We have reported the case of a patient diagnosed as having advanced gastric cancer at the age of 88 years old. An endoscopy revealed a type-2 gastric cancer of 25 x 30 mm in the lesser curvature of the middle stomach body and an IIa gastric cancer with T2 SS and cardiac accessory lesions. Both the type-2 and IIa lesions were defined as tub1 with surrounding atrophic gastritis and entero-epithelium metaplastic carcinoma. Considering the patient's age and her desire not to receive cancer treatment, we prescribed laughter therapy as recommended by the Society for Healing Environment. The program was implemented in a laughter-inducing environment and consisted of five stages: (1) Making the patient feel safe, (2) Relaxing the patient, (3) Increasing the effectiveness, (4) Improving her condition and (5) Increasing her joy of living. One year and seven months later, an endoscopy of the lesser curvature of the middle stomach body indicated that the lesions clearly improved with a morphological reduction into IIa + IIc masses. A tissue biopsy revealed that nucleus abnormality clearly improved from the initial diagnosis, with no irregularity in size. The suspected lesion was localized to a limited area near the stomach wall. Although partial gastric adenocarcinoma was suspected, the cancers turned into gastric adenoma, atrophic gastritis, and enteroepithelium metaplastic carcinoma. Now, five years after the initial diagnosis, she maintains a good condition. Laughter, one of our casual behaviors, has the effect of reducing the stress experienced by the human body. Laughter is expected to become alternative medicine in the future, and we hope to see more reports and evidence on soothing therapies using laughter.

The effect of viewing a humorous film on bronchial responsiveness to methacholine [methacholine study: 20 healthy participants and 20 patients with house dust mite (HDM)-allergic bronchial asthma (BA)] or to epigallocatechin gallate (EGCg; EGCg study: 15 normal participants and 15 EGCg-allergic BA patients) was studied. At baseline, bronchial challenge test to methacholine (20 normal participants and 20 HDM-allergic BA patients) or EGCg (15 normal participants and 15 EGCg-allergic BA patients) were performed. After 2 weeks, patients and healthy participants were randomly assigned to watch a humorous or a nonhumorous film. Two weeks later, the alternate film was watched. Immediately after viewing, bronchial challenge test to methacholine or ECGg to each study group were performed. Viewing a humorous film significantly reduced bronchial responsiveness to methacholine or EGCg, while viewing a nonhumorous film failed to do so in BA patients without affecting bronchial responsiveness to methacholine or EGCg in healthy participants. These findings indicate that viewing a humorous film may be useful in the treatment and study of BA.

AIM:To examine the effects of a once-weekly laughter and exercise program on physical and psychological health among elderly people living in the community. As a regular exercise program can be difficult to maintain, we provided a more enjoyable program to enhance adherence to exercise.

METHODS:A total of 27 individuals aged 60 years or older, without disabilities, were randomly assigned to either an immediate treatment group (n=14) or a delayed treatment group (n=13). The intervention was a 120-min session consisting of laughter and exercise, carried out once a week for 10 consecutive weeks. Measurements taken at baseline, 3 and 6 months included bodyweight, height, body fat, lean mass, bone mineral density, hemoglobin A1c (HbA(1c)), glucose, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides, as well as self-rated health and psychological factors.

RESULTS:All participants completed the 3-month program. Bone mineral density increased significantly in the immediate treatment group compared with the delayed treatment group during the first 3 months (P<0.001). In addition, HbA(1c) decreased significantly (P=0.001), and self-rated health increased significantly (P=0.012).

CONCLUSIONS:The combination of a laughter and exercise program might have physiological and psychological health benefits for the elderly. Laughter might be an effective strategy to motivate the elderly to participate in physical activity.

PURPOSE:In this study, the effects of laughter therapy on levels of depression, quality of life, resilience and immune responses in breast cancer survivors were examined.

METHODS:A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants (n=37) included breast cancer survivors who finished chemotheraphy and radiation therapy: 16 in the experiment group and 21 in the control group. Data were collected from August to November 2009. The experimental group participated in laughter therapy eight times, twice a week for 60 min per session. Questionnaires were used to measure pretest and posttest levels of depression, quality of life and resilience. A blood test was used to analyze changes in Total T cell, T helper, T suppressor, Th/Ts ratio, Total B cell, T cell/B cell ratio and NK cell for immune responses.

RESULTS:The results showed that laughter therapy was effective in increasing the quality of life and resilience in breast cancer survivors. but depression and immune responses did not differ significantly between the groups.

CONCLUSION:The results of the study indicate that laughter therapy may be an effective nursing intervention to improve quality of life and resilience in breast cancer survivors.

PURPOSE:The purpose of this study was to examine the effects of laughter therapy on postpartum fatigue and stress responses of postpartum women.

METHODS:The research design was a nonequivalent control group non-synchronized design. The participants were 67 postpartum women who agreed to participate in this study, selected by convenience sampling: (experiment group-33 and control group-34). The data were collected from August 5 to September 30, 2010. The experimental group received laughter therapy from a laughter therapy expert for 60 min, twice a week for 2 weeks, a total of 4 sessions. To evaluate the effects of laughter therapy, postpartum fatigue by self-report questionnaire and cortisol concentration in breast milk were measured. The data were analyzed using the SPSS WIN 13.0 Program.

RESULTS:The first hypothesis that"the degree of postpartum fatigue in the experimental group participating in laughter therapy would be lower than that of the control group"was accepted. These findings indicate that laughter therapy has a positive effect on decreasing postpartum fatigue.

CONCLUSION:The finding provides evidence for use of complementary and alternative nursing in Sanhujori facilities and obstetric units to reduce postpartum women's fatigue.

OBJECTIVE: To be hospitalized is a highly distressing event for children. At present, a resort used in Spain and other countries to reduce children's anxiety in the health context are hospital's clown. We studied the effect of the hospital's clowns about the anxiety in children that going to be operated. METHODS: We recruited 60 children aged 6 to 10 years scheduled to undergo elective surgery. 30 children would have clowns before the surgery (case group) and 30 would not have them (control group). In the case group, two clowns performed for children. We measured the anxiety with several scales (STAIC, CCPH, faces scale), after the performance and until 7 days after the surgery. RESULTS: The outcomes show both groups a tendency to increase anxiety but the children of the case group showed less increase at the anxiety's score. In the control group is showed that the children are more alterated at seven days from the discharge. CONCLUSIONS: Children that receive the clown's care, have tendency to be less distressing and with less fear that another ones, measurement by STAIC and faces scale, and these results are maintained seven days after the discharge.

Static and dynamic hyperinflation is an important factor of exertional dyspnea in patients with severe COPD. This proof-of-concept intervention trial sought to study whether laughter can reduce hyperinflation through repetitive expiratory efforts in patients with severe COPD. For small groups of patients with severe COPD (n = 19) and healthy controls (n = 10) Pello the clown performed a humor intervention triggering regular laughter. Plethysmography was done before and up to 24 hours after intervention. Laughing and smiling were quantified with video-analysis. Real-time breathing pattern was assessed with the LifeShirt, and the psychological impact of the intervention was monitored with self-administered questionnaires. The intervention led to a reduction of TLC in COPD (p = 0.04), but not in controls (p = 0.9). TLC reduction was due to a decline of the residual volume. Four (22 [CI 95% 7 to 46] %) patients were > or = 10% responders. The frequency of smiling and TLC at baseline were independent predictors of TLC response. The humor intervention improved cheerfulness, but not seriousness nor bad mood. In conclusion, smiling induced by a humor intervention was able to reduce hyperinflation in patients with severe COPD. A smiling-derived breathing technique might complement pursed-lips breathing in patients with symptomatic obstruction.

The effect of laughter therapy on the plasma levels of renin, angiotensinogen, and prorenin was investigated in patients with type 2 diabetes. In the diabetic patients, the mean plasma renin concentrations were 24.6+/-12.1 ng/ml/h in the first observation (at the beginning of laughter therapy), 8.2+/-3.4 ng/ml/h in the second observation (three months after the beginning of laughter therapy) and 7.7+/-1.7 ng/ml/h in the third observation (six months after the beginning of laughter therapy). The mean plasma angiotensinogen concentrations in the 1st, 2nd and 3rd observations were 0.19+/-0.08, 0.47+/-0.12, 0.42+/-0.14 microg/ml, respectively. The mean plasma prorenin concentrations in the 1st, 2nd and 3rd observations during the laughter therapy were 195.1+/-66.2, 193.4+/-88.2 and 170.7+/-52.5 pg/ml, respectively. Plasma renin concentrations were significantly decreased (p<0.05) by the therapy. Subnormal concentrations of plasma angiotensinogen were found in the 1st observation and increased significantly (p<0.05) to the normal range after the therapy. Plasma prorenin concentration only slightly changed during the laughter therapy. Other biochemical parameters remained unchanged during the laughter therapy. These results indicated that a long-term laughter therapy changed the plasma components of renin-angiotensin system in patients with diabetes. Thus, laughter therapy can be used as non-pharmacological treatment for the prevention of diabetic microvascular complications.

To elucidate the sustainable effects of laughter on gene expression, we recruited type 2 diabetic patients who were in-patient for receiving self-management education and examined time-dependent regulation for gene expression by laughter. Two-day experiment was performed. On one day, the patients watched comic video and laughed together with hospital staffs. On the other day, they participated in an inpatient diabetes educational program. Blood samples were collected before and 1.5, 4 h after watching comic video or spending lecture time, and changes in gene expression were comprehensively analyzed by microarray technique. Of the 41,000 genes analyzed, the laughter relatively up-regulated 39 genes, among which, 27 genes were relatively increased in the expression for all the observation period after watching comic video. By functional classification of these genes, 14 genes were found to be related to natural killer cell activity. No genes were included that are directly involved in blood glucose regulation, though successive suppression of postprandial blood glucose levels was observed. These results suggest that the laughter influences the expression of many genes classified into immune responses, and may contribute to amelioration of postprandial blood glucose elevation through a modulation of NK cell activity caused by up-regulation of relating genes.

OBJECTIVE:To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs).

METHODS:A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre-post design was used to measure positive and negative affect, happiness, blood pressure and pulse.

RESULTS:Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6.

CONCLUSION:This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs.

OBJECTIVE:To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs).

METHODS:A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre-post design was used to measure positive and negative affect, happiness, blood pressure and pulse.

RESULTS:Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6.

CONCLUSION:This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs.

BACKGROUND: Laughter Yoga founded by M. Kataria is a combination of unconditioned laughter and yogic breathing. Its effect on mental and physical aspects of healthy individuals was shown to be beneficial. OBJECTIVE: The objective of this study was to compare the effectiveness of Kataria's Laughter Yoga and group exercise therapy in decreasing depression and increasing life satisfaction in older adult women of a cultural community of Tehran, Iran. METHODS: Seventy depressed old women who were members of a cultural community of Tehran were chosen by Geriatric depression scale (score > 10). After completion of Life Satisfaction Scale pre-test and demographic questionnaire, subjects were randomized into three groups of laughter therapy, exercise therapy, and control. Subsequently, depression post-test and life satisfaction post-test were done for all three groups. The data wereanalyzed using analysis of covariance and Bonferroni's correction. RESULTS: Sixty subjects completed the study. The analysis revealed a significant difference in decrease in depression scores of both Laughter Yoga and exercise therapy group in comparison to control group (p < 0.001 and p < 0.01, respectively). There was no significant difference between Laughter Yoga and exercise therapy groups. The increase in life satisfaction of Laughter Yoga group showed a significant difference in comparison with control group (p < 0.001). No significant difference was found between exercise therapy and either control or Laughter Yoga group. CONCLUSION: Our findings showed that Laughter Yoga is at least as effective as group exercise program in improvement of depression and life satisfaction of elderly depressed women. Copyright © 2010 John Wiley&Sons, Ltd.

BACKGROUND: Laughter Yoga founded by M. Kataria is a combination of unconditioned laughter and yogic breathing. Its effect on mental and physical aspects of healthy individuals was shown to be beneficial. OBJECTIVE: The objective of this study was to compare the effectiveness of Kataria's Laughter Yoga and group exercise therapy in decreasing depression and increasing life satisfaction in older adult women of a cultural community of Tehran, Iran. METHODS: Seventy depressed old women who were members of a cultural community of Tehran were chosen by Geriatric depression scale (score > 10). After completion of Life Satisfaction Scale pre-test and demographic questionnaire, subjects were randomized into three groups of laughter therapy, exercise therapy, and control. Subsequently, depression post-test and life satisfaction post-test were done for all three groups. The data wereanalyzed using analysis of covariance and Bonferroni's correction. RESULTS: Sixty subjects completed the study. The analysis revealed a significant difference in decrease in depression scores of both Laughter Yoga and exercise therapy group in comparison to control group (p < 0.001 and p < 0.01, respectively). There was no significant difference between Laughter Yoga and exercise therapy groups. The increase in life satisfaction of Laughter Yoga group showed a significant difference in comparison with control group (p < 0.001). No significant difference was found between exercise therapy and either control or Laughter Yoga group. CONCLUSION: Our findings showed that Laughter Yoga is at least as effective as group exercise program in improvement of depression and life satisfaction of elderly depressed women. Copyright © 2010 John Wiley&Sons, Ltd.

BACKGROUND: Laughter Yoga founded by M. Kataria is a combination of unconditioned laughter and yogic breathing. Its effect on mental and physical aspects of healthy individuals was shown to be beneficial. OBJECTIVE: The objective of this study was to compare the effectiveness of Kataria's Laughter Yoga and group exercise therapy in decreasing depression and increasing life satisfaction in older adult women of a cultural community of Tehran, Iran. METHODS: Seventy depressed old women who were members of a cultural community of Tehran were chosen by Geriatric depression scale (score > 10). After completion of Life Satisfaction Scale pre-test and demographic questionnaire, subjects were randomized into three groups of laughter therapy, exercise therapy, and control. Subsequently, depression post-test and life satisfaction post-test were done for all three groups. The data wereanalyzed using analysis of covariance and Bonferroni's correction. RESULTS: Sixty subjects completed the study. The analysis revealed a significant difference in decrease in depression scores of both Laughter Yoga and exercise therapy group in comparison to control group (p < 0.001 and p < 0.01, respectively). There was no significant difference between Laughter Yoga and exercise therapy groups. The increase in life satisfaction of Laughter Yoga group showed a significant difference in comparison with control group (p < 0.001). No significant difference was found between exercise therapy and either control or Laughter Yoga group. CONCLUSION: Our findings showed that Laughter Yoga is at least as effective as group exercise program in improvement of depression and life satisfaction of elderly depressed women. Copyright © 2010 John Wiley&Sons, Ltd.

CONTEXT: Humor therapy and the related mirthful laughter are suggested to have preventive and healing effects. Although these effects may be mediated by neuroendocrine/neuroimmune modulation, specific neuroimmune parameters have not been fully investigated. OBJECTIVE: To determine the efficacy of mirthful laughter to modulate neuroimmune parameters in normal subjects. DESIGN: A series of 5 separate studies based on a multivariate repeated measures design, with post hoc simple contrast analysis. SETTING: The schools of medicine and public health at Loma Linda University, Loma Linda, Calif. SUBJECTS: 52 healthy men. INTERVENTION: Viewing of a humor video for 1 hour. Blood samples were taken 10 minutes before, 30 minutes into, and 30 minutes and 12 hours after the intervention. MAIN OUTCOME MEASURES: Natural killer cell activity; plasma immunoglobulins; functional phenotypic markers for leukocytes including activated T cells, nonactivated T cells, B cells, natural killer cells, T cells with helper and suppressor markers, and assessment of plasma volume and compartmental shifts; plasma cytokine--interferon-gamma; and total leukocytes with subpopulations of lymphocytes, granulocytes, and monocytes. RESULTS: Increases were found in natural killer cell activity (P < .01); immunoglobulins G (P < .02), A (P < .01), and M (P < .09), with several immunoglobulin effects lasting 12 hours into recovery from initiation of the humor intervention; functional phenotypic markers for leukocyte subsets such as activated T cells (P < .01), active cytotoxic T cells (P < .01), natural killer cells (P = .09), B cells (P < .01), helper T cells (P < .02), uncommitted T cells with helper and suppressor markers (P < .02), helper/suppressor ratio (P = .10) with several leukocyte subset increase effects lasting 12 hours after the humor experience; the cytokine interferon-gamma (P = .02), with increases lasting 12 hours; total leukocytes (P < .05), with specific subpopulation lymphocytes during the intervention (P < .01) and 90 minutes into recovery (P < .05); and granulocytes during the intervention (P < .05) and 90 minutes following the intervention (P < .01). CONCLUSION: Modulation of neuroimmune parameters during and following the humor-associated eustress of laughter may provide beneficial health effects for wellness and a complementary adjunct to whole-person integrative medicine therapies.

Rats make abundant 50 kHz ultrasonic vocalizations (USVs) when they play and exhibit other positive social interactions. This response can be dramatically increased by tickling animals, especially when directed toward bodily areas toward which animals direct their own play solicitations (e.g., nape of the neck). The analysis of this system indicates that the response largely occurs in positive, playful social situations, and may index willingness for social engagement, similar to human infantile laughter, which may mature into productive adult socio-sexual behaviors. There are now enough formal similarities between rat 50 kHz USVs and human laughter, to realistically hypothesize that they are neurally and functionally homologous at the subcortical level of brain organization. To help contrast this behavior with human laughter, the available evidence concerning neural organization of human laughter is summarized from brain imaging and neuropsychological perspectives. Thus, a study of 50 kHz USVs in rats may offer an animal model for studying some of the fundamental properties of laughter circuitry in humans, and the brain mechanisms that facilitate positive social engagement, in the mammalian brain. It is proposed that further study of this phenomenon may provide a theoretical as well as empirical handle on the sources of social joy within the mammalian brain.

OBJECTIVES:One objective of this study was to assess the effects of laughter on the psychological, immunological and physiological systems of the body. Another objective was to introduce the Laughing Qigong Program (LQP), as a method of standardization for simulated laughter interventions.

DESIGN:A randomized, prospective, experimental study of the LQP was conducted in a group of adolescents (n=67) in Taiwan. During study-hall sessions, experimental subjects (n=34) attended the LQP for eight-weeks. Simultaneously, control subjects (n=33) read or did their homework. All subjects were tested before and after the intervention on the following: Rosenberg Self-Esteem scale (RSE), Chinese Humor Scale (CHS) and Face Scale (FS) as psychological markers; saliva cortisol (CS) as an immunological marker; blood pressure (BP), heart rate (HR), and heart rate variability (HRV) as physiological markers of the body's response to stress. Mood states (FS) were measured before/after each LQP session.

RESULTS:Mood states (p=.00) and humor (p=.004; p=.003) improved in the experimental group; no significant changes were found in the controls (p=69; p=60). The immunological marker of stress, cortisol levels, decreased significantly for those who participated in the LQP (p=.001), suggesting lower levels of stress after completion of the program.

CONCLUSIONS:The LQP is a non-pharmacological and cost-effective means to help adolescents mitigate stresses in their everyday life.

Human emotional expressions, such as laughter, are argued to have their origins in ancestral nonhuman primate displays. To test this hypothesis, the current work examined the acoustics of tickle-induced vocalizations from infant and juvenile orangutans, gorillas, chimpanzees, and bonobos, as well as tickle-induced laughter produced by human infants. Resulting acoustic data were then coded as character states and submitted to quantitative phylogenetic analysis. Acoustic outcomes revealed both important similarities and differences among the five species. Furthermore, phylogenetic trees reconstructed from the acoustic data matched the well-established trees based on comparative genetics. Taken together, the results provide strong evidence that tickling-induced laughter is homologous in great apes and humans and support the more general postulation of phylogenetic continuity from nonhuman displays to human emotional expressions. Findings also show that distinctively human laughter characteristics such as predominantly regular, stable voicing and consistently egressive airflow are nonetheless traceable to characteristics of shared ancestors with great apes.