New policy challenges from financial integration and deepening in the emerging areas of Asia and Central and Eastern Europe

Since the mid-nineties international financial integration has advanced gradually in the emerging areas of Asia, while it has progressed rapidly in Central and Eastern Europe. This process has helped provide long-term benefits for the economies of the two regions in terms of faster productivity growth and deepening of domestic financial markets. The strong surge of international capital inflows since the early years of the current decade has, however, also potentially increased the financial vulnerability and the external sources of contagion for a number of countries, particularly those in Central and Eastern Europe that have seen a significant increase in their foreign borrowing, and also those with still relatively underdeveloped financial systems. We thus analyze the risks of financial instability and asset bubbles in the emerging economies of the two regions, taking into account the degree of development of their domestic financial systems. We conclude by discussing possible policy responses to these challenges by the monetary authorities of the concerned countries.Asian economies, Central and Eastern European economies, capital markets, international financial integration

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Industrial countries' protectionism with respect to Eastern Europe: the impact of the Association Agreement concluded with the EC on the exports of Poland, Czechoslovakia and Hungary

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EVOLUZIONE ATIPICA DI UN CASO DI LEIOMIOMA METASTATIZZANTE BENIGNO POLMONARE

Scopo del lavoro: descrivere un caso eccezionalmente raro di trasformazione maligna di un leiomioma metastatizzante benigno polmonare (LMB). Materiali e Metodi: una donna di 62 anni, ex-fumatrice, nel marzo 2011 si presenta alla nostra attenzione per il riscontro radiologico (TAC torace) di multipli noduli polmonari bilaterali. Nove anni prima, la paziente era stata sottoposta ad isterectomia per un leiomioma uterino. Una biopsia polmonare permette di porre diagnosi di LMB. Successivamente, si procede all’asportazione chirurgica dei noduli del polmone destro con diagnosi di LMB (Ki67: 1%; positività immunoistochimica per ER e PGR; Fig.1C-D-E). Da settembre 2011 a febbraio 2012, la paziente esegue una terapia con anastrazolo, assistendo tuttavia ad un incremento dei noduli del polmone sinistro. Viene pertanto posta indicazione ad asportazione chirurgica dei noduli polmonari a sinistra, il cui esame sitologico conferma la diagnosi di LMB. In seguito all’ulteriore ricomparsa di noduli polmonari bilaterali, da novembre 2013 a giugno 2014 viene intrapresa una terapia con tamoxifene, risultata anch’essa inefficace. Per questo motivo, nel gennaio 2015 viene nuovamente posta indicazione ad asportazione chirurgica dei noduli del polmone destro. Il decorso post-operatorio risulta regolare e la paziente viene dimessa in V giornata post-operatoria. Risultati: macroscopicamente, i noduli polmonari si presentano a margini lisci, giallo-biancastri e di consistenza teso-elastica (Fig.1A-B). Microscopicamente, si osservano fasci intersecati di cellule fusate, con moderate atipie nucleari, organizzate in un pattern fascicolare (Fig.1F). L’attività mitotica risulta incrementata rispetto alle precedenti lesioni polmonari asportate chirurgicamente tre anni prima (>10 mitosi/10 HPF). Dal punto di vista immunoistochimico, le cellule fusate risultano positive per actina muscolare liscia, desmina e negative per HMB-45, CD34, TTF-1. L’indice di proliferazione Ki67 risuta pari al 20% (Fig.1G). I recettori estrogenici e progestinici risultano debolmente positivi (Fig. 1H). In considerazione dell’attuale quadro istopatologico-immunoistochimico, viene posta diagnosi di leiomiosarcoma a basso grado. A distanza di un anno, la paziente presenta un riscontro TAC torace di noduli polmonari bilaterali. Attualmente risulta in terapia con megestrolo acetato. Conclusioni: il LMB polmonare è una condizione patologica rara riscontrata solitamente in donne con una pregressa storia di leiomioma uterino. La patogenesi non è ancora ben definita. Sebbene le caratteristiche istopatologiche depongono per una natura benigna, il suo comportamento biologico suggerisce un certo grado di malignità. Il decorso è tipicamente indolente e la terapia medica o chirurgica risulta spesso risolutiva. Una regressione parziale o totale può avvenire in età menopausale. Sebbene eccezionale, l’evoluzione verso un leiomiosarcoma a basso grado dovrebbe essere considerata nella storia naturale della malattia

Primary Pulmonary Large Cell Carcinoma with Syncytiotrophoblastic Aspect: Report of a Case

BACKGROUND: To present the case of a primary large cell lung carcinoma with syncytiotrophoblastic aspect. METHODS: A 54-year-old smoking man (60 pack/years), with no significant past medical history, presented for incidental radiological finding of a 5cm mass in the right middle lobe with partial invasion of the lower lobe (Fig.1). A PET/CT-scan showed a unique intense FDG-uptake of the pulmonary mass. A trans-thoracic fine-needle aspiration led to the diagnosis of non-small-cell lung cancer with sarcomatoid features. Preoperative cardiac and pulmonary function tests were normal. RESULTS: The patient underwent a right middle lobectomy and wedge resection of the lower lobe and radical lymphadenectomy through a posterolateral thoracotomy. The postoperative course was uneventful; the patient was discharged on the seventh postoperative day. After 52 months the patient is alive and disease-free. Macroscopically, the mass measured 5.5cm, had a greyish colour with lobulated margins. Microscopically, a poor differentiated tumor characterized by giant and medium pleomorphic cells sometimes with syncytial-trophoblastic features were observed (Fig.2a). Immunohistochemically, tumor cells were positive for beta-human-chorionic-gonadotrophin (Beta-HCG) (Fig.2b), anti-endomisium antibody (EMA), placental alkaline phosphatase (PLAP) e cytokeratin 7 (CK 7); the cells resulted negative for octamer-binding transcription factor-4 (OCT-4) (Fig.2c), spalt like transcription factor 4 (SALL4) (Fig.2d) and glypican-3. A subsequent genital examination and testicular ultrasonography excluded the presence of a primary gonadal choriocarcinoma. Beta-HCG serum levels were undetectable after surgery. Based on the above findings, a diagnosis of primary large cell lung carcinoma with syncytiotrophoblastic aspect was made. Final pathological stage was pT2aN0M0. No adjuvant therapy was proposed. CONCLUSION: Large cell lung carcinoma with syncytiotrophoblastic aspect is an extremely rare finding. The prognosis is usually poor irrespective of the treatment; a few long-term survivors have been reported