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Ran Zhang,1,2 Ya-Jie Lei,1,2 Sheng-Yue Wen,1,2 Jian Pang,1,2 Yue-Long Cao,1,2 Min Zhang,1,2 Hong-Sheng Zhan,1,2 Xun Lin,3 Bo Chen1,2 1Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Institute of Orthopedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Bo Chen; Xun Lin, Tel +86-21-20256519, Email cbm818@shutcm.edu.cn; linxund@163.comPurpose: To prove more accurately that Chinese herbal bath therapy may be a safe, effective, simple alternative treatment modality for knee OA, we designed a randomized, double-blind, placebo-controlled trial to explore the effectiveness of SSBD for the relief of pain, daily activities, and quality of life in patients with knee OA.Patients and Methods: A single-center, 52-week, randomized controlled trial of SSBD versus placebo is being performed. A total of 200 patients with symptomatic knee OA will be randomly allocated to the SSBD treatment or placebo intervention group for 4 weeks. The two groups of patients are allowed to steam and bathe their knees once every other day, using one packet of SSBD each time, for 30 minutes, 3 times a week, for a total of 4 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at 4 weeks is the primary outcome measure, and the secondary outcomes include WOMAC stiffness and function scores, the Lysholm knee scale score, quality of life, the Brief Pain Inventory score, the Patient’s Global Impressions of Improvement Scale score and the Clinical Global Impressions of Severity scale score. The safety of the herbal medications will also be evaluated.Conclusion: We will discuss whether SSBD has greater advantages in terms of efficacy, safety, and patient overall perception than does placebo control in middle-aged and elderly patients with knee OA. The findings may provide new and valuable information about the efficacy and safety of Chinese herbal bath therapy in the treatment of knee osteoarthritis.Keywords: balneotherapy, traditional Chinese medicine, complementary and integrative medicine, randomized placebo-controlled trial, knee osteoarthritis

Despite recent advancements in psoriasis treatment, challenges in management persist. Recently, there has been a rising interest amongst patients in complementary and alternative medicines (CAM), driven by the desire for more natural, holistic approaches and dissatisfaction with conventional treatments. Up to 41% of patients with psoriasis reported using alternative therapies and 39.5% use complementary therapies (Murphy EC, Nussbaum D, Prussick R, Friedman AJ (2019) Use of complementary and alternative medicine by patients with psoriasis. J Am Acad Dermatol 81:280–283). Despite their rapidly growing prevalence, literature on CAM therapies for psoriasis is lacking, making their recommendation difficult. Since the last systematic review on this topic published in 2018, evidence for new alternative therapies has emerged, promoting a further investigation of their efficacy (Gamret AC, Price A, Fertig RM, Lev-Tov H, Nichols AJ (2018) Complementary and Alternative Medicine Therapies for Psoriasis: A Systematic Review. JAMA Dermatol 154:1330–1337). This systematic review aims to compile recent literature on the most studied alternative therapies for psoriasis and further discuss their effectiveness in order to counsel clinicians in guiding patients on the use of these non-standard approaches. A literature search was conducted in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases for randomized controlled trials (RCT) on complementary and alternative therapies in psoriasis from March 2018 through April 2024, resulting in 12 studies being included in this review. The preliminary results for many treatments such as curcumin, dietary modification and additions, indigo naturalis, meditation, acupuncture, and balneotherapy showed positive clinical effects. However, additional well-designed randomized trials are needed to confirm the potential beneficial effects and to establish safety of use. [ABSTRACT FROM AUTHOR]

The influence of uncertainty on the method adopted for the determination of radioactive radium concentration in water was analyzed due to the assessment of the radiation hazards of balneotherapy. For the calculation, we considered the influence of the bath in radioactive water containing only 226Ra. 226Ra concentration was determined with two γ-spectrometers armed with HPGe detectors with different relative efficiencies. Both spectrometers were energy-efficiency calibrated with a calibration source and based on numerical simulations. Different methods for qualitative γ-spectrum analysis were adopted. The emanation method and the liquid scintillation method were also used. The uncertainty of humans hazard assessment linearly depends on the adopted radiometric method precision. For effective dose calculation, two models were adopted: the model of external exposure proposed by ICRP Publication 144 and the Reference Men model proposed by ICRP Publication 23, respectively.

Background: The sulfide–hydrogen sulfide brine balneotherapy (HSBB), including a combination of dissolved hydrogen sulfide (H2S) gas, inorganic sulfur ions (S2−), and hydrosulfide ions (HS−), is one of the most important and most effective forms of spa treatment in patients with osteoarticular disorders (OADs). Some cardiovascular diseases (CVDs) are often considered to be contraindications to HSBB since the presence of thiol groups may lead to an increased quantity of reactive oxygen species (ROS), which damage the vascular endothelium, and endothelial dysfunction is considered to be the main cause of atherosclerosis. However, there are a number of literature reports suggesting this theory to be false. H2S is a member of the endogenous gaseous transmitter family and, since it is a relatively recent addition, it has the least well-known biological properties. H2S–NO interactions play an important role in oxidative stress in CVDs. The general objective of this study was to assess the cardiovascular safety of HSBB and analyze the effect of HSBB on selected cardiovascular risk markers. Methods: A total of 100 patients at the age of 76.3 (±7.5) years from the Włókniarz Sanatorium in Busko-Zdrój were initially included in the study. The following parameters were assessed: age, sex, height, body weight, body surface area (BSA), body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), heart rate, the diagnosis of OAD that was the indication for balneotherapy, creatinine (CREAT), glomerular filtration rate (GFR), lipid panel, C-reactive protein (CRP), uric acid (UA), and fibrinogen (FIBR) and cardiovascular markers: (cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP). Results: A significant decrease in DBP and a trend towards SBP reduction were observed over the course of the study. A significant decrease was observed in CRP levels decreasing from 2.7 (±3.6) mg/L to 2.06 (±1.91) mg/L, whereas FIBR rose significantly from 2.95 (±0.59) g/L to 3.23 (±1.23) g/L. LDL-C levels decreased slightly, statistically significant, from 129.36 (±40.67) mg/dL to 123.74 (±36.14) mg/dL. HSBB did not affect the levels of evaluated cardiovascular biomarkers, namely NT-proBNP (137.41 (±176.52) pg/mL vs. 142.89 (±182.82) pg/mL; p = 0.477) and cTnT (9.64 (±4.13) vs. 9.65 (±3.91) ng/L; p = 0.948). A multiple regression analysis of pre-balneotherapy and post-balneotherapy values showed cTnT levels to be independently correlated only with CREAT levels and GFR values. None of the assessed parameters independently correlated with the NT-proBNP level. Conclusions: HSBB resulted in a statistically significant improvement in a subclinical pro-inflammatory state. HSBB has a beneficial effect in modifying key cardiovascular risk factors by reducing LDL-C levels and DBP values. HSBB has a neutral effect on cardiovascular ischemia/injury. Despite slightly elevated baseline levels of the biochemical marker of HF (NT-proBNP), HSBB causes no further increase in this marker. The use of HSBB in patients with OAD has either a neutral effect or a potentially beneficial effect on the cardiovascular system, which may constitute grounds for further studies to verify the current cardiovascular contraindications for this form of therapy. [ABSTRACT FROM AUTHOR]

Balneotherapy includes practices and methods using medically and legally recognized mineral-medicinal waters, muds and natural gases from natural springs for therapeutic purposes. One of the most widely used method in balneotherapy is bathing with thermal mineral water. In the course of the years, scientific community has produced an increasing number of evidences that this practice is an effective method for treating signs and symptoms of several pathologies such as rheumatic, cardiovascular and dermatological diseases. This systematic review is aimed at evaluating the effect of balneotherapy with thermal water baths as a treatment to manage signs and symptoms of patients affected by all types of dermatological diseases. The systematic review was conducted according to the PRISMA Statement, and its protocol was registered on PROSPERO platform (CRD42022295913). The research was performed on the databases Pubmed, Scopus, Web of Science and Cochrane. We included clinical trials evaluating the effects of balneotherapy using thermal mineral water baths for managing dermatological diseases in humans, published in English and Italian language. Eight studies were included, seven of them enrolled adults affected by psoriasis and one studied atopic dermatitis patients. The common result of all the articles included was a clear improvement of signs and symptoms of psoriasis and eczematous diseases after use of thermal mineral water baths. These effects seem to be strictly related to physical and chemical properties of thermal water used for balneotherapy. However, studies in this field are still limited to support robust evidence of the effectiveness of balneotherapy using thermal mineral water baths and often their quality is low. Thus, new clinical studies need to be carried out, using more correct methods for conducting the studies and for processing statistical data. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the leading cause of death globally accounting for 32 % of all global deaths. Addressing modifiable risk factors, including hypertension and stress, remains paramount in the prevention of CVD. This study aimed to assess the impact of the balneotherapy on blood pressure, heart rate, electrocardiogram parameters, utilization of antihypertensive medications, and stress levels. Methodology. Multicenter randomized controlled single-blind parallel group trial was made in 6 Lithuania resort centers. 373 participants with the stress level > 3 (10, VAS) randomly divided into 6 groups in two clusters for receiving a 6- or 11-day complex treatment using natural resources - mineral waters, peloids, salt, nature therapy; follow-up period was 6 months. The BP, HR, ECG, stress level and other parameters were analyzed in 131 participants who passed a full course of investigation. Results. The significant reduction of systolic blood pressure after treatment (7.8 mmHg) and during 6 months (7.3 mmHg) together with diastolic 5.5 after 6 month and heart rate (4 b/min) was achieved in 11-day ambulatory balneotherapy group. Increase in the activity of the parasympathetic nervous system was observed, which is reflected by an increase in the duration of the ECG indicators. The stress level decreased by up to 43%, and stress management improved by up to 41% following inpatient treatment. Conclusion. Therapy using natural resources could stand for additional cardiovascular disease prevention and management method in integrative therapy. [ABSTRACT FROM AUTHOR]

One of the oldest specialties in medicine is balneotherapy, which examines how to treat patients with mud and groundwater. Many nations use water therapy as a kind of treatment. The Blue Lagoon in Iceland, the Dead Sea in Israel, the Kangal hot springs in Turkey, several thermal pools in France, as well as Poland, are examples of natural balneotherapy locations. For the patient, this therapy is painless, and there are almost no adverse effects. Its positive effects have also been demonstrated in the management of lupus, psoriasis, atopic dermatitis, rosacea and other inflammatory skin conditions. The primary components of the mechanism are the deep water and peat baths' chemical, mechanical, thermal, and immunomodulatory impacts. It is desirable to use balneotherapies both alone and as a supplement to systemic therapy. Based on the most recent studies and clinical data, this article seeks to assess the present scientific understanding of the role of balneotherapy in dermatological care. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to evaluate the efficacy of balneological treatment in patients with knee osteoarthritis using clinical scales and to determine its effect on pain, function, and quality of life. Material and Method: Thirty-two patients with knee osteoarthritis were divided into two randomization groups. The patients in the study group were given a full bath for 20 min in the hydrotherapy pool at 38°C. Then, medical mud was applied to both knees at 43°C. The second group was not given any specific treatment and continued to receive routine treatment (control group). Patients completed the clinical scales with the blinded physician before treatment/day 1 (baseline), at the end of treatment/day 12, and 3 months. Result: At the end of treatment, WOMAC total, VAS pain, and global assessment scores of patients and physicians were statistically significant improved compared with baseline and thirdmonth controls in the study group. A statistically significant improvement occurred in the 12-d and 3-month Lequesne knee index scores compared with the baseline in the study group. A statistically significant improvement was observed in Nottingham Health Profile pain, emotional reactions, physical move ment, and energy scores in the study group on day 12 compared with baseline, and this significant difference continued in the third month for all scores, excluding the energy score. No change was observed in the control group. Conclusion: The positive effects of balneological treatment on pain, functional status, and quality of life in knee osteoarthritis have been demonstrated. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis is a prevalent and disabling musculoskeletal condition that affects a large number of individuals worldwide, characterized by its degenerative nature causing a significant impact on the quality of life of those who suffer from it. The study aimed to determine the effects of hydrotherapy in patients with knee osteoarthritis, carrying out a systematic review following the guidelines established by the PRISMA Statement, which included an exhaustive search of the scientific literature of the last 5 years in the following databases: PubMed, Scielo, PEDro and Google Scholar, clinical trials and pilot studies, in English and Spanish that evaluated hydrotherapy as a treatment for patients with knee osteoarthritis were included. The results obtained showed significant beneficial effects in the reduction of pain, joint stiffness, functional capacity and quality of life of patients. In this context, hydrotherapy is considered to represent an effective and safe therapeutic intervention for the management of knee osteoarthritis, complementing or potentially replacing conventional treatment approaches. [ABSTRACT FROM AUTHOR]

Thermal waters have a global distribution and find extensive therapeutic use. In Morocco, which boasts more than twenty high-quality therapeutic thermal springs, few studies have focused on the quality of these waters. In this context, the present study evaluated the water quality using physicochemical, bacteriological, and radioactive parameters for BENKACHOUR thermal spring waters in Morocco. The results indicate that all chemicals, bacteriological, and radiological parameters are below the standards, except for global beta activity and temperature, which makes it hyperthermal, with an annual average temperature of 50.54 °C. Based on the Piper diagram, the water type is chloride-sodium-potassium. Based on these results, we conclude that thermalism in the Eastern region of Morocco, specifically BENKACHOUR in Oujda, can contribute to sustainable tourist development at the national and international levels due to the quality of the parameters analyzed and can be an effective complementary approach in the treatment of low-grade pathologies. The data from this study can serve as a baseline for assessing future changes and defining standards for the quality of hydrothermal baths and balneotherapy worldwide.

Spa therapy consists of multiple techniques based on the healing effects of water, including hydrotherapy, balneotherapy, and mud therapy, often combined with therapeutic exercises, massage, or physical therapy. Balneotherapy is a clinically effective complementary approach in the treatment of low-grade inflammation- and stress-related pathologies, especially rheumatic conditions due to its anti-inflammatory properties. The main objective of this investigation was to conduct a systematic review analyzing the available evidence on the effect of spa therapy on serotonin and dopamine function. The databases PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were used from June to July 2023. Exclusion criteria were (1) articles not written in English, (2) full text not available, (3) article not related to the objective of the review. JADAD scale was used for methodological quality evaluation. Four studies were included in the systematic review. Two studies were related to serotonin in healthy individuals, one to serotonin in fibromyalgia, and one to dopamine in healthy individuals. One of the studies evaluated hydrotherapy, another one balneotherapy and mud-bath therapy, and the other two assessed balneotherapy interventions. Studies were very heterogeneous, and their methodological quality was low, making it difficult to draw clear conclusions regarding the effect of spa therapy on peripheral serotonin and dopamine function. The findings of this review highlight the lack of studies evaluating these neurotransmitters and hormones in the context of spa therapy. Further research is needed to evaluate the potential effects of these therapies on serotonin or dopamine function. [ABSTRACT FROM AUTHOR]

Aim: In this review, the authors characterise bioactive ingredients of humic waters, the chemical structure of humic acids and their properties, methods of their analysis and isolation. The aim of the study is also to review the application of humic waters and humic acids in different fields such as medicine and balneology. Materials and Methods: A literature review was done based on the available PubMed bibliographic database from 1994-2023. Articles in Polish and English were included. During the search the keywords such as humic waters, humic acids, peloids, balneotherapy and balneology were used. The authors also used other sources for the search, such as books and internet websites. Conclusions: Humic acids have a very high sorption capacity and a variety of biological properties including anti-inflammatory, antioxidant, antibacterial, antiviral, which can be successfully applied in different fields of medicine: dermatology, gastrology, diabetology and balneotherapy. The multitude of biological properties of humic waters and humic substances raises the question of whether or not they should be considered natural medicinal resources. [ABSTRACT FROM AUTHOR]

Aim: This article aims to analyze the scientific understanding of the role of balneotherapy in the treatment of numerous urological conditions based on the latest research and clinical findings. Materials and Methods: A review of literature from PubMed and Google Scholar databases published between 2000 and 2023 on the use of balneotherapy for urological conditions was performed. The literature data was analyzed to identify the most common urological conditions such as chronic pelvic pain, urinary incontinence, urolithiasis, rehabilitation after prostatectomy and overactive bladder syndrome in which this field of physical medicine is applicable. Publications containing the following keywords were selected for analysis: balneology, urology, cpp, OAB, urolithiasis, post-prostatectomy treatment. Out of 90 papers, 26 sources containing key information related to the topic of the paper were selected. Conclusions: While the potential of balneotherapy in urology appears promising, it is crucial to approach these findings with cautious optimism. Many studies are in their early stages, and larger, multicenter, randomized, controlled trials are essential for a solid understanding of the role of balneotherapy in urology. In addition, it is essential to establish standard protocols to ensure patient safety and treatment efficacy. As our knowledge deepens, balneotherapy, with its rich history, may become a cornerstone of modern urologic care. [ABSTRACT FROM AUTHOR]

Thermal waters have a global distribution and find extensive therapeutic use. In Morocco, which boasts more than twenty high-quality therapeutic thermal springs, few studies have focused on the quality of these waters. In this context, the present study evaluated the water quality using physicochemical, bacteriological, and radioactive parameters for the Benkachour thermal spring waters in Morocco. The results indicate that all chemicals, bacteriological, and radiological parameters are below the standards, except for global beta activity and temperature, which makes it hyperthermal, with an annual average temperature of 50.54°C. According to the Piper diagram, the water type is chloride-sodium-potassium. On the basis on these results, it was concluded that thermalism in the Eastern region of Morocco, specifically Benkachour in Oujda, can contribute to sustainable tourist development at the national and international levels due to the quality of the parameters analyzed and can be an effective complementary approach in the treatment of low-grade pathologies. The data from this study can serve as a baseline for assessing future changes and defining standards for the quality of hydrothermal baths as well as balneotherapy worldwide. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a systemic immune-mediated disease primarily manifesting as skin redness and inflammation. Balneotherapy proved to be a successful non-pharmacological option to reduce the skin areas affected by the disease, but the specific mechanisms underlying this effect have not been elucidated yet. Here we test the hypothesis that the effect of thermal treatments on psoriatic lesions could be partially mediated by changes in the resident microbial population, i.e., the microbiome. Methods: In this study, we enrolled patients with psoriasis and monitored changes in their skin and gut microbiome after a 12-bath balneotherapy course with a combination of 16S rRNA amplicon sequencing and metagenomics. Changes in the resident microbiome were then correlated with thermal therapy outcomes evaluated as changes in Psoriasis Area and Severity Index (PASI) and Body Surface Area index (BSA). Results: The amplicon sequencing analysis of the skin microbiome showed that after thermal treatment the microbiome composition of affected areas improved to approach that typical of unaffected skin. We moreover identified some low-abundance bacterial biomarkers indicative of disease status and treatment efficacy, and we showed via metagenomic sequencing that thermal treatments and thermal water drinking affect the fecal microbiome to host more species associated with favorable metabolic health. Conclusions: Changes in lower-abundance microbial taxa presence and abundance could be the basis for the positive effect of thermal water treatment and drinking on the cutaneous and systemic symptomatology of psoriasis. Plain Language Summary: Psoriasis is an immune-mediated disease primarily manifesting as skin redness and inflammation that affects 2–3% of the world's population. No cure is currently available for this condition, and patients are offered pharmacological and non-pharmacological options to alleviate the discomfort. Previous studies and clinical practice have shown that thermal water treatment can be a non-pharmacological option to reduce the areas affected by the disease. However, the specific mechanisms causing this reduction have not been clarified yet. Given that neither the chemical nor the physical composition of thermal water can explain this beneficial effect, recent studies have suggested that it might be due to the effect of thermal water on the microbial communities living on the skin (i.e., the skin microbiome). In this work carried out at Terme di Comano, Northern Italy, we describe the effect of thermal water treatment on the skin microbiome of patients with psoriasis and we highlight the potentially beneficial effect of thermal water drinking on the microbial communities living in the gut, namely the gut microbiome. Specifically, we show that after balneotherapy the areas affected by psoriasis have a higher diversity of microbes usually present on healthy skin, potentially explaining the reduction in disease severity after treatment, and we describe how the gut microbiome of patients who drank thermal water changes to host more species linked with favorable metabolic health. These findings highlight that thermal water treatment and drinking could reduce both the skin and systemic symptomatology of psoriasis by affecting the skin and gut microbiome. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to present physiotherapy and balneotherapy as an adjunct to treatment in reducing pain in women with endometriosis. Accordingly, databases were searched to find the most effective forms of physiotherapy for the treatment of endometriosis. Materials and Methods: Two independent reviewers have searched medical and public databases such as PubMed, Scopus and PEDro using search terms and MeSH such as endometriosis, pain, physiotherapy, physical activity, balneotherapy, marker miRNA. Subsequently, the data obtained after the queries were then evaluated with regard to the titles in order to remove works with other keywords. The inclusion and exclusion criterion was an article published in a peer-reviewed journal, limited as to the scope of the publication year 2020-2022. Conclusion: The literature review conducted here suggests that it is necessary to carry out multicentre studies in order to ascertain which forms of physiotherapy and balneotherapy may be most effective in reducing pain and improving the quality of life of women suffering from endometriosis. [ABSTRACT FROM AUTHOR]

Spa therapy is a medical treatment based on the use of natural mineral water. In France, spa therapy is delivered in spa care facilities (SCF) involving the intervention of several actors (stakeholders). Spa doctors are key stakeholders as they prescribe the treatments, follow spa patients and assess spa therapy with scientific studies. This study aimed to analyze the spa doctors' relationships in order to highlight their role in transferring information to other stakeholders, particularly to spa managers. For that purpose, we used the social network analysis (SNA) method by means of snowball data collection. We sent a questionnaire to all the spa therapy categories of actors. In total, 80 persons answered and declared 397 relationships. Our results, based on the categorization of respondents and of their relationships and on quantitative indicators (density, response rate), show that spa doctors demonstrate a very acceptable density of relations with spa managers and elected local authorities. However, they appear to be poorly involved in relations concerning the strategy and management of SCF, although they are essential actors in ensuring the medical relevance and sustainability of spa therapy. This research is of interest to patients' care as it recommends deeper involvement of spa doctors in the management of SCF in order to optimize access to informational resources, specifically regarding the evolution of treatments in accordance with scientific progress. Our data are of international scope because the organizational model of balneotherapy, based on the cooperation between spa doctors and SCF, is universal. [ABSTRACT FROM AUTHOR]

Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several 'unconventional' approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described. [ABSTRACT FROM AUTHOR]

Abstract Introduction Psoriasis is a systemic immune-mediated disease primarily manifesting as skin redness and inflammation. Balneotherapy proved to be a successful non-pharmacological option to reduce the skin areas affected by the disease, but the specific mechanisms underlying this effect have not been elucidated yet. Here we test the hypothesis that the effect of thermal treatments on psoriatic lesions could be partially mediated by changes in the resident microbial population, i.e., the microbiome. Methods In this study, we enrolled patients with psoriasis and monitored changes in their skin and gut microbiome after a 12-bath balneotherapy course with a combination of 16S rRNA amplicon sequencing and metagenomics. Changes in the resident microbiome were then correlated with thermal therapy outcomes evaluated as changes in Psoriasis Area and Severity Index (PASI) and Body Surface Area index (BSA). Results The amplicon sequencing analysis of the skin microbiome showed that after thermal treatment the microbiome composition of affected areas improved to approach that typical of unaffected skin. We moreover identified some low-abundance bacterial biomarkers indicative of disease status and treatment efficacy, and we showed via metagenomic sequencing that thermal treatments and thermal water drinking affect the fecal microbiome to host more species associated with favorable metabolic health. Conclusions Changes in lower-abundance microbial taxa presence and abundance could be the basis for the positive effect of thermal water treatment and drinking on the cutaneous and systemic symptomatology of psoriasis.

Balneotherapy, treating diseases by bathing in mineral-rich waters and mud, has a long historical application across various cultures. Despite its widespread use, comprehensive studies on its biological impacts are scant, particularly in quantifying effects at the cellular and systemic levels. This study aims to rigorously investigate the biological effects of therapeutic mud and mineral waters, providing a scientific basis for their clinical application. We focused on elucidating the mechanisms behind the observed therapeutic effects and determining these natural resources' safety profiles. Employing a dual approach, we conducted both in vitro and in vivo studies. For the in vitro experiments, human fibroblast cells were treated with different concentrations of mud extracts to assess cytotoxicity, proliferation, and apoptosis pathways. For the in vivo assessments, Wistar rats were exposed to mud and mineral water treatments, with subsequent evaluations of biochemical markers in blood and urine indicative of systemic physiological changes. Our findings reveal that mud extracts exert a dose-dependent influence on cell viability, with low concentrations promoting cellular proliferation while higher concentrations induce apoptosis. In vivo treatments demonstrated significant modulation of inflammatory markers and oxidative stress parameters without evident systemic toxicity. The therapeutic mud and mineral waters demonstrate pronounced biological effects, enhancing cellular health and modulating systemic physiological responses without adverse side effects.

Background: The sulfide–hydrogen sulfide brine balneotherapy (HSBB), including a combination of dissolved hydrogen sulfide (H2S) gas, inorganic sulfur ions (S2−), and hydrosulfide ions (HS−), is one of the most important and most effective forms of spa treatment in patients with osteoarticular disorders (OADs). Some cardiovascular diseases (CVDs) are often considered to be contraindications to HSBB since the presence of thiol groups may lead to an increased quantity of reactive oxygen species (ROS), which damage the vascular endothelium, and endothelial dysfunction is considered to be the main cause of atherosclerosis. However, there are a number of literature reports suggesting this theory to be false. H2S is a member of the endogenous gaseous transmitter family and, since it is a relatively recent addition, it has the least well-known biological properties. H2S–NO interactions play an important role in oxidative stress in CVDs. The general objective of this study was to assess the cardiovascular safety of HSBB and analyze the effect of HSBB on selected cardiovascular risk markers. Methods: A total of 100 patients at the age of 76.3 (±7.5) years from the Włókniarz Sanatorium in Busko-Zdrój were initially included in the study. The following parameters were assessed: age, sex, height, body weight, body surface area (BSA), body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), heart rate, the diagnosis of OAD that was the indication for balneotherapy, creatinine (CREAT), glomerular filtration rate (GFR), lipid panel, C-reactive protein (CRP), uric acid (UA), and fibrinogen (FIBR) and cardiovascular markers: (cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP). Results: A significant decrease in DBP and a trend towards SBP reduction were observed over the course of the study. A significant decrease was observed in CRP levels decreasing from 2.7 (±3.6) mg/L to 2.06 (±1.91) mg/L, whereas FIBR rose significantly from 2.95 (±0.59) g/L to 3.23 (±1.23) g/L. LDL-C levels decreased slightly, statistically significant, from 129.36 (±40.67) mg/dL to 123.74 (±36.14) mg/dL. HSBB did not affect the levels of evaluated cardiovascular biomarkers, namely NT-proBNP (137.41 (±176.52) pg/mL vs. 142.89 (±182.82) pg/mL; p = 0.477) and cTnT (9.64 (±4.13) vs. 9.65 (±3.91) ng/L; p = 0.948). A multiple regression analysis of pre-balneotherapy and post-balneotherapy values showed cTnT levels to be independently correlated only with CREAT levels and GFR values. None of the assessed parameters independently correlated with the NT-proBNP level. Conclusions: HSBB resulted in a statistically significant improvement in a subclinical pro-inflammatory state. HSBB has a beneficial effect in modifying key cardiovascular risk factors by reducing LDL-C levels and DBP values. HSBB has a neutral effect on cardiovascular ischemia/injury. Despite slightly elevated baseline levels of the biochemical marker of HF (NT-proBNP), HSBB causes no further increase in this marker. The use of HSBB in patients with OAD has either a neutral effect or a potentially beneficial effect on the cardiovascular system, which may constitute grounds for further studies to verify the current cardiovascular contraindications for this form of therapy.

Achamyelesh Gebretsadik School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Southern Nation Nationalities People Region, EthiopiaCorrespondence: Achamyelesh Gebretsadik, School of Public Health, Hawassa University, P.O. Box 1466, Hawassa, Ethiopia, Tel +251 911303128, Email agtsadik@gmail.comBackground: Balneotherapy is the use of mineral water for the treatment of a wide range of diseases including skin lesions. Even though Ethiopia has a large number of places with natural hot springs, their therapeutic value has not been thoroughly studied. The aim of this study was to determine the effect of balneotherapy among patients with skin lesions at hot springs in southern Ethiopia.Methods: A single-arm prospective cohort study design was used to assess patient’s progress from their skin lesion complaint after using the hot water for at least three consecutive days or more. An individual visiting the hot springs site and staying there for at least three days or more was included in the study. From four hot springs sites in Southern Ethiopia, 1320 study participants who were 18 years of age or older were enrolled. The data were gathered using a standardized questionnaire and a physical examination. A descriptive analysis was made.Results: Of the total, 142 (10.8%) of them had various skin lesions. Flexural lesions accounted 87 (61.3%), non-specific skin conditions 51 (35.9%), co-lesions at the scalp, external ear canal, trunk, and various locations, and psoriatic lesions comprised 4.8%. There were 72 (82.8%) typical eczematous lesions among the total number of flexural lesions. After using balneotherapy for 3– 7 days once daily, 69 (95.2%) cases of eczematous dermatitis and 30 (58.8%) cases of non-specific skin issues showed improvement from the lesion. Additionally, after 30 days of bathing once daily, the PASI score of more than 90% of the psoriatic cases dropped to a score of one.Conclusion: Patients with skin lesions benefit significantly from balneotherapy when it lasts for three or more days. In order to improve skin lesions, proper application for at least a week or longer is highly beneficial.Keywords: balneotherapy, hot springs, skin lesion, southern Ethiopia

Spa therapy refers to the preventative, therapeutic, and rehabilitative use of thermo mineral waters, mud/peloid compresses, and natural gases. Applications are administered in sessions, and treatment regimens are determined in detail. Various modalities, such as exercise interventions, massage, phytotherapy, relaxation techniques, psychotherapy, nutrition, and electrotherapy, can be incorporated into the treatment process. Spa therapy has been effectively used to manage various diseases in many European countries, Japan, and Israel. Due to its natural structure, the difficulties in using drugs that frequently have side effects, and the limitations of many contemporary therapeutic alternatives, it is still a choice for treating a number of chronic conditions, especially rheumatic disorders. Furthermore, the global population is getting older. Considering the comorbidities, organ dysfunctions, and multiple drug use of elderly individuals, non-pharmacological treatment methods such as spa therapy have become more prominent. Spa therapy has been shown to be effective in treating osteoarthritis, balance problems, and chronic pain in older adults. Additionally, it might be chosen for managing psychiatric conditions and mood changes. Alterations in telomere lengths, reduced pain levels, increased cortisol concentrations, and an overall anti-inflammatory influence may mediate spa therapy’s anti-aging effect. Although opinions and assumptions support its anti-aging properties, more research is needed to prove its biological effects.

Natural products (water, plants, and minerals) have been studied for diverse applications in health and disease. Since there has been a growing interest in the introduction of thermal water as a clinical complementary approach in the treatment of low-grade inflammation and stress-related conditions, this review focuses on the oldest spa in the world: Nitrodi's spring. Substantial studies in the 1960s showed that both the internal and external use of Nitrodi's water yielded several benefits in physiological processes and in treating certain disorders, mainly allergic and autoimmune inflammatory conditions. More recently, a novel interest in Nitrodi's water has prompted researchers to further explore the effects of this water and shed light on the molecular mechanisms sustaining its therapeutic efficacy. In different epithelial cell models, Nitrodi's water had strong promotional effects on proliferation, cell migration, cell viability, and fibroblast to myofibroblast transition, all of which essential for wound healing and tissue remodeling. Moreover, Nitrodi's water exhibited anti-oxidant and anti-inflammatory properties through the inhibition of ROS production and protein S-nitrosylation. Here, we have collected the clinical and basic data on Nitrodi's water and reviewed articles that have discussed its use as a potential treatment for several inflammatory and autoimmune diseases and age-related skin deterioration. [ABSTRACT FROM AUTHOR]

Treatment for chronic rheumatic diseases, included various modalities for pain management and for functioning modulation, has the main gole to increase the quality of life and to improve also the activities of daily living. Seronegative spondyloarthropathies (SpA) are a group of rheumatologic disorders that include ankylosing spondylitis, psoriatic arthritis, entheropatic SpA, reactive arthritis and undifferentiated SpA. Treatment methods include clasically pharmacological modalities. Physical therapy should also be highlighted as being part of the treatment. Balneotherapy and spa therapy are increasingly taken into account in evidence-based treatment guidelines for multiple rheumatic diseases, for specific effects on functional parameters and also for the involvement in cartilage regeneration. Balneotherapy is universally defined as the treatment method which uses bathing in thermal and mineral waters. Other balneological treatments include peloidotherapy, balneological gases and therapeutic waters in various forms of bathing, inhalation or drinking. Spa therapy comprises complementary and alternative treatment modalities including balneotherapy, hydrotherapy, exercises, and massage therapy. This systematic literature review aims to highlight the effects of balneotherapy in spondylarthropathies. The review is based on the internationally accepted method, the “PRISMA” methodology- “Preferred Reporting Items for Systematic Reviews and Meta-Analysis”. [ABSTRACT FROM AUTHOR]

Hypertension (high blood pressure) is one of the most common health conditions. When your blood pressure is high for a long term, it can cause health problems, such as heart disease. In addition to the main methods of treatment, there are various methods of adjuvant therapy, one of the most common of which is hydrotherapy. In this review study, we examined the effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure. We searched the PubMed/MEDLINE, Web of Science, Scopus, and Science Direct databases until April 2022 using related keywords. In summary, the current study shows that different hydrotherapy methods may improve blood pressure. Hydrotherapy as one of the adjunctive therapy methods can be effective in lowering blood pressure. Blood circulation is smoothed by the warmth of the water. This improvement may be achieved by regulating heart rate, releasing hormones that control blood pressure, or regulating the activity of baroreceptors or chemoreceptors. In addition to using medications, hypertension patients also use non-pharmacological approaches in their care, including hydrotherapy, balneotherapy, and warm water foot soaks performed at home. Although several lines of evidence show the potential effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure, many clinical trials are needed. [ABSTRACT FROM AUTHOR]

La cure thermale est un traitement traditionnel des rhumatismes. Le but de cet article est de discuter l'intérêt de celle-ci dans le traitement des rhumatismes inflammatoires. La cure thermale n'a pas vocation à se substituer au traitement médicamenteux car elle n'a pas d'action sur l'activité des rhumatismes inflammatoires chroniques. En revanche, elle a des effets sur la douleur et la fonction qui peuvent être prolongés, au moins jusqu'à 3 mois et elle semble bénéficier d'une bonne tolérance. Les données d'efficacité dans la polyarthrite rhumatoïde (PR) sont de faible niveau de preuve et les indications de la cure sont probablement à limiter à des formes peu actives présentant des séquelles des poussées antérieures. Les bains au radon donnent des résultats contradictoires dans la PR et ne semblent pas apporter un effet supplémentaire dans la spondylarthrite ankylosante (SPA) chez des patients engagés par ailleurs dans une prise en charge multimodale. Dans la SPA, il y a quelques études de bonne qualité en faveur de l'efficacité de la cure thermale combinée à un programme d'exercices incitant à proposer ce traitement en complément du traitement médicamenteux. Spa treatment is a traditional treatment for rheumatic diseases. The aim of this article is to discuss the interest of this one in the treatment of chronic inflammatory rheumatisms. Spa treatment is not intended to replace drug treatment because it has no effect on the activity of chronic inflammatory diseases. On the other hand, it has effects on pain and function that can be prolonged, at least up to 3 months, and it seems to be well tolerated. The data on efficacy in rheumatoid arthritis (RA) are of low level of proof and the indications of the treatment should probably be limited to forms that are not very active and have sequelae of previous attacks. In spondyloarthritis, there are a few good quality studies in favor of the effectiveness of a spa treatment combined with an exercise program, encouraging the use of this treatment as a complement to drug treatment. [ABSTRACT FROM AUTHOR]

The work carried out a multivariate study of the mechanisms of metabolic disorders, closely related to an increase in blood pressure in children with arterial hypertension from 10 to 17 years. For this purpose, 60 children with arterial hypertension and metabolic disorders were examined. 20 children made up the control group. Before and after spa treatment, all children underwent a set of clinical and laboratory examinations, which included daily monitoring of blood pressure, biochemical studies of lipid and carbohydrate profiles, insulin, insulin resistance indices HOMO and CARO, leptin, adiponectin. Besides the individual hypocaloric diet, the rehabilitation included proper physical activity, school of arterial hypertension, not allowing for a child to sit at the computer or watch TV for a long time (or at all), treatment of foci of chronic infection (including pelotherapy and inhalations), sedative aero-phytotherapy, aero-ionotherapy, exercise therapy in either arterial hypertension or obesity group, classical hand massage of the neck and shoulders, electrosleep therapy. Depending on the treatment received the children with arterial hypertension (n=60) were divided into three groups (using the method of simple randomisation). The use of balneotherapy and electrosleep therapy in complex spa treatment contributes to the normalization of initially disturbed biochemical carbohydrate and lipid metabolic markers, a decrease in high levels of leptin and insulin, and an increase in initially reduced adiponectin. This allows us to conclude that the combined sanatorium-resort rehabilitation of patients is highly effective, which is expressed in a decrease in blood pressure, body weight, indicators of fat and carbohydrate metabolism. Intensive spa treatment has a beneficial effect on changing the criteria for the development of MS in children with obesity and hypertension. Of course, to achieve the optimal effect in the correction of disorders of carbohydrate and lipid metabolism, a long period of therapeutic measures and observation of patients is required, at least 3-6 months. [ABSTRACT FROM AUTHOR]

Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting. [ABSTRACT FROM AUTHOR]

Objective: to study the mechanism of action of low-mineralized sulfate-chloride-sodium mineral water on the clinical picture and motor function of the stomach in patients with epigastric pain syndrome using the regulatory peptide motilin as an example. Materials and methods: 113 people of both sexes were examined, the average age was 22.3±0.21 years. The observation group (57 people) included individuals with functional dyspepsia in the variant of epigastric pain syndrome, the comparison group included practically healthy individuals (56 people). The questionnaire method was used according to the Gastrointestinal Symptom Rating Scale questionnaire; ELISA method for determining the concentration of motilin in the blood. Mineral water in a volume of 200 ml was taken once by both groups of patients, patients with EPS additionally received a course. Results: in persons with epigastric pain syndrome, abdominal pain prevails. The course intake of mineral water provides a positive clinical trend, confirmed by a decrease in the syndromes of lesions of the upper gastrointestinal tract. A single and course intake of mineral water provides a stable increase in the level of motilin in functional dyspepsia. Conclusion: patients suffering from functional dyspepsia in the variant of epigastric pain syndrome have persistent disorders of motilin secretion compared with healthy individuals. Stimulation of the stomach on a drinking test model showed inadequacy of changes in the level of this hormone. Both a single and a course intake of low-mineralized sulfate-chloride-sodium mineral water contributes to an increase in the concentration of motilin, which should be considered as a physical adaptogenic factor leading to a stable ordering of the body’s functional relationships.

Psoriasis is a chronic inflammatory skin disease. It is associated with changes in skin microbiome. The aim of this study was to evaluate how Lake Hévíz sulfur thermal water influences the composition of microbial communities that colonizes skin in patients with psoriasis. Our secondary objective was to investigate the effects of balneotherapy on disease activity. In this open label study, participants with plaque psoriasis underwent 30-min therapy sessions in Lake Hévíz, at a temperature of 36 °C, five times a week for 3 weeks. The skin microbiome samples were collected by swabbing method from two different areas (lesional skin-psoriatic plaque and non-lesional skin). From 16 patients, 64 samples were processed for a 16S rRNA sequence-based microbiome analysis. Outcome measures were alpha-diversity (Shannon, Simpson, and Chao1 indexes), beta-diversity (Bray–Curtis metric), differences in genus level abundances, and Psoriasis Area and Severity Index (PASI). Skin microbiome samples were collected at baseline, and immediately after treatment. Based on the visual examination of the employed alpha- and beta-diversity measures, no systematic difference based on sampling timepoint or sample location could be revealed in these regards. Balneotherapy in the unaffected area significantly increased the level of Leptolyngbya genus, and significantly decreased the level of Flavobacterium genus. A similar trend was revealed by the results of the psoriasis samples, but the differences were not statistically significant. In patients with mild psoriasis, a significant improvement was observed in PASI scores. [ABSTRACT FROM AUTHOR]

Balneotherapy comprises the use of natural mineral waters for health and/or well-being purposes. When balneotherapy is offered by the public health system, some countries with Latin-based languages call it social thermalism. The aim of this study is to compare balneotherapy in health systems of Spain, France, Italy, and Portugal. The study involves a qualitative systematic review of the literature using the systematic search flow method. Twenty-two documents, from 2000 to 2022, were included and its findings were described in seven categories: the first outlines the historical characterization of social thermalism in the systems analyzed and the others outline the components of the health systems: coverage/access, health financing, workforce, inputs and techniques, organization and regulation, and network provision of services. The models of insurance and social security that cover part of the thermal treatment are highlighted. Doctors with competence in medical hydrology constitute the majority of the workforce. Similarities regarding inputs and techniques are observed, with variation in the number of days of the balneotherapy treatment cycle. In the regulation of services, the Ministry of Health of each country is prominent. The provision of services is mainly performed in specialized care in accredited balneotherapy establishments. Despite the limitations of the method, the comparisons made may serve to support public policies for balneotherapy. [ABSTRACT FROM AUTHOR]

After the resolution of the acute SARS-COV-2 infection, an important percentage of patients do not fully recover and continue to present several symptoms. Nevertheless, there is a lack of data in the literature on the effects of rehabilitation programs on medium- and long-term long COVID symptoms. Therefore, the aim of this study was to evaluate the long-term outcomes after rehabilitation programs in long COVID syndrome patients. A prospective cohort study was conducted from August 2021 to March 2022, involving 113 patients with long COVID syndrome. The patients in the experimental group (EG, n=25) received a tailored and multidisciplinary rehabilitative program, involving aquatic exercises, respiratory and motor exercises, social integration training and neuropsychologic sessions, LASER therapy and magnetotherapy. Patients in the other three comparison groups received eastern medicine techniques (CG1), balneotherapy and physiotherapy (group CG2), self-training and home-based physical exercise (CG3). Once the several rehabilitation protocols had been performed, a structured telephone contact was made with the patients after 6 months ± 7 days from the end of the rehabilitation treatment, in order to record the frequency of hospital ad-missions due to exacerbation of post-exacerbation syndrome, death or disability, and the need for other types of care or drugs. The patients in the comparison groups were more likely to request therapeutic care for emerging long COVID symptoms (χ²=6.635, p=0.001; χ²=13.463, p=0.001; χ²=10.949, p=0.001, respectively), as well as more likely to be hospitalized (χ²=5.357, p=0.021; χ²=0.125, p=0.724; χ²=0.856, p=0.355, respectively) when compared to the patients of the EG. The relative risk (RR) of hospital admissions in the observed cohort was 0.143 ±1,031 (СI: 0.019; 1.078); 0.580±1,194 (CI: 0.056; 6.022); 0,340±1,087 (CI: 0.040; 2.860). The RR of hospital admissions for patients with long COVID syndrome was reduced by 85.7%; 42.0% and 66.0%, respectively, when the experimental rehabilitation technique was employed. In conclusion, a tailored and multidisciplinary rehabilitative program seems to have a better preventive effect not only in the short term, but also over the next 6 months, avoiding the new onset of disabilities and the use of medicines and specialist advice, than other rehabilitative programs. Future studies will need to further investigate these aspects to identify the best rehabilitation therapy, also in terms of costeffectiveness, for these patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION. The therapeutic strategies for managing patients with comorbid conditions, such as arterial hypertension (AH) and prediabetes, are widely adopting non-drug methods along with the recommended medications. AIM. To evaluate the effect on fat distribution and humoral status of sulfide balneotherapy in the conditions of the experiment on white rats and clinical study of AH and prediabetes patients. MATERIAL AND METHODS. The study was of a clinical and experimental nature and consisted of 2 phases – experimental and clinical. The experimental study was carried out on obese, non-pedigreed white rats. Animals were exposed to sulfide baths and a combination of sulfide applications and baths. In the clinical phase of the study, patients with AH and prediabetes were included. All patients included in the present study received standardised drug therapy according to clinical guidelines, and patients in the observation group additionally received combined sulphide balneotherapy (Suksun lake sulphide applications and baths) for 14 days. The study program included assessment of weight, waist circumference (WC), body mass index (BMI), assessment of serum concentrations of vascular endothelial growth factor (VEGF); tissue growth factor (TGF b), insulin and leptin, as well as determination of epicardial fat thickness (EFT). RESULTS AND DISCUSSION. The experimental conditions revealed lipolysis in adipocytes (omentum), as well as an increase in the number of hemocapillaries in all areas of the heart and the growth of CD34 expression. The results of the clinical stage of the study suggest redistribution of fat depots against the background of sulfide balneotherapy. There were no statistically significant differences in weight and BMI in the dynamics, but there was a significant decrease in OT and TEF in the group of patients who received balneotherapy, who also had a significant decrease in HEFR concentration, leptin and an increase in TEFR beta 1. CONCLUSION. The presence of lipolytic, regenerative and adipokine-regulating effects of sulfide balneotherapy was demonstrated in the experiment and clinical study.

Obesity is a complex, multifactorial metabolic pathology, within the path of modification of the endocrine system plays a significant role. Changes in growth hormone (GH) and in-sulin growth factor (IGF) have been associated with obesity in various ways, mainly through changes in GH-binding proteins, insulin and ghrelin levels. The balneal treat-ment with Techirghiol Romanian sapropelic mud has an important impact on the endo-crine system, primarily through the action on the hypothalamic-pituitary-adrenal axis. We investigated the secretory changes of the IGF-1 hormone that appeared after the balne-al treatment. It was a total number of 52 patients, divided into two groups: 1 group who performed the treatment with Techirghiol sapropelic mud at thermoneutrality temperatures - warm mud baths, and the second group who followed treatment with the balneal therapeutic factor in a thermal contrast regime - cold mud baths. We studied whether there are correlations between the body mass index (BMI) and the secretion of this hormone. We also determined the serum levels of blood glucose at admission and discharge. In the cold mud baths- thermal contrast therapy, can be observed a statistically significant increase in IGF-1 values during the balneal treatment (p = 0.044 < α = 0.05). Comparative-ly, in the warm mud baths, the increase in serum IGF-1 reached values close to statistical significance at the end of the treatment (p = 0.067 > α = 0.05). There were no statistically significant correlations between BMI and IGF-1 hormone secretion at admission and at discharge. The results showed a statistically significant decrease in blood glucose values determined at admission and discharge in the group that performed warm mud baths. The balneal treatment with sapropelic mud of Techirghiol lake, from Romania, through the impact on the endocrine system, on the hypothalamic-pituitary-adrenal axis, can be registered as a treatment with a natural therapeutic factor with an impact on obesity, therapy carried out within the parameters of metabolic safety, and the conduct of future re-search in this direction it will help develop new concepts and approaches to obesity. [ABSTRACT FROM AUTHOR]

Medical research has developed remarkably in recent years, including the involvement of the glutathione peroxidase (GPx) family of enzymes in the course of human aging, with numerous clinical studies published in the literature reporting this particular fact. Thus, mud therapy and its effect on biological aging have been represented in papers that have been published to date. Papers published in the literature analyzing GPx vari-ation during sapropelic mud therapy suggest the beneficial effect of this family of en-zymes in diseases with an important inflammatory component, mainly monitored in patients with osteoarthritis. This study investigated the effects of sapropelic mud treatment on GPx values in patients receiving treatment with sapropelic mud at the Balneal and Rehabilitation Sanatorium of Techirghiol, Romania. We included 52 patients, split into two groups, who received treatment with cold mud baths and warm mud baths. Values close to statistical significance were found in patients who received treatment with cold mud baths in terms of mean GPx values at the four-time points studied. Fur-ther studies evaluating GPx in patients receiving sapropelic mud treatment are needed. [ABSTRACT FROM AUTHOR]

The beneficial effects of balneotherapy have been proven by numerous clinical studies on locomotor disorders. To date, there is only scant data on changes in the microbiome system of the skin during balneotherapy. The aim of this study was to compare the effects of thermal water and tap water on the skin's microbiome in healthy volunteers. 30 healthy female volunteers participated in the study. The experimental group (of 15 women) spent 30-min 10 times, in Gabriella Spring's thermal baths (i.e., mineral water containing sodium hydrogen carbonate).The controlled group (15 women) had the same, but in tap water. The results of this study have proven that there is a difference in the influencing effects of tap water and medicinal water on the microbiome of the skin. After bathing in the thermal water of Lakitelek, Deinococcus increased significantly at the genus level, and the tendency for Rothia mucilaginosa bacteria also increased. At the species level, Rothia mucilaginosa increased significantly, while Paracoccus aminovorans and the tendency for Paracoccus marcusii decreased. When the values of the two trial groups after bathing at the genus level were compared, Rothia bacteria increased significantly, while Haemophilus tended to increase, Pseudomonas tended to decrease, Neisseria tended to increase significantly, and Flavobacterium tended to decrease. At the species level, Geobacillus vulcani decreased significantly, and the tendency for Burkholderia gladioli decreased. The growth of Rothia mucilaginosa and the decrease in the tendency of Paracoccus, Pseudomonas, Flavobacteroium, and Burkholderia gladioli confirm the beneficial effect of balneotherapy. In this study, trends are represented by the uncorrected p value. The main result was that the thermal water changed certain bacteria of the skin, both on the genus and species levels, but there were no significant changes in the tap water used, either at the genus or species level. We first compared the worlds of thermal water and tap water's microbiome systems. The thermal water decreased the number of certain inflammatory infectious agents and could enhance some of their positive effects, which have been proven at the molecular level. Our results can provide an important clue in the treatment of certain skin diseases. The research of the skin microbiome during balneotherapy can be one of the most intriguing and exciting topics of the future and can bring us closer to understanding the mechanism of action of balneotherapy. [ABSTRACT FROM AUTHOR]

In our minimized follow-up trial with 137 participants with chronic low back pain, one group of participants received regular outpatient care, and the other group received balneotherapy by immersion in 42℃ thermal-mineral water in addition to regular outpatient care on 15 occasions for 3 weeks. Pain on movement and at rest on the 0–100 mm visual analogue scale (VAS), Oswestry index, the number of participants evaluating the symptoms clinically acceptable (Patient Acceptable Symptom State, PASS) and the EuroQol-5D-5L (EQ-5D-5L) quality of life questionnaire were assessed at basal time (at week 0) and after balneotherapy (at weeks 3 and 12). The VAS pain scores, the Oswestry index, the EQ-5D-5L index and the EQ-VAS significantly improved in the balneotherapy group after treatment at week 3 (p < 0.001) and week 12 (p < 0.001) compared to baseline, with a significant between group difference at week 3 (p < 0.001) and week 12 (p < 0.001). The pain VAS score on movement was 66.82 ± 11.48, 26.69 ± 21.49, and 20.09 ± 23.29 in the balneotherapy group, and 63.67 ± 14.77, 67.35 ± 15.44, and 70.23 ± 18.26 in the control group at the consecutive visits. The PASS increased in both groups at week 3 and week 12 compared to the baseline, with a significant between-group difference at week 3 and week 12 for the balneotherapy group. Our results suggest the therapeutic efficacy of immersion in 42℃ thermal mineral water on chronic low back pain. ClinicalTrials.gov Identifier: NCT05342051. [ABSTRACT FROM AUTHOR]

To preliminarily explore a nondrug intervention method and evaluate its effects (sleep quality, physical examination indicators, and general physical symptoms) on people with sleep disorders. The intervention was based on regular balneotherapy, coupled with targeted health education, appropriate exercise, diet management, and other sleep-promoting measures. It was the combined effects that we evaluated. We recruited 31 volunteers with sleep disorders to receive a 7-day sleep-promoting experience in Tianxing International Hot Spring City, Nanchuan District, Chongqing. The intervention adopted a plan that combined balneotherapy with various sleep-promoting measures. Persisting baths in hot springs 1–2 times per day targeted health lectures about 1 h every morning, appropriate exercise every day (sleep-aid yoga, forest hiking, morning exercises, etc.), and diet management (the principle is to control oil, salt, and sugar, diversify food, keep meat and vegetable balanced, and control total calories. The dinner is light and easy to digest). During the intervention period, all participants followed the above intervention plan, and they lived in the spa resort to accept unified arrangement. This study adopted a self-contrast method by comparing the changes in sleep quality, physical examination indicators, and general physical symptoms before and after the intervention through physical examinations and questionnaire surveys. After the intervention, the subjects' total score of Insomnia Severity Index (ISI) decreased significantly (P = 0.006), and all seven dimensions showed a decrease, four of which included early morning awakening, sleep dissatisfaction, noticeability of sleep problems by others, and distress caused by sleep problems decreased significantly (all P < 0.05). The subjects' body mass index, waist circumference, fasting blood glucose, and triglycerides decreased significantly (all P < 0.05), and systolic blood pressure increased significantly (P = 0.006). Total cholesterol, high-density lipoprotein, low-density lipoprotein, and diastolic blood pressure did not change significantly (all P > 0.05). To some extent, all general health problems were improved than before the intervention (the improvement rate was up to 70% or more). The non-pharmacological intervention of balneotherapy combined with various sleep-promoting measures showed positive effects on sleep quality, general physical symptoms, and some physical examination indicators of sleep disorders. This comprehensive intervention may be an effective way to improve people's health with sleep disorders. [ABSTRACT FROM AUTHOR]

Background/Aim: This study aimed to research the effects of Harkány healing water on oxidative stress. The study was performed in a randomized, placebo-controlled, double-blind setup. Patients and Methods: Twenty patients with psoriasis who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and Malondialdehyde (MDA) - a marker of oxidative stress - were determined, on admission and before discharge. Patients were treated with dithranol. Results: The mean PASI score - determined on admission and before discharge - decreased significantly after the 3-week-long rehabilitation 8.17 vs. 3.51 (p<0.001). The baseline MDA value of patients with psoriasis was significantly higher compared to controls (3.0±3.5 vs. 8.4±7.4) (p=0.018). MDA levels of patients receiving placebo water increased significantly compared to MDA levels of patients receiving healing water (p=0.049). Conclusion: The effectiveness of dithranol resides in the formation of reactive oxygen species. No increased oxidative stress was found in the patients treated with healing water, thus healing water seems to be protective against oxidative stress. However, further research is needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

The importance of spa therapy is growing worldwide, with care practitioners paying more attention to how this intervention can alleviate various health issues. Multiple studies have been performed and reported on the efficiency of balneotherapy, creating a need to understand the quality of the information in the existing studies and how they can inform practitioners in promoting evidence-based practice. The SPAC assessment tool describes and assesses the quality of reports of interventional trials in balneotherapy. The present study had two goals. The first goal was the translation and cross-cultural adaptation of the SPAC assessment tool in Greek language following an internationally accepted methodology. The second goal was to assess the reliability of the tool employing test–retest and interrater reliability studies in a sample of 15 relative RCT papers and to assess the criterion validity of the Greek version by comparing its results with the original English version when assessing the same 15 papers. The results revealed that the SPAC checklist was translated and adapted in Greek without difficulties between the translators. Reliability of the SPAC was found excellent in both test–retest (ICC =.98) and interrater (ICC =.95) indexes. The criterion validity assessment for Greek version of SPAC checklist was also almost perfect (ICC =.98). In the present study, the Greek version of the SPAC checklist was found to be a comprehensible, reliable, and valid tool to assess the quality of interventional trial reports on the efficacy of spa therapy for cure and health enhancement. [ABSTRACT FROM AUTHOR]

Clinical trials have demonstrated traditional spa therapy effects in musculoskeletal disorders (MSDs). This is the first observational study in Italy aimed at evaluating in real-life the short-time effects of spa rehabilitation on pain, mood and quality of life (QoL) among degenerative or post-surgery MSDs patients. Through the involvement of six Italian spa facilities, 160 patients were enrolled; data from 123 patients were finally analysed. Seventy-nine patients (64.3%) accessed the spa for degenerative MSDs, while 44 (35.8%) had a post-surgical condition. All the patients included in the study underwent 12 sessions of water-based exercise (joint exercises, muscle strengthening, gait training, proprioceptive and balance techniques) conducted in thermal or in warm water pools, six sessions per week, for a period of 2 weeks from March 2019 up to October 2019. A group of 45 patients (36.6%) also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for 2 weeks. Evaluation before and after the treatment included the Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12) and the EuroQol-5D (EQ-5D). The analysis of the scores reported in the questionnaires after the treatment showed a significant improvement in all the scores evaluated. Comparison between patients that performed water-based exercise protocols alone (group A) and patients that in addition to water exercise performed traditional thermal interventions (group B) showed no statistically significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D variations; only NRSa value reduction was lower in group B. Sulphate water was found to be associated with a lower reduction of all the scores considered, when compared to the other water types. Patients with degenerative or post-surgery MSDs showed favourable effects on pain, mood and QoL after water exercise training alone or in combination with traditional thermal therapy. Our research provides the first proof that spa rehabilitation can be in real-life conditions an appropriate alternative strategy for post-orthopaedic surgical outcomes recovery. In the future, these results will need to be further investigated. [ABSTRACT FROM AUTHOR]

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After the resolution of the acute SARS-COV-2 infection, an important percentage of patients do not fully recover and continue to present several symptoms. Nevertheless, there is a lack of data in the literature on the effects of rehabilitation programs on medium- and long-term long COVID symptoms. Therefore, the aim of this study was to evaluate the long-term outcomes after rehabilitation programs in long COVID syndrome patients. A prospective cohort study was conducted from August 2021 to March 2022, involving 113 patients with long COVID syndrome. The patients in the experimental group (EG, n=25) received a tailored and multidisciplinary rehabilitative program, involving aquatic exercises, respiratory and motor exercises, social integration training and neuropsychologic sessions, LASER therapy and magnetotherapy. Patients in the other three comparison groups received eastern medicine techniques (CG1), balneotherapy and physiotherapy (group CG2), self-training and home-based physical exercise (CG3). Once the several rehabilitation protocols had been performed, a structured telephone contact was made with the patients after 6 months ± 7 days from the end of the rehabilitation treatment, in order to record the frequency of hospital ad-missions due to exacerbation of post-exacerbation syndrome, death or disability, and the need for other types of care or drugs. The patients in the comparison groups were more likely to request therapeutic care for emerging long COVID symptoms (χ2=6.635, p=0.001; χ2=13.463, p=0.001; χ2=10.949, p=0.001, respectively), as well as more likely to be hospitalized (χ2=5.357, p=0.021; χ2=0.125, p=0.724; χ2=0.856, p=0.355, respectively) when compared to the patients of the EG. The relative risk (RR) of hospital admissions in the observed cohort was 0.143 ±1,031 (СI: 0.019; 1.078); 0.580±1,194 (CI: 0.056; 6.022); 0,340±1,087 (CI: 0.040; 2.860). The RR of hospital admissions for patients with long COVID syndrome was reduced by 85.7%; 42.0% and 66.0%, respectively, when the experimental rehabilitation technique was employed. In conclusion, a tailored and multidisciplinary rehabilitative program seems to have a better preventive effect not only in the short term, but also over the next 6 months, avoiding the new onset of disabilities and the use of medicines and specialist advice, than other rehabilitative programs. Future studies will need to further investigate these aspects to identify the best rehabilitation therapy, also in terms of cost-effectiveness, for these patients.

Lymphedema is a chronic and progressive disorder of the lymphatic system that impairs the return of lymphatic fluid. Breast cancer treatment can cause breast cancer-related lymphedema (BCRL), with axillary lymph node dissection and regional lymph node radiation being established risk factors. BCRL can cause severe morbidity, disability, and reduced quality of life. Early detection and treatment are essential to prevent the disease from progressing and causing complications. According to the International Society of Lymphology, complex decongestive therapy (CDT) is the most effective conservative treatment for lymphedema. Aquatic exercise is a safe and effective form of therapeutic CDT exercise that can improve joint range of motion, reduce pain, and positively impact limb volume. Additionally, health resort medicine and thermal mineral-rich waters may provide synergistic benefits for therapeutic exercise programs. Therefore, we believe that consideration should be given to whether the spa setting could represent a viable alternative for the rehabilitation of BCRL patients. [ABSTRACT FROM AUTHOR]

Introduction: To analyze the influence of balneotherapy applied under real clinical practice conditions on the quality of life and functionality of patients diagnosed with rheumatoid arthritis. Methods: Prospective, observational study conducted with a group of patients under real clinical practice conditions, with a 6-month follow-up. The participants were beneficiaries of the social thermalism programme of the Spanish Ministry of Health, Consumption and Social Well-being, aged 60-80 years and diagnosed with rheumatoid arthritis, who were treated at Fitero's Spa (Spain). The study excluded those individuals who had undergone another balneotherapeutic treatment in the previous 6 months, and those who had scheduled one in the following 6 months. Ten treatment sessions were applied. Each session included a bath and one or two additional techniques, which varied in each case, depending on the characteristics and preferences of the patient. The variables were gathered before initiating the treatment, and at 1, 3 and 6-months posttreatment. Results: The study included 49 individuals with an average age of 71.0 (SD 4.79) years. The variable "current health state" of EuroQol 5D-5L increased by 6.73 [-13.44 to -2.53] points and 6.26 [-12.07 to -0.46] in the first and third month, respectively. Pain was the dimension in which the largest number of participants reduced the level of their response in all the follow-up periods. Functionality showed an improvement of 0.196 [0.060 to 0.332] in the third month. Conclusions: The beneficial effects of balneotherapy on the health-related quality of life and functionality in individuals with rheumatoid arthritis can be positive. [ABSTRACT FROM AUTHOR]