***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Waon therapy improves heart failure ( HF ) symptoms , but further evidence in patients with advanced HF remains uncertain . METHODS AND RESULTS In 19 institutes , we prospect ively enrolled hospitalized patients with advanced HF , who had plasma levels of B-type natriuretic peptide ( BNP ) > 500 pg/ml on admission and BNP > 300 pg/ml regardless of more than 1 week of medical therapy . Enrolled patients were r and omized into Waon therapy or control groups . Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60 ℃ for 15 min , followed by bed rest for 30 min covered with a blanket . The primary endpoint was the ratio of BNP before and after treatment . In total , 76 Waon therapy and 73 control patients ( mean age 66 years , men 61 % , mean plasma BNP 777 pg/ml ) were studied . The groups differed only in body mass index and the frequency of diabetes . The plasma BNP , NYHA classification , 6-min walk distance ( 6MWD ) , and cardiothoracic ratio significantly improved only in the Waon therapy group . Improvements in NYHA classification , 6MWD , and cardiothoracic ratio were significant in the Waon therapy group , although the change in plasma BNP did not reach statistical significance . No serious adverse events were observed in either group . CONCLUSIONS Waon therapy , a holistic soothing warmth therapy , showed clinical advantages in safety and efficacy among patients with advanced HF BACKGROUND We developed a Waon therapy ( soothing warm therapy ) and have previously reported that repeated Waon therapy improves hemodynamics , peripheral vascular function , arrhythmias , and clinical symptoms in patients with chronic heart failure ( CHF ) . The aim of this study was to investigate the effect of Waon therapy on the prognosis of CHF patients . PATIENTS AND METHODS We studied 129 patients with CHF in NYHA functional class III or IV who were admitted to our hospital between January 1999 and March 2001 . In the Waon therapy group , 64 patients were treated with a far infrared-ray dry sauna at 60 degrees C for 15 min and then kept on bed rest with a blanket for 30 min . The patients were treated daily for 5 days during admission , and then at least twice a week after discharge . In the control group , 65 patients , matched for age , gender , and NYHA functional class , were treated with traditional CHF therapy . The follow-up time was scheduled for 5 years . RESULTS Recent , complete follow-up data on each patient were obtained . The overall survival rate was 84.5 % ( Kaplan-Meier estimate ) . Twelve patients died in the control group and 8 patients died in the Waon therapy group at 60 months of follow-up . Cardiac events due to heart failure or cardiac death occurred in 68.7 % of the control group but only 31.3 % of the Waon therapy group ( P<0.01 ) at 60 months of follow-up . CONCLUSION Waon therapy reduced cardiac events in patients with CHF . This therapy is a promising non-pharmacological treatment for CHF BACKGROUND The aim of the present study was to determine whether repeated 60 degrees C sauna treatment improves cardiac arrhythmias in chronic heart failure ( CHF ) patients , because ventricular arrhythmias are an important therapeutic target in CHF . METHODS AND RESULTS Thirty patients ( 59+/-3 years ) with New York Heart Association functional class II or III CHF and at least 200 premature ventricular contractions (PVCs)/24 h assessed by 24-h Holter recordings were studied . They were r and omized into sauna-treated ( n=20 ) or non-treated ( n=10 ) groups . The sauna-treated group underwent a 2-week program of a daily 60 degrees C far infrared-ray dry sauna for 15 min , followed by 30 min bed rest with blankets , for 5 days per week . Patients in the non-treated group had bed rest in a temperature-controlled room ( 24 degrees C ) for 45 min . The total numbers of PVCs/24 h in the sauna-treated group decreased compared with the non-treated group [ 848+/-415 vs 3,097+/-1,033/24 h , p<0.01 ] . Heart rate variability ( SDNN , st and ard deviation of normal-to-normal beat interval ) increased [ 142+/-10 ( n=16 ) vs 112+/-11 ms ( n=8 ) , p<0.05 ] and plasma brain natriuretic peptide concentrations decreased [ 229+/-54 vs 419+/-110 pg/ml , p<0.05 ] in the sauna-treated group compared with the non-treated group . CONCLUSION Repeated sauna treatment improves ventricular arrhythmias in patients with CHF BACKGROUND We conducted a prospect i ve multicenter case-control study to confirm the clinical efficacy and safety of Waon therapy on chronic heart failure ( CHF ) . METHODS Patients ( n=188 ) with CHF were treated with st and ard therapy for at least 1 week , and then were r and omized to  Waon therapy ( n=112 ) or a control group ( n=76 ) . All patients continued conventional treatment for an additional 2 weeks . The Waon therapy group was treated daily with a far infrared-ray dry sauna at 60 degrees C for 15 min and then kept on bed rest with a blanket for 30 min for 2 weeks . Chest radiography , echocardiography , and plasma levels of brain natriuretic peptide ( BNP ) were measured before and 2 weeks after treatment . RESULTS NYHA functional class significantly decreased after 2 weeks of treatment in both groups . Chest radiography also showed a significant decrease of the cardiothoracic ratio in both groups ( Waon therapy : 57.2+/-8.0 % to 55.2+/-8.0 % , p<0.0001 ; control : 57.0+/-7.7 % to 56.0+/-7.1 % , p<0.05 ) . Echocardiography demonstrated that left ventricular diastolic dimension ( LVDd ) , left atrial dimension ( LAD ) , and ejection fraction ( EF ) significantly improved in the Waon therapy group ( LVDd : 60.6+/-7.6 to 59.1+/-8.4 mm , p<0.0001 ; LAD : 45.4+/-9.3 mm to 44.1+/-9.4 mm , p<0.05 ; EF : 31.6+/-10.4 % to 34.6+/-10.6 % , p<0.0001 ) , but not in the control group ( LVDd : 58.4+/-10.3 mm to 57.9+/-10.4 mm ; LAD : 46.3+/-9.7 mm to 46.2+/-10.1 mm ; EF : 36.6+/-14.1 % to 37.3+/-14.0 % ) . The plasma concentration of BNP significantly decreased with Waon therapy , but not in the control group ( Waon : 542+/-508 pg/ml to 394+/-410 pg/ml , p<0.001 ; control : 440+/-377 pg/ml to 358+/-382 pg/ml ) . CONCLUSION Waon therapy is safe , improves clinical symptoms and cardiac function , and decreases cardiac size in CHF patients . Waon therapy is an innovative and promising therapy for patients with CHF OBJECTIVES To perform a pilot study and make a preliminary assessment of the safety and acceptance of supervised sauna bathing at moderate temperatures in people with chronic heart failure ( CHF ) . Secondary measures included its impact on exercise tolerance and neuroendocrine concentrations . DESIGN R and omized , controlled , cross-over trial . SETTING Physical medicine and rehabilitation clinic . PARTICIPANTS Six men and 3 women ( age , 62 - 87y ) with New York Heart Association Class III and IV CHF . INTERVENTIONS Subjects were r and omized into 2 groups and told to maintain their normal medication and activity regimens . One group then began a 3-times-a-week , 4-week sauna bathing program at 60+/-1 degrees C while the other continued with their usual activities and medications . Assignments were then reversed . Sessions were 15 minutes in length but were prolonged an additional 5 minutes for oral temperature increases less than 1.0 degrees C. MAIN OUTCOME MEASURES Patient acceptance , Minnesota Living With Heart Failure Question naire ( MLWHFQ ) scores ; treadmill exercise duration and plasma adrenaline , noradrenalin , aldosterone , atrial naturectic factor , adrenomedulin , and endothelin . RESULTS Sauna bathing was well tolerated and no adverse effects were reported . Improvements in MLWHFQ scores and treadmill endurance did not achieve statistical significance on a between-group basis but were more marked after the sauna than during the control phase . Neuroendocrine concentrations showed no clear effect of sauna treatment with a between-group statistically significant difference ( P=.049 ) found only in the case of noradrenalin 's 24 % decrease . CONCLUSIONS Sauna bathing under the moderate and supervised conditions of this study appears to be well tolerated and may be safe for people with CHF . More research is needed to further evaluate the safety and potential benefits of this approach OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Heart failure ( HF ) is a disease of neurohumoral dysfunction and current pharmacological therapies for HF have not improved mortality rates , thus requiring additional new strategies . Waon therapy for HF patients may be a complementary strategy with peripheral vasodilation via nitric oxide . We hypothesized that Waon therapy would improve neurohumoral factors , such as natriuretic peptides ( NP ) and the renin-angiotensin-aldosterone system ( RAAS ) in HF . Methods and Results : Plasma sample s were collected from patients enrolled in the WAON-CHF Study ( Waon therapy ( n=77 ) or control ( n=73 ) ) before and after the treatment . B-type NP ( BNP ) , C-type NP ( CNP ) , and aldosterone ( Aldo ) levels were measured by respective specific radioimmunoassays . Although clinical parameters significantly improved in the Waon group compared with the control group , BNP , Aldo , and CNP levels were not statistically different between groups . On sub analysis with patient variables , BNP levels were improved in the Waon group treated with angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker or spironolactone . In addition , Aldo levels were improved in the Waon group patients with diabetes mellitus , hypertension , and inotrope use , and CNP levels were improved in Waon group patients with estimated glomerular filtration rate < 60 mL/min/1.73 m2 . These changes were not observed in the control group . CONCLUSIONS Waon therapy may accelerate the favorable actions of RAAS modulators in HF . ( WAON-CHF Study : UMIN000006705 ) 
    Output:
    
RESULTS In the meta- analysis , exposure to an infrared sauna bath in 60 ° C for 15 minutes , followed by a 30-minute rest in warm environment , five times a week for 2 to 4 weeks , was associated with a significant reduction in B-type natriuretic peptide , cardiothoracic ratio , and an improvement in left-ventricular ejection fraction .
There was no significant effect on left-ventricular end-diastolic diameter , left atrial diameter , systolic blood pressure , or diastolic blood pressure .
CONCLUSION Infrared sauna bath was associated with short-term improvement in cardiac function .