Molecular dynamics simulation of phosphatidylcholine membrane in low ionic strengths of sodium chloride.

The one-microsecond molecular dynamics simulations of a membrane-protein complex investigate the influence of the aqueous sodium chloride solutions on the structure and dynamics of a palmitoyl-oleoyl-phosphatidylcholine bilayer membrane. The simulations were performed on five different concentrations (40, 150, 200, 300, and 400 mM) in addition to a salt-free system by using the charmm36 force field for all atoms. Four biophysical parameters, (membrane thicknesses of annular and bulk lipids, and the area per lipid of both leaflets), were computed separately. Nevertheless, the area per lipid was expressed by using the Voronoi algorithm. All time-independent analyses were carried out for the last 400 ns trajectories. Different concentrations revealed dissimilar membrane dynamics before equilibration. The biophysical properties of the membrane (thickness, area-per-lipid, and order parameter) have non-significant changes with increasing ionic strength, however, the 150 mM system had exceptional behavior. Sodium cations were dynamically penetrating the membrane forming weak coordinate bonds with single or multiple lipids. Nevertheless, the binding constant was unaffected by the cation concentration. The electrostatic and Van der Waals energies of lipid-lipid interactions were influenced by the ionic strength. On the other hand, the Fast Fourier Transform was performed to figure out the dynamics at the membrane-protein interface. The nonbonding energies of membrane-protein interactions and order parameters explained the differences in the synchronization pattern. All results were consensus with experimental and theoretical works.Communicated by Ramaswamy H. Sarma.

The effect of low-level laser on the quality of dentin barrier after capping with bioceramic material: A histomorphometric analysis.

The study aims to investigate the quality of dentin barriers and pulp reaction to EndoSequence Root Repair Material (ERRM) combined with low-level laser application. In eight dogs, pulps were exposed via class V, half of the samples received low-level diode laser at 870 nm. Thereafter, cavities were capped with fast-set or regular-set ERRM. The specimens were processed for histomorphological and immunohistochemical examination after 2 weeks and 2 months. Dentin bridges were observed in all samples, and 87.5% were complete. The low-level laser group had significantly more reparative dentin area than the non-lased group (p < 0.05). The dentin bridges were found to have an unprecedented tubularity of 43%-89%. Tiny dentin island formation was observed within the material particles. Initial mild-to-moderate inflammatory reactions were observed, which subsided after 2 months. RUNX2 and osteocalcin staining were evident for all samples at both time intervals. Low-level laser combined with bioactive ERRM is effective in inducing reparative dentin formation.

Pulpal and periapical tissue response after direct pulp capping with endosequence root repair material and low-level laser application.

BACKGROUND: The study aims to investigate the pulp and periapical reaction and healing after capping with EndoSequence Root Repair Material (ERRM) combined with low-level laser application. METHODS: In 6 rabbits, pulps were exposed via class V, half of the samples received a low-level diode laser at 980 nm. Thereafter, cavities were capped with regular-set ERRM. The specimens were processed for histomorphological examination after 2 weeks and two months. RESULTS: After 2 weeks, images show mild inflammation and organized odontoblasts in lased group. The non-lased group shows more severe inflammation. The predentin thickness was thicker in the lased group with statistical significance (p < 0.05). After 2 months, inflammatory cells were sparse in both lased and non-lased groups. In the periapical area, group one showed dilated blood vessels and thick fibrous connective tissues. In group two, there were more numerous maturations of PDL fibers with scattered inflammatory cells and congested blood vessel. CONCLUSIONS: Using low-level laser therapy in combination with ERRM for pulp capping shortens the inflammatory phase and enhances healing.

Root canal morphology and symmetry of mandibular second premolars using cone-beam computed tomography.

OBJECTIVES: The current study aims to investigate the morphology and symmetry of root canals of mandibular second premolar teeth via Cone-Beam Computed Tomography (CBCT) among a sample of the Saudi population. METHODS: A total of 1200 CBCT images were examined in the study. The number of roots in the mandibular second premolars was identified, and canal configurations were classified according to Vertucci classification. Bilateral symmetry and association between gender and number of roots and root canal configuration were investigated using a chi-square test was utilized for data analysis and p value was set at 0.05 for significance. RESULTS: Of the total 2400 Mandibular second premolars, 98.33% were single rooted and 1.67% were double rooted. The prevalence of double roots in females on the right side was significantly higher than that on the left side (p = 0.017), but the opposite was found among males. Only Type I and II canal configurations showed significant differences regarding gender and sides. 98.0% of teeth showed the symmetrical number of roots in both genders. The symmetry in canal configuration was 96.7% in males and 97.3% in females and 99.1% was Type I in both sides, 0.5% Type III, and 0.3% Type IV in both sides. CONCLUSIONS: The root morphology of mandibular second premolars in the Saudi population demonstrated a high degree of variability. The vast majority of mandibular premolars have a single root with one canal and a low prevalence of two rooted teeth. Contralateral mandibular second premolars exhibited great symmetry of roots and root canal configuration.

Dielectric properties and in vitro hemocompatibility of Nd:YAG laser-irradiated polyethylene terephthalate.

Surface properties and morphology of the biomaterial play an essential role in the polymer-material interaction. In this work, laser surface modification of polyethylene terephthalate as a polymer with distinguished mechanical properties was carried out using (neodymium-doped yttrium aluminum garnet) Nd:YAG laser (1.064 µm) with different output power (0.3, 3, and 6 W). The structural, surface, and dielectric properties of PET before and after laser irradiation have been studied using attenuation total reflection-Fourier transform infrared (ATR-FTIR), dielectric spectroscopy (DS), scanning electron microscope (SEM), and contact angle measurements. Moreover, the anticoagulant properties of the laser-irradiated PET was determined through measuring the prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR). In vitro platelet adhesion test was used to assess the platelets adhered to the surface of the samples; in addition to hematological study. It was found that contact angle (θ) measurements of laser-irradiated PET samples decreased compared to the unirradiated PET. The irradiated samples at 0.3 W have the lowest contact angle which is a clear indication that surface treatment with Nd:YAG laser brought about improving the wettability of the polymer. From the dielectric measurements, both values of permittivity and dielectric loss decrease by increasing the laser power. The electrical conductivity decreases with increasing laser power, but still in the same order 10-14 S/cm. The decrease in electrical conductivity σ may be due to the cross-linking of the polymeric matrix which led to a decrease in the total polarity and consequently decrease in electrical conductivity. The magnitude of σ obtained is highly recommended to be used for insulator purposes in addition to the main purpose that is blood contact.

Preparation and characterization of polyethylene terephthalate-chamomile oil blends with enhanced hydrophilicity and anticoagulant properties.

New blend films based on polyethylene terephthalate (PET) with different concentrations (50, 100 and 200 µL) of chamomile oil (CAO) were prepared. The effect of oil on the dielectric properties, structural and surface properties of PET was studied. The wettability of the blend films was evaluated by contact angle measurements. In vitro platelet adhesion on the surface and coagulation assessment were conducted to evaluate the behavior of the new blends for blood contact applications. Results of the study indicate that the wettability of PET-CAO blends up to 100 µL has been enhanced relative to the pure PET as indicated by the decrease in contact angle measurements. The attenuation total reflection-Fourier transform infrared spectra of the blends confirmed the presence of chamomile oil in the polymer matrix and suggested the presence of interaction between them. The permittivity ε' values decreased by increasing oil content upto 100 µL. On the other hand, the values of dielectric loss ε″ were found to increase by increasing oil content to 100 µL after which it decreased. The delay in partial thromboplastin time (PTT) of the blood would validate the anti-coagulant property of PET-CAO blends. The results demonstrated that the PET-CAO blends with concentration of 100 µL could be considered as a promising candidate material in blood contact application.

Strengthening effect of bioceramic cement when used to repair simulated internal resorption cavities in endodontically treated teeth.

BACKGROUND: The reinforcement of teeth with internal root resorption is essential to prevent their fracture. OBJECTIVES: The aim of this study was to assess the fracture resistance of the premolar teeth with internal root resorption cavities (IRCs), repaired with glass-ionomer cement (GIC), gutta-percha (GP) or EndoSequence® Root Repair MaterialTM (RRM). MATERIAL AND METHODS: Forty lower premolars, instrumented to size 50, were used. Ten teeth were assigned to the control group, which received the full obturation of the root canals. In the remaining 30, IRCs were prepared with Gates-Glidden burs. The apical 8 mm was obturated to the level of IRC using the single-cone technique. Then, the teeth were divided into 3 groups according to the material used for repairing the cavities (n = 10): GIC; GP; and RRM. The canals were filled with respective materials and backfilled with GP. All of the specimens were scanned at the level of IRC with a micro-computed tomography (micro-CT) system, and the volume of the IRCs and the percentages of voids in the filling materials were measured. The specimens were subjected to fracture testing. The force recorded at the time of fracture was analyzed with the Kruskal-Wallis test and the independent t-test. RESULTS: The control group showed a significantly higher mean value of fracture resistance as compared to the groups with IRCs (p < 0.05). No significant difference was found between GIC and RRM, whereas the GP group had a significantly lower fracture resistance than other tested IRC groups (p < 0.05). The percentage of voids was significantly higher in the GIC group as compared to the GP and RRM groups (p < 0.05). CONCLUSIONS: EndoSequence Root Repair Material provides more strength to the teeth than the GP/sealer technique when both are used to fill a resorption cavity. The fracture resistance of the teeth filled with RRM was close to that obtained with GIC.

Biocompatibility enhancement of graphene oxide-silver nanocomposite by functionalisation with polyvinylpyrrolidone.

Several materials such as silver are used to enhance graphene oxide (GO) sheets antimicrobial activity. However, these toxic materials decrease its biocompatibility and hinder its usage in many biological applications. Therefore, there is an urgent need to develop nanocomposites that can preserve both the antimicrobial activity and biocompatibility simultaneously. This work highlights the importance of functionalisation of GO sheets using Polyvinylpyrrolidone (PVP) and decorating them with silver nanoparticles (AgNPs) in order to enhance their antimicrobial activity and biocompatibility at the same time. The structural and morphological characterisations were performed by UV-Visible, Fourier transform infrared (FTIR), and Raman spectroscopic techniques, X-ray diffraction (XRD), and high-resolution transmission electron microscopy (HR-TEM). The antimicrobial activities of the prepared samples against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans were studied. The cytotoxicity of prepared materials was tested against BJ1 normal skin fibroblasts. The results indicated that the decoration with AgNPs showed a significant increase in the antimicrobial activity of GO and FGO sheets, and functionalisation of GO sheets and GO-Ag nanocomposite with PVP improved the cell viability about 40 and 35%, respectively.

Cyclic fatigue, bending resistance, and surface roughness of ProTaper Gold and EdgeEvolve files in canals with single- and double-curvature.

OBJECTIVES: The purpose of this study was to evaluate the cyclic fatigue, bending resistance, and surface roughness of EdgeEvolve (EdgeEndo) and ProTaper Gold (Dentsply Tulsa Dental Specialties) nickel-titanium (NiTi) rotary files. MATERIALS AND METHODS: The instruments (n = 15/each) were tested for cyclic fatigue in single- (60° curvature, 5-mm radius) and double-curved (coronal curvature 60°, 5-mm radius, and apical curvature of 30° and 2-mm radius) artificial canals. The number of cycles to fracture was calculated. The bending resistance of both files were tested using a universal testing machine where the files were bent until reach 45°. Scanning electron microscopy and x-ray energy-dispersive spectrometric analysis were used for imaging the fractured segments, while the atomic force microscope was used to quantify the surface roughness average (Ra). RESULTS: EdgeEvolve files exhibited higher cyclic fatigue resistance than ProTaper Gold files in single- and double-curved canals (p < 0.05) and both files were more resistant to cyclic fatigue in single-curved canals than double-curved canals (p < 0.05). EdgeEvolve files exhibited significantly more flexibility than did ProTaper Gold files (p < 0.05). Both files had approximately similar Ni and Ti contents (p > 0.05). EdgeEvolve files showed significantly lower Ra values than ProTaper Gold files (p < 0.05). CONCLUSIONS: Within the limitation of this study, EdgeEvolve files exhibited significantly higher cyclic fatigue resistance than ProTaper Gold files in both single- and double-curved canals.

Doxorubicin loaded magnetic gold nanoparticles for in vivo targeted drug delivery.

Treatment of approximately 50% of human cancers includes the use of chemotherapy. The major problem associated with chemotherapy is the inability to deliver pharmaceuticals to specific site of the body without inducing normal tissue toxicity. Latterly, magnetic targeted drug delivery (MTD) has been used to improve the therapeutic performance of the chemotherapeutic agents and reduce the severe side effects associated with the conventional chemotherapy for malignant tumors. In this study, we were focused on designing biocompatible magnetic nanoparticles that can be used as a nanocarrier's candidate for MTD regimen. Magnetic gold nanoparticles (MGNPs) were prepared and functionalized with thiol-terminated polyethylene glycol (PEG), then loaded with anti-cancer drug doxorubicin (DOX). The physical properties of the prepared NPs were characterized using different techniques. Transmission electron microscopy (TEM) revealed the spherical mono-dispersed nature of the prepared MGNPs with size about 22 nm. Energy dispersive X-ray spectroscopy (EDX) assured the existence of both iron and gold elements in the prepared nanoparticles. Fourier transform infrared (FTIR) spectroscopy assessment revealed that PEG and DOX molecules were successfully loaded on the MGNPs surfaces, and the amine group of DOX is the active attachment site to MGNPs. In vivo studies proved that magnetic targeted drug delivery can provide a higher accumulation of drug throughout tumor compared with that delivered by passive targeting. This clearly appeared in tumor growth inhibition assessment, biodistribution of DOX in different body organs in addition to the histopathological examinations of treated and untreated Ehrlich carcinoma. To assess the in vivo toxic effect of the prepared formulations, several biochemical parameters such as aspartate aminotransferase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), creatine kinase MB (CK-MB), urea, uric acid and creatinine were measured. MTD technology not only minimizes the random distribution of the chemotherapeutic agents, but also reduces their side effects to healthy tissues, which are the two primary concerns in conventional cancer therapies.

Can Mineral Trioxide Aggregate and Nanoparticulate EndoSequence Root Repair Material Produce Injurious Effects to Rat Subcutaneous Tissues?

INTRODUCTION: The aim of this study was to evaluate the injurious effects of mineral trioxide Aggregate (MTA) and EndoSequence Bioceramic Root Repair Material (ERRM; Brassler USA, Savannah, GA) 7 and 30 days after their implantation into rat subcutaneous tissues. METHODS: Twelve Wistar rats were selected for the present study. Each animal received 3 implants: one contained MTA, one contained ERRM, and one was an empty tube that served as a control. Half of the animals were killed after 7 days, and the remaining animals were killed 30 days after implantation. Histologic sections prepared from the skin specimens were stained with H&E, toluidine blue, Masson trichrome, and Congo red. The data were statistically analyzed with 1-way analysis of variance and paired t tests. The P value for significance was set at .05. RESULTS: After 7 days, MTA produced a significantly greater inflammatory reaction that involved the deposition of amyloidlike protein and an increase in the mast cell population compared with ERRM (P < .05). After 30 days, the ERRM group exhibited significantly reduced inflammatory reactions compared to the MTA groups (P < .05). Areas of mononuclear cell aggregation, abscess formation, and necrosis were observed more frequently in the MTA group. The thickness of the fibrous capsule was significantly increased in the MTA compared with the ERRM groups (P < .05). Amyloidlike proteins were more frequently observed around the fibrous capsule and subdermal blood vessels and were more frequently deposited in the MTA than the ERRM specimens. CONCLUSIONS: The findings of the present study suggest that both ERRM and MTA cause an injurious effect when implanted in rat subcutaneous tissues after 7 and 30 days. ERRM is significantly less injurious to tissues than MTA.

Preparation and characterization of magnetic gold nanoparticles to be used as doxorubicin nanocarriers.

Magnetic targeted drug delivery (MTD), using magnetic gold nanoparticles (Fe3O4@Au NPs) conjugated with an anti-cancer drug is a promise modality for cancer treatment. In this study, Fe3O4@Au NPs were prepared and functionalized with thiol-terminated polyethylene glycol (PEG), then loaded with anti-cancer drug doxorubicin (DOX). The physical properties of the prepared NPs were characterized using different techniques. Transmission electron microscopy (TEM) revealed the mono dispersed nature of Fe3O4@Au NPs with an average size of 20 nm which was confirmed using Dynamic light scattering (DLS) measurements. Zeta potential measurements along with UV-VIS spectroscopy demonstrated surface DOX loading on Fe3O4@Au NPs. Energy Dispersive X-ray Spectroscopy (EDX) assured the existence of both iron and gold elements in the prepared NPs. The paramagnetic properties of the prepared NPs were assessed by vibrating sample magnetometer (VSM). The maximum DOX-loading capacity was 100 µg DOX/mg of Fe3O4@Au NPs. It was found that DOX released more readily at acidic pH. In vitro studies on MCF-7 cell line elucidated that DOX loaded Fe3O4@Au NPs (Fe3O4@Au-PEG-DOX) have more potent therapeutic effect than free DOX. Knowledge gained in this study may open the door to pursue Fe3O4@Au NPs as a viable nanocarriers for different molecules delivery in many diagnostic and therapeutic applications.

Enhancement of the ocular therapeutic effect of prednisolone acetate by liposomal entrapment.

Eye drops account for 90% of ophthalmic formulations despite of the rapid precorneal drug loss. Our aim is to test the effect of positive charge induction and the subsequent size reduction on the efficiency of liposomes as ocular drug delivery system for the lipophilic drug prednisolone acetate (PSA). Different formulations of PSA-loaded liposomes, positive multilamellar liposomes (pMLV), positive small (nano-sized) unilamellar liposomes (pSUV) and neutral multilamellar liposomes (nMLV), were prepared. These formulations were characterized by measuring surface charge, size distribution, entrapment efficiency, release rate, and ability to deliver PSA across the cornea. In vitro studies showed that positive charge induction reduces the transcorneal flux (about 1.9-fold lower than nMLV), while the subsequent size reduction results in higher flux (about 1.2-fold higher than nMLV). But in vivo results revealed that pSUV produced more concentrations of PSA in aqueous humor than nMLV (P < 0.05) suggesting greater chance for drug penetration, pSUV were more effective than nMLV in this regard (P < 0.05). As revealed by in vivo studies and ophthalmic examinations, positive charge induction and the subsequent size reduction increased the efficiency of liposomes as ocular drug delivery system for PSA.

Preparation and evaluation of warfarin-ß-cyclodextrin loaded chitosan nanoparticles for transdermal delivery.

The main objective of the present work was to prepare warfarin-ß-cyclodextrin (WAF-ß-CD) loaded chitosan (CS) nanoparticles for transdermal delivery. CS is a hydrophilic carrier therefore, to overcome the hydrophobic nature of WAF and allow its incorporation into CS nanoparticles, WAF was first complexed with ß-cyclodextrin (ß-CD). CS nanoparticles were prepared by ionotropic pre-gelation using tripolyphosphate (TPP). Morphology, size and structure characterization of nanoparticles were carried out using SEM, TEM and FTIR, respectively. Nanoparticles prepared with 3:1 CS:TPP weight ratio and 2mg/ml final CS concentration were found optimum. They possessed spherical particles (35±12nm diameter) with narrow size distribution (PDI=0.364) and 94% entrapment efficiency. The in vitro release as well as the ex vivo permeation profiles of WAF-ß-CD from the selected nanoparticle formulation were studied at different time intervals up to 8h. In vitro release of WAF-ß-CD from CS nanoparticles followed a Higuchi release profile whereas its ex vivo permeation (at pH 7.4) followed a zero order permeation profile. Results suggested that the developed WAF-ß-CD loaded CS carrier could offer a controlled and constant delivery of WAF transdermally.

Biophysical characterization of gold nanoparticles-loaded liposomes.

Gold nanoparticles were prepared and loaded into the bilayer of dipalmitoylphosphatidylcholine (DPPC) liposomes, named as gold-loaded liposomes. Biophysical characterization of gold-loaded liposomes was studied by transmission electron microscopy (TEM) and Fourier transform infrared (FTIR) spectroscopy as well as turbidity and rheological measurements. FTIR measurements showed that gold nanoparticles made significant changes in the frequency of the CH(2) stretching bands, revealing that gold nanoparticles increased the number of gauche conformers and create a conformational change within the acyl chains of phospholipids. The transmission electron micrographs (TEM) revealed that gold nanoparticles were loaded in the liposomal bilayer. The zeta potential of DPPC liposomes had a more negative value after incorporating of Au NPs into liposomal membranes. Turbidity studies revealed that the loading of gold nanoparticles into DPPC liposomes results in shifting the temperature of the main phase transition to a lower value. The membrane fluidity of DPPC bilayer was increased by loading the gold nanoparticles as shown from rheological measurements. Knowledge gained in this study may open the door to pursuing liposomes as a viable strategy for Au NPs delivery in many diagnostic and therapeutic applications.

Biophysical studies on chitosan-coated liposomes.

Liposomes have been used as delivery vehicles for stabilizing drugs, overcoming barriers to cellular and tissue uptake, and for directing their contents toward specific sites in vivo. Chitosan is a biological macromolecule derived from crustacean shells and has several emerging applications in drug development, obesity control, and tissue engineering. In the present work, the interaction between chitosan and dipalmitoyl phosphatidylcholine (DPPC) liposomes was studied by transmission electron microscopy (TEM), zeta potential, solubilization using the nonionic detergent octylglucoside (OG), as well as Fourier transform infrared (FTIR) spectroscopy and viscosity measurements. The coating of DPPC liposomes by a chitosan layer was confirmed by electron microscope images and the zeta potential of liposomes. Coating of liposome by chitosan resulted in an increase in liposomal size by addition of a layer of 92 +/- 27.1 nm. The liposomal zeta potential became increasingly positive as chitosan concentration increased from 0.1 to 0.3% w/v, then it held at a relatively constant value. The amount of detergent needed to completely solubilize the liposomal membrane was increased after coating of liposomes with chitosan, indicating an increased membrane resistance to the detergent and hence a change in the natural membrane permeation properties. In the analysis of FTIR spectra of DPPC, the symmetric and antisymmetric CH(2) (at 2,800-3,000 cm(-1)) bands and the C=O (at 1,740 cm(-1)) stretching band were investigated in the absence and presence of the chitosan. It was concluded that appropriate combining of the liposomal and chitosan characteristics might be utilized for the improvement of the therapeutic efficacy of liposomes as a drug delivery system.

Evaluation of left ventricular ejection fraction by the quantitative algorithms QGS, ECTb, LMC and LVGTF using gated myocardial perfusion SPECT: investigation of relative accuracy.

AIM: To compare the quantitative algorithms Emory Cardiac Toolbox (ECTb), quantitative gated SPECT (QGS), layer of maximum counts (LMC), and left ventricular global thickening fraction (LVGTF) using gated myocardial tomography in the calculation of the left ventricular ejection fraction using the regression without truth (RWT) technique. MATERIALS AND METHODS: Seventy-four consecutive patients were included in the study (59 males). All patients underwent stress-rest myocardial perfusion SPECT using Tc-tetrofosmin. Analysis of variance (ANOVA), the paired Student's t-test, the Pearson correlation coefficient and Bland-Altman were used for comparing the methods. The relative accuracy was performed by RWT. RESULTS: ANOVA revealed a significant difference among the methods in calculating the ejection fraction. RWT showed that ECTb and QGS outperformed the other two methods. The ECTb was slightly better than QGS, and LMC was slightly better than LVGTF. QGS and ECTb achieved good correlations in end diastolic volume, end systolic volume and ejection fraction measurements. One-way ANOVA demonstrated that QGS was the only software program affected by the category of the perfusion summed stress score (SSS), P=0.038. The ejection fraction determined by the QGS, ECTb and LVGTF methods correlated significantly with defect size (r=0.545, P<0.0001; r=0.530, P<0.0001; and r=0.419, P<0.0001, respectively), but the LMC method was not significantly correlated (r=0.216, P=0.067). CONCLUSIONS: There was a considerable variation among the quantitative gated SPECT methods in the evaluation of the ejection fraction. RWT revealed that the ECTb and QGS outperformed the other two methods with respect to the bias and precision of the measurements. Pair-wise correlations of the four methods ranged from mild to good with large agreement limits. Results of RWT provided important information in ranking the quantitative gated SPECT methods.

Assessment of left ventricular ejection fraction by four different methods using 99mTc tetrofosmin gated SPECT in patients with small hearts: correlation with gated blood pool.

AIM: To compare the currently available gated SPECT software programs, quantitative gated SPECT (QGS), Emory Cardiac Toolbox (ECTb), Left Ventricular Global Thickening Fraction (LVGTF), and the recently developed Layer of Maximum Count (LMC) method with equilibrium Gated Blood Pool (GBP) scintigraphy in calculating the ejection fraction in patients with small hearts. METHODS: Twenty patients with small hearts (end diastolic volume <85 ml) were collected for the study. Gated myocardial perfusion SPECT and planar GBP were performed for all patients. The four methods QGS, ECTb, and LVGTF and LMC were used for volumes estimation and ejection fraction calculation. RESULTS: ANOVA analysis revealed significant differences among the methods in ejection fraction estimation (P<0.0001). The mean ejection fraction by GBP was significantly overestimated by QGS and ECTb and LVGTF (P<0.0001, P<0.0001 and P=0.006, respectively). The mean ejection fraction by GBP was not significantly different from that by the LMC method (P=0.213). Ejection fraction measurements by QGS and ECTb yielded moderate correlation with GBP values (r=0.588, P=0.006; and r=0.564, P=0.010, respectively). The ejection fraction by the LMC method was marginally correlated but LVGTF showed a non-significant correlation with GBP (r=0.438, P=0.053; and r=0.155, P=0.515, respectively). Agreement analysis for ejection fraction estimation by QGS and ECTb demonstrated a non-significant correlation between the difference and the mean. The LMC method showed a non-significant trend to decrease the difference with GBP as the mean increased. However, the LVGTF method significantly increased the difference as the mean increased. CONCLUSION: The currently available gated SPECT methods have moderate to poor correlations in addition to wide agreement limits with gated blood pool studies in patients with small hearts. Improvement of these methods to achieve better results in such patients is recommended. The newly developed LMC method yielded better results in the group with small hearts but with low interchangeability with GBP studies.