Definition of the Snoring Episode Index Based on the Analyses of Snoring Parameters and the Apnea Hypopnea Index

Objective Although snoring is the most common subjective symptom in obstructive sleep apnea (OSA), an international consensus on the definition of snoring is lacking. This study aimed to define snoring by analyzing correlations between snoring parameters and the apnea hypopnea index (AHI). Methods We retrospectively analyzed the polysomnography data of patients with OSA. A snoring event was defined when airflow pressure was >200 microbar. We included four snoring parameters. Snoring percentage was defined as the cumulative time of snoring events divided by total sleep time. A snoring episode was defined as the occurrence of ≥3 consecutive snoring events, and the snoring episode index was defined as the number of snoring episodes per hour. The average and longest durations of snoring episodes were also investigated. Results The study enrolled 5,035 patients. Their mean AHI was 26.5/h and the mean snoring episode index was 19.2/h. Although the four snoring parameters showed significant correlations with the AHI, the snoring episode index showed the strongest positive correlation with the AHI (r = 0.741, P < 0.001). Conclusion The snoring episode index may be used as a definition of snoring from the perspective of a highly positive correlation with the AHI.

QOLP-09. AUTONOMY DURATION AS ANALYZED BY KPS ≥ 70 CUMULATIVE TIME IN PATIENTS WITH BIOPSY-ONLY GLIOBLASTOMA (BO-GBM). A SUB-ANALYSIS OF THE TIMONE COHORT

BACKGROUND Maintenance of autonomy is a crucial and understudied issue for glioblastoma patients whose outcome is poor. Biopsy-only glioblastoma (BO-GBM) present with short survival and independence is of particular importance. Our objective was to explore their functional outcome. MATERIAL AND METHODS A regional glioma SIRIC cohort was conducted at CHU Timone in 2014-2017 and we retrospectively reviewed the BO-GBM subgroup. We prospectively collected age, tumoral surface, treatment allocated and completed, and survival outcome. Functional independence was analyzed as a cumulative time of Karnofsky performance status (KPS) ≥ 70 from the date of diagnosis until death. We analyzed potential factors associated to time with KPS ≥ 70. RESULTS Among 535 patients enrolled in the cohort, surgery was restricted to biopsy in 139 patients (BO-GBM). Mean tumoral surface measured on gadolinium-enhanced T1-weighted MRI was 1198 mm2 (min: 65; max: 4515mm2). Forty-seven patients were referred to radiotherapy-temozolomide (RT-TMZ), 75 considered unfitted for RT received chemotherapy upfront (CT-UF), and 17 patients were referred to palliative care. Median OS was 7.5 months (95%CI: 6.0-9.2), 14.0 months (95%CI: 9.7-18.7) and 6.0 months (95%CI: 4.6-7.7) for BO-GBM, RT-TMZ and CT-UF respectively. At diagnosis, 81 (58.3%) patients presented with self-care capacity (KPS ≥ 70%). For these patients, median time of autonomy preservation was 7.6 months (95%CI: 6.1-9.0). Median time of autonomy preservation differed according to treatment modalities: it was 8.6 months (95%CI: 5.9-11.3) versus 6.3 months (95%CI: 2.9-9.7) for RT-TMZ versus CT-UF group respectively (p&lt; 0.001). In multivariate analysis, time with KPS ≥ 70 was correlated with age (p=0.001) and KPS at diagnosis (p&lt; 0.001). CONCLUSION Patients with inoperable GBM referred to radiotherapy-temozolomide present a valuable duration of functional independence, although shorter in patients not referred to RT. Duration of functional independence could be considered in addition to PFS and OS for treatment evaluation in patients with GBM.

P11.04 Autonomy duration as analyzed by KPS≥70 cumulative time in patients with biopsy-only glioblastoma (BO-GBM). A sub-analysis of the Timone cohort

BACKGROUND Improvement or maintenance of autonomy is a crucial and understudied issue for glioblastoma (GBM) patients whose outcome is poor. Biopsy-only GBM (BO-GBM) is a situation where survival is short and independence is of particular importance. Our objective was to explore functional outcome in biopsy-only patients. MATERIAL AND METHODS A regional glioma SIRIC cohort was conducted at CHU Timone in 2014–2017 and we retrospectively reviewed the BO-GBM subgroup. We prospectively collected age, corticosteroid dose, tumoral surface, treatment allocated and completed, and survival outcome. Functional independence was analyzed as a cumulative time of Karnofsky performance status (KPS) ≥70 from the date of diagnosis until death. We analyzed potential factors associated to time with KPS ≥70. RESULTS Among 535 patients enrolled in the cohort, surgery was restricted to biopsy in 139 patients (BO-GBM). Mean tumoral surface measured on gadolinium-enhanced T1-weighted MRI was 1198mm2 (min: 65; max: 4515mm2). Mean steroid dose at diagnosis was 50mg prednisolone per day. Corticosteroid dose was ≥50mg prednisolone per day for 77 patients and &lt;50mg per day for 56 patients. Fifty-four patients (39%) were referred to radiotherapy-temozolomide (RT-TMZ), 68 (49%) considered unfitted for RT received chemotherapy upfront only (CT-UF), and 17 patients (12%) were referred to palliative care only. Median overall survival (OS) was 7.5 months (95%CI: 6.0–9.2), 14.0 months (95%CI: 9.7–18.7) and 6.0 months (95%CI: 4.6–7.7) for BO-GBM, RT-TMZ and CT-UF respectively. At diagnosis, 81 (58.3%) patients presented with self-care capacity (KPS ≥ 70%). For these patients, median time of autonomy preservation was 7.6 months (95%CI: 6.1–9.0). Median time of autonomy preservation differed according to treatment modalities: it was 8.6 months (95%CI: 5.9–11.3) versus 6.3 months (95%CI: 2.9–9.7) for RT-TMZ versus CT-UF group respectively (p&lt;0.001). In univariate analysis, time with KPS ≥ 70% was correlated with age (p=0.001), initial KPS (p&lt;0.001), tumoral surface measured on gadolinium-enhanced T1-weighted MRI (p=0.03) and corticosteroid dose (p=0.001). In multivariate analysis, time with KPS≥70 was correlated with age (p=0.001) and KPS at diagnosis (p&lt;0.001). CONCLUSION Patients with inoperable GBM referred to radiotherapy-temozolomide present a valuable duration of functional independence, although shorter in patients not referred to RT. Duration of functional independence could be considered in addition to PFS and OS for treatment evaluation in patients with GBM.

Hypothyroidism and risks of cerebrovascular complications among patients with head and neck cancer after radiotherapy

Background Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear. Methods Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to > 50 % stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group. Results 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement. Conclusions Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

Hypothyroidism and Risks of Cerebrovascular Complications Among Patients with Head and Neck Cancer After Radiotherapy

Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

Lifetime testing of a flexure based natural gas fired 1 kW thermoacoustic genset

Etalim has developed and lifetime tested a flexure-based thermoacoustic (TAC) genset operating at high pressure and frequency. It is an efficient and practical 1 kWe genset ready for deployment as a genset or a micro-cogeneration system when integrated with a recuperated natural gas burner and stroke controlling power electronics. It is a maintenancefree, extreme reliability genset particularly suited for remote power applications. The genset is fully costed and designed for manufacturing. Fuel-to-electric efficiency of 22% has been achieved, and one remaining avenue for significant improvement identified. A test TAC has been run for a cumulative time of about 8000 hours to date without any component failures.

Frailty Severity and Hospitalization After Dialysis Initiation

Background: Frailty is associated with hospitalization and mortality among dialysis patients. To now, few studies have considered the degree of frailty as a predictor of hospitalization. Objective: We evaluated whether frailty severity was associated with hospitalization after dialysis initiation. Design: Retrolective cohort study. Setting: Nova Scotia, Canada. Patients: Consecutive adult, chronic dialysis patients who initiated dialysis from January 1, 2009 to June 30, 2014, (last follow-up June, 2015). Methods: Frailty Severity, as determined by the 7-point Clinical Frailty Scale (CFS, ranging from 1 = very fit to 7 = severely frail), was measured at dialysis initiation and treated as continuous and in categories (CFS scores of 1-3, 4/5, and 6/7). Hospitalization was characterized by cumulative time admitted to hospital (proportion of days admitted/time at risk) and by the joint risk of hospitalization and death. Time at risk included time in hospital after dialysis initiation and patients were followed until transplantation or death. Results: Of 647 patients (mean age: 62 ± 15), 564 (87%) had CFS scores. The mean CFS score was 4 (“corresponding to “vulnerable”) ± 2 (“well” to “moderately frail”). In an adjusted negative binomial regression model, moderate-severely frail patients (CFS 6/7) had a >2-fold increased risk of cumulative time admitted to hospital compared to the lowest CFS category (IRR = 2.18, 95% confidence interval [CI] = 1.31-3.63). In the joint model, moderate-severely frail patients had a 61% increase in the relative hazard for hospitalization (hazard ratio [HR] = 1.61, 95% CI = 1.29-2.02) and a 93% increase in the relative hazard for death compared to the lowest CFS category (HR = 1.93, 95% CI = 1.16-3.22). Limitations: Potential unknown confounders may have affected the association between frailty severity and hospitalization given observational study design. The CFS is subjective and different clinicians may grade frailty severity differently or misclassify patients on the basis of limited availability. Conclusions: Among incident dialysis patients, a higher frailty severity as defined by the CFS is associated with both an increased risk of cumulative time admitted to hospital and joint risk of hospitalization and death.

Hypothyroidism and Risks of Cerebrovascular Complications Among Patients with Head and Neck Cancer After Radiotherapy

Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

Recovery Efficiency of an Aquifer Storage and Recovery (ASR) Experiment from Saline Aquifer under Controlled Conditions

Present work was carried out in an experimental model developed at the institute, sand was used as prototype artificial aquifer and was saturated with highly saline water having Electrical Conductivity (EC) equal to 8500 µS/cm. Fresh water with average EC = 467.50 µS/cm and temperature = 25oC was injected in the known amount in the saline water and this water was extracted at a fixed time interval of 1, 1.5, 2, 2.5, 3, 3.5, 4, 4, 8 24, 48, 72, 96, 120, 144, and 168 hours in a cumulative time of 735.30 hours with average recovery efficiency of 63%. Recovered water has salinity equal to or less than 1000 µS/cm. Although, this experiment was carried out at a small scale but this can be tried at a bigger scale for skillfully managing the surface or reclaimed water in problematic areas where demand exceeds the supply.

PATHOGENICITY OF BACTERIA ENTEROBACTERIACEAE ON ZEBRAFISH AS ANIMAL MODEL

Enterobacteriaceae are Gram negative bacteria contain endotoxin and exotoxins which are requirements for pathogenic bacteria and act as opportunistic pathogens. The purpose of this research was to determine the ability of Enterobacteriaceae bacteria to infect zebrafish (Danio rerio) by observing anatomical pathology, mortality, time death and cumulative time of death. The method used in this research is a completely randomized design method (CRD). This research was conducted in three stages, first preparation of zebrasfish as animal model by average size 3-5cm and reach three months old. Second, bacterial cultures from 10 species of Enterobacteriaceae were Escherichia coli 1, E. coli 2, Enterobacter cloacae 1, Acinetobacter calcoaceticus, Enterobacter amnigenus 1, Enterobacter amnigenus 1, Escherichia coli 3, Pantoea spp., E. cloacae 1, E. cloacae 2, E. cloacae 3, cultured in Brain Heart Infused Broth (BHIB) and later media washed with Phospate Buffer Saline (PBS) 0.45%. The third stage was bacterial infection to zebrafish using immersion method with each treatment repeated 3 times and observed for 120 hours. The results showed 10 species that used caused death (mortality), the highest mortality in fish that infected with E. coli 2 and E. cloacae 1 with a percentage of 66.67% infected by E. coli 2 and E. cloacae 1. Anatomical pathology in the external organs and internal organs showed post-infectious symptoms. Infection occurred with mean time to death of 12-86 hours, as long as the cumulative time of fish death caused by E. coli 2, A.cinetobacter calcoaceticus and E. cloacae 1 causing death from 24 hours after infection until the end of observation.