At Saitama Medical University, practical training in pharmaceutical service and rehabilitation services is conducted. Due to the spread of COVID-19 infection in 2020, it was difficult for third-year medical students to practice in the actual medical field. For this reason, students have been provided a remote practical training in pharmaceutical service and rehabilitation services, such as watching videos of working situations and interviews for pharmacist, physical therapist, occupational therapist and speech therapist, group works using Zoom, and exchanging questions and answers with those professions. Although student’s levels of readiness were diverse, they could learn more deeply about the roles and perspectives they had not learned previously, compared to conventional practical training. In addition to this effect, the program provided more opportunities for students to deepen their learning. Therefore, in the future, we would like to consider implementing a training program that provides both virtual and onsite experiences.

Background: Hot spring inhalation and rock bathing are widely practiced in Europe, and immersion in water up to the shoulders is popular in Japanese balneotherapy. We designed a combination therapy of steam rock bathing and immersion in an open-air hot spring pool for allergic rhinitis.Methods: Data were obtained by anonymous questionnaires from 19 participants with perennial allergic rhinitis who underwent the combination therapy for several days during the spring-pollen season. The participants immersed themselves in a sitting position in Saiboku hot spring water (sodium salt hot spring) at 41°C up to the shoulder level for 10 min in the open-air and then lay on a floor paved with small rocks in a supine position for 20 min in a room filled with the steam from hot springs, then immersed themselves again in the hot spring water for 10 min, and finally rested and sat on a chair for 20 min in a comfortable room. The hot spring water circulated through tubes with small holes that were embedded under the floor, which was paved with small rocks consisting of tourmaline and lime stones. Steam from the hot spring water penetrated through the floor and vaporized in the room. The rock bathing room was 40°C in temperature and 75% in humidity.Results: Clinical symptoms were alleviated in 17 of 19 participants. Watery rhinorrhea, eye itching, sneeze, and sore throat were improved in 100%, 75%, 40%, and 100% of the participants, respectively, compared with symptoms during the previous several years. No adverse effects were observed in any participants. Conclusion: Steam rock bathing, combined with immersion in an open-air hot spring pool, is useful in ameliorating the focal and systemic symptoms of allergic rhinitis.

  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.

Background: Japanese loves very hot hot-spring bathing although it has some adverse reactions. Jikan-yu (timed bathing), or repeated head-out water immersion in Kusatsu hot-spring at 47C, 4 times a day, each for 3minutes, is a traditional bathing method continued since more than 200 years ago in Kusatsu spa resort, Japan. We previously reported that a very hot hot-spring bathing might result in cerebral or myocardial infarction, although appropriate hyperthermia is beneficial for human body. We summarize the effects on hemostasis after 3-minutes bathing at 47°C. Methods and Subjects: Healthy subjects aged from 22 to 40 years old bathed up to the shoulder level in a sitting position in acidic hot-spring at 47°C for 3 minutes. Blood pressure, blood viscosity, coagulation and fibrinolytic markers, as well as ultrastructure and P-selectin of circulating platelets were analyzed before and after the bathing. Results: Blood pressure increased during bathing but decreased after the bating. A trend toward an increase in blood viscosity after the bathing was observed. Plasma tissue plasminogen activator decreased slightly and plasminogen activator inhibitor increased transiently but markedly after the bathing at 47C. In contrast, the coagulation and fibrinolytic markers were not changed significantly after the bathing at 40 or 42C. Ultrastructural changes (folds, pseudopods, vacuoles and centralization) were increased after the bathing at 47°C. Flowcytometry demonstrated an increase in P-selectin on the surface of platelets after the bathing at 47C. See References 1-8. Discussions: It is suggested that the bathing at 47°C leads to a thrombotic state, and further to a thrombosis when combined with endothelial dysfunction or atherosclerosis.

Crow-Fukase syndrome is diagnosed by the presence of polyneuropathy in conjunction with several other characteristic generalized symptoms, including organomegaly, endocrinopathy, M protein, and skin changes (POEMS syndrome). Rehabilitation is very important for patients with Crow-Fukase syndrome because progressive polyneuropathy reduces a patient's muscle strength. We report a case of long-term rehabilitation after high-dose chemotherapy with autologous peripheral blood stem cell transplantation. After transplantation, neurologic improvement began, and following rehabilitation therapy, the patient's proximal lower extremity muscle strength recovered to an almost normal level. At 2 months after transplantation, the patient could walk again using a cane and an ankle-foot orthosis. At six and a half years after transplantation, the neuropathy was still improving and there was no recurrence of other symptoms. We suggest that rehabilitation combined with autologous peripheral blood stem cell transplantation for Crow-Fukase syndrome is very useful for improving the disuse condition and for recovering muscle strength.