Complete Eradication of Biofilm From Orthopedic Materials

Background

Interest exists in finding alternatives to current management strategies in periprosthetic joint infections, which typically include a 2-stage revision with placement of an antibiotic spacer and delayed placement of a new implant. We studied the efficacy of autoclaving, ultrasonication, and mechanical scrubbing for sterilization and biofilm eradication on infected cobalt-chrome discs.

Chimeric Antigen Receptor T Cells in Hematologic Malignancies

Patients with B‐cell hematologic malignancies who progress through first‐ or second‐line chemotherapy have a poor prognosis. Early clinical trials with autologous anti‐CD19 chimeric antigen receptor (CAR) T cells have demonstrated promising results for patients who have relapsed or refractory disease. Lymphodepleting conditioning regimens, including cyclophosphamide, fludarabine, pentostatin, bendamustine, interleukin‐2, and total body irradiation, are often administered before the infusion of CAR T cells, allowing for greater T‐cell expansion. The major toxicity associated with CAR T‐cell infusions is cytokine release syndrome (CRS), a potentially life‐threatening systemic inflammatory disorder. The quick onset and progression of CRS require rapid detection and intervention to reduce treatment‐related mortality. Management with tocilizumab can help ameliorate the symptoms of severe CRS, allowing steroids, which diminish the expansion and persistence of CAR T cells, to be reserved for tocilizumab‐refractory patients. Other toxicities of CAR T‐cell therapy include neutropenia and/or febrile neutropenia, infection, tumor lysis syndrome, neurotoxicity and nausea/vomiting. A review of patients’ medications is imperative to eliminate medications that may contribute to treatment‐related toxicities. Studies are ongoing to help optimize patient selection, preparation, safety, and management of individuals receiving CAR T cells. Long‐term follow‐up will help establish the place of CAR T cells in therapy.     

Population characteristics associated with pharmacy-based influenza vaccination in United States survey data

Objectives

To examine the population characteristics associated with the health behavior of receiving an influenza vaccine from a pharmacy-based setting.

A comparison of facemask and respirator filtration test methods

NIOSH published a Federal Register Notice to explore the possibility of incorporating FDA required filtration tests for surgical masks (SMs) in the 42 CFR Part 84 respirator certification process. There have been no published studies comparing the filtration efficiency test methods used for NIOSH certification of N95 filtering facepiece respirators (N95 FFRs) with those used by the FDA for clearance of SMs. To address this issue, filtration efficiencies of “N95 FFRs” including six N95 FFR models and three surgical N95 FFR models, and three SM models were measured using the NIOSH NaCl aerosol test method, and FDA required particulate filtration efficiency (PFE) and bacterial filtration efficiency (BFE) methods, and viral filtration efficiency (VFE) method. Five samples of each model were tested using each method. Both PFE and BFE tests were done using unneutralized particles as per FDA guidance document. PFE was measured using 0.1 µm size polystyrene latex particles and BFE with ～3.0 µm size particles containing Staphylococcus aureus bacteria. VFE was obtained using ～3.0 µm size particles containing phiX 174 as the challenge virus and Escherichia coli as the host. Results showed that the efficiencies measured by the NIOSH NaCl method for “N95 FFRs” were from 98.15–99.68% compared to 99.74–99.99% for PFE, 99.62–99.9% for BFE, and 99.8–99.9% for VFE methods. Efficiencies by the NIOSH NaCl method were significantly (p = <0.05) lower than the other methods. SMs showed lower efficiencies (54.72–88.40%) than “N95 FFRs” measured by the NIOSH NaCl method, while PFE, BFE, and VFE methods produced no significant difference. The above results show that the NIOSH NaCl method is relatively conservative and is able to identify poorly performing filtration devices. The higher efficiencies obtained using PFE, BFE and VFE methods show that adding these supplemental particle penetration methods will not improve respirator certification.     

Novel intraoperative radiotherapy utilizing prefabricated custom three-dimensionally printed high-dose-rate applicators

BackgroundIntraoperative radiotherapy (IORT) is an effective strategy for the delivery of high doses of radiotherapy to a residual tumor or resection cavity with relative sparing of nearby healthy tissues. This strategy is an important component of the multimodality management of pediatric soft tissue sarcomas, particularly in cases where patients have received prior courses of external beam radiotherapy.PurposeTumor beds with significant topographic irregularity remain a therapeutic challenge because existing IORT technologies are typically most reliable with flat surfaces. To address this limitation, we have developed a novel strategy to create custom, prefabricated high-dose-rate (HDR)-IORT applicators designed to match the shape of an anticipated surgical cavity.Methods and MaterialsSilastic applicators are constructed using three-dimensional (3D) printing and are derived from volumetric segmentation of preoperative imaging.ResultsHDR preplanning with the applicators improves dosimetric accuracy and minimizes incremental operative time. In this report, we describe the fabrication process for the 3D-printed applicators and detail our experience utilizing this strategy in two pediatric patients who underwent HDR-IORT as part of complex base of skull sarcoma resections.ConclusionsEarly experience suggests that usage of the custom applicators is feasible, versatile for a variety of clinical situations, and enables the uniform delivery of high superficial doses of radiotherapy to irregularly shaped surgical cavities.     

Children’s family experiences: development of the PROMIS<Superscript>®</Superscript> pediatric family relationships measures

Purpose

To describe the development of pediatric family relationships measures, with versions for child self-report (8–17 years) and parent-report for children 5–17 years old. Measures were created for integration into the Patient Reported Outcomes Measurement Information System (PROMIS^®).

Methods

Semi-structured interviews with 10 experts, 24 children, and 8 parents were conducted to elicit and clarify essential elements of family relationships. A systematic literature review was conducted to identify item concepts representative of each element. The concepts were transformed into items that were iteratively revised based on cognitive interviews (n = 43 children) and item translatability review. Psychometric studies involving 2846 children and 2262 parents were conducted to further refine and validate the instruments.

Results

Qualitative procedures supported the development of content valid Family Relationships item banks. Final child- and parent-report item banks each contain 47 items. Unidimensional item banks were calibrated using IRT-modeling to estimate item parameters representative of the US population and to enable computerized adaptive test administration. Four- and eight-item short forms were constructed for standard fixed format administration. All instruments have strong internal consistency, retest-reliability, and provide precise estimates of various levels of family relationship quality. Preliminary evidence of the instruments’ validity was provided by known-group comparisons and convergence with legacy measures.

Conclusion

The PROMIS pediatric Family Relationships measures can be applied in research focused on determinants, outcomes, and the protective effects of children’s subjective family relationship experiences.