Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outst...Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.展开更多
The chemodivergent ring-opening of cyclobutanols is described under the carbocatalytic assistance of graphene oxide(GO).The protocol enables the synthesis of diversely functionalized dienes or indenes(26 examples)base...The chemodivergent ring-opening of cyclobutanols is described under the carbocatalytic assistance of graphene oxide(GO).The protocol enables the synthesis of diversely functionalized dienes or indenes(26 examples)based on the amount of GO employed.Spectroscopic(XPS and ssNMR)as well as experimental investigations revealed a direct involvement of theπ-domains of GO in tuning the stability of carbocationic intermediates during the reaction.展开更多
文摘Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.
基金financial support and to the Italian Ministry of Education,University and Research(MIUR)PRIN-2017 project 2017W8KNZWThe research leading to these results has received funding from the European Union's Horizon 2020 research and innovation programme under Graphene Core3881603-Graphene+1 种基金Flagship.F.B.and E.R.acknowledge the MIUR,and European Social Fund(ESF)for the PON R&l 2014-2020 program,action IV.4"Doctorates and research contracts on Innovation topics"This work benefited from access(ITAO17)to CERM/CIRMMP,Italy centre of Instruct-ERIC,a Landmak ESFRI project,for the ssNMR measurements and support.
文摘The chemodivergent ring-opening of cyclobutanols is described under the carbocatalytic assistance of graphene oxide(GO).The protocol enables the synthesis of diversely functionalized dienes or indenes(26 examples)based on the amount of GO employed.Spectroscopic(XPS and ssNMR)as well as experimental investigations revealed a direct involvement of theπ-domains of GO in tuning the stability of carbocationic intermediates during the reaction.