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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., (© 2024. The Author(s).)

This research article elucidates the pivotal role of radiopharmacy in the contemporary landscape, underscoring its potential therapeutic efficacy in addressing symptoms associated with aged-related neurocognitive processes. Clinical trials, characterized by the judicious application of modest radiation doses, exemplified by low-dose radon, have yielded affirmative outcomes in the amelioration of aged, related symptoms., Material and Methods: The study was conducted on an animal model. The effect of low doses of radon on cognitive processes is being studied by inhalation of randomized mineral water. Changes in the clinical picture were studied using behavioral tests, namely the Barnes maze tests. At the cellular level, radon-contained water inhalation causes different changes: in the fraction of synaptic membranes (determined by Na, K-ATPase activity), aged, related changes by telomerase activity and oxidative stress level changes., Results: Our studies show that age-related changes in brain tissue are less noticeable after radon inhalation, namely, the concentration of amyloid plaques decreases in a group of aged rats after radon therapy. A significant improvement in cognitive function was observed after radon inhalation in aged rats., Conclusion: The results show that exposure to radon-containing mineral water leads to improved spatial perception, potentially improving age-related cognitive functions not only at the level of neurocognitive tests, but also changes at the level of cellular functioning.

Quantifying the water and mineral losses in feces is essential to determine the optimal composition of oral rehydration solutions (ORS) for diarrheic animals. In a randomized complete block design, this study evaluated water, mineral, and blood acid-base balance of calves with naturally occurring diarrhea receiving ORS or a placebo. On d 0, 45 calves (age: 18 ± 3.2 d; mean ± SD) were selected based on the presence of visual signs of diarrhea, such as dirty tail or wet feces, along with clinical symptoms evaluated by measuring the skin turgor and the degree of enophthalmos. On d 1, calves were divided into blocks of 3 animals based on blood base excess (BE) measured at 0900 h, and within each block, calves were randomly assigned to 1 of 3 treatments (15 calves per treatment) including (1) a hypertonic ORS (HYPER; Na + = 110 mmol/L; 370 mOsm/kg; strong ion difference [SID] = 60 mEq/L), (2) a hypotonic ORS with low Na + (HYPO; Na + = 77 mmol/L; 278 mOsm/kg; SID = 71 mEq/L), and (3) a placebo consisting of lukewarm water with 5 g/L of whey powder (CON). Milk replacer (MR) was fed through teat buckets twice daily at 0630 h and 1700 h in 2 equally sized meals of 2.5 L from d 1 to 3 and of 3.0 L on d 4 and 5. Treatments consisting of 2.0 L lukewarm solutions were administered between milk meals from d 1 to 3 at 1200 h and 2030 h through teat buckets. Refusals of MR and treatments were recorded daily, and blood samples were collected from the jugular vein once daily at arrival in the afternoon of d 0 and at 0900 h from d 1 to 5 after arrival. Urine and feces were collected quantitatively over a 48-h period from 1200 h on d 1 to 1200 h on d 3, and a representative sample of each 24-h period was stored. In addition, the volume of extracellular fluid was evaluated on d 2 by postprandial sampling over a 4-h period relative to the injection of sodium thiosulfate at 1300 h. Total daily fluid intake (MR, treatment, and water) from d 1 to 3 was greater in HYPER (LSM ± SEM; 8.9 ± 0.36 L/d) and HYPO (7.8 ± 0.34 L/d) than in CON (6.6 ± 0.34 L/d). This resulted in a greater water balance (water intake - fluid output in urine and feces) in calves receiving ORS (59.6 ± 6.28 g/kg BW per 24 h vs. 39.6 ± 6.08 g/kg BW per 24 h). Fecal Na + losses were greater in HYPER than in the other treatments (81 ± 12.0 mg/kg BW per 24 h vs. 24 ± 11.8 mg/kg BW per 24 h). Blood pH was higher in HYPO (7.41 ± 0.016) than CON (7.35 ± 0.016) over the 5 monitoring days, whereas HYPER (7.37 ± 0.017) did not differ with other treatments. In this experimental model, diarrheic calves were likely unable to absorb the high Na + load from HYPER, resulting in greater Na + losses in feces, which might have impaired the alkalinizing capacity of HYPER. In contrast, HYPO significantly sustained blood acid-base balance compared with CON, whereas HYPER did not. This suggests that low tonicity ORS with a high SID are more suitable for diarrheic calves., (© 2024, The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Background: For centuries, spring and other natural waters have been recommended as external or internal remedies for numerous diseases. For studies that examined the effects of drinking mineral waters against heartburn, gastroesophageal reflux disease (GERD), or functional dyspepsia, a systematic review is lacking., Objectives: The main aim of this systematic review was to examine the effects of drinking natural mineral waters on heartburn from various causes by identifying all published intervention studies and critically appraising their methods as well as summarizing their results., Methods: We systematically searched the largest medical literature database MEDLINE, further relevant web sources, and gray literature for randomized and nonrandomized trials, with or without control groups, up to September 2021 and no language restrictions. Further inclusion criteria were adult patients with heartburn, drinking cure with natural mineral water as the intervention, compared to no or other interventions (care-as-usual, waiting list). We defined the reduction of heartburn symptoms and duration of disease episodes as primary and quality of life as secondary outcomes. Two reviewers independently carried out the study quality assessments (risk of bias) using the National Institutes of Health-Study Quality Assessment Tools., Results: Nine trials comprising 393 patients from Italy, Russia, Ukraine, and Germany fulfilled all inclusion criteria. We identified three randomized controlled trials (all with poor methodological quality), plus six before-after (pre/post) intervention studies without a control group. The intervention groups of the three comparative trials seemed to show a stronger reduction of self-reported heartburn symptoms, and duration of heartburn episodes than the respective control groups; however, they all had poor methodological quality., Conclusion: Based on the best available evidence of clinical studies, we cannot recommend or advise against drinking natural mineral waters as a treatment for heartburn. The potential benefits of natural mineral waters that were reported in some studies with a lower evidence level (e.g., lacking a control group) should be verified by good quality randomized clinical trials with adequate comparison groups and longer follow-up periods., Seit Jahrhunderten werden Quell- und andere natürliche Wässer als äußerliche oder innerliche Heilmittel für zahlreiche Krankheiten empfohlen. Für Studien, die die Wirkung des Trinkens von Mineralwasser gegen Sodbrennen, gastroösophageale Refluxkrankheit (GERD) oder funktionelle Dyspepsie untersuchten, fehlt eine systematische Übersicht.Das Hauptziel dieser systematischen Übersichtsarbeit war es, die Auswirkungen von Trinkkuren mit natürlichen Mineralwässern auf Sodbrennen verschiedener Ursachen zu untersuchen, indem alle veröffentlichten Interventionsstudien identifiziert und ihre Methoden kritisch bewertet sowie ihre Ergebnisse zusammengefasst wurden.Wir durchsuchten systematisch die größte medizinische Literaturdatenbank MEDLINE, weitere relevante Internetquellen und graue Literatur nach randomisierten und nicht-randomisierten Studien, mit oder ohne Kontrollgruppen, bis September 2021 und ohne sprachliche Einschränkungen. Weitere Einschlusskriterien waren erwachsene Patienten mit Sodbrennen, Trinkkur mit natürlichem Mineralwasser als Intervention, im Vergleich zu keiner oder anderen Interventionen (care-as-usual, Warteliste). Wir definierten die Abnahme der Symptome des Sodbrennens und die Dauer der Krankheitsepisoden als primäre und die Lebensqualität als sekundäre Endpunkte. Zwei Gutachter bewerteten unabhängig voneinander die Qualität der Studien (Verzerrungsrisiko) anhand der National Institutes of Health-Study Quality Assessment Tools.Neun Studien mit 393 Patienten aus Italien, Russland, der Ukraine und Deutschland erfüllten alle Einschlusskriterien. Wir identifizierten drei randomisierte kontrollierte Studien (alle mit schlechter methodischer Qualität) sowie sechs Vorher-Nachher-Studien (Prä-/Post-Studien) ohne Kontrollgruppe. Die Interventionsgruppen der drei randomisierten Vergleichsstudien schienen eine stärkere Verringerung der selbstberichteten Symptome und der Dauer der Episoden des Sodbrennens zu zeigen als die jeweiligen Kontrollgruppen, allerdings waren sie alle von schlechter methodischer Qualität.Auf der Grundlage der besten verfügbaren Belege aus klinischen Studien können wir das Trinken natürlicher Mineralwässer zur Behandlung von Sodbrennen weder empfehlen noch davon abraten. Die potenziellen Vorteile natürlicher Mineralwässer, die in einigen Studien mit geringerer Evidenz (z. B. ohne Kontrollgruppe) berichtet wurden, sollten durch qualitativ hochwertige randomisierte klinische Studien mit angemessenen Vergleichsgruppen und längeren Nachbeobachtungszeiträumen überprüft werden., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

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., (© 2023. The Author(s) under exclusive licence to International Society of Biometeorology.)

Objective: We assessed whether the bicarbonate-rich mineral water Staatl. Fachingen STILL is superior over conventional mineral water in relieving heartburn., Design: Multicentre, double-blind, randomised, placebo-controlled trial STOMACH STILL in adult patients with frequent heartburn episodes since ≥6 months and without moderate/severe reflux oesophagitis. Patients drank 1.5 L/day verum or placebo over the course of the day for 6 weeks. Primary endpoint was the percentage of patients with reduction of ≥5 points in the Reflux Disease Questionnaire (RDQ) score for 'heartburn'. Secondary endpoints included symptom reduction (RDQ), health-related quality of life (HRQOL, Quality of Life in Reflux and Dyspepsia (QOLRAD)), intake of rescue medication and safety/tolerability., Results: Of 148 randomised patients (verum: n=73, placebo: n=75), 143 completed the trial. Responder rates were 84.72% in the verum and 63.51% in the placebo group (p=0.0035, number needed to treat=5). Symptoms improved under verum compared with placebo for the dimension 'heartburn' (p=0.0003) and the RDQ total score (p=0.0050). HRQOL improvements under verum compared with placebo were reported for 3 of 5 QOLRAD domains, that is, 'food/drink problems' (p=0.0125), 'emotional distress' (p=0.0147) and 'vitality' (p=0.0393). Mean intake of rescue medication decreased from 0.73 tablets/day at baseline to 0.47 tablets/day in week 6 in the verum group, whereas in the placebo group it remained constant during the trial. Only three patients had treatment-related adverse events (verum: n=1, placebo: n=2)., Conclusion: STOMACH STILL is the first controlled clinical trial demonstrating superiority of a mineral water over placebo in relieving heartburn, accompanied by an improved HRQOL., Trial Registration Number: EudraCT 2017-001100-30., Competing Interests: Competing interests: During conduct of the trial and preparation of the manuscript, JL received honoraria for consultancy from Fachingen Heil- und Mineralbrunnen GmbH. MA and JW were employees of SocraTec R&D GmbH. R-SW was an employee of SocraTec R&D GmbH and SocraMetrics GmbH. HW was an employee of Fachingen Heil- und Mineralbrunnen GmbH. BS was cofounder and managing director of SocraTec R&D GmbH and SocraMetrics GmbH., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There are rich reserves of underground mineral waters in the south of Tyumen region, which are generally deep located, in the so-called difficult exchange water zone (on average at a depth of 1311.29±34.53 m). Currently, there is a lack of assessment of prognostic resources of underground mineral waters in the south of Tyumen region. The article provides an assessment of underground mineral (therapeutic) waters' reserves (2011-2019 yrs.) in the considered territory. It was shown that the number of deposits, their sites and underground mineral waters' well bores is 76, of which less than half are in operation, as at date of 01.07.2021. Moreover, the number of deposits is remained almost constant since 2011 yr. Meanwhile, underground mineral (therapeutic) waters' reserves are gradually decreasing. Thus, there is a necessity to intensify not only the stocktaking and identification of mineral waters' well bores, but also to develop the new medical technologies to use geothermal waters in rehabilitation and prevention. Monitoring for underground waters' condition should be continued with the use of modern research tools and techniques. The above mentioned will give a new impetus to the development of health resort sphere in the tourism industry, in addition to increasing the therapeutic effects of mineral waters.

Stress or stress-induced intestinal disturbances, especially diarrhea, are the main triggers for inflammatory bowel disease and irritable bowel syndrome. Diarrhea and intestinal inflammatory disease afflict patients around the world, and it has become a huge burden on the global health care system. Drinking sodium metasilicate-based alkaline mineral water (SM-based AMW) exerts a potential therapeutic effect in gastrointestinal disorders, including gut inflammation, and diarrhea, but the supportive evidence on animal studies and mechanism involved remain unreported. The maternally separated (MS) piglet (Newly weaned piglet) is an excellent model to investigate the treatment of diarrhea in infant. This study aims to determine whether drinking SM-based AMW confers diarrhea resistance in maternally separated (MS) piglets under weaning stress and what the underlying mechanisms are involved. 240 newly weaned piglets were randomly divided into the Control group and the sodium metasilicate pentahydrate (SMP) group. A decreased diarrhea incidence was observed in SMP treatment piglets. The intestine injury and activated stress hormones (COR and ACTH) induced by weaning was alleviated by SM-based AMW. This may be related to the improvement of intestinal microflora structure and function by SMP, especially the increase of s&#95;copri abundance. Meanwhile, SMP maintained the integrity of the duodenal mucus barrier in MS piglets. Importantly, by targeting NF-κB inhibition via the microbiota-gut interaction, SM-based AMW alleviated intestinal inflammation, maintained fluid homeostasis by modulating aquaporins and fluid transporter expression, and enhanced barrier integrity by suppressing MLCK/p-MLC signaling. Therefore, drinking metasilicate-based alkaline mineral water confers diarrhea resistance in MS piglets via the microbiota-gut interaction., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Declaration of Competing Interest There is no conflict of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The effects of bath therapy are complex and result from a unique interaction between the aquatic environment and the human body functions. The effect of bath therapy depends on both water temperature and chemical additives (mineral substances and humic substances). Värska Resort Centre, in south-eastern Estonia, uses for the balneotherapy the local curative mud and mineral water. The aim of the study was to evaluate and compare the effects of Värska's local mud bath and mineral water bath on moderate musculoskeletal pains in working-age people. The study involved 64 working-age subjects: within two weeks, 32 of them received five general mineral water baths, and another 32 received five general curative mud baths. Pain was assessed with the Nordic Musculosceletal Questionnaire, and muscle tension was measured with a myotonometer in m. erector spinae and m. trapezius. Measurements were performed three times: before the start of the study, immediately after the last procedure, and 2-3 weeks after the last procedure. Both the Värska curative mud bath and the Värska mineral water bath showed a positive effect on musculoskeletal pain and muscle tension. Both procedures can be recommended as drug-free interventions for mild to moderate musculoskeletal pain syndrome and muscle tensions, in both prevention and treatment., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

The purpose of the study was to determine the effect of native and selenium-modified mineral waters on metabolic syndrome models. Combined metabolic syndrome (combMS) was simulated in 70 white rats of male gender under standard vivarium conditions, using high-calorie food and single administration of streptozotocin. During the random sampling study the following groups of animals were formed: in the control group 1 (n=6) the rats had standard forage during the experiment; in the control group 2 (n=10) there were rats with combMS model without treatment; in the main groups, starting at the 61st day of combMS, the rats received: the 1st group (n=11) - Essentuki mineral water №4; the 2nd (n=16) - the same water with selenium; in the 3rd (n=11) - Slavyanovskaya mineral water; in the 4th (n=16) - Slavyanovskaya with selenium. Registration of the effects was determined by carbohydrate, protein and lipid metabolism. Metabolic syndrome was monitored by recording animal weight gain and the level of glycemia by the express method at the beginning and the end of the treatment course. As a result, in main groups glucose increased 1.5-2 times, urea and lactate - 1.5 times, triglycerides - 30-40% compared, to the data in the control group 1, against the background of reduced content of contrinsular hormones. All the animals with combMS (control 2 and all the main groups) increased α-amylase activity. The most significant corrective parameters of the metabolic syndrome were established: in the main group 1 - a decrease in hyperglycemia, in the 3rd main group - urea, and in the main groups 2 and 4 the lipid spectrum recovered and the level of lactate decreased. Modification of different mineral waters by selenium provides leveling of differences between them in therapeutic effectiveness.

The combination of traditional basic pharmacotherapy for rheumatoid arthritis (RA) and physiotherapeutic methods can reduce the activity of the disease and accelerate the onset of remission, and therefore the development of new non-drug methods for the treatment of RA is relevant., Purpose of the Study: Study of the effect of natural mineral water « Tib-1» on the lipid peroxidation system in an experiment with a model adjuvant-induced RA in rats., Material and Methods: The object of the study were Wistar rats, divided into three groups: negative control (solvents), positive control (model of adjuvant-induced RA by subcutaneous injection of complete Freund's adjuvant) and experimental (correction of RA with mineral water « Tib-1», diluted in a ratio of 1:3 during the first 2 weeks from the moment the model was formed in the ad libitum mode). On the 3rd and 7th weeks in the blood of the animals were determined: the total number of leukocytes, the content of hydroperoxides according to Gavrilov, the level of malondialdehyde (MDA), catalase activity. Pathological changes in the hip and knee joints were recorded using radiography., Results: The inflammatory process in the positive control group by the 3rd week was characterized by an increase in the number of leukocytes by 66% ( p <0.01) and was accompanied by an increase in MDA by 60% ( p <0.001). By the 7th week, despite a relative increase in catalase activity (16%), the MDA level continued to be elevated compared to the negative control by 67% ( p <0.001). Against the background of exposure to mineral water, inflammation decreased (the number of leukocytes in the "model/experiment" groups turned out to be reduced by 41%; p <0.01) and an increase in compensatory-adaptive reactions in the form of catalase activation was noted (by 8%; p <0.01), which was accompanied by a persistent (weeks 3 and 7) decrease in MDA output (by 20%; p <0.01). Using the method of radiation diagnostics, positive changes in the articular apparatus of experimental animals were revealed, consisting in the relief of signs of subchondral sclerosis of the bone heads, which were noted for animals of the model group., Conclusion: The use of natural mineral water «Tib-1» helps to reduce the acute inflammatory response during the formation of adjuvant-induced RA in Wistar rats, initiates the normalization of the balance of pro- and antioxidant processes in the body, and minimizes the intensity of degenerative-inflammatory joint lesions.

The need to expand the resort and recreational potential in the Siberian Federal District is due to the growing need for sanatorium treatment and rehabilitation of the population. Balneological studies conducted in different regions of Siberia make it possible to position these territories as promising for resort and recreational activities., Objective: Comprehensive integral assessment of the resort and recreational potential of the treatment areas of the Republic of Tyva., Material and Methods: Taking into account the requirements of the guidelines "Bioclimatic passport of the medical and recreational areas" No. 96/226, approved by the Ministry of Health of Russia on February 7, 1997, an integral medical and climatic assessment of the territories of the medical and recreational areas of the Republic of Tyva was carried out. The assessment of the quality of water resources was carried out in accordance with the criteria of the methodological recommendations "Control of the quality and safety of mineral waters by chemical and microbiological indicators" No. 96/225, approved by the Ministry of Health of Russia on 07.04.1997. The typification of water resources is given in accordance with GOST R 54316-2011 "Natural mineral drinking waters"., Results: The territory of the Republic of Tyva has the richest reserves of unique therapeutic hydro-mineral resources, and the existing features of landscape and climatic conditions determine the prospects for their widespread use. The surveyed areas are located on mid-mountain and low-mountain landscapes with favorable bioclimatic conditions for the organization of climate treatment and recreation, especially in the warm season. The prospects for the development of climate-balneological and climate-mud resorts in Tuva are shown, especially in terms of medical and health tourism., Conclusion: A detailed database has been developed on the components of the resort and recreational potential (bioclimate, mineral waters, therapeutic mud) of the treatment areas of Tuva. The data obtained formed the basis of proposals for updating the register of resorts and health-improving areas of the Siberian Federal District, which is formed on the basis of the results of many years of research.

The article dwells upon the history of the discovery of the Tumnin mineral spring, the establishment and development of the Far Eastern health resort «Goryachy Klyuch,» located in the basin of Chope creek, a tributary of the largest river in the eastern macroslope of Sikhote Alin, Tumnin river, located 25 km from the Strait of Tartary. A historical sketch since the first mentioning of the Tumnin mineral spring from 1903 to the present day, as well as the results of hydrogeological expeditions to determine the chemical composition and α-activity of Tumnin mineral water at different periods, are presented. A contribution of a geological expedition that established a large deep-lying tectonic structure permeable to upwelling thermal water flows is described. The role of the staff of the physiotherapy and balneology department of the Khabarovsk Medical Institute in the study of the mechanism of action and clinical effectiveness of the Tumnin mineral water is addressed. A balneological characteristic of nitric and siliceous thermal water, the basic therapeutic factor of «Goryachy Klyuch» health resort, which has always been popular among the Far East residents, but gained special importance and appreciation of patients during the pandemic of new coronavirus infection, is given. Currently, in the health resort «Goryachy Klyuch», patients with skin diseases, musculoskeletal, gynecologic, neurologic diseases, digestive tract disorders, metabolic conditions, upper airways, cardiovascular disorders, occupational diseases are treated using balneotherapy and other methods of non-drug therapy. At present, the health resort «Goryachy Klyuch» is going through a difficult but interesting period of improvement of recreation opportunities for the Far East residents.

Objective: Osteoarthritis (OA) results from loss of cartilage in-tegrity in association with changes to the structure of the entire joint. Treatment of OA is based on different pharmaceutical and no phar-maceutical approaches and the latter include the use of spa-therapy. The biological effects of mud-bath therapy are mainly secondary to heat stimulation and to physic-chemical properties of mineral waters and mud-packs. Mud-bath therapy likely exerts its effects modulating several cytokines and other molecules involved in inflammation and cartilage degradation. Our aim was to perform an updated meta-analysis of the effectiveness of the mud-bath therapy on knee osteoarthritis and briefly to discuss the mechanisms of action of this treatment., Materials and Methods: A MEDLINE on PubMed for articles on knee OA and spa therapy published from 1995 through up to April 2019 was performed. Then, we checked the Cochrane Central Register of Controlled Trials to find additional references included up to April 2019. Articles were included if in accordance with the eligibility cri-teria. Sample size and effect sizes were processed with the MedCalc software package., Results: Twenty one studies met the inclusion criteria and were included in meta-analysis. We examined WOMAC Index and VAS pain. We found significant improvements in function scores and painful symptoms after mud-bath therapy in patients with knee joint osteoarthritis., Conclusions: Spa therapy is a non-drug treatment modalities, non invasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis. It cannot substitute for conventional therapy but can integrated or alternated to it. Treatment with mud-bath therapy may relieve pain, stiffness and improve functio-nal status in patients with knee OA.

The effect of hyper-mineral waters on human health has long been debated. This pilot study evaluated the influence of San Martino® water (Sardinia, Italy), on clinical and biological parameters, following the treatment of 10 hospitalized patients. Crenotherapy consisted of 1-2 L of the water daily for 10 days. A complete blood count, serum electrolytes, liver and kidney function tests, fasting lipid profile and plasma glucose, and abdominal ultrasound imaging were assessed before and at the end of treatment. In addition, body weight, dyspeptic symptoms, bowel movements, diuresis, uricuria and blood pressure were evaluated daily. According to its physico-chemical properties, the water is hyper-mineral (TDS 2808 mg/L) with a high content of bicarbonate and iron. At the end of the study, diuresis increased by 60% (850 vs 1295 ml/24 h, P = 0.009) and uricuria by 41% (362 vs 490 mg/24 h, P = 0.022) respectively, whereas plasma uric acid level decreased by 7% (4.7 vs 4.3 mg/dL, P = 0.043). Compared to the basal values, serum gamma-glutamyl transferase, alkaline phosphatase and total bilirubin levels, showed a reduction of 65% (31 vs 18 U/L, P = 0.022), 15% (96 vs 90 U/L, P = 0.041), and 11% (0.53 vs 0.45 g/dL, P = 0.041), respectively. Bowel movements improved in 62.5% of patients with constipation, and 80% of dyspeptic patients experienced symptoms relief. Compliance to the treatment reached 100%. Mild differences were observed in body weight and blood pressure, although not in ultrasound imaging during crenotherapy. These findings suggest that the San Martino® hyper-mineral water may have some benefits to human health. Additional studies with a larger-sized cohort and for a longer period are needed to confirm these preliminary results., (Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: To evaluate the effectiveness and safety of thermal mineral waters therapy for pain relief, and functional improvement, and quality of life (QoL) in patients with osteoarthritis (OA)., Methods: Cochrane Library, Web of science, EMBASE, ClinicalTrials.gov and PubMed were systematically searched for randomized controlled trials. Study inclusion criteria included assessment of the visual analog scale and Western Ontario and McMaster Universities scores and the lequesne index to evaluate the effects of thermal mineral waters on pain relief and functional improvement. Also, studies that used the European quality of life 5-dimension scale and health assessment questionnaire to assess the impact of thermal mineral waters therapy on improving QoL were included., Results: Sixteen studies were included. A meta-analysis showed that thermal mineral waters therapy could significantly reduce pain as measured visual analog scale and Western Ontario and McMaster Universities assessments (P < .001). Thermal mineral waters significantly reduced the lequesne index (P < .001) and improved joint function. Finally, compared with a control group, European quality of life 5-dimension scale and health assessment questionnaire improved significantly in patients with OA receiving thermal mineral waters therapy (P  < .05). There is no evidence that thermal mineral waters is unsafe for treating OA., Conclusion: Thermal mineral waters therapy is a safe way to relieve pain, improve physical functions, and QoL in patients with OA., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Gastroesophageal reflux disease (GERD) is one of the most common gastric pathologies. Recently, there has been a growing interest in the healing effects of mineral waters (MW)., Methods: Ninety patients with GERD were under observation. The study used the following methods: anamnestic, clinical, studies of biochemical blood parameters, ultrasonographic studies of the digestive system, fibroesophagogastroduodenoscopy with intragastric pH-metric. After preliminary research, all patients were randomly divided into three groups of 30 people. The control group (group 1) who were prescribed a basic treatment complex-dietary and proton pump inhibitor group drugs. Patients of group 2 in addition to the standard course of treatment received boric highly mineralized bicarbonate sodium water. Patients of group 3 in addition to the basic therapy were prescribed an internal course treatment of highly mineralized sulfate-bicarbonate sodium-magnesium water., Results: The use of the basic complex of treatment for a month in control group did not lead to a significant leveling of signs of dyspeptic and asthenic syndromes. The use of boron highly mineralized sodium bicarbonate water led to a significant leveling of signs of abdominal pain and dyspeptic syndromes, improvement of acid-forming function of the stomach, but no reliable dynamics were observed in eliminating signs of cytolytic, mesenchymal inflammatory and cholestatic syndromes. Application of highly mineralized sulfate-hydrocarbonate sodium magnesium water improves the elimination of dyspepsia and pain syndromes, normalization of the functional state of the liver., Conclusions: The obtained data confirm the prospects of using highly mineralized mineral waters in the complex treatment of GERD patients.

The common therapeutic indications of Portuguese Natural Mineral Waters (NMWs) are primarily for respiratory, rheumatic and musculoskeletal systems. However, these NMWs have been increasingly sought for dermatologic purposes. Opposing to what is observed in the major European Thermal Centres, there are few scientific evidences supporting the use of Portuguese NMWs for clinical applications. The aim of this study was to characterize the antimicrobial profile of individual NMWs from the central region of Portugal and correlate the results with their physicochemical characterization. An extensive multivariate analysis (principal component analysis) was also performed to further investigate this possible correlation. Six collection strains representing skin microbiota, namely Staphylococcus aureus, Escherichia coli, Corynebacterium amycolatum, Candida albicans, Staphylococcus epidermidis and Cutibacterium acnes, were analysed, and their antimicrobial profile was determined using Clinical and Laboratory Standards Institute M07-A10, M45-A2, M11-A6 and M27-A3 microdilution methods. Different NMWs presented different antimicrobial profiles against the strains used; the physicochemical composition of NMWs seemed to be correlated with the different susceptibility profiles. Cutibacterium acnes showed a particularly high susceptibility to all NMWs belonging sulphurous/bicarbonated/sodic ionic profile, exhibiting microbial reductions up to 65%. However, due to the complex physicochemical composition of each water an overall conclusion regarding the effect of a specific ion on the growth of different microorganisms is yet to be known.

Background: Chronic plaque psoriasis is an immune-mediated, chronic, inflammatory skin disease, which can impair quality of life and social interaction. Disease severity can be classified by the psoriasis area and severity index (PASI) score ranging from 0 to 72 points. Indoor artificial salt bath with or without artificial ultraviolet B (UVB) light is used to treat psoriasis, simulating sea bathing and sunlight exposure; however, the evidence base needs clear evaluation., Objectives: To assess the effects of indoor (artificial) salt water baths followed by exposure to artificial UVB for treating chronic plaque psoriasis in adults., Search Methods: We searched the following databases up to June 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trial registers, and checked the reference lists of included studies, recent reviews, and relevant papers for further references to relevant trials., Selection Criteria: Randomised controlled trials (RCTs) of salt bath indoors followed by exposure to artificial UVB in adults who have been diagnosed with chronic plaque type psoriasis. We included studies reporting between-participant data and within-participant data. We evaluated two different comparisons: 1) salt bath + UVB versus other treatment without UVB; eligible comparators were exposure to psoralen bath, psoralen bath + artificial ultraviolet A UVA) light, topical treatment, systemic treatment, or placebo, and 2) salt bath + UVB versus other treatment + UVB or UVB only; eligible comparators were exposure to bath containing other compositions or concentrations + UVB or UVB only., Data Collection and Analysis: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. The primary efficacy outcome was PASI-75, to detect people with a 75% or more reduction in PASI score from baseline. The primary adverse outcome was treatment-related adverse events requiring withdrawal. For the dichotomous variables PASI-75 and treatment-related adverse events requiring withdrawal, we estimated the proportion of events among the assessed participants. The secondary outcomes were health-related quality of life using the Dermatology Life Quality Index, (DLQI) pruritus severity measured using a visual analogue scale, time to relapse, and secondary malignancies., Main Results: We included eight RCTs: six reported between-participant data (2035 participants; 1908 analysed), and two reported within-participant data (70 participants, 68 analysed; 140 limbs; 136 analysed). One study reported data for the comparison salt bath with UVB versus other treatment without UVB; and eight studies reported data for salt bath with UVB versus other treatment with UVB or UVB only. Of these eight studies, only five reported any of our pre-specified outcomes and assessed the comparison of salt bath with UVB versus UVB only. The one included trial that assessed salt bath plus UVB versus other treatment without UVB (psoralen bath + UVA) did not report any of our primary outcomes. The mean age of the participants ranged from 41 to 50 years of age in 75% of the studies. None of the included studies reported on the predefined secondary outcomes of this review. We judged seven of the eight studies as at high risk of bias in at least one domain, most commonly performance bias. Total trial duration ranged between at least two months and up to 13 months. In five studies, the median participant PASI score at baseline ranged from 15 to 18 and was balanced between treatment arms. Three studies did not report PASI score. Most studies were conducted in Germany; all were set in Europe. Half of the studies were multi-centred (set in spa centres or outpatient clinics); half were set in a single centre in either an unspecified settings, a psoriasis daycare centre, or a spa centre. Commercial spa or salt companies sponsored three of eight studies, health insurance companies funded another, the association of dermatologists funded another, and three did not report on funding. When comparing salt bath plus UVB versus UVB only, two between-participant studies found that salt bath plus UVB may improve psoriasis when measured using PASI 75 (achieving a 75% or more reduction in PASI score from baseline) (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.24 to 2.35; 278 participants; low-certainty evidence). Assessment was conducted at the end of treatment, which was equivalent to six to eight weeks after start of treatment. The two trials which contributed data for the primary efficacy outcome were conducted by the same group, and did not blind outcome assessors. The German Spas Association funded one of the trials and the funding source was not stated for the other trial. Two other between-participant studies found salt bath plus UVB may make little to no difference to outcome treatment-related adverse events requiring withdrawal compared with UVB only (RR 0.96, 95% CI 0.35 to 2.64; 404 participants; low-certainty evidence). One of the studies reported adverse events, but did not specify the type of events; the other study reported skin irritation. One within-participant study found similar results, with one participant reporting severe itch immediately after Dead Sea salt soak in the salt bath and UVB group and two instances of inadequate response to phototherapy and conversion to psoralen bath + UVA reported in the UVB only group (low-certainty evidence)., Authors' Conclusions: Salt bath with artificial ultraviolet B (UVB) light may improve psoriasis in people with chronic plaque psoriasis compared with UVB light treatment alone, and there may be no difference in the occurrence of treatment-related adverse events requiring withdrawal. Both results are based on data from a limited number of studies, which provided low-certainty evidence, so we cannot draw any clear conclusions. The reporting of our pre-specified outcomes was either non-existent or limited, with a maximum of two studies reporting a given outcome. The same group conducted the two trials which contributed data for the primary efficacy outcome, and the German Spas Association funded one of these trials. We recommend further RCTs that assess PASI-75, with detailed reporting of the outcome and time point, as well as treatment-related adverse events. Risk of bias was an issue; future studies should ensure blinding of outcome assessors and full reporting., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Competing Interests: Declaration of competing interest None to declare.

Purpose of Review: The role of the mineral constituents in water and their role in kidney stone disease (KSD) have been a long-standing subject of debate. The aim of our systematic review was to evaluate the relevance of different types of water in stone disease., Recent Findings: Studies to date have had varying results regarding the importance of hardness of water which is mostly determined by its calcium content. Other elements including magnesium and bicarbonate also play a crucial role in prevention of renal stones. Patients with stone disease are provided varying advice due to a lack of consensus on the types of water recommended. Increased fluid intake prevents stone formation. Our review of the literature suggests that hard water and bottled mineral water might be helpful for calcium stone formers. High calcium content in them leads to hypercalciuria; however, other factors also influence stone formation and the overall impact seems to be a reduction in calcium stone formation. The mineral content varies across different water types but high magnesium and bicarbonate content in water is also recommended for kidney stone patients.

The sequelae of burns often are complicated by inflammatory and hypertrophic scars. Thermal cures can make a noticeable difference in improving these situations, which can be associated with considerable aesthetic damage and altered function. In this setting the benefits of the anti-inflammatory and antipruritic properties of thermal waters are combined with a high-pressure shower technique - the filiform shower - designed to soften and shape the infiltrated and hypertrophied skin areas. It is important to integrate the thermal cure at an early stage in the management of the condition, always considering it as an adjunct to the other therapeutic options available for the management of post-burn scarring. © 2020 Elsevier Masson SAS. All rights reserved., (Copyright © 2020 Elsevier Masson SAS. Tous droits réservés.)

In this article we present the review of the literature and our own research regarding gastroesophageal reflux disease (GERD) with cardiac manifestations. The methods of treatment of patients with GERD using mineral waters, physio- and balneotherapeutic factors, as well as acupuncture are discussed. The conclusion is drawn about the effectiveness of the use of non-pharmacological methods in mono- and complex therapy of GERD and the need for further research in this direction.

Natural mineral waters can be characterised according to their different thermal, mineral and physicochemical properties. France has a wide scale of natural mineral waters of very varied composition and temperature. Thermal waters do not undergo any treatment and are used on the thermal site with a constant temperature, mineralisation and flow. In France there are about 90 spas; each year more than 600,000 patients benefit from the therapeutic properties of thermal waters. © 2020 Elsevier Masson SAS. All rights reserved., (Copyright © 2020 Elsevier Masson SAS. Tous droits réservés.)

Dermatological toxicities (affecting the skin, mucous membranes, nails or hair) are frequently associated with cancer treatments. They can represent a real burden for patients, with physical, social and psychological repercussions. These dermatological adverse events can also persist long after the treatment has ended, especially after treatment with cytotoxic chemotherapeutic agents such as taxanes. There is a clear need for the development of suitable supportive care measures to help manage these toxicities. The place of a hydrotherapy treatment in this context remains to be clarified. This article summarizes the main data available on the quality of life, and more specifically the dermatological quality of life, of patients for whom hydrotherapy was proposed after breast cancer. © 2020 Elsevier Masson SAS. All rights reserved., (Copyright © 2020 Elsevier Masson SAS. Tous droits réservés.)

Thermalism is one of the oldest medical disciplines with a history of thousands of years and whose benefits are well documented. The therapy is based on a program of daily care for a period of three weeks in a thermal station. Hydrotherapy is particularly suitable in dermatology since the thermal water will be in direct contact with the skin lesions. The main indications are eczema, psoriasis, chronic pruritus, and wound healing disorders with new indications emerging, such as for cancer treatment-related side effects and follow-up care after cancer treatment. Thermalism encompasses much more than hydrotherapy, acquiring over the past few years a distinct place in therapeutic education. The therapy, which for a long time has been seen as an alternative to pharmacological treatments, should be positioned as an adjunct treatment for chronic dermatoses, aiming at reducing in the mid and long term the severity of the disease and drug dependence. © 2020 Elsevier Masson SAS. Tous droits réservés., (Copyright © 2020 Elsevier Masson SAS. Tous droits réservés.)

The classical description of psoriasis does not include any of the subjective symptoms that accompany skin manifestations (pruritus, burning, tingling, pain), which is surprising especially for pruritus, a symptom present in the majority of patients with this disease, in a variable proportion between 60% and more than 90%. For the last two decades, the scientific interest for this symptom has increased. Many studies are evaluating the potential positive effect of various classes of drugs. No therapy is totally free of side effects. Psoriasis is an indication of the thermal treatment. The thermal water from Avène Hydrotherapy Center is known for its anti-inflammatory and immunomodulatory properties, as shown by many scientific studies. In this context, from the year 2016, in the Thermal Center, we studied the prevalence and characteristics of pruritus in patients with psoriasis, who came for a thermal treatment, but also the effect of hydrotherapy. In 2016, a study based on a dedicated questionnaire, administered at the entrance of the thermal station, revealed the presence of pruritus for 92% of patients who responded. In the period 2017-2018, the evaluation of pruritus associated with psoriasis on a numerical scale, in parallel with the evaluation of the severity of the disease by the thermal physician, showed the improvement of the psoriatic pruritus by 42% after the hydrotherapy cure. Recent results suggest that treatment in Avène Hydrotherapy Center might be considered for managing psoriasis accompanied by subjective symptoms, especially pruritus. © 2020 Elsevier Masson SAS. All rights reserved., (Copyright © 2020 Elsevier Masson SAS. Tous droits réservés.)

Objectives: First-line recommendations for the management of functional constipation include nutritional-hygienic measures. We previously showed that a natural mineral water rich in sulphates and magnesium (Hépar) is efficient in the treatment of functional constipation. The aim of this study was to consolidate those first results and determine a precise time to respond to Hépar., Methods: This multicenter, randomized, double-blind, controlled study of the effect of Hépar on stool consistency and frequency in functional constipation included 226 outpatients. After washout, patients used 1.5 L of water daily, including 1 L of Hépar or of low-mineral water, during 14 d. In addition to a daily reporting of stool consistency by the patient, an expert investigator blindly analyzed stool consistency (Bristol stool scale) based on photographs taken by the patient., Results: The primary endpoint was met. Treatment response was more frequent in the Hépar arm than in the control group at day 14 (50% versus 29%, respectively; P = 0.001). Mean time to treatment response was shorter in the Hépar group (6.4 d) than in the control arm (7.3 d; P = 0.013). Concomitant stool scoring was available for 60% of the patients. Scores given to 79% of the stools were similar between the patient and the expert (differences ≤1). Safety analyses showed excellent results., Conclusion: This study confirms the efficacy and safety of Hépar in the treatment of functional constipation and shows that it is associated with a response within 7 d. Hépar could be a safe response to the current absence of first-line medication in the treatment of functional constipation., (Copyright © 2019. Published by Elsevier Inc.)

The use of alkaline mineral waters leads to alkalization of urine and an increase in level of urinary citrate, which represent important factor inhibiting the formation of urinary stones. Combination of alkaline mineral waters with citrates facilitates the achievement of target urine pH level not only during dissolution therapy, but also during recurrence prevention. Alkalization of urine and reducing of the influence of alimentary factor dont preclude drug therapy. Patients should be counselled about complex strategies aimed to modifiable risk factors for urinary stone disease.

The place and indications for recurrence prevention of urinary stone disease, general principles of recurrence prevention, role of mineral water and changes of dietary habits during recurrence prevention are reviewed in the article.

Background: Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group., Methods: Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO 4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days., Results: Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP., Conclusions: The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO 4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach., Trial Registration: ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Background: Exercise and heat trigger dehydration and an increase in extracellular fluid osmolality, leading to deficits in exercise performance and thermoregulation. Evidence from previous studies supports the potential for deep-ocean mineral water to improve recovery of exercise performance post-exercise. We therefore wished to determine whether acute rehydration and muscle strength recovery was enhanced by deep-ocean mineral water following a dehydrating exercise, compared to a sports drink or mountain spring water. We hypothesized that muscle strength would decrease as a result of dehydrating exercise, and that recovery of muscle strength and hydration would depend on the type of rehydrating fluid., Methods: Using a counterbalanced, crossover study design, female (n = 8) and male (n = 9) participants performed a dehydrating exercise protocol under heat stress until achieving 3% body mass loss. Participants rehydrated with either deep-ocean mineral water (Deep), mountain spring water (Spring), or a carbohydrate-based sports drink (Sports) at a volume equal to the volume of fluid loss. We measured relative hydration using salivary osmolality (S osm ) and muscle strength using peak torque from a leg extension maneuver., Results: S osm significantly increased (p < 0.0001) with loss of body mass during the dehydrating exercise protocol. Males took less time (90.0 ± 18.3 min; P < 0.0034) to reach 3% body mass loss when compared to females (127.1 ± 20.0 min). We used a mono-exponential model to fit the return of S osm to baseline values during the rehydrating phase. Whether fitting stimulated or unstimulated S osm , male and female participants receiving Deep as the hydrating fluid exhibited the most rapid return to baseline S osm (p < 0.0001) regardless of the fit parameter. Males compared to females generated more peak torque (p = 0.0005) at baseline (308.3 ± 56.7 Nm vs 172.8 ± 40.8 Nm, respectively) and immediately following 3% body mass loss (276.3 ± 39.5 Nm vs 153.5 ± 35.9 Nm). Participants experienced a loss. We also identified a significant effect of rehydrating fluid and sex on post-rehydration peak torque (p < 0.0117)., Conclusion: We conclude that deep-ocean mineral water positively affected hydration recovery after dehydrating exercise, and that it may also be beneficial for muscle strength recovery, although this, as well as the influence of sex, needs to be further examined by future research., Trial Registration: clincialtrials.gov PRS, NCT02486224 . Registered 08 June 2015.

The therapeutic effects of mineral waters have been attributed to the inorganic components alone; however, biologically active organic components are also present. We aimed to investigate whether the healing effect of Szigetvár thermal mineral water could relate to the organic matter in patients suffering from osteoarthritis of the hips and the knees. XAD macroreticular resins were used to prepare the organic fraction. Patients received a 30-min thermal water (34 °C) treatment in a bath tub, five times a week for 3 weeks. After randomization, patients were divided into three groups: tap water, mineral water, and organic fraction group. Primary outcomes were range of movement (ROM), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain severity, and the Short Form 36 (SF-36) questionnaire was used. These scores and indices were measured at baseline, after the last treatment, and at the end of the 3-month follow-up period. Seventy-four patients (age 67.3 ± 4.48 years) were enrolled: tap water n = 24, mineral water n = 26, and organic fraction n = 24. Treatment with the redissolved organic fraction significantly improved ROM, WOMAC, and SF-36 scores compared to the tap water. Our clinical trial provided evidence for the beneficial health effects of the organic fraction of Szigetvár medicinal water.

Background: The relevance of this study is determined by the need for the scientifically sound substantiation of the possibility for the use of acidic mineral waters in the treatment of digestive diseases taking into consideration their widespread application in ethnomedicine, in particular in the Republic of Tuva., Aim: The objective of the present study was to elucidate the gastroprotective action of acidic mineral water from the Azhyg-Sug source (Republic of Tyva) on the experimental animals as exemplified by the model of ulcerogenesis under the conditions of immobilization stress., Material and Methods: The experimental studies were carried out with the use of 32 white rats of the Wistar line. Ulcerogenesis was initiated by means of immobilization stress. We evaluated the pathomorphological characteristics of the gastric mucosa and the number of destructions based on the Pauls index. The state of the lipid peroxidation system and antioxidative protection were determined from the content of malon dialdehyde and reduced glutathione, extracellular catalase and superoxide dismutase activities in erythrocytes., Results: The study has demonstrated that the mineral water from the Azhyg-Sug source slows down the development of the inflammatory and destructive necrotic processes in the mucosa of the stomach of albino rats. The depth of erosion in the animals receiving mineral water was 2.3 and 3.4 times lower than in the control animals (p≤0.05). The antioxidant effect of mineral water was confirmed by the 14-20% decrease of the MDA concentration as well as by the increase of the catalase and superoxide dismutase (SOD) activities by 21-25% and 20-30% respectively in comparison with the control animals., Conclusion: The Azhyg-Sug mineral water has the strong gastroprotective influence on the experimental animals having the induced neurogenic ulcer. One of the mechanisms underlying the gastroprotective action of the investigated mineral water arises from its ability to inhibit the processes of lipid peroxidation with the simultaneous enhancement of the activity of the antioxidant system of the organism.

The article presents the main stages of studying the mineral ferruginous waters of the first Russian spa 'Marcial Waters', the beginning of the 300-year history of which is associated with the name of Peter I. It gives the results of studies of natural sources in the 18 th and 19 th centuries. Studies of the mineral waters during the exploration and exploitation of the field in the 20 th century have shown that in the local area, wells open confined groundwater that has various mineralization and iron content and forms the characteristic hydrochemical type of mineral water called marcial. It is noted that the results of the long-term, but insufficiently regular and analytically comprehensive series of observations of the composition of an extremely unstable system of ferruginous waters do not allow one to unequivocally identify seasonal and long-term changes in the composition of the water. Regular isotope-chemical studies, which began in 2018, will make it possible to identify the patterns of formation of unique fresh high-iron waters.

Natural medicinal resources are a country’s natural wealth. Natural medicinal waters, medicinal gases, and peloids have many properties that enable their use in the treatment of gastrointestinal, circulatory, respiratory, bone and joint, and skin and soft tissue disorders. Balneotherapy can be also applicable in prevention of many diseases and rehabilitation. At present, because there are several chemicals of synthetic origin, there is a need to search for nonpharmacological approaches and explore natural healing sources, which better fit the human body. Compared to synthetic drugs, these resources rarely show side effects, which increases the comfort of therapy. The use of natural medicinal resources in the form of treatments in health resort medicine centers under the supervision of balneologists, combined with the healing properties of the climate, contributes not only to the reduction of treatment time for many diseases but also to improvement of therapy’s results. The article discusses natural medicinal resources and some of their therapeutic applications., Competing Interests: The authors declare no conflict of interest, (National Institute of Public Health - National Institute of Hygiene)

Background: Investigations into the medicinal properties of 'Omonkhona' mineral water used for the treatment of hepatobiliary pathology make up the entirely new field of balneological research in Uzbekistan., Aim: The objective of the present study was to identify the hepatoprotective and choleretic components of the 'Omonkhona' mineral water and elucidate their action in the patients presenting with the diseases of the hepatobiliary system., Material and Methods: A total of 77 patients suffering from the diseases of the hepatobiliary system were available for the examination including 38 patients with chronic hepatitis (CH), 17 with chronic cholecystitis (CC), and 22 patients with liver cirrhosis (Cr). All the patient were prescribed drinking the mineral water (from 1.0 to 3.0 liters per day) during consequtive 12-14 days. The clinical, biochemical, and instrumental studies were carried before and after the treatment., Results: The treatment with 'Omonkhona' water resulted either in the complete elimination or the significant alleviation of pain in the right hypochondrium. The patients presenting with CH and CC experienced normalization of ESR even though it remained high in the Cr patients. All the patients exhibited a decrease of specific gravity of the urine, probably due to the diuretic effect of the mineral water. The biochemical studies of blood and bile showed that the initially slightly enhanced bilirubin levels, alanine aminotransferase and alkaline phosphatase activities in the CH and CC patients normalized after a course of the treatment with 'Omonkhona' mineral water (p<0.05). No such changes were documented in the patients with liver cirrhosis. The patients with CH and CC experienced the two-fold reduction in the intensity of inflammation whereas the bilirubin and bile acid levels increased although the relative cholesterol content decreased and the cholate-cholesterol coefficient increased (p<0.05). The Cr patients demonstrated only insignificant changes of these parameters. The ultrasound examination showed that the CC patients treated with 'Omonkhona' mineral water had a decrease in the swelling of the gallbladder walls, the improvement of its motor function and the disappearance of the stagnation phenomenon. In the CH patients, there was a significant decrease in the cranio-caudal size of the right lobe of the liver, the cranio-caudal size of the left lobe, and the anteroposterior size of the left lobe (p<0.05). A decrease in the acoustic conductivity was noted that can probably be attributed to the reduced swelling of the liver parenchyma. The Cr patients had no significant changes of these parameters following the treatment., Conclusions: The results of this study give evidence that the treatment of the diseases of the hepatobiliary system with 'Omonkhona' mineral water exerts the well apparent positive influence on the patients presenting with CC and CH even though its beneficial effect was less pronounced in the patients with livre cirrhosis.

Background: The urgent tasks of experimental balneology are to design and investigate of the action of native mineral waters (MW) enriched with essential trace elements in order to improve their therapeutic and prophylactic effects., Objective: To investigate the mechanisms of direct action of the cycle intake of Essentuki MWs modified with selenium (Essentuki Novaya - MW1, Essentuki No. 4 - MW2) on healthy animals., Material and Methods: According to the experimental conditions, 102 male albino rats were divided into 7 groups using a simple randomization method. Group 1 (n=15) received only drinking water (DW) (a control group); Group 2 (n=13) used native MW1; Group 3 (n=13) took native MW2; Group 4 (n=15) had MW1 with selenium (MW1Se1 - 3 mcg/kg); Group 5 (n=15) received MW1Se2; Group 6 (n=15) had MW2Se1 - 300 mcg/kg; and Group 7 (n=16) used MW2Se2., Results: After cycle drinking, the body weight of the animals in the experimental groups did not significantly differ from that in the control group and was determined within the normal species range. X-ray densitometry showed that the body fat composition in the rats was lower than the control values only after MW1Se1, MW1Se2, and MW2Se1 cycles. The rat lipid spectrum in different groups displayed differences: the atherogenic index was low after MW1, MW1Se1, and MW1Se2 cycles. The blood glucose levels increased in the rats after drinking native MWs (F=2.7; p=0.01). After selenium-modified MW cycles, the blood glucose levels corresponded to the control values. The blood of experimental and control animals showed no differences in bone mineral density (BMD), levels of hormones (insulin, thyroxine, dehydroepiandrosterone (DHEA) and end products of protein metabolism. Selenium-modified Essentuki No. 4 changed the orientation of functional relationships from negative to positive ones between glucose and BMD., Conclusion: The findings suggest that cycle drinking with native and selenium-enriched Essentuki MWs differently affect the animals. The Essentuki Novaya MW (MW1, MW1Se1, and MW1Se2) drinking cycles predominantly affected in reducing blood atherogenic lipids. The volume of an animal fat component was lower after selenium-modified Essentuki Novaya and Essentuki No. 4 water (MW1Se1, MW1Se2, and MW2Se1) cycles. A direct relationship between DHEA and BMD was found in animals after using the selenium-enriched Essentuki No. 4 cycle.

Supersaturation of hydroxyapatite is very important in order to preserve the homeostasis of mineral metabolism in the oral cavity. This indicates to the ability of saliva to preserve the homeostasis of the tooth tissues. So it is very important to use inhalations and rinses with Tskhaltubo mineral water. It is the alpha radiation of radon contained in the water of Tskhaltubo that plays a very important role in the regulation of inflammatory processes and the preservation of homeostasis of the oral cavity. A lot of works have been published lately proving that these doses are characterized by the so-called "hormesis", so the object of our interest is to determine the mechanism of radon hormesis and its effects on preserving the homeostasis of mineral metabolism in the oral cavity. Inhalation with mineral water of Tskhaltubo and its use for rinsing in case of parodontitis leads to decrease and ultimately elimination of the developed inflammatory processes. Tests were conducted on 150 volunteers, 120 of which were sick and 30 were practically healthy (control). As a result of the research it was established that inhalations with mineral water of Tskhaltubo and its use for rinsing in case of parodontitis leads to decrease and ultimately elimination of the developed inflammatory processes of the oral cavity. The unique properties of the mineral water of Tskhaltubo are an important component of the treatment of parodontitis at the initial stage of the disease.

To determine whether spa therapy has a beneficial effect on pain and disability in patients with chronic shoulder pain, this single-blind randomised controlled clinical trial included patients with chronic shoulder pain due to miscellaneous conditions attending one of four spa centres as outpatients. Patients were randomised into two groups: spa therapy (18 days of standardised treatment combining thermal therapy together with supervised mobilisation in a thermal pool) and controls (spa therapy delayed for 6 months: 'immediate versus delayed treatment' paradigm). All patients continued usual treatments during the 6-month follow-up period. The main endpoint was the mean change in the French-Quick DASH (F-QD) score at 6 months. The effect size of spa therapy was calculated, and the proportion of patients reaching minimal clinically important improvement (MCII) was compared. Secondary endpoints were the mean change in SF-36, treatment use and tolerance. One hundred eighty-six patients were included (94 patients as controls, 92 in the spa group) and analysed by intention to treat. At 6 months, the mean change in the F-QD score was statistically significantly greater among spa therapy patients than controls (- 32.6 versus - 8.15%; p < 0.001) with an effect size of 1.32 (95%CI: 0.97-1.68). A significantly greater proportion of spa therapy patients reached MCII (59.3 versus 17.9%). Spa therapy was well tolerated with a significant impact on SF-36 components but not on drug intake. Spa therapy provided a statistically significant benefit on pain, function and quality of life in patients with chronic shoulder pain after 6 months compared with usual care.

Balneotherapy is the treatment of disease by bathing in thermal spring water. This therapy has been used for centuries and remains a popular form of treatment for dermatologic and rheumatologic diseases today. Although the favorable climates of balneotherapy thermal centers have known beneficial effects on psoriasis and atopic dermatitis, the thermal spring waters themselves can also potentially decrease skin inflammation. The addition of phototherapy to balneotherapy, or balneophototherapy, further enhances the anti-inflammatory effects of thermal spring water. We have reviewed the literature on balneotherapy in the treatment of skin diseases, as well as describing their use in three different treatment sites, each with unique climates and chemical properties of the mineral water used in balneotherapy-the Dead Sea in Israel and Jordan, the La Roche-Posay Thermal Center in France, and the Blue Lagoon in Iceland., (Copyright © 2018. Published by Elsevier Inc.)

The aim of this study was to investigate the effects of balneotherapy on chronic low back pain. This is a minimized, follow-up study evaluated according to the analysis of intention to treat. The subjects included in the study were 105 patients suffering from chronic low back pain. The control group (n = 53) received the traditional musculoskeletal pain killer treatment, while the target group (n = 52) attended thermal mineral water treatment for 3 weeks for 15 occasions on top of the usual musculoskeletal pain killer treatment. The following parameters were measured before, right after, and 9 weeks after the 3-week therapy: the level of low back pain in rest and the level during activity are tested using the Visual Analog Scale (VAS); specific questionnaire on the back pain (Oswestry); and a questionnaire on quality of life (EuroQual-5D). All of the investigated parameters improved significantly (p < 0.001) in the target group by the end of the treatment compared to the base period, and this improvement was persistent during the follow-up period. There were no significant changes in the measured parameters in the control group. Based on our results, balneotherapy might have favorable impact on the clinical parameters and quality of life of patients suffering from chronic low back pain.

Our previous crossover randomized trial suggested that spa therapy added to usual pharmacotherapy provides benefits that lasted 6 months over pharmacotherapy alone in rheumatoid arthritis patients. We now extend, and report the long-term results of that study. In the crossover trial, patients were randomized to spa therapy first group or control first group (first assignment, period 1, 6 months); after this period and washout phase (9 months), they crossed over to the other arm (second assignment, period 2, 6 months). In this long-term study, we now analyze the 15-month results of the first assignment, and 12-month results of the second assignment in the opposite side with a 6-month extension of the follow-up period. The clinical outcome measures were pain, patient and physician global assessment, Health Assessment Questionnaire, and Disease Activity Score-28. The 15-month results of first assignment revealed no statistically significant differences between the groups in any of the efficacy outcomes (p > 0.05 for all). The 12-month results for the second assignment after crossover revealed a statistically significant decrease between the groups regarding the patient global assessment scores (p = 0.016), physician global assessment scores (p = 0.003) and swollen joints counts (p = 0.030); however, no statistically significant difference was found between the groups in any of the other efficacy outcomes (p > 0.05 for all). The short- and medium-term beneficial effects of the 2-week spa therapy added to the usual pharmacotherapy observed through the initial 6-month evaluation period may be maintained mildly to moderately to the 12-month mark in rheumatoid arthritis patients receiving conventional disease-modifying antirheumatic drugs. Further studies with a larger sample size are needed for the confirmation of the study results.

Since 1966, Szigetvár in Hungary is well recognised as a thermal spa. Many patients suffering from rheumatic diseases are treated with its thermal mineral water. Our objective was to investigate the effects of a 3-week-long outpatient balneotherapy-based rehabilitation program on patients suffering from osteoarthritis of the hips and the knees. During the treatment period, patients received a 30-min underwater jet massage in a bath tub, five times a week. One patient group received jet massage in a bath tub containing mineral water; the other group received the same treatment in tap water. Primary outcomes were measured by range of movement of the involved joints and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Visual analogue scale (VAS) was applied to measure current severity of pain. Furthermore, quality of life was assessed using the Short Form 36 questionnaire (SF-36). Range of movement (ROM) score, Western Ontario and McMaster University Osteoarthritis Index and visual analogue scale were determined before the first treatment, after the last treatment and 3 months after the last treatment. SF-36 questionnaire was filled in before the first and after the last treatment. Fifty patients (17 male, 33 female mean age 66.7 ± 4.79 years) were enrolled. After randomisation, patients were divided into two groups: tap water n = 24 and mineral water n = 26. Treatment with the thermal mineral water of Szigetvár significantly improved ROM, WOMAC scores, and SF-36-scored quality of life of the patients. Our double-blind study provided evidence for the beneficial health effects of another Hungarian thermal mineral water masking the colour, odour and pH of the tap water and mineral water.

This article presents data concerning the natural medicinal resources in the southern part of the Tyumen region with special reference to the mineral water resources. The relevance of the work is determined by the presence of the huge deposits of medicinal sodium chloride and iodine-bromine thermal waters with the composition highly enriched in the trace elements suitable for the internal and external use and by the necessity of the assessment of their therapeutic value. The characteristics of the mineral waters of special interest are presented with the major emphasis placed on the chemical composition of sodium chloride waters used by the authors in the routine medical practice. The concrete results of the studiesdesigned to determine content of anions, cations, and trace elements in the water are reported. Taken together the high levels of iodine, bromine, and silica in mineral waters and their naturally high temperature provide a basis for their extensive and efficient application as a balneotherapeutic factor to be used for the purpose of the spa and health resort-based treatment and prophylaxis. Also, it opens up the prospects for the extension of the medical indications for the use of mineral waters the basis for further detailed study with a view to increasing medical evidence and taking into account regional particularities of natural iodine deficiency. Study of the action of trace elements of natural mineral waters taking into consideration the specific regional features of the territory in question, such as natural iodine deficiency. The study of the action of the microelements on the human organism in the cases of their combined application as well as the evaluation of their use for the prophylactic purposes constitutes an important scientific and practical problem.

The development of modern technologies in physiotherapy with the use of mineral waters, the expansion of the assortment of the medicinal and medicinal table waters as well as increasing the competitive advantages of domestic products require the more extensive marketing survey of the consumers' preferences in the market of mineral waters., Aim: The objective of the present study was the marketing evaluation of the consumers' preference in the segment of medicinal and medicinal table mineral waters in the city of Moscow., Materials and Methods: The survey involved 697 consumers of medicinal and medicinal table mineral waters. The sampling was carried out by the deterministic quota method. The field research was conducted by means of personal verbal interviews (32%) and the CATI to Web method (phone recruiting and on-line questioning) (68%) with the use of the structured questionnaire. Positioning was carried out making use of the two-dimensional schematic map and scoring assessment on an individual basis with calculation of integrated indicators., Results: The marketing evaluation has demonstrated that the principal motive for purchasing mineral waters in more than 40% of respondents was the treatment and prevention of various diseases including disturbances in the urogenital system as well as digestive and respiratory disorders that appear to be the most frequent reasons for the consumption of mineral waters. The main factors that form the preferences of the consumers as regards the use of a concrete variety of mineral waters were elucidated. Of crucial importance for approximately 40% of the consumers (p<0.01) proved to be their health condition, the medical indications, and the available information about the therapeutic effectiveness of one or another type of mineral waters. Other factors were the quality of mineral water, its cost, the manufacturer and/or place of production, the attractiveness of the packaging, etc., Conclusion: The evaluation of the positioning of the mineral water consumers' preferences made it possible to identify the most preferable products in the group of medicinal mineral waters and in the group of medicinal table mineral waters. The mechanisms governing the formation of the consumers' preferences as regards the use of various mineral waters have been clarified in the course of the present study.

The ever increasing attention to the further development of the health resort business and touristic activities in this country implies the necessity of the proper scientifically sound substantiation for the more efficient exploitation of the available spa and health resort resources of the Russian Far East as well as the ample recreational potential of this region taking into consideration that they have not been completely utilized during the preceding period., Aim: The objective of the present study was to evaluate the of the «Goryachy Plyazh (Hot Beach)» physiotherapeutic facility on the Kunashir island., Materials and Methods: We have studies the chemical, bacteriological, and radiological properties of thermal waters from the natural sources located in the vicinity of the «Goryachy Plyazh» physiotherapeutic facility. The medical potential of the area was assessed in accordance with the methodological guidelines №96/226 on drawing up the bioclimatic passport approved by the Ministry of Public Health of the Russian Federation on the 7thFebruary of 1997., Results: We have proposed the aggregate indicator of the therapeutic and recreational potential making it possible to evaluate the totality of health-improving properties in the combination with the landscape and climatic characteristics of the locality of interest. The neighbourhood of the «Goryachy Plyazh» physiotherapeutic facility on the Kunashir island was found to harbour the sources of mineral waters of various types. Specifically, siliceous thermal waters of varying ionic composition (e.g. containing chlorides, sodium, silicium, and boron) of the Omsk and Ursdon types are suitable for multipurpose therapeutic utilization including the protracted internal application for the treatment of chronic gastritis and other intestinal problems, diseases of liver and endocrine system, as well as metabolic disorders. Mineral water of the Kul'dursky type can be used for the external use in the form of bathing and other hydrotherapeutic procedures for the management and prevention of the diseases of various dermatoses, the diseases of the nervous, musculoskeletal, and genitourinary systems., Conclusion: The results of the study give evidence of the ample aggregate therapeutic and recreational potential of the localities in the neighbourhood of the «Goryachy Plyazh» physiotherapeutic facility located on the Kunashir island amounting to 76.5% which suggests the very promising prospects for the further development and utilization of this territory for the health resort business and touristic activities.