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Introduction: Busulfan (Bu)-based regimens are crucial for myeloablative conditioning in pediatric allogeneic stem cell transplantation. Despite its efficacy, Intravenous Bu has a narrow therapeutic index and variable pharmacodynamics especially in children, heightening the risk of adverse events. This study explores Bu dosing and related organ toxicities in pediatric patients at a tertiary center in Saudi Arabia.Methodology: This retrospective study at King Fahad Specialist Hospital in Dammam (KFSH-D), Saudi Arabia, included pediatric patients (≤16 years) treated with intravenous Bu before bone marrow transplantation from 2010 to 2022. Pharmacokinetic dose adjustments were based on AUC targets of 900-1350 µMol-min. Descriptive measures included mean, Standard Deviation (SD), median, minimum-maximum values, counts, and percentages. Statistical analyses used Kruskal-Wallis, Chi-square, and Fisher’s exact tests. Ethical approval was obtained from KFSH-D.Results: We identified 44 pediatric patients who underwent Bu prior to HSCT. Mean age was 4.95 ± 2.49 years, with a female majority (56.8%). Primary diseases included Beta Thalassemia (34.09%), Neuroblastoma (29.55%) among others. There was no significant difference in the cohort’s demographic and clinical features of the cohort. Nonetheless, higher infections were found in the Low-AUC group (66.7%) compared to the Target-AUC (40.0%) and Higher-AUC groups (0.0%) (p = 0.015).Conclusion: This study emphasizes the need for therapeutic drug monitoring and individualized Bu dosing in pediatric HSCT to minimize toxicity and improve outcomes. Larger multicenter studies are recommended to refine dosing strategies and enhance the safety and efficacy of Bu-based regimens.

Context: Several texts and literature suggest that corpus callosum may be sexually dimorphic. Previous researchers found that the length of the corpus callosum is larger in males than in females. Reviewing various foreign literature found that the length of the corpus callosum may change in many diseases in Neurology, Neurosurgery, and Psychiatry. So, knowledge of the normal morphological difference of the length of corpus callosum between Bangladeshi males and females is essential for the diagnosis in brain imaging and treatment of those diseases. Objective: The present study was conducted to provide data on the length of the corpus callosum of our people, which can be used to set a standard measurement for the Bangladeshi population. Materials and methods: A cross-sectional, descriptive study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, Bangladesh, from July 2009 to June 2010, based on the collection of 60 human brains (male 36 and female 24) from unclaimed dead bodies. The lengths were measured by using digital slide calipers in mm.Results: The mean length of the corpus callosum in males and females in groups A, B, C & D (grouping in done on age difference) were 68.04 ± 0.99 and 67.03 ± 0.05 mm, 67.50 ± 0.13 and 67.02 ± 0.03 mm and 67.51 ± 0.03 and 67.02 ± 0.03 mm respectively.Conclusion: Statistically significant differences were found between males and females in all age groups in the length of the corpus callosum.

There is increasing evidence of the difficulty in understanding the “biological functioning” of some complex microbial communities. Complex microbial communities exist everywhere in nature, and the interactions among their constituent microorganisms are a crucial aspect that influences their development. The ability of microorganisms to colonize an environment includes their ability to interact with other species in the same ecosystem, as well as their ability to adapt and integrate into the evolving community. The interactions among microorganisms and not just their numbers, or the presence of different species, biotypes, and variants, in many cases, seems to become a decisive factor in understanding and analyzing the development of microbial ecosystems and the biological function of the individual microbial entities that are part of them.After working to isolate individual microbial cells and study the mechanisms of their functioning and development, it is time to embark on a backward journey “from the small to the complex” for a better understanding of complex microbial ecosystems and their application potential. The purpose of this brief contribution is to further the development of the understanding of the role of microbial communities in nature and the mode of their development and evolution.

Sleep disorders represent a significant public health concern due to their widespread prevalence, impact on overall health, and the economic burden they impose. These disorders encompass a broad spectrum of conditions, ranging from insomnia and obstructive sleep apnea (OSA) to narcolepsy, restless legs syndrome (RLS), and parasomnias. They are often associated with comorbidities such as cardiovascular diseases, metabolic dysfunctions, and mental health disorders, making their identification and management critical.The publication of this work is of high interest as it contributes to the expanding body of literature focused on understanding the complex interplay between sleep disorders and health outcomes. By presenting detailed case reports, this study provides valuable insights into the diagnostic challenges, treatment modalities, and potential avenues for personalized interventions in sleep medicine. Case reports are particularly important in this field as they shed light on unique presentations and rare conditions that might otherwise go unnoticed in large-scale epidemiological studies. From an epidemiological perspective, sleep disorders are highly prevalent globally. According to the World Health Organization (WHO), approximately 30% - 45% of the global population experiences sleep disturbances. Obstructive sleep apnea, for instance, affects nearly 1 billion individuals worldwide, with varying prevalence across age, gender, and geographic regions. Insomnia affects roughly 10% - 30% of adults, with rates as high as 50% - 60% in older populations.Meanwhile, narcolepsy, though rare, is estimated to affect 1 in 2,000 people in the general population. These statistics underscore the pressing need for enhanced diagnostic methods, improved treatment strategies, and comprehensive patient management. By detailing real-world cases, this publication aims to bridge the gap between clinical observations and broader scientific understanding. The insights gained from these case studies have the potential to inform future research directions, improve clinical practices, and ultimately enhance patient outcomes in sleep medicine.Sleep disorders affect millions of individuals globally, disrupting physical, mental, and emotional well-being. Conditions such as insomnia, obstructive sleep apnea (OSA), narcolepsy, and restless legs syndrome (RLS) are among the most studied. This paper examines the etiology, diagnosis, and management of sleep disorders, presenting detailed case reports and integrating relevant sleep study findings. Figures such as polysomnography (PSG) outputs and statistical trends provide visual insights into diagnostic and therapeutic interventions. Sleep disorders encompass a wide range of conditions that significantly disrupt sleep quality and overall well-being. Common disorders such as insomnia, obstructive sleep apnea (OSA), narcolepsy, and restless legs syndrome (RLS) affect millions globally, posing risks to physical health, mental stability, and cognitive performance. This study explores the clinical presentation, diagnostic approaches, and management of sleep disorders through the lens of detailed case reports and sleep study data.Polysomnography (PSG), the gold standard for sleep disorder diagnosis, plays a pivotal role in identifying abnormal sleep patterns, respiratory irregularities, and neural disruptions. Multiple sleep latency tests (MSLT) and actigraphy complement PSG, offering insights into disorders like narcolepsy and circadian rhythm abnormalities. This paper presents three representative case reports: chronic insomnia, severe OSA, and narcolepsy with cataplexy. Each case is analyzed in-depth, highlighting patient history, PSG findings, treatment interventions, and outcomes. For chronic insomnia, cognitive-behavioral therapy for insomnia (CBT-I) and pharmacological intervention resulted in marked improvements in sleep latency and efficiency. In the OSA case, continuous positive airway pressure (CPAP) therapy significantly reduced the apnea-hypopnea index (AHI) and alleviated daytime symptoms. The narcolepsy case demonstrates the efficacy of modafinil and sodium oxybate in managing excessive daytime sleepiness and cataplexy.Despite advancements, challenges persist in the field, including patient adherence to therapy, accessibility to specialized sleep studies, and the ethical implications of AI-driven diagnostic tools. Future research should focus on scalable, patient-centric approaches and the role of emerging technologies in enhancing diagnostic accuracy and treatment efficacy. This paper aims to contribute to the evolving understanding of sleep disorders, bridging clinical case insights with the broader implications for sleep health and research.

This review aims to emphasize the scientific focus on platelet therapies by presenting the results already obtained in mares susceptible to Persistent Breeding-Induced Endometritis (PBIE), as well as highlighting opportunities for further improvement. The recent publication demonstrating the absence of bacterial growth in susceptible mares treated with PRP underscores the potential of regenerative therapies to control infections without promoting the emergence of multidrug-resistant bacteria. Alternative therapies have gained prominence in the current public health context, with the World Health Organization listing antimicrobial resistance among the ten most significant global threats. Endometritis is the leading cause of subfertility in mares, and empirical antibiotic therapies are commonly used in the field due to market pressures related to the high financial value of embryos, along with logistical challenges in obtaining laboratory-dependent diagnostic results. Platelet-Rich Plasma (PRP) is an alternative therapy derived from whole blood plasma with a high concentration of platelets. Its anti-inflammatory, regenerative, and antimicrobial properties are particularly tested when traditional therapies fail to achieve the desired effect. In recent years, research on the use of PRP in equine reproduction has primarily focused on endometritis, with a particular emphasis on persistent breeding-induced endometritis (PBIE). However, there is a growing interest in other platelet derivatives, such as lyophilized platelet-rich plasma and platelet lysate, which offer practical field applications.

Background: High blood pressure and dyslipidemia are risk factors that begin silently and share many pathophysiological mechanisms of tissue damage.Aim: Draw attention to this binomial (Hypertension and dyslipidemia) that is highly prevalent in Mexico and is mainly responsible for the leading atherothrombotic process as a cause of death in Mexico and the world.Methods: Reflective analysis of the evidence accumulated in the last 20 years. We launch key messages and support why every hypertensive patient should be treated with a statin.Results: We call for awareness to measure lipid levels and blood pressure twice a year from the age of 20 and to detect these devastating nosological entities as soon as possible. We remove the myth that PCSK9 inhibitors as well as the small interfering RNA of its synthesis are only for familial dyslipidemia. Measurement of serum Lp(a) should be routine, especially if you have a history of your own and family cardiovascular events.Conclusion: We should be aware of the little impact that health strategies have had to stop the main cause of death in Mexico. Every hypertensive patient should receive a statin, even if their serum LDLc levels are apparently normal. The great challenge of optimal control of the population with hypertension and/or dyslipidemia continues. The small interfering RNA synthesis PCSK9 should also be considered when conventional therapies are not sufficient and this situation is not infrequent.

Conventional antibiotics are resisted by bacteria at an increasing rate, prompting studies into the development of alternate antibiotic agents. This work demonstrates the fabrication and characterization of amine functionalized graphene quantum dots (af-GQDs) with starting materials of graphene oxide, ammonia, and hydrogen peroxide by chemical oxidation and hydrothermal methods. The synthesized af-GQDs were characterized using analytical techniques such as UV-vis, fluorescence, FTIR, Raman spectroscopy, and morphological studies through TEM. TEM images showed that af-GQDs have smooth surface morphology with porous in nature and are spherical in shape with particle size less than 20 nm. The prepared af-GQDs show a quantum yield of 26.32%. A growth inhibition test was performed on E. coli and S. aureus for the prepared af-GQDs at different increasing concentrations. The minimum inhibitory concentration for the prepared af-GQDs on E. coli was found to be 55 μg/mL and for S. aureus was found to be 35 μg/mL. Percentage cell viability studies were performed on HeLa and Jukart cells for 24 hours at different concentrations. Both cells showed maximum cell viability percentage at the initial concentration. At higher concentrations, the cell viability is decreased for both cells but the Jukart cells show a minimum percentage of cell viability at higher concentrations than the HeLa cells.

The psychophysical impact of a high-complexity environment such as the dental office is not a novelty. This article outlines the organizational and human factors that impact the overall health of dentists, assistants, hygienists, and administrative staff. A careless organizational and human factors approach cannot only function as a stress and error trigger but also affect the highly precise requirements of dentistry and task performance in the daily demands of the office. Ergonomics and human factors principles guidelines should be structured and taught from the basics in dental schools and supported by prevention programs and interventions in the dental professional field, as in other industries, to promote safety, health, and efficiency within the integration of humans, systems, and environments.Usually, the main focus of dentistry research is the physical aspect of the job; the high rates of musculoskeletal disorders are a real problem, but the cognitive-organizational element of the job is not a minimal issue, which highly contributes to physical-emotional exhaustion in the work environment.A fatigued mind impacts the physical aspect of the job, and physical fatigue impacts the mental aspect of the job. This dual effect in a job that requires dealing with anxiety and fear patients, administrative situations in the office, financial aspects, and technical and skill aspects from the dentist, among other requirements, makes dentistry a unique profession.This article addresses the components of the factors that promote cognitive depletion in our field and provides simple tips on controlling them to avoid burnout among dentists. It highlights the importance of awareness of how we manage the organization in the office and the effect on human behavior and performance. It wants to bring to light a common problem for dental practitioners and the workforce to prevent health and performance decrease.

Objective: Current guidelines favour radial access (TRA) over femoral access (TFA) for percutaneous coronary interventions due to lower bleeding risks and quicker patient recovery. This study compares patient satisfaction and complications between the two methods to identify the most suitable access route in coronary angiography (CAG).Materials and methods: A total of 152 patients who underwent CAG between February and June 2024 at our clinic were included. The operator and patient made access site decisions. Patients were surveyed 24 hours post-procedure, and complications were tracked for one month. The primary endpoint was patient satisfaction, while complications were classified as minor and major bleeding, pseudoaneurysm, hematoma, and spasm.Results: Of the 152 patients, 33% (n = 50) underwent TRA and 67% (n = 102) underwent TFA. Minor bleeding occurred in 16% (n = 24) and major bleeding in 0.02% (n = 3) patients. Pre-procedure anxiety, satisfaction with the access method, and awareness of TRA showed no significant differences between groups. However, post-procedure pain was higher in the TRA group (46% vs. 15%, p < 0.001), and systolic blood pressure was slightly elevated in the TRA group. Anxiety was more common in females, while elderly and obese patients showed no significant differences in bleeding or complications.Conclusion: Despite TRA’s benefits, no significant difference in satisfaction between TRA and TFA was observed. Patient preferences, radial artery spasms in females, and improved TFA techniques may influence outcomes. A shared decision-making process between operator and patient seems optimal for access site choice, with further investigation into patient satisfaction factors warranted.

Visualizing a nodule in the liver parenchyma of a patient with chronic liver disease raises the suspicion of hepatic malignancy. We report here the case of a 63-year-old female with primary biliary cholangitis (PBC) in whom a hepatic pseudolymphoma (HPL) was incidentally detected. This fairly rare lesion mimics primary liver cancer, has no specific radiological features, and requires histology for a definite diagnosis. This tumor-like lymphoid liver proliferation has been reported in clinical situations with immune-mediated inflammation including PBC. It can be observed in many organs but very rarely in the liver. The diagnosis of HPL should be considered when detecting a liver nodule in a patient with this particular chronic cholestatic liver disease.

Shoulder dystocia is a rare but severe complication of vaginal delivery with possibly serious consequences. Certain risk factors are associated with shoulder dystocia, but a general forecasting model is lacking. We present a Case report using a newly modified Posterior Axilla Maneuver technique that saved a 5.140 g (11 lbs. 5 oz.) newborn from shoulder dystocia. The child was born with Apgar 7/9, pH 7.17. Currently, there are no signs of any long-term sequelae.Our procedure comprised the following steps: 1. First, we pulled the posterior shoulder downwards - in the direction and to the outer surface of the perineum. 2. Then we pulled the posterior shoulder backward - toward the maternal spine - when it was already outside the perineum and finished extracting the posterior shoulder. 3. By completing the first two steps, a Tilt of the shoulder girdle was reached in the midsagittal plane, resulting in a backward slope for the shoulder girdle so that the anterior shoulder touched the symphysis slightly from the back in a skewed manner, freeing it from the initial impacted position. 4. We applied the Kristeller procedure only after dislodging the anterior shoulder from its initial impacted position. 5. We also applied the McRoberts Maneuver at the end of the process to increase the diameter of the birth canal.

Africa is one of the continent’s most vulnerable to the effects of climate change despite contributing the least to global greenhouse gas emissions. The continent has faced many environmental challenges recently, including rising temperatures, altered precipitation patterns, frequent droughts, and extreme weather events. These changes exacerbate existing vulnerabilities in agriculture, water resources, human health, and infrastructure, which are vital for the livelihoods of millions of people. Africa’s population is 60% occupied by agriculture and is threatened by shifting rainfall patterns and extended droughts. Crop yields are increasingly variable, leading to food insecurity and exacerbating poverty. Water scarcity is another pressing concern, as reduced rainfall and more frequent droughts strain already limited water resources, affecting agriculture and access to clean drinking water. Coastal regions are also at risk, with rising sea levels threatening millions living in low-lying areas. In effect, the impacts of climate change extremely affect Africa’s low-level income populations, deepening social and economic inequalities. Africa’s limited financial resources and infrastructure hinder its ability to adapt to these challenges. Nonetheless, Africa also has the potential for resilience through nature-based solutions, renewable energy investments, and regional cooperation. Efforts to enhance climate adaptation, such as sustainable farming practices, improved water management, and climate-smart policies, are critical in building the resilience of communities in combating climate change.

The amniotic membrane, used for over a century, is a widely recognized therapeutic tool in regenerative medicine and reconstructive surgery. Its primary indication is in the treatment of deep partial-thickness burns, where it facilitates epithelialization by providing an optimal environment for tissue regeneration. However, its versatility allows its use in various clinical scenarios, particularly in wounds or trauma where immediate closure is not possible, either due to the patient’s condition or the characteristics of the wound itself. Its most notable benefits include the prevention of necrosis due to desiccation, minimizing the loss of essential proteins, fluids, and electrolytes, reducing the risk of infection by acting as a physical barrier and alleviating pain by covering and stabilizing the wound.Additionally, its ability to act as a temporary biological cover offers a valuable solution in complex cases, improving both the prognosis and the patient’s management.A case series is presented demonstrating various applications of the amniotic membrane.

Background: Stunting is a condition of growth and development disorders in children under 5 years of age who appear shorter than their age caused by nutritional deficiencies. The stunted growth and development of children can be influenced by deficiencies in the intake of macronutrients such as protein and micronutrients such as calcium, phosphorus, zinc, and vitamin D. One nutrient that is relevant to current dental health research is vitamin D. Objective: This review article will further analyze the relationship between vitamin D deficiency and Porphyromonas gingivalis bacterial lipopolysaccharide in stunting children. Literature review: Vitamin D deficiency can cause various problems related to the oral cavity such as a decrease in salivary flow rate, buffer capacity, and salivary content such as protein. A decrease in salivary flow rate causes secretory Immunoglobulin A (IgA) to decrease, thus disrupting the colonization of normal microflora in the oral cavity. Reduced vitamin D levels can potentially increase the number of Porpyhromonas gingivalis bacteria and also lipopolysaccharides (LPS), thus inhibiting the proliferation and differentiation of alveolar bone cells. Conclusion: Therefore, lack of micronutrient intake such as vitamin D deficiency can trigger the growth of Porphyromonas gingivalis bacteria and an increase in bacterial products such as lipopolysaccharides, especially in stunted children. 

The National Health Surveillance Agency (ANVISA) is a public institution created by Law 9782/1999, which integrates the field of Collective Health and acts in the prevention, control, and inspection of sanitary conditions in various sectors, such as food, health, pharmacies, hospitals, and commercial establishments. Its main objective is to guarantee the protection of public health, ensuring that products, services, and environments comply with established standards, to promote health and preventing diseases. To exercise its inspection and control function, Sanitary Surveillance has the power of sanitary police, which gives it the authority to apply necessary measures and curb practices that pose risks to the health of the population.The performance of the Sanitary Surveillance is fundamental to prevent health risks in any part of society and to guarantee national programs for patient safety. It is also essential to prevent diseases, control risks, and monitor compliance with health standards and specific regulations. The police power of Sanitary Surveillance consists of establishing norms and technical regulations, carrying out inspections and inspections, issuing temporary or permanent interdiction orders in establishments that do not comply with the norms, as well as forwarding complaints to the Public Ministry in cases of crimes against public health. Arrests carried out by Sanitary Surveillance agents are extreme measures and applied in serious situations of risk to public health or when there is repeated disrespect for sanitary regulations. The prohibited establishments have the right of defense and may seek to regularize the situation to obtain the release of activities.The performance of the Sanitary Surveillance has significant impacts on the prevention of disease outbreaks and epidemics. Identifying and correcting inappropriate practices helps to prevent the spread of pathogenic agents and reduce the risk of contagion in collective environments. The institution’s preventive and supervisory activities contribute to reducing risks to the population’s health, preventing disease outbreaks, food poisoning, and the proliferation of pests, among other problems. Finally, the importance of exercising police power with transparency, impartiality, and respect for individual rights is emphasized, always aiming at the collective interest and the promotion of the common good. In summary, Health Surveillance plays an essential role in protecting public health, seeking to ensure that the population has access to safe products and services, contributing to the improvement of quality of life and disease prevention.

A details development in recent dermal studies being carried out and purposed dermal studies is investigated in this research review globally and the various disease and process functions and treatment with symptoms and etiology and pathophysiology of skin-related issues are studies and practically feasible solution of various integumentary systems related problem and it’s function is researched and almost 30 types of common skin related diseases and remedies studies by researcher and it’s company KIRDPL in global perspectives and especially in tropical climate zone in various cases in patients is mentioned including plastic surgery to gene therapy and dermabrasion to the genetic disease as well. The integumentary systems in the animal kingdom as a whole are focused and homosapiens' human dermal functions and their development and future developments of stem cells laboratory-grown skin coats of different colors for shedding and treatments of cancerous skin and integumentary system and gene therapy of the ailments are discussed.

Aim and objective: This study aimed to determine the prevalence and characteristics of drug dependency among patients in various rehabilitation centers in the Shimla district. Introduction: Drug abuse is a multifaceted and significant issue impacting individuals worldwide, and the city of Shimla in Himachal Pradesh is no exception. Despite its reputation as a picturesque hill station known for its natural beauty and rich cultural heritage, Shimla faces challenges related to substance abuse. Materials and methods: A cross-sectional survey was conducted, gathering demographic data, drug history, and indicators of dependency from the participants.Results: The findings revealed that 60% of the patients were drug-dependent, with 44% addicted to heroin and 11% to alcohol. Additionally, 60% of the patients reported a family history of chemical dependency. The study also identified associated psychological disorders such as depression and anxiety, as well as interpersonal and environmental factors like peer pressure and coping mechanisms such as avoidance and denial. Conclusion: These findings underscore the complexity of drug dependency, highlighting the need for comprehensive, multidimensional approaches to address the medical, emotional, and social aspects of addiction.

Extrahepatic biliary neuroendocrine tumors (EBNETs) are a rare group of neoplasms with varying characteristics, with 223 cases documented since their discovery. In this case report, an EBNET is described as a result of vague abdominal pain and significantly elevated liver function tests in a 41-year-old woman who presented with vague abdominal pain and elevated liver function tests. Despite the challenges faced in preoperative diagnosis, including the need to differentiate from cholangiocarcinoma, surgical intervention was successful. Due to the tumor’s complex nature, meticulous dissection and reconstruction were required, leading to crucial insights into surgical management. In addition to highlighting the rarity of EBNETs, this case emphasizes the importance of early detection and customized surgical approaches.

Burnout among clinicians is a pressing concern worldwide, manifesting as emotional exhaustion, depersonalization, and reduced professional efficacy. This article explores the intersection of burnout and allostatic load, the physiological burden resulting from chronic stress, to elucidate the consequences for healthcare providers. Burnout impacts clinicians’ mental and physical health, leading to compromised patient care, reduced job satisfaction, and increased attrition rates. A comparative analysis of recent scholarly works reveals converging evidence on systemic contributors such as excessive workloads, inadequate support systems, and organizational inefficiencies, further compounded by individual vulnerabilities like lack of resilience. These challenges have been exacerbated by the COVID-19 pandemic, which has significantly increased stress levels among healthcare professionals globally. This article synthesizes insights from studies conducted between 2020 and 2024, emphasizing the need for holistic approaches to mitigate burnout. It highlights the physiological underpinnings of allostatic load, including chronic dysregulation of stress-response systems that predispose clinicians to adverse health outcomes like cardiovascular diseases, immune dysfunction, and mental health disorders. To address these issues, the article proposes a multidimensional strategy encompassing organizational reforms, evidence-based interventions, and policy advocacy. Recommendations include reducing administrative burdens, fostering supportive work environments, and integrating wellness programs targeting both systemic and individual stressors. Limitations and directions for future research emphasize the importance of inclusive, longitudinal studies focusing on diverse populations to develop tailored solutions. This comprehensive approach aims to enhance clinician well-being and improve healthcare outcomes globally.

Direct myocardial transplant of HFDSCs (human fetal derived stem cells) by open chest surgical procedure was performed in 10 patients with Heart Failure (HF) due to no ischemic, no chagasic dilated cardiomyopathy. All 10 patients survived the operation. At 40 months, the mean (±SD) NYHA class decreased from 3.4 ± 0.5 to 1.33 ± 0.5 (p = .001); the mean EF increased 31%, from 26.6% ± F) 34.8% ± 7.2% (p = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (p < .0001); the mean LVEDD decreased 15%, from 6.85 ± 0.6 cm to 5.80 ± 0.58 cm (p < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 ± 113.1 seconds to 360  0 seconds (p = .01); the mean distance increased 64.4%, from 284.4  144.9 m to 468.2 ± 89.8 m (p = .004); and the mean result in the Minnesota test decreased from 71 ± 27.3 to 6 ± 5.9 (p < .001). Six patients survived after 40 months; 5 of them had complete reverse remodeling after 3 months after transplants. The average age at the moment of the transplants was 62 years (s/d 11.6). Results: The first patient died at 5,4 years for an infection; the second patient died at,7,4 years for heart failure; the third patient died at 8,4 years for heart failure; the fourth patient died at 10 years for heart failure and the fifth patient died at 14,4 years after transplant at the age of 83 for heart failure. The average age at the moment of death was 70 years (s/d12.9). The survival rate at 4 years was 100% (K/M) and at 14 years (25%K/M). Conclusion: These initial worldwide experiences with the surgical direct transplant of liver fetal stem cells in patients with end-stage HF shows clearly the positive effect in the reverse remodeling of the left ventricle of 50% of the cohort and excellent long-term results in these types of patients opening a new avenue for treating end-stage HF patients without any other option of treatment.