Infection and Nonunion Following Operative Treatment of Lateral Humeral Condyle Fractures.

Background: Lateral humeral condyle fractures (LHCF) are the second most frequent type of pediatric elbow fracture. The purpose of this study is to characterize infections and nonunions of LHCF treated at a single institution. This is the largest series on infections and nonunions of LHCF to date.

Mitral Regurgitation in Female Patients: Sex Differences and Disparities.

Mitral regurgitation is the most common valvular disease, particularly in older adults. Recent literature has consistently supported that there are significant differences in mitral regurgitation outcomes between male and female patients and that this is likely multifactorial. Numerous sex differences in anatomy and pathophysiology may play a role in delayed diagnoses, referrals, and treatments for female patients.

Practical Considerations for Integrating Biosimilars Into Clinical Practice.

The development of innovator biologics and now their biosimilars has created some unique challenges in oncology practice. The oncology advanced practitioner (OAP) must understand the key differences between the innovator biologic and biosimilars in regard to efficacy, safety, and immunogenicity. In addition, the OAP must be able to evaluate and successfully navigate factors that may affect the adoption of biosimilars, such as the perceived cost-benefit and clinician and patient acceptance.

Challenges of Integrating Biosimilars Into Clinical Practice.

Presenters at JADPRO Live 2019 discussed the chemical and clinical nature of biosimilars, reviewed biosimilar development in oncology, and discussed implementation strategies for biosimilars.

Immune checkpoint inhibitors: Significant advancements in non-small cell lung cancer treatment.

Purpose: This article explores the efficacy, toxicity, place in therapy, and considerations for use of recently approved immune checkpoint inhibitors (ICIs) in the treatment of non-small cell lung cancer (NSCLC).

Summary: Lung cancer is the leading cause of cancer mortality in the United States and is responsible for more cancer-related deaths than breast, prostate, and colorectal cancer combined. The landscape for lung cancer treatment is evolving with the approval of new and exciting novel therapies.

Alpelisib: A Novel Therapy for Patients With Mutated Metastatic Breast Cancer.

In the United States, 1 in 8 women will be diagnosed with invasive breast cancer in her lifetime. Breast cancer death rates are higher for women in the United States than any other cancer, followed by lung cancer (National Cancer Institute, 2019). More than 70% of breast cancers are hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative, and of those patients, 40% have driver mutations in the gene phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha () resulting in damaged phosphatidylinositol 3-kinase (PI3K) and uncontrolled cell growth (Mollon et al.

Combined Effects of HLA-B*57/5801 Elite Suppressor CD8+ T Cells and NK Cells on HIV-1 Replication.

Elite controllers or suppressors (ES) are HIV-1 infected individuals who maintain undetectable viral loads without anti-retroviral therapy. The HLA-B*57 allele is overrepresented in ES suggesting a role for HIV-specific CD8+ T cells in immune control. Natural killer (NK) cells also play a role in controlling viral replication, and genetic studies demonstrate that specific combinations of killer cell immunoglobulin-like receptor (KIR) alleles and HLA subtypes including HLA-B*57 correlate with delayed progression to AIDS.

Accelerated Venovenous Hemofiltration as a Transitional Renal Replacement Therapy in the Intensive Care Unit.

Background: Continuous renal replacement therapy (CRRT) is commonly employed in the intensive care unit (ICU), though there are no guidelines around the transition between CRRT and intermittent hemodialysis (iHD). Accelerated venovenous hemofiltration (AVVH) is a modality utilizing higher hemofiltration rates (4-5 L/h) with shorter session durations (8-10 h) to "accelerate" the clearance and volume removal that normally is spread out over a 24-h period in CRRT. We examined AVVH as a transition therapy between CRRT and iHD, with the aim of decreasing time on CRRT and providing a more graduated transition for hemodynamically unstable patients requiring RRT.

Apalutamide: A new agent in the management of prostate cancer.

Apalutamide is a competitive inhibitor of the androgen receptor and binds directly to the ligand-binding domain. The US Food and Drug Administration approved apalutamide on 14 February 2018 for use in patients with nonmetastatic castration-resistant prostate cancer based upon results from the phase III SPARTAN trial demonstrating significantly longer metastasis-free survival over placebo. The SPARTAN trial evaluated 1207 patients with nonmetastatic castration-resistant prostate cancer who were randomized 2:1 to apalutamide or placebo in combination with androgen deprivation therapy.

Epidermal Growth Factor Receptor Inhibitor Skin Rash Prophylaxis in a Community Oncology Setting.

Epidermal growth factor receptor inhibitors (EGFRIs) can potentially cause a debilitating rash despite use of reactive-based treatment. Prophylactic rash management is a controversial rash-mitigating approach. The impact of a prophylactic rash treatment protocol for EGFRIs at a community hospital was evaluated.

Development of an electronic health record-based chronic kidney disease registry to promote population health management.

Background: Electronic health record (EHR) based chronic kidney disease (CKD) registries are central to population health strategies to improve CKD care. In 2015, Partners Healthcare System (PHS), encompassing multiple academic and community hospitals and outpatient care facilities in Massachusetts, developed an EHR-based CKD registry to identify opportunities for quality improvement, defined as improvement on both process measures and outcomes measures associated with clinical care.

Methods: Patients are included in the registry based on the following criteria: 1) two estimated glomerular filtration rate (eGFR) results < 60 ml/min/1.

Cross-reactive microbial peptides can modulate HIV-specific CD8+ T cell responses.

Heterologous immunity is an important aspect of the adaptive immune response. We hypothesized that this process could modulate the HIV-1-specific CD8+ T cell response, which has been shown to play an important role in HIV-1 immunity and control. We found that stimulation of peripheral blood mononuclear cells (PBMCs) from HIV-1-positive subjects with microbial peptides that were cross-reactive with immunodominant HIV-1 epitopes resulted in dramatic expansion of HIV-1-specific CD8+ T cells.

Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study.

Background: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high morbidity, mortality and resource utilization. The type of vascular access placed for AKI-RRT is an important decision, for which there is a lack of evidence-based guidelines.

Methods: We conducted a prospective cohort study over a 16-month period with 154 patients initiated on AKI-RRT via either a non-tunneled dialysis catheter (NTDC) or a tunneled dialysis catheter (TDC) at an academic hospital.

Chronic Opioid Use Following Surgery for Oral Cavity Cancer.

Importance: Opioid misuse and overuse has become an epidemic. Chronic opioid use among oral cavity cancer patients after surgery has not been described.

Objectives: To assess the prevalence of chronic opioid use in patients undergoing surgery for oral cavity cancer, and evaluate possible associated clinical factors; and the association between opioid use and survival.

Factors Associated With the Control of Viral Replication and Virologic Breakthrough in a Recently Infected HIV-1 Controller.

HIV-1 controllers are patients who control HIV-1 viral replication without antiretroviral therapy. Control is achieved very early in the course of infection, but the mechanisms through which viral replication is restricted are not fully understood. We describe a patient who presented with acute HIV-1 infection and was found to have an HIV-1 RNA level of <100copies/mL.

Novel Uses for Lipid-Lowering Agents.

Statin use leads to a reduction in the downstream products of the mevalonate pathway. Knowledge of this pathway has led scientists to investigate the role of statins in cancer prevention and treatment. Statins appear to possess a variety of pleiotropic effects, including inhibition of cell proliferation; enhanced apoptosis; and modulation of inflammation, endothelial function, and angiogenesis.

Pre-authorization processes have no effect on patients undergoing knee MRI in a pediatric setting when evaluated by specialists.

Objective: Pre-authorization processes are often used by medical insurance companies to reduce costs by managing the utilization of advanced diagnostic imaging, and their impact on patient care is unclear. The purpose of our study is to determine if a pre-authorization process increases the rate of surgically significant abnormal knee MRI and surgical referrals compared with patients referred from pediatric orthopedic specialists who do not undergo a pre-authorization process.

Materials And Methods: A retrospective study was performed; 124 patients were identified who were referred for knee MRI by a pediatric orthopedist.

Rising Cost of Cancer Pharmaceuticals: Cost Issues and Interventions to Control Costs.

The rising cost of pharmaceuticals and, in particular, cancer drugs has made headline news in recent years. Several factors contribute to increasing costs and the burden this places on the health care system and patients. Some of these factors include costly cancer pharmaceutical research and development, longer clinical trials required to achieve drug approval, manufacturing costs for complex compounds, and the economic principles surrounding oncology drug pricing.

Dronabinol for chemotherapy-induced nausea and vomiting unresponsive to antiemetics.

Chemotherapy-induced nausea and vomiting (CINV) is one of the most common symptoms feared by patients, but may be prevented or lessened with appropriate medications. Several antiemetic options exist to manage CINV. Corticosteroids, serotonin receptor antagonists, and neurokinin receptor antagonists are the classes most commonly used in the prevention of CINV.

Blinatumomab: A novel, bispecific, T-cell engaging antibody.

Purpose: The pharmacology, pharmacodynamics, pharmacokinetics, efficacy in clinical trials, safety and tolerability, and place in therapy of blinatumomab are reviewed.

Summary: Blinatumomab is a novel, bispecific, T-cell engaging antibody that targets tumor-associated antigens CD19 and CD3. Blinatumomab was approved through an accelerated pathway for the treatment of Philadelphia (Ph) chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).

Point-of-Use Mixing of Influenza H5N1 Vaccine and MF59 Adjuvant for Pandemic Vaccination Preparedness: Antibody Responses and Safety. A Phase 1 Clinical Trial.

Background: Avian influenza A/H5N1 has threatened human health for nearly 2 decades. Avian influenza A vaccine without adjuvant is poorly immunogenic. A flexible rapid tactic for mass vaccination will be needed if a pandemic occurs.