[Skin-to-skin caesarean section: better patient care]. / De huid-op-huidsectio: betere patiëntenzorg.

Five years ago, we described the skin-to-skin caesarean section, a procedure in which parental participation, slow delivery and direct skin-to-skin contact are important aspects. By multiple research, the skin-to-skin CS has been shown to have positive outcomes for the child and parents, as long as there is attention for neonatal thermal regulation. These outcomes should lead to cost reduction, versus the extra personnel costs for the nurse. However, a proper cost-effectiveness analysis has not yet been described. There are still many local differences in availability and performance of the skin-to-skin CS in the Netherlands, often caused by logistical challenges. In the meanwhile the protocol has been further optimized. In our opinion, the skin-to-skin caesarean section is better care for parents and their child, and should be available anywhere anytime, as long as the fetal and maternal condition permits this.

Rapamycin induces heme oxygenase-1 in liver but inhibits bile flow recovery after ischemia.

BACKGROUND/AIMS: Rapamycin, which is employed in the management of patients undergoing liver surgery, induces the synthesis of heme oxygenase-1 (HO-1) in some non-liver cell types. The aim was to investigate whether rapamycin can induce HO-1 expression in the liver, and to test the effects of rapamycin on liver function in the early phase of ischemia reperfusion (IR) injury. METHODS: Isolated rat hepatocytes and a rat model of segmental hepatic ischemia and reperfusion were employed. Bile flow was measured gravimetrically or by using indocyanine green. mRNA and protein (by quantitative PCR and Western blot, respectively) and blood concentrations of rapamycin, bilirubin, and liver marker enzymes were measured. RESULTS: In isolated hepatocytes, rapamycin induced a 6-fold increase in HO-1, comparable to that induced by cobalt proporphyrin (CoPP), and a 2-fold increase in peroxiredoxin-1. Pretreatment of rats with rapamycin resulted in a small increase in liver HO-1 expression, a 20% inhibition of the basal rate of bile flow, and a 50% inhibition in the rate of bile flow recovery after ischemia. CoPP increased basal bile flow by 20% and inhibited bile flow recovery by 50%. These effects were associated with small increases in the blood concentrations of bilirubin and liver marker enzymes. CONCLUSIONS: Rapamycin, through HO-1 induction, has the potential to protect the liver against damage in the late phase of IR. The inhibition by rapamycin of bile flow indicates that its actions on liver function in the acute phase of IR injury are complex.