How Titanic continues to change the future: machine learning in respiratory practice

The application of artificial intelligence (AI) in all fields and in medicine in particular is gaining more and more popularity. Machine learning (ML) is part of AI, in which computers use statistical methods for self-learning without being explicitly programmed to do so. The challenge Titanic: Machine Learning from Disaster is probably the most popular among researchers entering the field of artificial intelligence and machine learning.In almost all cases, ML goes through several successive stages: definition of the problem, data gathering, data preparation, exploratory analysis, feature engineering; model creation, and model evaluation. The following manuscript briefly describes each of them. With their help, a model for the challenge "Titanic: Machine Learning from Disaster" was created. This model outperformed most of the models featured in the competition. It achieved a 99.8% better result than the other models presented.Machine learning could improve the accuracy of different models with the same data (equal start). In this way, proper data processing could lead to higher accuracy, which in medicine translates into improved clinically significant endpoints.

Resection and a rare type of reconstruction of the superior vena cava with the left brachiocephalic vein

Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed

European Respiratory Society International Congress 2017:highlights from the Clinical Assembly

This article contains highlights and a selection of the scientific advances from the European Respiratory Society's Clinical Assembly (Assembly 1 and its six respective groups) that were presented at the 2017 European Respiratory Society International Congress in Milan, Italy. The most relevant topics from each of the groups will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data as well as award-winning abstracts and highlight sessions will be discusse

MS in COPD

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Endobronchial Ultrasound Transbronchial Needle Aspiration for the Diagnosis of Paratracheal and Peribronchial Central Parenchymal Lesions

Objectives: Obtaining qualitative, sufficient material for the diagnosis of malignancies in cases with normal endoscopic findings in patients with suspected lung cancer and hilar and mediastinal lymphadenopathy is challenging.Materials and methods: Endobronchial ultrasound (EBUS) was used to control a transbronchial needle biopsy (ТBNA) for the first time in our country. From 2015 to 2018, TBNA with a convex probe EBUS was performed on 57 patients [41 men, 16 women, mean age 56.10 (range 37-77 years)] with mediastinal lesions found on CT scan. We used the Hitachi Aloka - ProSound Alpha 7 and BF-UC180F (Olympus) 21G and 22G needles Ultrasound System. In 22 of the cases, we performed a biopsy of hilum lesions (9 on the left and 13 on the right), in 13 - of subcarinal lesions, and in 4 - of lesions located on the right paratracheal lymphatic chain. Results: EBUS-TBNA confirmed lung cancer in 48 patients (84.2%). In 33 of them, it was non-small cell lung cancer: spinocellular in 13 cases and adenocarcinoma in 17 cases; three cases were without accurate verification. Small cell lung cancer was found in 15 cases. In two cases, the biopsies were negative for tumor (3.5%), and in seven - non-specific inflammatory process (12.3%). Conclusions: This study confirms the high diagnostic success rate of EBUS-TBNA reported in similar studies developed on a daily routine basis without adhering to a specific protocol. EBUS-TBNA is an interventional procedure with high sensitivity in diagnosing hilar and mediastinal lesions in negative conventional bronchoscopy and thus is useful in patients with paratracheal and peribronchial lesions. The results could be improved with training and experience

Two cases with postintubation tracheal stenosis after COVID-19 pneumonia

Only a small percent of all intubated SARS-CoV-2-positive patients survive because of the development of severe respiratory and multiorgan failure. The development of tracheal stenosis after orotracheal intubation or tracheostomy is a dangerous complication with gross consequences for the patient and medical staff. Endoscopic interventional procedures could be used in simple tracheal stenosis and surgical resection and anastomosis are reserved for complex stenosis or after unsuccessful endoscopic treatment. We present two cases with tracheal stenosis as a complication of prolonged intubation in COVID-19 survivors which was diagnosed up to 6 months after discharge. Clinical management and surgical techniques are also discussed

Resection and a rare type of reconstruction of the superior vena cava with the left brachiocephalic vein

Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed

Development of organized pleural empyema as a result of occult foreign body aspiration

Foreign body (FB) aspiration is a rare incident in adults. Many patients cannot recall the episode of aspiration and are hospitalized with complications of an endobronchial FB. We present a case with right-sided chronic pleural empyema, ineffectively treated in another hospital with chest drainage, uniportal VATS, and insertion of five chest drains as a result of occult foreign body aspiration. Endoscopic extirpation of a foreign body in the right lower lobar bronchus was performed. Right posterolateral thoracotomy, decortication, and pleurectomy were performed because of a trapped right lung. Preoperative bronchoscopy is recommended in all patients with pleural empyema before surgery. When chest drainage and VATS are unsuccessful in expanding the lung in chronic empyema then thoracotomy, debridement, pleurectomy, and decortication are indicated

A metachronous second primary lung cancer after laryngectomy for laryngeal carcinoma

A combination of laryngeal carcinoma and subsequent primary lung cancer is rare yet important in terms of therapeutic strategy and prognosis. We present a case of primary squamous cell laryngeal carcinoma treated with laryngectomy and chemoradiation therapy. One year later, the patient developed metachronous squamous cell carcinoma of the lung and underwent left pneumonectomy. A second primary lung cancer after laryngeal cancer presents a significant challenge for surgeons, oncologists, and radiotherapists. The differentiation between lung metastasis and primary lung cancer is of paramount importance for the correct therapeutic strategy and prognosis

Epidemiology, Etiology and Prevention of Postpneumonectomy Pleural Empyema

Background: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge.Materials and methods: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention.Results: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications.Conclusion: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications