To clarify a mechanism of psychologic relaxation by artificial hot spring, the effect of hot spring bathing on psychologic sweating was studied in 11 healthy subjects (1 female and 10 males, age 26±5.7 years). After lying in the supine position for 5 minutes, the subjects were asked to take a bath with plain water or artificial hot spring for 5 minutes in the sitting position. The temperature of the bath was 40°C. To prepare the artificial hot spring, sodium sulfate tablet (Tsumura & Co.) was solved in 200L of plain water. For the measurement of psychologic sweating, Perspiro (Suzuken, Co. Ltd) was used. Sensor was attached to the first finger by biphasic adhesive tape. The psychologic sweating was induced by deep respiration, mental arithmetic, hand grip, blood pressure measurement and blood sampling. There were no statistical significant differences of CV value, heart rate, blood pressures, catecholamine values and serum β endorphin levels before and after the bathing. The psychologic sweating markedly decreased after the bathing (11.5±19.6 to 1.1±2.7 for plain water bathing, 14.9±21.9 to 1.6±5.1 for artificial hot spring, N. S.).
The decrease in psychologic sweating after bathing suggests the action of psychologic relaxation by bathing.

  New information has been accumulated in the various fields of balneology including reports in terms of the molecular genetics. Recently, fatal accidents with hot-bathing have been increasingly reported. This has become a serious social issue especially in a high-aged population like in Japan. These backgrounds therefore create the theme for the meeting “New Development and Challenge of Balneoterapy”. I have here presented about the new approach for balneotherapy in a high-aged population, which was focused the anti-aging effects to promote health and well being. It is well known that balneotherapy (BT) has not only warming-up of body temperature, but also have the inhibition of inflammation and the increase of metabolism. I can suppose that BT is effective for aged people to keep the increasing core temperature, and then they will live in healthy long life as anti-aging action. We have examined the effects of BT in patients with chronic heart failure. It was concluded that BT showed to improve both of the cardiac function and inflammatory status. In animal study, repetitive hyperthermia (RHT) by bathing indicated to attenuate the progression of cardiac hypertrophy and to delay the transition to heart failure. From data of heart tissue samples, the levels of heat shock protein were partly elevated and the telomere biology which is a marker of aging process was improved by RHT. Thus, BT may be useful as a novel therapeutic tool for anti-aging action as well as patients with heart failure.

Objectives: The purpose of this study was to examine the beneficial effects of balneotherapy in patients with chronic heart failure (CHF).
Background: Some reports have shown that balneotherapy reduces systemic blood pressure in healthy volunteers. However, it is not clear whether balneotherapy improves the status of CHF. We hypothesized that hyperthermia using hot water would improve cardiac and peripheral endothelial function and clinical symptoms.
Methods: Twenty-six patients with chronic systolic heart failure classified as New York Heart Association (NYHA) functional status II or III were divided into two groups. In the balneotherapy group, patients were immersed in a hot spring at 40°C for 10min daily for two weeks; in the control group, patients took a daily shower. We measured plasma brain natriuretic peptide (BNP) and asymmetric dimethylarginine (ADMA). The left ventricular ejection fraction (LVEF) and cardiothoracic ratio (CTR) were evaluated by echocardiography and chest radiography, respectively. Brachial-ankle pulse-wave velocity (baPWV) was measured non-invasively using an automatic device.
Results: Clinical symptoms were improved after two weeks of hot spring therapy. Although heart rate and CTR did not change, clinical symptom and LVEF improved and mean blood pressure, BNP, ADMA and PWV significantly decreased.
Conclusions: Repeated immersion in a hot spring improves peripheral vascular endothelial function, thus leading to improvement of clinical activity and symptoms in patients with CHF.

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.

  Objective: Beppu city is a world-famous resort. Spa bathing has been reported to yield psychophysiological relaxation. Beppu city office planned a health-promoting tour including spa-bathing activities in Beppu for the aging population, which is growing rapidly in Japan. This tour provided spa-bathing experiences, walks through urban districts where old townscapes remain, yoga, mountain hikes and shrine visits. We investigated whether such a short tour brought about a detectable medical effect toward health promotion for the elderly.  Methods: Twenty applicants (mean age: 67.7±3.5 years; male, n＝9 [mean age, 68.9±2.9 years]; female, n＝11 [mean age, 66.7±3.7 years]), joined the tour. These voluntary participants, who were over 60 years of age, participated in a five-day-tour in Oita prefecture. Health checks were conducted on the first and last days of the tour. This tour was conducted in areas containing a gulf, mountain areas, lakeside areas, forests and shrines. Participants visited these areas during the tour.  Outcome Measures: The following parameters of the participants were measured at the beginning and end of tour: stress score, blood pressure, salivary amylase level, serum C-reactive protein level, and serum cortisol level. The results were compared and analyzed by a paired t-test and a simple regression analysis.  Results: The mean values of the following parameters (pre-intervention and post-intervention) showed significant changes after the program: stress score (43.7±8.05 and 39.4±6.57; p-value＝0.005); systolic blood pressure (131±17.8 mmHg and 125±16.2 mmHg; p＝0.018); diastolic blood pressure (73±7.3 mmHg and 70±6.6 mmHg; p＝0.016); serum cortisol (7.7±3.16 µg/dL and 6.1±1.82 µg/dL; p＝0.027). Moreover, the participants’ cortisol levels tended to converge into a normal range.   Conclusion: Tourism in a spa resort can relieve mental and physical stress, reducing blood pressure and correcting the adrenocortical function.

Objective: The antitumor effects of anti-PD-1 antibody against mismatch repair deficiency (MMR-D)-associated cancers have been reported. MMR-D is found in approximately 20%–30% of endometrial carcinomas (ECs) and frequently occurs due to MLH1 promoter hypermethylation (MLH1-PHM). ECs with MLH1-PHM are classified according to the molecular screening of Lynch syndrome (LS), but few detailed reports are available. The purpose of this study was to clarify the clinical features of EC with MLH1-PHM. Methods: Immunohistochemistry of MMR proteins (MLH1, MSH2, MSH6, and PMS2) was performed on specimens from 527 ECs treated at our university hospital from 2003 to 2018. MLH1 methylation analysis was added to cases with MLH1/PMS2 loss. ECs were classified as follows: cases that retained MMR proteins as “MMR-proficient;” cases with MLH1/PMS2 loss and MLH1-PHM as “met-EC;” and cases with other MMR protein loss and MLH1/PMS2 loss without MLH1-PHM as “suspected-LS.” The clinical features, including long-term prognosis, of each group, were analyzed. Results: Accordingly, 419 (79.5%), 65 (12.3%), and 43 (8.2%) cases were categorized as “MMR-proficient,” “suspected-LS,” and “met-EC,” respectively. Significantly, “met-EC” had a lower proportion of grade 1 tumors (37.5%) and a higher proportion of stage III/IV tumors (37.2%) than the other groups. The overall and progression-free survival of “met-EC” were significantly worse than those of “suspected-LS” in all cases. Conclusion In ECs with MMR-D, “met-ECs” were a subgroup with a poorer prognosis than “suspected-LS.” “Met-ECs” would be the main target for anti-PD-1 antibody treatment, and its clinical susceptibility should be verified individually.

A Valsalva aneurysm filled with thrombi can be difficult to diagnose, because it mimics a cardiac tumor. Both cardiac magnetic resonance imaging (MRI) and transesophageal echocardiogram (TEE) were performed on a patient who showed a low-echoic mass located between the atrial septum and the non-coronary sinus. Based on MRI findings allowing tissue characterization and the accurate location of the mass and the TEE findings of an irregular surface of the mass and a partial defect in the edge of the non-coronary sinus, we diagnosed the mass as a thrombosed Valsalva aneurysm that had perforated the inter-atrial septum. The operative findings coincided with the preoperative diagnosis. Both MRI and TEE are useful for diagnosing this condition.
Aneurysm ; Atrial Septum ; Echocardiography ; Heart Neoplasms ; Humans ; Magnetic Resonance Imaging ; Sinus of Valsalva

  Although body-warming with hot spa-bathing has been proposed to exert medical therapeutic effects on certain diseases, whether body-warming has preventive and promotive effects remains unknown. To clarify this issue, an epidemiological questionnaire study regarding personal hot spa-bathing habits and disease history was carried out in Japan, where individuals engage in daily warm water bathing. Questionnaires regarding hot spa-bathing habits and disease history were randomly sent to 20,000 residents aged ≥65 years living in Beppu, a city in Japan that has the highest concentration of hot spa sources in the world. The results showed that habitual hot spa-bathing exerts preventive or promotive effects on the occurrence of certain diseases, such as hypertension (preventive) and collagen disease (promotive) in women, and cardiovascular diseases (preventive) in men. These findings suggest that habitual body warming is an effective and economical method with beneficial preventive and promotive effects on various diseases.