•Inflation targeting was implemented and failed in Argentina in 2016.•Inflation targeting suffered from implementation inconsistencies.•A negative credibility shock accelerated the loss of control of ...the inflation targeting regime.
Argentina’s experience with inflation targeting started in 2016 and ended in 2018, lasting a total of only 25 months. In this paper, we study the reasons why this monetary regime failed in Argentina. We argue that the main reason for its failure was an internal inconsistency in how the central bank implemented inflation targeting, and a negative credibility shock accelerated that said inconsistency in December 2017.
The aim of this study is to compare the accuracy of Airgo™, a non-invasive wearable device that records breath, with respect to a gold standard. In 21 healthy subjects (10 males, 11 females), four ...parameters were recorded for four min at rest and in different positions simultaneously by Airgo™ and SensorMedics 2900 metabolic cart. Then, a cardio-pulmonary exercise test was performed using the Erg 800S cycle ergometer in order to test Airgo™'s accuracy during physical effort. The results reveal that the relative error median percentage of respiratory rate was of 0% for all positions at rest and for different exercise intensities, with interquartile ranges between 3.5 (standing position) and 22.4 (low-intensity exercise) breaths per minute. During exercise, normalized amplitude and ventilation relative error medians highlighted the presence of an error proportional to the volume to be estimated. For increasing intensity levels of exercise, Airgo™'s estimate tended to underestimate the values of the gold standard instrument. In conclusion, the Airgo™ device provides good accuracy and precision in the estimate of respiratory rate (especially at rest), an acceptable estimate of tidal volume and minute ventilation at rest and an underestimation for increasing volumes.
Objectives
To evaluate whether ERAS is feasible and beneficial in elderly patients undergoing VATS lobectomy for lung cancer.
Methods
From February 2016 to March 2019, 182 patients were included into ...a 17-items ERAS pathway. Patients were divided into two groups according to age: Group A (< 75 years) 138 patients and Group B (≥ 75 years) 44 patients. End points were: length of stay (LoS), 30-day morbidity, 90-day mortality, 30-day re-admittance rate, and ERAS–score (number of ERAS objectives achieved).
Results
Elderly patients had significantly more chronic renal failure (
p
= 0.039) and a worse pulmonary function. Mean FEV1% was 101.6% (± 21.0% SD) and 90.8% (± 19.1% SD) and mean FEV1/FVC was 0.75 (± 0.10 SD) and 0.68 (± 0.12 SD) for group A and B, respectively (
p
= 0.02 and
p
= 0.01). Median LoS was longer in Group B (6 days) than in Group A (5 days;
p
= 0.006). Morbidity was higher for elderly patients (A 32.6%
vs
B 56.8%;
p
= 0.007), major complication rates were similar (
p
= 0.782). No post-operative mortality was observed, re-admittance rates were similar (A 7.8% vs B 11.5%;
p
= 0.548). Mean ERAS-scores were 13.8 (± 1.83 SD) for Group A and 13.4 (± 1.98 SD) for Group B (
p
= 0.240). Multivariable analysis showed previous major surgery (
p
= 0.028), COPD (
p
= 0.027), history of arrhythmic disease (
p
= 0.015), post-operative complications (
p
< 0.001), and ERAS-score (
p
< 0.001) as independent predictive factors of LoS, age did not significantly influence LoS.
Conclusions
Elderly patients adhere to an ERAS protocol similarly to younger ones. ERAS pathway in VATS lobectomy patients seems to be beneficial regardless the age.
Purpose
The TNM staging remains the best prognostic descriptor of lung cancer; however, new independent prognostic factors are needed, particularly for early stage disease.
Methods
An evaluation of ...the pleural lavage cytology (PLC) was performed in 436 consecutive NSCLC patients who underwent surgical resection; clinical, pathological and follow-up data were available for 414 patients.
Results
The PLC was positive in 15 patients (3.6 %). The overall five-year survival was 35.9 % in PLC-positive and 57.8 % in PLC-negative patients (
p
= 0.004). To compare groups with the same prognostic characteristics, the analysis was restricted to p-stage I patients, but the survival remained worse in the PLC-positive patients (42.9 vs 69.4 %;
p
= 0.001). Recurrence was also observed more frequently in PLC-positive cases: 69.2 vs 34.5 %, OR 4.28 (95 % CI 1.29–14.18;
p
= 0.01). Among the PLC-positive patients, no difference between the local (44.4 %) and distant (55.6 %) relapse patterns was found (
p
= 0.82). The multivariate analysis identified four independent prognostic factors: age (
p
< 0.001), disease stage (
p
< 0.001), gender (
p
= 0.025) and PLC status (
p
= 0.012).
Conclusions
PLC is an independent prognostic factor for NSCLC. PLC-positive NSCLC patients have a worse overall survival and a higher recurrence rate, even in stage I disease. PLC-positive patients should be considered a high risk category, who should potentially be eligible for adjuvant therapy regardless of their p-stage.
Presentazione del volume M. Guirguis - S. Muscuso - R. Pla Orquín (eds), Cartagine, il Mediterraneo centro-occidentale e la Sardegna. Società, economia e cultura materiale tra Fenici e autoctoni. ...Studi in onore di Piero Bartoloni (Le Monografie della SAIC 3), voll. I-II, Sassari: SAIC Editore, 2020-2021
Objective
To enhance the positive predictive value (PPV) of chest digital tomosynthesis (DTS) in the lung cancer detection with the analysis of radiomics features.
Method
The investigation was ...carried out within the SOS clinical trial (NCT03645018) for lung cancer screening with DTS. Lung nodules were identified by visual analysis and then classified using the diameter and the radiological aspect of the nodule following lung-RADS. Haralick texture features were extracted from the segmented nodules. Both semantic variables and radiomics features were used to build a predictive model using logistic regression on a subset of variables selected with backward feature selection and using two machine learning: a Random Forest and a neural network with the whole subset of variables. The methods were applied to a train set and validated on a test set where diagnostic accuracy metrics were calculated.
Results
Binary visual analysis had a good sensitivity (0.95) but a low PPV (0.14). Lung-RADS classification increased the PPV (0.19) but with an unacceptable low sensitivity (0.65). Logistic regression showed a mildly increased PPV (0.29) but a lower sensitivity (0.20). Random Forest demonstrated a moderate PPV (0.40) but with a low sensitivity (0.30). Neural network demonstrated to be the best predictor with a high PPV (0.95) and a high sensitivity (0.90).
Conclusions
The neural network demonstrated the best PPV. The use of visual analysis along with neural network could help radiologists to reduce the number of false positive in DTS.
Key Points
•
We investigated several approaches to enhance the positive predictive value of chest digital tomosynthesis in the lung cancer detection.
•
Neural network demonstrated to be the best predictor with a nearly perfect PPV.
•
Neural network could help radiologists to reduce the number of false positive in DTS.
With the widespread availability of lung cancer screening programs, the number of small lung nodules requiring histological characterization has dramatically increased. Because computed ...tomography–guided fine-needle aspiration may frequently yield false-negative results, excisional biopsy using thoracoscopy is frequently required. Although thoracoscopic procedure has been known to be ideal for nodule resection, the identification of very small, subsolid and deep pulmonary nodules may still be challenging. Precise lesion localization is a key prerequisite to avoid conversion to an unplanned thoracotomy. In the traditional workflow, the localization procedure is performed in the radiology suite, after which the patient is moved to an operating room. With the availability of hybrid operating rooms, a new approach encompassing simultaneous localization and removal of non-palpable lung nodules has become feasible. In this article, we review the procedural workflow of this new technique and discuss its indications and results.
In potentially resectable non-small cell lung cancer (NSCLC) accurate mediastinal staging is crucial not only to offer the optimal management but also to avoid unnecessary surgery. Mediastinal ...staging is generally performed by the use of imaging techniques (computed tomography and positron emission tomography). However, the accuracy of radiological imaging in mediastinal staging is suboptimal. Therefore, additional invasive mediastinal staging is frequently required to select patients who can benefit from a neoadjuvant treatment. In recent years, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has progressively replaced mediastinoscopy as a test for invasive mediastinal staging. The considerable potential of EBUS-TBNA as minimally invasive staging method has been understood by pulmonologists since the early 2000s but only recently by thoracic surgeons. The clinical impact of this diagnostic technology has been broadly highlighted in the literature and EBUS-TBNA is currently considered the test of first choice in preoperative nodal staging of NSCLC. We analyze the actual role of EBUS-TBNA in invasive mediastinal staging of NSCLC patients from the thoracic surgeon point of view, with particular emphasis on the performance characteristics of this endoscopic diagnostic method as well as its clinical use within the published guidelines.
Objective
We report our experience with simultaneous localization and thoracoscopic removal for nonpalpable undiagnosed pulmonary nodules.
Methods
All patients with nonpalpable lesions requiring ...video-assisted thoracoscopic surgery (VATS) wedge resection underwent localization of the targets and surgical removal in a hybrid operating room. Lesions were considered nonpalpable if they were small (<1 cm), deep (>1 cm from the surface), subsolid, or located within a dystrophic area. In all cases, intraoperative cone-beam computed tomography was performed for nodule localization and targeting, metal hookwires, or coils were alternatively used for intraoperative marking.
Results
From April 2016 to November 2019, 39 image-guided VATS (iVATS) were performed. The mean lesion size was 12 ± 6 mm. The mean distance from the deep edge of the lesion to the pleural surface was 24 ± 9 mm. The localization was performed with 20 hookwires and 19 coils. iVATS localization was successful in 36 patients (92.3%). Thirty-seven wedge resections were completed by VATS, 2 (5%) required conversion to thoracotomy. In 9 patients with intraoperative diagnosis of lung cancer, a lobectomy was performed (7 VATS and 2 thoracotomies). Mean length of iVATS localization was 30 ± 13 minutes. Median postoperative length of stay was 4 days (IQR 3 to 5).
Conclusions
iVATS seems to be a helpful tool for simultaneous localization and removal of nonpalpable nodules. A versatile approach using different devices seems advisable for the removal of targets in every clinical scenario reducing VATS conversion rate. Future research is required to compare iVATS with traditional preoperative localization techniques.
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