-and-reach distance. Skin temperature, blood flow rate, blood pressure, and heart rate were compared between before and after the intervention, and muscle rigidity and muscle extensibility were compared before and after the intervention and after stretching.
Results: A significant improvement was found in muscle extensibility in the intervention group but not in the controls. Muscle extensibility improvements due to stretching were noted regardless of electric field exposure, but the degree and percentage of change in muscle extensibility was significantly higher after stretching following electric field exposure. Electric field exposure had no effect on muscle rigidity or circulatory dynamics.
Conclusions: Exposure to the high-voltage AC electric field appeared to increase muscle extensibility and heighten the effect of stretching. However, as the mechanism for improved muscle extensibility due to high-voltage AC electric field exposure was not clear, further study is necessary.

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Background: The beneficial clinical effects of Korean hot spring spa therapy, as well as their underlying mechanisms are still poorly understood. We performed a series of clinical and laboratory investigations for better understanding of the clinical effects as well as possible mechanisms of their beneficial effects.
Methods: HaCaT cells were prepared and treated with TLR agonist in the presence or absence of HS water for quantification of IL-6, IL-8, GM-CSF, and TNF-α levels. The serum levels of IFN-ɤ, IL-4, IL-5, and IgE were measured. CD4⁺ naïve cells were allowed to polarize into Th1, Th2, Th17, and Treg cells, and CD4⁺ and CFSE⁺ cells were measured for the degree of proliferation. Total RNA from the lesional skin was transcribed into cDNA using a reverse transcription system, and RT-PCR was performed subsequently. Confocal microscopy and RT-PCR were utilized to evaluate the target skin localization of Th cell subsets and associated inflammatory cytokine milieu.
Results: Treatment with agonists of TLR 1 through 6 induced attenuation of cytokine production in the exposure to HS water. HS water suppressed the proliferation of Th1, Th2, and Th17 cells with anti-CD3 stimulation, while proliferation and differentiation to Treg cells were promoted under HS water treatment. On RT-PCR of the lesional skin, thymic stromal lymphopoietin (TSLP) mRNA decreased dramatically after bathing with HS. IL-33 mRNA decreased markedly in HS water group as compared to control group. Foxp3 mRNA expression, same as in confocal microscopic finding, showed tendency to increase more in HS.
Conclusions: HS water suppressed the proliferation of Th1, Th2, and Th17 cells. In contrast, proliferation and differentiation to Treg cells were promoted under HS water treatment. These results indicate that HS water may affect the distribution of the helper T cells in the immune response, by suppressing the polarization of the Th1, Th2, and Th17 cells. Also, APC induced TNF-α and IL-6 levels were reduced in the presence of HS water. These results showed that TLR-triggered inflammatory responses in APCs might also be modulated under HS water treatment. Overall, our findings suggest that HS spa therapy could be an effective and safe modality for the management of adult AD.

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Background: Diabetes mellitus and its complications are a source of considerable morbidity and mortality, with important medical and social implications. The aim of our study was to establish the efficacy of combined application of seawater, Pomorie therapeutic mud and lye in diabetic polyneuropathy rehabilitation.
Materials and methods: The study was carried out during the 2011 and 2012 summer seasons in 43 patients (18 male and 25 female) with diabetic polyneuropathy from Germany, Russia and Bulgaria. The average age was 62±2.15 years and the average duration of diabetes was 16±3.4 years. All patients underwent combined treatment with mud baths (temp 37°C, duration 15-20min, 10 applications) and 10 lye electrophoresis procedures to the lower limbs, and sea water baths. The visual analogue scale (VAS) was used before and after the course of treatment to objectively measure the pain and parasthesiae of the lower limbs.
Results: Following a 2 week treatment course there was significant improvement in the clinical symptoms of diabetic polyneuropathy. 90% of patients reported improvement in pain, with VAS decreasing from 4.85±0.31 to 2.75±0.24, p<0.05. There was also a decrease in lower limb parasthesiae in 95% of patients, with VAS decreasing from 5.61±0.65 to 3.26±0.31, p<0.05.
Conclusion: The clnical symptoms and quality of life of patients with diabetic polyneuropathy imroved significantly following combined treatment with Pomorie natural resources as a result of the trophic and pain-reducing properties of therapeutic mud, lye and sea water. We support the combined application of these treatments in the rehabilitation of patients with diabetic polyneuropathy.

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Purpose: The aim of present study was to investigate the endothelial function of immersion of patients with diabetes in carbon dioxide (CO₂)-enriched water
Methods: Sixteen diabetic patients with minor complications were immersed in CO₂-enriched water for 4 weeks, and 8 patients were immersed in normal spa water for the same duration. To assess endothelial function, forearm flow-mediated dilation (FMD) was measured in those patients, and %FMD at pre-immersion was compared to that at post-immersion in CO₂-enriched water. The pulse wave velocity (PWV) was also measured to determine whether vascular stiffness was affected in those patients. The percent coefficient of variation of R-R intervals was examined as CVR-R (%). All patients were medicated with antidiabetic drugs, which were not changed during the study.
Results: %FMD showed no significant difference in any patients between pre- and post-CO₂-enriched water bathing. However, %FMD was significantly increased in patients under 8.0% of HbA1c after CO₂-enriched water bathing (p<0.05), but it was not significantly increased in patients over 8.0 of HbA1c. PWV and CVR-R (%) were significantly reduced in all patients after CO₂-enriched water bathing.
Conclusion: CO₂-enriched water immersion had a positive effect on endothelial function, and reduced arterial wall stiffness in patients with diabetes. These findings suggest that CO₂-enriched water bathing may improve microcirculation, as well as subjective symptoms, in patients with controlled diabetes.

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Background: Myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS) is an illness characterized by disabling fatigue. We examined the applicability of Waon therapy as a new method of fatigue treatment in patients with ME/CFS.
Methods: Nine female ME/CFS patients (mean age, 38.4±11.2 years old; range, 21-60) who fulfilled the criteria of the Canadian clinical case definition of ME/CFS participated in this study. Patients received 30 sessions of modified Waon therapy, infrared-ray dry sauna maintained at an even temperature of 40°C or 45°C for 15 minutes twice a day for 3 weeks in a hospital, or once a day for five weeks at an outpatient clinic. Their functional health and well-being scores were determined using SF-36 and compared with those of six ME/CFS patients who did not undergo Waon therapy.
Results: Seven of nine Waon therapy patients experienced a significant improvement in physical and mental condition, and the effect continued throughout the observation period. Waon therapy brought improvements in the scores of: Role physical (p<0.05); Bodily pain (p<0.05); General health perceptions (p<0.05); and Role emotional (p<0.05) of SF-36 in those who responded well (good responders) to the therapy. In two patients who responded poorly (poor responders) to Waon therapy, and in the non-Waon therapy patients, no significant improvement in the scores was observed.
Conclusions: Waon therapy is effective for the treatment of ME/CFS.

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