Improvement of autonomic nervous activity by Waon therapy in patients with chronic heart failure

Mild Water-Filtered Infrared-A Whole-Body Hyperthermia Reduces Pain in Patients with Fibromyalgia Syndrome-A Randomized Sham-Controlled Trial

The challenging treatment situation of patients with fibromyalgia syndrome (FMS) requires additional therapy options. The effects of water-filtered infrared-A whole-body hyperthermia (WBH) versus sham hyperthermia on pain intensity were investigated in an outpatient setting within a two-armed randomized sham-controlled trial. n = 41 participants aged between 18 and 70 years with a medically confirmed diagnosis of FMS were randomized to WBH (intervention; n = 21) or sham hyperthermia (control; n = 20). Six treatments with mild water-filtered infrared-A WBH over a period of three weeks with at least one day in between treatments were applied. On average, the maximum temperature was 38.7 °C for a duration of approximately 15 min. The control group received exactly the same treatment except that an insulating foil between the patient and the hyperthermia device blocked most of the radiation. Primary outcome was pain intensity measured by the Brief Pain Inventory at week 4. Secondary outcomes included blood cytokine levels and FMS-related core symptoms and quality of life. Pain intensity at week 4 was significantly different between the groups in favor of WBH (p = 0.015). A statistically significant pain reduction in favor of WBH was also found at week 30 (p = 0.002). Mild water-filtered infrared-A WBH effectively reduced pain intensity at the end of treatment and follow-up.

Coefficient of R-R interval variations under deep breathing load in patients with wild-type transthyretin amyloid cardiomyopathy: A case-control study

Background and Aims

An autonomic nervous disorder is an important characteristic of cardiac amyloidosis; however, the prevalence of autonomic dysfunction in wild-type transthyretin amyloidosis (ATTRwt) has not been established. Analysis of the R-R interval coefficient of variation (CVR-R) is a noninvasive method to measure parasympathetic activity. We aimed to assess autonomic dysfunction of ATTRwt and determine the utility of CVR-R for the detection of ATTRwt in other cardiac diseases.

Methods

This is a single-center, retrospective, case-control study. Fifty patients with heart failure (HF) were studied. The etiologies of HF were as follows: ATTRwt, n = 10; previous myocardial infarction (MI), n = 20; and left ventricular hypertrophy (LVH) due to other disease processes (e.g., aortic stenosis), n = 20. We measured the CVR-R at rest (CVR-Rrest), CVR-R with deep breaths (CVR-Rbreath), and the change rate (CVR-Rdiff rate). The relative change formula is as follows: CVR-Rdiff rate = (CVR-Rbreath - CVR-Rrest)/CVR-Rrest×  100 (%).

Results

There was no difference in the CVR-Rrest levels among the three groups. The CVR-Rdiff rate levels in the ATTRwt group were significantly lower (ATTRwt: -8.77 [-43.8 to 10.9]; LVH: 67.4 [38.7 to 89.4]; MI: 83.7 [60.4 to 142.9]). Based on the receiver operative characteristic curve analysis to identify ATTRwt in HF, the best cut-off value for the CVR-Rdiff rate was 19.7 (area under the curve: 0.848).

Conclusion

Our data suggested autonomic dysfunction in patients with ATTRwt. Measurement of the CVR-R in HF patients may be a convenient support tool for the detection of ATTRwt.

Crossover trial of the effects of a far-infrared heater that heats the feet with ceramic balls on autonomic nervous activity and mood states

INTRODUCTION

The accumulation of fatigue and stress creates problems, including reductions in quality of life and productivity.

OBJECTIVES

To investigate the effects of a far-infrared heater that heats the feet with ceramic balls on autonomic nervous activity and mood states.

METHODS

This study was performed as a crossover trial. Participants comprised 20 women. On different days, each participant underwent 15 min of foot warming with the far-infrared heater (far-infrared group) or remained seated for 15 min (control group). Autonomic nervous activity (low-frequency component/high-frequency component, high-frequency) and mood states scales (Profile of Mood States Second Edition and Two-Dimensional Mood Scale for Self-monitoring and Self-regulation of Momentary Mood States) during the study intervention were measured and compared between groups.

RESULTS

Low-frequency/high-frequency was significantly higher in the control group 10 min after the start of intervention than at baseline (P = .033). Low-frequency/high-frequency was significantly lower in the far-infrared group than in the control group at 5 min (P = .027), 10 min (P = .011), and 15 min (P = .015). High-frequency was significantly higher in the far-infrared group at 5 min (P = .008), 10 min (P = .004), and 15 min (P = .015) than at baseline. High-frequency 5 min after the start of intervention was significantly higher in the far-infrared group than in the control group (P = .033). POMS2 scores improved significantly more in the far-infrared group than in the control group, including in fatigue-inertia (P = .019), tension-anxiety (P = .025), and total mood disturbance (P = .019). Finally, the far-infrared group showed greater improvements in Two-Dimensional Mood Scale-Short Term scores such as stability (P = .002) and pleasure (P = .013).

CONCLUSION

Using the far-infrared heater to heat the feet with ceramic balls stabilized and improved mood, reduced Fatigue-Inertia and Tension-Anxiety, and alleviated total mood disturbance. Parasympathetic nervous system activation was observed from 5 min after the start of heating, suggesting that short-duration heat stimulation of the feet is effective.

Comparison of Blood Pressure and Pulse Adaptations Between Younger and Older Patients During Balneotherapy With Physiotherapy

Objective

This study aimed to investigate the blood pressure and pulse adaptation characteristics between younger and older patients with musculoskeletal disorders during acute and recovery responses at the first and 10th sessions of balneotherapy added to physiotherapy.

Methods

Forty-six participants (n = 22, between 18 and 35 years of age as young adults; n = 24, more than 65 years of age as older adults) with musculoskeletal disorders admitted to physiotherapy therapy sessions with balneotherapy were enrolled. The participants' immersion time was 20 minutes each during 10 sessions occurring over the course of 2 weeks. Blood pressure and pulse were measured at the baseline and the 5th minute as acute responses, and at the baseline and the 30th minute as recovery responses during the first and 10th sessions.

Results

First, the group and session effect was examined. There was no significance in this part. Then, session main effect and group main effect were examined. The group main effect was significant, that is, a difference was found between groups independent of the session in terms of only pulse values (P < .001). There was no difference in sessions. The acute and recovery responses of the pulse at the first and 10th sessions of balneotherapy showed higher alterations in the young people compared with the older people (P < .008).

Conclusion

Greater pulse alterations at the acute and recovery phases of the first and 10th sessions were observed in young adults.

Decreased Frequency of Mental Workload-Induced Subjective Hot Flashes Through Gum Massage: An Open-Label, Self-Controlled Crossover Trial

Objective:

Hot flashes, a symptom of menopause, can decrease women's quality of life. Sympathetic nervous system activation has been identified as an important factor in the occurrence of hot flashes. Given that somatosensory stimulation of the oral cavity can affect autonomic nervous activity, we aimed to investigate the possibility that somatosensory stimulation of the gums (i.e., gum massage) could improve hot flashes.

Materials and Methods:

Nineteen women experiencing at least one hot flash per day were instructed to perform a gum massage on themselves before undertaking mental workload, using arithmetic task, and the frequency of hot flashes experienced during this task was measured. Changes in autonomic nervous activity were assessed based on heart rate variability.

Results:

Massage conditions promoted a significantly lower arithmetic task-induced hot flash frequency compared with nonmassage conditions (p < 0.05). During gum massage, the ratio between low and high frequency (LF/HF) values decreased significantly under massage conditions compared with nonmassage conditions (p < 0.01). During the arithmetic task, the gum massage-induced reduction in LF/HF, which changed from baseline, was significantly correlated with the gum massage-induced reduction in hot flash frequency.

Conclusions:

The results of this study indicate that gum massage can reduce the subjective frequency of hot flashes over a certain period under mental workload. Our study also indicates that gum massage can potentially decrease sympathetic nerve activity, which is known to be involved in the occurrence of hot flashes.

Clinical Trial Registration number 328 (the institutional review board of Lion Corporation).

Infrared sauna as exercise-mimetic? Physiological responses to infrared sauna vs exercise in healthy women: A randomized controlled crossover trial

BACKGROUND

Passive heat therapies have been reported to have similar effects on the cardiovascular system as exercise. Studies supporting these findings in healthy populations have predominantly been done with men using warm water immersions or traditional saunas, rather than newer infrared-based saunas.

OBJECTIVE

To explore short-term thermal and cardiovascular responses in women using an infrared sauna as compared to moderate-intensity exercise.

STUDY DESIGN

Randomized controlled crossover trial with balanced allocations.

SETTING

Brisbane, Australia (August 2019 - March 2020) PARTICIPANTS: Ten healthy women (36 ± 9 years) INTERVENTIONS: 45 min of resting, infrared sauna or indoor bicycling PRIMARY OUTCOME MEASURES: tympanic/skin temperatures; respiratory rate; blood pressure; arterial stiffness; heart rate variability RESULTS: Tympanic temperatures were elevated during infrared sauna as compared to both control (mean diff = +1.05 ^oC ± SEM 0.12 ^oC, 95% C.I.: 0.73 - 1.36, p < 0.0005) and exercise (mean diff = +0.79 ^oC ± SEM 0.12 ^oC, 95% C.I.: 0.49 - 1.08, p < 0.0005). Respiratory rates were higher during exercise as compared to both control (mean diff = +7.66 ± SEM 1.37, 95% C.I.: 4.09 - 11.23, p < 0.0005) and infrared sauna (mean diff = +6.66 ± SEM 1.33, 95% C.I.: 3.20 - 10.11, p < 0.0005). No significant differences in non-invasive measures of blood pressure, arterial stiffness or heart rate variability were detected between any of the interventions.

CONCLUSIONS

These findings suggest the physiological effects of infrared sauna bathing are underpinned by thermoregulatory-induced responses, more so than exercise-mimetic cardiorespiratory or cardiovascular activations.

Blood pressure-lowering effect of repeated Waon therapy in non-smokers with hypertension

Waon therapy (WT) has been used as a thermal therapy in chronic heart failure patients. However, its effect in patients with hypertension is unclear. This study aimed to reveal the hypotensive effect of WT in patients with hypertension. WT was performed on 31 patients with hypertension (63.9 ± 11.9 years, male: 17) on standard hypertension treatment focusing on lifestyle modification and medication. Systolic and diastolic blood pressures were measured before and after WT using an upper arm automated sphygmomanometer. We investigated the effect of single and repeated (1 time/d, >5 times) WT sessions on blood pressure and further compared its effect between current smoking (n = 11, 55.4 ± 6.4 years, 8.5 ± 2.4 times) and non-smoking (n = 11, 66.9 ± 8.5 years, 12.2 ± 5.9 times) groups. A total of 370 sessions of WT were conducted. Systolic and diastolic blood pressures significantly decreased after a single WT session (systolic blood pressure: 118.5 ± 10.1 to 115.1 ± 9.0 mm Hg, P < .001; diastolic blood pressure: 70.5 ± 6.4 to 65.9 ± 5.3 mm Hg, P < .001). The blood pressure decrease following repeated WT was not significant when all participants were considered (systolic blood pressure: 122.3 ± 15.2 to 116.9 ± 19.6 mm Hg; diastolic blood pressure: 73.8 ± 16.7 to 68.2 ± 13.2 mm Hg); however, it was significant in the non-smoking group (systolic blood pressure: 124.2 ± 11.3 to 108.8 ± 13.4 mm Hg, P < .001; diastolic blood pressure: 73.6 ± 4.9 to 62.1 ± 7.6 mm Hg, P < .001). Repeated WT (at least 5 sessions) decreased blood pressure in patients with hypertension, especially in non-smokers. WT is a simple method to reduce blood pressure in non-smoking patients with hypertension.

The effect of heat therapy on blood pressure and peripheral vascular function: A systematic review and meta-analysis

NEW FINDINGS

What is the topic of this review? We have conducted a systematic review and meta-analysis on the current evidence for the effect of heat therapy on blood pressure and vascular function. What advances does it highlight? We found that heat therapy reduced mean arterial, systolic and diastolic blood pressure. We also observed that heat therapy improved vascular function, as assessed via brachial artery flow-mediated dilatation. Our results suggest that heat therapy is a promising therapeutic tool that should be optimized further, via mode and dose, for the prevention and treatment of cardiovascular disease risk factors.

ABSTRACT

Lifelong sauna exposure is associated with reduced cardiovascular disease risk. Recent studies have investigated the effect of heat therapy on markers of cardiovascular health. We aimed to conduct a systematic review with meta-analysis to determine the effects of heat therapy on blood pressure and indices of vascular function in healthy and clinical populations. Four databases were searched up to September 2020 for studies investigating heat therapy on outcomes including blood pressure and vascular function. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess the certainty of evidence. A total of 4522 titles were screened, and 15 studies were included. Healthy and clinical populations were included. Heat exposure was for 30-90 min, over 10-36 sessions. Compared with control conditions, heat therapy reduced mean arterial pressure [n = 4 studies; mean difference (MD): -5.86 mmHg, 95% confidence interval (CI): -8.63, -3.10; P < 0.0001], systolic blood pressure (n = 10; MD: -3.94 mmHg, 95% CI: -7.22, -0.67; P = 0.02) and diastolic blood pressure (n = 9; MD: -3.88 mmHg, 95% CI: -6.13, -1.63; P = 0.0007) and improved flow-mediated dilatation (n = 5; MD: 1.95%, 95% CI: 0.14, 3.76; P = 0.03). Resting heart rate was unchanged (n = 10; MD: -1.25 beats/min; 95% CI: -3.20, 0.70; P = 0.21). Early evidence also suggests benefits for arterial stiffness and cutaneous microvascular function. The certainty of evidence was moderate for the effect of heat therapy on systolic and diastolic blood pressure and heart rate and low for the effect of heat therapy on mean arterial pressure and flow-mediated dilatation. Heat therapy is an effective therapeutic tool to reduce blood pressure and improve macrovascular function. Future research should aim to optimize heat therapy, including the mode and dose, for the prevention and management of cardiovascular disease.

Heat therapy: mechanistic underpinnings and applications to cardiovascular health

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and novel therapies are drastically needed to prevent or delay the onset of CVD to reduce the societal and healthcare burdens associated with these chronic diseases. One such therapy is "heat therapy," or chronic, repeated use of hot baths or saunas. Although using heat exposure to improve health is not a new concept, it has received renewed attention in recent years as a growing number of studies have demonstrated robust and widespread beneficial effects of heat therapy on cardiovascular health. Here, we review the existing literature, with particular focus on the molecular mechanisms that underscore the cardiovascular benefits of this practice.

No Impact of Stochastic Galvanic Vestibular Stimulation on Arterial Pressure and Heart Rate Variability in the Elderly Population

Objective

Noisy galvanic vestibular stimulation (nGVS) is often used to improve postural stability in disorders, such as neurorehabilitation montage. For the safe use of nGVS, we investigated whether arterial pressure (AP) and heart rate vary during static supine and slow whole-body tilt with random nGVS (0.4 mA, 0.1–640 Hz, gaussian distribution) in a healthy elderly population.

Methods

This study was conducted with a double-blind, sham-controlled, cross-over design. Seventeen healthy older adults were recruited. They were asked to maintain a static supine position on a bed for 10 min, and the bed was tilted up (TU) to 70 degrees within 30 s. After maintaining this position for 3 min, the bed was passively tilted down (TD) within 30 s. Real-nGVS or sham-nGVS was applied from 4 to 15 min. The time course of mean arterial pressure (MAP) and RR interval variability (RRIV) were analyzed to estimate the autonomic nervous activity.

Result

nGVS and/or time, including pre-/post-event (nGVS-start, TU, and TD), had no impact on MAP and RRIV-related parameters. Further, there was no evidence supporting the argument that nGVS induces pain, vertigo/dizziness, and uncomfortable feeling.

Conclusion

nGVS may not affect the AP and RRIV during static position and whole-body tilting or cause pain, vertigo/dizziness, and discomfort in the elderly.

Heart Rate Variability in Children With Autism Spectrum Disorder and Associations With Medication and Symptom Severity

Decreased heart rate variability (HRV) is considered a common marker of autonomic dysfunction that contributes to poor health outcomes. While some studies have suggested that children with autism spectrum disorder (ASD) show reduced HRV, research is yet to consider whether this may be associated with medication use and symptom severity. This study examined the relationship between resting state HRV, medication use and symptom severity in children diagnosed with ASD. Children with ASD (N = 86), aged between 3 and 12 years (M = 8.09), were compared to 44 neurotypical children of similar age (M = 7.15). Laboratory assessment of HRV involved 5 min of non-invasive baseline electrocardiogram assessments while participants viewed an age-appropriate non-verbal animated video. Time-domain and frequency-domain HRV measures were analyzed. ASD symptom severity was assessed using the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Social Responsiveness Scale (SRS-2). Results indicated that children with ASD exhibited reduced resting HRV relative to neurotypical children. Subsequent analyses within the ASD group suggested that this group difference was greater in children who were taking psychotropic medication (N = 36). Our data also provides tentative evidence of a relationship between HRV and social impairment symptoms in children with ASD, with more severe repetitive behaviors (as measured by the ADOS-2) associated with decreased resting HRV. Overall, these findings suggest that HRV may be atypical in children with ASD and suggest the importance of exploring HRV as a risk factor for cardiovascular health in this group. LAY SUMMARY: Cardiac activity, such as heart rate variability (HRV), can provide insight into the autonomic nervous system. This study reports on the association between resting-state HRV and autonomic nervous system activity in young children with autism spectrum disorder (ASD) compared to neurotypical children. These results may help us understand what underlies autonomic nervous system dysfunction and the potential pathophysiological mechanisms leading to increased cardiovascular risk in ASD.

Can heat therapy help patients with heart failure?

To review and analyze the clinical outcomes of thermal therapy (≤1.4°C increase in core body temperature) in patients with heart failure (HF). A systematic review and meta-analysis regarding the effects of thermal therapy on HF was done by searching PubMed, Ovid Medline, Ovid Embase, Scopus, and internal databases up to date (2019). Improvement in the New York Heart Association (NYHA) class: Ten studies with 310 patients showed significant improvement in NYHA class. Only 7 among 40 patients remained in Class IV and 99 patients in Class III from 155 patients. Increased patients in lower classes indicate that more patients showed improvement. Sixteen studies on 506 patients showed an overall improvement of 4.4% of left ventricular ejection fraction (LVEF). Four studies reported improved endothelial dysfunction by 1.7% increase in flow-mediated dilation (FMD) on 130 patients. Reduction in blood pressure: Thermal therapy reduced both systolic blood pressure (SBP) and diastolic blood pressure by 3.1% and 5.31%, respectively, in 431 patients of 15 studies. Decrease in cardiothoracic ratio (CTR): Eight studies reported an average of 5.55% reduction of CTR in a total of 347 patients. Improvement in oxidative stress markers: Plasma brain natriuretic peptide (BNP) levels significantly decreased (mean difference of 14.8 pg/dL) in 303 patients of 9 studies. Improvement of quality of life: Among 65 patients, thermal therapy reduced cardiac death and rehospitalization by 31.3%. A slight increase in core body temperature is a promising, noninvasive, effective, and complementary therapy for patients with HF. Further clinical studies are recommended.

Far-infrared Ray-mediated Antioxidant Potentials are Important for Attenuating Psychotoxic Disorders

Far-infrared ray (FIR) is an electromagnetic wave that produces various health benefits against pathophysiological conditions, such as diabetes mellitus, renocardiovascular disorders, stress, and depression etc. However, the therapeutic ap-plication on the FIR-mediated protective potentials remains to be further extended. To achieve better understanding on FIR-mediated therapeutic potentials, we summarized additional findings in the present study that exposure to FIR ameliorates stressful condition, memory impairments, drug dependence, and mitochondrial dysfunction in the central nervous system. In this review, we underlined that FIR requires modulations of janus kinase 2 / signal transducer and activator of transcription 3 (JAK2/STAT3), nuclear factor E2-related factor 2 (Nrf-2), muscarinic M1 acetylcholine receptor (M1 mAChR), dopamine D1 receptor, protein kinase C δ gene, and glutathione peroxidase-1 gene for exerting the protective potentials in response to neuropsychotoxic conditions

The Effect of Warm Footbath on the Quality of Sleep on Patients with Acute Coronary Syndrome in Cardiac Care Unit

Introduction: This study aimed to determine the effect of warm footbath before bedtime on the quality of sleep on patients with acute Coronary Syndrome in Cardiac Care Unit.

Methods: This study was conducted on 120 patients admitted to CCU at Mazandaran Heart Center and randomly divided into two groups of intervention and control. In the intervention group, warm footbath was performed after the second night in hospital before bed time by 41 C water for 20 minutes for three consecutive nights; in contrast, the control group did not receive anything of this sort. The next day, St Mary's Hospital Sleep Questionnaire was completed to evaluate sleep quality. Then, the obtained data were analyzed using SPSS software and Friedman, Wilcoxon exact statistical tests.

Results: The quality of sleep in the first night of hospitalization was different from the third night after the intervention in both groups and the improvement process of sleep quality was observed in both groups. Most patients had moderate impairments (23-36), which had not changed during the intervention. In intervention groups, 8 patients had severe sleep disorders (greater than 37), which declined to 1 after three nights of intervention. While, in the control group this number fell from 10 patients with severe sleep disorders to 5. Warm footbath had a great positive impact on patients suffering from severe sleep disorders (P<0.05).

Conclusion: Although warm footbath did not improve the quality of sleep in all patients, it reduced the number of patients who had severe sleep disturbances.

Recovery from sauna bathing favorably modulates cardiac autonomic nervous system

OBJECTIVE

Sauna bathing is becoming a common activity in many countries and it has been linked to favorable health outcomes. However, there is limited data on the heart rate (HR) and heart rate variability (HRV) responses to an acute sauna exposure.

DESIGN

We conducted a single-group, longitudinal study utilizing a pre-post design to examine acute effects of sauna bathing on the autonomic nervous system as reflected by HRV. A total of 93 participants (mean [SD] age: 52.0 [8.8] years, 53.8% males) with cardiovascular risk factors were exposed to a single sauna session (duration: 30 min; temperature: 73 °C; humidity: 10-20%) and data on HRV variables were collected before, during and after sauna.

RESULTS

Time and frequency-domain HRV variables were significantly modified (p < 0.001) by the single sauna session, with most of HRV variables tending to return near to baseline values after 30 min recovery. Resting HR was lower at the end of recovery (68/min) compared to pre-sauna (77/min). A sauna session transiently diminished the vagal component, whereas the cooling down period after sauna decreased low frequency power (p < 0.001) and increased high frequency power in HRV (p < 0.001), favorably modulating the autonomic nervous system balance.

CONCLUSIONS

This study demonstrates that a session of sauna bathing induces an increase in HR. During the cooling down period from sauna bathing, HRV increased which indicates the dominant role of parasympathetic activity and decreased sympathetic activity of cardiac autonomic nervous system. Future randomized controlled studies are needed to show if HR and HRV changes underpins the long-term cardiovascular effects induced by regular sauna bathing.

Effects of sauna bath on heart failure: A systematic review and meta-analysis

BACKGROUND

Sauna bath has potential as a lifestyle treatment modality for heart failure (HF). It is important to analyze the current evidence to help suggest paths of future study and potential for clinical application.

HYPOTHESIS

Sauna bath has a positive effect on HF patients.

METHODS

PubMed, Cochrane Library, and CINAHL databases were searched to identify randomized and nonrandomized controlled studies to compare effects of sauna bath with no sauna bath. Studies were searched for both infrared sauna bath and Finnish sauna bath. The strength of evidence was rated using a modified GRADE approach. Out of 1444 studies, nine met the inclusion criteria and were included in this review. Seven of these nine studies were included in the meta-analysis. Only studies with infrared sauna bath met the inclusion criteria.

RESULTS

In the meta-analysis, exposure to an infrared sauna bath in 60°C for 15 minutes, followed by a 30-minute rest in warm environment, five times a week for 2 to 4 weeks, was associated with a significant reduction in B-type natriuretic peptide, cardiothoracic ratio, and an improvement in left-ventricular ejection fraction. There was no significant effect on left-ventricular end-diastolic diameter, left atrial diameter, systolic blood pressure, or diastolic blood pressure. The strength of evidence varied from moderate to insufficient.

CONCLUSION

Infrared sauna bath was associated with short-term improvement in cardiac function. More evidence is needed about long-term effects of sauna bath and the effects of a Finnish sauna on cardiovascular health among patients with HF or other cardiovascular diseases.

Potential mechanisms for the effects of far-infrared on the cardiovascular system - a review

Far-infrared (FIR) is a form of thermal radiation, which may have beneficial effects on cardiovascular health. Clinical studies suggest that FIR irradiation may have therapeutic effects in heart failure, myocardial ischaemia and may improve flow and survival of arteriovenous fistula. Animal studies have suggested a wide range of potential mechanisms involving endothelial nitric oxide synthase and nitric oxide bioavailability, oxidative stress, heat shock proteins and endothelial precursor cells. However, the exact cellular and molecular mechanism of FIR on the cardiovascular system remains elusive. The purpose of this review is to discuss the current literature, focusing on mechanistic studies involving the cardiovascular system, and with a view to highlighting areas for future investigation.

Sauna bathing, health, and quality of life among octogenarian men: the Helsinki Businessmen Study

BACKGROUND AND AIM

Sauna-type bathing has increased worldwide, and it has been related to both harmful and beneficial effects. There are few studies of bathing in sauna in very old age.

METHODS

The series consists of 524 mostly home-living survivors of the Helsinki Businessmen Study (HBS, mean age 86 years, range 80-95), who in 2015 responded to a questionnaire survey about lifestyle (including sauna bathing), prevalent diseases, and health-related quality of life (HRQoL, RAND-36).

RESULTS

Of the men 57.6% (n = 302) reported all-year round and 17.6% (n = 92) part-year sauna bathing. Sauna was currently used mostly once a week, but 10% bathed more than twice a week. Median time in the hot room was 15 min at 80 °C. Among 45.7% of the men, the habit had decreased with ageing, and 130 (24.8%) did not attend sauna. However, 92.2% of the latter had discontinued an earlier habit, respective proportions 20.7% and 75.0% among all-year and part-year users. Overall, reasons for decreased sauna bathing were nonspecific or related to mobility problems or diverse health reasons (n = 63). The most frequent motivations for sauna were relaxation and hygienic reasons. Of the RAND-36 domains physical function, vitality, social functioning, and general health were significantly better among sauna users than non-users. These differences partly remained after adjusting for prevalent diseases and mobility-disability.

CONCLUSIONS

Regular sauna bathing was common among octogenarian men and was associated with better HRQoL. However, reverse causality must be taken into account in this cross-sectional study. The bathing habit seemed to be prudent and had decreased in almost half of the cohort.

Short-term effects of Finnish sauna bathing on blood-based markers of cardiovascular function in non-naive sauna users

Emerging evidence suggests that sauna bathing is associated with reduced risk of cardiovascular and all-cause mortality events. However, the biochemical pathways by which sauna bathing might confer its effects on cardiovascular function are not certain. We aimed to study the acute effects of Finnish sauna bathing on various blood-based cardiovascular biomarkers. The study included 102 non-naive sauna users (54% male) with mean age of 51.9 years, who had at least one cardiovascular risk factor. Participants underwent a 30-min single sauna session (mean temperature, 73 °C). Biochemical profiling was conducted before, immediately after sauna and 30-min post-sauna. Overall median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (n = 20 participants) was 46.0 ng/L before sauna exposure, which increased to 50.5 ng/l immediately after sauna (median change, + 12.00%; p < 0.001) and remained persistent at 30-min post-sauna (median change from pre-sauna to post-30-min sauna, + 13.93%; p < 0.001). The changes were more evident in males compared with females. There were no significant changes in overall levels of high sensitivity C-reactive protein, creatine kinase, high sensitivity troponin I, and creatine kinase-MBm. However, levels of creatine kinase increased in males (median change immediately after sauna, + 2.99%; p = 0.024). Levels of NT-proBNP increased after sauna exposure. The increase in levels of creatine kinase was more evident in males. Long-term interventional studies are warranted to evaluate if these biomarkers are involved in pathways underlying the associations of sauna bathing with cardiovascular outcomes.

Clinical Effects of Regular Dry Sauna Bathing: A Systematic Review

Introduction

Many health benefits are claimed by individuals and facilities promoting sauna bathing; however the medical evidence to support these claims is not well established. This paper aims to systematically review recent research on the effects of repeated dry sauna interventions on human health.

Methods

A systematic search was made of medical databases for studies reporting on the health effects of regular dry sauna bathing on humans from 2000 onwards. Risk of bias was assessed according to the Cochrane Collaboration guidelines.

Results

Forty clinical studies involving a total of 3855 participants met the inclusion criteria. Only 13 studies were randomized controlled trials and most studies were small (n < 40). Reported outcome measures were heterogeneous with most studies reporting beneficial health effects. Only one small study (n = 10) reported an adverse health outcome of disrupted male spermatogenesis, demonstrated to be reversible when ceasing sauna activity.

Conclusions

Regular dry sauna bathing has potential health benefits. More data of higher quality is needed on the frequency and extent of adverse side effects. Further study is also needed to determine the optimal frequency and duration of distinct types of sauna bathing for targeted health effects and the specific clinical populations who are most likely to benefit.

Improvement in exercise capacity and delayed anaerobic metabolism induced by far-infrared-emitting garments in active healthy subjects: A pilot study

Background Far-infrared-emitting garments have several biological properties including the capability to increase blood perfusion in irradiated tissues. Design The aim of the study was to evaluate whether far-infrared radiation increases exercise capacity and delays anaerobic metabolism in healthy subjects. Methods With a double-blind, crossover protocol, a maximal cardiopulmonary exercise test was performed in 20 volunteers, wearing far-infrared or common sport clothes, identical in texture and colour. Results Comparing far-infrared with placebo garments, higher oxygen uptake at peak of exercise and longer endurance time were observed (peak oxygen uptake 38.0 ± 8.9 vs. 36.2 ± 8.5 ml/kg/min, endurance time 592 ± 85 vs. 570 ± 71 seconds; P < 0.01); the anaerobic threshold was significantly delayed (anaerobic threshold time 461 ± 93 vs. 417 ± 103 seconds) and anaerobic threshold oxygen uptake and anaerobic threshold oxygen pulse were significantly higher (25.3 ± 6.4 vs. 20.9 ± 5.4 ml/kg/min and 13.3 ± 3.8 vs. 12.4 ± 3.3 ml/beat, respectively). In 10 subjects the blood lactate concentration was measured every 2 minutes during exercise and at peak; lower values were observed with far-infrared fabrics compared to placebo from the eighth minute of exercise, reaching a significant difference at 10 minutes (3.6 ± 0.83 vs. 4.4 ± 0.96 mmol/l; P = 0.02). Conclusions In healthy subjects, exercising with a far-infrared outfit is associated with an improvement in exercise performance and a delay in anaerobic metabolism. In consideration of the acknowledged non-thermic properties of functionalised clothes, these effects could be mediated by an increase in oxygen peripheral delivery secondary to muscular vasodilation. These data suggest the need for testing far-infrared-emitting garments in patients with exercise limitation or in chronic cardiovascular and respiratory patients engaged in rehabilitation programmes.

Exposure to far-infrared rays attenuates methamphetamine-induced recognition memory impairment via modulation of the muscarinic M1 receptor, Nrf2, and PKC

We demonstrated that activation of protein kinase Cδ (PKCδ) and inactivation of the glutathione peroxidase-1 (GPx-1)-dependent systems are critical for methamphetamine (MA)-induced recognition memory impairment. We also demonstrated that exposure to far-infrared rays (FIR) causes induction of the glutathione (GSH)-dependent system, including induction of the GPx-1 gene. Here, we investigated whether exposure to FIR rays affects MA-induced recognition memory impairment and whether it modulates PKC, cholinergic receptors, and the GSH-dependent system. Because the PKC activator bryostatin-1 mainly induces PKCα, PKCε, and PKCδ, we assessed expression of these proteins after MA treatment. MA treatment selectively increased PKCδ expression and its phosphorylation. Exposure to FIR rays significantly attenuated MA-induced increases in PKCδ phosphorylation. Importantly, bryostatin-1 potentiated MA-induced phosphorylation of PKCδ. MA treatment significantly decreased M1, M3, and M4 muscarinic acetylcholine receptors (mAChRs) and β2 nicotinic acetylcholine receptor expression. Of these, the decrease was most pronounced in M1 mAChR. Exposure to FIR significantly attenuated MA-induced decreases in the M1 mAChR and phospho-ERK_1/2, while it facilitated Nrf2-dependent GSH induction. Dicyclomine, an M1 mAChR antagonist, and l-buthionine-(S, R)-sulfoximine (BSO), an inhibitor of GSH synthesis, counteracted against the protective potentials mediated by FIR. More importantly, the memory-enhancing potential of FIR rays was significantly counteracted by bryostatin-1, dicyclomine, and BSO. Our results suggest that exposure to FIR rays attenuates MA-induced impairment in recognition memory via up-regulation of M1 mAChR, Nrf2-dependent GSH induction, and ERK_1/2 phosphorylation by inhibiting PKCδ phosphorylation by bryostatin-1.

Exposure to far-infrared ray attenuates methamphetamine-induced impairment in recognition memory through inhibition of protein kinase C δ in male mice: Comparison with the antipsychotic clozapine

We have previously demonstrated that repeated treatment with methamphetamine (MA) results in a recognition memory impairment via upregulation of protein kinase C (PKC) δ and downregulation of the glutathione peroxidase-1 (GPx-1)-dependent antioxidant system. We also demonstrated that far-infrared ray (FIR) attenuates acute restraint stress via induction of the GPx-1 gene. Herein, we investigated whether exposure to FIR modulates MA-induced recognition memory impairment in male mice, and whether cognitive potentials mediated by FIR require modulation of the PKCδ gene, extracellular signal-regulated kinase (ERK) 1/2, and glutathione-dependent system. Repeated treatment with MA significantly increased PKCδ expression and its phosphorylation out of PKC isoenzymes (i.e., PKCα, PKCβI, PKCβII, PKCζ, and PKCδ expression) in the prefrontal cortex of mice. Exposure to FIR significantly attenuated MA-induced increase in phospho-PKCδ and decrease in phospho-ERK 1/2. In addition, FIR further facilitated the nuclear factor E2-related factor 2 (Nrf2)-dependent glutathione synthetic system. Moreover, L-buthionine-(S, R)-sulfoximine, an inhibitor of glutathione synthesis, counteracted the FIR-mediated phospho-ERK 1/2 induction and memory-enhancing activity against MA insult. More important, positive effects of FIR are comparable to those of genetic depletion of PKCδ or the antipsychotic clozapine. Our results indicate that FIR protects against MA-induced memory impairment via activations of the Nrf2-dependent glutathione synthetic system, and ERK 1/2 signaling by inhibition of the PKCδ gene.

Neurohumoral Modulation During Waon Therapy in Chronic Heart Failure - Subanalysis of Waon-CHF Study

BACKGROUND

Heart failure (HF) is a disease of neurohumoral dysfunction and current pharmacological therapies for HF have not improved mortality rates, thus requiring additional new strategies. Waon therapy for HF patients may be a complementary strategy with peripheral vasodilation via nitric oxide. We hypothesized that Waon therapy would improve neurohumoral factors, such as natriuretic peptides (NP) and the renin-angiotensin-aldosterone system (RAAS) in HF.Methods and Results:Plasma samples were collected from patients enrolled in the WAON-CHF Study (Waon therapy (n=77) or control (n=73)) before and after the treatment. B-type NP (BNP), C-type NP (CNP), and aldosterone (Aldo) levels were measured by respective specific radioimmunoassays. Although clinical parameters significantly improved in the Waon group compared with the control group, BNP, Aldo, and CNP levels were not statistically different between groups. On subanalysis with patient variables, BNP levels were improved in the Waon group treated with angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker or spironolactone. In addition, Aldo levels were improved in the Waon group patients with diabetes mellitus, hypertension, and inotrope use, and CNP levels were improved in Waon group patients with estimated glomerular filtration rate <60 mL/min/1.73 m². These changes were not observed in the control group.

CONCLUSIONS

Waon therapy may accelerate the favorable actions of RAAS modulators in HF. (WAON-CHF Study: UMIN000006705).

Optimization of pressure settings during adaptive servo-ventilation support using real-time heart rate variability assessment: initial case report

Background

Adaptive servo-ventilation (ASV) therapy is a recent non-invasive positive pressure ventilation therapy that was developed for patients with heart failure (HF) refractory to optimal medical therapy. However, it is likely that ASV therapy at relatively higher pressure setting worsens some of the patients’ prognosis compared with optimal medical therapy. Therefore, identification of optimal pressure settings of ASV therapy is warranted.

Case presentation

We present the case of a 42-year-old male with HF, which was caused by dilated cardiomyopathy, who was admitted to our institution for evaluating his eligibility for heart transplantation. To identify the optimal pressure setting [peak end-expiratory pressure (PEEP) ramp test], we performed an ASV support test, during which the PEEP settings were set at levels ranging from 4 to 8 mmHg, and a heart rate variability (HRV) analysis using the MemCalc power spectral density method. Clinical parameters varied dramatically during the PEEP ramp test. Over incremental PEEP levels, pulmonary capillary wedge pressure, cardiac index and high-frequency level (reflecting parasympathetic activity) decreased; however, the low-frequency level increased along with increase in plasma noradrenaline concentrations.

Conclusions

An inappropriately high PEEP setting may stimulate sympathetic nerve activity accompanied by decreased cardiac output. This was the first report on the PEEP ramp test during ASV therapy. Further research is warranted to determine whether use of optimal pressure settings using HRV analyses may improve the long-term prognosis of such patients.

Assessment of various parameters using simple non-invasive tests in patients with cardiovascular diseases with or without cardiac rehabilitation

Cardiac rehabilitation (CR) improves cardiac function and exercise capacity in patients with cardiovascular disease (CVD). Simpler techniques are needed for use by physicians in the examination room to assess the usefulness of CR. We enrolled 46 consecutive CVD patients in a CR program (CR group) and prospectively followed them for 3 months. We compared them to 18 age-, gender- and body mass index-matched CVD patients without CR (non-CR group). Various parameters were measured at baseline and after 3 months using 3 simple non-invasive tests: severity of atherosclerosis [arterial velocity pulse index and arterial pressure volume index (API)] were determined using PASESA®, an autonomic nerve total activity amount index and a coefficient of variation of the R–R interval (CVRR) were determined using eHEART®, and peripheral resistance index, pressure rate product, stroke volume and cardiac index were determined using nico®]. There were no significant differences in patient characteristics including percentages (%) of ischemic heart disease and heart failure between the non-CR and CR groups. Systolic blood pressure (SBP), diastolic BP, heart rate and API at baseline significantly decreased and CVRR at baseline significantly increased after 3 months in the CR group, but not in the non-CR group. In addition, ΔAPI (Δ = the value after 3 months minus the value at baseline) was positively associated with ΔSBP in the CR group. In conclusion, CR significantly decreased BP and improved atherosclerosis and sympathetic nerve activity. These findings suggest that simple non-invasive tests may be useful for assessing the effects of CR.

Waon Therapy for Managing Chronic Heart Failure - Results From a Multicenter Prospective Randomized WAON-CHF Study

BACKGROUND

Waon therapy improves heart failure (HF) symptoms, but further evidence in patients with advanced HF remains uncertain.

METHODS AND RESULTS

In 19 institutes, we prospectively enrolled hospitalized patients with advanced HF, who had plasma levels of B-type natriuretic peptide (BNP) >500 pg/ml on admission and BNP >300 pg/ml regardless of more than 1 week of medical therapy. Enrolled patients were randomized into Waon therapy or control groups. Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60℃ for 15 min, followed by bed rest for 30 min covered with a blanket. The primary endpoint was the ratio of BNP before and after treatment. In total, 76 Waon therapy and 73 control patients (mean age 66 years, men 61%, mean plasma BNP 777 pg/ml) were studied. The groups differed only in body mass index and the frequency of diabetes. The plasma BNP, NYHA classification, 6-min walk distance (6MWD), and cardiothoracic ratio significantly improved only in the Waon therapy group. Improvements in NYHA classification, 6MWD, and cardiothoracic ratio were significant in the Waon therapy group, although the change in plasma BNP did not reach statistical significance. No serious adverse events were observed in either group.

CONCLUSIONS

Waon therapy, a holistic soothing warmth therapy, showed clinical advantages in safety and efficacy among patients with advanced HF.

Repeated exposure to far infrared ray attenuates acute restraint stress in mice via inhibition of JAK2/STAT3 signaling pathway by induction of glutathione peroxidase-1

Exposure to far-infrared ray (FIR) has been shown to exert beneficial effects on cardiovascular and emotional disorders. However, the precise underlying mechanism mediated by FIR remains undetermined. Since restraint stress induces cardiovascular and emotional disorders, the present study investigated whether exposure to FIR affects acute restraint stress (ARS) in mice. c-Fos-immunoreactivity (IR) was significantly increased in the paraventricular hypothalamic nucleus (PVN) and dorsomedial hypothalamic nucleus (DMH) in response to ARS. The increase in c-Fos-IR parallels that in oxidative burdens in the hypothalamus against ARS. Exposure to FIR significantly attenuated increases in the c-Fos-IR, oxidative burdens and corticosterone level. ARS elicited decreases in GSH/GSSG ratio, cytosolic Cu/Zn-superoxide dismutase (SOD-1), glutathione peroxidase (GPx), and glutathione reductase (GR) activities. FIR-mediated attenuation was particularly observed in ARS-induced decrease in GPx, but not in SOD-1 or GR activity. Consistently, ARS-induced decreases in GPx-1-immunoreactivity in PVN and DMH, and decreases in GPx-1 expression in the hypothalamus were significantly attenuated by FIR. ARS-induced significant increases in phosphorylation of JAK2/STAT3, and nuclear translocation and DNA-binding activity of NFκB were observed in the hypothalamus. Exposure to FIR selectively attenuated phosphorylation of JAK2/STAT3, but did not diminish nuclear translocation and DNA-binding activity of NFκB, suggesting that JAK2/STAT3 constitutes a critical target for FIR-mediated pharmacological potential. ARS-induced increase in c-Fos-IR in the PVN and DMH of non-transgenic mice was significantly attenuated by FIR exposure or JAK2/STAT3 inhibitor AG490. GPx-1 overexpressing transgenic mice significantly protected increases in the c-Fos-IR and corticosterone level induced by ARS. However, neither FIR exposure nor AG490 significantly affected attenuations by genetic overexpression of GPx-1. Moreover, AG490 did not exhibit any additional positive effects against the attenuation by genetic overexpression of GPx-1 or FIR exposure. Our results indicate that exposure to FIR significantly protects ARS-induced increases in c-Fos-IR and oxidative burdens via inhibition of JAK2/STAT3 signaling by induction of GPx-1.

Orthostatic Blood Pressure Changes and Subclinical Markers of Atherosclerosis

BACKGROUND

Using a simple standing-up test in normotensive subjects, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP changes and subclinical markers of atherosclerosis.

METHODS

A total of 515 normotensive subjects aged 35-75 years (58.4±10.0 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP), serum lipids, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and urinary albumin-to-creatinine ratio. Brachial to ankle pulse wave velocity (baPWV) and carotid mean intima-media thickness (IMT) were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency.

RESULTS

SBP and DBP decreased when standing, with a reduction of SBP when changing position of -8.0±10.2mm Hg. Orthostatic hypotension (OH) produced a significantly higher SBP than without OH. The baPWV was significantly higher in OH than in without OH. Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, HbA1c, hs-CRP, IMT, late systolic peak of the pressure wave form (SBP2), and baPWV confirmed that baPWV, SBP2, and triglycerides were independently related to orthostatic BP changes. Multiple regression analyses showed that a decrease in SBP as well as baseline SBP, age, BMI, and fasting glucose were independent determinants of PWV.

CONCLUSIONS

We have shown that increased arterial stiffness was associated with OH during a standing-up test. Arterial stiffness may contribute to greater BP responses to postural changes from standing.

Heart rate variability in patients with atrial septal defect and healthy children

OBJECTIVE

Heart rate variability (HRV) measures are altered in various cardiac and non-cardiac situations in children. The autonomic nervous system is assumed to have a role in the pathophysiology of atrial septal defect (ASD). In this study, we evaluated the autonomic system by measuring HRV in children with ASD.

METHODS

Twenty-eight patients with ASD and 32 healthy children (mean ages: 6.6±2.1 years and 6.4±2.2 years, respectively) were enrolled in the study. Twenty-four-hour ambulatory electrocardiographic recordings were obtained and the seven time-domain (SDNN, SDANN, rMSSD, SD, SDNN index, PNN50, and mean RR) and four frequency-domain (VLF, LF, HF, and LF/HF ratio) indices of HRV were analyzed.

RESULTS

A significant decrease in calculated HRV variables was observed in children with ASD as compared to controls. The HRV alteration was found in both time-domain and frequency-domain parameters.

CONCLUSIONS

Our results indicate that HRV is decreased in children with ASD, which implies parasympathetic withdrawal and sympathetic predominance.

Role of central oxytocin in stress-induced cardioprotection in ischemic-reperfused heart model

BACKGROUND AND PURPOSE

There is growing evidence that stress contributes to cardiovascular disease and triggers the release of oxytocin. Moreover previous studies confirmed oxytocin mimics the protection associated with ischemic preconditioning. The present study was aimed to assess the possible cardioprotective effects of the centrally released oxytocin in response to stress and intracerebroventricular (i.c.v.) administration of exogenous oxytocin in ischemic-reperfused isolated rat heart.

METHODS AND SUBJECTS

Rats were divided in two main groups and all of them were subjected to i.c.v. infusion of vehicle or drugs: unstressed rats [control: vehicle, oxytocin (OT; 100 ng/5 μl), atosiban (ATO; 4.3 μg/5 μl) as oxytocin antagonist, ATO+OT] and stressed rats [St: stress, OT+St, ATO+St]. After anesthesia, hearts were isolated and subjected to 30 min regional ischemia and 60 min reperfusion (IR). Acute stress protocol included swimming for 10 min before anesthesia. Myocardial function, infarct size, coronary flow, ventricular arrhythmia, and biochemical parameters such as creatine kinase and lactate dehydrogenase were measured. Ischemia-induced ventricular arrhythmias were counted during the occlusion period.

RESULTS

The plasma levels of oxytocin and corticosterone were significantly elevated by stress. Unexpectedly hearts of stressed rats showed a marked depression of IR injury compared to control group. I.c.v. infusion of oxytocin mimicked the cardioprotective effects of stress, yet did not elevate plasma oxytocin level. The protective effects of both stress and i.c.v. oxytocin were blocked by i.c.v. oxytocin antagonist.

CONCLUSIONS

These findings suggest that i.c.v. infusion of exogenous oxytocin and centrally released endogenous oxytocin in response to stress could play a role in induction of a preconditioning effect in ischemic-reperfused rat heart via brain receptors.

Short-term effects of low-dose tolvaptan on hemodynamic parameters in patients with chronic heart failure

BACKGROUND

We evaluated the short-term effects of low-dose tolvaptan treatment on hemodynamic parameters in patients with chronic heart failure (HF).

METHODS

We studied 22 patients (69 ± 10 years) with chronic HF and excess fluid retention despite receiving appropriate medical therapy, including loop and/or thiazide diuretics. The therapeutic effects of low-dose (7.5mg) once-daily tolvaptan on hemodynamics associated with changes in fluid balance and neurohumoral activations were investigated after a seven day treatment period.

RESULTS

After the treatment period, body weight decreased (-2.7 ± 2.3 kg) associated with increases in daily urine output. Whereas plasma arginine-vasopressin levels, serum aldosterone concentration, and plasma renin activity mildly increased, plasma levels of B-type natriuretic peptide and atrial natriuretic peptide significantly decreased after tolvaptan treatment. Serum electrolytes were not adversely affected by tolvaptan treatment. Although cardiac index and systemic vascular resistance index remained unchanged, mean pulmonary artery wedge pressure (22 ± 7 mmHg vs. 17 ± 7 mmHg, p<0.05), mean right atrial pressure (12 ± 5 mmHg vs. 9 ± 5 mmHg, p<0.05), mean pulmonary artery pressure (32 ± 9 mmHg vs. 25 ± 7 mmHg, p<0.05), and pulmonary vascular resistance index (332 ± 207 dynes/cm(-5)/m(2) vs. 245 ± 110 dynes/cm(-5)/m(2), p<0.05) significantly decreased after tolvaptan treatment. The extent of the reduction in pulmonary vascular resistance index after tolvaptan treatment strongly correlated with baseline values.

CONCLUSIONS

Short-term treatment with low-dose tolvaptan improved hemodynamic parameters and correlated with significant fluid removal in patients with chronic HF.

Waon therapy upregulates Hsp90 and leads to angiogenesis through the Akt-endothelial nitric oxide synthase pathway in mouse hindlimb ischemia

BACKGROUND

Thermal therapy, namely Waon therapy, has previously been reported to regulate nitric oxide (NO) and endothelial NO synthase (eNOS) and augment ischemia-induced angiogenesis in mice and improve limb ischemia in patients with peripheral artery disease. The aim of this study was to clarify the precise mechanism by which Waon therapy augments angiogenesis in mice with hindlimb ischemia.

METHODS AND RESULTS

Unilateral hindlimb ischemia was induced in apolipoprotein E-deficient mice and Waon therapy was performed for 5 weeks. Heat shock protein 90 (Hsp90), phosphorylated-Akt, and phosphorylated-eNOS were detected in arterial endothelial cells of ischemic hindlimbs and all were upregulated by Waon therapy compared to controls. Waon therapy also increased serum concentrations of nitrite and nitrate. Capillary density and the ischemic limb/normal side blood perfusion ratio monitored by laser Doppler perfusion imaging in the Waon therapy group were significantly increased beyond those in the control group. The effect of Waon therapy on angiogenesis through the activation of the Hsp90/Akt/eNOS pathway was attenuated by the administration of a Hsp90 inhibitor.

CONCLUSIONS

It is suggested that Waon therapy upregulates Hsp90, which contributes to the activation of the Akt/eNOS/NO pathway, and induces angiogenesis in mice with hindlimb ischemia.