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[ ]lessons learned from previous pandemics helped catalyze COVID19 preparedness in several countries 2 Scientists in China identified and shared genetic sequencing of SARS-CoV-2 on January 10, allowing international jump starts in testing technology (South Korea) and vaccine development (e g , United States, United Kingdom) [ ]of the 2015 SARS (severe acute respiratory syndrome) epidemic, South Korea established the Infectious Disease Control Center, which later distributed COVID-19 testing guidelines before the first confirmed South Korean case 2 Responses in Hong Kong, Taiwan, and South Korea used technology- including mobile phone data, credit card records, and closed-circuit TV recordings-to help identify, isolate, and contact trace COVID-19-positive individuals 2 Despite encroachment on individual privacy and liberties, public recall of SARS and MERS (Middle East respiratory syndrome) facilitated adherence to these procedures 2 Unlike the fragmented US health care system, universal health care access in all other developed nations facilitated support of pandemic responses [ ]strong central coordination is essential to COVID-19 mitigation and precision public health

Objectives Diagnostic programs and second opinion clinics have grown and evolved in the recent years to help patients with rare, puzzling, and complex conditions who often suffer prolonged diagnostic journeys, but there is a paucity of literature on the clinical characteristics of these patients and the efficacy of these diagnostic programs. This study aims to characterize the diagnostic journey, case features, and diagnostic outcomes of patients referred to a team-based second opinion clinic at Stanford. Methods Retrospective chart review was performed for 237 patients evaluated for diagnostic second opinion in the Stanford Consultative Medicine Clinic over a 5 year period. Descriptive case features and diagnostic outcomes were assessed, and correlation between the two was analyzed. Results Sixty-three percent of our patients were women. 49% of patients had a potential precipitating event within about a month prior to the start of their illness, such as medication change, infection, or medical procedure. A single clear diagnosis was determined in 33% of cases, whereas the remaining cases were assessed to have multifactorial contributors/diagnoses (20%) or remained unclear despite extensive evaluation (47%). Shorter duration of illness, fewer prior specialties seen, and single chief symptom were associated with higher likelihood of achieving a single clear diagnosis. Conclusions A single-site academic consultative service can offer additional diagnostic insights for about half of all patients evaluated for puzzling conditions. Better understanding of the clinical patterns and patient experiences gained from this study helps inform strategies to shorten their diagnostic odysseys.

Shared decision making (SDM) may result in treatment plans that best reflect the goals and wishes of patients, increasing patient satisfaction with the decision-making process. There is a knowledge gap to support the use of decision aids in SDM for anticoagulation therapy in patients with atrial fibrillation (AF). We describe the development and testing of a new decision aid, including a multicenter, randomized, controlled, 2-arm, open-label ENHANCE-AF clinical trial (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention) to evaluate its effectiveness in 1,200 participants.Participants will be randomized to either usual care or to a SDM pathway incorporating a digital tool designed to simplify the complex concepts surrounding AF in conjunction with a clinician tool and a non-clinician navigator to guide the participants through each step of the tool. The participant-determined primary outcome for this study is the Decisional Conflict Scale, measured at 1 month after the index visit during which a decision was made regarding anticoagulation use. Secondary outcomes at both 1 and 6 months will include other decision making related scales as well as participant and clinician satisfaction, oral anticoagulation adherence, and a composite rate of major bleeding, death, stroke, or transient ischemic attack. The study will be conducted at four sites selected for their ability to enroll participants of varying racial and ethnic backgrounds, health literacy, and language skills. Participants will be followed in the study for 6 months.The results of the ENHANCE-AF trial will determine whether a decision aid facilitates high quality shared decision making in anticoagulation discussions for stroke reduction in AF. An improved shared decision-making experience may allow patients to make decisions better aligned with their personal values and preferences, while improving overall AF care.

Background: Patient education before the placement of an implantable cardioverter-defibrillator (ICD) is strongly recommended to prevent or mitigate feelings of regret and frustration in ICD recipients. Medicare guidelines for ICDs require a shared decision-making approach that focuses on patients' health goals, values, and preferences before implantation. However, many patients are not fully informed of what to expect when recovering from ICD placement or living with an ICD long-term. Objectives: Our objective is to understand decision-making processes and decisional regret in patients requiring ICDs using in-depth interviews. Methods: Nineteen patients at Stanford University Medical Center were recruited to participate in individual interviews using closed-ended and open-ended questions to engage dialogue. Notes taken during interviews were assessed and used to identify major themes. Results: Participants described a lack of adequate education about ICD postoperative recovery and long-term, postimplantation considerations such as avoiding electromagnetic fields, false-positive ICD shocks, and the esthetic effect of ICD implantation. In addition, feelings of fear and anxiety were prevalent in participants' recollections of accepting an ICD. Conclusion: Further improvement in patient education before ICD placement is needed. The decision-making process can be simplified and patient regret and frustration minimized by providing reliable information that is accessible and interactive.

Background Shared decision-making (SDM) is an approach in which patients and clinicians act as partners in making medical decisions. Patients receive the information needed to decide and are encouraged to balance risks, benefits, and preferences. Informative materials are vital to SDM. Atrial fibrillation (AF) is the most common cardiac arrhythmia and responsible for 10% of ischemic strokes, however 1/3 of patients are not on appropriate anticoagulation. Decision sharing may facilitate treatment acceptance, improving outcomes. Aims To develop a framework of the components needed to create novel SDM tools and to provide practical examples through a case-study of stroke prevention in AF. Methods We analyze the design values of a web-based SDM tool created to better inform AF patients about anticoagulation. The tool was developed in partnership with patient advocates, multi-disciplinary investigators, and private design firms. It was refined through iterative, recursive testing in patients with AF. Its effectiveness is being evaluated in a multisite clinical trial led by Stanford University and sponsored by the American Heart Association. Findings The main components considered when creating the Stanford AFib tool included: design and software; content identification; information delivery; inclusive communication, user engagement; patient feedback; clinician experience; and anticipation of implementation and dissemination. We also highlight the ethical principles underlying SDM; matters of diversity and inclusion, linguistic variety, accessibility, and health literacy. The Stanford AFib Guide patient tool is available at: https://afibguide.com and the clinician tool at https://afibguide.com/clinician. Conclusion Attention to a range of vital development and design factors can facilitate tool adoption and information acquisition by diverse cultural, educational, and socioeconomic subpopulations. With thoughtful design, digital tools may decrease decision regret and improve treatment outcomes across many decision-making situations in healthcare.

Introduction CPAP is the gold standard therapy for OSA. Unfortunately, a significant percentage of patients do not tolerate CPAP therapy. Of those who struggle, a significant portion state that nasal congestion is a limiting factor. Acoustic Resonance Therapy (ART) is a new non-medication based treatment for nasal congestion. We sought to determine if patients struggling with Medicare CPAP adherence and reporting nasal symptoms would benefit by the addition of ART. Methods This was an IRB approved, prospective, non-randomized, controlled pre-/post-treatment study. Twenty-five adult participants with an OSA diagnosis (AHI>5) were enrolled by BetterNight (OSA management, San Diego, CA). Participants were new to CPAP within the previous 90 days and were not Medicare adherent. Participants self-reported nasal congestion as a significant contributor to non-adherence. After struggling with CPAP for varying durations, participants began the Sonu vibrational headband system (SoundHealth Systems, Los Altos, CA) for 15 minutes each evening, immediately prior to wearing CPAP, on 28 sequential nights. The Sonu headband is worn circumferentially just above the eyebrows. It utilizes a smartphone application and the self-facing camera to capture a facial scan and estimate sinonasal volume which determines the appropriate resonant frequencies and harmonics. Two vibrational transducers produce a signal in the audible acoustic range, from 80 Hz to 16 KHz. Total nasal symptom scores (TNSS) were obtained at baseline and self-reported daily during Sonu use. Results Participants were 64% male, age 48.2±12.9, AHI 31.6±22.7, BMI 32.5±6.6 (mean±SD). On days the 25 participants used CPAP, mean hours (h) of use increased during the intervention from 2.7h±1.9 to 4.0h±2.2 (48%,p=0.004). On a subset of 12 participants for whom 28 days of pre/post data was available, mean total hours of CPAP use increased from 64.8h±51.6 to 94.0h±59.4 (45%,p=0.0107). CPAP Medicare adherence increased from 30.0%±27.4 to 45.8%±35.0 (53%,p=0.0175). TNSS decreased from 4.8±2.2 to 2.1±1.9 (-56%,p=0.0016). Conclusion The use of the Sonu headband was associated with increased hours of CPAP use, improved CPAP adherence and reduced nasal symptoms. Support (if any)

There exists no coherent national strategy for the early detection or prevention of gastric cancer in the United States (US), even among identified high-risk groups such as Asian Americans, African Americans, Hispanic Americans, and Alaska Native/American Indian peoples. As a result, patients with gastric cancer in the US are diagnosed at later stages and demonstrate worse overall survival compared to nations of East Asia with established screening programs (Table 1). The under-recognition of gastric cancer risk within minority communities is a significant unaddressed healthcare disparity.

Asians as a group comprise > 60% the world’s population. There is an incredible amount of diversity in Asian and admixed populations that has not been addressed in a pharmacogenetic context. The known pharmacogenetic differences in Asian subgroups generally represent previously known variants that are present at much lower or higher frequencies in Asians compared with other populations. In this review we summarize the main drugs and known genes that appear to have differences in their pharmacogenetic properties in certain Asian populations. Evidence‐based guidelines and summary statistics from the US Food and Drug Administration and the Clinical Pharmacogenetics Implementation Consortium were analyzed for ethnic differences in outcomes. Implicated drugs included commonly prescribed drugs such as warfarin, clopidogrel, carbamazepine, and allopurinol. The majority of these associations are due to Asians more commonly being poor metabolizers of cytochrome P450 (CYP) 2C19 and carriers of the human leukocyte antigen (HLA)‐B*15:02 allele. The relative risk increase was shown to vary between genes and drugs, but could be > 100‐fold higher in Asians. Specifically, there was a 172‐fold increased risk of Stevens‒Johnson syndrome and toxic epidermal necrolysis with carbamazepine use among HLA‐B*15:02 carriers. The effects ranged from relatively benign reactions such as reduced drug efficacy to severe cutaneous skin reactions. These reactions are severe and prevalent enough to warrant pharmacogenetic testing and appropriate changes in dose and medication choice for at‐risk populations. Further studies should be done on Asian cohorts to more fully understand pharmacogenetic variants in these populations and to clarify how such differences may influence drug response.

In this manuscript, we discuss critical health outcome differences between the 6 major Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and highlight the critical issues that contribute to the Asian American health disparity gap. We also propose approaches to address these critical issues, with approaches shown effective in other populations.By considering these approaches, we hope that stakeholders of Asian American health outcomes can steer current health research agendas and efforts towards improving Asian health equity.

Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003 to 2017, we report age-standardized mortality rates, standardized mortality ratios and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention.

Visit-to-visit blood pressure variability (BPV) has been shown to be a predictor of cardiovascular disease. We aimed to classify the BPV levels using different machine learning algorithms. Visit-to-visit blood pressure readings were extracted from the SPRINT study in the United States and eHealth cohort in Hong Kong (HK cohort). Patients were clustered into low, medium, and high BPV levels with the traditional quantile clustering and 5 machine learning algorithms including K-means. Clustering methods were assessed by Stability Index. Similarities were assessed by Davies-Bouldin Index and Silhouette Index. Cox proportional hazard regression models were fitted to compare the risk of myocardial infarction, stroke, and heart failure. A total of 8133 participants had average blood pressure measurement 14.7 times in 3.28 years in SPRINT and 1094 participants who had average blood pressure measurement 165.4 times in 1.37 years in HK cohort. Quantile clustering assigned one-third participants as high BPV level, but machine learning methods only assigned 10% to 27%. Quantile clustering is the most stable method (stability index: 0.982 in the SPRINT and 0.948 in the HK cohort) with some levels of clustering similarities (Davies-Bouldin Index: 0.752 and 0.764, respectively). K-means clustering is the most stable across the machine learning algorithms (stability index: 0.975 and 0.911, respectively) with the lowest clustering similarities (Davies-Bouldin Index: 0.653 and 0.680, respectively). One out of 7 in the population was classified with high BPV level, who showed to have higher risk of stroke and heart failure. Machine learning methods can improve BPV classification for better prediction of cardiovascular diseases.

BACKGROUND Digital health is an important part of the future of health care, prevention and management of disease and innovative monitoring solutions. With an aging population and rising health related costs, digital health is an essential part of the solution, alongside the emerging big data and associated analytics. To varying extents, digital health and big data are present worldwide. However, consistency in terminology, regulation and implementation differ. As an international network of interdisciplinary experts we review and discuss the digital health and big data landscape. OBJECTIVE We firstly identify current challenges and solutions in digital health development, research, deployment in the management of non-communicable disease and regulation and then go on to establish an ongoing and international collaboration of multidisciplinary researchers and educators; creating opportunities for research and education. METHODS The Digital Health Research Network was established using the Worldwide Universities Network as a platform and a funding resource. The newly formed network harnesses expertise from a wide array of academic disciplines within applications of digital health and big data for health. Meetings took place both electronically and face to face, with a Research Open Day in Sydney and the International Symposium for Digital Health in Hong Kong facilitating wider networking and discussion. RESULTS Many challenges working across disciplines in the digital health area have been identified. These include inconsistent definitions for digital health and big data, a diverse range of digital technologies available across the globe, differences in regulation of such technologies. There is not equity in resources and standards globally. He range of stakeholders involved in digital health and big data relating to health are extensive. It is important that these stakeholders can communicate effectively, with a common technical language. Continued development, education and widening engagement are integral components of developing digital health worldwide. CONCLUSIONS Digital Health is a necessary and sufficient factor in achieving health gains. However, in is critical that digital health is leveraged appropriately and that transformation of interdisciplinary practices can intelligently link digital health with care management processes to make a difference. The new interdisciplinary, International Society for Digital Health aims to provide a platform to facilitate this. CLINICALTRIAL n/a

Flip chip market is driven by the imminent need for circuit miniaturization, growth in internet of things, big opportunities in data centers and technological superior packaging. With the never ending need for smaller form factors and more & more IOs, bump pitches are getting smaller and smaller. Flip chip packaging with denser and smaller bumps in big packages becomes a challenge. Number of thermal processes also increases in flip chip processing. High layer count substrates added more stress to the bumps and the underfill material supporting the bumps. Bumps are the interconnect between the die and the organic substrate. Bumps are covered by underfill material in order to support the bumps mechanically and also to prevent solder extrusion. Bump solder extrusion is one of the challenging failures to overcome during processing and in the field application. Solder extrusion can happen due to underfill cracks or polyimide (PI) cracks or there is a delamination between underfill and PI, which is coated on the die surface. If the bonding strength between underfill and PI is weak, it can delaminate due to thermo-mechanical stresses during processing or in the field applications. This paper discusses critical factors which impact the adhesive strength between underfill and PI layer, the inputs and parameters required for critical factors and the results.

Background Endoscopic posterior nasal nerve (PNN) resection has been described as an efficacious surgical treatment of allergic and nonallergic rhinitis, but the requirement for surgery under general anesthesia has limited its acceptance. We report the first series of patients treated for chronic rhinitis using a novel device designed for office-based cryosurgical ablation of the PNN. Methods Twenty-seven patients with chronic rhinorrhea and/or nasal congestion for >3 months were recruited (allergic or nonallergic rhinitis), with minimum rhinorrhea and/or congestion subscores of 2 as part of the Total Nasal Symptom Score [TNSS]). Under local anesthesia, the cryotherapy device was applied endoscopically to the posterior middle meatus and was used to freeze the PNN region bilaterally. Patients were followed up after 7, 30, 90, 180, and 365 days to assess TNSS. Results The procedure was successfully completed in 100% of patients, with no complications; 74% reported no or mild discomfort by the first postprocedure day. TNSS was reduced significantly at 30 days (mean ± standard deviation: 6.2 ± 0.5 at baseline, 2.6 ± 0.3 at 30 days, n = 27, p Conclusion Office-based cryotherapy of the PNN region is safe and well tolerated. Symptom scores were significantly decreased by 7 days postprocedure and remained lower at 30, 90, 180, and 365 days.

Bumping is an indispensable part of Flip Chip packaging. Bumping technologies require Under Bump Metallization (UBM) to meet package reliability requirements. UBM provides the critical interface between the metal pads of the IC chip and solder bumps. To prevent direct interaction of die’s metal pad with Cu or solder, a diffusion barrier layer of Ti or TiW is sputtered on top of metal pad of IC chip. The solder wetting layer can be a single layer or double layer like combination of copper and Nickel. One of the potential weak links in UBM stack up is the bonding strength between the UBM layers, namely between Ni & Cu. If the adhesive strength is below requirement, the layer can give way and fail under the applied voltage combined with moisture and operating temperature. Galvanic reaction is the predominant failure mechanisms with applied voltage and moisture. This paper discusses the critical factors affecting the bonding strength between Cu & Ni layers, the inputs required for maintain the critical factors and the results.

Background Endoscopic posterior nasal nerve (PNN) resection has been described as an efficacious surgical treatment of allergic and nonallergic rhinitis, but the requirement for surgery under general anesthesia has limited its acceptance. We report the first series of patients treated for chronic rhinitis using a novel device designed for office‐based cryosurgical ablation of the PNN. Methods Twenty‐seven patients with chronic rhinorrhea and/or nasal congestion for >3 months were recruited (allergic or nonallergic rhinitis), with minimum rhinorrhea and/or congestion subscores of 2 as part of the Total Nasal Symptom Score [TNSS]). Under local anesthesia, the cryotherapy device was applied endoscopically to the posterior middle meatus and was used to freeze the PNN region bilaterally. Patients were followed up after 7, 30, 90, 180, and 365 days to assess TNSS. Results The procedure was successfully completed in 100% of patients, with no complications; 74% reported no or mild discomfort by the first postprocedure day. TNSS was reduced significantly at 30 days (mean ± standard deviation: 6.2 ± 0.5 at baseline, 2.6 ± 0.3 at 30 days, n = 27, p < 0.001), with continued reduction at 90 (2.7 ± 0.4, n = 24, p < 0.001), 180 (2.3 ± 0.5, n = 21, p < 0.001), and 365 days (1.9 ± 0.3, n = 15, p < 0.001). Both rhinorrhea and congestion subscores decreased significantly at 30, 90, 180, and 365 days compared to baseline (p < 0.001). Allergic and nonallergic subcohorts both appeared to benefit from treatment. Conclusion Office‐based cryotherapy of the PNN region is safe and well tolerated. Symptom scores were significantly decreased by 7 days postprocedure and remained lower at 30, 90, 180, and 365 days.

The efficacy of pulmonary vein isolation for the treatment of atrial fibrillation may be limited by the ability to make continuous and transmural lesions utilizing an ablation catheter. Gaps often persist between ablation lesions leading to failed electrical isolation and thus failed ablation. Recently, a deflectable fiberoptic endocardial visualization catheter has been introduced for use in imaging the coronary sinus using light in the visible spectrum. We utilize this catheter to visualize the endocardial surface and examine radiofrequency ablation lesions in porcine endocardium to determine the presence of gaps between radiofrequency lesions. Videos were taken of the lesions and shown to two readers who were asked to identify the gaps ranging from less than 0.1 mm–9.8 mm. Ninety-four lesion gaps were reviewed. The readers demonstrated a combined accuracy of 98.4% at identifying gaps. Gaps between ablation lesions can be accurately identified down to less than 1 mm distances in vitro using a direct visualization catheter. Further studies are warranted to confirm these finding in vivo.

Inappropriate shocks due to misclassification of supraventricular and ventricular arrhythmias remain a major problem in the care of patients with Implantable Cardioverter Defibrillators (ICDs). The purpose of this study was to investigate the ability of a new covariance-based support vector machine classifier, to distinguish ventricular tachycardia from other rhythms such as supraventricular tachycardia. The proposed algorithm is applicable on both single and dual chamber ICDs and has a low computational demand. The results demonstrate that suggested algorithm has considerable promise and merits further investigation.

Effective ablation of atrial fibrillation and other cardiac arrhythmias requires precise catheter navigation and controlled delivery of energy to cardiac tissue. In this study, we summarize our initial experience using a fiber optic direct visualization catheter to evaluate and guide placement of endocardial radiofrequency (RF) ablation lesions. RF lesions were created in cadaveric porcine hearts and examined in a blood-filled field using a direct visualization catheter. Direct visualization of RF lesions was repeated in vivo using an ovine model. Lesions and interlesion gaps were clearly identifiable using the direct visualization catheter. It was possible to place lesions in proximity to anatomical landmarks and in relation to one another. Catheter-generated images correlated well with lesion appearance on gross examination. Direct catheter-based visualization is a feasible technique for guiding RF lesion placement, estimating lesion size, and identifying interlesion gaps. Future work is needed to correlate surface appearance with transmurality and electrical isolation.

Background: Morphologic identification of ectopic P-waves from surface ECGs can be challenging, particularly when the P-wave is buried in the QRST wave complex. Because ECGs are often available on paper and not digitally, we developed a method of subtracting the T-wave from the buried P-wave complex on paper ECGs. Methods: To validate our system, an atrial extrastimulus was introduced during and following the T-wave. The ECGs were scanned and then transformed from an image format to a digital format. A computer algorithm digitally subtracted a QRST with no buried P-wave from one with a buried P-wave, thus resulting in an extracted P-wave. The extracted P-waves were compared to the nonburied P-wave by determining correlation coefficients and by visual grading by two independent reviewers. Results: Visual grading comparing the buried P-wave with the exposed paced P-wave was 94%. The median correlation coefficient was 85%. Conclusions: An ectopic atrial P-wave obscured by a coincident QRST wave complex can be accurately derived from printed ECG using this PC-based system. Addition of this technique to the existing methods may aid in the localization and ablation of ectopic atrial foci.

The human meniscus is subject to injury that necessitates repair or removal. Many aspects of the cellular response to injury have not been well characterized. The purpose of this study was to describe the cellular distributions within the torn human meniscus. In addition to evaluating the cell density in selected regions, we investigated the cellular expression of a contractile actin isoform that has recently been found in the intact human meniscus. Included as a contemporaneous comparative group were torn human meniscal allografts. We hypothesized that a hypercellular surface zone would be found in the torn menisci, with a higher percentage of cells in this peripheral region expressing alpha-smooth muscle actin compared with other locations in the interior of the remnant. The rationale for this hypothesis was based on prior immunohistochemical investigations of the distribution of alpha-smooth muscle actin-containing cells in the torn human anterior cruciate ligament. Eighteen torn meniscal specimens were obtained from 17 patients, 0.5 to 84 months after injury, and four torn allograft meniscal samples were retrieved from three patients, 11 to 49 months after implantation. Microtomed sections of paraffin-embedded tissue were stained with hematoxylin and eosin and a monoclonal antibody to alpha-smooth muscle actin. The cell density and percentage of cells containing alpha-smooth muscle actin were determined in the following zones: synovial, vascular, hypercellular with loose collagen, hypocellular with dense collagen, and organized collagen. A cellular layer that resembled synovium was present on the surface of all but two of the specimens. Vascular regions were often continuous with the synovium abutting the more interior loose collagen zones. The total cell density was greatest in each of the zones closest to the periphery (synovium, vascular, and loose collagen; p < 0.001), when compared to the interior of the tissue. The synovium-like layer was found to have the highest percentage of alpha-smooth muscle actin-expressing cells and the highest alpha-smooth muscle actin-containing cell density (p < 0.05). Similar results were found for the torn allograft menisci. These findings confirm the working hypothesis and suggest that the torn human meniscus is capable of mounting a reparative response, including the proliferation of cells capable of contributing to wound closure. This underscores the importance of providing a bridging scaffold into which such cells can migrate.