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Background: We are investigating decellularized vein allograft as a scaffold to engineer a non-synthetic, small-diameter vascular graft. This study examines the in vivo behavior of this scaffolding after implantation into the arterial circulation., Materials and Methods: Canine animals underwent bilateral carotid interposition grafting using jugular vein implanted as either: 1) fresh autograft, 2) fresh allograft, or 3) decellularized allograft. Decellularization was achieved using sodium dodecyl sulfate. Grafts were examined with duplex ultrasound biweekly to determine luminal diameter, thrombosis, stenosis, or anastomotic breakdown. After perfusion fixation at 2 or 8 weeks, grafts underwent histological, morphometric, and immunohistochemical examination., Results: All animals survived without neurological or hemorrhagic complication. No deterioration of graft integrity (rupture, aneurysm) was observed in any group. Luminal narrowing was observed in both allograft groups, but secondary to different pathology. Fresh allografts had significant mononuclear cell infiltrate, intimal hyperplasia, and intramural hemorrhage consistent with rejection. Conversely, decellularized allografts had minimal evidence of rejection but instead had a compact fibrin layer formed along their lumen. This fibrin layer was absent in the peri-anastomotic regions where endothelium had migrated from the native artery. By 8 weeks, decellularized grafts had repopulated with cells staining positive for smooth muscle alpha-actin., Conclusions: After 8 weeks of arterial flow, decellularized vein allograft exhibits satisfactory strength, reduced antigenicity compared to fresh allograft, and supports cellular repopulation. These characteristics make it satisfactory for further tissue engineering; combined with luminal vascular cell seeding, it may prove useful as a small-diameter arterial bypass graft.

Purpose: Current strategies to create small-diameter vascular grafts involve seeding biocompatible, compliant scaffolds with autologous vascular cells. Our purpose was to study the composition and strength of decellularized vein to determine its potential as a vascular tissue-engineering scaffold., Methods: Intact human greater saphenous vein specimens were decellularized by using sodium dodecyl sulfate (SDS). Residual cellular and extracellular matrix composition was studied with light and electron microscopy as well as immunohistochemistry. Burst and suture-holding strength was measured in vitro by insufflation and pull-through techniques. To assess initial handling and durability of decellularized vein in vivo, a canine model was developed wherein decellularized canine jugular veins were implanted as carotid interposition grafts in recipient animals. After two weeks of arterial perfusion, these grafts were studied with duplex imaging and histologic methods., Results: Human saphenous vein decellularized by using SDS was devoid of endothelial cells and >94% of the cells resident within the vein wall. Collagen morphology appeared unchanged, and elastin staining decreased only slightly. Basement membrane collagen type IV remained intact. Compared with fresh vein, decellularized vein had similar in vitro burst (2480 +/- 460 mm Hg vs 2380 +/- 620 mm Hg; P >.05) and suture-holding (185 +/- 30 gm vs 178 +/- 66 gm; P >.05) strength. Decellularized canine vein functioned well in vivo without dilation, anastomotic complication, or rupture over 2 weeks of arterial perfusion., Conclusions: Vein rendered acellular with SDS has well-preserved extracellular matrix, basement membrane structure, and strength sufficient for vascular grafting. These properties suggest proof of concept for its use as a scaffold for further vascular tissue engineering., Clinical Relevance: The following research examines the creation of a new small-diameter bypass graft. It is clinically relevant to patients who need distal arterial bypass, coronary artery bypass, or hemodialysis access, but who do not have adequate autologous vein for their surgeries. Future investigations will involve further tissue engineering of this vascular scaffold (eg, autologous endothelial seeding of its lumen) and testing the clinical usefulness of the completed graft.

Press-fit implants can be used to meet the prosthetic needs of patients who require immediate loading of their implants. This procedure may be necessary because of a patient's unwillingness and/or inability to tolerate a removable prosthesis. The implants reported in this study had a similar success rate to those immediately loaded screw-type implants previously reported by others. The lack of large numbers of long-term immediately loaded implants dictates the need for detailed informed consent when using immediately loaded cylinder implants for dental reconstruction.

We reviewed 400 consecutive knee arthroscopy cases in a predominantly sports medicine practice to determine (1) the frequency of posteromedial portal usage under a prospectively established set of indications, and (2) the impact of posteromedial portal access on patient diagnosis and management. Diagnostic posteromedial portals were used in 22% of anterior cruciate ligament (ACL)-deficient knees, and in 11% of stable knees with nonpatellar (usually meniscal) lesions. When used, posteromedial portal visualization showed treatable lesions 64% of the time, the majority of which were repairable peripheral meniscus tears. In 63% of these cases, no definite lesion had been identified by initial routine anterior portal viewing and probing. Of the 22 patients with posteromedial meniscus tears that were discovered only via posteromedial portal access, 9 had recently undergone anterior portal arthroscopy by other surgeons, during which none of these tears were detected. Posteromedial surgical portals (19 cases) were most useful for synovectomy, posterior cruciate stump resection before arthroscopic reconstruction, and posterior horn medial meniscectomy in exceptionally tight knees. Posteromedial portal access is often useful diagnostically in cases where (1) posteromedial meniscal lesions are frequent (i.e., ACL-deficient knees) and/or suspected on the basis of preoperative symptoms or imaging studies, and (2) full, direct visualization of the entire superior meniscosynovial junction is not possible via standard anterior portals. The option of a surgical posteromedial portal should be entertained whenever frontal approaches for posteromedial instrument work prove inefficient or unsuccessful.

Muscle fibers from fourth and fifth instar caterpillars were examined with scanning and thin section electron microscopy. Scanning micrographs showed that early fifth instar specimens had a population of cells lying beneath the basal lamina over the surface of the muscle fiber and in conjunction with tracheoles and nerves. At least two cell types were present. One type could be categorized as tracheoblasts of their close association with the tracheoles and the presence of taenidia within the tracheoblast cytoplasm in sectioned material. A second cell type, characterized by long filamentous processes, contained extensive rough endoplasmic reticulum and cisternae swollen with an electron-dense substance similar in appearance to the basal lamina. This ultrastructural appearance is characteristic of vertebrate fibroblasts and certain types of insect hemocytes. Early and late fourth instar specimens had few cells on their muscle fiber surfaces. Measurements of the basal lamina thickness were taken from thin sections of nondigested muscle fibers of early fourth, late fourth, and early fifth instar animals. The results showed that the basal lamina underwent a large increase in thickness between the fourth and fifth instars. The proliferation of cells which appeared to be in an actively synthesizing state paralleled the increase in basal lamina thickness. This suggests the hypothesis that these cells are active in connective tissue formation, and contribute to the formation of the basal lamina that lies over both them and the muscle fiber.

The nerves and nerve terminals to tonic larval muscle fibers in third and fifth instar caterpillars were studied to compare them with those formed by the same motor neurons on phasic flight muscles in adult moths. Scanning micrographs showed a primary nerve branch running the length of each fiber, with secondary nerve branches extending from it at intervals. There was a great deal of variability in both the length of the branches and the distance from the nerve at which the neuromuscular junctions were formed. The rapid increase in muscle fiber size during larval development may be responsible for this variability. The nerves and junctions were often found to be obscure by overlying fibroblasts and tracheoblasts or entering the deep muscle clefts. Those examined were similar in appearance to the adult junctions formed by the same neurons, although some may have formed single branches instead of y-shapes. The membrane specializations of the synapse seen in freeze-fractured specimens were similar to those of the adult junction. However, the overall shape of the nerve terminal within the junction differed. The larval nerve terminals appeared varicose instead of having a uniform diameter. The spacing of the nerve plaques varied, in contrast with the relatively straight alignment and even spacing of plaques found in adult junctions. Such differences could result from an interaction between the motor neuron and the two different types of muscle fiber that it innervates, an intrinsic change in the motor neurons themselves that occurs with metamorphosis, or a plastic functional response that occurs as a result of the different types of motor patterns that are used in the two stages.

Individual insect muscle fibers, whose neuromuscular junctions have been stained with a modification of Ranvier's gold chloride method, can be dissected free and mounted whole if the muscle is prefixed in aldehydes. The neuromuscular junctions along the length of the individual fibers are well delineated and can be measured and counted. Effective procedures include fixation with glutaraldehyde buffered to low pH with sodium citrate, or glutaraldehyde and paraformaldehyde combined in phosphate buffer at neutral pH, followed by exposure to citric acid and to gold chloride. The method is convenient, and could be useful for the study of arthropod neuromuscular junctions in general, since their nerve terminals do not release acetylcholine as a transmitter and cannot be stained by the more commonly used cholinesterase methods.