Research Spotlight

Posted November 15th 2017

Treatment of Posterior Dislocation of the Mandibular Condyle With the Double Mitek Mini Anchor Technique: A Case Report.

Larry M. Wolford D.M.D.

Larry M. Wolford D.M.D.

Albilia, J. B., H. Weisleder and L. M. Wolford (2017). “Treatment of posterior dislocation of the mandibular condyle with the double mitek mini anchor technique: A case report.” J Oral Maxillofac Surg: 2017 Oct [Epub ahead of print].

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Posterior dislocation of the mandibular condyle is a rare disorder caused by trauma to the chin accompanied by damage to the external auditory canal. Treatment of posterior condylar dislocation (PCD) is directed at repositioning the condyle into the glenoid fossa, preventing recurrent dislocations, and maintaining patency of the ear canal. With early intervention, closed reduction with manual manipulation is successful but could be ineffective for chronic protracted PCD. This case report describes an elderly patient with a chronic protracted PCD resulting from a blow to the chin and in which manual reduction was unsuccessful. An open arthroplasty for condylar reduction and application of a “reverse” double Mitek mini anchor technique was required to prevent recurrence of PCD, with a successful outcome.


Posted November 15th 2017

Human innate responses and adjuvant activity of TLR ligands in vivo in mice reconstituted with a human immune system.

Gerard Zurawski Ph.D.

Gerard Zurawski Ph.D.

Cheng, L., Z. Zhang, G. Li, F. Li, L. Wang, L. Zhang, S. M. Zurawski, G. Zurawski, Y. Levy and L. Su (2017). “Human innate responses and adjuvant activity of tlr ligands in vivo in mice reconstituted with a human immune system.” Vaccine 35(45): 6143-6153.

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TLR ligands (TLR-Ls) represent a class of novel vaccine adjuvants. However, their immunologic effects in humans remain poorly defined in vivo. Using a humanized mouse model with a functional human immune system, we investigated how different TLR-Ls stimulated human innate immune response in vivo and their applications as vaccine adjuvants for enhancing human cellular immune response. We found that splenocytes from humanized mice showed identical responses to various TLR-Ls as human PBMCs in vitro. To our surprise, various TLR-Ls stimulated human cytokines and chemokines differently in vivo compared to that in vitro. For example, CpG-A was most efficient to induce IFN-alpha production in vitro. In contrast, CpG-B, R848 and Poly I:C stimulated much more IFN-alpha than CpG-A in vivo. Importantly, the human innate immune response to specific TLR-Ls in humanized mice was different from that reported in C57BL/6 mice, but similar to that reported in nonhuman primates. Furthermore, we found that different TLR-Ls distinctively activated and mobilized human plasmacytoid dendritic cells (pDCs), myeloid DCs (mDCs) and monocytes in different organs. Finally, we showed that, as adjuvants, CpG-B, R848 and Poly I:C can all enhance antigen specific CD4+ T cell response, while only R848 and Poly I:C induced CD8+ cytotoxic T cells response to a CD40-targeting HIV vaccine in humanized mice, correlated with their ability to activate human mDCs but not pDCs. We conclude that humanized mice serve as a highly relevant model to evaluate and rank the human immunologic effects of novel adjuvants in vivo prior to testing in humans.


Posted November 15th 2017

Spectrum of orocutaneous disease associations: Immune-mediated conditions.

Alan M. Menter M.D.

Alan M. Menter M.D.

Cizenski, J. D., P. Michel, I. T. Watson, J. Frieder, E. G. Wilder, J. M. Wright and M. A. Menter (2017). “Spectrum of orocutaneous disease associations: Immune-mediated conditions.” J Am Acad Dermatol 77(5): 795-806.

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There are a number of diseases that manifest both on the skin and the oral mucosa, and therefore the importance for dermatologists in clinical practice to be aware of these associations is paramount. In the following continuing medical education series, we outline orocutaneous disease associations with both immunologic and inflammatory etiologies.


Posted November 15th 2017

Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?

Richard Hostin M.D.

Richard Hostin M.D.

Ferrero, E., B. Liabaud, J. K. Henry, C. P. Ames, K. Kebaish, G. M. Mundis, R. Hostin, M. C. Gupta, O. Boachie-Adjei, J. S. Smith, R. A. Hart, I. Obeid, B. G. Diebo, F. J. Schwab and V. Lafage (2017). “Sagittal alignment and complications following lumbar 3-column osteotomy: Does the level of resection matter?” J Neurosurg Spine 27(5): 560-569.

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OBJECTIVE Three-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions. METHODS In this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery. RESULTS A total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1 degrees and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2 degrees per more caudal level, R = -0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026). CONCLUSIONS In this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.


Posted November 15th 2017

A comparison of lipid minimization strategies in children with intestinal failure.

Jessica Gonzalez-Hernandez M.D.

Jessica Gonzalez-Hernandez M.D.

Gonzalez-Hernandez, J., P. Prajapati, G. Ogola, V. Nguyen, N. Channabasappa and H. G. Piper (2017). “A comparison of lipid minimization strategies in children with intestinal failure.” J Pediatr Surg: 2017 Oct [Epub ahead of print].

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PURPOSE: The purpose of this study was to compare outcomes of lipid minimization with either Intralipid (IL) or Omegaven(R) in children with intestinal failure (IF) who developed intestinal failure-associated liver disease (IFALD) while receiving parenteral nutrition (PN). METHODS: A retrospective review of children with IF requiring PN who developed IFALD (direct bilirubin >2 mg/dL) while receiving IL (2009-2016) was performed. Clinical characteristics, nutritional, and laboratory values were compared between children treated with reduced IL or Omegaven(R). RESULTS: 16 children were reviewed (8 treated with IL and 8 treated with Omegaven(R) at a median dose of 1g/kg/d). Both groups had similar demographics, small bowel length, and parenteral nutritional intake during the study (82.9+/-27.1 kcal/kg/d vs. 75.9+/-16.5 kcal/kg/d, p=0.54). The mean direct bilirubin (DBili) prior to initiating treatment was 7.8+/-4.3 mg/dL and 7.5+/-3.5 mg/dL (p=0.87) in the IL and Omegaven(R) groups, respectively. The IL group took a median of 113 days to achieve a DBili <0.5 mg/dL compared to 124 days in the Omegaven(R) group (p=0.49). There were no differences in markers of liver function or growth trajectories among groups. CONCLUSIONS: Lipid minimization with either IL or Omegaven(R) has similar success in achieving a normal DBili in children with IF and IFALD without major differences in nutritional status or growth.