Editorial Commentary: Is Posterior Distal Clavicle Beveling for Chronic Nonincarcerated Type IV Acromioclavicular Separation a Sufficient Treatment?

While low-grade acromioclavicular injuries can be managed nonoperatively, high-grade separations may result in persistent pain or functional decline and require surgical intervention. The authors of “Posterior Distal Clavicle Beveling for Chronic Nonincarcerated Type IV Acromioclavicular Separations: Surgical Technique and Early Clinical Outcomes” present a case series reporting convincing results concerning functional outcomes and early return-to-sport rates for this rather rare condition. While this technique seemed to work well in this small series of patients, in our opinion, this procedure should be reserved for use in exceptional cases only.     

Individualized 6‐mercaptopurine increments in consolidation treatment of childhood acute lymphoblastic leukemia: A NOPHO randomized controlled trial

Objectives

This randomized controlled trial tested the hypothesis that children with non‐high‐risk acute lymphoblastic leukemia could benefit from individualized 6‐mercaptopurine increments during consolidation therapy (NCT00816049). Primary and secondary end points were end of consolidation minimal residual disease (MRD) positivity and event‐free survival.

Methods

392 patients were randomized to experimental and 396 to standard therapy. Patients allocated to standard therapy received oral 6‐mercaptopurine (25 mg/m²/day) from days 30 to 85, while the experimental arm received stepwise increments of additional 25 mg/m²/day beginning on days 50 and/or 71 unless dose‐limiting myelosuppression had occurred.

Results

In the experimental arm, 166 patients (42%) received one dose increment, and 62 (16%) received two. Fifty‐seven of 387 (15%) patients in the experimental arm were MRD positive at end of consolidation vs 77 of 389 (20%) in the control arm (P = .08). Five‐year probability of event‐free survival was 0.89 (95% CI: 0.85‐0.93) in the experimental arm vs 0.93 (0.90‐0.96) in the control arm (P = .13). The median accumulated length of 6‐mercaptopurine treatment interruptions was 7 (IQR 2‐12) in the experimental arm vs 4 (IQR 0‐10) in the control arm (P = .002).

Conclusion

This study found no benefit from individualized 6‐mercaptopurine increments compared to standard therapy.     

Effect of low-level laser therapy on repair of the bone compromised by radiotherapy

Radiotherapy (RDT) is commonly used for cancer treatment, but high doses of ionizing radiation can directly affect healthy tissues. Positive biological effects of low-level laser therapy (LLLT) on bone repair have been demonstrated; however, this effect on surgical defects of bone previously compromised by radiotherapy has not been evaluated. The aim of this study was to investigate the influence of LLLT (λ?=?830 nm) in femur repair after ionizing radiation. Twenty Wistar rats were divided into four groups: control group (GC, n?=?5) creation of bone defects (BDs) only; laser group (GL), with BD and LLLT (n?=?5); radiotherapy group (GR), submitted to RDT and BD (n?=?5); and radiotherapy and laser group (GRL), submitted to RDT, BD, and LLLT (n?=?5). GL and GRL received punctual laser application (DE?=?210 J/cm², P?=?50 mW, t?=?120 s, and beam diameter of 0.04 cm²) immediately after surgery, with 48-h interval during 7 days. Animals were euthanized at 7 days after surgery, and bone sections were evaluated morphometrically with conventional microscopy. Bone repair was only observed in nonirradiated bone, with significant improvement in GL in comparison to GC. GR and GRL did not present any bone neoformation. The result demonstrated a positive local biostimulative effect of LLLT in normal bone. However, LLLT was not able to revert the bone metabolic damage due to ionizing radiation.     

Simultaneous large bi-atrial device-related thrombi

Journal of Thrombosis and Thrombolysis - Simultaneous appearance of a pacemaker-lead associated thrombus and a left atrial appendage closure device related thrombus in a patient with urothelial...