***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Autologous adult stem cell transplantation has been touted as the latest tool in regenerative medical therapy . Its potential for use in cardiovascular disease has only recently been recognized . A r and omized study was conducted with a novel epicardial technique to deploy stem cells as an adjuvant to conventional revascularization therapy in patients with congestive heart failure . METHODS After institutional review board and government approval , adult autologous stem cell transplantation ( CD34 + ) was performed in patients with ischemic cardiomyopathy and an ejection fraction of less than 35 % who were scheduled for primary off-pump coronary artery bypass grafting . Preoperatively , the patients underwent echocardiography , stress thallium imaging single photon emission computed tomography , and cardiac catheterization to identify ischemic regions of the heart and to guide in the selection of stem cell injection sites . The patients were prospect ively r and omized before the operative therapy was performed . Patient follow-up was 1 , 3 , and 6 months with echocardiography , single photon emission computed tomography , and angiography . RESULTS There were 20 patients enrolled in the study . Ten patients had successful subepicardial transplantation of autologous stem cells into ischemic myocardium . The other 10 patients , the control group , only had off-pump coronary artery bypass grafting . There were 8 male and 2 female subjects in each group . The median number of grafts performed was 1 in both groups . On angiographic follow-up , all grafts were patent at 6 months . The ejection fractions of the off-pump coronary artery bypass grafting group versus the off-pump coronary artery bypass grafting plus stem cell transplantation group were as follows : preoperative , 30.7 % + /- 2.5 % versus 29.4 % + /- 3.6 % ; 1 month , 36.4 % + /- 2.6 % versus 42.1 % + /- 3.5 % ; 3 months , 36.5 % + /- 3.0 % versus 45.5 % + /- 2.2 % ; and 6 months , 37.2 % + /- 3.4 % versus 46.1 % + /- 1.9 % ( P < .001 ) . There were no perioperative arrhythmias or neurologic or ischemic myocardial events in either group . CONCLUSIONS Autologous stem cell transplantation led to significant improvement in cardiac function in patients undergoing off-pump coronary artery bypass grafting for ischemic cardiomyopathy . Further investigation is required to quantify the optimal timing and specific cellular effects of the therapy Background — Recent trials have shown that intracoronary infusion of bone marrow cells ( BMC s ) improves functional recovery after acute myocardial infa rct ion . However , whether this treatment is effective in heart failure as a consequence of remodeling after organized infa rcts remains unclear . In this r and omized trial , we assessed the hypothesis that direct intramyocardial injection of autologous mononuclear bone marrow cells during coronary artery bypass graft ( CABG ) could improve global and regional left ventricular ejection fraction ( LVEF ) at 4-month follow-up . Methods and Results — Twenty patients ( age 64.8±8.7 ; 17 male , 3 female ) with a postinfa rct ion nonviable scar , as assessed by thallium ( Tl ) scintigraphy and cardiac magnetic resonance imaging ( MRI ) , scheduled for elective CABG , were included . They were r and omized to a control group ( n = 10 , CABG only ) or a BMC group ( CABG and injection of 60.106±31.106 BMC ) . Primary end points were global LVEF change and wall thickening changes in the infa rct area from baseline to 4-month follow-up , as measured by MRI . Changes in metabolic activity were measured by Tl scintigraphy and expressed as a score with a range from 0 to 4 , corresponding to percent of maximal myocardial Tl uptake ( 4 indicates < 50 % , nonviable scar ; 3 , 50 % to 60 % ; 2 , 60 % to 70 % ; 1 , 70 % to 80 % ; 0>80 % ) . Global LVEF at baseline was 39.5±5.5 % in controls and 42.9±10.3 % in the BMC group ( P=0.38 ) . At 4 months , LVEF had increased to 43.1±10.9 % in the control group and to 48.9±9.5 % in the BMC group ( P=0.23 ) . Systolic thickening had improved from −0.6±1.3 mm at baseline to 1.8±2.6 mm at 4 months in the cell-implanted scars , whereas nontreated scars remained largely akinetic ( −0.5±2.0 mm at baseline compared with 0.4±1.7 mm at 4 months , P=0.007 control versus BMC -treated group at 4 months ) . Defect score decreased from 4 to 3.3±0.9 in the BMC group and to 3.7±0.4 in the control group ( P=0.18 ) . Conclusions — At 4 months , there was no significant difference in global LVEF between both groups , but a recovery of regional contractile function in previously nonviable scar was observed in the BMC group Implantation of bone-marrow stem cells in the heart might be a new method to restore tissue viability after myocardial infa rct ion . We injected up to 1.5x10(6 ) autologous AC133 + bone-marrow cells into the infa rct border zone in six patients who had had a myocardial infa rct ion and undergone coronary artery bypass grafting .  3 - 9 months after surgery , all patients were alive and well , global left-ventricular function was enhanced in four patients , and infa rct tissue perfusion had improved strikingly in five patients . We believe that implantation of AC133 + stem cells to the heart is safe and might induce angiogenesis , thus improving perfusion of the infa rct ed myocardium . See Commentary page OBJECTIVES Cell therapy may offer novel therapeutic options for chronic ischemic heart disease . In a clinical trial , we first assessed the feasibility and safety of intramyocardial CD133 + bone marrow cell injection together with coronary artery bypass grafting ( CABG ) . We then tested the hypothesis that CABG plus CD133 + cell injection would result in better contractile function than CABG alone . METHODS Fifteen patients took part in the safety study , followed by 40 patients who underwent either CABG with cell therapy or CABG alone . Bone marrow was harvested from the iliac crest one day before surgery , and purified CD133 + progenitor cells were injected in the infa rct border zone during the CABG operation .  LV function was measured by echocardiography and myocardial perfusion by SPECT . RESULTS In the safety study , no procedure-related complications were observed for up to 3 years . LV injection fraction ( LVEF ) increased from 39.0 % + /- 8.7 % preoperatively to 50.2 % + /- 8.5 % at 6 months and 47.9 % + /- 6.0 % at 18 months ( F = 6.03 , P = .012 ) . In the efficacy study , LCEF rose form 37.4 % + /- 8.4 % to 47.1 % + /- 8.3 % at 6 months in the group with CABG and cell therapy ( F = 24.16 , P < .0001 ) but only from 37.9 % + /- 10.3 % to 41.3 % + /- 9.1 % in the CABG-only group ( F = 7.72 , P = .012 ) . LVEF was significantly higher at 6 months in the group with CABG and cell therapy than in the CABG-only group ( P = .03 ) . Similarly , perfusion of the infa rct ed myocardium improved more in patients treated with CABG and cell therapy than in those treated with CABG alone . CONCLUSION Intramyocardial delivery of purified bone marrow stem cells together with CABG surgery is safe and provides beneficial effects , though it remains to be seen whether thewe effects produce a lasting clinical advantage BACKGROUND 99mTc sestamibi is a recently developed radioisotope that has been used to measure myocardium at risk and infa rct size . The relation between these measurements and subsequent patient outcome has not yet been demonstrated . METHODS AND RESULTS Two hundred seventy-four consecutive patients with acute myocardial infa rct ion underwent tomographic 99mTc sestamibi imaging on arrival at the hospital ( to measure myocardium at risk before reperfusion therapy ) and at hospital discharge ( to measure the amount of salvaged myocardium and final infa rct size ) . Defect size on the sestamibi images was quantified using a threshold value of 60 % of peak counts from the circumferential count profile curves generated for five representative slices of the left ventricle . Patients were followed after hospital discharge to evaluate the association between final infa rct size and subsequent mortality . The median defect size measured was 27 % of the left ventricle at presentation to the hospital ( range , 0 % to 77 % ) and was 12 % of the left ventricle at hospital discharge ( range , 0 % to 68 % ) . Almost one half of the patients had a final infa rct size of < or = 10 % . The median amount of myocardium salvaged was 9 % ( range , -31 % to 75 % ) . During a median duration of follow-up of 12 months , there were 10 deaths ( 7 cardiac and 3 noncardiac ) and 1 resuscitated out-of-hospital cardiac arrest . There was a significant association between infa rct size and overall mortality ( chi 2 = 8.66 , P = .003 ) and cardiac mortality ( chi 2 = 11.89 , P < .001 ) . Two-year mortality was 7 % for patients whose infa rct size was > or = 12 % versus 0 % for patients whose infa rct size was < 12 % . There also was a significant association between myocardium at risk and cardiac mortality ( chi 2 = 6.87 , P = .009 ) . There was no association between myocardium at risk and overall mortality or between amount of myocardium salvaged and either overall mortality or cardiac mortality . CONCLUSIONS Larger infa rct size measured by 99mTc sestamibi imaging after acute myocardial infa rct ion is associated with increased mortality risk during short-term follow-up BACKGROUND Mononuclear bone marrow cell ( MN- BMC ) transplantation has great clinical potential to promote myocardiogenesis and angiogenesis . This r and omized study was design ed to assess the feasibility and safety of MN- BMC transplantation during coronary artery bypass grafting ( CABG ) in patients with ischemic heart failure . METHODS Thirty-six patients were prospect ively enrolled and r and omized to a  MN- BMC group ( n = 18 ) and a control group ( n = 18 ) . A mean number of 6.59 x 10(8 ) + /- 5.12 x 10(8 ) MN- BMC were injected into the infa rct ed and marginal areas during CABG in the MN- BMC group . The patients in the control group underwent CABG alone . All patients were followed up to 6 months . RESULTS There was one death in the MN- BMC group and no death in the control group . Two patients developed ventricular arrhythmia in the MN- BMC group . Compared with baseline and the control group , therapeutic effects of MN- BMC transplantation  were observed over time . Heart function ( New York Heart Association ) was significantly improved and angina pectoris was alleviated in the MN- BMC group . Left ventricular ejection fraction in the MN- BMC group was greater than the control group . The thickness and motion velocity of the infa rct ed wall were significantly increased in the MN- BMC group . More pronounced perfusion improvements of ischemic regions and LV were observed in the MN- BMC group . There was one late death in the MN- BMC group . No procedure-related complications occurred . CONCLUSIONS MN- BMC transplantation improves cardiac function and regional perfusion in ischemic heart failure patients during CABG . A large cohort with long-term follow-up is needed to further evaluate the safety of MN- BMC transplantation AIMS Mesenchymal stem cells ( MSCs ) , rare bone marrow-derived stem cell precursors of non-haematopoietic tissues , have shown promise in potentially repairing infa rct ed myocardium . These and similar cell types are being tested clinical ly , but underst and ing of delivery and subsequent biodistribution is lacking . This study was design ed to quantitatively compare MSC engraftment rates after intravenous ( IV ) , intracoronary ( IC ) , or endocardial ( EC ) delivery in a porcine myocardial infa rct ion ( MI ) model . METHODS AND RESULTS Allogeneic , male MSCs were cultured from porcine bone marrow aspirates . Iridium nanoparticles were added during culturing and internalized by the MSCs . An MI was induced in female swine ( 2 
    Output:
    
Clinical evidence suggests that intramyocardial bone marrow stem cell transplantation in combination with coronary artery bypass grafting is associated with improvements of functional parameters in patients with chronic ischemic heart disease .
Furthermore , surgical intramyocardial bone marrow stem cell transplantation seems to be safe