Non-destructive prediction of fertility and sex in chicken eggs using the short wave near-infrared region.

The objective of this study was to evaluate the ability of a handheld near-infrared device (900-1600 nm) to predict fertility and sex (male and female) traits in-ovo. The NIR reflectance spectra of the egg samples were collected on days 0, 7, 14 and 18 of incubation and the data was analysed using principal component analysis (PCA), linear discriminant analysis (LDA) and support vector machines classification (SVM). The overall classification rates for the prediction of fertile and infertile egg samples ranged from 73 % to 84 % and between 93 % to 95 % using LDA and SVM classification, respectively. The highest classification rate was obtained on day 7 of incubation. The classification between male and female embryos achieved lower classification rates, between 62 % and 68 % using LDA and SVM classification, respectively. Although the classification rates for in-ovo sexing obtained in this study are higher than those obtained by chance (50 %), the classification results are currently not sufficient for industrial in-ovo sexing of chicken eggs. These results demonstrated that short wavelengths in the NIR range may be useful to distinguish between fertile and infertile egg samples at days 7 and 14 during incubation.

Characteristics of zero-absenteeism in hospital care.

BACKGROUND: Literature on sickness presenteeism is emerging, but still little is known about employees who are never absent from work due to injuries or illness. Insight into the determinants and characteristics of such zero-absentees may provide clues for preventing sickness absence. AIMS: To investigate the characteristics of zero-absentees, defined as employees without sickness absence over a period of 5 years. METHODS: A mixed-method qualitative study comprising semi-structured interviews and focus groups for which Azjen and Fishbein's theory of planned behaviour was used as a framework. Zero-absentees working in hospital care were invited for semi-structured interviews until saturation was reached. The results of semi-structured interviews were validated in two focus groups. RESULTS: Of 1053 hospital employees, 47 were zero-absentees of whom 31 (66%) agreed to participate in the study. After 16 semi-structured interviews, no new insights or information were gathered from the interviews. The remaining 15 employees were invited to two (n = 8 and n = 7) focus groups. Personal attitudes and self-efficacy were more important in zero-absenteeism than social pressures of managers, colleagues or patients. Zero-absentees were found to be intrinsically motivated to try attending work when ill. CONCLUSIONS: In the present study population of hospital employees, we found indications that zero-absenteeism and sickness presenteeism might be different types of work attendance. Managers should realize that zero-absentees are driven by intrinsic motivation rather than social pressures to attend work.

Leadership effectiveness: a supervisor's approach to manage return to work.

PURPOSE: To investigate adaptive leadership in relation to personnel sickness absence (SA). In situational leadership, supervisors are effective if they adapt their leadership style appropriately to a given situation. METHODS: A managerial reorganization in a Dutch hospital with reassignment of supervisors provided the opportunity to compare SA in the same wards while under the leadership of different supervisors. Leadership effectiveness was measured with the Leader Effectiveness and Adaptability Description (LEAD). Personnel SA was retrieved from employer's records and cumulated at the individual level, distinguishing between short-term (1-7 day) and long-term (>7 days) SA. Cumulated SA days and mean SA lengths before and after managerial reorganization were compared at the individual level by using non-parametric paired statistical analyses. Employer's costs to compensate sick-listed employees' salaries before and after reorganization were cumulated and compared at ward level by using non-parametric statistics. RESULTS: 6 wards (N = 403) retained the same supervisor, 6 wards (N = 504) were assigned more effective supervisors, and 4 wards (N = 184) got less effective supervisors than the ones before reorganization. Cumulated short-term SA days and lengths did not change with leadership effectiveness. Employees who got more effective supervisors had fewer long-term SA days and shorter long-term SA lengths than before reorganization. More effective supervisors saved an average of 21,368 Euros per ward, particularly due to less long-term SA. CONCLUSIONS: Long-term SA was shorter after employees got more effective supervisors. Adaptive supervisors can facilitate return to work and save SA costs by providing the right type of support to sick-listed employees.

The history of registered sickness absence predicts future sickness absence.

BACKGROUND: The history of sickness absence has been found to predict future sickness absence. AIMS: To establish the review period of historical sickness absence data that is needed to predict future sickness absence. METHODS: The individual number of days and episodes of sickness absence were ascertained for 762 hospital employees from 2004 to 2008 inclusive. Past sickness absence was included stepwise in ordinal regression models. The explained variance of the ordinal regression models reflected the extent to which future sickness absence could be predicted and was expressed in percentages calculated as Nagelkerke's pseudo R(2) × 100%. RESULTS: A total of 551 employees (72%) had complete data and were eligible for regression analysis. Days of sickness absence in the past year predicted up to 15% of future days of sickness absence. Adding the sickness absence data of the past 2 or 3 years did not further increase the predictability of days of sickness absence. Episodes of sickness absence in the past year predicted up to 25% of future episodes of sickness absence. The predictability of episodes of sickness absence increased to 30% when the past 2 years of sickness absence were included in the regression model, but did not further increase when sickness absence of the past 3 years was included. CONCLUSIONS: Employees who are more likely to have an above average sickness absence can be identified from their history of sickness absence in the past 2 years.

Barcoding reveals complex clonal behavior in patient-derived xenografts of metastatic triple negative breast cancer.

Primary triple negative breast cancers (TNBC) are prone to dissemination but sub-clonal relationships between tumors and resulting metastases are poorly understood. Here we use cellular barcoding of two treatment-naïve TNBC patient-derived xenografts (PDXs) to track the spatio-temporal fate of thousands of barcoded clones in primary tumors, and their metastases. Tumor resection had a major impact on reducing clonal diversity in secondary sites, indicating that most disseminated tumor cells lacked the capacity to 'seed', hence originated from 'shedders' that did not persist. The few clones that continued to grow after resection i.e. 'seeders', did not correlate in frequency with their parental clones in primary tumors. Cisplatin treatment of one BRCA1-mutated PDX model to non-palpable levels had a surprisingly minor impact on clonal diversity in the relapsed tumor yet purged 50% of distal clones. Therefore, clonal features of shedding, seeding and drug resistance are important factors to consider for the design of therapeutic strategies.

Publisher Correction: Barcoding reveals complex clonal behavior in patient-derived xenografts of metastatic triple negative breast cancer.

The original version of this Article contained an error in Fig. 4. In the left histogram of the right panel of Fig. 4d, several data points were inadvertently deleted from the histogram during the production process. This error has been corrected in both the PDF and HTML versions of the Article. The original, incorrect version of Fig. 4 is presented in the accompanying Publisher Correction.

Acute and short-term effects of partial left ventriculectomy in dilated cardiomyopathy: assessment by pressure-volume loops.

OBJECTIVES: The aim of this study was to evaluate the short-term effects of partial left ventriculectomy (PLV) on left ventricular (LV) pressure-volume (P-V) loops, wall stress, and the synchrony of LV segmental volume motions in patients with dilated cardiomyopathy. BACKGROUND: Surgical LV volume reduction is under investigation as an alternative for, or bridge to, heart transplantation for patients with end-stage dilated cardiomyopathy. METHODS: We measured P-V loops in eight patients with dilated cardiomyopathy before, during and two to five days after PLV. The conductance catheter technique was used to measure LV volume instantaneously. RESULTS: The PLV reduced end-diastolic volume (EDV) acutely from 141+/-27 to 68+/-16 ml/m2 (p < 0.001) and to 65+/-6 ml/m2 (p < 0.001) at two to five days postoperation (post-op). Cardiac index (CI) increased from 1.5+/-0.5 to 2.6+/-0.6 l/min/m2 (p < 0.002) and was 1.8+/-0.3 l/min/m2 (NS) at two to five days post-op. The LV ejection fraction (EF) increased from 15+/-8% to 35+/-6% (p < 0.001) and to 26+/-3% (p < 0.003) at two to five days post-op. Tau decreased from 54+/-8 to 38+/-6 ms (p < 0.05) and was 38+/-5 ms (NS) at two to five days post-op. Peak wall stress decreased from 254+/-85 to 157+/-49 mm Hg (p < 0.001) and to 184+/-40 mm Hg (p < 0.003) two to five days post-op. The synchrony of LV segmental volume changes increased from 68+/-6% before PLV to 80+/-7% after surgery (p < 0.01) and was 73+/-4% (NS) at two to five days post-op. The LV synchrony index and CI showed a significant (p < 0.0001) correlation. CONCLUSIONS: The acute decrease in LV volume in heart-failure patients following PLV resulted at short-term in unchanged SV, increases in LVEF, and decreases in peak wall stress. The increase in LV synchrony with PLV suggests that the transition to a more uniform LV contraction and relaxation pattern might be a rationale of the working mechanism of PLV.

The volume-dependency of parallel conductance throughout the cardiac cycle and its consequence for volume estimation of the left ventricle in patients.

OBJECTIVE: To study the hypothesis that the electrical conductance of tissues and fluids (parallel conductance (G(p))) around the ventricle depends on left ventricular volume throughout the cardiac cycle. METHODS: We extended a recently developed method to determine G(p) throughout the cardiac cycle. First, we compared the estimates of parallel conductances obtained with the new method (G(a)(p)) with those of the conventional one (G(1)(p)), both averaged over the cardiac cycles. Secondly, G(a)(p) was determined throughout the cardiac cycle and its volume dependency was assessed. Thirdly, the factor alpha was calculated as the ratio between stroke volume, obtained by the conductance method using G(1)(p), and that obtained by a thermodilution method. Because the non-homogeneous field was indicated to be the reason for the dependency of G(p) on left ventricular volume as well as for the need for alpha, we tested whether the hypothesis implies that a correction with alpha is not needed if G(p) is determined throughout the cardiac cycle. RESULTS: We found a negative linear relation between G(p) and left ventricular volume. This relation appeared to be reproducible within each patient. Furthermore, we found that alpha deviates from 1 primarily due to the dependency of G(p) on left ventricular volume. CONCLUSION: To obtain stroke volume or to determine absolute left ventricular volume continuously within a cardiac cycle, G(p) should be determined throughout each cardiac cycle and if a constant G(p) throughout the cardiac cycle is used a correction with the factor alpha should be made to correct for a possible influence of electrical field heterogeneity.

A new approach to determine parallel conductance for left ventricular volume measurements.

OBJECTIVES: To determine absolute ventricular volume with the conductance catheter technique, the electrical conductance of tissues and fluids (parallel conductance) around the ventricle should be determined precisely. METHODS: A new objective method to estimate parallel conductance based on analysis of the dilution curve of hypertonic saline was investigated. The parallel conductances obtained with the new method (G(a)(p)) were compared to those obtained with the conventional method (G(l)(p)). The study was performed in the left ventricle of 12 patients. RESULTS: G(a)(p) was not significantly different from G(l)(p). For the G(l)(p) method the average percentage difference between duplicate values, both taken as absolute values, was 15.06% and for the G(a)(p) method it was 4. 01%. Thus the reproducibility of the method is a factor four better than that of the method. This difference appeared to be significant. CONCLUSION: We conclude that a smaller number of injections will be required to obtain the same precision using our method.

Amitriptyline metabolism in relation to antidepressive effect.

The relationship between amitriptyline (AT) metabolism and clinical response was studied in 14 outpatients treated with a daily dose of 150 mg AT. Riboflavin was added to the medication to check compliance. On days 0, 2, and 7 and at 3, 6, 9, and 13 wk after onset of therapy, blood samples were drawn from the patients 3 (+/- 0.5) hr after the first morning dose and a sample of the first morning urine was taken to check riboflavin. Serum levels of AT and its metabolites, nortriptyline (NT), E- and Z-10-hydroxynortriptyline (E- and Z-10-OH-NT), total (E + Z) 10-hydroxyamitriptyline (tot-10-OH-AT), and desmethylnortriptyline (DNT), were measured by means of HPLC while minimizing adsorption onto glass. On day 0 and after 6 and 13 wk the severity of the depressive disorder was scored by means of the self-rating depression scale of Zung.28 Mean steady-state concentrations of AT, NT, and E-10-OH-NT were in the order of 100 micrograms/l and tot-10-OH-AT and Z-10-OH-NT approximated 20 micrograms/l. DNT concentrations were under 15 micrograms/l. There was great variation in metabolic pattern between patients. After 6 wk concentrations of all compounds were approximately 15% lower than at 3 wk, indicating a weak autoinducible effect of AT or its metabolites. Steady-state concentrations of AT correlated well with that of NT (r = 0.64; P less than 0.05) but not with that of E-10-OH-NT.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole-lung lavage under hyperbaric oxygen conditions for alveolar proteinosis with respiratory failure.

Whole-lung lavage under hyperbaric oxygen conditions was performed in two patients suffering from severe respiratory insufficiency in pulmonary alveolar proteinosis. Under these conditions, gas exchange was maintained and the mixed venous partial pressure of oxygen and oxygen saturation showed increases to acceptable levels. This enabled us to limit the FIO2 in order to extend the oxygen tolerance and to perform lavage procedures more effectively. Both patients showed a very significant improvement of their clinical course, and we conclude that elective use of hyperbaric oxygen in unilateral lung lavages should be considered in these severe cases.

An adequate strategy for the thermodilution technique in patients during mechanical ventilation.

The application of the thermodilution method in conditions associated with variations in blood flow implies a misuse of the Stewart Hamilton equation. Therefore, we studied the reliability of the thermodilution method for the estimation of mean cardiac output (CO) during mechanical ventilation in patients (n = 9). Variation of the injection moment in the ventilatory cycle elicited a cyclic variation of CO estimates. This variation was not the same for all patients neither in phase nor in amplitude. Therefore, no specific phase in the ventilatory cycle could be selected for an accurate estimation of mean CO. Averaging CO estimates randomly distributed in the ventilatory cycle led to an improvement of accuracy with the square root of the number of observations. The averaging of CO estimates spread equally over the ventilatory cycle led to a much better result, e.g., the variation in the average of two estimates equally spread in the ventilatory cycle was similar to the variation in the average of four random estimates. We conclude that averaging of 3 or 4 estimates spread equally over the ventilatory cycle is an adequate strategy to estimate mean cardiac output in patients reliably.

Automated infusion of nitroglycerin to control arterial hypertension during cardiac surgery.

OBJECTIVE: To evaluate the feasibility of closed-loop blood pressure control during cardiac surgery. DESIGN: A closed-loop system regulated peroperative hypertension by controlling the infusion rate of the vasodilator nitroglycerin (NTG). The controller consisted of a regulator which was monitored by a supervisory computer program. Mean arterial pressure (MAP) was calculated every 5 s from measurements of the radial artery pressure signal. The regulator calculated an NTG infusion rate with each new MAP measurement. The supervisory computer program monitored the regulator's actions and adapted or overruled the regulator when required. SETTING: The cardiac surgery operating room. PATIENTS: 46 patients who were scheduled for cardiac surgery and who developed peroperative hypertension. INTERVENTIONS: Patients were scheduled for either bypass or valve replacement surgery. The closed-loop system was used to control hypertension before and after cardiopulmonary bypass. The use of the closed-loop system did not require deviation from the protocol normally used during cardiac surgery. All patients received standard continuous anaesthesia with opioids. MEASUREMENTS AND RESULTS: Initial automatic control was achieved in 9.4 (4.1 SD) min. The percentage of time that MAP remained in a range around the target MAP of +/- 10 and +/- 20 mmHg was 74 and 94%, respectively. The mean NTG infusion rate while MAP was within 5 mmHg of target MAP was 1.14 (0.84 SD) micrograms kg-1 min-1. Target MAP was set between 65 and 90 mmHg. There was a small group of patients (6 out of 46) who did not respond to NTG and required alternative drug therapy. CONCLUSIONS: The controller provided fast and stable control in all patients. The expert knowledge implemented through the supervisory computer program enabled the controller to respond adequately to the rapid changes in arterial pressures commonly associated with cardiac surgery. We conclude that closed-loop control of arterial pressure is feasible not only in the cardiac surgical care unit but also during cardiac surgery.

Tracing best PEEP by applying PEEP as a RAMP.

OBJECTIVE: The aim of this study was to show the feasibility of a slow, continuously increasing level of positive end-expiratory pressure (PEEP) (ramp manoeuvre) in selecting best PEEP and to evaluate whether best PEEP, as defined by maximal oxygen transport, coincides with best systemic arterial oxygenation or best compliance. DESIGN: In 11 anaesthetized piglets, PEEP was increased between 0 cmH2O (zero end-expiratory pressure; ZEEP) and 15 cmH2O (PEEP15) with a constant rate of 0.67 cmH2O x min(-1). This ramp manoeuvre was performed both under normal conditions and after induction of an experimental lung oedema. During the ramp manoeuvre, haemodynamic and pulmonary variables were monitored almost continuously. RESULTS: During the rise in PEEP, cardiac output declined in a non-linear way. In the series with normal conditions, best PEEP was always found at ZEEP. In the series with experimental lung oedema, best PEEP, as defined by maximum oxygen transport, was found at PEEP1-6, as defined by maximal compliance, at PEEP7.5 and by maximal arterial oxygen tension (PaO2) at PEEP10-14. CONCLUSIONS: Best PEEP according to oxygen transport is lower than best PEEP according to compliance and PaO2; the use of PEEP as a ramp might prevent unnecessarily high levels of PEEP.

Hemodynamic effects of PEEP applied as a ramp in normo-, hyper-, and hypovolemia.

Nonlinear hemodynamic responses on positive end-expiratory pressure (PEEP) have been attributed to a rise of mean central venous pressure (Pcv), to compensatory cardiovascular control mechanisms, and to the occurrence of a lung stretch depressor reflex above a threshold lung stretch. We tested the hypothesis that the contribution of each of these mechanisms is dependent on the preexisting volemic load. PEEP was applied as a continuous rise (ramp) in piglets in three different volemic loads. In the normovolemic circulation cardiac output (CO) decreased nonlinearly in three phases during the PEEP ramp up to 15 cmH2O. CO decreased gradually in phase I, followed by a sharp decrease in phase II between a PEEP of 3 and 9 cmH2O and again a more gradual decrease in phase III up to a PEEP of 15 cmH2O. Heart rate (HR) and mean aortic pressure (PaO) also decreased during phase II, indicating the predominance of a lung stretch depressor reflex. In the hypervolemic circulation (loading 15 ml . kg-1 dextran) only phases I and II were observed with the onset of phase II at a higher level of PEEP (6 cmH2O). More lung stretch appeared to be necessary to elicit the lung stretch depressor reflex. In the hypovolemic circulation (hemorrhage 15 ml . kg-1) CO decreased linearly, Pao was stable after an initial decrease, and HR increased continuously, indicating a predominance of cardiovascular compensatory mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Ventricular motion during the ejection phase: a computational analysis.

In the present paper, the study of the ventricular motion during systole was addressed by means of a computational model of ventricular ejection. In particular, the implications of ventricular motion on blood acceleration and velocity measurements at the valvular plane (VP) were evaluated. An algorithm was developed to assess the force exchange between the ventricle and the surrounding tissue, i.e., the inflow and outflow vessels of the heart. The algorithm, based on the momentum equation for a transitory flowing system, was used in a fluid-structure model of the ventricle that includes the contractile behavior of the fibers and the viscous and inertial forces of the intraventricular fluid. The model calculates the ventricular center of mass motion, the VP motion, and intraventricular pressure gradients. Results indicate that the motion of the ventricle affects the noninvasive estimation of the transvalvular pressure gradient using Doppler ultrasound. The VP motion can lead to an underestimation equal to 12.4 +/- 6.6%.

Computation of aortic flow from pressure in humans using a nonlinear, three-element model.

We computed aortic flow pulsations from arterial pressure by simulating a nonlinear, time-varying three-element model of aortic input impedance. The model elements represent aortic characteristic impedance, arterial compliance, and systemic vascular resistance. Parameter values for the first two elements were computed from a published, age-dependent, aortic pressure-area relationship (G. J. Langewouters et al. J. Biomech. 17:425-435, 1984). Peripheral resistance was predicted from mean pressure and model mean flow. Model flow pulsations from aortic pressure showed the visual aspects of an aortic flow curve. For evaluation we compared model mean flow from radial arterial pressure with thermodilution cardiac output estimations, 76 times, in eight open heart surgical patients. The pooled mean difference was +7%, the SD 22%. After using one comparison per patient to calibrate the model, however, we followed quantitative changes in cardiac output that occurred either during changes in the state of the patient or subsequent to vasoactive drugs. The mean deviation from thermodilution cardiac output was +2%, the SD 8%. Given these small errors the method could monitor cardiac output continuously.

The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique.

OBJECTIVES: Mitral-valve repair in Barlow's disease is challenging; conventional techniques are difficult to perform, and there is a high risk of a postoperative suboptimal result. Double-orifice repair has been applied in a standardized approach to treat patients with severe mitral regurgitation and bileaflet prolapse due to Barlow's disease. METHODS: Since 1993, 82 patients with severe mitral regurgitation due to Barlow's disease underwent correction applying the edge-to-edge concept. They were submitted to double-orifice repair in a standardized fashion, suturing the middle portions of both leaflets. RESULTS: There were no hospital deaths. The repair was unsatisfactory in one patient who underwent valve replacement soon after the repair. The mean postoperative valve area was 3.7+/-0.79 cm(2) against a mean preoperative value of 9.2+/-2.1 cm(2). No or mild regurgitation was found in all but three patients who showed moderate residual regurgitation. There were no late deaths. Freedom from reoperation was 86+/-14% at 5 years. At the latest follow-up, all patient but one were New York Heart Association (NYHA) functional class I, and echo-Doppler assessment of valve reconstruction showed stable valve function in all patients. CONCLUSIONS: The double-orifice repair can be used as a standardized approach to treat valve regurgitation due to Barlow disease with low risk and good early and mid-term results.

Preserved skeletal muscle structure with modified electrical stimulation protocol in a cardiomyoplasty patient: a clinico-pathological report.

Experimental and clinical studies have recently shown variable degrees of structural abnormalities in the transposed and chronically stimulated muscle graft after cardiomyoplasty procedure. The postoperative stimulation protocol of wrapped skeletal muscle has been claimed to be a major determinant of late structural derangement. Therefore, a modified stimulation protocol had been used after a cardiomyoplasty procedure in a 63-year-old patient. Improved postoperative hemodynamic data could be detected by pressure/volume analysis. After unexpected sudden death occurred at 15 months, autoptic examination showed preserved muscle structure, suggesting that a prudent stimulation protocol may maintain muscle viability and contribute to effective cardiac support.

Cardiomyoplasty as an isolated procedure to treat refractory heart failure.

OBJECTIVE: Cardiomyoplasty represents a controversial therapy for chronic heart failure. The aim of this study is to review our experience of such a surgical procedure as an isolate approach to treat refractory left ventricular dysfunction. METHODS: Twenty-two patients were considered candidates for cardiomyoplasty because of chronic heart failure. Mean age was 58.7 +/- 5.3 (range 48-71 years), 19 patients were male and 3 were female. Ischemic or idiopathic etiology was present in 11 cases, respectively. Traditional as well as innovative techniques were used to assess hemodynamic function. Pre-operative hemodynamic profile included mean left ventricular ejection fraction of 20 +/- 5.8% (9-28%), absence of severe right ventricular failure, and mean left ventricular end-diastolic diameter of 75.5 +/- 7.4 mm (range 61-92 m). All patients were in New York Heart Association Class III or Intermittent IV despite conventional medical therapy. RESULTS: There was no intra-operative death. No additional surgery was performed. Left latissimus dorsi (LD) muscle was used in 20 cases, and right LD in two patients. Early mortality occurred in one patient (low cardiac output syndrome), whereas late mortality in five patients (three sudden deaths, one lung cancer, one heart failure). Mean follow-up is 20.7 +/- 16.7 months (3-51 months). Actuarial survival at 4 years is 70%. Cardiac index increased at 6 months (3.08 +/- 0.5 l/min per m2, P = 0.04), but no other significant changes were observed in the long term (3.03 +/- 0.7 l/min per m2, 3 +/- 0.7 l/min per m2, and 2.85 +/- 0.7 l/min per m2, at 12, 24 and 36 months, respectively). Ejection fraction improved at 6 and 12 months (29.1 +/- 1.03%, P = 0.0017; and 27.3 +/- 5.6%, P = 0.0091, respectively), while no substantial augmentation was documented at 2 and 3 years (25.6 +/- 2.5% and 25.1 +/- 4.0%, respectively). Left ventricular end-diastolic diameter was markedly reduced at 6 (73.2 +/- 8.0 mm, P = 0.0176), 12 (69.4 +/- 8.5 mm, P = 0.002) and 24 months (71.1 +/- 7.0 mm, P = 0.011), and was then stable (74.0 +/- 9.1 mm, P = 0.47) at 36 months. Postoperative pressure/volume loop evaluation showed some improvement of hemodynamic function from skeletal muscle assistance. Acute pulmonary edema episodes, as well as number of hospitalizations, were considerably reduced following cardiomyoplasty. CONCLUSIONS: In our experience, cardiomyoplasty was shown to exert moderate beneficial influence on left ventricular performance, to significantly reduce cardiac dilatation and to promote the stabilization of the disease course.