Response to Tembhre et al.: 'Enhanced expression of angiotensin-converting enzyme 2 in psoriatic skin and its upregulation in keratinocytes by interferon-γ: implication of inflammatory milieu in skin tropism of SARS-CoV-2'

Linked Article: Tembhre et al. Br J Dermatol 2021; 184:577–579.

Rapidly increasing liver progenitor cell numbers in human regenerating liver after portal vein ligation and liver partition

BACKGROUND

Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitor cells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells. Although liver progenitor cell proliferation during the regenerative process has been observed in animal models of severe liver injury, it has never been observed in vivo in humans because it is unethical to take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitor cells and the roles they play in liver regeneration. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a staged procedure for inducing remnant liver hypertrophy so that major hepatectomy can be performed safely. This staged procedure allows for liver biopsy specimens to be taken before and after the liver begins to regenerate.

CASE PRESENTATION

The liver progenitor cell proliferation is observed in a patient undergoing ALPPS for a metastatic hepatic tumour. Liver biopsy is acquired before and after ALPPS for the calculation of average number of liver progenitor cell under high magnification examination by stain of immunomarkers. This is the first in vivo evidence of growing liver progenitor cells demonstrated in a regenerating human liver.

[The evaluation of the anti-shivering effect of tramadol during epidural anesthesia]

60 patients (except parturients) suffering from shivering after receiving epidural anesthesia were randomly divided into 2 equal groups. In order to evaluate the effect of Tramadol on the shivering, i.v. Tramadol (1 mg/Kg), in contrast to distilled water (20 ml) for the control group, was administered to the patients in the experimental group. We compared the arrest time between the two groups in addition to systolic blood pressure, diastolic blood pressure, heart rate, arterial O2 saturation, respiratory rate and body surface temperature. Furthermore, the degree of shivering was also compared sequentially. The systolic pressure of the control group declined significantly in the first 30 minutes (P < 0.05). The other data, including the diastolic pressure, heart rate, arterial O2 saturation, respiratory rate and body surface temperature, showed no significant difference (P > 0.05). The arrest time in the experimental group was 179 +/- 71.25 seconds in contrast to 2790 +/- 440.23 seconds in the control group, a large significant difference (P < 0.001). 10% of the patients in the experimental group experienced nausea or vomiting and 6.67% of the patients showed sedation which did not disturb consciousness level of psychomotor status. Since the exact mechanism of shivering during epidural anesthesia is not established, we sincerely hope more information about the effect to Tramadol on shivering can be uncovered.

["Walkman music" during epidural anesthesia]

The sedating effect and influence of walkman music on 120 patients, that were randomly divided into a music and non-music group, who had received epidural anesthesia were investigated. It was found that significantly fewer patients in the music group felt anxious during surgery (P = 0.049). Meanwhile, heart rate and mean arterial pressure of the non-music group remained at a higher level, resulting in higher heart loading. Furthermore, patients listening to music had a significantly smaller need of sedatives (P = 0.001). With the purpose of reducing the consumption of sedatives, and offering a better anesthetic environment, we recommend the use of music during regional anesthesia.