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Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients-results after three years of practice

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World Journal of Hepatology 2016年第26期8卷 1097-1104页

作者： Antonio Siniscalchi Lorenzo Gamberini Tommaso Bardi Cristiana Laici Elisa Gamberini Letizia Francorsi stefano faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna

AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific *** A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia. RESULTS Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure(P = 0.041) and received more colloid infusions(P = 0.007). Postoperative liver and kidney function did not differ *** of mechanical ventilation(P = 0.003) and hospital stay(P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was *** The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient's outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies.

关键词： Anesthesia Postoperative care Analgesia Epidural Postoperative Liver cirrhosis Liver function tests Complication

Incoherent non-Hermitian skin effect in photonic quantum walks

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Light(Science & Applications) 2024年第5期13卷 885-893页

作者： stefano Longhi Dipartimento di Fisica Politecnico di MilanoPiazza L.da Vinci 32I-20133 MilanoItaly IFISC(UIB-CSIC) Instituto de Fisica Interdisciplinar y Sistemas ComplejosE-07122 Palma de MallorcaSpain

The non-Hermitian skin effect describes the concentration of an extensive number of eigenstates near the boundaries of certain dissipative *** phenomenon has raised a huge interest in different areas of physics,including photonics,deeply expanding our understanding of non-Hermitian systems and opening up new avenues in both fundamental and applied aspects of topological *** skin effect has been associated to a nontrivial pointgap spectral topology and has been experimentally demonstrated in a variety of synthetic matter systems,including photonic *** most of physical models exhibiting the non-Hermitian skin effect full or partial wave coherence is generally *** we push the concept of skin effect into the fully incoherent regime and show that rather generally(but not universally)the non-Hermitian skin effect persists under dephasing *** results are illustrated by considering incoherent light dynamics in non-Hermitian photonic quantum walks.

关键词： dynamics. quantum effect

Thoracic epidural anesthesia:Effects on splanchnic circulation and implications in Anesthesia and Intensive care

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World Journal of Critical Care Medicine 2015年第1期4卷 89-104页

作者： Antonio Siniscalchi Lorenzo Gamberini Cristiana Laici Tommaso Bardi stefano faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna

AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic ***:A Pub Med search was conducted using the Me SH ***,Epidural was always the first MeS H heading and was combined by boolean operator AND with the following headings:Circulation,Splanchnic;Intestines;Pancreas and Pancreatitis;LiverFunction ***,Cochrane library,ClinicalT *** and *** were also searched using the same ***:Twenty-seven relevant studies and four ongoing trials were *** data regarding the effects of epidural anesthesia on splanchnic perfusion are *** studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery,demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia(TEA).On the other hand most of the studies focusing on micro-hemodynamics,especially in pathologic low flow conditions,suggested that TEA could foster ***:The available studies in this field are heterogeneous and the results conflicting,thus it is difficult to draw decisive *** there is increasing evidence deriving from animal studies,that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage,regardless of the effects on macro-hemodynamics.

关键词： Anesthesia Epidural Circulation Splanchnic Intestine Microcirculation Pancreatitis Liver function tests

Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome

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World Journal of Transplantation 2016年第2期6卷 389-395页

作者： Antonio Siniscalchi Lucia Aurini Beatrice Benini Lorenzo Gamberini stefano Nava Pierluigi Viale stefano faenza Division of Anesthesiology Depart-ment of General Surgery of Sant’Orsola HospitalUniversity of Bologna Department of Specialist Diagnostic and Experimental MedicinePneumology and Respiratory Intensive Care UnitSant’Orsola HospitalUniversity of Bologna Clinic of Infectious Diseases Department of Internal Medicine Geriatrics and Nephrologic DiseasesUniversity of Bologna

AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.

关键词： Liver transplantation Ventilator associated pneumonia Perioperative period Infection

Post reperfusion syndrome during liver transplantation:From pathophysiology to therapy and preventive strategies

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World Journal of Gastroenterology 2016年第4期22卷 1551-1569页

作者： Antonio Siniscalchi Lorenzo Gamberini Cristiana Laici Tommaso Bardi Giorgio Ercolani Laura Lorenzini stefano faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna40138 BolognaItaly Division of Surgery Alma Mater Studiorum University of Bologna40138 BolognaItaly

This review aims at evaluating the existing evidence regarding post reperfusion syndrome, providing a description of the pathophysiologic mechanisms involved and possible management and preventive strategies. A Pub Med search was conducted using the Me SH database, "Reperfusion" AND "liver transplantation" were the combined Me SH headings; EMBASE and the Cochrane library were also searched using the same terms. 52 relevant studies and one ongoing trial were found. The concept of post reperfusion syndrome has evolved through years to a multisystemic disorder. The implications of the main organ, recipient and procedure related factors in the genesis of this complex syndrome are discussed in the text as the novel pharmacologic and technical approaches to reduce its incidence. However the available evidence about risk factors, physiopathology and preventive measures is still confusing, the presence of two main definitions and the numerosity of possible confounding factors greatly complicates the interpretation of the studies.

关键词： Liver transplantation Reperfusion Ischemiareperfusioninjury Hemodynamics Drug therapy

Time reversal of a discrete system coupled to a continuum based on non-Hermitian flip

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Science Bulletin 2017年第12期62卷 869-874页

作者： stefano Longhi Dipartimento di Fisica Politecnico di Milano and Istituto di Fotonica e Nanotecnologie del Consiglio Nazionale delle RicerchePiazza L.da Vinci 321-20133 MilanoItaly

Time reversal in quantum or classical systems described by an Hermitian Hamiltonian is a physically allowed process, which requires in principle inverting the sign of the Hamiltonian. Here we consider the problem of time reversal of a subsystem of discrete states coupled to an external environment characterized by a continuum of states, into which they generally decay. It is shown that, by flipping the discrete-continuum coupling from an Hermitian to a non-Hermitian interaction, thus resulting in a non unitary dynamics, time reversal of the subsystem of discrete states can be achieved, while the continuum of states is not reversed. Exact time reversal requires frequency degeneracy of the discrete states,or large frequency mismatch among the discrete states as compared to the strength of indirect coupling mediated by the continuum. Interestingly, periodic and frequent switch of the discrete-continuum coupling results in a frozen dynamics of the subsystem of discrete states.

关键词： Non-Hermitian dynamicsTime reversalLoschmidt echo

Reply to "Discussion 1 on 'Introspection on improper seismic retrofit of Basilica Santa Maria di Collemaggio after 2009 Italian earthquake' by ***,*** and *** stefano" by Vincenzo Ciampi

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Earthquake Engineering and Engineering Vibration 2012年第2期11卷 283-288页

作者： Gian Paolo Cimellaro Andrei M.Reinhorn Alessandro De stefano Department of Structural Geotechnical & Building Engineering(DISEG)Politecnico di TorinoCorso Duca degli Abruzzi 2410129 TurinItaly Department of Civil Structural & Environmental EngineeringUniversity at Buffalothe State University of New York135 Ketter HallBuffalo NYUSA

The authors thank the discusser for his interest and careful review of the paper and his valuable comments. They also welcome this discussion,because it gives the authors the opportunity to clarify several points whic... 详细信息

关键词： Introspection on improper seismic retrofit of Basilica Santa Maria di Collemaggio after 2009 Italian earthquake by Vincenzo Ciampi Discussion 1 on Reply to De

Reply to "Discussion 2 on 'Introspection on improper seismic retrofit of Basilica Santa Maria di Collemaggio after 2009 Italian earthquake' by G.P. Cimellaro, A.M. Reinhorn and *** stefano" by Enzo Cartapati

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Earthquake Engineering and Engineering Vibration 2012年第2期11卷 291-292页

作者： Gian Paolo Cimellaro Andrei M. Reinhorn Alessandro De stefano Department of Structural Geotechnical & Building Engineering (DISEG) Politecnico di Torino Corso Duca degli Abruzzi 24 10129 Turin Italy Department of Civil Structural & Environmental Engineering University at Buffalo the State University of New York 135 Ketter Hall Buffalo NY USA

The authors thank the discusser for the additional information,which is provided related to the historical interventions of the church through the centuries. This information was known to the authors,however they deci... 详细信息

关键词： Reply to A.M Reinhorn and A.De stefano Introspection on improper seismic retrofit of Basilica Santa Maria di Collemaggio after 2009 Italian earthquake by G.P Discussion 2 on De

A flexible multi-body model of a surface miner for analyzing the interaction between rock-cutting forces and chassis vibrations

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International Journal of Mining Science and Technology 2021年第3期31卷 365-375页

作者： Alessandro Medolago stefano Melzi Tesmec S.p.A. Grassobbio 24050Italy Department of Mechanics Politecnico di MilanoMilano 20156Italy

The discontinuous nature of rock cutting can easily cause unwanted vibrations in the structure of a surface *** these vibrations are not properly addressed,the related stress cycles can gradually damage the chassis resulting in fatigue *** events can seriously undermine the safety of operators and digging operations may be stopped for days,with an obvious economic *** work presents an analysis of the dynamics of a surface miner,focusing on the interaction between cutting machine dynamics and cutting forces,which is a new approach for this type of *** this purpose,the authors developed a numerical model of the cutting process made up of(1)a multi-body model of the cutting machine,which takes into account the chassis's flexibility;(2)a model of the rotating cutting head;and(3)a model of the interaction between the cutting head and rock,based on Shao's *** model was compared with experimental results and then used to investigate the effects of cutting speed and cutting depth on the machine dynamics.

关键词： Surface miner Flexible multi-body model Validation Cutting forces Chassis vibrations