指南建议询问孕妇的心理健康

英国国家医疗卫生服务体系（NHS）的新指南建议，在产前及产后护理中，妇女的心理健康应与机体健康受到同样的重视。     

Five year follow-up and dose delivery analysis of cisplatin, iproplatin or carboplatin in combination with cyclophosphamide in advanced ovarian carcinoma

Eighty eight patients with FIGO stage IIb/c (postoperative residual) or III/IV epithelial ovarian cancer were randomised to receive cycles of cyclophosphamide (600 mg/m2) with either iproplatin (240 mg/m2), cisplatin (100 mg/m2) or carboplatin (300 mg/m2). A total of six cycles were given at monthly intervals. Patients were well-balanced for major prognostic factors. There was no significant difference in overall response rate (iproplatin arm, 64.3%, cisplatin arm 72.7% and carboplatin arm 66.7%). There were more complete remissions on the carboplatin arm, 45.8% compared with 21.4% on iproplatin and 22.7% on cisplatin but the difference was not statistically significant (p = 0.11). With a median follow up of 50 months the median survival for the iproplatin arm is 18 months, for the cisplatin arm 19 months and for the carboplatin arm 24 months (p = 0.15). Toxicity was greatest with cisplatin and least with carboplatin. Myelotoxicity limited the dose delivery of iproplatin as measured by total dose, dose intensity and dose intensity product. Carboplatin is at least as effective and less toxic than cisplatin when used in conjunction with cyclophosphamide for the treatment of ovarian carcinoma, and this analogue has been selected for dose intensification studies in this tumour at the Christie Hospital.     

NALP Inflammasomes: a central role in innate immunity

Inflammasomes are cytoplasmic multiprotein complexes that mediate the maturation of the proinflammatory cytokines interleukin-1β (IL-1β), IL-18, and possibly IL-33 by controlling the activation of the inflammatory caspases-1 and -5. Assembly of inflammasomes depends on NOD-like receptor (NLR) family members such as NALPs, NAIP, and IPAF. Various microbial and endogenous stimuli activate different types of inflammasomes. This article focuses on the Pyrin domain containing NLRs, known as NALP proteins. Recent findings provide exciting insights into how these proteins might be activated and also provide evidence of the critical role of the NALP inflammasomes in innate immunity and inflammatory diseases.     

Gamma-irradiation Sterilization in an Inert Environment: A Partial Solution

Background  

In the mid to late 1990s, to sterilize UHMWPE bearings, manufacturers changed from gamma-irradiation-in-air (gamma-air) sterilization, which initiated oxidation leading to bearing fatigue, to gamma-irradiation sterilization in an inert environment (gamma-inert). The change to gamma-inert sterilization reportedly prevented shelf oxidation before implantation but not in vivo oxidation.     

Metal transfer on a ceramic head with a single rim contact

A notable feature of retrieved ceramic-on-ceramic hips is metal transfer on the femoral head, which is an important alteration of the bearing surface. This report documents metal transfer streaks on a ceramic femoral head resulting from discrete subluxations, which occurred intraoperatively during reduction and stability testing. An important implication is that metal transfer can occur whenever a femoral head is reduced into the liner during surgery or from in vivo subluxation/dislocation. If a ceramic liner is recessed below a raised metal rim, care should be taken to prevent head-to-rim contact during intraoperative reductions and stability testing. If metal transfer occurs during final surgical reduction of the hip, its presence may remain undetected, and detrimental effects are present from the time of surgery.