Nuova ricerca

Alberto BARBIERI

Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

Home | Curriculum(pdf) | Didattica |


Pubblicazioni

2022 - Delirium in Older Adults: What a Surgeon Needs to Know [Articolo su rivista]
Melegari, Gabriele; Gaspari, Arianna; Gualdi, Eugenia; Zoli, Michele; Meletti, Stefano; Barbieri, Alberto
abstract

2021 - A machine learning approach to predict healthcare-associated infections at intensive care unit admission: findings from the SPIN-UTI project [Articolo su rivista]
Martina, Barchitta; Andrea, Maugeri; Giuliana, Favara; Paolo Marco, Riela; Giovanni, Gallo; Ida, Mura; Antonella, Agodi; behalf of the SPIN-UTI network Paola Murgia, On; Dolores, Maria; Masia, ; Brusaferro, Silvio; Celotto, Daniele; Arnoldo, Luca; Bissolo, Emanuela; Rigo, Alberto; Tardivo, Stefano; Moretti, Francesca; Carli, Alberto; Pascu, Diana; Tessari, Lorella; Olga Bernasconi, Mara; Brusaferro, Marco; Pappalardo, Federico; Auxilia, Francesco; Fenaroli, Salesia; Pasquarella, Cesira; Sicoli, Ennio; Teresa Montagna, Maria; Egitto, Giovanni; Squeri, Raffaele; Tribastoni, Salvatore; Pulvirenti, Alessandro; Catalano, Sebastiano; Battaglia, Pietro; Bellocch, Patrizia; Castiglione, Igiacomo; Rita Mattaliano, Anna; Astuto, Marinella; Giuseppa LaCamera, Marinella; Maria Longhitano, Anna; Scrofani, Giorgio; Concetta Monea, Maria; Milazzo, Marina; Giarratano, Antonino; Calamusa, Giuseppe; Valeriatorregrossa, Maria; Di Benedetto, Antonino; MariaGisella Rizzo, Giuseppa; Manta, Giuseppe; Tetamo, Romano; Mancuso, Rosa; Maria Mella, Laura; Dei, Ignazio; Pandiani Antonino Cannistrà, Irene; Piotti, Paola; Girardis, Massimo; Righi, Elena; Barbieri, Alberto; Crollari, Patricia; Borracino, Albino; Coniglio, Salvatore; Palermo, Rosaria; Pintaudi, Sergio; Distefano, Daniela; Romeo, Antonina; Sticca, Giovanna; Minerva, Massimo; Fabiani, Leila; Gentile, Alessandra; Stefanini, Paolo; Mario D'Errico, Marcello; Donati, Abele; Deremigis, Santa; Venturoni, Federica; Antoci, Manuela; Pagliarulo, Riccardo; Bianco, Aida; Pavia, Maria; Pasculli, Marcello; Vittori, Cesare; Battista Orsi, Giovanni; Arrigoni, Cristina; Patrizia Olori, Maria; Antonelli, Massimo; Laurenti, Patrizia; Ingala, Franco; Conte, Carmela; Russo, Salvatore; Condorelli, Laura; Farruggia, Patrizia; Maria Luisa, Cristina; Galassi, Italia
abstract

BACKGROUND: Identifying patients at higher risk of healthcare-associated infections (HAIs) in intensive care unit (ICU) represents a major challenge for public health. Machine learning could improve patient risk stratification and lead to targeted infection prevention and control interventions.AIM: To evaluate the performance of the Simplified Acute Physiology Score (SAPS) II for HAIs risk prediction in ICUs, using both traditional statistical and machine learning approaches.METHODS: We used data of 7827 patients from the "Italian Nosocomial Infections Surveillance in Intensive Care Units" project. The Support Vector Machines (SVM) algorithm was applied to classify patients according to sex, patient origin, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II at admission, presence of invasive devices, trauma, impaired immunity, antibiotic therapy in 48 hours before ICU admission.FINDINGS: The performance of SAPS II for predicting the risk of HAIs provides a ROC (Receiver Operating Characteristics) curve with an AUC (Area Under the Curve) of 0.612 (p<0.001) and an accuracy of 56%. Considering SAPS II along with other characteristics at ICU admission, we found an accuracy of the SVM classifier of 88% and an AUC of 0.90 (p<0.001) for the test set. In line, the predictive ability was lower when considering the same SVM model but removing the SAPS II variable (accuracy= 78% and AUC= 0.66).CONCLUSIONS: Our study suggested the SVM model as a tool to early predict patients at higher risk of HAI at ICU admission.

2021 - Hemoadsorption cartridge and coronavirus disease 2019 infections: A case report and brief literature review [Articolo su rivista]
Melegari, G.; Bertellini, E.; Melegari, A.; Trenti, T.; Malaguti, S.; Barbieri, A.
abstract

The cytokine storm has been frequently reported to occur in patients with severe coronavirus disease 2019 (COVID-19). Data from the literature suggest that elevated levels of inflammatory mediators, such as interleukin (IL)-6, IL-8, and tumor necrosis factor, indicate a severe course or the fatality of the disease. Several therapeutic options have been employed to treat critically ill patients, including hemoadsorption of inflammatory mediators. We here present a case of severe acute respiratory syndrome caused by COVID-19 and acute renal failure. The patient was admitted to our intensive care unit and treated with mechanical ventilation, renal replacement therapy, and hemoadsorption to reduce the cytokine release syndrome, which plays a fundamental role in the clinical presentation of COVID-19 patients. We also discuss the potential advantages of reducing cytokine plasma levels using a hemoadsorption cartridge.

2021 - Intensive care patients from the first covid-19 wave: One-year survival after tocilizumab treatment [Articolo su rivista]
Melegari, G.; Giuliani, E.; Dallai, C.; Veronesi, L.; Bertellini, E.; Osmenaj, S.; Barbieri, A.
abstract

Introduction: An infection by COVID-19 triggers a dangerous cytokine storm, so tocilizumab has been introduced in Italy as an agent blocking the cytokine storm. This paper aims to describe the one-year survival of ICU patients treated with tocilizumab. Methods: This observational study enrolled all patients confirmed to be infected by COVID-19 who were admitted to the ICU in our center. We offered tocilizumab to all non-septic patients if they did not present any contraindications. Results: We enrolled 68 ICU patients in our center on 72 occasions during the enrollment period; we excluded four patients due to study criteria. The one-year mortality hazard ratio of treated patients was 0.64, with a confidence interval of 0.31 to 1.19, with p = 0.169. Among the survivors, 32 of 35 patients answered the phone interview (14 patients in the treated group and 18 in the untreated group); overall, the effect of COVID-19 on quality of life was 58.14%. These effects were lower in the tocilizumab group, with p = 0.016 *. Conclusions: Our observational data follow the most relevant largest trial. Patients treated with tocilizumab had lower rates of new-onset symptoms later COVID-19 ICU hospitalizations. As reported by recent medical literature, the presence of these symptoms suggests that a follow-up program for these types of patients could be useful.

2021 - Interprofessional high-fidelity simulation on nursing students’ collaborative attitudes: A quasi-experimental study using a mixed-methods approach [Relazione in Atti di Convegno]
Ferri, P.; Rovesti, S.; Barbieri, A.; Giuliani, E.; Vivarelli, C.; Panzera, N.; Volpi, P.; Di Lorenzo, R.
abstract

Background: interprofessional simulation appears to be effective training for nursing students, yet many questions remain about its feasibility, acceptability and efficacy in improving students’ collaborative attitudes. Study design and participants: the aim of this quasi-experimental study, with a mixed-methods approach, was to evaluate changes in interprofessional collaborative attitudes after a training session based on an interprofessional high-fidelity patient simulation (IHFPS). The sample was composed of students attending the 2nd and 3rd year of the Nursing Degree Program and residents of the Anaesthesia Residency Program at University of Modena and Reggio Emilia in 2019. Methods: nursing students and residents were grouped into small interprofessional teams and participated in an IHFPS focused on acute care. To measure interprofessional collaboration attitude, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and the Readiness for Interprofessional Learning Scale (RIPLS) were administered to nursing students. They completed a post-test to investigate their satisfaction with IHFPS and they replied to open-ended statements. Results and conclusions: 204 nursing students completed both the pre- and post-test surveys. Our results suggested that an IHFPS, with small teams of nursing students and residents, improved interprofessional collaborative attitudes of nursing students. We reported a statistically significant improvement in three factors of JSAPNC and in the RIPLS, which showed the positive effects of this experience on many collaborative skills. The students expressed high satisfaction with the training conducted in a realistic and safe setting, which improved their awareness of working in an effective multidisciplinary team.

2021 - Mild to severe neurological manifestations of covid-19: Cases reports [Articolo su rivista]
Melegari, G.; Rivi, V.; Zelent, G.; Nasillo, V.; De Santis, E.; Melegari, A.; Bevilacqua, C.; Zoli, M.; Meletti, S.; Barbieri, A.
abstract

The main focus of Coronavirus disease 2019 (COVID-19) infection is pulmonary complications through virus-related neurological manifestations, ranging from mild to severe, such as encephalitis, cerebral thrombosis, neurocognitive (dementia-like) syndrome, and delirium. The hospital screening procedures for quickly recognizing neurological manifestations of COVID-19 are often complicated by other coexisting symptoms and can be obscured by the deep sedation procedures required for critically ill patients. Here, we present two different case-reports of COVID-19 patients, describing neurological complications, diagnostic imaging such as olfactory bulb damage (a mild and unclear underestimated complication) and a severe and sudden thrombotic stroke complicated with hemorrhage with a low-level cytokine storm and respiratory symptom resolution. We discuss the possible mechanisms of virus entrance, together with the causes of COVID-19-related encephalitis, olfactory bulb damage, ischemic stroke, and intracranial hemorrhage.

2021 - Review how artificial intelligence and new technologies can help the management of the covid-19 pandemic [Articolo su rivista]
Barbieri, D.; Giuliani, E.; Del Prete, A.; Losi, A.; Villani, M.; Barbieri, A.
abstract

The COVID-19 pandemic has worked as a catalyst, pushing governments, private compa-nies, and healthcare facilities to design, develop, and adopt innovative solutions to control it, as is often the case when people are driven by necessity. After 18 months since the first case, it is time to think about the pros and cons of such technologies, including artificial intelligence—which is probably the most complex and misunderstood by non-specialists—in order to get the most out of them, and to suggest future improvements and proper adoption. The aim of this narrative review was to select the relevant papers that directly address the adoption of artificial intelligence and new technologies in the management of pandemics and communicable diseases such as SARS-CoV-2: environmental measures; acquisition and sharing of knowledge in the general population and among clinicians; development and management of drugs and vaccines; remote psychological support of patients; remote monitoring, diagnosis, and follow-up; and maximization and rationalization of human and material resources in the hospital environment.

2021 - The effects of the general anesthetic sevoflurane on neurotransmission: an experimental and computational study [Articolo su rivista]
Mapelli, J.; Gandolfi, D.; Giuliani, E.; Casali, S.; Congi, L.; Barbieri, A.; D'Angelo, E.; Bigiani, A.
abstract

The brain functions can be reversibly modulated by the action of general anesthetics. Despite a wide number of pharmacological studies, an extensive analysis of the cellular determinants of anesthesia at the microcircuits level is still missing. Here, by combining patch-clamp recordings and mathematical modeling, we examined the impact of sevoflurane, a general anesthetic widely employed in the clinical practice, on neuronal communication. The cerebellar microcircuit was used as a benchmark to analyze the action mechanisms of sevoflurane while a biologically realistic mathematical model was employed to explore at fine grain the molecular targets of anesthetic analyzing its impact on neuronal activity. The sevoflurane altered neurotransmission by strongly increasing GABAergic inhibition while decreasing glutamatergic NMDA activity. These changes caused a notable reduction of spike discharge in cerebellar granule cells (GrCs) following repetitive activation by excitatory mossy fibers (mfs). Unexpectedly, sevoflurane altered GrCs intrinsic excitability promoting action potential generation. Computational modelling revealed that this effect was triggered by an acceleration of persistent sodium current kinetics and by an increase in voltage dependent potassium current conductance. The overall effect was a reduced variability of GrCs responses elicited by mfs supporting the idea that sevoflurane shapes neuronal communication without silencing neural circuits.

2021 - Why should you stay one night? Prospective observational study of enhanced recovery in elderly patients [Articolo su rivista]
Melegari, G.; Albertini, G.; Romani, A.; Malaguti, S.; Traccitto, F.; Giuliani, E.; Cavallini, G. M.; Bertellini, E.; Barbieri, A.
abstract

Background: Delirium is a severe condition that can arise in many contexts during hospitalization. The aim of this research was to measure the incidence of postoperative delirium in patients aged 75 years or older, with the exclusion of those with preexisting neurocognitive disorders (NCD), who underwent fast-track, moderate surgery. Methods: We conducted a prospective cohort study with patients ≥ 75 years of age who were eligible for fast-track, moderate surgery, without severe dementia, with a planned hospitalization of 24 h and with a physical status varying from very fit to vulnerable. The 4-item confusion assessment method (CAM4) was used to measure delirium. Results: Of the 209 eligible patients, 195 subjects were enrolled in the study. The percentage of the population with a CAM4 score above 0 before surgery was 2.56%; after surgery, the percentage was 10.25%; and on the following day, the percentage was 4.61%. There was a statistically significant difference in the CAM4 scores between immediately after surgery and at 24 h after surgery (p = 0.0172). Conclusion: The data from this study support an enhanced recovery approach for elderly patients, in which after a minor surgical procedure with anaesthesia, a recovery period of one night in the hospital can contribute to normalizing the CAM4 score and reducing the incidence of delirium. Graphic abstract: [Figure not available: see fulltext.]

2020 - Could an electronic log-book be effective for medical training in anaesthesiology? [Articolo su rivista]
Barbieri, A.; Melegari, G.; Giuliani, E.
abstract

2020 - First experiences of hemoadsorption in donation after circulatory death [Articolo su rivista]
Baroni, S.; Melegari, G.; Brugioni, L.; Gualdi, E.; Barbieri, A.; Bertellini, E.
abstract

2020 - Keyboard Contamination in Intensive Care Unit: Is Cleaning Enough? Prospective Research of In Situ Effectiveness of a Tea Tree Oil (KTEO) Film [Capitolo/Saggio]
Melegari, Gabriele; Iseppi, Ramona; Mariani, Martina; Giuliani, Enrico; Caciagli, Valeria; Bertellini, Elisabetta; Messi, Patrizia; Barbieri, Alberto
abstract

After the SARS-CoV-2 pandemic, disinfection practices and microbial load reduction have become even more important and rigorous. To determine the contamination of keyboard surface and the relative risk to transfer healthcare-associated pathogens to susceptible patients, as it frequently happens in Intensive Care Unit (ICU), a standard keyboard (SK), a cleanable keyless keyboard (KK) with smooth surface and a standard keyboard coated with a 3M Tegaderm film added with active essential oil (tea tree oil) (KTEO) were tested. S. aureus, including MRSA strains, were detected in ICU, with values ranging from 15% to 57%. Gram negative strains belonging to the Enterobacteriaceae family were also found with values ranging from 14% to 71%. Similar Gram positive and Gram negative strains were found on all surfaces, but with low percentage, and only environmental bacteria were detected using the settling plates method. The Microbial Challenge Test performed on KTEO showed high rates of decrease for all the pathogens with statistical significance both at 24 and 48h (p=0.003* and p=0.040*, respectively). Our results suggest that the use of KTEO may be a feasible strategy for reducing the transmission of pathogens in health care setting and may be complementary to surface cleaning protocols.

2020 - Novel coronavirus (2019-nCov): do you have enough intensive care units? [Articolo su rivista]
Melegari, G.; Giuliani, E.; Maini, G.; Barbieri, L.; Baffoni, P.; Bertellini, E.; Barbieri, A.
abstract

2020 - Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting [Articolo su rivista]
Giuliani, E.; Melegari, G.; Carrieri, F.; Barbieri, A.
abstract

Background: In shared decision making, health care professionals and patients collaborate in making health-related choices. This process is based on autonomy and constitutes one to the elements of patient-centered care. However, there are situations where shared decision making is more difficult, if not impossible, due to barriers, which may be related to language, culture, education, or mental capacity and external factors like the state of emergency or the availability of alternative sources of information. Aim: The aim of this paper is to identify some of the main obstacles to the adoption of shared decision making in an intensive and critical care scenario and discuss potential ways to facilitate its implementation. Methods: We conducted a literature review on shared decision making from the perspective of intensive and critical care specialists. Discussion: Although the health care context is complex and the variety of situation that can arise makes it impossible to prepare professionals for every occurrence, shared decision making process should be structured at an organization level, engaging health care professionals, experts of communication, and patient representatives coming from different cultural backgrounds, languages, and education to assemble for all the main procedures, where shared decision making is involved, the specific information packages health care professionals will use in order to guide them through the process and ensuring all patients receive a comparable level of engagement. Shared decision making should not become a hindrance for the health care professional but on the contrary a way to strengthen their relationship with the patient. Conclusion: The implementation of the shared decision making approach at an organization-wide level improves its quality and effectiveness.

2019 - Nursing activity measurement for intensive care unit patients with specific conditions – An area of further investigation [Articolo su rivista]
Giuliani, E.; Lionte, G.; Ferri, P.; Barbieri, A.
abstract

2018 - Propofol: a safe anaesthetic drug in experimental cardiac surgery in rabbits [Articolo su rivista]
Giuliani, Enrico; Manenti, Antonio; Barbieri, Alberto; Farinetti, Alberto; Mattioli, Anna Vittoria
abstract

Experimental surgery needs a pharmacological approach that can interfere with cardiac function.

2018 - Response by Twin Italian Hub Hospitals in a Double Seismic Event: A Retrospective Observational Investigation [Articolo su rivista]
Barbieri, Alberto; Melegari, Gabriele; Lob, Valentina; Mazzali, Lorenzo; D'Amelio, Luca; Giovannoni, Andrea; Giuliani, Enrico
abstract

Introduction: The objectives of this study were to compare prevalence rates of different pathologies, ambulance system and emergency department management times, and patient survival and hazard ratios for codes 2 and 3 in two hub hospitals in Modena in the 36-month period across the stages of two major earthquakes in short sequence in Northern Italy in 2012. Methods: Clinical records pertaining to the emergency care of patients were analyzed and only those assigned status codes 2 and 3 by ambulance professionals were included (if the assessment was confirmed by emergency department triage). The statistical analysis of data was divided by three time periods studied: before, during/between, and after the earthquakes. Results: Among the 2,278 retained records, there were no statistically significant differences in the prevalence of the main pathologies presented at the two hubs in the studied period. A Cox regression model was used to analyze the survival of patients in the different stages of the emergency; there were no statistically significant differences in the hazard ratios of death before, during, and after the earthquake. The study found a significant increase in emergency department treatment times. Discussion: Redundancies in the Modena medical system were found to have compensated for damaged hospital facilities. In particular, they helped emergency systems reorganize themselves faster in order to bring medical assistance to people during and around seismic events with as a minimal amount of disruption as possible. Conclusion: The Modena medical system was redundant and ensured that disrupted emergency systems were reorganized and put back online while damaged hospital facilities were compensated for/reproduced elsewhere.

2018 - The burden of not-weighted factors – Nursing workload in a medical Intensive Care Unit [Articolo su rivista]
Giuliani, E.; Lionte, G.; Ferri, P.; Barbieri, A.
abstract

Objectives: Body weight and infection status affect nursing workload and are not accounted for in the Therapeutic Intervention Scoring System 28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS). The objective of this study was to analyse the correlation between weight and infection status with TISS 28 and NEMS in a cohort of medical Intensive Care Unit patients. Research methodology: A retrospective observational trial was conducted on the nursing records of 26 randomly selected patients over a 12-month period. TISS-28 and NEMS were calculated for each day of ICU stay. Infectious status was determined based on positive cultures to multi-resistant organisms while overweight and obesity were based on Body Mass Index. Results: A total of 809 nursing shifts’ activity records were analysed. There were 12 infected patients that required isolation, 14 overweight patients and 3 obese: 9 patients presented both conditions. Only the presence of both conditions was statistically associated with an increase in workload (TISS-28p-value = 0.041 and NEMS p-value = 0.011). Conclusions: Although TISS-28 and NEMS do not specifically consider body weight and infection status, their integration into nursing workload scores may improve the accuracy as management tools, increasing the quality of the cares provided.

2018 - The efficacy of interprofessional simulation in improving collaborative attitude between nursing students and residents in medicine. A study protocol for a randomised controlled trial [Articolo su rivista]
Ferri, Paola; Rovesti, Sergio; Magnani, Daniela; Barbieri, Alberto; Bargellini, Annalisa; Mongelli, Francesca; Bonetti, Loris; Vestri, Annarita; Alunni Fegatelli, Danilo; DI LORENZO, Rosaria
abstract

Background: Effective collaboration among health professionals is an essential component to ensure quality of care. Many adverse events experienced by patients are attributed to misunderstanding or poor communication among members of the interprofessional team. Interprofessional simulation is a learning strategy used to improve collaboration and facilitate communication between medical and nursing students. Aim of the work: To determine the efficacy of educational program based on high-fidelity interprofessional simulation aimed at improving collaborative attitude. Method: For this purpose, a protocol for a planned single-center, non-blinded and Randomized Controlled Trial (RCT) was chosen. The present has been approved by the Ethics Committee of Area Vasta Emilia Nord (Italy) (n° 479/2018). All students attending the second and third year of nursing and all resident physicians in anesthesia, reanimation, intensive care and pain management of University of Modena and Reggio Emilia, will be recruited and randomly assigned to two groups. The Experimental Group (EG) will receive an educational intervention based on high-fidelity simulation and the Control Group (CG) will attend a traditional classroom lesson. Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and Readiness for Interprofessional Learning Scale (RIPLS) will be administered before and after the educational program in both the EG and CG. Conclusion: Expected outcomes is that, at the end of the study, nursing students and resident physicians who participated in the interprofessional simulation show significantly higher levels of interprofessional collaboration compared to the CG, evaluated through the JSAPNC.

2017 - Contemporary Thoracic Aortic and Abdominal Injuries: An Emergency Strategy. [Articolo su rivista]
Manenti, Antonio; Melegari, Gabriele; Zizzo, Maurizio; Barbieri, Alberto
abstract

To the Editor: Topcu and colleagues [1] interestingly bring attention to the management of contemporary injury of the thoracic aorta and spleen. On the basis of our experience, we would like to consider some basic points. In each case of severe thoracoabdominal trauma, it is essential to perform a hemodynamic monitoring and contrast-enhanced computed tomography (CT) angiography to detect a condition of circulatory instability, and to obtain a complete imaging of the thorax, abdomen, and vessels. The most common injuries of the thoracic aorta involve isthmus. In addition, high-grade lesions (III and IV) are preferentially treated with an endovascular technique [2]. Usually, treatment priority is given to the aortic isthmus injuries, possibly considering an endovascular procedure [3]. Subsequently, the other concomitant injuries, especially abdominal ones, must be treated adequately. This strategy was applied successfully in our last consecutive 5 cases of injuries of the aortic isthmus of grade IV, with an associated spleen rupture (3 cases) and a liver laceration (2 cases), obtaining a complete recovery without important complications. On the contrary, a prompt emergency laparotomy becomes necessary when an endovascular treatment is not possible, and the subsequent cardiovascular surgery requires a cardiopulmonary bypass and a prolonged full heparinization, with the risk of increased or recurrent abdominal hemorrhage [1]. Interestingly, we applied an equivalent strategy in three cases of injuries of the left subclavian artery, with secondary hemothorax and associated blunt abdominal trauma [4]. CT allowed a precise diagnosis of the vascular injury. A prompt endovascular treatment was successful, and the subsequent laparotomy for spleen rupture followed without difficulties. When this strategy is not possible, direct surgery of the injured supraaortic branch is indicated. In cases of polytrauma involving contemporaneously the thoracic aorta or its supraaortic branches and the abdomen, and an associated massive hemoperitoneum and hemodynamic instability, a prompt laparotomy becomes necessary. It must be performed under careful hemodynamic control, avoiding increase or recurrence of the thoracic hemorrhage after resolution of the circulatory hypotension. We believe that these challenging clinical situations merit further study and contributions.

2017 - Does stem cell therapy induce myocardial neoangiogenesis? Histological evaluation in an ischemia/reperfusion animal model [Articolo su rivista]
Pennella, Sonia; Bonetti, L. R.; Migaldi, Mario; Manenti, Antonio; Lonardi, Roberto; Giuliani, Enrico; Barbieri, Alberto; Farinetti, Alberto; Mattioli, Anna Vittoria
abstract

Background: In an experimental model in the rabbit, a myocardial ischemia-reperfusion injury was obtained. Subsequently, the effects of homologous bone marrow stem cell (BMSC) administration were studied. Methods: In 21 New Zealand adult rabbits, ischemia/reperfusion damage was induced by temporary occlusion of the anterior descending coronary artery. Homologous BMSCs were isolated, cultured and re-suspended for injection at the level of the ischemic zone. We evaluated the proangiogenetic effect of intramyocardial injections of BMSC at the peri-infarcted area. Histological evaluations were made after 20 days from the surgical procedure. Results: In rabbits treated with intramyocardial BMSC administration, we demonstrated histologically capillary neoangiogenesis, without signs of tissue immunological reaction or of generation of new myocardial cells. On the contrary, only minimal neovascular supply was detected in rabbits treated with intravenous administration of BMSC. Only typical signs of ischemic myocardium injury were observed in the control group. Conclusion: These observations suggest that the effect of direct BMSC administration in ischemic myocardium could promote a capillary neoangiogenesis, which helps to prevent ischemic myocardial damage.

2017 - Epidural catheter cutting: mechanisms and management. [Articolo su rivista]
Melegari, Gabriele; Taddia, Gabriele; Manenti, Antonio; Barbieri, Alberto
abstract

To the Editor, Epidural catheter insertion can be followed by different complications appearing at its insertion, maintenance and removal. They can be distinguished in haemorrhagic, infectious and mechanical, when directly involving the device with different mechanisms: obstruction, kinking, knotting, displacement, migration, and breakage, or more frequently cutting [1]. Our experience, even limited to a single case, illustrates well this uncommon and unexpected event. A young man with no prior medical history, and a normal body mass index was scheduled for a radical cysto-prostatectomy for a bladder leio-myosarcoma. As usually, a tactile modified point epidural Thouy needle, 18 G, 3.5 in. length, was inserted with a right paramedian approach at the L1–L2 vertebral interlaminar space with the patient in a sitting position; a closed end, 3 holes, 20 G, 36 in. long polyamide catheter was inserted; the aspiration test was negative. At this moment, the patient presented a sudden vaso-vagal crisis, with involuntary contraction of its lumbar muscles. The Thouy's needle, with the catheter inside, was removed without difficulties. Unexpectedly the catheter was discovered sharply cut and missing 2 cm in its distal part. Considering the absence of local or neurological signs, the quick resolution of the vaso-vagal crisis, and the most probably extradural position of the catheter, it was decided to proceed with surgery, which providentially was successful. The first postoperative was uneventful, in particular without motor or sensitive neurological signs. On day 1 a Computed Tomography (CT) showed inside the right epidural space a tubular foreign body, 2 cm long, and exactly corresponding to the missed distal part of the catheter, without signs of other complications as haematoma, oedema or serous collection (Fig. 1). The conservative treatment was confirmed and a second CT control after three months did not show differences. The 6 months follow-up persisted negative for neurological signs. Considering the entire dynamics of the events, we suppose that the polyamid catheter was completely cut, just after its insertion, by the sharp bevel of the Thouy's, needle inadvertently pushed forward by the involuntary contraction of the spine muscle during the vaso-vagal crisis. Most probably, the vertebral transverse process and the yellow ligament acted as a plane of contra-resistance. Critically evaluating our experience we acknowledge that every not-urgent surgical procedure must be postponed when an epidural catheter, removed, is found damaged or missing in a part. On the base of the recent literature, we propose an algorithm in case of epidural catheter cutting or breakage (Fig. 2).The missed fragment must be localized by cross-sectional imaging tools, Computer Tomography (CT) or Magnetic Resonance [2]. When it is found intrathecal, or complicated by infection, subdural or epidural haematoma, or by a large blood effusion inside the spinal muscles, its quick extraction is mandatory. Similarly, when the missed fragment is in the sub-cutaneous tissue or close to lumbar fascia, its easy removal can be performed. On the contrary, if the fragment remains fixed in the epidural space, in absence of further complications, its extraction is not directly indicated, considering also the good tissue tolerance of the actual polyamide devices [3]; [4] ; [5]. To avoid this complication, we underline that, after insertion of the epidural catheter, the external needle must be carefully removed with a slow and continuous traction, avoiding any movement of re-pushing forward.

2017 - Letter Re: Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology [Articolo su rivista]
Melegari, Gabriele; Barbieri, Alberto; Manenti, Antonio; Bertellini, Elisabetta; Giuliani, Enrico
abstract

A shockable rhythm influences the ouctome of cardiac arrest.

2016 - A Novel Cooling Device for Targeted Brain Temperature Control and Therapeutic Hypothermia: Feasibility Study in an Animal Model. [Articolo su rivista]
Giuliani, Enrico; Magnoni, Sandra; Fei, Marco; Addis, Alessandro; Zanasi, Roberto; Stocchetti, Nino; Barbieri, Alberto
abstract

BACKGROUND: Therapeutic hypothermia (i.e., temperature management) is an effective option for improving survival and neurological outcome after cardiac arrest and is potentially useful for the care of the critically ill neurological patient. We analyzed the feasibility of a device to control the temperature of the brain by controlling the temperature of the blood flowing through the neck. METHODS: A lumped parameter dynamic model, with one-dimensional heat transfer, was used to predict cooling effects and to test experimental hypotheses. The cooling system consisted of a flexible collar and was tested on 4 adult sheep, in which brain and body temperatures were invasively monitored for the duration of the experiment. RESULTS: Model-based simulations predicted a lowering of the temperature of the brain and the body following the onset of cooling, with a rate of 0.4 °C/h for the brain and 0.2 °C/h for the body. The experimental findings showed comparable cooling rates in the two body compartments, with temperature reductions of 0.6 (0.2) °C/h for the brain and 0.6 (0.2) °C/h for the body. For a 70 kg adult human subject, we predict a temperature reduction of 0.64 °C/h for the brain and 0.43 °C/h for the body. CONCLUSIONS: This work demonstrates the feasibility of using a non-invasive method to induce brain hypothermia using a portable collar. This device demonstrated an optimal safety profile and represents a potentially useful method for the administration of mild hypothermia and temperature control (i.e., treatment of hyperpyrexia) in cardiac arrest and critically ill neurologic patients.

2016 - Dabigatran anticoagulation and Stanford type A aortic dissection: not a lethal coincidence. [Articolo su rivista]
Marchetti, Gabriello; Giuliani, Enrico; Urbinati, Stefano; Barbieri, Alberto
abstract

Dear Sir, We appreciate the opportunity to comment on the Letter to the Editor concerning “Dabigatran and Stanford type A dissection: not a lethal coincidence” by Marchetti et al.[1] They refer to a female patient with a Stanford type A dissection and therapeutic dabigatran anticoagulation. In our original case report,[2] the patient died due to uncontrolled bleeding in the context of therapeutic plasma levels of dabigatran even after multiple exchange transfusions and more than 24 h after the last oral dabigatran intake. Marchetti et al.'s patient had a favourable outcome with a change in management in that they treated the patient pre-operatively with haemodialysis and only operated when the dabigatran plasma concentration decreased below 100 ng/ml. We proposed this procedure to avoid exsanguination due to severe coagulopathy at high dabigatran plasma concentration, but never had the chance to test the efficacy of this by ourselves. Interestingly, dabigatran plasma levels also started to increase due to redistribution after stopping the haemodialyis, as we had observed,[2] and also Chang et al[3] had described. Therefore, continuous haemodialysis is necessary to maintain dabigatran clearance and stable plasma levels. At a dabigatran plasma concentration of 100 ng/ml, Marchetti et al. used FEIBA to improve blood coagulation. However, FEIBA is neither designed nor sufficiently tested in the context of dabigatran-induced coagulopathy, and the coagulation boost can be lethal during extracorporeal circulation, which jeopardizes indication and timing of its application. Moreover, in a very similar case FEIBA neither normalized clinical bleeding nor corrected altered coagulation measurements in conjunction with high dabigatran plasma levels.[4] Fortunately, idarucizumab[5] has been approved by the FDA[6] and the EMA,[7] and we should have this antidote available early in 2016. Until then and probably even beyond the introduction of idarucizumab, timing of “emergency” interventions in relation to the last intake of dabigatran and the patient's renal function will be very important.

2015 - An unusual case of enoxaparin induced thrombocytopenia in intensive care unit [Articolo su rivista]
Giuliani, Enrico; Melegari, Gabriele; Farinetti, Alberto; Barbieri, Alberto; Mattioli, Anna Vittoria
abstract

OBJECTIVES: To present a case of heparin induced thrombocytopenia in a patient treated with enoxaparin. METHODS: A case of heparin-induced thrombocytopenia was examinated with a detailed platelet count analysis over the time and with detection of platelets antibodies. RESULTS: The detection of platelet antobodies and the recovery of platelet count after cessation of enoxaparin strongly support the diagnosis of heparin-induced thrombocytopenia (HIT). CONCLUSION: HIT is a severe side effects of heparin administration. It is more frequent in patients treated with unfractionated heparin however can also be induced by low molecular weight heparin. Guideline suggests the cessation of heparin administration and the treatment of patients with fondaparinux.

2015 - Education in anesthesia: three years of online logbook implementation in an Italian school [Articolo su rivista]
Barbieri, Alberto; Giuliani, Enrico; Lazzerotti, Sara; Villani, Matteo; Farinetti, Alberto
abstract

BACKGROUND: The progress of physicians through residency training in anesthesiology can be monitored using an online logbook. The aim of this investigation was to establish how residents record clinical activities in their computerized web-based logbooks during their first years of anesthesiology training. METHODS: For this retrospective observational trial, the ESSE 3(©) digital registry of the University of Modena and Reggio Emilia, Italy was used to record all anesthesia-related activities performed by three consecutive year-groups of residents (Groups A, B and C) between 2009 and 2012. The ratio of activities to sessions was chosen as a surrogate measure of compliance. RESULTS: A total of 41,348 actions were analyzed. The ratio of activities to sessions showed a statistically significant decline for all activities concerning the perioperative management of anesthesia, with a steady reduction from the first to the last year-group (Group A 23.7, Group B 14.1 and Group C 2.2; p = 0.003). CONCLUSIONS: An online activities logbook is a useful tool for recording and assessing the clinical activities undertaken by each resident during residency training in anesthesiology.

2015 - Ibuprofen timing for hand surgery in ambulatory care [Articolo su rivista]
Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto
abstract

OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies.

2015 - NDP-α-MSH attenuates heart and liver responses to myocardial reperfusion via the vagus nerve and JAK/ERK/STAT signaling [Articolo su rivista]
Ottani, Alessandra; Giuliani, Daniela; Neri, Laura; Calevro, Anita; Canalini, Fabrizio; Vandini, Eleonora; Cainazzo, Maria Michela; Ruberto, Ippazio Antonio; Barbieri, Alberto; Rossi, Rosario; Guarini, Salvatore
abstract

Melanocortin peptides afford cardioprotection during myocardial ischemia/reperfusion via janus kinases (JAK), extracellular signal-regulated kinases (ERK) and signal transducers/activators of transcription (STAT) pathways. Here we investigated whether melanocortin-induced modulation of the JAK/ERK/STAT signaling occurs via the cholinergic anti-inflammatory pathway, focusing our study on cardiac and hepatic responses to prolonged myocardial ischemia/reperfusion. Ischemia was produced in rats by ligature of the left anterior descending coronary artery for 30min; effects of ischemia/reperfusion were evaluated using Western blot of heart and liver proteins. Intravenous treatment, during coronary artery occlusion, with the melanocortin analog (Nle(4), D-Phe(7))α-melanocyte-stimulating hormone (NDP-α-MSH) induced a left ventricle up-regulation of the cardioprotective transcription factors pJAK2, pERK1/2 and pTyr-STAT3 (JAK-dependent), and a reduction in the levels of the inflammatory mediators tumor necrosis factor-α (TNF-α) and pJNK (a transcription factor also involved in apoptosis), as assessed at the end of the 2-h reperfusion period. Further, these beneficial effects of NDP-α-MSH were associated with heart over-expression of the pro-survival proteins heme oxygenase-1 (HO-1) and Bcl-XL, and decrease of ventricular arrhythmias and infarct size. In the liver NDP-α-MSH induced a decrease in the pJAK2 and pTyr-STAT3 levels, and strongly reduced pERK1/2 expression. In the liver of ischemic rats NDP-α-MSH also blunted pJNK activity and TNF-α expression, and up-regulated Bcl-XL. Bilateral cervical vagotomy prevented all effects of NDP-α-MSH, both in the heart and liver. These results indicate that melanocortins inhibit heart and liver damage triggered by prolonged myocardial ischemia/reperfusion likely, as main mechanism, via the vagus nerve-mediated modulation of the JAK/STAT/ERK signaling pathways.

2015 - The effect of desflurane on neuronal communication at a central synapse [Articolo su rivista]
Mapelli, Jonathan; Gandolfi, Daniela; Giuliani, Enrico; Prencipe, FRANCESCO PIO; Pellati, Federica; Barbieri, Alberto; D'Angelo, Egidio; Bigiani, Albertino
abstract

Although general anesthetics are thought to modify critical neuronal functions, their impact on neuronal communication has been poorly examined. We have investigated the effect induced by desflurane, a clinically used general anesthetic, on information transfer at the synapse between mossy fibers and granule cells of cerebellum, where this analysis can be carried out extensively. Mutual information values were assessed by measuring the variability of postsynaptic output in relationship to the variability of a given set of presynaptic inputs. Desflurane synchronized granule cell firing and reduced mutual information in response to physiologically relevant mossy fibers patterns. The decrease in spike variability was due to an increased postsynaptic membrane excitability, which made granule cells more prone to elicit action potentials, and to a strengthened synaptic inhibition, which markedly hampered membrane depolarization. These concomitant actions on granule cells firing indicate that desflurane re-shapes the transfer of information between neurons by providing a less informative neurotransmission rather than completely silencing neuronal activity.

2014 - Neural damage biomarkers during open carotid surgery versus endovascular approach [Articolo su rivista]
Giuliani, Enrico; Genedani, Susanna; Moratto, Roberto; Veronesi, Jessica; Carone, Chiara; Bonvecchio, Cinzia; Mosca, Francesco; Coppi, Gioachino; Barbieri, Alberto
abstract

BACKGROUND: Carotid endarterectomy (CEA) is the gold standard for treating severe carotid artery stenosis, whereas carotid artery stenting (CAS) represents an endovascular alternative. The objective of this study was to assess the potential neural damage following open or endovascular carotid surgery measured by peripheral blood concentration of 3 biomarkers: S100β, matrix metalloproteinase-9 (MMP-9), and d-dimer. METHODS: Data for this prospective investigation were obtained from the Carotid Markers study (January 2010-2011), which sought to measure the levels of specific biomarkers of neuronal damage and thrombosis on candidates to CEA or CAS presenting at the Department of Vascular Surgery of the Nuovo Ospedale S. Agostino Estense of Modena (Italy) at baseline and at 24 hr after surgery. Relevant medical comorbidities were noted. RESULTS: A total of 113 consecutive patients were enrolled in the study, 41 in the endarterectomy group and 72 in the endovascular group. The baseline levels of the studied biomarkers did not show any statistically significant difference between the groups with the exception of MMP-9, which showed higher concentrations in the endovascular group (median 731 vs. 401, P = 0.0007), while 24 hr after surgery the endarterectomy group featured significantly higher peripheral blood concentrations of MMP-9, S100β, and d-dimer. Conversely, no significant difference was detected in the endovascular group except the d-dimer level. CONCLUSIONS: Neural damage biomarkers demonstrated a substantial difference between open and endovascular carotid surgery, which, if performed in selected patients, may become a less invasive alternative to CEA.

2014 - The effect of anesthesia on neuronal communication [Poster]
Mapelli, Jonathan; Giuliani, Enrico; Gandolfi, D.; Congi, L.; Barbieri, Alberto; D'Angelo, E.; Bigiani, Albertino
abstract

One challenging aspect in the analysis of neuronal circuits is the lack of quantitative and objective measurements of network activity to be translated into functional states. For example, the clinical assessment of the consciousness state in a brain-injured, unresponsive patient can be hardly analyzed at the cellular and network level. General anesthesia employs different classes of molecules to modulate at various levels neuronal functional states. General anesthetics (GA) are known to progressively and selectively reduce consciousness, perception and motor control. In this work we have investigated in a simplified neuronal circuit the effect of GA on information transfer. The Shannon mutual information (MI) was used to evaluate how much the neuron response reflected the input stimuli versus its intrinsic variability, providing a statistical tool to dissect the contribution of spike timing to neural information transmission. The cerebellum granule cell (GrC), due to its limited number of excitatory inputs, can be used to calculate the Mutual Information (MI) and its variation during a perturbed state (e.g. under anesthesia). The MI was experimentally assessed by detecting action potentials elicited in response to specific inputs through whole-cell patch-clamp recordings in rat acute cerebellar slices (P18-24). In order to test the action of the application of GA, GABAergic currents elicited by inhibitory afferent connections were recorded. The action of GA (in particular Sevoflurane and Desflurane) increased (+120%) post-synaptic inhibitory currents (IPSCs) in less than 10 sec and was fully recovered in 30 sec. Furthermore, the action of GA was to markedly reduce the MI measured in control condition (-57.4%). This control condition was fully recovered after removal the anesthetics, therefore leaving unaltered neuronal activity. This approach will be applied to larger circuits and investigated with other techniques (e.g. Multielectrode array recordings or cellular imaging), moreover different concentration of anesthetics could lead to the identification of multiple functional states.

2013 - Author reply to “ Can renin predict mortality of patients in intensive care unit?” [Articolo su rivista]
Barbieri, Alberto; Giuliani, Enrico; Marchetti, Gabriello; Ugoletti, Eleonora; Della Volpe, Salvatore; Albertini, Giovanna
abstract

Can renin predict mortality of patients in intensive care unit?

2013 - Clinical severity of ischemic stroke and neural damage biomarkers in the acute setting: the STROke MArkers (STROMA) study [Articolo su rivista]
Barbieri, Alberto; Giuliani, Enrico; Carone, Chiara; Pederzoli, Francesca; Mascheroni, Giorgio; Greco, Gabriele; Stucchi, Carlo; Genedani, Susanna
abstract

BACKGROUND: Stroke is a leading cause of long-term morbidity and mortality affecting several hundred-thousand people annually in the Western Countries. Various panels of biomarkers of neural damage have been developed and validated. The primary objective of this investigation was to measure the correlation between the clinical severity of stroke and the serum/plasma concentrations of neural damage biomarkers. METHODS: A prospective investigation was conducted on a panel of biomarkers composed of S100β, matrix metalloproteinase-9 (MMP-9), N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and D-dimer at admission and after 24 hours, in a cohort patients with a confirmed diagnosis of stroke in an emergency setting (STROke-MArkers STROMA). RESULTS: A total of 58 consecutive patients were enrolled, no participant was excluded; according to clinical severity measured by National Institute of Health Stroke Scale (NIHSS) there were 29 minor strokes, 24 moderate, 3 moderate-severe, 2 severe. The Spearman's rank correlation test was used to assess the relationship between the baseline NIHSS value and the concentrations of the four biomarkers: all the studied biomarkers showed a statistically significant correlation with baseline NIHSS at 24 hours. A multivariate ordinal regression model was used to analyze the correlation of markers with stroke severity, stratified, according to NIHSS score: MMP-9 and S100β showed a statistically significant correlation after 24 hours. CONCLUSION: MMP-9, S100β, NT pro-BNP and D-dimer showed a good correlation with the clinical severity of stroke which may become an additional resource in the acute patient evaluation and potentially follow-up.

2013 - Critical Illness in Energy Metabolism Genetic Disorder: Rhabdomyolysis, Acute Kidney Injury, Respiratory Arrest [Articolo su rivista]
Giuliani, Enrico; Coppi, Francesca; Bertolotti, Valentina; Gorlato, Giulia; Zavatta, Marco; Barbieri, Alberto
abstract

In very long-chain acylCoA dehydrogenase deficiency (VLCAD), the activity of this enzyme is either reduced or absent with the inability to use long-chain fatty acids as energy substrates. A 25-year old male with VLCAD was admitted to the Emergency Department of Policlinico Teaching Hospital (Modena, Italy)for generalized weakness and oliguria, after a period of physical and mental stress and inadequate compliance to a long-chain fatty acid free diet. Laboratory tests were compatible with acute kidney injury. Seventy-two hours after admission, the subject had an episode of chest pain with elevated markers of myocardial necrosis. The rapid deterioration of muscular strength and the subsequent worsening respiratory failure necessitated ventilator support within the local Medical Intensive Care Unit. There, the patient showed a prompt normalization of respiratory parameters and a steady improvement of renal function. An inadequate compliance to lifestyle and dietary restriction in VLCAD may trigger severe and potentially lethal crisis. The in-hospital management of these patients calls for early intensive care admission as their conditions may deteriorate without warning.

2013 - Estudio de los tiempos trascurridos desde el inicio de los sintomas hasta la angioplastica primaria [Articolo su rivista]
Giuliani, Enrico; Melegari, Gabriele; Lazzerotti, Sara; Fantini, Giuseppe; Serantoni, Carlo; Barbieri, Alberto
abstract

Introduction: ST-elevation myocardial infarction (STEW) must be treated early and aggressively. The aim of this retropective observational study was to measure the times from first medical contact (FMC) to balloon inflation and from Symptom onset to balloon inflation. Methods: The consecutive records of all the patients who underwent a primary percutaneous coronary intervention (PCI) for STEMI in the catheterization laboratory over a 12-month period were included. Patients were classified as group A if emergency medical responders brought them directly to the catheterization laboratory or to the emergency department, or group B if they were self-presenters to the emergency department. The duration of the process was calculated in 2 ways, from symptom onset (T1) to balloon inflation and from FMC (T2) to balloon inflation. Relevant medical history and hospital and 30-day mortality were extracted from medical records. Results: Seventy-five patients (group A, 42; group B, 33) we included. The groups were similar in sex, age, and hospital and 30-day mortality. Times until balloon inflation from T1 and T2 in group A were 149.5 and 98 minutes respectively, in group B the times were 147 and 90 minutes, respectively (P=.9498 between groups for the times from T1; P=.0404 between groups for the times from T2). The differences between T1 and T2 (P<.0001 and P<.0001, respectively) were significat between group. The delay between T1 and FMC showed a statistically significant correlation with hospital mortality (rise in mortality of 5.94% for every 10-minute delay, P=.0110). Conclusions: The time between symptoms onset and FMC in STEMI management Primary care doctors would be the most appropriate professionals to educate the population at risk about the need to call emergency medical services or go to a hospital emergency department quickly.

2013 - Surgical approach to intramyocardial administration of bone marrow stem cells in an animal model. [Articolo su rivista]
Farinetti, Alberto; Lonardi, Roberto; Barbieri, Alberto; Giuliani, Enrico; Pennella, Sonia; Pozza, M; Saviano, Massimo; Manenti, Antonio; Mattioli, Anna Vittoria
abstract

Abstract AIM: The aim of the study was to evaluate the surgical approach to intramyocardial (i.m.) injection of Bone Marrow Stem Cells (BMSCs) in a pre-clinical model and its complications. MATERIAL OF STUDY: In New Zealand rabbits an ischemia reperfusion injury lasting 20 min was induced by temporary ligation of anterior descending coronary artery during cardiac surgical procedure. Homologous BMSCs were isolated from the posterior iliac crest, cultured and re-suspended for injection. BMSC were injected at the peri-infarcted area and side effects were evaluated. A control group with myocardial infarction was treated with i.m. injections of saline, to evaluate possible side effects of injection. Comparison of ventricular premature contractions (VPC), ventricular tachycardia and ventricular fibrillation were recorded during surgery and after 7 and 21 days. RESULTS: Seven rabbits developed intractable ventricular fibrillation during the experimental protocol, three during coronary ligation but before cell injections and four following i.m. injections. At day 7, hourly PVC were more frequent in the groups of animals that received i.m. injections of BMSCs (132 +/- 19 beats) compared to saline injections. (54 +/- 14). CONCLUSIONS: Intramyocardial injections of BMSCs induced an electrical instability as shown by a high number of PVC as compared with intramyocardial injections of saline.

2012 - Analysis of pro-arrhythmic effects induced by different routes of administration of bone marrow stem cells [Articolo su rivista]
Mattioli, Anna Vittoria; Lonardi, Roberto; Giuliani, Enrico; Barbieri, Alberto; S., Pennella; Farinetti, Alberto
abstract

Bone Marrow Stem Cells,Intramyocardial injections,Ischemia/Reperfusion,Pre-Clinical Study,QT interval

2012 - Cranial nerve involvement as presenting sign of multifocal motor neuropathy. [Articolo su rivista]
G., Galassi; G., Albertini; F., Valzania; Barbieri, Alberto
abstract

Multifocal motor neuropathy (MMN) is characterized by slowly progressive,predominantly distal,asymmetric limb weakness and partial conduction blocks (CB) of motor axons. Cranial nerve involvement and respiratory failure are uncommon. We report two patients who exhibited unilateral hypoglossal and abducens palsy as presenting signs. Other remarkable features were autonomic instability and respiratory failure due to bilateral phrenic nerve involvement. Treatment with intravenous (IV) immunoglobulin (Ig) resulted in an improvement. Patient 2,who showed IgM reactivity against ganglioside GM1,has been receiving maintenance therapy with IVIg for 7years. We speculate that cranial weakness of our patients could be due to CB similar to those detected in the motor nerves of the extremities.

2012 - Log-book implementation in anaesthesiology residency training: a retrospective analysis [Articolo su rivista]
Barbieri, Alberto; Giuliani, Enrico; Lazzerotti, Sara
abstract

Log-book implementation in anaesthesiology residency training: a retrospective analysis.

2012 - Multi-organ failure following severe cocaine-tetramisole intoxication in a body-packer [Articolo su rivista]
Giuliani, Enrico; G., Albertini; C., Vaccari; Manenti, Antonio; Barbieri, Alberto
abstract

Multi-organ failure following severe cocaine-tetramisole intoxication in a body-packer.

2012 - Plasma renin concentration as a predictor of outcome in a medical intensive care setting: a retrospective pilot study. [Articolo su rivista]
Barbieri, Alberto; Giuliani, Enrico; G., Marchetti; E., Ugoletti; S., Della Volpe; G., Albertini
abstract

BACKGROUND:Renin and aldosterone are involved in an organ perfusion pathway that may be an estimate of disease severity. The primary objective was to explore the relationship between outcome and aldosterone and renin levels at medical intensive care unit (MICU) admissions in comparison to SAPS II scores. METHODS:This retrospective study was conducted on patients admitted to the adult MICU during 12 months. Exclusion: subjects with creatinine >176 mmol/l, chronic arrhythmia and ACE-inhibitor therapy. Admission aldosterone and renin plasma levels were measured and SAPS II scores were calculated. RESULS: Eighty-two patients were included. Only the plasma renin median concentration difference between survivors and non-survivors was significant (P=0.0168). The area under the ROC curve for mortality and plasma renin concentration was similar to that of SAPS II. The correlation between mortality and renin >84 pg/mL showed an odds ratio of 5.78±3.45, P=0.003. CONCLUSION:Renin was correlated to outcome in critically ill medical patients.

2012 - Sorveglianza delle infezioni ospedaliere nell’Unità di Rianimazione dell’Azienda Ospedaliera-Universitaria Policlinico di Modena [Abstract in Rivista]
Righi, Elena; Barbieri, Alberto; Conigliaro, Concetta; Giuliani, Enrico; Carluccio, Eugenia; Bisaccia, Eufemia; Marchigiano, P; Aggazzotti, Gabriella
abstract

Nell’Unità di Rianimazione dell’Azienda Ospedaliero-Universitaria Policlinico di Modena è stato applicato un sistema di sorveglianza delle infezioni ospedaliere (IOS) denominato SPIN-UTI (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unita di Terapia Intensiva), un sistema di rilevazione utilizzato in diverse terapie intensive italiane, costruito e messo punto utilizzando la metodologia dal network europeo di sorveglianza delle infezioni HELICSICU, con l’obiettivo di consentire valutazioni e confronti sul fenomeno estesi ed affidabili sia a livello nazionale che internazionale.La sorveglianza, di tipo prospettico e patient-based, è durata per 6 mesi (ottobre 2010-marzo 2011): tutti i pazienti ricoverati in TerapiaIntensiva per più di 48h sono stati monitorati per tutto il tempo del ricovero e le IOS sorvegliate sono state le polmoniti nosocomiali; le infezioni del torrente ematico; le infezioni associate a cateteri intravascolari centrali; le infezioni delle vie urinarie. 70 pazienti (51% maschi) con una età media pari a 74 anni (± 15) sono stati ospitati per più di 48 ore prevalentemente (91%) per un ricovero di tipo medico. Durante la sorveglianza sono state registrate 24 infezioni in 15 soggetti: l’incidenza cumulativa di soggetti con infezione potenzialmente correlata alla attività assistenziale risulta così pari al 21.4%, mentre la densità di incidenza pari a 23.7 infezioni ogni 1000 giornate di degenza. Le infezioni più diffuse sono risultate le polmoniti (16 episodi pari al 67% delle infezioni registrate) seguite da quelle delle vie urinarie (6 episodi- 25%). La durata della degenza in rianimazione (34 vs 9 giorni) così come la mortalità ospedaliera (67% vs 26%) appaiono significativamente più elevate per i pazienti con IOS rispetto a quelle registrate per i soggetti privi di infezioni.I dati rilevati risultano in linea con quanto osservato nello stesso periodo nelle altre TI italiane aderenti al sistema di sorveglianza SPINUTI.

2012 - The effects of volatile halogenated anesthetics on information flow at the cerebellum input stage [Abstract in Rivista]
Mapelli, Jonathan; Gandolfi, D.; Giuliani, Enrico; Barbieri, Alberto; D'Angelo, E.; Bigiani, Albertino
abstract

The cerebellum is of crucial importance for sensory-motor integration and is also involved in cognitive processing. Blended anesthesia employs different molecules whose mechanisms of action are not fully understood. Among these, sevoflurane and desflurane are currently used in clinic for maintenance of general anesthesia. In this work, we have tested how anesthetics affect the flow of excitatory information transmitted by cerebellum granule cells (GCs). It is in fact still unknown the way the neuronal network activity is modulated during anesthesia. Whole-cell patch clamp recordings from GCs were performed in current-clamp mode in rat cerebellar slices. The bath application of sevoflurane (8%), on one hand dramatically reduced the total number of synaptically evoked spikes (-79%±10; n=4), on the other hand, the first spike latency and the temporal precision were increased (+23%±5; +32%±5 respectively). Furthermore, the spike timing data were used to estimate how anesthetics can modulate information transmission through the measure of Mutual Information (MI). Preliminary results show that the effect of sevoflurane perfusion was to reduce up to the 80% (n=4, p<0.05) the MI measured in control condition. Interestingly, the control condition was fully recovered after the removal of the anesthetic. These evidences indicate that anesthetics perfusion can potentially affect the cerebellar network which is fundamental for sensory-motor integration, memory formation and consolidation.

2012 - Tuna Cornea as Biomaterial for Cardiac Applications [Articolo su rivista]
Parravicini, Roberto; F., Cocconcelli; A., Verona; V., Parravicini; Giuliani, Enrico; Barbieri, Alberto
abstract

Among available biomaterials, cornea is almost completely devoid of cells and is composed only of collagen fibers oriented in an orderly pattern, which contributes to low antigenicity. Thunnus thynnus, the Atlantic bluefin tuna, is a fish with large eyes that can withstand pressures of approximately 10 MPa. We evaluated the potential of this tuna cornea in cardiac bioimplantation. Eyes from freshly caught Atlantic bluefin tuna were harvested and preserved in a fixative solution. Sterilized samples of corneal stroma were embedded in paraffin and stained with hematoxylin and eosin, and the histologic features were studied. Physical and mechanical resistance tests were performed in comparison with bovine pericardial strips and porcine mitral valves. Corneal material was implanted subcutaneously in 7 rats, to evaluate in vivo calcification rates. Mitral valves made from tuna corneal leaflets were implanted in 9 sheep. We found that the corneal tissue consisted only of parallel collagen fibers without evidence of vascular or neural structures. In tensile strength, the tuna corneal specimens were substantially similar to bovine pericardium. After 23 days, the rat-implanted samples showed no calcium or calcium salt deposition. Hydrodynamic and fatigue testing of valve prototypes yielded acceptable functional and long-term behavioral results. In the sheep, valvular performance was stable during the 180-day follow-up period, with no instrumental sign of calcification at the end of observation. We conclude that low antigenicity and favorable physical properties qualify tuna cornea as a potential material for durable bioimplantation. Further study is warranted.

2011 - Acute-onset MMN [Abstract in Rivista]
Galassi, G.; Albertini, G.; Orlandi, C.; Valzania, F.; Barbieri, Alberto
abstract

...

2011 - Analgesia and endocrine surgical stress: effect of two analgesia protocols on cortisol and prolactin levels during abdominal aortic aneurysm endovascular repair. [Articolo su rivista]
Barbieri, Alberto; Giuliani, Enrico; Genazzani, Alessandro; Baraldi, E; Ferrari, Anna; D'Amico, Roberto; Coppi, Gioachino
abstract

OBJECTIVES:Endovascular abdominal aortic aneurysm (AAA) repair was performed with local anaesthesia and intravenous analgesia. The objective of the study was to evaluate how two analgesia protocols affected stress response, measured as cortisol, 17-OH progesterone (17OHP) and prolactin (PRL) concentration during the procedure.METHODS:44 patients undergoing elective AAA endovascular repair were included to either receive regular boluses of fentanyl midazolam or remifentanil continuous infusion, analgesia was monitored by Visual Analogue Scale (VAS) measurement; cortisol, 17OHP and PRL were sampled preoperatively, at skin incision, endovascular prosthesis release and skin suture.RESULTS:42 patients were included. Mean VAS values were lower in the remifentanil group 0.50±0.68 vs 1.48±1.20, p=0.002 at incision, 0.24±0.58 vs 1.45±1.18, p<0.001 prosthesis release, 0.51±0.90 vs 1.73±1.45, p=0.002 suture. No statistically significant difference was found among cortisol and 17OHP levels; PRL was significantly lower in the fentanyl-midazolam group (23.83±16.92 ng/ml vs 40.81±22.45 p=0.009 at prosthesis release and 28.23±15.05 vs 41.37±14.54, p=0.007 at suture).CONCLUSIONS:Although statistically significant VAS difference had a limited clinical impact due to its small entity. The group that experienced less pain showed a more intense PRL response, while cortisol and 17OHP did not reach statistical significance.

2011 - Botulin toxin type A (BTA) for esophageal achalasia: a double-edged sword. [Articolo su rivista]
Galassi, G.; Orlandi, C.; Valzania, F.; Albertini, G.; Barbieri, Alberto
abstract

Botulin toxin in esophageal achalasia

2011 - Circumflex Coronary Artery Agenesis Associated with Thoracic Great Vessels Anomalies [Articolo su rivista]
Coppi, Francesca; Roversi, Sara; Giuliani, Enrico; Sansone, R.; Sangiorgi, G. m.; Modena, Maria Grazia; Barbieri, Alberto
abstract

Coronary artery anomalies are identified in approximately 1% of patients who undergo angiography; among these, circumflex branch agenesis represents 0.003%. A 38-year-old woman was brought to our emergency department with clinical findings suggestive of acute myocardial infarction. Absence of circumflex branch was reported during angiography. Further analysis showed great vessel abnormalities: the presence of a left superior vena cava, a left arterial trunk of abnormal origin, and a small cerebral aneurysm. To our knowledge, this is the only reported case with such vascular anomalies.

2011 - Generalized weakness after focal injection of botulin toxin type A (BTA) [Abstract in Rivista]
G., Galassi; C., Orlandi; F., Valzania; G., Albertini; A., Ariatti; Barbieri, Alberto
abstract

Objective: Botulinum toxin type A (BTA) is established treatment for muscle, autonomic nerve terminal overactivity.BTA is primarily presynaptic neuromuscular blocking agent inducing selective. reversible muscle weakness lasting several months when injected intramuscu1arly.The toxin in therapeutic doses is safe.Generalizcd weakness of distant muscles is seldom reported. BTA is digested ingastrointestinal tract as it forms complex with proteins that protect and stabilize ncurotoximit considered treatment option for gastrointestinal achalasia. Methods: A75 year old diabetic woman developed functional obstructive gastrointestinal symptoms due to esophageal achalasia. She received endoscopically epicardial BTA injection (Botox Aller- gan I00 U).By day 3 patient developed shortness of breath, dysarthria, dysphagia, nasal regurgitation.By day 7 she exhibited respiratory distress.When admitted to ICU (day 8) patient was alert; eye movements were full with normally reactive pupils. There was neck flexor, upper, lower limb weakness graded Z/5-3/5 respectively (MRC scale).Deep jerks were brisk throughout. Results: Blood tests showed anemia; tumor marker titer, autoim- mune screenings, antibody scarch of muscle tyrosin kinase, acetilcholine receptors, voltage gated calcium channels were negative.Brain,total body computed tomography was inconclusive. Three Hz repetitive nerve stimulation(RS)on day 8 showed 25 % decrement of ulnar compound muscle action potential(CMAP). Repeated low rate RS(day I2) revealed up tol8% CMAP decrement before and after activation.No increment was recorded at 20 Hz whereas initial CMAPs were low in amplitude(l—2 mV). Overall findings suggested severe neuromuscular transmission defect. Necdle electromyography (day I2, 45) showed widespread denervation. increased brief duration polyphasia. Oral pyridostigmine bromide(60 mg every 4 hour)was commenced on day 8. Four courses of plasma exchanges (PEX) were given from day 21.By day 48.patient was able to protrude her tongue,to bend upper, lower limbs. By day 5, she developed respiratory failure due to superimposed pneumonia from which she recovered. Conclusions: Our patient exhibited neuromuscular junction (nmj) disorder chronologically related to BTA injection.Electi-ophysiology suggested transmitter release block.The disorder partially responded to oral anticholincsterases and PEX. In our view,pathogencsis was related either to distant effect of BTA or to uncover underlying nmjdisorder.

2011 - Relationship between ventricular arrhythmias and prologed QT time duration after intramyocardial administration of bone marrow stem cells. [Abstract in Rivista]
Mattioli, Anna Vittoria; Pennella, S.; Lonardi, R.; Giuliani, E.; Barbieri, Alberto; Farinetti, A.
abstract

...

2011 - S100-b levels after carotid endoaterectomy -pilot study. [Abstract in Rivista]
Giuliani, Enrico; Coppi, G.; Genedani, Susanna; Bonvecchio, C.; Mosca, F.; Barbieri, Alberto
abstract

n/a

2011 - Stima del fabbisogno calorico e nutrizionale in Terapia Intensiva. [Abstract in Rivista]
Giuliani, Enrico; Albertini, G.; Iseppi, D.; Barbieri, Alberto
abstract

Stima fabbisogno nutrizionale in Terapia Intensiva

2010 - Acute myocardial infarction - From territory to definitive treatment in an Italian province [Articolo su rivista]
Giuliani, E.; Lazzerotti, S.; Fantini, G.; Guerri, E.; Serantoni, C.; Modena, Maria Grazia; Barbieri, Alberto
abstract

Rationale, aims and objectives Early reperfusion is the key to therapeutic success in acutemyocardial infarction (AMI). The duration of the process is influenced by various factorswhich in most of the cases are not easily modifiable. The aim of this study is to analyseAMItreatment process duration to identify determining factors. The objective is to better exploittime intervals imposed by spatial distance from the hospital.Method One-year data regarding acute coronary syndromes with elevated ST segment forpatients presenting to Policlinico teaching hospital (Modena, Italy) have been studied.Patients were divided into two groups for hospital access: A – ambulance access toPoliclinico emergency room (ER); B – self-referral to ER.Results Atotal of 141 patients have undergone percutaneous transluminal coronary angioplastyfor AMI at Policlinico, 106 males, 35 females (58.1% males in group A, 82.7% in B,P 0.002), with an average age of 66.09 14.30 years in group A and 60.90 13.47 in B(P 0.047). Mean pre-hospital time for group A was 122.54 130.69 minutes and B171.49 353.60 (P 0.25), mean hospital time in group A was 196.03 67.66 andB 255.14 113.16 (P < 0.001), mean total time in group A was 318.56 146.91 and B426.63 382.01 (P 0.02).Discussion Data show that group B suffered on average a 108-minute delay from symptomsinsurgence to definitive treatment. The duration of hospital time plays more importantrole in this finding than distance from the medical facility. In fact, on the ambulancea medical crew starts the diagnostic and therapeutic process relieving ER from initialevaluation.

2010 - Cardiac arrhythmias after intramyocardial administration of mesenchymal bone marrow stem cells in acute myocardial infarction [Abstract in Atti di Convegno]
Mattioli, Anna Vittoria; Farinetti, Alberto; Lonardi, Roberto; Enrico, Giuliani; Sonia, Pennella; Losi, Lorena; Barbieri, Alberto
abstract

...

2010 - EuroSCORE and 4Ts score could predict thrombotic complications after cardiac surgery [Abstract in Atti di Convegno]
Mattioli, Anna Vittoria; Farinetti, A.; Barbieri, Alberto; Lonardi, R.; Pennella, S.; Ambrosio, G.
abstract

...

2010 - Heat stroke in the workplace: description of a case with fatal outcome [Articolo su rivista]
Roccatto, L; Modenese, Alberto; Occhionero, V; Barbieri, Alberto; Serra, D; Miani, E; Gobba, Fabriziomaria
abstract

BACKGROUND: Heat exposure represents an occupational risk factor in various work settings. Adverse effects may range from mild symptoms, like muscular cramps, to life threatening conditions, like heat stroke. Data on the occurrence of work-related adverse effects of heat exposure in Italy are lacking.OBJECTIVES:To highlight the risk of heat stroke in a common working activity.METHODS:The case of a fatal heat stroke in a 19-year-old worker, in apparently good health, employed in maintenance of open park spaces is presented. After working 7 hours outdoors on a sunny day he was found unconscious. He was immediately taken to the local Emergency Department, where he arrived in hyperthermic and comatose conditions, and died due to multiple organ failure after 36 hours. After excluding other main causes of hyperthermia, heatstroke was identified as the initial cause of death.RESULTS:The case presented describes the possible extreme consequences of an underestimation of the risk related to occupational heat exposure, even in young and apparently healthy workers. Heat-related adverse effects may occur in a number of common activities, not necessarily involving heavy workload or extreme temperatures. Different methods, including simplified methods, are available for heat stress risk evaluation. The main preventive measures include adequate acclimatization, periodic interruption of exposure, sufficient fluid intake, adequate clothing and appropriate Personal Protective Equipment. Adequate training and workers' health surveillance are also essential.CONCLUSIONS:Heat exposure may be a significant occupational risk, potentially inducing life-threatening conditions, in a number of common activities but is frequently underestimated. An example of undervaluation of the risk and of the possible consequences, are presented and discussed in this case report.

2010 - La nostra storia. Geminiano Grimelli, patriota e ricercatore, una gloria emiliana. [Articolo su rivista]
Bellucci, G.; Barbieri, Alberto
abstract

...

2010 - Prolonged neurological burden in severe lithium intoxication [Articolo su rivista]
Giuliani, Enrico; Iseppi, D.; Orlandi, M. c.; Barbieri, Alberto
abstract

A 53-year-old woman was brought to the Emergency Department for a persistent state of stupor, tremors, fever and oliguria. The patient had been under treatment for depression. The electrocardiogram showed a wider QRS complex; laboratory tests were as follows: urea 110 mg/dL, creatinine 3 mg/dL, sodium 135 mEq/L, potassium 4.5 mEq/L, and lithium 8.0 mEq/L. Renal replacement was initiated to normalize plasma lithium levels; both stupor and speech impairment persisted for several days after dialysis. Complete recovery was achieved several days afterwards.

2010 - Ritardo evitabile: è un problema solo extraospedaliero? [Articolo su rivista]
Grassi, L.; Casali, E.; Bonfreschi, V.; Molinari, R.; Reggianin, L.; Callegaro, A.; Fruggeri, L.; Barbieri, Alberto; Pasetto, A.; Modena, Maria Grazia
abstract

...

2010 - ph 6.68-surviving metformin intoxication. [Articolo su rivista]
Giuliani, Enrico; Albertini, G.; Vaccari, C.; Barbieri, Alberto
abstract

Metformin, a widely used anti-diabetic agent of the biguanide family, although generally safe holds the risk of developing a potentially lethal acidosis. The association between lactic acidosis and metformin is well-established but rarely seen in patients taking this medication. Its elimination relies solely on kidneys’ excretion, so its accumulation is feasible in just two circumstances: renal failure (RF) and acute overdosage. At normal dosage, a toxic accumulation of drug requires time after the development of RF, due to metformin high clearance. About 90% of the drug is eliminated by glomerular filtration and tubular secretion (serum half-life of 1.5–5 h). Moreover, RF is itself associated with acidosis as it impairs kidneys’ ability to excrete protons. Acute intoxication on the other hand is a viable option in those cases where renal function is normal and can correlate with a psychiatric disorder. The mechanism thought to be responsible for lactic acidosis is suppression of gluconeogenesis forming lactate, pyruvate, glycerol and amino acids leading to lactate accumulation, a risk that is increased by either chronic or acute RF (ARF). Usually hyperlactatemia is the most common finding leaving lactic acidosis for the most severe intoxications.

2009 - Analgesia during abdominal aortic aneurysm endovascular repair: remifentanil vs fentanyl-midazolam - a randomized controlled trial [Articolo su rivista]
Giuliani, Enrico; D'Amico, Roberto; Barbieri, Alberto; Bonfreschi, V.; Malagnino, F. C.; Navi, A.; Coppi, Gioachino; Silingardi, R.
abstract

BACKGROUND AND OBJECTIVE: Endovascular repair offers a less surgically invasive procedure for abdominal aortic aneurysms but nevertheless, still requires analgesic sedative cover to ensure an acceptable level of patient comfort and cardiorespiratory stability. The peculiarity of this kind of operation is that painful stimuli are concentrated in specific moments separated by intervals devoid of pain, so the insurgence of pain can be predicted and prevented with a bolus of analgesic, making a continuous infusion not essential, but potentially useful in achieving a better analgesic stability. The primary objective of the study was pain control measured by Visual Analogue Scale; secondary endpoints were cardiorespiratory stability and an acceptable level of sedation. METHODS: The sedative analgesic protocols of two groups of randomly allocated patients, undergoing abdominal aortic aneurysm endovascular repair, were compared. The experimental group received remifentanil infusion (0.03-0.1 microg kg min) and the control group received intravenous doses of fentanyl and midazolam (1-3 microg kg and 0.05-0.1 mg kg, respectively). RESULTS: Fifty patients were investigated out of 60 enrolled. There were no relevant differences concerning cardiorespiratory stability and level of sedation, but pain levels were significantly lower in the experimental group: mean Visual Analogue Scale 0.35+/-0.40 vs. 1.49+/-0.62 (P&lt;0.001) and area under the curve 17.48+/-5.09 vs. 33.05+/-8.19 (P&lt;0.001). CONCLUSION: Both techniques were shown to be safe and most importantly effective in offering cardiovascular stability and analgesia for American Society of Anaesthesiologists III-IV patients undergoing endovascular abdominal aortic aneurysm repair. However, remifentanil continuous infusion proved to offer significantly more stable pain control compared with the currently used combination fentanyl-midazolam.

2009 - Restoring and maintaining sinus rhythm may improve quality of life and exercise capacity of life in patients with persistent atrial fibrillation. [Articolo su rivista]
Marchetti, G.; Roncuzzi, R.; Zaniboni, A.; Barbieri, Alberto; Rafanelli, C.; Urbinati, S.
abstract

...

2009 - Specificity and reliability of prognostic indexes in intensive care evaluation: The spontaneous cerebral haemorrhage case [Articolo su rivista]
Barbieri, Alberto; Pinna, C.; Basso, G. P.; Molinari, R.; Giuliani, Enrico; Fruggeri, L.; Nolli, M.
abstract

Objective To determine the reliability of a generic index such as Simplified Acute PhysiologyScore II (SAPSII), compared with a specific one Intra Cerebral Haemorrhage score(ICH score), as an intensive care unit (ICU) outcome predictor when evaluating a generalfacility that frequently treats a specific type of patients – those with spontaneous cerebralhaemorrhage.Methods The study cohort consisted of a random sample of patients (81) admitted toModena’s Policlinico Teaching Hospital’s ICU with spontaneous ICH over a 24-monthperiod.Main outcome measure SAPSII, ICH score, overall mortality.Results The mean ICH score for the 32 surviving patients was 3.41 1.012 while forthe 49 deceased patientswas of 4.24 0.855 (P = 0.000). The mean SAPSII value for the 32surviving patientswas 49.09 16.58 while for the 49 deceased patientswas 49.51 15.93.SAPSII, ICH scores were analysed for mortality, by receiver operating characteristic curves:the area under the curve was significant for ICH, not-significant for SAPSII.Conclusions Regional quality controls use generic prognostic indexes (SAPSII) in relationto mortality and outcome to assess ICUs, which is appropriate when dealing with ageneral facility when there is not a predominant type of patient, but it may bias theevaluation if the population with specific pathologies (ICH), not included in the generalindex, is statistically considerable, leading to an incorrect criticality assessment, an inappropriatestrategic plan and the subsequent inefficient resource allocation.

2009 - Ventricular Arrhythmias After Intramyocardial Administration of Mesenchymal Bone Marrow Stem Cells in Acute Myocardial Infarction: An Animal Model [Abstract in Rivista]
Mattioli, Anna Vittoria; Farinetti, Alberto; Lonardi, Roberto; Losi, Lorena; Barbieri, Alberto; Enrico, Giuliani; Mattioli, Giorgio
abstract

Background. Mesenchymal bone marrow derived cells (MSCs) have been shown to home to injured tissue and produce growth factors that aid angiogenesis. We aim to evaluate ventricular premature contractions (VPCs) and mechanical properties of cardiomyocytes after MSC transplantation using the micro-electrical mechanical systems (MEMS) Technology; these tiny microchips implanted in the heart may be used to monitor heart physiology. Methods. An acute myocardial infarction was induced by ligation of anterior coronary artery in New Zealand rabbits, weighting >3 kg (10 min of ischemia followed by reperfusion). MSCs were isolated, cultured and re-suspended in saline for injection. Injections were done at the peri-infarcted areas, in 5 rabbits we injected MSC whereas in 5 control rabbits we injected saline (to evaluate pro-angiogenic effect of intramyocardial injections i.m.). An arrhythmias recorder was located on the animal and the ECG was recorded for 7 days. Animals were sacrificed and histological and morphological analysis was performed.

2008 - Analisi dei cicli atriali durante la fibrillazione atriale persistente e chemioriflesso dopo ripristino del ritmo sinusale con cardioversione elettrica esterna. [Abstract in Atti di Convegno]
Marchetti, G.; Roncuzzi, R.; Zaniboni, A.; Barbieri, Alberto; Vivoli, D.; Urbinati, S.
abstract

...

2008 - Pretreatment with mineralcorticoid receptor antagonist plus beta bllockers and angiotensin converting enzyme inhibitors increase the proportion of patients in sinus rythm after electrical cardioversion for persistent atrial fibrillation and heart failure. [Articolo su rivista]
Marchetti, G.; Roncuzzi, R.; Urbinati, S.; Vivoli, D.; Barbieri, Alberto; Zaniboni, A.
abstract

...

2007 - Identificazione di differenti potenziali d'azione nei cardiomiociti in un modello sperimentale di infarto miocardico: valutazione della componente pro-aritmica indotta da cellule staminali mesenchimali. [Abstract in Rivista]
Mattioli, Anna Vittoria; Farinetti, A.; Barbieri, Alberto; Pinna, M. C.; Mattioli, G.
abstract

...

2007 - Identificazione di differenti potenziali d’azione nei cardiomiociti in un modello sperimentale di infarto miocardico valutazione della componente pro-aritmica indotta da cellule staminali mesenchimali Dati preliminari [Abstract in Rivista]
Mattioli, Anna Vittoria; Farinetti, Alberto; M. C., Pinna; Barbieri, Alberto; Mattioli, Giorgio
abstract

...

2007 - La fibrillazione atriale. strategie di approccio e di trattamento. [Articolo su rivista]
Marchetti, G.; Albertini, G.; Vivoli, D.; Giuliani, E.; Barbieri, Alberto; Lodi, R.
abstract

...

2007 - Tracheostomizzati in terapia intensiva: problematiche e percorsi clinico-organizzativi. [Articolo su rivista]
Barbieri, Alberto; Pinna, C.; Callegaro, A.; Albertini, G.; Molinari, R.
abstract

...

2007 - Valutazione della componente pro-aritmica indotta da cellule staminali mesenchimali mediante identificazione di diversi potenziale d’azione in cardiomiociti in un modello sperimentale di infarto miocardico: dati preliminari [Abstract in Atti di Convegno]
Mattioli, Anna Vittoria; Farinetti, Alberto; M. C., Pinna; Barbieri, Alberto; Mattioli, Giorgio
abstract

..

2007 - Valutazione della componentepro-aritmica indotta da cellule staminali mesenchimali mediante l'identificazione di differenti potenziali d'azione in cardiomiociti in un modello sperimentale di infarto miocardico: dati preliminari. [Abstract in Atti di Convegno]
Mattioli, Anna Vittoria; Farinetti, A.; Barbieri, Alberto; Pinna, M. C.; Mattioli, G.
abstract

...

2006 - Heat wave in Italy and Hyperthermia syndrome [Articolo su rivista]
Barbieri, Alberto; Pinna, C; Fruggeri, L; Biagioni, E; Campagna, A.
abstract

Abstract: In the city of Modena, Italy, daily temperatures registeredduring the year 2003 showed a higher mean increase of 3° C comparedwith the previous three years, with average temperature of26.1° C, compared with 22.8° C. The reported ambient temperaturewas higher than 32.3° C in 84% of the recorded days, and dailyvalues exceeded 35.1° C in 62% of the days. During the summer,four heat waves occurred (June 11–15, July 21–23, August 3–15 andAugust 17–24).Nine patients affected by hyperthermia syndrome with a mean bodytemperature of 41.4 1.3° C were admitted to the Intensive CareUnit (ICU) of the Modena Teaching Hospital. Another patient withsimilar clinical features was not admitted to ICU, but to a generalward, and eventually died a few hours later. Mortality reached 80%and the mean survival time was 4.2 days with median values of oneday. All patients except for one were admitted during one of the fourabove-mentioned heat waves, and in particular, 7 patients were admittedduring the period from August 3rd to 15th. A common featureamong 8 of the 10 patients was the chronic consumption of psychoactivedrugs.According to these observations, it is important to identify a populationat risk in case of bioclimatological alarm, to find preventionstrategies. It is extremely important in patients with hyperthermia tolower body temperature levels in the early hours to influence themalignant evolution of this severe pathologic process.

2006 - Il grave trauma stradale nella provincia di Modena. [Articolo su rivista]
Barbieri, Alberto; Nicolini, M.; Pinna, C.; Pantazopoulos, P.; Ranzi, A.; Lauriola, P.; Rinaldi, G.; Stacca, R.; Vecchi, E.; Trianni, G.
abstract

...

2006 - Preemptive analgesia nell’estrazione dell’ottavo incluso. [Articolo su rivista]
Barbieri, Alberto; Giannetti, Luca; Pinna, Cristina; A., Murri; Piacente, Marco
abstract

Objective: valutare l’effetto della somministrazione preemptive dell’analgesico, nello specifico naprossene sodico a basso dosaggio (220 mg), nell’estrazione dell’ottavo incluso.Material and methods: sono stati studiati 20 pazienti da sottoporre ad estrazione dell’ottavo incluso inferiore bilaterale suddivisi in due gruppi (gruppo 1: 1 compressa di naprossene sodico 220 mg 1 ora prima dell’intervento; gruppo 2: 1 compressa di naprossene sodico 220 mg al termine dell’intervento; gruppi 1 e 2: 1 compressa di naprossene sodico 220 mg dopo 6 e dopo 16 ore dalla fine dell’intervento). La misura del dolore è stata eseguita mediante VAS mentre lo stato psicologico è stato valutato attraverso il Symptom Rating Test.Results: l’elaborazione dei SRTs ha mostrato omogeneità e normalità del campione. Il VAS medio dei due interventi nei tre tempi era di 2.42±1.64, 3.17±1.75 e 2.52±1.51. Il confronto tra i VAS nei soggetti sottoposti a preemptive e i non trattati mostrato una tendenza alla significatività. Nei soggetti sottoposti a tale tecnica nella seconda seduta il confronto è risultato significativo.Conclusions: i VAS medi di tutti i pazienti erano bassi e molto inferiori al limite per eventuali rescue medication; il farmaco impiegato è risultato pertanto efficace ed anche sicuro non essendo stati riscontrati effetti indesiderati. La preemptive analgesia, inoltre, è risultata utile poiché il dolore nei pazienti trattati con essa era inferiore ai non trattati.

2006 - Validità predittiva degli indici prognostici nel grave trauma. [Articolo su rivista]
Barbieri, Alberto; Nicolini, M.; Pinna, C.; Pantazopoulos, P.; Ranzi, A.; Lauriola, P.; Rinaldi, G.; Stacca, R.; Trianni, G.
abstract

...

2005 - Wernicke's encephalopathy in a malnourished surgical patient: Clinical features and magnetic resonance imaging [Articolo su rivista]
Nolli, M.; Barbieri, Alberto; Pinna, C.; Pasetto, A.; Nicosia, F.
abstract

..

2004 - Arresto cardiaco intra-ospedaliero: fattori predittivi di sopravvivenza ed esiti neurologici. [Articolo su rivista]
Fruggeri, L; Bonfreschi, V; Silvestri, A; Barbieri, Alberto; Pasetto, A; Molinari, R.
abstract

...

2004 - Limitations of cardiac risk stratification in vascular surgery. [Articolo su rivista]
A., Rumolo; M., Gargiulo; I., Polverini; Barbieri, Alberto; F., Bursi; Lonardi, Roberto; R., Corradi; Modena, Maria Grazia
abstract

...

2004 - Modifications of plasma concentrations of hormonal and tissue factors during mechanical ventilation with positive end-expiratory pressure. [Articolo su rivista]
Barbieri, Alberto; Siniscalchi, A.; DE PIETRI, L.; Pasetto, A.; Torsello, A.; Nolli, M.
abstract

...

2004 - Sterss nel paziente odontoiatrico [Articolo su rivista]
Barbieri, Alberto; Ghirardini, A. M.; Pinna, C.; Giannetti, L.; Genazzani, Alessandro
abstract

...

2003 - Analisi del ritmo cardiaco. [Articolo su rivista]
Pinna, C; Marchetti, G; Sandroni, C; Barbieri, Alberto
abstract

...

2003 - Aritmie ipercinetiche. [Articolo su rivista]
Barbieri, Alberto; Pinna, C; Mattioli, Anna Vittoria; Sandroni, C.
abstract

...

2003 - GESTIONE DEL PAZIENTE BRADICARDICO IN ANESTESIA E TERAPIA INTENSIVA. [Articolo su rivista]
Sandroni, C; Cavallaro, F; Fenici, P; Barbieri, Alberto; Pinna, C.
abstract

...

2003 - Il Gruppo Interdisciplinare di Sperimentazione della Qualità in Anestesia (GISQuA). Lo sviluppo del Progetto di valutazione dei processi di gestione e di miglioramento continuo della Qualità in Anestesia, Medicina Perioperatoria e Area Critica. [Articolo su rivista]
Barbieri, Alberto
abstract

Il Gruppo Interdisciplinare di Sperimentazione della Qualità in Anestesia (GISQuA). Lo sviluppo del Progetto di valutazione dei processi di gestione e di miglioramento continuo della Qualità in Anestesia, Medicina Perioperatoria e Area Critica.

2003 - Miglioramento della performance cardiaca con farmaci inotropi in pazienti affetti da insufficienza cardiaca durante ventilazione meccanica. [Articolo su rivista]
Mattioli, Anna Vittoria; Barbieri, Alberto; G., Albertini; A. M., Ghirardini
abstract

...

2003 - Trattamento delle aritmie in anestesia e rianimazione. [Articolo su rivista]
Mattioli, Anna Vittoria; Barbieri, Alberto; C., Pinna; C., Sandroni
abstract

...

2002 - Associazione Italiana di Anestesia Odontostomatologica. Gruppo di studio sul dolore acuto postoperatorio in odontostomatologia. Raccomandazioni sulla terapia del dolore acuto postoperatorio in odontostomatologia. [Articolo su rivista]
Barbieri, Alberto
abstract

Raccomandazioni sulla terapia del dolore acuto postoperatorio in odontostomatologia.

2001 - Commentary [Articolo su rivista]
Barbieri, A.
abstract

2001 - Effects of chronic exposure to anaesthetic gases on some immune parameters [Articolo su rivista]
Bargellini, Annalisa; Rovesti, Sergio; Barbieri, Alberto; R., Vivoli; R., Roncaglia; Righi, Elena; Borella, Paola
abstract

A cross-sectional survey was carried out to evaluate the relation between occupational exposure to low levels of anaesthetic gases (nitrous oxide and isoflurane) and immune parameters. Fifty-one anaesthetists were recruited among different Services of Anaesthesiology and Reanimation. The control group consisted of non-exposed physicians, similar for gender, age, and job grade. Total number of lymphocytes, lymphocyte subpopulations and the natural killer (NK) cytotoxic activity were measured. Information on personal and professional characteristics and on short- and long-term exposure was collected. Percentages of T cells (CD3) decreased significantly in anaesthetists compared to controls, whereas numbers of NK cells (CD16(+)CD3(-)) increased. After correction for confounders, short-term (last 2 weeks) exposure was associated with a decrease in percentages of total T and T helper (CD4) cells. Furthermore, T helper percentages were significantly reduced with increasing individual exposure score evaluated on the basis of working days and levels of anaesthetic gases in operating rooms. A significant X-ray-associated increase of numbers and percentages of NK cells was lastly observed. Despite limited present exposure to anaesthetic gases, a specific derangement in lymphocyte subpopulations, with T lymphocytes more affected than B, has been observed.

2001 - Efficacia e sicurezza del trattamento farmacologico della fibrillazione atriale in pazienti in terapia intensiva non coronarica. [Articolo su rivista]
Mattioli, Anna Vittoria; Barbieri, Alberto; Bonatti, S; Collioli, F; Bonetti, L; Mattioli, G.
abstract

...

2001 - Il Clordemetildiazepam per via gastrointestinale, farmaco di scelta nell'ansiolisi del paziente odontoiatrico. [Articolo su rivista]
Marsili, M.; Adrario, E.; Barbieri, Alberto; Berengo, M.; Di Massa, A.; Pagnacco, O.; Bazzato, Mf; Manani, G.
abstract

Il Clordemetildiazepam per via gastrointestinale, farmaco di scelta nell'ansiolisi del paziente odontoiatrico.

2000 - Monitoraggio emodinamico invasivo: cateterismo cardiaco destro. Analisi delle pressioni e misurazioni della gittata cardiaca. [Capitolo/Saggio]
Barbieri, Alberto; Siniscalchi, A; DE PIETRI, L. M.
abstract

Monitoraggio emodinamico invasivo: analisi delle pressioni e misurazione della gittata cardiaca

2000 - Relation between immune variables and burnout in a sample of physicians [Articolo su rivista]
Bargellini, Annalisa; Barbieri, Alberto; Rovesti, Sergio; R., Vivoli; R., Roncaglia; Borella, Paola
abstract

OBJECTIVES: To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables. METHODS: Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures. RESULTS: With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables. CONCLUSIONS: In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.

2000 - Rottura di cuore da trauma toracico. [Articolo su rivista]
Siniscalchi, A; Barbieri, Alberto; DE PIETRI, L; Rossi, Rosario
abstract

...

2000 - Tracheotomia chirurgica in Terapia Intensiva. [Articolo su rivista]
Leonelli, V.; Guasti, G.; Barbieri, Alberto
abstract

BACKGROUND: To test validity, safety, costs and healing-outcome of surgical minitracheotomy after cannula removing. METHODS: Design: Opened, perspective. Site: Polyvalent ICU. Patients: 40 patients underwent surgical minitracheotomy, in a year. Traditional surgical technique was adopted. Minitracheotomy was performed by intravenous general anesthesia with curarization and in mechanical ventilation. Intra-operative monitoring: ECG, non-invasive blood pressure and SaO2 by digital pulse oximetry. If a bleeding appeared, hemorrhage was stopped by vessel binding. RESULTS: Technical difficulty was the same in every tracheotomy carried out. Complications appeared in 7 patients. There were 2 infectious cases for stoma, resolved in 7 and 12 days respectively by local disinfection and antibiotic therapy. There were 5 cases with moderate bleeding; in one patient only a surgical procedure was necessary. CONCLUSIONS: Surgical tracheotomy represents a good and safe method in ICU; complications are few, if safety conditions are observed. Tracheotomy made in ICU reduced the use of medical and paramedical staff and operative rooms; unlike percutaneous procedure, in the surgical technique an always the same set after simple sterilization is used. Healing-outcome of surgical tracheotomy, after cannula removing, is the same with both techniques.

1999 - Aritmie pericolose. [Relazione in Atti di Convegno]
Barbieri, Alberto; Ghirardini, A. M.
abstract

Aritmie Pericolose

1999 - Aspetti epidemiologici del burnout in un campione di medici anestesisti. [Articolo su rivista]
Bargellini, Annalisa; Barbieri, Alberto; Rovesti, Sergio; Vivoli, R.; Borella, Paola
abstract

E’ stata condotta un’indagine trasversale su un gruppo di anestesisti, e per confronto su un gruppo di medici di sanità pubblica, per verificare se lo stress occupazionale misurato con il Maslach Burnout Inventory correla con alcune variabili personali e con la tipologia dell’attività lavorativa. I risultati indicano l’esistenza di un profilo di rischio secondo il quale non essere coniugati, essere di sesso femminile ed espletare mansioni superiori si associa ad un maggior livello di esaurimento emotivo, mentre la depersonalizzazione è correlata alle mansioni e alla tipologia del servizio in cui si opera. Va inoltre sottolineato che elevati livelli di ansietà correlano positivamente con l’esaurimento emotivo e negativamente con la realizzazione personale.

1998 - Detection of viable myocardium: Comparison between dobutamine echocardiography and dobutamine cine magnetic resonance in patients with Q-wave myocardial infarction scheduled for revascularization [Abstract in Rivista]
Modena, Maria Grazia; Rossi, Rosario; Molinari, R; Barbieri, Alberto; Muia, N; Sgura, Fa; Montanari, N; Romagnoli, R.
abstract

Detection of viable myocardium: Comparison between dobutamine echocardiography and dobutamine cine magnetic resonance in patients with Q-wave myocardial infarction scheduled for revascularization

1998 - Influenza della ventilazione con pressioni polmonari positive sui parametri di funzione cardiaca destra in giovani vittime "del sabato sera". [Abstract in Rivista]
Mattioli, Anna Vittoria; TARABINI CASTELLANI, E; Bertoncelli, P; Muja, N; Barbieri, Alberto; Siniscalchi, A; Mattioli, G.
abstract

Influenza della ventilazione con pressioni polmonari positive sui parametri di funzione cardiaca destra in giovani vittime "del sabato sera".

1998 - Terapia farmacologica con inotropi guidata dal monitoraggio emodinamico. [Articolo su rivista]
Barbieri, Alberto; Ghirardini, A. M.
abstract

Terapia farmacologica con inotropi guidata dal monitoraggio emodinamico.

1996 - Trattamento inotropo d'emergenza: valutazione emodinamica. [Articolo su rivista]
Barbieri, Alberto; Ghirardini, Am; Mattioli, Anna Vittoria
abstract

Trattamento inotropo d'emergenza: valutazione emodinamica.

1996 - Valutazione ecocardiografica del trattamento inotropo. [Articolo su rivista]
Mattioli, Anna Vittoria; Casali, E; Barbieri, Alberto
abstract

Valutazione ecocardiografica del trattamento inotropo.

1995 - Livelli plasmatici di beta-endorfine e infarto miocardico acuto. [Abstract in Rivista]
Magnavacchi, P; Bagni, E; Barbieri, Alberto; Petraglia, F; Bompani, B; Accietto, C; Bellesi, P; Fantini, G; Pedrazzini, F.
abstract

Livelli plasmatici di B-endorfine e infarto miocardico acuto

1994 - Insufficienza cardiaca: trattamento farmacologico del deficit meccanico. [Articolo su rivista]
Barbieri, Alberto; Ruini, D; Albertini, G; Salzano, S.
abstract

Insufficienza cardiaca: trattamento farmacologico del deficit meccanico.

1994 - L'anestesia nel paziente con cardiopatia ischemica in chirurgia non cardiaca. Il postoperatorio [Relazione in Atti di Convegno]
Barbieri, Alberto; G., Albertini; Ga, Lagan; G., Marchetti
abstract

L'anestesia nel paziente con cardiopatia ischemica in chirurgia non cardiaca. Il postoperatorio

1994 - THROMBOCYTOPENIA, ANTIPHOSPHOLIPID ANTIBODIES, ASSOCIATED LYNPHOADENOMA (WHARTIN) AND ISCHEMIC ACUTE CORONARY SINDROMES. [Articolo su rivista]
Marchetti, G; Pozzetti, D; Cappelli, S; Martelli, M; Barbieri, Alberto
abstract

THROMBOCYTOPENIA, ANTIPHOSPHOLIPID ANTIBODIES, ASSOCIATED LYNPHOADENOMA (WHARTIN) AND ISCHEMIC ACUTE CORONARY SINDROMES.

1993 - Embolizzazione distale del trombo endoventricolare sinistro con stroke ischemico in corso di trombolisi tardiva nell'infarto miocardico acuto [Abstract in Rivista]
Marchetti, G; Pancaldi, S; Barbieri, Alberto; Rigo, R.
abstract

Embolizzazione distale trombo endoventricolare sinistro con stroke ischemico in corso di trombolisi tardiva nell'infarto miocardico acuto

1993 - Two cases of acute coronary thrombosis with antiplatelet IgM and antiphospholipides antibodies. [Abstract in Rivista]
Marchetti, G; Pozzetti, D; Barbieri, Alberto; Rigo, R.
abstract

Two cases of acute coronary thrombosis with antiplatelet IgM and antiphospholipides antibodies.

1992 - Inibitori delle fosfodiesterasi. [Articolo su rivista]
Barbieri, Alberto
abstract

Inibitori delle fosfodiesterasi

1992 - Postoperative pneumomediastinum. A case report [Articolo su rivista]
Manenti, A.; Barbieri, A.; Buttazzi, A.; Gibertini, G.
abstract

1992 - The experimental systemic perfused lung: histological observations in the dog [Articolo su rivista]
Manenti, Antonio; A. R., Botticelli; A., Rossi; G., Giliberti; Barbieri, Alberto; G., Gibertini
abstract

An experimental model of pulmonary hypertension was obtained in the dog implanting the left main pulmonary artery in the descending thoracic aorta. The main histological lesions consisted in an increased muscularity of the pulmonary artery itself and of its lobar branches.

1992 - Trattamento antalgico post toracotomia: blocco anestetico versus catetere endopleurico. [Abstract in Atti di Convegno]
Briccoli, Antonio; L., Caregnato; Farinetti, Alberto; R., Stacca; Barbieri, Alberto
abstract

...

1991 - AN EMPYEMA AND RUPTURED SUB-DIAPHRAGMATIC ABSCESS [Articolo su rivista]
Manenti, Antonio; Gibertini, G; Buttazzi, A; Barbieri, Alberto
abstract

The authors report a case of a ruptured right subphrenic abscess causing a diffuse peritonitis complicating a chronic empyema. The authors recommend active treatment of purulent pleurisies, particularly when they are associated with a broncho-pleural fistula.

1991 - Brain and Spinal Cord Metabolic Activity during Propofol Anaesthesia [Articolo su rivista]
Cavazzuti, Milena; Porro, Carlo Adolfo; Barbieri, Alberto; G., Galetti
abstract

We have investigated the effects of propofol anaesthesia on the metabolic activity pattern of 35 regions of the rat brain and cervical spinal cord using the 14C-2-deoxyglucose technique. Anaesthesia was produced by an i.v. bolus of the commercial preparation of the drug (8 mg kg-1) and maintained with successive bolus administrations of 6 mg kg-1. Functional activity values (expressed as rates of local utilization of glucose) were reduced in 31 grey matter and two white matter structures in a propofol group relative both to saline-injected and vehicle-injected (aqueous emulsion containing 10% soya bean oil, 1.2% egg phosphatide and 2.25% glycerol) controls. Values from the two control groups did not differ significantly. Propofol-induced depression of metabolic activity was present in central nervous system regions belonging to sensory (auditory, visual and somatosensory), motor and limbic systems, including spinal cord grey matter. Mean percentage decreases ranged from 40% (vestibular nuclei) to 76% (cingulate cortex). Although these values may be slightly overestimated because of the modest increase in PaCo2 in the anaesthetized group, propofol appeared to elicit generalized reduction of central nervous system functional activity.

1990 - La funzione ventricolare sinistra dopo infarto miocardico trattato con urochinasi per via endovenosa. [Abstract in Rivista]
Benenati, Pm; Marchetti, G; Barbieri, Alberto; Menghini, S; Pozzetti, D; Pancaldi, S; Rigo, R.
abstract

La funzione ventricolare sinistra dopo infarto miocardico trattato con urochinasi per via endovenosa.

1990 - Metabolic activity changes in the brain and spinal cord during propofol anesthesia - A comparison with other anesthetic drugs [Articolo su rivista]
Porro, C. A.; Cavazzuti, M.; Bonatesta, P.; Barbieri, A.
abstract

1989 - Analisi della funzione ventricolare sinistra mediante cineangiografia dopo infarto miocardico trattato con trombolisi. [Abstract in Rivista]
Benenati, Pm; Marchetti, G; Barbieri, Alberto; Malavasi, V; Menghini, S; Fini, M; Rigo, R.
abstract

Analisi della funzione ventricolare sinistra mediante cineangiografia dopo infarto miocardico trattato con trombolisi.

1989 - Anestesia generale e beta-bloccanti: esperienza clinica. [Abstract in Rivista]
Piccinini, P; Morselli, L; Mattioli, Anna Vittoria; Barbieri, Alberto
abstract

Anestesia generale e beta-bloccanti: esperienza clinica.

1989 - Aspetti anatomici dell'angina preinfartuale. [Abstract in Rivista]
Barbieri, Alberto; Geraci, C; Zennaro, Rg; Mattioli, G.
abstract

Aspetti anatomici dell'angina preinfartuale.

1989 - Cranial injury in children [Articolo su rivista]
Campisi, M.; Caregnato, L.; Barbieri, A.; Piccinini, P.
abstract

The Authors report personal experience in management of 23 children after severe head injury. All patients were submitted to TC scanning and their performance status was evaluated according to Glasgow Coma Scale (G.C.S.). All children were treated with hyperventilation, steroids, mannitol and, when necessary, Penthobarbital (TPS). Authors present the outcome at a distance of 6 months from trauma's beginning.

1989 - La funzione ventricolare sinistra dopo infarto miocardico (IMA) trattato con trombolisi. [Abstract in Rivista]
Benenati, Pm; Marchetti, G; Menghini, S; Pancaldi, S; Barbieri, Alberto; Rigo, R.
abstract

La funzione ventricolare sinistra dopo infarto miocardico (IMA) trattato con trombolisi.

1989 - Left extrapleural hemothorax from rupture of the subclavian artery. [Articolo su rivista]
Manenti, A; Buttazzi, A; Speranza, M; Barbieri, Alberto
abstract

Left extrapleural hemothorax from rupture of the subclavian artery.

1989 - Nostra esperienza di stimolazione elettrica permanente con VDD monocatetere. [Abstract in Rivista]
Rigo, R; Benenati, Pm; Barbieri, Alberto; Pancaldi, S; Gibertoni, L; Marchetti, G.
abstract

Nostra esperienza di stimolazione elettrica permanente con VDD monocatetere.

1989 - Pazienti con turbe della conduzione ed intervento chirurgico. [Abstract in Rivista]
Mattioli, Anna Vittoria; Barbieri, Alberto; Bettelli, G; Teti, C.
abstract

Pazienti con turbe della conduzione ed intervento chirurgico.

1989 - Stimolazione cardiaca a bassa energia mediante elettrocateteri CapSure a rilascio di steroide: nostra esperienza. [Articolo su rivista]
Rigo, R; Marchetti, G; Benenati, Pm; Barbieri, Alberto; Malavasi, V.
abstract

Stimolazione cardiaca a bassa energia mediante elettrocateteri CapSure a rilascio di steroide: nostra esperienza.

1989 - Transvesical cesarian section [Articolo su rivista]
Manenti, A.; Segre, A.; Barbieri, A.; Arisi, E.
abstract

On the basis of a clinical case the authors report the technique of laparotomic transvesical incision for cesarian section, which, nevertheless, has limited and special indications.

1988 - Cardiomiopatia congestizia: valutazione della capacità di esercizio mediante test a diversa progressione di carico. [Articolo su rivista]
Masciocco, L; Greco, A; Mattioli, Anna Vittoria; Barbieri, Alberto; Mattioli, G.
abstract

Cardiomiopatia congestizia: valutazione della capacità di esercizio mediante test a diversa progressione di carico.

1988 - Modificazioni delle concentrazioni plasmatiche di beta-endorfina e beta-lipotropina in corso di angor. [Abstract in Rivista]
Barbieri, Alberto; Facchinetti, Fabio; Porro, Ca; Genazzani, Ar; Mattioli, G.
abstract

Modificazioni delle concentrazioni plasmatiche di beta-endorfina e beta-lipotropina in corso di angor.

1988 - Treatment of congestive heart failure with oral enoximone. [Articolo su rivista]
Masciocco, L; Cipressi, F; Barbieri, Alberto; Reggiani, S; Mattioli, G.
abstract

Treatment of congestive heart failure with oral enoximone.

1988 - Valutazione del consumo di O2 e EF in pazienti con insufficienza cardiaca congestizia cronica. [Abstract in Rivista]
Masciocco, L; Mattioli, Anna Vittoria; Barbieri, Alberto; Modena, Maria Grazia; Mattioli, G.
abstract

Valutazione consumo 02 e EF in pazienti con insufficienza cardiaca congestizia cronica

1987 - A dose response study of intravenous enoximone in congestive heart failure. [Articolo su rivista]
Erbel, R; Meyer, J; Diefenbach, C; Delorme, G; Bourdarias, Jp; Vernant, P; Lellouche, D; Mattioli, G; Barbieri, Alberto; Install, E; Gonzales, M; Mitrovic, V; Neuzner, J; Salvade, G.
abstract

Abstract Previous clinical studies with intravenous enoximone have used cumulative dosing to quantify enoximone's hemodynamic effects. The magnitude and duration of the hemodynamic effects of single intravenous doses of enoximone were evaluated in patients with congestive heart failure. Sixty patients, who were in New York Heart Association functional classes III and IV, received single intravenous doses of enoximone, either 0.25 (12 patients), 0.5 (13 patients), 1 (14 patients), 1.5 (10 patients) or 2 mg/kg (11 patients). Cardiac index was increased by 20% with the 0.25 mg/kg dose and by 48% and 42% with the 1.5 and 2 mg/kg doses, respectively. These increases were statistically significant (Student's paired t test with Bonferroni's correction, p less than 0.007) for 1 hour after 0.25 and 0.5 mg/kg, for 2 hours after 1 mg/kg and for 4 hours after 1.5 and 2 mg/kg. Enoximone also reduced pulmonary artery diastolic pressure by 19% with 0.25 mg/kg and by 29% with 2 mg/kg. The duration of effect varied from 1 hour with 0.25 mg/kg to 4 hours with 2 mg/kg. Enoximone produced no consistent or dose-related effects on heart rate or blood pressure. Eighteen adverse reactions were reported by 15 patients, of which 11 were minor and transient (vein pain, flushes, nausea). In 5 patients ventricular or supraventricular arrhythmias were observed, including nonsustained ventricular tachycardia and extrasystoles; 3 of these patients had evidence of arrhythmias before enoximone. Laboratory studies before and after treatment showed no drug-related effects. Dose-related effects on the magnitude and duration of hemodynamic responses to intravenous enoximone were evident within the dose range of 0.25 to 2 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

1987 - Assenza di complicanze cardiache nei pazienti portatori di turbe intraventricolari della conduzione sottoposti ad anestesia per intervento chirurgico. [Articolo su rivista]
Mattioli, Anna Vittoria; Barbieri, Alberto; Bettelli, G; Teti, C.
abstract

Assenza di complicanze cardiache nei pazienti portatori di turbe intraventricolari della conduzione sottoposti ad anestesia per intervento chirurgico.

1987 - Valutazione della capacità di esercizio in pazienti con cardiomiopatia congestizia mediante test all'esercizio a diverso carico. [Abstract in Rivista]
Mattioli, Anna Vittoria; Greco, A; Masciocco, L; Barbieri, Alberto; Mattioli, G.
abstract

Valutazione della capacità di esercizio in pazienti con cardiomiopatia congestizia mediante test all'esercizio a diverso carico.

1986 - Trattamento orale a lungo termine con enoximone in pazienti affetti da insufficienza cardiaca congestizia. [Abstract in Rivista]
Reggiani, S; Masciocco, L; Barbieri, Alberto; Ronchetti, E; Mattioli, G.
abstract

Trattamento orale a lungo termine con enoximone in pazienti affetti da insufficienza cardiaca congestizia.

1985 - L'enoximone, una nuova sostanza ad azione inotropa e vasodilatatrice. Effetti emodinamici nell'insufficienza congestizia cronica. [Articolo su rivista]
Mattioli, G; Rigo, R; Barbieri, Alberto
abstract

L'enoximone, una nuova sostanza inotropa vasodilatatrice. Effetti emodinamici nell'insufficienza congestizia cronica