Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus.

Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice.

Synthesis of Brominated Lactones Related to Mycalin A: Selective Antiproliferative Activity on Metastatic Melanoma Cells and Inhibition of the Cell Migration.

Starting from D-xylonolactone and D-ribonolactone, several five-membered bromolactones, related to the C1-C5 portion of mycalin A lactone, have been synthesized. The bromination of D-ribonolactone with HBr/AcOH, without a subsequent transesterification step, has been studied for the first time, giving us most of the acetylated lactones investigated in the present study. For each compound, where possible, both the C-3 alcohol and the corresponding acetate were prepared. Evaluation of their anti-tumor activity showed that all the acetates possess a good cytotoxicity towards human melanoma (A375), human cervical adenocarcinoma (HeLa) and human metastatic melanoma (WM266) cancer cells, comparable or even higher than that displayed by the original mycalin A lactone. Lactone acetates derived from D-ribonolactone showed the higher selectivity of action, exhibiting a strong cytotoxicity on all the tested tumor cells but only a limited toxicity on healthy human dermal fibroblast (HDF) cells, used as a control. Wound healing assays showed that two of these substances inhibit the migration of the WM266 cells.

Synthetic approaches for accessing rare-earth analogues of UiO-66.

Rare-earth (RE) analogues of UiO-66 with non-functionalised 1,4-benzenedicarboxylate linkers are synthesised for the first time, and a series of synthetic approaches is provided to troubleshoot the synthesis. RE-UiO-66 analogues are fully characterised, and demonstrate a high degree of crystallinity, high surface area and thermal stability, consistent with the UiO-66 archetype.

A historical perspective on porphyrin-based metal-organic frameworks and their applications.

Porphyrins are important molecules widely found in nature in the form of enzyme active sites and visible light absorption units. Recent interest in using these functional molecules as building blocks for the construction of metal-organic frameworks (MOFs) have rapidly increased due to the ease in which the locations of, and the distances between, the porphyrin units can be controlled in these porous crystalline materials. Porphyrin-based MOFs with atomically precise structures provide an ideal platform for the investigation of their structure-function relationships in the solid state without compromising accessibility to the inherent properties of the porphyrin building blocks. This review will provide a historical overview of the development and applications of porphyrin-based MOFs from early studies focused on design and structures, to recent efforts on their utilization in biomimetic catalysis, photocatalysis, electrocatalysis, sensing, and biomedical applications.

The "Lazio Network" experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program. A collective database with 1200 patients in 2016-2017.

AIM: Enhanced Recovery After Surgery (ERAS) guidelines represent one of the most important steps forward in colorectal surgery in the last ten years. Despite the well-known and demonstrated positive impact on the clinical outcomes that this pathway provides, a cultural revolution in patient management is needed. This is not easy to obtain, especially in small and peripheral centers. In Italy, the diffusion of minimally invasive surgery and "fast-track" perioperative management of the patient is rapidly spreading, even in the central and southern regions. However, in these regions, the percentage of laparoscopic colorectal procedures is dramatically less than in the north of Italy. In this context, the idea of a research group based in Rome focused on the development and spreading of ERAS protocols in the Lazio Region was developed. METHODS: A research group, based in Rome, was founded in December 2016 to evaluate the diffusion of the ERAS program over the main colorectal centers of the region. This "Lazio Network" began with a group of surgeons and anesthesiologists from 5 hospitals. After one and half years, the project now includes 17 hospitals in the region. A multicenter database was created, including consecutive patients who underwent laparoscopic colorectal resection following the ERAS program in the participating centers between January 2016 and December 2017. RESULTS: Data for more than 1200 patients were collected over the observed period. The rate of minimally invasive surgery was higher compared to the regional rate (90% vs. 30%), adherence to the ERAS pathway was around 60% of the items per patient. A clinical study will result from this database. The objective is to evaluate the mean number of ERAS items applied, the most common and uncommon items applied and the influence of this application on the clinical outcomes. CONCLUSIONS: The adoption of the ERAS program is rapidly increasing even in central Italian regions, even though the total rate of minimally invasive surgery procedures still low. Benefits in terms of clinical outcomes will be evaluated from the analysis of a multi-center database of patients treated between January 2016 and December 2017, including more than 1200 patients. KEY WORDS: Coloretal surgery, ERAS guidelines, Fast track surgery.

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study.

INTRODUCTION: During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients. METHODS: This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts. RESULTS: High initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=-1.26, 95% CI -1.57 to -0.95; p<0.001) and foam swabs (mean change=-1.28, 95% CI -1.54 to -1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=-0.92; 95% CI -1.19 to -0.64; p<0.001) and foam swabs (mean change=-0.85; 95% CI -1.10 to -0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104 colony-forming units (CFUs); minimum to maximum (-2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (-3.1×1010 CFUs, 3.0×107 CFUs)). CONCLUSIONS: Patients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation. TRIAL REGISTRATION NUMBER: NCT01154257; Pre-results.

Normal distribution of an intravascular ultrasound index of vessel remodeling.

BACKGROUND: As a consequence of plaque accumulation, coronary arteries may undergo both compensatory enlargement and paradoxical constriction. The aim of this study was to address the distribution of the different remodeling patterns in patients with obstructive coronary atherosclerosis. METHODS: Eighty-seven non-branching segments of native coronary arteries with de novo, focal, non-ostial lesions were imaged at intravascular ultrasound (IVUS). Images were acquired with a motorized pull-back at a speed of 0.5 mm/s. The cross-sectional area (CSA) circumscribed by the external elastic membrane (EEM), the plaque + media complex and the lumen area were measured at its narrowest site (CSA with the minimal lumen area) and in the reference segment (average of proximal and distal reference cross-sections, defined as the most normal looking sites). The IVUS index of vessel remodeling (VRI) was calculated using the following formula: (narrowest site EEM CSA--reference EEM CSA)/reference EEM CSA*100. The index was tested for normality using the Kolmogorov-Smirnov goodness-of-fit test. RESULTS: The frequency distribution of VRI was found to have a normal unimodal distribution (p = 0.60). VRI ranged from -60 to +164, with a mean of 9.3 +/- 28.0 and a median of 3.6. Frequency distribution of VRI slightly skewed towards right (skewness index 1.69). None of the analyzed clinical and morphological variables predicted the presence of compensatory enlargement as opposed to paradoxical constriction. CONCLUSIONS: The frequency distribution of the vascular remodeling of de novo coronary lesions is unimodal. Therefore, compensatory enlargement and paradoxical constriction represent the extremes of a continuous spectrum.