Machine learning in lung transplantation: Where are we?

Lung transplantation has been accepted as a viable treatment for end-stage respiratory failure. While regression models continue to be a standard approach for attempting to predict patients' outcomes after lung transplantation, more sophisticated supervised machine learning (ML) techniques are being developed and show encouraging results. Transplant clinicians could utilize ML as a decision-support tool in a variety of situations (e.g. waiting list mortality, donor selection, immunosuppression, rejection prediction). Although for some topics ML is at an advanced stage of research (i.e. imaging and pathology) there are certain topics in lung transplantation that needs to be aware of the benefits it could provide.

Non-invasive ventilation: a safe and effective respiratory support method in hypoxemic acute respiratory failure due to pneumonia with or without acute respiratory distress syndrome.

INTRODUCTION: The benefit of non-invasive ventilation (NIV) in cases of hypercapnic acute respiratory failure (ARF) has already been proven. Still, its safety and efficacy as a respiratory support method for patients with hypoxemic ARF hasn't been studied so well. AIM: The aim of our study was to examine the safety and efficacy of NIV in hypoxemic ARF of primary lung origin. MATERIALS AND METHODS: This was a prospective observational cohort study of patients with hypoxemic ARF due to communityacquired pneumonia with or without acute respiratory distress syndrome (ARDS) treated using NIV. They were divided into four groups: pneumonia without ARDS, mild, moderate, or severe ARDS. Their clinical and ABG parameters were recorded before initiation of NIV, at 1 hour and 24 hours after ventilation onset and at transition to non-intensive NIV or before endotracheal intubation in NIV failure cases. RESULTS: A total of 63 patients were included. NIV trial was successful in 85.71% of them, while 14.29% experienced NIV failure. In the general population, we observed a significant difference in PaO2/FiO2 only before transition to non-intensive NIV in comparison to the value at admission. This trend was seen in the patients with pneumonia without ARDS and moderate ARDS, but not in those with mild and severe ARDS. The clinical parameters showed improvement early in the course of treatment both in the entire study population and all subgroups. CONCLUSIONS: NIV is an effective and safe option for respiratory support in patients with severe CAP only when an adequate etiological treatment has been applied.

Low density polyethylene degradation by filamentous fungi.

Polyethylene (PE) is the most abundant non-degradable plastic waste, posing a constant and serious threat to the whole ecosystem. In the present study, the fungal community of plastic wastes contaminating a landfill soil has been studied. After 6 months of enrichment, 95 fungi were isolated, mostly belonging to the Ascomycota phylum. They were screened under in vitro condition: most of fungi (97%) were capable of growing in the presence of PE powder (5-10 g L-1) as sole carbon source. Fusarium strains better tolerated high concentration of PE. Up to 13 strains were chosen for further degradation trails, where the process was monitored by respirometry tests and by observing changes in PE chemical and physical structure by FTIR analysis and SEM images. Major results were observed for Fusarium oxysporum, Fusarium falciforme and Purpureocillum lilacinum, as they caused strong oxidation phenomena and changes in the PE film morphology. Results suggested that the initial oxidation mechanisms targeted first the methyl terminal groups. Changes in the infrared spectra were strongly strain-dependent, denoting the activation of different degradation pathways. Through the SEM analysis, the actual damages provoked by fungi were observed, including swellings, pits and furrows, bumps and partial exfoliations. Considering the rising concern about plastic disposal worldwide, the ability of these fungi to colonize PE and utilize it as carbon source is of great interest, as no pretreatments and pro-oxidant stimulants were needed.

COVID-19 and gastrointestinal injury: a brief systematic review and data from Bulgaria.

In December 2019, a new Coronavirus (SARS-CoV-2) emerged in China, causing the pandemic disease COVID-19. The clinical presentation is variable, but the predominant symptoms are those of the upper respiratory tract. AIM: The aim of the current study is to describe the incidence and type of the gastrointestinal injury (GI) in COVID-19, as well as their prognostic value. MATERIALS AND METHODS: We conducted a coincidental search on this topic in PubMed, Web of Science and EMBASE. We also followed a group of 31 Bulgarian COVID-19 patients throughout the course of their disease and analyzed their symptoms (catarrhal and other) and outcome. RESULTS: The publications concerning our survey followed a total of 1509 COVID-19 patients. In the Bulgarian cohort, only 14 from the 31 patients were laboratory-confirmed COVID-19 cases. Approximately 1/3 of the infected individuals presented with GI. In some patients this was the first, or only, symptom of the disease. It was also indicative of a more severe disease course. CONCLUSION: GI may be an important symptom and prognostic factor in COVID-19. Therefore, patients with acute gastrointestinal symptoms must be actively tested for SARS-CoV-2.

Nanomembrane-Based Therapeutic Plasmapheresis after Non-Invasive Ventilation Failure for Treatment of a Patient with Acute Respiratory Distress Syndrome and Myasthenia Gravis: A Case Report.

Acute respiratory distress syndrome (ARDS) is characterized by a widespread inflammation of the lungs, causing severe hypoxemia. Several mediators have been associated with it and almost all of them are small enough to be filtrated through a nanomembrane. We present a case report of a 41-year-old man with myasthenia gravis in remission; he developed ARDS caused by pneumonia. Although he performed well on both non-invasive and invasive mechanical ventilation, his oxygenation continued to deteriorate. As a last resort of treatment, we decided to apply nanomembrane-based apheresis to cleanse his plasma from the harmful inflammatory mediators. After 3 sessions of plasmapheresis, his condition improved and he was successfully weaned from mechanical ventilation. The obtained results gave us ground to assume that the removal of bioactive molecules can be a useful adjunct to protective mechanical ventilation in ARDS.