OS from initial breast cancer diagnosis significantly improved over time for patients with HER2-positive breast cancer who develop BCBM, now exceeding 7 years; survival from BCBM diagnosis may now exceed 2 years.

The incidence of breast cancer brain metastasis (BCBM) is increasing due in part to improved management of systemic disease and prolonged survival. Despite this growing population of patients, there exists little consensus for the treatment of HER2-positive BCBM. Lapatinib, the only brain permeable targeted agent for HER2-positive cancer, has demonstrated limited intracranial response rates and little improvement in progression free survival (PFS) for HER-2 positive patients. Size constraints are believed to prevent larger monoclonal antibodies, such as pertuzumab and trastuzumab, from crossing the blood brain barrier (BBB). However, emerging evidence reveals that the BBB is perturbed in the setting of metastases, allowing for improved penetrance of these larger targeted agents. The disrupted BBB may allow for passage of ado-trastuzumab emtansine (TDM1), though little clinical information about its activity in BCBM patients is currently known.

The University of North Carolina at Chapel Hill has created a clinic to provide medical and radiation oncology, neurosurgical, and supportive services to patients with breast cancer brain metastases. Of the 65 patients seen between January 2012 and January 2015, 78% returned for a follow-up visit and 32% were enrolled in a clinical trial. The clinic is a model that can be adapted at other centers.

Ewend owns stock in Falcon Therapeutics. Carey Anders is an uncompensated consultant/advisory board member for Novartis, Merrimack, Lily, Nektar, Cascadian, Seattle Genetics, and Genentech, a compensated consultant/advisory board member for Merck, PUMA, and Eisai, receives unrelated research funding from Novartis, Merrimack, PUMA, Lily, Merck, Cascadian, Seattle Genetics, Nektar, Tesaro, and G1-Therapeutics, and receives honoraria from UptoDate and Jones and Bartlett Publishing. The other authors declare that they have no conflicts of interest.Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Ethical standard This article does not contain any studies with animals performed by any of the authors. Informed consentInformed consent or waiver of consent granted by local IRB was obtained from all individual participants included in the study.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Multiple factors have been identified as contributing to polyethylene wear and debris generation of the acetabular lining. Polyethylene wear is the primary limiting factor in the functional behavior and consequent longevity of a total hip arthroplasty (THA). This retrospective study reviewed the clinical and radiographic data of 77 consecutive THAs comparing in vivo polyethylene wear of two similar acetabular cup liners. Minimum follow-up was 7 years (range 7–15). The incidence of measurable wear in a group of machined liners sterilized with ethylene oxide and composed of GUR 1050 stock resin was significantly higher (61%) than the compression-molded, GUR 1020, O2-free gamma irradiation sterilized group (24%) (P = 0.0004). Clinically, at a 9-year average followup, both groups had comparable HHS scores and incidence of thigh or groin pain, though the machined group had an increased incidence of osteolysis and annual linear wear rate.