Constrained total shoulder replacement is a salvage procedure for the patient with disabling pain... more Constrained total shoulder replacement is a salvage procedure for the patient with disabling pain and a nonfunctioning rotator cuff mechanism. The results of pain relief have been gratifying. When active overhead motion is a goal of treatment a strong deltoid muscle is required. The rationale for fixing a fulcrum is to substitute for the loss of the rotator cuff mechanism that stabilizes the humeral or prosthetic head on the shallow glenoid. The best method of attachment for the glenoid component to an intact glenoid vault described herein has been found to be superior to other methods. In particular, the vault should not be mutilated. This is borne out by the clinical experience and laboratory testing that loosening or pull-out does not occur with an intact glenoid. Moreover, the attachment is stronger than the dry bone just medial to the vault where fracture always occurred through the suprascapular notch in laboratory tests. Although there may be good pain relief with this operation, active function still depends on residual deltoid muscle power wherein a poor deltoid will only allow passive motion. Moreover, the outcome of any shoulder operation still depends in large measure on the excellence of the postoperative rehabilitation program. Finally, other worthwhile shoulder operations should be given first consideration in order to serve the needs of individual patients.
Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended... more Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended as a means of minimizing a progression of symptoms and findings. It was more important to achieve adequate tension in the cuff tissues than to obtain a water-tight closure. Even patients with old complete tears may obtain good results from reconstruction of the rotator cuff. However, merely closing a rotator cuff tear will not permit a good functional result if the ability of the muscles to contract adequately is lost forever. This group of patients rarely achieves full restoration of muscle strength in their operated shoulders, primarily due to muscle atrophy. In shoulders previously operated on, functional results were not as good as in those cases operated on for the first time. Avoidance of interposed soft tissue grafts and restoration of a direct continuity of viable rotator cuff tissue to its bony insertion are recommended whenever possible, to achieve the optimum functional result. In those patients with arthritis of the glenohumeral joint or permanent long-standing nonfunctional rotator cuff muscle, the results of reconstruction were poor. A carefully supervised postoperative rehabilitation program is essential for optimum results.
Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: ... more Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: vaccine delivery systems and immunostimulatory adjuvants. Vaccine delivery systems are generally particulate (e.g., emulsions, microparticles, immunostimulatory complexes and liposomes) and function mainly to target associated antigens into antigen-presenting cells. However, increasingly, more complex formulations are being developed in which delivery systems are exploited both for the delivery of antigens and also for the delivery of coadministered immunostimulatory adjuvants. The rationale for this approach is to ensure that both antigen and adjuvant are delivered into the same population of antigen-presenting cells. In addition, delivery systems can focus the effect of the adjuvants onto the key cells of the immune system and limit the systemic distribution of the adjuvant, to minimize its potential to induce adverse effects. The formulation and delivery of potent adjuvants in microparticles may allow the development of prophylactic and therapeutic vaccines against cancers and chronic infectious diseases, which are currently poorly controlled. In addition, microparticle formulations may also allow vaccines to be delivered mucosally.
Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: ... more Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: vaccine delivery systems and immunostimulatory adjuvants. Vaccine delivery systems are generally particulate (e.g., emulsions, microparticles, immunostimulatory complexes and liposomes) and function mainly to target associated antigens into antigen-presenting cells. However, increasingly, more complex formulations are being developed in which delivery systems are exploited both for the delivery of antigens and also for the delivery of coadministered immunostimulatory adjuvants. The rationale for this approach is to ensure that both antigen and adjuvant are delivered into the same population of antigen-presenting cells. In addition, delivery systems can focus the effect of the adjuvants onto the key cells of the immune system and limit the systemic distribution of the adjuvant, to minimize its potential to induce adverse effects. The formulation and delivery of potent adjuvants in microparticles may allow the development of prophylactic and therapeutic vaccines against cancers and chronic infectious diseases, which are currently poorly controlled. In addition, microparticle formulations may also allow vaccines to be delivered mucosally.
Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glyc... more Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glycolide) (monomer ratio 65:35) of Mol. Wt 75 000. The method of preparation was emulsification-solvent evaporation. In vitro vaccine release data are discussed. An in vivo ...
Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated... more Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated bacteria/viruses. These vaccines would require optimal adjuvants and delivery systems to accord long-term protection from infectious diseases in animals. There is an urgent need for the development of new and improved veterinary and human vaccine adjuvants. Adjuvants can be broadly divided into two classes, based on their principal mechanisms of action: vaccine delivery systems and 'immunostimulatory adjuvants'. Vaccine delivery systems are generally particulate e.g. emulsions, microparticles, ISCOMS and liposomes, and mainly function to target associated antigens into antigen presenting cells (APC). In contrast, immunostimulatory adjuvants are predominantly derived from pathogens and often represent pathogen associated molecular patterns, e.g. LPS, MPL and CpG DNA, which activate cells of the innate immune system. Recent progress in innate immunity is beginning to yield insight into the initiation of immune responses and the ways in which immunostimulatory adjuvants might enhance this process in animals and humans alike.
New generation vaccines, particularly those based on recombinant proteins and DNA, are likely to ... more New generation vaccines, particularly those based on recombinant proteins and DNA, are likely to be less reactogenic than traditional vaccines but are also less immunogenic. Therefore, there is an urgent need for the development of new and improved vaccine adjuvants. Adjuvants can be broadly separated into two classes based on their principal mechanisms of action: vaccine delivery systems and immunostimulatory adjuvants. Vaccine-delivery systems generally are particulate (e.g., emulsions, microparticles, iscoms, and liposomes)and function mainly to target associated antigens into antigen-resenting cells. In contrast, immunostimulatory adjuvants are derived predominantly from pathogens and often represent pathogen-ssociated molecular patterns (e.g., lipopolysaccaride, monophosphoryl lipid A, CpG DNA), which activate cells of the innate immune system. Recent progress in innate immunity is beginning to yield insight into the initiation of immune responses and the ways in which immunostimulatory adjuvants may enhance this process. The discovery of more potent adjuvants may allow the development of prophylactic and therapeutic vaccines against cancers and chronic infectious diseases. In addition, new adjuvants may also allow vaccines to be delivered mucosally.
Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glyc... more Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glycolide) (monomer ratio 65:35) of Mol. Wt 75 000. The method of preparation was emulsification-solvent evaporation. In vitro vaccine release data are discussed. An in vivo ...
DNA vaccines have demonstrated a lack of adequate potency in humans, which has necessitated the e... more DNA vaccines have demonstrated a lack of adequate potency in humans, which has necessitated the exploration of various adjunct technologies. Inefficient delivery of DNA vaccines, particularly to antigen-presenting cells, may be contributing to this lack of potency. One effective means of facilitating delivery of DNA vaccines to APCs is through the use of microparticles. In this article, we review the background and rationale for microparticles as a vaccine delivery system, data demonstrating their utility and mode of action for DNA delivery, and the prospects for their development.
Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated... more Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated bacteria/viruses. These vaccines would require optimal adjuvants and delivery systems to accord long-term protection from infectious diseases in animals. There is an urgent need for the development of new and improved veterinary and human vaccine adjuvants. Adjuvants can be broadly divided into two classes, based on their principal mechanisms of action: vaccine delivery systems and 'immunostimulatory adjuvants'. Vaccine delivery systems are generally particulate e.g. emulsions, microparticles, ISCOMS and liposomes, and mainly function to target associated antigens into antigen presenting cells (APC). In contrast, immunostimulatory adjuvants are predominantly derived from pathogens and often represent pathogen associated molecular patterns, e.g. LPS, MPL and CpG DNA, which activate cells of the innate immune system. Recent progress in innate immunity is beginning to yield insight into the initiation of immune responses and the ways in which immunostimulatory adjuvants might enhance this process in animals and humans alike.
Constrained total shoulder replacement is a salvage procedure for the patient with disabling pain... more Constrained total shoulder replacement is a salvage procedure for the patient with disabling pain and a nonfunctioning rotator cuff mechanism. The results of pain relief have been gratifying. When active overhead motion is a goal of treatment a strong deltoid muscle is required. The rationale for fixing a fulcrum is to substitute for the loss of the rotator cuff mechanism that stabilizes the humeral or prosthetic head on the shallow glenoid. The best method of attachment for the glenoid component to an intact glenoid vault described herein has been found to be superior to other methods. In particular, the vault should not be mutilated. This is borne out by the clinical experience and laboratory testing that loosening or pull-out does not occur with an intact glenoid. Moreover, the attachment is stronger than the dry bone just medial to the vault where fracture always occurred through the suprascapular notch in laboratory tests. Although there may be good pain relief with this operation, active function still depends on residual deltoid muscle power wherein a poor deltoid will only allow passive motion. Moreover, the outcome of any shoulder operation still depends in large measure on the excellence of the postoperative rehabilitation program. Finally, other worthwhile shoulder operations should be given first consideration in order to serve the needs of individual patients.
Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended... more Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended as a means of minimizing a progression of symptoms and findings. It was more important to achieve adequate tension in the cuff tissues than to obtain a water-tight closure. Even patients with old complete tears may obtain good results from reconstruction of the rotator cuff. However, merely closing a rotator cuff tear will not permit a good functional result if the ability of the muscles to contract adequately is lost forever. This group of patients rarely achieves full restoration of muscle strength in their operated shoulders, primarily due to muscle atrophy. In shoulders previously operated on, functional results were not as good as in those cases operated on for the first time. Avoidance of interposed soft tissue grafts and restoration of a direct continuity of viable rotator cuff tissue to its bony insertion are recommended whenever possible, to achieve the optimum functional result. In those patients with arthritis of the glenohumeral joint or permanent long-standing nonfunctional rotator cuff muscle, the results of reconstruction were poor. A carefully supervised postoperative rehabilitation program is essential for optimum results.
Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: ... more Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: vaccine delivery systems and immunostimulatory adjuvants. Vaccine delivery systems are generally particulate (e.g., emulsions, microparticles, immunostimulatory complexes and liposomes) and function mainly to target associated antigens into antigen-presenting cells. However, increasingly, more complex formulations are being developed in which delivery systems are exploited both for the delivery of antigens and also for the delivery of coadministered immunostimulatory adjuvants. The rationale for this approach is to ensure that both antigen and adjuvant are delivered into the same population of antigen-presenting cells. In addition, delivery systems can focus the effect of the adjuvants onto the key cells of the immune system and limit the systemic distribution of the adjuvant, to minimize its potential to induce adverse effects. The formulation and delivery of potent adjuvants in microparticles may allow the development of prophylactic and therapeutic vaccines against cancers and chronic infectious diseases, which are currently poorly controlled. In addition, microparticle formulations may also allow vaccines to be delivered mucosally.
Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: ... more Adjuvants can be broadly divided into two groups, based on their principal mechanisms of action: vaccine delivery systems and immunostimulatory adjuvants. Vaccine delivery systems are generally particulate (e.g., emulsions, microparticles, immunostimulatory complexes and liposomes) and function mainly to target associated antigens into antigen-presenting cells. However, increasingly, more complex formulations are being developed in which delivery systems are exploited both for the delivery of antigens and also for the delivery of coadministered immunostimulatory adjuvants. The rationale for this approach is to ensure that both antigen and adjuvant are delivered into the same population of antigen-presenting cells. In addition, delivery systems can focus the effect of the adjuvants onto the key cells of the immune system and limit the systemic distribution of the adjuvant, to minimize its potential to induce adverse effects. The formulation and delivery of potent adjuvants in microparticles may allow the development of prophylactic and therapeutic vaccines against cancers and chronic infectious diseases, which are currently poorly controlled. In addition, microparticle formulations may also allow vaccines to be delivered mucosally.
Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glyc... more Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glycolide) (monomer ratio 65:35) of Mol. Wt 75 000. The method of preparation was emulsification-solvent evaporation. In vitro vaccine release data are discussed. An in vivo ...
Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated... more Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated bacteria/viruses. These vaccines would require optimal adjuvants and delivery systems to accord long-term protection from infectious diseases in animals. There is an urgent need for the development of new and improved veterinary and human vaccine adjuvants. Adjuvants can be broadly divided into two classes, based on their principal mechanisms of action: vaccine delivery systems and 'immunostimulatory adjuvants'. Vaccine delivery systems are generally particulate e.g. emulsions, microparticles, ISCOMS and liposomes, and mainly function to target associated antigens into antigen presenting cells (APC). In contrast, immunostimulatory adjuvants are predominantly derived from pathogens and often represent pathogen associated molecular patterns, e.g. LPS, MPL and CpG DNA, which activate cells of the innate immune system. Recent progress in innate immunity is beginning to yield insight into the initiation of immune responses and the ways in which immunostimulatory adjuvants might enhance this process in animals and humans alike.
New generation vaccines, particularly those based on recombinant proteins and DNA, are likely to ... more New generation vaccines, particularly those based on recombinant proteins and DNA, are likely to be less reactogenic than traditional vaccines but are also less immunogenic. Therefore, there is an urgent need for the development of new and improved vaccine adjuvants. Adjuvants can be broadly separated into two classes based on their principal mechanisms of action: vaccine delivery systems and immunostimulatory adjuvants. Vaccine-delivery systems generally are particulate (e.g., emulsions, microparticles, iscoms, and liposomes)and function mainly to target associated antigens into antigen-resenting cells. In contrast, immunostimulatory adjuvants are derived predominantly from pathogens and often represent pathogen-ssociated molecular patterns (e.g., lipopolysaccaride, monophosphoryl lipid A, CpG DNA), which activate cells of the innate immune system. Recent progress in innate immunity is beginning to yield insight into the initiation of immune responses and the ways in which immunostimulatory adjuvants may enhance this process. The discovery of more potent adjuvants may allow the development of prophylactic and therapeutic vaccines against cancers and chronic infectious diseases. In addition, new adjuvants may also allow vaccines to be delivered mucosally.
Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glyc... more Tetanus toxoid (TT) loaded biodegradable microspheres were prepared from poly(dl-lactide-co -glycolide) (monomer ratio 65:35) of Mol. Wt 75 000. The method of preparation was emulsification-solvent evaporation. In vitro vaccine release data are discussed. An in vivo ...
DNA vaccines have demonstrated a lack of adequate potency in humans, which has necessitated the e... more DNA vaccines have demonstrated a lack of adequate potency in humans, which has necessitated the exploration of various adjunct technologies. Inefficient delivery of DNA vaccines, particularly to antigen-presenting cells, may be contributing to this lack of potency. One effective means of facilitating delivery of DNA vaccines to APCs is through the use of microparticles. In this article, we review the background and rationale for microparticles as a vaccine delivery system, data demonstrating their utility and mode of action for DNA delivery, and the prospects for their development.
Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated... more Next generation veterinary vaccines are going to mainly comprise of either subunit or inactivated bacteria/viruses. These vaccines would require optimal adjuvants and delivery systems to accord long-term protection from infectious diseases in animals. There is an urgent need for the development of new and improved veterinary and human vaccine adjuvants. Adjuvants can be broadly divided into two classes, based on their principal mechanisms of action: vaccine delivery systems and 'immunostimulatory adjuvants'. Vaccine delivery systems are generally particulate e.g. emulsions, microparticles, ISCOMS and liposomes, and mainly function to target associated antigens into antigen presenting cells (APC). In contrast, immunostimulatory adjuvants are predominantly derived from pathogens and often represent pathogen associated molecular patterns, e.g. LPS, MPL and CpG DNA, which activate cells of the innate immune system. Recent progress in innate immunity is beginning to yield insight into the initiation of immune responses and the ways in which immunostimulatory adjuvants might enhance this process in animals and humans alike.
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