Energy and Balance Essay Example | Topics and Well Written Essays - 500 words

Energy and Balance - Essay Example Contamination of the food potions interferes with the energy requirement in the oxidation of the food. The amount of energy required in the breakdown or oxidation of the foods, which contain the carbohydrates, proteins and fats, can be obtained by computation of the energy required in breaking these food components (Hervera, et al, 2008). The figures gotten are then computed and thus the energy requirement for the oxidation of the food can easily be determined. There are specific values of energies required to break down the food components in the various portions. This implies that as the food increase in volume and mass, the amount of energy in them is higher than the ones outlined in the formulation of the energy determination in the foods contain. The determine values of the contained calories in the given foods and the feeding stuffs; will provide exact estimation of the energy present in the foods being tested. The higher the amount needed to oxidize the foods, the higher the number of calories in the foods under examination (Hervera, et al, 2008). Nitrogen balance is the measurement of the input nitrogen and the output of nitrogen within a given set of products in the production line. This involves the nitrogen being taken in by the organism and finding a possible amount of nitrogen the substance produces. The difference between the nitrogen intake and output will determine the amount of nitrogen that the substance is giving out to balance the surrounding (Moya, Tenorio & Bond, 2013). Nitrogen balance can be portrayed in the Blood Urea Nitrogen and urea concentration in urine. The urea is a component of the nitrogen balance of the substance, organism, ecosystem or environments. Energy balances is the outcome of the comparison of the amount calories taken by a body and the amount of the elements or calories taken out. The energy in, involves the energy that is taken in through eating

Add Research Paper Example | Topics and Well Written Essays - 250 words

Add - Research Paper Example This article gives most of the details outlined above, such as the fact that it appears a Saudi airline truly did serve donkey meat, and is useful because it is one of the most reputable news organizations to report on the findings. It points out that Saudi airlines has mostly Muslim customers, who would be especially upset about the donkey meat. Saudi airlines constitutes a three start airline because it meets satisfactory standards in every category of airline care, including food. This means that the expectation level of a passenger on this airline should be fairly high, because they are paying for an airline that is supposed to deliver consistently good qualities of service in every area. Donkeys are considered Haram animals (forbidden animals) to be eaten because of their having cloven hooves. This means that it would be against religious practice for many Muslims to eat Donkey, even accidentally, and could be very troubling to a Muslim who

The Responsible Leader and Manager Essay Example | Topics and Well Written Essays - 1250 words

The Responsible Leader and Manager - Essay Example Among the managers are Stacey Miguel, Kathy Buttimer and Annama Schaeffer. They are, respectively, district manager in Indiana, recruiting manager in Rhode Island and investor relations manager. The district manager oversees all the operations of the district including customer satisfaction and preparing stakeholders’ reports. The recruiting manager is responsible for getting qualified and competent staff to drive the business’ success. The investor relations manager ensures the stakeholders’ interests are taken care of while updating them on the company’s progress. This paper will explain how the managers can use their personal, interpersonal and societal values to manage the stakeholders. It will also show how they demonstrate their awareness of social issues and corporate citizenship responsibilities. Stakeholders Stakeholder management is the process that promotes a company’s strategic goals by influencing internal and external environments to c reate beneficial relationships between the company and its stakeholders (Bolman & Deal 1995). This is achieved through management of the agreed objectives and expectations. Among the stakeholders of Limited Brands are the customers, corporate shareholding companies and suppliers. By the end of 2012, Janus Capital Management LLC had 22.8 million shares, representing a 15.9 percent shareholding in Limited Brands. It is the duty of the managers to integrate their personal values and corporate values in order to ensure the success of the business and encourage stakeholders to invest more. Apart from Mr. Leslie Wexner, the owner, Janus Capital Management is the next largest shareholder. Customers The customers are among the key stakeholders, and the company instills the value of the customer being king to all managers. The managers at Limited Brands know that the business cannot survive without its customers. Even after bringing quality products to the market, the customers’ choic e to buy or not can determine the business’ fate (Chappell 1993). It is, therefore, significant to portray themselves as a company that focuses on excellence driven by customer satisfaction and motivational leadership on top of giving value for money in their products. In mirroring their customers’ values, the recruiting manger, district manager and investor relationship manager bring out their humility in a bid to empower women and improve children’s education. All the managers possess personal values of reaching out a helping hand to the needy. They themselves must possess values of honesty and integrity so as to enroll into the programs genuinely deserving students and women. In light to aiding talented students who need to gain experience before venturing into the employment world, the company offers internships and the successful applicants receive firsthand 10 weeks of immersion experience. They get to learn how products, brands and customer experiences ar e built and delivered. Some are even enrolled into accounting or systems support positions. The managers ensure, through their values of sharing knowledge and opportunity, that the interns learn in the best environment and they can share their experiences with the general public, and customers, upon completion. They subject the interns to the actual and challenging experiences of the working field. The interpersonal values of the managers help the interns to build and develop networks of relationships with other managers and the broader customer base by introductions and recommendations. This gesture serves to attract, build and maintain loyal customers who ensure that business flourishes. With retail stores in 49 states in the US and over 700 products, the interns also stand a better chance of being taken up

Managing Activities To Achieve Results Essay Example | Topics and Well Written Essays - 1250 words

Managing Activities To Achieve Results - Essay Example They focus on demand from all over the world, to supply customers with products of a good price. Since it is an innovation based company that focuses on lower and competitive prices and food for all, its structure is a matrix structure. That is, it is divided into departments called functional departments. These include sales and marketing, global supply, research and development and global support functions. Even though these are independent functions, they function together as well, as teams are made to bridge the different departments. This helps bring diverse talent together and benefit the organization as a whole. It also has a culture of being forward looking, passionate and creative, where employees are made to think of new ideas while at the same time understanding that they need to meet deadlines. Employees are also appreciate and rewarded for the work that they do. LO1.2. Process management is when the company increases the effectiveness of the entire processes in Syngenta by applying the knowledge base to all the activities in the organization rather than a specific project so that optimal customer satisfaction can be achieved. The entire business process is included in this process and all the aspects of the organization are made according to the customer’s demand. ... The next step is to model the theories and test out their practicality and workability with a number of variables as situations in the world are dynamic. Execution is the next step and it is used to apply the theoretical concepts in the workplace such as the software or computer applications that allow the workplace to function. Service quality is defined as a comparison of what people are expecting to be delivered or offered and what they actually get offered or what actually is offered to them. If a business is eyeing to remain competitive and as well as a strong customer base, it is vital for them to offer the kind of service quality that is higher than the industry average. The business is able to establish itself as a successful enterprise only when they actually cater to the customers that they are looking for. A customer is always willing to pay as much as demanded when they are offered the equal price in return. The price in return that the customer is looking for is a good r eception of their demands and the fulfillment of their request to the maximum limit. Service quality has two aspects to it, one of them is objective and the other is subjective. The objective part of the service quality relates to the tangible factors, things that are visible while subjective part are the intangibles, things that are only felt or experienced. It is important for the business to be able to distinguish them and hence appear more appealing to their customers. To keep a constant check on the Service Quality that is being provided by them, the Sygentas should design a measurement scale, or predefined criteria that will actually help them judge their own service quality. Every business process also

Media changes Essay Example for Free

Media changes Essay Media changes the rules of how we can view the world. It lets us see that there are realities aside from the reality that we already know. The media shows, for instance, how tragic calamities like tsunamis and hurricanes could be. It also reveals that public school teachers in U. S. could also be violent and abusive towards their students. Now, if these realities didn’t come out of media, would we know that such injustices and inequalities still rampantly occur in human existence? Media also spreads bad influences like violence and pornography. However, these should not constitute the only basis for condemning media. Pornography and hostility already existed decades before media came out. Negligence of parents can’t be blamed for this violence. But it we want our children to view wholesome materials, then parents should initiate a move in monitoring their children’s activities and orient them what materials would be considered as garbage. Youtube. com is just one of the popular forms of media where the people visit to watch and upload videos. While some other sites have a team of reviewers to check on the videos beings submitted to their sites, YouTube o n the other hand is the free site where people can easily upload and access even the inappropriate ones. Inappropriate means videos containing obscene, violent, and offensive language. Kids 11-14 can say that there are videos with inappropriate content. Videos like Hentai (a Japanese pornographic animation) and Harry Potter Puppet Pals are examples of videos that have sexual, gory and foul content. These videos are obviously catchy to children. Indeed, children should never be deprived of their rights to be educated of ugly realities but posting violent and pornographic videos in a site where people, even the young ones, often â€Å"drop by† when they’re on the net could be dangerous. These videos might bring shock to these young, or they might think it is okay to show pornography. With all these issues, parents should guide their children on what they watch and, in some cases, what they upload. Some of these inappropriate videos can only be accessed when he/she registers and must not be a minor, but anybody could lie about the age. It is also advised that children below 18 should have parental guidance, but some parents are not aware that these sites exist. Some parents are not even familiar with the Internet. If children are guarded at home, the could always go to Internet cafes if they would insist or too curious to access these videos. This could still be possible since some cafe’s are very lenient when it comes to censorship. In our generation today, technology is changing and evolving every minute. Though measures are taken and warnings are given, improvement will only be realized with the virtue of responsibility. References Media Awareness Network (n. d. ) Violence in Media Entertainment. Retrieved October 12, 2008, from http://www. media-awareness. ca/english/issues/violence/violence_entertainment. cfm

Role of Fast Food in Increasing Childhood Obesity

Role of Fast Food in Increasing Childhood Obesity The pandemic of childhood obesity is something that should be concerning to the individuals of our country as it is something that can be prevented. Within the last 3 decades, child obesity has more than doubled in children and quadrupled in adolescents. In 1980, only about 7% of US children between the ages of 6 and 11 were obese, while in 2012 about 18% of them were. Similar results were seen in US children aged 12 to 19 years old, jumping from 5% to 21% during that same time. A person is considered overweight when they have excess body weight from fat, muscle, bone, or water for a certain height. A person who is considered obese has excess body fat (â€Å"Adolescent and School Health†, 2014). Caloric imbalance, which is when more calories are consumed than expended, contributes to obesity and can be affected by an assortment of behavioral, genetic, and environmental factors. Considered both an environmental and behavioral factor, the consumption of fast-food and convenience food contributes to higher obesity rates among children. The pace of the fast-food industry has only sped up in the past 30 years, as fast-food chains are rapidly multiplying and popping up faster than ever before on every street corner. They are known to serve calorie-dense foods which are high in salt and fat, and low in micronutrients (Fraser, Clarke, Cade, Edwards, 2012). These extra calories consumed in addition to the sedentary lifestyles of many children create an â€Å"obesogenic environment.† Extra calories get stored as adipose fat and contribute greatly to obesity (Fraser et al., 2012). Today, over 50 million customers are served each and every day from more than 3,000 different fast-food restaurants across the country. Promotional activities sponsored by these fast-food restaurants often target vulnerable populations including families with children or of low socio economic status, and stress that their products are quick and inexpensive meal replacements (Newman, Howlett, Burton, 2014). Like fast-food outlets, convenience stores are viewed as unhealthy since most of the products on their shelves are non-perishable and can last for long periods of time. The majority of the shelves in these types of stores are stocked with snacks and junk food. Seeing that portion sizes are significantly larger at fast-food and sit-down restaurants, they contain more calories and fat than meals prepared in the home would have (Lee, 2012). Many families opt for these alternatives because they do not have the time to cook a meal in the home or they are trying to save money and this is the only way they know how to. Consuming fast-food and convenience food is unhealthy for people, especially children since their bodies are still growing and need essential nutrients for proper development. An additional 150 calories a day has been associated with children who choose to eat fast-food for one of their meals throughout the day (Lee, 2012). Extra calories get stored as adipose fat, which can lead to being overweight and becoming obese if not monitored closely. The negative effects are numerous and can last a lifetime. Immediate effects of childhood obesity include greater risk for cardiovascular disease, insulin resistance, and developing asthma. Children can also develop sleep apnea and trigger the onset of early puberty by simply being overweight. This can cause a child to become self-conscious about their body image because they are developing faster than their peers. If not monitored before a child reaches adulthood, they have a greater risk of becoming obese as an adult, which can then lead to p roblems such as stroke, hypertension, type 2 diabetes, arthritis and a variety of different cancers (â€Å"Adolescent and School Health†, 2014). The rate of childhood obesity is climbing in every country with rates around 10% for school-aged children from all over the world. This is concerning since it is known that obesity can stay with a child through adulthood and cause disease. The more accessible grocery stores and farmers markets are, the smaller the risk a person has at becoming obese. While on the opposite end, the more one is surrounded by fast-food and convenience stores the higher their weight status usually is. In 2009, a study performed on 1,669 children indicated that 23% of them were overweight or obese. Additional findings included body weight to be 1.3 kg lower, BMI 0.5 kg/m ² lower, and body fat 1.1% lower in children who had access to supermarkets and food options than those who did not have this advantage (Jennings et al., 2011). Similar results were seen in another study that compared 72,900 children, from 17 different countries aged 6 to 7 years old. Twenty-three percent of the children said that they consumed fast food, while 4% of them said that they consume fast-food on a daily basis. The children who rarely came in contact with fast-food had an average BMI of 16.35, those who consumed fast-food once or twice a week had an average BMI of 16.5, and those who consumed fast-food daily had an average BMI of 16.57 (Braithwaite et al., 2014). Consumption of fast food only increases as a child gets older into their teen years. The more frequent fast-food is consumed, the higher a child’s BMI will be. Children are in a vulnerable state during their childhood, but also have an opportunity for extraordinary growth. It is important to nip these bad habits now, so they do not become the norm in the future. A study of 13 to 15 year olds in the United Kingdom showed associations between eating fast-food and the increase of body fat. Persons who ate fast-food typically had 2% more body fat and increased their odds of becoming obese by 23% (Fraser et al., 2012). Due to its expanding fr anchises, calorie dense products and large portion sizes, fast-food chains have become a major concern in several countries. Another thing to consider is the location of fast-food restaurants and convenience stores in relation to the school and the home. At least one fast-food chain has been found within walking distance of about 37% of all schools around the country (Newman, Howlett, Burton, 2014). Fewer servings of fruits and vegetables and increased servings of soda were seen in students who walked one half mile or less to a fast-food chain from school. The population of students who attended schools close to fast-food chains were more likely to be seen as overweight or obese than students who were not considered to be in that type of environment. In this study, the average BMI was 21.7 kg/m ² for students aged at least 12.5 years old. According to the Center for Disease Control (CDC), this is considered to be in the healthy weight range. With only 55% of children attending a school within walking distance of a fast-food restaurant, 27.7% of the total sample was overweight and 12% were considered obe se. A 0.10 unit increase in BMI was also seen in children who attended schools with a fast-food restaurant nearby (Davis Carpenter, 2009). Almost the same results were seen in a Leeds, UK population of 33,594 children ages 3 to 14. Of those living within the metropolitan boundaries, 27.1% of the population was overweight with 12.6% being obese (Fraser Edwards, 2010). Not only does fast-food cause an increase in BMI, but also increases a child’s risk of becoming obese. The odds of being overweight increases 1.06 times and the odds of being obese increases 1.07 times for children who attend schools that are in close proximity to a fast-food chain (Davis Carpenter, 2009). In a California-based study, the occurrences of obesity in high schools were significantly higher for students that could walk to fast-food outlets during or after school (Lee, 2012). Another survey conducted at a medium-sized public school district in Virginia showed that students within one-tenth of a mile of any fast-food place were 3.9 times more likely to be obese and have an increase of 2.32 units in BMI. BMI increased another 0.40 units if there was another restaurant within one quarter of a mile (Mellor, Dolan, Rapoport, 2011). It is all about location; children are more tempted to grab a bite to eat from a fast-food restaurant if it is on their way to and from sch ool. Convenience food is another factor that contributes greatly to childhood obesity. In a national study, 9,760 children were tracked from kindergarten until the spring of their eighth grade on fast-food, snack, and soda consumption. Fifth-graders showed that they ate an average of 0.46 fast-food/snacks per day, while 12% of them consumed fast-food daily. The average soft drink consumption was 0.91 servings daily with 19% reporting that they had more than twice the daily recommended serving (Andreyeya, Kelly, Harris, 2011). Another national survey states that an extra soft drink serving for children is associated with a 15% increase in the probability of obesity, while an additional serving of fast-food causes a 25% increase. Also, an extra serving of juice a day is associated with a 10% increase (Mandal Powell, 2014). An additional study of 350 kindergarteners in south-eastern Poland reported that 14.6% of all children were overweight. After reviewing their diets, it was found that m ost of the foods were calorie dense and loaded in added sugar. Snacking was seen between all meals and the consumption of sugary drinks was high. At least once a week, fruit juice high in sugar was drunk by 66% of children and sweetened sodas by 44.6% of them. Furthermore, 58% of children ate only one serving of sweets per day, while roughly one third ate these treats multiple times per week. Research indicates that young children with a BMI above the 80th percentile are at three times the risk to experience obesity during the ages from 24 to 29. The risk even increases to four times for adolescents who are overweight (Kostecka, 2014). Even though more and more children these days are eating convenience food and fast-food, there are several ways parents, schools, and communities can help to prevent this from happening. Prevention programs must have an approach that aims to boost energy expenditure and reduce intake. Individually, caregivers would need to be targeted since most children are too young to understand. Caregivers should have nutrition education and be able to prepare healthy meals. At home, parents should be encouraged to serve proper food portions, support physical activity, and minimize or eliminate sedentary behaviors. They should also prepare meals in the home versus grabbing fast-food on the run. A good idea might be to make leftovers so that they can be heated up when in a time crunch. That way, the children are still getting a healthy and satisfying meal that gives them plenty of energy for whatever activities they might be doing. At school, school lunches can be altered to lower the caloric cont ent and vending machines can be removed. That will eliminate any energy dense snack foods and sugary drinks, although children may still bring these kinds of snacks from home. Another idea for schools is to design their buildings so that students expend more energy throughout the day. This can be done by designing a multistory building where each succeeding class is on a different level which promotes significant stair stepping during the day. In the community, public policies and mass media campaigns can aim to promote healthy eating and an active lifestyle. The community can also place taxes on sugary items and fast-food in the hopes that the extra cost will deter people from purchasing these items. An example of a public policy that helps prevent child obesity can be seen in Arkansas. It called for mandatory BMI testing of children in public schools starting in 2003 (Han, Lawlor, Kimm, 2010). This type of testing has been used in 13 other states and should be considered in state s currently lacking this screening. This way, children’s weight can be monitored from an early age and preventative measures can be taken before it is too late. As one can see, the rate of childhood obesity has been growing rapidly all over the world. Rates are only going to keep increasing if nothing is done to prevent it. All the studies have shown that there is a positive association between BMI and fast-food intake, and BMI and convenience food intake. A higher BMI than the norm indicates that the child is either overweight or obese. Positive associations were also seen between BMI, obesity, and distance between fast-food/convenience stores and the home/school. It is our job as a community to reduce the prevalence of obesity in children. There will always be a continued need for nutritional education concerning fast-food and its health consequences. Of the United States total gross domestic product, about 12.7% is spent on health care annually. Seeing that obesity is one of the most expensive medical conditions, the need for intervention is clear (Davis Carpenter, 2009).

Cell-based Therapy For Myocardial Regeneration

Cell-based Therapy For Myocardial Regeneration ABSTRACT Myocardial infarction is one of the main cause of mortality in many countries. Therefore, an effective therapy for myocardial infarction is required. Reperfusion and other conventional therapy have been the mainstay therapy for myocardial infarction. However, many patients remain refractory to this therapy. Cell-based therapy is considered a novel therapy, in which stem cells are used for cardiac repair. Stem cells are potential therapeutic and promising option that could be the alternative solution for salvaging damaged cardiomyocyte. Based on current studies, stem cells are a promising therapeutic approach for myocardial infarction. However, some challenges need to be answered by future studies before this novel therapy can be widely applied. This essay provides an overview of the progress in stem cell therapy for myocardial infarction. INTRODUCTION The robust potential of stem cells were still a mystery, but today, we are constantly getting new information on this particular topic. One of the prospects of stem cell therapy is to treat damaged cardiomyocyte (Fischer, et.al, 2009; Beltrami, 2003).Acute myocardial infarction is one of the main causes of mortality and morbidity in many countries. Not only this disease causes a massive socio-economic burden, but also reduces the quality of live for patients who survive the attack (Hamm, 2016). Currently, one of the mainstay therapy for myocardial infarction is rapid revascularization to limit ischaemic damage. Reperfusion and other conventional therapy have undoubtedly saved so many lives, yet there are patients remained refractory to this therapy and left with no other treatment options. In addition to that, many patients who have underwent reperfusion strategy and survived, often left with significant impairment of left ventricular systolic function. One big question remain unansw ered. Is there any other treatment option for these patients? Medical therapeutic approach to reduce damaged cardiomyocyte and generate new functioning muscle is the current unmeet need. Stem cells emerge as the novel procedure to restore damaged cardiomyocytes, and this procedure is popularly known as cellular cardiomyoplasty (Pendyala, et.al, 2008; Reinlib, 2000). Many preclinical and clinical trials have documented the potential use of stem cells to generate viable cardiomyocyte and improve cardiac function (Bergmann, et.al, 2009). To date, there are many different types of adult stem cells and progenitor cells used for this procedure, some of which are bone marrow derived stem cells, hematopoietic stem cells, mesenchymal stem cells and so on. Since the advance of stem cells technology is faster than ever before, this essay aimed to give an evidence based update on stem cells use for myocardial infarction, what we have achieved so far, and what does the future hold for this breakthrough. CELL-BASED THERAPY FOR MYOCARDIAL REGENERATION After an ischaemic attack due to occluded coronary vessels, heart muscle usually left damaged and nonfunctioning. However, recent evidence suggested that the cardiac muscle could actually undergo a limited amount of renewal. A prospect of inducing muscle cell to undergo division for cardiomyocyte replacement, or generating new muscle by stem cells are certainly intriguing (Roell, et.al, 2002; Santoso, et.al, 2011). Stem cells are capable to proliferate in the same state (self-renewal) and differentiate into multiple cell lineages. On the other hand, progenitor cells are more specific and have limited differentiation potential. Mechanism on how stem cells work are as follows: firstly, these stem cells need to be extracted from the source (eg. bone marrow), after that these stem cells need to be delivered to the injured area. These cells are implanted in the myocardium, and due to the nature of these cells, they would grow and differentiate/transdifferentiate into cardiomyocyte. To achieve the goal of cardiac repair, these cells should also have the ability to fuse with the surrounding tissues that their harmonious contraction increases the heart contraction. Furthermore, these newly-formed cardiomyocyte should also express the appropriate electromechanical properties required for contraction to yield a synchronous contraction (Templin, et.al, 2011; Makino, et.al, 1999). Many clinical studies have documented the feasibility and safety of cellular cardiomyoplasty in patients with coronary artery disease (Makino, et.al, 1999; Strauer, et.al, 2002). To date, there are some different types of adult stem cells and progenitor cells used for this procedure, some of which are bone marrow derived stem cells, hematopoietic stem cells, mesenchymal stem cells and many others (Jackson, et.al, et.al, 2001; Kamihata, et.al, 2001; Bolli, et.al, 2011) POTENTIAL SOURCE AND TYPE OF STEM CELLS Bone Marrow Derived Stem Cells Bone marrow derived stem cells (BMCs) are the most widely studied type of stem cells. Orlic et al. (2001) first describe the ability of bone marrow cells to regenerate infarcted myocardium in mouse models. The transplanted cells showed transdifferentiation into cardiomyocyte which eventually lead to improved left ventricular ejection fraction (Orlic, 2001). The three types of stem cells derived from bone marrow are hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), and endothelial progenitor cells (EPCs) (Orlic, 2001; Piao, et.al, 2005; Badorff, et.al, 2003). The role of BMCs for acute myocardial infacrtion has been reported to improve left ventricular ejection fraction (LVEF), both in REPAIR-AMI and BOOST trial (Meyer, et.al, 2006; Schachinger, et.al, 2006).BOOST trial demonstrate an acceleration of LVEF after intracoronary BMCs transfer (ejection fraction increased by 6.7% in the BMCs group as compared to 0.7% in the control group), and significant result was sustained until 18 months (Meyer, et.al, 2006). While in REPAIR AMI trial, improvement of LVEF, infarct size and wall thickening of infarcted segments were reported at two years follow up. At two years, the cumulative end point of death, myocardial infarction, or necessity for revascularization was significantly reduced in the BMC group compared with placebo (hazard ratio, 0.58; 95% CI, 0.36 to 0.94; P=0.025) (Assmus, et.al, 2010; Perin, et.al, 2012). Skeletal Myoblast Skeletal muscle has the ability to regenerate under certain circumstances. Skeletal resident stem cells are usually known as satellite cells, and these cells would differentiate to new myocytes in response to injury. However, whether this ability can be translated to a different condition, as in cardiomyocyte repair, should be further studied (Taylor, 198; Reinecke, et.al, 2002). MAGIC trial, a randomized controlled phase II trial, showed no significant changes in terms of global and regional LV function in skeletal myoblast- treated patients (Mensche, et.al, 2008). Another study performed by Dib et al.(2005) showed an increased in LV ejection fraction in the group treated with transepicardial injection of autologous SMs. Mesenchymal Stem Cells Mesenchymal stem cells (MSCs) are another potential option for cellular cardiomyoplasty. Mesenchymal stem cells can be found in various tissue, such as bone marrow and adipose tissue (Pittenger, 2004). One interesting mechanism by which MSCs mediate cardiac function improvement is the paracrine effect. MSCs may secrete soluble cytokines and growth factors that would eventually influence adjacent cardiomyocyte (Gharaibeh, et.al, 2011). Hare JM et al. (2009) studied the efficacy of intravenous allogenic human mesenchymal stem cells in patients with myocardial infarction. According to this study, intravenous MSCs were safe as showed by the similar adverse event rates in both intervention and control group. MSCs injection favorably affected patient functional capacity, quality of life and LV remodeling (Hare, et.al, 2012). Endothelial Progenitor Cells Endothelial progenitor cells (EPCs) have been linked with neovascularization in ischemic tissue. This interesting finding lead to the use of EPCs for another therapeutic purpose like cellular cardiomyoplasty (Isner, et.al, 1999). The human peripheral blood-derived EPCs would be a potential approach because those cells can be easily isolated without the need of major surgical intervention (Lin, et. Al, 2000). This assumption was later confirmed by Badorff et al. In this study, Badorff et al. (2003) reported that EPCs from healthy volunteers and Coronary Artery Disease (CAD) patients can transdifferentiate into functionally active cardiomyocytes when co-cultivated with rat cardiomyocytes. However, this finding was later opposed by Gruh I et al. According to this study, there was no significant evidence of transdifferentiation of human EPCs into cardiomyocyte (Gruh, et.al, 2006). Resident Cardiac Stem Cells Until recently, we believe that heart is a fully mature organ with no capability of self-renewal. However, the adult heart is not a terminally   differentiated organ, but harbors stem cell with regenerative capacity, namely resident cardiac stem cells (CSCs). Although the origins of CSCs are yet unclear, they can be isolated from heart tissue and expanded ex vivo for use as a cell-based therapy. There were many types of CSCs have been described in previous studies, like: epicardium-derived cells, cardiosphere-derived cardiac cells, and cardiac Sca-1+ cells. These resident stem cells have the potential to differentiate into different types of cells like vascular smooth muscle and myocardial cells (Tang, et.al, 2013; Tang, et.al, 2006; Fazel, et.al, 2006). Embryonic Stem Cells and Induced Pluripotent Stem Cells (iPS) Embryonic stem cells (ESC) are derived from the blastocyst (inner cell mass) of human embryo prior to implantation. ESCs are pluripotent cells, which means they have the capability to differentiate into any cells, one of which is cardiac myocytes. Due to the source of these cells, there are ethical issues regarding the use of ESC (Kofidis, 2005).The huge potential of ESC comes with a price. The pluripotency of ESC made these cells predisposes to tumor formation including teratomas. Amariglio N et al. (2009) documented the occurence of a human brain tumour following neural stem cell therapy. A boy with telangiectasia was treated with intracerebellar and intrathecal injection of human fetal neural stem cells. Four years later, he was diagnosed with a multifocal brain tumour. After thorough analysis, the tumor was of nonhost origin, indicating it was derived from the transplanted neural stem cells (Amariglio, 2009). To date, due to the scarcity of studies on ESC and negative experiences of previous studies, the significance of ESC as cell-based therapy for myocardial infaction remains elusive. The above-mentioned limitation would hopefully be elucidated in future research. Human Umbilical Cord Blood Cells Human umbilical blood cells (hUCB) contains a large number of non-hematopoietic stem cells which rarely express human leukocyte antigen (HLA) class II antigens, thus reducing the risk of rejection. Many studies have reported the efficacy and safety of hUCB administration in acute myocardial infarction model, with conflicting result (Henning, 2004; Moelker, 2007).According to Henning RJ et al. (2004) hUCB administration reduce infarction size and improve ventricular function in rats without requirements for immunosuppression (Henning, 2004). Similar positive finding were documented by Kim et al. Circulating Blood-derived Progenitor cells Circulating blood-derived progenitor cells (CPCs) are similar to BMCs, which mainly composed of EPCs. Santoso T et al. (2011) studied the safety and feasibility of combined granulocyte colony stimulating factor (G-CSF) and erythropoetin (EPO) based-stem cell therapy using intracoronary infusion of peripheral blood stem cells in patients with recent anterior myocardial infarction. G-CSF is used to mobilized stem cells to the injured area, inhibits cardiomyocyte apoptosis, promotes neovascularization, and increase the production of nitric oxide. While EPO, that is originally thought to be a hematopoietic hormone only, also may inhibited apoptosis and induced angiogenesis. This phase I study concluded that this procedure is safe and resulted in improved endpoints for LV ejection fraction and cardiac viability (Santoso, 2011). Cardiopoietic Stem Cells Cardiopoietic stem cells are not a distinct type of stem cells but refer to the novel way of processing stem cells in order to get a lineage specification. Cardiopoietic stem cells are harvested stem cells that are treated with a protein cocktail to replicate natural cues to heart development, before being injected into the patients heart. The C-CURE trial studied the efficacy of bone marrow derived-mesenchymal stem cells in chronic heart failure. The isolated mesenchymal stem cells were exposed to a cardiogenic cocktail that trigger expression and nuclear translocation of cardiac transcription factors, before being injected to the patients heart. After six months follow up, patients in the treatment group significantly improved in terms of LVEF and fitness capacity. There was no evidence of increased cardiac or systemic toxicity induced by cardiopoietic cell therapy (Bartunek, 2013). Unfortunately, data comparing the efficacy and safety between cardiopoietic stem cells and ordinary stem cells without cocktail-based priming is still lacking. DELIVERY METHODS In order to make these stem cells reach the heart, a reliable delivery method need to be employed. The ideal method should be able to safely and efficiently deliver an optimal number of stem cells to the target tissue. Beside the high efficacy, this delivery method should be as minimally invasive as possible for the sake of patients comfort. There are some delivery methods worthy to know. Intracoronary Infusion As the name implies, intracoronary infusion is a process of delivering stem cells through coronary artery, usually through intracoronary catheterization. Stem cells are infused under pressure via a ballon catheter. The ballon was inflated in order to prevent anterogade blood flow that would compromize stem cells delivery. Catheter guided cell transfer has its unique advantage of safety under local anesthesia, and a part of routine cardiac catheterization. The intracoronary method provide a maximum number of cells to the target area, with good blood supply which is crucial for cell survival. Multiple studies have reported the use of intracoronary infusion for stem cells delivery (Strauer, 2002; Schachinger, 2006). Intravenous Peripheral Infusion Intravenous stem cells administration is one of the easiest method to be employed. Intravenous administration is possible through homing phenomenon of stem cells to the injured heart. Unfortunately, intravenous peripheral infusion comes with some disadvantages. First, only 3% of normal cardiac output will flow per minute through the left ventricle. This low amount of blood would limit the amount of stem cells delivered. Secondly, due to the passing of venous blood in the lung, many cells would trap in lung vasculature that eventually lead to stem cells reduction (Grieve et.al, 2012). Intramyocardial, Transendoccardial and Transpericardial Route As mentioned earlier, the downside of intravenous administration is the passing of the blood in certain organs that would entraped some of the stem cells. Unlike intravenous route, intramyocardial method is undoubtly provide direct access to the injured cardiomyocyte bypassing the need for mobilization, homing and any risk of cells entrapment in other organ, thus provide a more effective way to deliver abundant stem cells to the injured area. However, this method comes with its own expense of a more invasive method, not to mention the risk of ventricular perforation in the already damaged cardiomyocyte. Intramyocardial delivery usually performed during an open heart surgery or needle-tipped delivery catheter (Strauer, 2003; Forrester, 2003). Nelson et al.(2009) documented that intamyocardial delivery of iPS originating from reprogrammed fiobroblast, yielded progeny that properly engrafted and resulted in restored contractile performance, increased ventricular wall thickness, and elec tric stability (Nelson, et.al, 2009). STUDIES USING STEM CELLS IN MYOCARDIAL INFARCTION Many studies have been carried out to investigate the efficacy and safety of stem cell therapy in patients with myocardial infarction. Each of these studies investigated different kind of stem cells with different delivery methods. The ultimate goal of these studies is to answer whether stem cell therapy could be a feasible therapeutic approach for patients with myocardial infarction. The result of these studies were not always positive, even some of the studies did not document any beneficial effect of stem cell therapy. However, this conflicting result need to be intepreted with caution due to the different study method, different type of stem cells used, and different delivery methods employed. Three meta- analysis on the efficacy of BMCs therapy for myocardial infarction have been published. In a meta-analysis by Delewi R et al, intracoronary BMCs infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. The benefit in terms of LVEF improvement was more pronounced in patients with a worse baseline LVEF (LVEF cut off: 40%) and younger age (age cut off: 55 years) (Delewi, et.al, 2013).   In a second meta-analysis by Clifford DM et al. (2012) which include thirty-three RCTs, there was no significant difference in hard end point like mortality and morbidity in the BMCs treated group. However global heart function, as represented by LVEF and infarct size, was improved significantly and was sustained long term (12 to 61 months) in the BMCs group (Clifford, et.al, 2012). The third meta-analysis by Long C et al. (2013) further confirmed the beneficial effect of intracoronary BMCs in patients with acute my ocardial infraction. According to this meta-analysis, BMCs therapy significantly improved LVEF, while mildly but not significantly reduced left ventricular end-systolic volume and left ventricular end-diastolic volume (Lond, et.al, 2013). These three meta-analysis synonymously agree that BMCs therapy is beneficial in terms of improved heart function and reduced infarct size. CHALLENGES AND THE FUTURE We have just entered the new era of stem cell therapy. When advanced therapy like primary PCI and thrombolytic showed more limited beneficial for patients with myocardial infarction, the concept of cell-based therapy is definitely appealing. This new approach could be the answer that have been waited for sometime. As we have discussed previously, there are many issues on stem cell therapy that need to be addressed in future studies. Firstly, what is considered to be the best stem cells to replace cardiomyocyte. Secondly, the right delivery method of these stem cells need to be determined. Whether different type of stem cells required certain delivery methods also need to be further elucidated. Another question is the right timing of delivery (acute, sub-acute or chronic), whether it contributes to the fate of stem cells. Fourth, the concentration of stem cells, dose-effect relationship and safety of stem cell therapy need to be further investigated. One particular topic in regard to stem cell safety is the tumorigenicity of ESC. We need to disentangle a way to reprogram these cells so they can differentiate into functional cells, but lack the ability to form tumours. 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