***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Congestive heart failure ( CHF ) is characterized by enhanced immune activation , and immune-mediated mechanisms may play a pathogenic role in this disorder . Based on the immunomodulatory effects of intravenous immunoglobulin ( IVIG ) , we hypothesized that IVIG could downregulate inflammatory responses in CHF patients and have potential beneficial effects on the left ventricular ejection fraction ( LVEF ) . Methods and Results Forty patients with chronic symptomatic CHF and LVEF of < 40 % , stratified according to cause ( ie , ischemic and idiopathic dilated cardiomyopathy ) , were r and omized in a double-blind fashion to receive therapy with  IVIG or placebo for a total period of 26 weeks . Our main findings were that ( 1 ) IVIG , but not placebo , induced a marked rise in plasma levels of the anti-inflammatory mediators interleukin (IL)-10 , IL-1 receptor antagonist , and soluble tumor necrosis factor receptors ; ( 2 ) significantly correlated with these anti-inflammatory effects , IVIG , but not placebo , induced a significant increase in LVEF from 26±2 % to 31±3 % ( P < 0.01 ) , and this was found independent of the cause of heart failure ; and ( 3 ) N-terminal pro – atrial natriuretic peptide decreased significantly after induction therapy and continued to decrease toward the end of study during IVIG therapy ( P < 0.001 ) but remained unchanged during placebo . Conclusions We demonstrated an IVIG-induced change in the balance between inflammatory and anti-inflammatory cytokines that favored an anti-inflammatory net effect in CHF . This effect was significantly correlated with an improvement in LVEF , suggesting a potential for immunomodulating therapy in addition to optimal conventional cardiovascular treatment regimens in CHF patients Abstract Background . Chronic heart failure ( CHF ) is associated with increased inflammation , and exercise training has in some studies been shown to have anti-inflammatory effect , although controversies exist . We investigated the effects of exercise training in CHF patients on markers of inflammation , and further explored any association between inflammation and the severity and etiology of the disease . Methods . Eighty patients in stable CHF were r and omized to 4 months of group-based high intensity exercise training or to a control group . Physical capacity was measured by 6-minute walk test and cycle ergometer test . Blood sample s were drawn at baseline , after 4 months and after 12 months follow-up for analyses of a range of biomarkers . Results . Physical capacity was significantly inversely related to CRP , IL-6 , VCAM-1 and TGF-β , and NT pro-BNP levels were significantly correlated to CRP , TNF-α , IL-6 , VCAM-1 , ICAM-1 and TGF-β ( p < 0.05 for all ) . Patients with hypertension as etiology of CHF showed higher levels of CRP ( p < 0.01 ) , IL-6 ( p = 0.05 ) and TNF-α ( p = 0.02 ) as compared to other etiologies . No significant differences in changes between the exercise group and the control group were obtained in any of the measured variables , except in patients with idiopathic dilated cardiomyopathy ( IDCM ) , where significant reductions in CRP , ICAM-1 , TGF-β and TNF-α levels were observed ( p < 0.05 for all ) . Conclusions . Measures of CHF severity were significantly correlated with several markers of inflammation . We could not demonstrate over-all anti-inflammatory effect of exercise in this population of CHF patients . However , the etiology of CHF affected the inflammatory profile and the effect of exercise training We measured skeletal muscle mass and peak oxygen consumption ( VO2 ) in 13 cachectic heart failure patients , 14 noncachectic patients , and in 52 healthy controls to examine skeletal muscle atrophy and its relation to low peak VO2 in heart failure patients . Our results show that skeletal muscle atrophy is associated with prior weight loss and is related to low peak VO2 in heart failure patients Background Chronic heart failure ( CHF ) is associated with progressive muscle atrophy and reduced local expression of insulin-like growth factor I ( IGF-I ) . Design The present study was design ed to test the hypothesis that the local deficiency of IGF-I in the skeletal muscle of patients with CHF would respond to a 6-months aerobic training intervention . Therefore , 18 patients [ mean age 52.4 ( SD 4.8 ) years , left ventricular ejection function ( LVEF ) 27 ( SD 6)% ] were prospect ively r and omized to either 6 months of training or sedentary lifestyle . Methods Serum levels of growth hormone ( GH ) were measured by immunofluorometric assay , IGF-I by competitive solid phase immunoassay . IGF-I expression was assessed in vastus lateralis biopsies by real-time PCR . Results Exercise training led to a significant increase in peak oxygen uptake by 26 % [ from 20.3 ( SD 3.3 ) ml/kg per min to 25.5 ( SD 5.7 ) ml/kg per min , P=0.003 versus control ] . Local expression of IGF-I increased significantly after exercise training by 81 % [ from 6.3 ( SE 0.8 ) to 11.4 ( SE 1.4 ) relative units , P=0.007 versus control ] while IGF-I receptor expression was reduced by 33 % [ from 20.0 ( SE 2.1 ) to 13.8 ( SE 1.7 ) relative units , P=0.008 versus control ] . Serum growth hormone ( GH ) rose modestly from 0.12 ( SE 0.07 ) to 0.65 ( SE 0.37 ) ng/ml in the training group ( P=0.043 versus baseline ) , however , this change was not significant compared to the control group ( P=0.848 ) . IGF-I serum levels remained virtually unchanged . Conclusions Exercise training improves local IGF-I expression without significant changes of systemic parameters of the GH/IGF-I axis . These findings indicate that exercise training has the therapeutic potential to attenuate peripheral skeletal muscle alterations in particular with respect to local IGF-I expression in patients with moderate CHF BACKGROUND : Muscle wasting in chronic heart failure ( CHF ) is a result of increased catabolism induced by proinflammatory cytokines like tumor necrosis factor & agr ; ( TNF-&agr ; ) and interleukin 6 ( IL-6 ) , and decreased anabolism due to alterations in the insulin-like growth factor 1 (IGF-1)/growth hormone ( GH ) axis . The goal of this study was to analyze the effects of 3 different training modalities ( endurance training , strength training , and combined strength and endurance training [ CT ] ) on circulating cytokines , IGF-1 , and GH levels . METHODS : Patients with CHF ( N = 45 ) , NYHA class II-III , left ventricular ejection fraction < 35 % , were r and omly assigned to 1 of 3 training modalities . They trained for 40 sessions , 3 times weekly . Fifteen CHF patients served as a control group .  Blood sample s were collected at baseline and 48 hours after the last training session . RESULTS : There was a significant decrease in circulating IL-6 with all 3 training modalities . Tumor necrosis factor & agr ; levels decreased in the training groups and reached statistical significance for the CT group . No change was observed in the control group . There was no difference between the 4 groups . When comparing all trained patients with the control group , the decrease in IL-6 was significant . Concerning IGF-1 and GH , there was no change with training and no change in the control group . CONCLUSION : Exercise training has no effects on circulating IGF-1 and GH . The decreases in cytokines are evident only when all trained patients are compared with the control group , independently of the modality of training intervention OBJECTIVE To evaluate six-minute walking test ( 6-MWT ) in treatment of CHF and to investigate the effect of exercise training on blood leucocyte and its components and plasma TNF alpha in CHF patients . METHODS 60 cases with NYHA II-III CHF patients underwent 6-MWT within 24 hours after hospitalization . The walking distance , heartbeat , plasma TNF alpha , and blood leucocyte and its components were investigated before and after walking test . These patients were then r and omized into two groups , a training group ( 32 cases ) and a control group ( 28 cases ) . Besides routine medication , 6-MWT was performed in the training group twice a day for 8 weeks . The same parameters were redetermined after 8 weeks of follow-up . 23 cases with NYHA IV CHF patients were investigated with the same parameters in the first day after hospitalization . RESULTS Blood leucocyte count and percentage of granulocytes and mononuclears in cases with NYHA III-IV were significantly higher than those with NYHA II . There were significant reduction of heartbeat and prolongation of walking distance in CHF patients after exercise training .  Blood leucocyte count and the percentage of granulocytes and mononuclear and plasma TNFalpha level were reduced more in the training group than the control group after 8 weeks the treatment . CONCLUSIONS There is significantly higher leucocyte count and percentage of granulocytes and mononuclears in CHF with NYHA III-IV than those with NYHA II . 6-MWT , as an exercise training , is simple , safe , and not harmful . It can not only evaluate the severity of CHF but also serve as a therapeutic measure for CHF . Moreover the excessive activation of cytokines as TNFalpha could be reduced by 6-MWT training in CHF patients BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Background Heart failure ( HF ) patients are at an increased risk of thrombotic events . Here , we investigated the effects of exercise training on platelet function and factors involved in its modulation in HF . Design and methods Thirty HF patients were r and omized to 6 months of supervised exercise training or to a control group that remained sedentary . Exercise training consisted of 30 min of moderate-intensity treadmill exercise , followed by resistance and stretching exercises , performed three times a week . Blood was collected before and after the intervention for platelet and plasma obtainment . Results Peak VO2 increased after exercise training ( 18.0 ± 2.2 vs. 23.8 ± 0.5 mlO2/kg/min ; p < 0.05 ) . Exercise training  reduced platelet aggregation induced by both collagen and ADP ( approximately –6 % ; p < 0.05 ) , as well as platelet nitric oxide synthase activity ( 0.318 ± 0.030 vs. 0.250 ± 0.016 pmol/108 cells ; p < 0.05 ) . No difference in the above-mentioned variables were observed in the control group . No significant difference was observed in intraplatelet cyclic guanosine monophosphate levels among groups . There was a significant increase in the activity of the antioxidant enzymes superoxide dismutase and catalase in plasma and platelets , result ing in a decrease in both lipid and protein oxidative damage . Systemic levels of the inflammatory markers C-reactive protein , fibrinogen , and tumour necrosis factor α were also reduced in HF after training . Conclusions Our results suggest that regular exercise training is a valuable adjunct to optimal medical management of HF , reducing platelet aggregation via antioxidant and anti-inflammatory effects , and , therefore , reducing the risk of future thrombotic events 
    Output:
    
We conclude that the decreases in catabolic markers and increases in anabolic  after exercise training were evident only by local skeletal muscle biopsy .