Immunologic and pharmacologic concepts of monoclonal antibodies

While monoclonal antibodies have solved many of the difficulties of using immunologic reagents for radioimmunodiagnosis and therapy, in the 13 years since their introduction a number of persistent problems remain, most notably a low yield of antibody-producing cells from the fusion process, difficulty in obtaining high-affinity antibodies, and the potential immunogenicity of murine immunoglobulins (Igs). Several solutions are under development, including fusion techniques that enrich for cells producing desired antibodies, production of human-mouse chimeric antibodies by recombinant DNA technology, and the generation of human monoclonal antibodies by promising new approaches. Until these upcoming methodologies are established, and to better direct their development and application, a sound understanding of the pharmacology of presently available native and modified monoclonal antibodies is crucial. Although much has been already determined in this area, a great deal of further clarification remains necessary.     

Determinants of left ventricular systolic function recovery after an acute coronary syndrome.

INTRODUCTION: Ischemic heart disease is a major cause of heart failure in western societies. However, the factors that may influence left ventricular function (LVF) recovery after an acute coronary syndrome (ACS) are still unclear. OBJECTIVE: To identify variables that may influence LVF evolution one year after ACS. METHODS: 104 patients hospitalized with ACS between 7/1/2001 and 12/31/2002 and with systolic dysfunction--defined as an echocardiographic ejection fraction (EF) < or = 45%--were randomly allocated to a planned coronary follow-up program (FUP) or a general cardiology clinic (GC); patients from both groups were also randomly referred to a structured cardiac rehabilitation program (CRP). EF was re-assessed at one year. We compared differences between patients who recovered left ventricular function (EF > 45%; group 1) and those who did not (group 2). RESULTS: One year after discharge, 44.2% of the patients had recovered function. There were no significant differences between the groups in gender (77.7 vs. 76.5% male), age (56 vs. 59 years), hypertension, diabetes, dyslipidemia, smoking habits or family history. A previous history of cardiovascular events was more frequent in group 2 (11.1% vs. 35.3%, p = 0.03). Cardiac catheterization was performed before discharge in 88.8% and 88.2% in groups 1 and 2 respectively (p = NS); no differences were found in coronary anatomy between the two groups. Angioplasty was performed in 54.2% in group 1 and 50% in group 2 (p = NS). There were no differences in the use of angiotensin-converting enzyme inhibitors (83.3% vs. 87.5%), beta-blockers (87.5% vs. 87.5%), nitrates (37.5% vs. 33.3%), aspirin (95.8% vs. 95.8%), statins (79.1% vs. 75%) or diuretics (20.8% vs. 45.8%). There was no significant difference in LVF recovery between patients randomized to FUP or GC (38.5% vs. 54.5%). 87.5% of patients who completed the CRP had normal EF at one year compared to 32.7% of patients not referred to the program (p = 0.009). Although EF improved in both groups, this improvement was greater in patients who completed a CRP (EF 8% vs. 5%, p = 0.003). CONCLUSION: A previous cardiovascular event and completion of a CRP were the only variables that influenced LVF recovery. Thus, enrollment in a CRP, in addition to standard therapy, could be an important therapeutic measure in patients with systolic dysfunction after ACS; our data suggest that these programs should be more widely used.     

Review of facial muscle spasms

Facial muscle spasms, which are rare in adults, present a particularly difficult entity for the optometrist to recognise. The condition may not even manifest itself at an eye examination and the optometrist may have to rely on subjective symptoms to assist in the recognition of the condition. It is important to diagnose the condition correctly as specific and effective treatment is available.     

Evaluation of the debonding characteristics of 2 ceramic brackets: an in vitro study.

The objectives of this study were to evaluate and compare the shear bond strengths and bond failure locations of 2 currently available orthodontic ceramic brackets. Forty polycrystalline ceramic brackets (Clarity, 3M Unitek, Monrovia, Calif) and 40 monocrystalline ceramic brackets (Inspire, Ormco, Orange, Calif) were bonded to 80 extracted premolars with the same bonding system. All bonded specimens were placed in distilled water for 42 hours at 37 degrees C followed by thermal cycling for 700 complete cycles. Forty ceramic brackets, 20 of each type, were tested on a universal testing machine to determine the shear force levels required to debond them. Forty ceramic brackets were removed with the debonding pliers recommended by the manufacturers. All teeth were examined under an optical microscope, and the adhesive remnant index was used to assess the bond failure locations. The mean shear bond strength of the Clarity brackets was 21.67 +/- 5.19 MPa, and the mean shear bond strength of the Inspire brackets was 20.32 +/- 8 MPa. The mean shear bond strengths of both brackets were higher than those considered clinically optimal. Most of the brackets (85% of Clarity and 75% of Inspire) tested on the machine failed at the bracket-adhesive interface. One premolar bonded with an Inspire bracket had enamel fracture upon debonding. Most of the brackets (90% of Clarity and 95% of Inspire) debonded with pliers failed at the bracket-adhesive interface. No enamel damage was evident in any specimen when the brackets were removed with the appropriate pliers. The results indicate that the safest way to remove ceramic brackets with respect to reducing the chance of enamel damage is to use the debonding technique specifically designed for each.