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Background and Objective: Case reports have suggested that continuous positive airway pressure (CPAP) telemonitoring can detect the onset of acute cardiac events such as decompensated heart failure (HF) or atrial fibrillation through an increase in the apnoea-hypopnoea index (AHI) and onset of Cheyne-Stokes Respiration (CSR). This study addressed whether long-term remote CPAP treatment telemonitoring revealing CSR can help detect serious cardiac events (SCEs) in obstructive sleep apnoea (OSA) patients., Methods: This monocentric prospective cohort study included adults receiving CPAP therapy for OSA with daily telemonitoring. Any sudden increase in AHI generated an alert for the home healthcare provider to download CPAP data to identify CSR. A medical consultation was scheduled if CSR was detected., Results: We included 555 adults (412 men; 57% with known cardiovascular comorbidities). During the 1-year follow-up, 78 CSR episodes were detected in 74 patients (CSR+). The main conditions associated with incident CSR were HF (24 patients [30.8%]), ventilatory instability (21, 26.9%), leaks (13, 16.7%), medications inducing central apnoeas (baclofen, ticagrelor, opioids) (7, 9.0%), arrhythmias (6, 7.7%) and renal failure (2, 2.6%). Fifteen (20.3%) CSR+ patients had a confirmed SCE. In univariable analysis, a CSR episode increased the risk of an SCE by 13.8-fold (5.7-35.6) (p < 0.0001), with an adjusted OR of 5.7 (2.0-16.8) in multivariable analysis., Conclusion: Long-term telemonitoring of patients on CPAP treatment can alert CSR episodes and allows early detection of SCEs in patients with or without known cardiac comorbidities., (© 2021 Asian Pacific Society of Respirology.)

Over the last 30 years, structural reinforcement and retrofitting with externally bonded composite materials have proven to be efficient and cost-effective solutions to increase both the safety and the lifespan of civil engineering structures, including nuclear power plants. The effectiveness of the strengthening system highly depends on the level of adhesion between the fiber-reinforced polymer (FRP) composite material and the concrete surface. Therefore, on-site evaluation of the bond quality is critical to assess the performance and predict the durability of the system in place. The direct tension pull-off test is most commonly used to quantify the adhesion level, but this standardized method has many drawbacks. In the present study, it is proposed to evaluate the bond properties by using a nondestructive test (NDT) derived from the standard pull-off test. This innovative test enables the measurement of an interfacial "stiffness" which may be used as a bond quality criterion. This paper gives an insight into the performance of the proposed NDT method, when applied in laboratory conditions to concrete slabs reinforced with bonded pultruded carbon FRP plates (CFRP). Three different epoxy adhesive systems with a broad range of Young's moduli were used for the specimens' preparation, in order to vary the stiffness of the concrete/CFRP interface. The purpose was to simulate different levels of interfacial adhesion that could be observed for a single adhesive system. It was shown that the test method was able to detect differences in the interface stiffness beyond experimental uncertainties, and it should therefore enable the detection of differences in the bond quality for a given adhesive system as well. The sensitivity of the NDT was then discussed, and its detection capabilities were predicted for standard field conditions. In the last part, strain measurements were collected during the NDT, thanks to distributed optical fiber sensors (DOFS) embedded in the adhesive joints of the strengthened specimens. An analysis of the strain profiles was found to provide complementary information on the quality of the adhesive bond.

The present study investigated the strain response of a distributed optical fiber sensor (DOFS) sealed in a groove at the surface of a concrete structure using a polymer adhesive and aimed to identify optimal conditions for crack monitoring. A finite element model (FEM) was first proposed to describe the strain transfer process between the host structure and the DOFS core, highlighting the influence of the adhesive stiffness. In a second part, mechanical tests were conducted on concrete specimens instrumented with DOFS bonded/sealed using several adhesives exhibiting a broad stiffness range. Distributed strain profiles were then collected with an interrogation unit based on Rayleigh backscattering. These experiments showed that strain measurements provided by DOFS were consistent with those from conventional sensors and confirmed that bonding DOFS to the concrete structure using soft adhesives allowed to mitigate the amplitude of local strain peaks induced by crack openings, which may prevent the sensor from early breakage. Finally, the FEM was generalized to describe the strain response of bonded DOFS in the presence of crack and an analytical expression relating DOFS peak strain to the crack opening was proposed, which is valid in the domain of elastic behavior of materials and interfaces., Competing Interests: The authors declare no conflicts of interest.

We report 5 cases of sarcoidosis in 4 men and 1 woman who presented multinodular pulmonary lesions. Seldom described (1 to 4% of all cases of sarcoidosis), a multinodular pulmonary presentation is suggestive of metastatic disease. In our patients, the parenchymal opacities were multiple, peripheral and exhibited fuzzy limits, measuring 1 to 7 cm in size and frequently associated with mediastinal adenopathies. The radiographic pattern contrasted with the clinical manifestations (3 of the 5 cases were fortuitous discoveries). Pathological proof required to rule out other disease, especially tumor formation, was acquired; mediastinoscopy allowing the diagnosis in 3 out of 5 cases. The clinical course was favorable in all cases without treatment within 8 +/- 5 months and a mean follow-up of 5 years (range 9 months to 14 years).

There are different causes leading to formation of pulmonary bullae, in particular tuberculosis. There is some debate concerning the pathophysiology of bullae extension although two mechanisms are put forward: partial obstruction of the airways and elastic recoil of adjacent lung parenchyma with a negative pressure in the bullae. Pulmonary function tests are highly perturbed in patients with giant bullae. The natural history of bullae is enlargement although spontaneous regression is rarely described. Bullae should be resected in selected patients, others require careful follow-up. We present the case of a man with tuberculosis who developed a giant pulmonary bulla that regressed spontaneously in a few years.

We report a case of pulmonary carcinosarcoma. Surgery is required for this rare mixed type, biphasic tumor. It is generally considered to be a malignant formation issuing from a single cell line but with a two-way differentiation into epithelial and conjunctive components. There is a differentiation continuum between spindle-cell carcinomas (also called monophasic sarcomatoid carcinoma) and carcinosarcoma (or biphasic sarcomatoid carcinoma) leading to debate concerning the immunohistochemical and ultrastructural features.

Examination of the equilibria of the standard two-locus two-allele selection model leads to the construction of a polynomial with coefficients derived from selective values in the genotypic fitness matrix. This polynomial can be partially factored algebraically and numerical techniques are available to extract the roots of the remainder. Each root provides a possible value of the disequilibrium coefficient and the gametic frequencies at equilibrium, and these can be readily checked for stability.

The preliminary results of our experience with the "inverted" subxiphoid approach for 2D echocardiographic visualisation of patent ductus arteriosus (PDA) in premature neonates and infants are reported. Eight premature ventilated neonates weighting 870 to 1,200 g with an isolated PDA were examined by this technique using a mechanical sector scanner and a 7.5 MHz transducer; three views were obtained (left ventricular outflow tract or "long axis"; an oblique view through the two atria and aortic arch; short axis view of the ventricles). A PDA was directly visualised in 6 of the 8 patients. It was possible to measure its diameter and observe its tortuous or rectilinear trajectory; the outcome of Indomethacin therapy or surgical ligature could also be evaluated. In the 2 patients in whom the PDA was not visualised, there were no clinical symptoms or echocardiographic signs of shunt: these PDA were therefore probably extremely small. In the neonate and infant, it is relatively easy to demonstrate a PDA by this approach. The PDA can also be followed up in "ductus dependent" congenital heart disease during treatment with Prostaglandin E. In conclusion, the subxiphoid approach represents an interesting alternative for the visualisation of PDA, especially in premature neonates in whom the suprasternal and parasternal views are often difficult to obtain.

Two coronary artery anomalies associated with the Williams-Beuren syndrome are reported. The first case was a 14 year old child with severe supra-aortic stenosis associated with severe hypoplasia of the ascending aorta; 2 D echocardiography and angiography showed a voluminous aneurysm of the left main coronary artery. Aortoplasty with a patch gave a good early result. The second case was a two and a half months old baby operated as an emergency after cardiac arrest and who died at the end of surgery. The baby had severe supra-aortic stenosis, occlusion of the left coronary ostium by the left anterior cusp which was abnormally adherent to the aortic wall with subendocardial infarction and reaction fibroelastosis. The frequency of coronary anomalies associated with the Williams-Beuren syndrome is probably underestimated. Because of their severity they must be looked for routinely, by echocardiography and angiography. Their tendency to progress is an indication for early surgical correction of severe supra-aortic stenosis.