human
***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: Enhanced recovery following physical activity and exercise-induced muscle damage ( EIMD ) has become a priority for athletes . Consequently , a number of post-exercise recovery strategies are used , often without scientific evidence of their benefits . Within this framework , the purpose of this study was to test the efficacy of whole body cryotherapy ( WBC ) , far infrared ( FIR ) or passive ( PAS ) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race . In 3 non-adjoining weeks , 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill  , design ed to induce muscle damage . Immediately ( post ) , post 24 h , and post 48 h after exercise , all participants tested three different recovery modalities ( WBC , FIR , PAS ) in a r and om order over the three separate weeks . Markers of muscle damage ( maximal isometric muscle strength , plasma creatine kinase [ CK ] activity and perceived sensations [ i.e. pain , tiredness , well-being ] ) were recorded before , immediately after ( post ) , post 1 h , post 24 h , and post 48 h after exercise . In all testing sessions , the simulated 48 min trail run induced a similar , significant amount of muscle damage . Maximal muscle strength and perceived sensations were recovered after the first WBC session ( post 1 h ) , while recovery took 24 h with FIR , and was not attained through the PAS recovery modality . No differences in plasma CK activity were recorded between conditions . Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage ( EIMD ) and inflammation obtained after a simulated trail running race . Endurance trained males ( n = 11 ) completed two experimental trials separated by 1 month in a r and omized crossover design ; one trial involved passive recovery ( PAS ) , the other a specific whole body cryotherapy ( WBC ) for 96 h post-exercise ( repeated each day ) . For each trial , subjects performed a 48 min running treadmill exercise followed by PAS or WBC .  The Interleukin ( IL ) -1 ( IL-1 ) , IL-6 , IL-10 , tumor necrosis factor alpha ( TNF-α ) , protein C-reactive ( CRP ) and white blood cells count were measured at rest , immediately post-exercise , and at 24 , 48 , 72 , 96 h in post-exercise recovery . A significant time effect was observed to characterize an inflammatory state ( Pre vs. Post ) following the exercise bout in all conditions ( p<0.05 ) . Indeed , IL-1β ( Post 1 h ) and CRP ( Post 24 h ) levels decreased and IL-1ra ( Post 1 h ) increased  following WBC when compared to PAS .  In WBC condition ( p<0.05 ) , TNF-α , IL-10 and IL-6 remain unchanged compared to PAS condition . Overall , the results indicated that the WBC  was effective in reducing the inflammatory process . These results may be explained by vasoconstriction at muscular level , and both the decrease in cytokines activity pro-inflammatory , and increase in cytokines anti-inflammatory Fibromyalgia is a chronic widespread pain disorder in which , the neurogenic origin of the pain , featured by allodynia and hyperalgesia , results from an imbalance in the levels of neurotransmitters and consequently of the peripheral pro- and anti-inflammatory mediators . Whole body cryotherapy is a peculiar physical therapy known to relieve pain and inflammatory symptoms characteristics of rheumatic diseases , through the regulation of the cytokine expression . The aim of this study was to qualitatively evaluate the effects of cryotherapy on the clinical output of fibromyalgic patients . A total of 100 fibromyalgic patients ( age range 17–70 years ) were observed ; 50 subjects were addressed to cryotherapy , while the second group ( n = 50 ) did not underwent to the cryotherapic treatment .  All subjects kept the prescribed pharmacological therapy during the study ( analgesic and antioxidants ) . The referred health status pre- and post-observation was evaluated with the following scales : Visual Analogue Scale , Short Form-36 , Global Health Status and Fatigue Severity Scale . Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life , in comparison with the non-cryo treated fibromyalgic subjects , as indicated by the scores of the qualitative indexes and sub-indexes , that are widely recognized tools to assess the overall health status and the effect of the treatments . We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain OBJECTIVE To compare 2 different treatment approaches , physical therapy modalities , and joint mobilization versus whole-body cryotherapy ( WBC ) combined with physical therapy modalities and joint mobilization , for symptoms of adhesive capsulitis ( AC ) of the shoulder . DESIGN A r and omized trial . SETTING Hospital . PARTICIPANTS Patients with AC of the shoulder ( N=30 ) . INTERVENTION Patients were r and omly assigned to 2 groups . The WBC group received physical therapy modalities , passive joint mobilization of the shoulder , and WBC , whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder . MAIN OUTCOME MEASURES Visual analog scale ( VAS ) , active range of motion ( ROM ) of flexion , abduction , internal and external rotation of the shoulder , and the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) were measured before and after the intervention . RESULTS A statistically significant difference between groups was found for the VAS , active ROM of flexion , abduction , internal rotation , and external rotation , and the ASES with greater improvements in the WBC group ( Ps<.01 ) . Overall , both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01 . CONCLUSIONS There is significant improvement with the addition of WBC to treatment interventions in this sample of patients OBJECTIVE To examine the effect of intensive lipid-lowering therapy on a composite cardiovascular outcome ( cardiovascular disease [ CVD ] ) , consisting of mortality and morbidity end points , in patients with inflammatory joint disease ( rheumatoid arthritis [ RA ] , ankylosing spondylitis [ AS ] , or psoriatic arthritis [ PsA ] ) by post hoc analysis of 2 prospect i ve trials of statins with a secondary end point of CVD outcome ( the Treating to New Targets [ TNT ] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [ IDEAL ] studies ) . METHODS Of the 18,889 patients participating in the 2 trials , 199 had RA , 46 had AS , and 35 had PsA.  Lipid-lowering therapy consisted of an intensive regimen of atorvastatin 80 mg or a conventional/low-dose regimen of atorvastatin 10 mg or simvastatin 20 - 40 mg . The median duration of followup was nearly 5 years . Changes in lipid levels were examined by analyses of covariance . The effect on CVD was examined by Cox regression analyses , and heterogeneity tests were performed . RESULTS Patients with RA and those with AS had lower baseline cholesterol levels than patients without inflammatory joint disease ( least squares mean ± SEM 180.7 ± 2.3 mg/dl and 176.5 ± 4.7 mg/dl , respectively , versus 185.6 ± 0.2 mg/dl ; P = 0.03 and P = 0.05 , respectively ) . Statin treatment led to a comparable decrease in lipid levels and a 20 % reduction in overall risk of CVD in both patients with and those without inflammatory joint disease . CONCLUSION Our findings indicate that patients with and those without inflammatory joint disease experience comparable lipid-lowering effects and CVD risk reduction after intensive treatment with statins PURPOSE To investigate the effects of different conditions used during  cardiopulmonary bypass ( CPB ) surgery  on accompanying production of cytokine and nitric oxide ( NO ) . METHODS Patients undergoing CPB for the first time were prospect ively enrolled and divided into two groups according to CPB parameters performed : i )  normothermia ( 36.5 - 37 degrees C ) with blood cardioplegia ( NB group , n=10 ) and ii ) hypothermia ( 29 - 31 degrees C ) with crystalloid cardioplegia ( HC group , n=10 ) . Plasma sample s obtained following intubation ( baseline ) , during ( 5 and 30 min ) and after ( 4 and 24 h ) CPB were assayed for cytokines ( ELISA ) and NO metabolites ( Griess reaction ) . RESULTS Peak concentrations of interleukin (IL)-6 and IL-8 were reached at 4 h post CPB in both groups , but in the HC group those levels increased earlier and persisted for longer ( 24 h ) compared to baseline ( P < 0.05 ) . IL-10 levels also increased at 4 h compared to baseline , but only significantly so in the HC group . NO metabolites were reduced in HC group at all time points compared to baseline ( P < 0.05 ) , while no significant differences were detected in the NB group . CONCLUSION The association between increased systemic levels of cytokines and reduced NO production in the HC group suggests that different myocardial protection and /or perfusion temperature used during CPB may contribute to the extent of inflammatory response The aim of the study was the thermovisual comparison of mean temperature of h and surface changes after local cryotherapy with vapors of nitrogen ( −160 ° C ) and cold air ( −30 ° C ) . Forty-seven patients with rheumatoid arthritis ( 39 women and 8 men ; average age 56.2 ± 10.5 years ) were included in the study . They had the application of topic cryotherapy using nitrogen vapors or cold air on one h and . Main outcome measure was surface temperature of dorsal sides of the cooled and contralateral h and s. Thermal images of both h and s were taken before and up to 3 h after the treatment . One minute after application , nitrogen vapors induced decrease in surface skin temperature of the cooled h and from 28.9 ± 1.8 ° C to 17.9 ± 2.2 ° C , P < 0.05 , whereas cold air from 29.4 ± 2.4 ° C to 23.1 ± 2.2 ° C , P < 0.05 . However , significantly lower temperature was obtained with vapors of nitrogen ( P < 0.05 ) . Just after the treatment , a rapid rewarming occurred and h and s reached baseline temperature in 15 min in both applications and they did not differ till the end of the procedure . Both nitrogen vapors and cold air induce similar temperature changes in h and s with the exclusion of temperature obtained 1 min after the treatment . Changes in non-cooled h and s indicate contralateral reaction This study examined the immunological responses to cold exposure together with the effects of pretreatment with either passive heating or exercise ( with and without a thermal clamp ) . On four separate occasions , seven healthy men [ mean age 24.0 + /- 1.9 ( SE ) yr , peak oxygen consumption = 45.7 + /- 2.0 ml . kg(-1 ) . min(-1 ) ] sat for 2 h in a climatic chamber maintained at 5 degrees C. Before exposure , subjects participated in one of four pretreatment conditions . For the thermoneutral control condition , subjects remained seated for 1 h in a water bath at 35 degrees C. In another pretreatment , subjects were passively heated in a warm ( 38 degrees C ) water bath for 1 h. In two other pretreatments , subjects exercised for 1 h at 55 % peak oxygen consumption ( once immersed in 18 degrees C water and once in 35 degrees C water ) . Core temperature rose by 1 degrees C during passive heating and during exercise in 35 degrees C water and remained stable during exercise in 18 degrees C water ( thermal clamping ) . Subsequent cold exposure induced a leukocytosis and granulocytosis , an increase in natural killer cell count and activity , and a rise in circulating levels of interleukin-6 . Pretreatment with exercise in 18 degrees C water augmented the leukocyte , granulocyte , and monocyte response . These results indicate that acute cold exposure has immunostimulating effects and that , with thermal clamping , pretreatment with physical exercise can enhance this response . Increases in levels of circulating norepinephrine may account for the changes observed during cold exposure and their modification by changes in initial status Introduction  Hypothermia  improves survival and neurological recovery  after cardiac arrest . Pro-inflammatory cytokines have been implicated in focal cerebral ischemia/reperfusion injury . It is unknown whether cardiac arrest also triggers the release of cerebral inflammatory molecules , and whether therapeutic hypothermia alters this inflammatory response . This study sought to examine whether hypothermia or the combination of hypothermia with anesthetic post-conditioning with sevoflurane affect cerebral inflammatory response after cardiopulmonary resuscitation . Methods Thirty pigs ( 28 to 34 kg ) were subjected to cardiac arrest following temporary coronary artery occlusion . After 
    Output:
    
agent
***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: Enhanced recovery following physical activity and exercise-induced muscle damage ( EIMD ) has become a priority for athletes . Consequently , a number of post-exercise recovery strategies are used , often without scientific evidence of their benefits . Within this framework , the purpose of this study was to test the efficacy of whole body cryotherapy ( WBC ) , far infrared ( FIR ) or passive ( PAS ) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race . In 3 non-adjoining weeks , 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill  , design ed to induce muscle damage . Immediately ( post ) , post 24 h , and post 48 h after exercise , all participants tested three different recovery modalities ( WBC , FIR , PAS ) in a r and om order over the three separate weeks . Markers of muscle damage ( maximal isometric muscle strength , plasma creatine kinase [ CK ] activity and perceived sensations [ i.e. pain , tiredness , well-being ] ) were recorded before , immediately after ( post ) , post 1 h , post 24 h , and post 48 h after exercise . In all testing sessions , the simulated 48 min trail run induced a similar , significant amount of muscle damage . Maximal muscle strength and perceived sensations were recovered after the first WBC session ( post 1 h ) , while recovery took 24 h with FIR , and was not attained through the PAS recovery modality . No differences in plasma CK activity were recorded between conditions . Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage ( EIMD ) and inflammation obtained after a simulated trail running race . Endurance trained males ( n = 11 ) completed two experimental trials separated by 1 month in a r and omized crossover design ; one trial involved passive recovery ( PAS ) , the other a specific whole body cryotherapy ( WBC ) for 96 h post-exercise ( repeated each day ) . For each trial , subjects performed a 48 min running treadmill exercise followed by PAS or WBC .  The Interleukin ( IL ) -1 ( IL-1 ) , IL-6 , IL-10 , tumor necrosis factor alpha ( TNF-α ) , protein C-reactive ( CRP ) and white blood cells count were measured at rest , immediately post-exercise , and at 24 , 48 , 72 , 96 h in post-exercise recovery . A significant time effect was observed to characterize an inflammatory state ( Pre vs. Post ) following the exercise bout in all conditions ( p<0.05 ) . Indeed , IL-1β ( Post 1 h ) and CRP ( Post 24 h ) levels decreased and IL-1ra ( Post 1 h ) increased  following WBC when compared to PAS .  In WBC condition ( p<0.05 ) , TNF-α , IL-10 and IL-6 remain unchanged compared to PAS condition . Overall , the results indicated that the WBC  was effective in reducing the inflammatory process . These results may be explained by vasoconstriction at muscular level , and both the decrease in cytokines activity pro-inflammatory , and increase in cytokines anti-inflammatory Fibromyalgia is a chronic widespread pain disorder in which , the neurogenic origin of the pain , featured by allodynia and hyperalgesia , results from an imbalance in the levels of neurotransmitters and consequently of the peripheral pro- and anti-inflammatory mediators . Whole body cryotherapy is a peculiar physical therapy known to relieve pain and inflammatory symptoms characteristics of rheumatic diseases , through the regulation of the cytokine expression . The aim of this study was to qualitatively evaluate the effects of cryotherapy on the clinical output of fibromyalgic patients . A total of 100 fibromyalgic patients ( age range 17–70 years ) were observed ; 50 subjects were addressed to cryotherapy , while the second group ( n = 50 ) did not underwent to the cryotherapic treatment .  All subjects kept the prescribed pharmacological therapy during the study ( analgesic and antioxidants ) . The referred health status pre- and post-observation was evaluated with the following scales : Visual Analogue Scale , Short Form-36 , Global Health Status and Fatigue Severity Scale . Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life , in comparison with the non-cryo treated fibromyalgic subjects , as indicated by the scores of the qualitative indexes and sub-indexes , that are widely recognized tools to assess the overall health status and the effect of the treatments . We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain OBJECTIVE To compare 2 different treatment approaches , physical therapy modalities , and joint mobilization versus whole-body cryotherapy ( WBC ) combined with physical therapy modalities and joint mobilization , for symptoms of adhesive capsulitis ( AC ) of the shoulder . DESIGN A r and omized trial . SETTING Hospital . PARTICIPANTS Patients with AC of the shoulder ( N=30 ) . INTERVENTION Patients were r and omly assigned to 2 groups . The WBC group received physical therapy modalities , passive joint mobilization of the shoulder , and WBC , whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder . MAIN OUTCOME MEASURES Visual analog scale ( VAS ) , active range of motion ( ROM ) of flexion , abduction , internal and external rotation of the shoulder , and the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) were measured before and after the intervention . RESULTS A statistically significant difference between groups was found for the VAS , active ROM of flexion , abduction , internal rotation , and external rotation , and the ASES with greater improvements in the WBC group ( Ps<.01 ) . Overall , both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01 . CONCLUSIONS There is significant improvement with the addition of WBC to treatment interventions in this sample of patients OBJECTIVE To examine the effect of intensive lipid-lowering therapy on a composite cardiovascular outcome ( cardiovascular disease [ CVD ] ) , consisting of mortality and morbidity end points , in patients with inflammatory joint disease ( rheumatoid arthritis [ RA ] , ankylosing spondylitis [ AS ] , or psoriatic arthritis [ PsA ] ) by post hoc analysis of 2 prospect i ve trials of statins with a secondary end point of CVD outcome ( the Treating to New Targets [ TNT ] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [ IDEAL ] studies ) . METHODS Of the 18,889 patients participating in the 2 trials , 199 had RA , 46 had AS , and 35 had PsA.  Lipid-lowering therapy consisted of an intensive regimen of atorvastatin 80 mg or a conventional/low-dose regimen of atorvastatin 10 mg or simvastatin 20 - 40 mg . The median duration of followup was nearly 5 years . Changes in lipid levels were examined by analyses of covariance . The effect on CVD was examined by Cox regression analyses , and heterogeneity tests were performed . RESULTS Patients with RA and those with AS had lower baseline cholesterol levels than patients without inflammatory joint disease ( least squares mean ± SEM 180.7 ± 2.3 mg/dl and 176.5 ± 4.7 mg/dl , respectively , versus 185.6 ± 0.2 mg/dl ; P = 0.03 and P = 0.05 , respectively ) . Statin treatment led to a comparable decrease in lipid levels and a 20 % reduction in overall risk of CVD in both patients with and those without inflammatory joint disease . CONCLUSION Our findings indicate that patients with and those without inflammatory joint disease experience comparable lipid-lowering effects and CVD risk reduction after intensive treatment with statins PURPOSE To investigate the effects of different conditions used during  cardiopulmonary bypass ( CPB ) surgery  on accompanying production of cytokine and nitric oxide ( NO ) . METHODS Patients undergoing CPB for the first time were prospect ively enrolled and divided into two groups according to CPB parameters performed : i )  normothermia ( 36.5 - 37 degrees C ) with blood cardioplegia ( NB group , n=10 ) and ii ) hypothermia ( 29 - 31 degrees C ) with crystalloid cardioplegia ( HC group , n=10 ) . Plasma sample s obtained following intubation ( baseline ) , during ( 5 and 30 min ) and after ( 4 and 24 h ) CPB were assayed for cytokines ( ELISA ) and NO metabolites ( Griess reaction ) . RESULTS Peak concentrations of interleukin (IL)-6 and IL-8 were reached at 4 h post CPB in both groups , but in the HC group those levels increased earlier and persisted for longer ( 24 h ) compared to baseline ( P < 0.05 ) . IL-10 levels also increased at 4 h compared to baseline , but only significantly so in the HC group . NO metabolites were reduced in HC group at all time points compared to baseline ( P < 0.05 ) , while no significant differences were detected in the NB group . CONCLUSION The association between increased systemic levels of cytokines and reduced NO production in the HC group suggests that different myocardial protection and /or perfusion temperature used during CPB may contribute to the extent of inflammatory response The aim of the study was the thermovisual comparison of mean temperature of h and surface changes after local cryotherapy with vapors of nitrogen ( −160 ° C ) and cold air ( −30 ° C ) . Forty-seven patients with rheumatoid arthritis ( 39 women and 8 men ; average age 56.2 ± 10.5 years ) were included in the study . They had the application of topic cryotherapy using nitrogen vapors or cold air on one h and . Main outcome measure was surface temperature of dorsal sides of the cooled and contralateral h and s. Thermal images of both h and s were taken before and up to 3 h after the treatment . One minute after application , nitrogen vapors induced decrease in surface skin temperature of the cooled h and from 28.9 ± 1.8 ° C to 17.9 ± 2.2 ° C , P < 0.05 , whereas cold air from 29.4 ± 2.4 ° C to 23.1 ± 2.2 ° C , P < 0.05 . However , significantly lower temperature was obtained with vapors of nitrogen ( P < 0.05 ) . Just after the treatment , a rapid rewarming occurred and h and s reached baseline temperature in 15 min in both applications and they did not differ till the end of the procedure . Both nitrogen vapors and cold air induce similar temperature changes in h and s with the exclusion of temperature obtained 1 min after the treatment . Changes in non-cooled h and s indicate contralateral reaction This study examined the immunological responses to cold exposure together with the effects of pretreatment with either passive heating or exercise ( with and without a thermal clamp ) . On four separate occasions , seven healthy men [ mean age 24.0 + /- 1.9 ( SE ) yr , peak oxygen consumption = 45.7 + /- 2.0 ml . kg(-1 ) . min(-1 ) ] sat for 2 h in a climatic chamber maintained at 5 degrees C. Before exposure , subjects participated in one of four pretreatment conditions . For the thermoneutral control condition , subjects remained seated for 1 h in a water bath at 35 degrees C. In another pretreatment , subjects were passively heated in a warm ( 38 degrees C ) water bath for 1 h. In two other pretreatments , subjects exercised for 1 h at 55 % peak oxygen consumption ( once immersed in 18 degrees C water and once in 35 degrees C water ) . Core temperature rose by 1 degrees C during passive heating and during exercise in 35 degrees C water and remained stable during exercise in 18 degrees C water ( thermal clamping ) . Subsequent cold exposure induced a leukocytosis and granulocytosis , an increase in natural killer cell count and activity , and a rise in circulating levels of interleukin-6 . Pretreatment with exercise in 18 degrees C water augmented the leukocyte , granulocyte , and monocyte response . These results indicate that acute cold exposure has immunostimulating effects and that , with thermal clamping , pretreatment with physical exercise can enhance this response . Increases in levels of circulating norepinephrine may account for the changes observed during cold exposure and their modification by changes in initial status Introduction  Hypothermia  improves survival and neurological recovery  after cardiac arrest . Pro-inflammatory cytokines have been implicated in focal cerebral ischemia/reperfusion injury . It is unknown whether cardiac arrest also triggers the release of cerebral inflammatory molecules , and whether therapeutic hypothermia alters this inflammatory response . This study sought to examine whether hypothermia or the combination of hypothermia with anesthetic post-conditioning with sevoflurane affect cerebral inflammatory response after cardiopulmonary resuscitation . Methods Thirty pigs ( 28 to 34 kg ) were subjected to cardiac arrest following temporary coronary artery occlusion . After 
    Output:
    