ABSTRACT
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.
ABSTRACT
<p><b>Background:</b> 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.</p><p><b>Methods:</b> 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.</p><p><b>Results:</b> 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. </p><p><b>Conclusion:</b> 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.</p>
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
<b>Background: </b>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.<BR><b>Methods and Subjects: </b>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.<BR><b>Results: </b>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.<BR><b>Discussions: </b>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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
We investigated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, by way of clarification of relationship between weather and health. This study covered the new outpatients of our division, and carried out on February '03 and June '03 (February: 72 males, 106 females, aged 49.9±18.5, June: 98 males, 109 females, aged 47.6±19.5). We categorized their clinical data into chief complaints (pain, headache, discomforts, fever, cough, vertigo/stagger, palsy) and disorders (gastrointestinal, mental, inflammatory, orthopedic, infection, respiratory, circulatory, tumorous, urinary, autoimmune/allergic, dental/oral, gynecological), then, compared the clinical data of February with June, in terms of seasonal disease. Additionally, we investigated the relationship between weather data and clinical data of February and June, from a perspective of meteoropathy. The average of meteorological phenomena (air pressure, air temperature, relative humidity, velocity of wind, day length, rainfall level) of a week before first visit, were used as weather data. The main results of analysis about seasonal disease, showed that the complaint of discomfort were more frequent in June than February (p=0.005). The orthopedic disorder was more frequent in June than February (p=0.012). Infection was more frequent in February than June (p=0.011). The analyses in terms of meteoropathy, showed that the complaint of cough were more frequent after cold temperature in February (p=0.014). The gastrointestinal disorders were more frequent after humid (p=0.018) and pluvious days (p=0.016) in February. The complaint of headache was liable to be frequent after pluvious weather in June.<br>The relationship between weather and health is known in the prior an, and our study anew demonstrated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, as statistical evidence.
ABSTRACT
This study investigated the existence of platelet activation before the onset of cerebral infarction, and analyzed the association between the platelet activation and the degree of atherosclerosis. Furthermore, prediction of the risk of cerebral infarction by assessing platelet activation was attempted. Thirteen patients with cerebral infarction, 7 patients with atherosclerosis and 8 healthy subjects were enrolled in this study. Ultrastructural shape change, peroxidase reaction, and fibrinogen content in the platelets were observed and plasma levels of thrombin antithrombin complex, α<sub>2</sub>-plasmin inhibitor plasmin complex, β-thromboglobulin and platelet factor-4 were measured in patients with atherosclerosis and cerebral infarction at the acute, subacute and chronic phases. The ultrastructural shape change, peroxidase reaction, and fibrinogen content did not differ among acute, subacute and chronic phases of cerebral infarction. The frequency of platelet shape changes were also increased in patients with atherosclerosis, compared with healthy subjects. Plasma levels of β-thromboglobulin, platelet factor-4, and thrombin antithrombin complex increased only during the acute phase of cerebral infarction. It is suggested that platelet activation occurs before the onset of cerebral infarction and that platelet shape change is associated with the degree of atherosclerosis, or plaque stability. Platelet activation would be derived not from thrombotic event itself but from endothelial damage or pre-existing atherosclerosis. Platelet shape change, therefore, could predict the risk of cerebral infarction. Taken together with our previous reports demonstrating increased blood viscosity, noctural hypotension, increased human atrial natriuretic peptide, decreased fibrinolytic activity, and platelet shape change were observed after very hot hot-spring bathing, cerebral infarction in spa-resort could be caused partly by very hot hot-spring bathing after traveling on a tight schedule and alcohol drinking by elderly patients with atherosclerosis.
ABSTRACT
A patient with atopic dermatitis who presented muscular weakness of lower extrimities and tetany due to severe hypokalemia, hypocalcemia and hypomagnemia was described. The hypokalemia and hypomagnemia were caused by pseudo-Bartter's syndrome due to persistent dehydration, and the hypocalcemia was caused by pseudohypoparathyroidism due to hypomagnemia. The persistent dehydration was considered to be resulted from long-term and long-time bathing. Thus, adequate supply of water and electrolytes may be necessary in long-term balneotherapy.
ABSTRACT
From March 1990 to September 2001, 24 patients with psoriasis (16 males and 8 females, 54±18 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The psoriasis had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by application of vitamine D3 ointment 1-2 times daily for 37±19 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 20 of 24 cases (83%) were improved through the balneotherapy, while those of the remaining 4 cases were not changed. No side effects were observed. The serum levels of uric acid, GOT and GPT which are reported to be increased slightly did not correlate with the skin symptoms. The serum LDH level which is associated with the skin manifestastions in patients with atopic dermatitis also gave no useful information in the treatment of psoriasis. Although the mechanism of the improvement of skin manifestations is not clarified, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of psoriasis as alternative and complementary medicine
ABSTRACT
The circumferences of chest, abdomen, thigh and calf during head-out water immersion up to chin level were measured in 8 healthy male subjects (age 35.4±1.6years old, body mass index 23.7±1.6kg/m<sup>2</sup>) in standing and sitting positions. The circumferences of chest, abdomen, thigh and calf decreased significantly during immersion in standing position. The circumferences of chest, abdmen and thigh decreased significantly in sitting position. The circumference of chest decreased from 90.6±3.4 to 90.1±3.1cm, that of abdomen decreased from 81.4±2.8 to 80.6±2.5cm, that of thigh decreased from 47.1±1.6 to 46.6±1.8cm, and that of calf decreased from 37.7±1.8 to 37.2±1.8cm during immersion in standing position. As the body surface area is about 1.6m<sup>2</sup>, the decrease in the volume of human body is considered to be 730cm<sup>3</sup> or less when the body shape change during immersion is not taken into considerarion.
ABSTRACT
We have investigated change in platelets and the blood coagulation and fibrinolytic systems as a mechanism of the onset of thrombotic diseases during and after hot-spring bathing. In this study, We examined effect of 10min 42°C and 37°C hot-spring bathing on protein C, protein S and antithrombin III in seven healthy male subjects. The mean values of protein C antigen, protein C activity, total and fee protein S antigens, protein S activity and antithrombin III activity were slightly increased by both methods, while these changes were not statistically significant. Taken together with our previous reports, 10min 42°C hot-spring bathing gives no effect on the blood coagulation system.
ABSTRACT
From June 1990 to October 1998, 100 patients with adult-type atopic dermatitis (59 males and 41 females, 25±8 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The atopic dermatitis in all but 9 cases occurred while the patients were still under 20 and had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by immediate application of white petrolatum 1-2 times daily for 75±46 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 79 of 100 cases (79%) were improved through the balneotherapy and furthermore pruritus was improved in 55 of the 79 cases (70%). The improvement of skin manifestations was supported by a significant decrease in serum LDH levels. In contrast, pruritus was not improved in the remaining 21 cases who showed no changes in skin symptoms and serum LDH levels. Moreover, changes in the number of <i>Staphylococcus aureus</i> on the skin surface were examined before and after balneotherapy. In the 69 cases examined whose skin symptoms were improved, many <i>Staphylococci aureus</i> were detected in 52 of the cases but not in the other 17 cases before starting balneotherapy. They disappeared in 24 cases and decreased in 18 cases of the 52 cases, but were not changed in the remaining 10 cases through the balneotherapy. On the other hand, the number of <i>Staphylococcus aureus</i> on the skin surface was not changed in 11 of the 14 cases examined whose skin symptoms were not improved. Our previous study reported that bactericidal activity against <i>Staphylococcus aureus</i> is expressed by the co-existence of manganese and iodide ions contained in the hot-spring water under an acidic (pH 2.0-3.0) condition. Thus, the mechanisms of the improvement of skin manifestations through the balneotherapy may be explained by considering bactericidal activity of Kusatsu hot-spring water against <i>Staphylococcus aureus</i> inducing acute flares of skin manifestations. Therefore, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of adult-type atopic dermatitis as a suitable method of skin care.
ABSTRACT
A 3-min bath in 47°C hot-spring water called ‘jikan-yu’ has been recommended for over 130 years at Kusatsu-spa. There is a traditional custom of pouring hot-spring water of the same temperature over the head before entering the bath to avert an afflux of blood to the brain. The medical significance of this custom was investigated in 8 healthy male volunteers (age 31±6 years and body mass index 22.4±1.6kg/m<sup>2</sup>). There were no significant differences in plasma levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, and β-endorphin on a comparison of findings before and after the action of pouring 20 pails of 47°C hot-spring water over the parietal and occipital areas of the head. However, the direct effect of heat stress on the internal thermosensor in the anterior hypothalamus regulating heat loss and thermogenesis was not examined in this study. Thus, it is considered that the action does not provide a direct hyperthermal stimulus to the brain stem to release stress hormones but may dilate blood vessels of the head to prepare for the abrupt afflux into the cerebral circulation of blood heated by subsequent very hot hot-spring bathing.
ABSTRACT
A total of 422 patients who were hospitalized in the Division of Rehabilitation, Kusatsu Branch Hospital of the Gunma University Hospital from 1986 to 1996 was analysed with respect to the patients' sex, age, place of residence, disease, complications, day from onset to admission to our hospital, days of treatment in the hospital, outcome, reason to receive rehabilitation, persons who took care of the patient, and family members. Of the 422 cases, 262 (62.1%) were 65 or more years old. 193 patients (45.7%) were residents of Kusatsu, and 143 patients (33.9%) were from outside Gunma Prefecture.<br>With respect to diseases, cerebral diseases had the highest percentage (148 cases, 35.1%) and 277 (65.6%) cases had complications. The mean days of treatment in the hospital were 73 days. Hot-spring bathing was used for rehabilitation in 351 (83.2%) cases, resulting in improvement of clinical symptoms and quality of life in almost all cases. As to reason to receive rehabilitation in our hospital, 202 (47.9%) came of own will, 79 (18.7%) were recommended by doctors of other hospitals, and 68 (16.1%) were emergency admissions. Most patients lived alone or had only one family member of an old age and 83.2% of the persons who took care of patients were female family members. Many patients still wanted to receive rehabilitation even long after the onset of their impairment. These findings suggest that hot-spring bathing is effective for rehabilitation of various kinds of diseases. Although it has been found that many patients came to our hospital from various areas in the country expecting to rehabilitation using hot-spring water, it is difficult to follow up on them and to contact their family members for instructions.
ABSTRACT
To clarify possible involvement of hot spring bathing in the occurrence of acute myocardial infarction and cerebral infarction at Kusatsu, its effects on blood pressure, heart rate, plasma cortisol and hematocrit were examined in 9 healthy young men. Abrupt increase in systolic blood pressure was observed immediately after starting a 3-minute 47°C or a 10-minute 42°C hot-spring bath. Both systolic and diastolic blood pressure were abruptly decreased one minute after completing either 47°C or 42°C bathing. The heart rate was increased gradually after the start of either 47°C or 42°C bathing and was decreased gradually after the completion of either 47°C or 42°C bathing. It was considered that the plasma Cortisol level was increased 15 minutes after starting 47°C bathing and the hematocrit was increased 15 minutes after starting 42°C bathing. We have already reported that fibrinolytic activity was decreased and platelet function was activated by 47°C bathing. Taken together, it is suggested that the mechanism of the occurrence of thrombotic diseases after hot spring bathing may be explained by considering transient changes in blood pressure, heart rate, blood viscosity, fibrinolytic activity and platelet function induced by hyperthermal stress.
ABSTRACT
The effect of hot spring bathing on nocturnal blood pressure was investigated in 6 normotensive young individuals at Kusatsu. Blood pressure and heart rate were measured at 1-hour intervals from 18:00 one day until 12:00 the following day. The experiments were performed on 2 consecutive days. Three subjects took a 10-minute 42°C hot-spring bath at 20:00 on the first experimental day but did not on the second experimental day. The order of experiments was inverted in the other 3 subjects. While not statistically significant, the nocturnal blood pressure on the “bathing” day tended to be decreased more than that on the control day. However, there was no difference in the heart rate. These findings may suggest possible involvement of hot spring bathing in the initiation of thrombotic diseases occurred in the morning hours at Kusatsu.
ABSTRACT
The change in the skin surface temperature after taking a 3-minute 47°C hot-spring bath was examined in five healthy male volunteers whose mean age was 29.5 years and body mass index was 22.6kg/m<sup>2</sup>, As a control, they took a 10-minute 42°C hot-spring bath after 4 days. Skin surface temperature was measured by a thermotracer in a room where the ambient temperature was maintained at 25°C and relative humidity at 38%. To eliminate any effect of diurnal variation in skin surface temperature, the experiment was started at 1 p.m. of each day. There was no significant difference in the highest value of skin surface temperature of the face, chest, arm, hand, leg and foot between both bathings. However, the abdominal skin surface temperature was slightly higher after the 3-minute 47°C bath than after the 10-minute 42°C bath. The skin surface temperature of the chest was transiently decreased after the 3-minute 47°C bath. The highest value of skin surface temperature of all areas examined after the 3-minute 47°C bath was about 34°C and did not differ from that after the 10-minute 42°C bath. These findings suggest that external heat stress gives no influence on the skin surface temperature and the transient decline of the skin surface temperature of the chest after the 3-minute 47°C bath may be due to some pathophysiological change in the vascular and respiratory systems.