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Sleep is defined as unconsciousness from which the person can be aroused by sensory or other stimuli. Long-term consequences of sleep deprivation increased the risk of hypertension, diabetes mellitus, obesity, heart failure, stroke, memory impairment as well as depression. Obesity is one of the factors that affect sleep quality. Obesity is associated with sleep quality through its effect of causing obstructive sleep apneu (OSA), increased proinflammatory cytokins and gastrointestinal disorders. This study aims to analyze the correlation between body mass index and waist circumference with the quality of sleep of the pre-clinical students of the Mulawarman University, Faculty of Medicine. This research is an observational analytic study with a cross-sectional approach. Sleep quality data were collected using the PSQI questionare while body mass index and waist circumference data were collected by measuring body height using microtoise, body weight using a weighing scale and waist circumference using an anthropometric band. The result showed that 81.2% of respondents had poor sleep quality, 28.2% of respondents with obesity category and 35.9% of respondents who had central obesity. The result of hypothesis testing using chi square showed that both body mass index and waist curcumference had a significant relationship with sleep quality (p=0.046 and p=0.027).

Insomnia is difficulty starting or maintaining sleep. There are several factors that are considered to be able to trigger and perpetuate insomnia, one of which is the sleep hygiene, which is included in the moderation factor. However, there is some controversy regarding the involvement of insufficient sleep hygiene towards insomnia. This study aims to determine the effect of sleep hygiene attitudes on the incidence of insomnia and a description of the incidence of insomnia and sleep hygiene in Mulawarman University students. The design of this study was observational analytic with a cross-sectional method, which consisted of 140 Mulawarman University students from 14 faculties. The sampling technique used is consecutive sampling. The data taken is primary data in 14 faculties of Mulawarman University. The research instrument used was the Insomnia Rating Scale questionnaire from the Kelompok Studi Psikiatri Biologi Jakarta and the Sleep Hygiene Index. The results of the study used the Chi-Square test and the Kolmogorov-Smirnov test obtained p value> 0.005. Based on the degree of insomnia, found 65% of respondents suffer from mild insomnia. The frequency of the sexes of women who suffer from insomnia more than men. Based on the degree of sleep hygiene attitudes, it was found that 78.6% of respondents had moderate sleep hygiene attitudes. This study concluded that there was no effect of sleep hygiene attitudes on the incidence of insomnia in Mulawarman University students.

Introduction: The purpose of these case reports was to evaluate the thickness of the lower anterior alveolar trough in patients with tongue thrusting habit. Materials and Methods: Lateral cephalogram and CBCT was evaluated in these patients. Result: Both lateral cephalogram and CBCT confirmed reduced thickness of anterior trough in patients with tongue thrust habit. Conclusion: Depending on the thickness of the alveolar bone, the extend of lower incisor retraction could be evaluated. Keywords: Tongue, alveolar trough, Lateral cephalogram, CBCT.

Background Urinalysis data in preclinical toxicology studies can be influenced by preanalytic and analytic factors which have the potential to confound interpretation. There is a paucity of information regarding positive reagent strip urinary blood reactions in healthy nonhuman primates (NHP) and Beagle dogs used in preclinical toxicology studies. Objectives The objectives were (1) to establish historical control data for reagent strip urinary blood reactions in healthy NHP and Beagle dogs, (2) to determine the incidence of positive urinary blood reactions during predose and dosing phases, and (3) to determine if collection practice was a relevant parameter. Methods Historical control data from 2 institutions in the biopharmaceutical industry were retrospectively analyzed for reagent strip urinary blood reactions in healthy NHP and Beagles. The incidence of positive results between the 2 institutions with different urine collection practices and between males and females was compared. Results The incidence of positive urinary blood reactions in NHP was comparable between institutions (≤ 14% in males; ≤ 33% in females), while the incidence of positive urinary blood reactions in Beagles was more variable (≤ 77% in males; ≤ 69% in females), and higher in females during the dosing phase. Conclusions Positive urinary blood results that could potentially be misinterpreted as toxicologically relevant were identified in healthy NHP and Beagles during predose and dosing phases. Different incidences of positive results between the 2 institutions were likely related to collection practices. Strategies to reduce feces and food contamination of collected urine samples should help minimize false-positive urinary blood reactions.

The recent arrival of Drosophila suzukii, an invasive pest of soft-skinned fruit with a wide host range, has resulted in increased production costs for growers and the need for additional insecticide applications each growing season. There are few effective organic insecticides for D. suzukii, and insecticide use in conventional farms may be disruptive to natural enemies, suggesting a need for effective biological control to combat D. suzukii. Commercially available natural enemies were evaluated for their potential use in augmentative releases, including: the predators Orius insidiosus and Dalotia coriaria; the entomopathogenic fungi Metarhizium anisopliae, Beauveria bassiana and Paecilomyces fumosoroseus; and the entomopathogenic nematodes Heterorhabditis bacteriophora, Steinernema feltiae and S. carpocapsae. This suite of natural enemies was chosen to target D. suzukii adults as well as larvae in hanging or dropped fruit. Of the cultured fungal strains tested, only M. anisopliae significantly decreased D. suzukii survival, but it had low residual activity and no effect on D. suzukii fecundity. O. insidiosus decreased D. suzukii survival in simple laboratory arenas but not on potted blueberries or bagged blueberry branches outdoors. D. coriaria did not decrease D. suzukii survival in infested blueberries in simple laboratory arenas. The nematodes tested showed low infection rates and were not able to affect D. suzukii survival. Although this suite of natural enemies showed limited ability to suppress D. suzukii under the tested conditions, these and related natural enemies are present as part of the endemic natural enemy community in agricultural fields, where they may contribute to D. suzukii suppression.

BACKGROUND: The spotted wing Drosophila, Drosophila suzukii (Matsumura, 1931) (Diptera: Drosophilidae), is an invasive pest of small-fruit crops. Unlike most other Drosophila, this insect is able to oviposit into and damage ripe and ripening fruit, making it unmarketable. Because this is a new pest in the United States, it is necessary to identify registered insecticides to manage this insect effectively in conventional and organic production systems. RESULTS: The present laboratory bioassays and field trials identified a number of insecticides representing various modes of action that are effective in controlling D. suzukii. Products that performed well in the laboratory bioassay also performed well in the field, indicating that screening of new chemistries in the laboratory is a worthy exercise. Field application of pyrethoids, organophosphates or spinosyns provided 5–14 days of residual control of D. suzukii. The efficacy of the neonicotinoids as adulticides was not satisfactory compared with the other contact-mode-of-action chemistries. Based on the zero tolerance by the small-fruit industry and the individual effects mentioned above, neonicotinoids are not currently recommended for D. suzukii management. CONCLUSIONS: There are effective insecticides registered for controlling D. suzukii infestations in susceptible small-fruit crops. Copyright © 2011 Society of Chemical Industry

Spotted wing drosophila, Drosophila suzukii Matsumura, a native of eastern and southeastern Asia, is a pest of small and stone fruits. First detected in California in 2008, the insect is now found across the Pacific Coast states. Its penchant for attacking healthy, ripening fruit (as opposed to overripe and rotting fruit favored by other so-called “vinegar flies”) makes it a potential economic threat to a host of soft- and thin-skinned fruit crops including cherry, raspberry, blackberry, blueberry, strawberry, peach, plums, pluots, nectarines, juice grape, table grape, and wine grape. Coordinated research projects to determine host preference, seasonal phenology, biology, and management options are taking place among entomologists in Washington, Oregon, and California. A description of the pest and initial findings on its biology, life history, known and expected geographic range, management and monitoring techniques, and economic considerations are presented and discussed.

Microprocessor-controlled knee joints appeared on the market a decade ago. These joints are more sophisticated and more expensive than mechanical ones. The literature is contradictory regarding changes in gait and balance when using these sophisticated devices.This study employed a crossover design to assess the comparative performance of a passive mechanical knee prosthesis compared to a microprocessor-controlled knee joint in 15 subjects with an above-knee amputation. Objective measurements of gait and balance were obtained.Subjects demonstrated significantly improved gait characteristics after receiving the microprocessor-controlled prosthetic knee joint (p0.01). Improvements in gait were a transition from a hyperextended knee to a flexed knee during loading response which resulted in a change from an internal knee flexor moment to a knee extensor moment. The participants' balance also improved (p0.01). All conditions of the Sensory Organization Test (SOT) demonstrated improvements in equilibrium score. The composite score also increased.Transfemoral amputees using a microprocessor-controlled knee have significant improvements in gait and balance.

Background. Walking is a widely used approach to increase physical activity levels in obese patients. In this paper, we investigate the precision and accuracy of an ankle-worn dual-axis accelerometer (Stepwatch) and investigate its potential application as a predictor of energy expenditure. Methods. Twenty healthy subjects (10 lean, 10 obese) wore spring-levered (Accusplit), piezoelectric (Omron HF-100), and Stepwatch pedometers. Subjects walked on a treadmill at 1, 2, and 3 mph and in a hallway at 1 and 1.85 mph, during which energy expenditure was measured. Results. The Stepwatch counted 99.7 ± 0.67% (mean ± SEM) of the manual counts. In comparison, the Omron pedometer counted 61 ± 3.3% and the Accusplit counted 26 ± 2.8% of the manual counts at 1 mph although all pedometers were accurate (> 98% of counts) at 3 mph. In repeated measures, the Stepwatch produced negligible variance (SD = 0.36) over all speed whereas the other pedometers showed a large amount of variance at all speed (SD = 4–13). Stepwatch counts were predictive of walking energy expenditure corrected by weight (r2 > 0.8). Conclusion. The counts from the Stepwatch were virtually identical to the manual counts from a trained investigator and provided a reliable predictor of walking energy expenditure.

The purpose of this study was to quantify electromyographic (EMG) activity in the immobilized shoulder girdle musculature at rest and during a battery of contralateral upper limb activities. Six asymptomatic men, aged 22 to 33 years, volunteered to participate. Fine-wire (supraspinatus, infraspinatus) and surface (deltoids, trapezii, biceps, serratus anterior) electrodes recorded the mean peak normalized (percent maximal voluntary contraction [%MVC]) EMG activity from each immobilized muscle at rest and during slow, fast, and incrementally resisted contralateral upper limb motions (5, 15, and 25 lb). EMG activity in all muscles was low during quiet immobilized standing (1.5% maximal voluntary contraction [MVC]). During slow contralateral upper limb motions, activity ranged from 0.7% to 51.6% MVC (highest in trapezii) and was less than 15% MVC in the supraspinatus, infraspinatus, and anterior deltoid. Bimanual jar opening increased biceps activity from 7.8% to 16.1% MVC. During fast contralateral upper limb motions, peak infraspinatus activity increased to 56.7% during a fast straightforward reach. Supraspinatus activity was relatively high during all resisted backward-pulling motions (25.2%-32.1% MVC), whereas resisted forward reaching produced relatively little activity in the anterior deltoid, supraspinatus, infraspinatus, or biceps. Several slow and fast motions produced high trapezius activity (45% MVC) with low supraspinatus, biceps, and anterior deltoid activities (10% MVC). Our findings suggest that (1) immobilized shoulder girdle muscle EMG activity during quiet standing is negligible in asymptomatic individuals; (2) contralateral upper limb motions at self-selected speeds are not likely to be harmful to healing tissues; (3) during early healing periods, patients with biceps-labral injury should minimize bimanual activities, those with supraspinatus injury should avoid backward-pulling motions, and those with infraspinatus injury should avoid fast straightforward reaches; and (4) cross-body, straightforward, or downward reaches at either a slow or fast speed may be appropriately prescribed as rehabilitative exercises that can be initiated while the shoulder remains immobilized.

Smith J, Padgett DJ, Kaufman KR, Harrington SP, An K-N, Irby SE. Rhomboid muscle electromyography activity during 3 different manual muscle tests. Arch Phys Med Rehabil 2004;85:987–92. Objective To determine which of 3 previously published rhomboid manual muscle tests (MMTs) elicits the maximal rhomboid electromyographic activity in an asymptomatic population. Design Criterion standard. Setting Motion analysis laboratory at tertiary care medical center. Participants Eleven male volunteers (age range, 24–40y) without shoulder or neck pain. Interventions Not applicable. Main outcome measures Peak 1-second normalized electromyographic activity in the rhomboid muscle during 8 different MMT positions, including 3 different rhomboid MMT positions (Kendall, Kendall-Alternative, Hislop-Montgomery). Results The Kendall MMT (78% maximal voluntary contraction [MVC]) produced higher rhomboid electromyographic activity than the Kendall-Alternative (71% MVC) or the Hislop-Montgomery MMT (52% MVC), but the differences were not statistically significant. The posterior deltoid MMT generated the greatest rhomboid electromyographic activity of all MMTs, and 4% to 30% greater rhomboid electromyographic activity than the 3 rhomboid MMTs ( P =.0001; posterior deltoid > Hislop-Montgomery). Electromyographic profiles of the Kendall and Kendall-Alternative MMTs were similar, whereas the Hislop-Montgomery MMT produced less upper trapezius activity ( P =.0001 vs Kendall and Kendall-Alternative) and more latissimus dorsi activity ( P =.0001 vs Kendall-Alternative). The standard MMT positions for the middle trapezius, levator scapula, posterior deltoid, and latissimus dorsi produced the maximal electromyographic activity for their respective target muscles. Conclusions The posterior deltoid MMT position should be used to produce maximal rhomboid electromyographic activity for normalization purposes during kinesiologic studies. The Kendall and Kendall-Alternative rhomboid MMT are likely to be clinically indistinct. It is unlikely that clinicians can use standard MMT positions to distinguish rhomboid strength from synergists, such as the levator scapula and middle trapezius muscle, for diagnostic purposes.

Reconstruction after the resection of pelvic tumors is a major challenge. It depends on many factors such as age, activity level, type of tumor, its adjuvant treatment, and the extent of the disease. The purpose of the current study was to analyze the functional and oncologic outcomes of patients who had an iliofemoral arthrodesis after resection of a pelvic sarcoma. Between 1981 and 1999, 20 males and 12 females with a mean age of 39.9 years (range, 10-71 years) had an iliofemoral arthrodesis, either as a solid fusion or primary pseudarthrosis, at one institution. The functional outcome was evaluated using the Musculoskeletal Tumor Society and the Toronto Extremity Salvage scores. At a mean followup of 97 months (range, 14-226 months), 15 of 32 patients were alive, all without disease. The radiographic union rate was 86%. The mean overall Musculoskeletal Tumor Society and Toronto Extremity Salvage scores were 64% and 48%, respectively. Patients with a primary solid fusion did functionally better compared with patients who had pseudarthrosis (Toronto Extremity Salvage Score, 76%; Musculoskeletal Tumor Society Score, 71% versus Toronto Extremity Salvage Score, 52%; Musculoskeletal Tumor Society Score, 25%). Biomechanical analysis showed that the loss of motion in the hip is well-compensated. The authors conclude from this series that iliofemoral reconstruction after resection of a pelvic sarcoma provides acceptable and durable long-term results, not only from the oncologic, but also from the functional perspective.

In August 2008, the first detection of the spotted wing drosophila, Drosophila suzukii, to the North America mainland in California caused great concern, as the fly was found infesting a variety of commercial fruits. Subsequent detections followed in Oregon, Washington, Florida and British Columbia in 2009; in Utah, North Carolina, South Carolina, Michigan, and Louisiana in 2010; and in Virginia, Montana, Wisconsin, Pennsylvania, New Jersey, Maryland and Mexico in 2011. In Europe, it has been detected in Italy and Spain in 2009 and in France in 2010. Economic costs to the grower from D. suzukii include the increased cost of production (increased labor and materials for chemical inputs, monitoring and other management tools) and crop loss. An effective response to the invasion of D. suzukii requires proper taxonomic identification at the initial phase, understanding basic biology and phenology, developing management tools, transferring information and technology quickly to user groups, andevaluatingtheimpactoftheresearchandextensionprogramonaneconomic,social,andenvironmentallevel.AsD.suzukii continues to expand its range, steps mustbe initiated in each new region to educate and inform the public as well as formulate managementtactics suitable for the crops and growing conditions in each. c � 2011 Society of Chemical Industry

This Phase III randomized trial examined efficacy and safety of a novel once-daily extended-release tacrolimus formulation (LCP-Tacro [LCPT]) versus twice-daily tacrolimus in de novo kidney transplantation. Primary efficacy end point was proportion of patients with treatment failure (death, graft failure, biopsy-proven acute rejection or lost to follow-up) within 12 months. Starting doses were, LCPT: 0.17 mg/kg/day and tacrolimus twice-daily: 0.1 mg/kg/day; 543 patients were randomized, LCPT: n = 268; tacrolimus twice-daily: n = 275. At 12 months treatment failure was LCPT: 18.3% and tacrolimus twice-daily: 19.6%; the upper 95% CI of the treatment difference was +5.27%, below the predefined +10% noninferiority criteria. There were no significant differences in the incidence of individual efficacy events or adverse events. Target tacrolimus trough levels were more rapidly achieved in the LCPT group. Following initial dose, 36.6% of patients in the LCPT group had rapidly attained trough levels within 6-11 ng/mL versus 18.5% of tacrolimus twice-daily patients; majority of tacrolimus twice-daily patients (74.7%) had troughs

Scapular position has been hypothesized to influence rotator cuff function, but no current methods exist to reliably measure shoulder rotation strength in different scapular positions. The purpose of this study was to develop a reliable technique to measure isokinetic (ISOK) and isometric (ISOM) shoulder rotation strength with the scapula protracted. Ten healthy volunteers (5 male, 5 female, ages 20-41) completed two to three ISOM and five ISOK (90 degrees/second) internal rotation (IR) and external rotation (ER) repetitions in a position of scapular protraction with the shoulder abducted 45 degrees in the scapular plane. Subjects returned 24-72 hours later to repeat testing. All torque measurements in the protracted position exhibited excellent intersession reliability (ICCs > 0.97). Shoulder rotational torque can be measured in the protracted scapula position with excellent reliability using the new technique described. Establishing the reliability of the protracted technique is a necessary prerequisite for the completion of future studies examining quantitative differences in rotational torque generation between the neutral and protracted scapula positions in the functional shoulder position of 45 degrees of scapular plane abduction.

Invasive cytology of the thoracic and abdominal cavities can provide diagnostic information in a timely manner for the practitioner. The information depends on obtaining a quality sample followed by thorough cytologic evaluation. As an adjunct to the historical and clinical information, cytology is valuable in establishing a diagnosis or a list of differentials and directing future diagnostics or therapy. The application of cytology of internal organs opens a new window for the differential diagnosis of disease.

Kaufman KR, Levine JA, Brey RH, McCrady SK, Padgett DJ, Joyner MJ. Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Objective To quantify the energy efficiency of locomotion and free-living physical activity energy expenditure of transfemoral amputees using a mechanical and microprocessor-controlled prosthetic knee. Design Repeated-measures design to evaluate comparative functional outcomes. Setting Exercise physiology laboratory and community free-living environment. Participants Subjects (N=15; 12 men, 3 women; age, 42±9y; range, 26–57y) with transfemoral amputation. Intervention Research participants were long-term users of a mechanical prosthesis (20±10y as an amputee; range, 3–36y). They were fitted with a microprocessor-controlled knee prosthesis and allowed to acclimate (mean time, 18±8wk) before being retested. Main Outcome Measures Objective measurements of energy efficiency and total daily energy expenditure were obtained. The Prosthetic Evaluation Questionnaire was used to gather subjective feedback from the participants. Results Subjects demonstrated significantly increased physical activity–related energy expenditure levels in the participant's free-living environment ( P =.04) after wearing the microprocessor-controlled prosthetic knee joint. There was no significant difference in the energy efficiency of walking ( P =.34). When using the microprocessor-controlled knee, the subjects expressed increased satisfaction in their daily lives ( P =.02). Conclusions People ambulating with a microprocessor-controlled knee significantly increased their physical activity during daily life, outside the laboratory setting, and expressed an increased quality of life.

A dog with severe cholestasis secondary to chronic hepatitis was treated with ursodeoxycholic acid (UDCA) PO. After 2 weeks of daily treatment, the dog was more active and had an improved appetite. Monthly serum biochemical determinations and analysis of individual bile acid profiles documented improvement in hepatobiliary tests and a marked reduction in the concentrations of potentially hepatotoxic endogenous bile acids. These effects were maintained for approximately 6 months. The findings in this dog are similar to those reported for human patients treated with UDCA and provide preliminary evidence in support of its continued evaluation in the treatment of cholestatic liver disease in the dog.

UNLABELLED Functional outcomes of patients with arthrodesis after resection of a shoulder girdle neoplasm are only sparsely reported. Fusion of the shoulder can be done as a primary reconstruction or secondarily for salvage of a failed limb-sparing procedure. We retrospectively reviewed 21 patients at a mean followup of 11 years. In eight patients, arthrodesis was done as the primary reconstruction and in 13 patients as the secondary procedure. There were no local recurrences, and no patient had metastatic disease develop. The overall Toronto extremity salvage and Musculoskeletal Tumor Society scores were 81% (range, 46-97) and 23 points (range, 17-26), respectively. There was no difference with respect to function between patients who had their arthrodesis as a primary or secondary procedure. Eight of 21 patients (43%) had a complication that required major surgical intervention. Shoulder arthrodesis as a limb salvage procedure after tumor resection provides good function independent of whether the procedure is done primarily or secondarily. Because of the high complication rate, future efforts must be directed at surgical methods to decrease such complications. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines to Authors for a complete description of levels of evidence.

OSI-211 (liposomal lurtotecan), was evaluated using several different dose schedules (1mg/kg, d1-5, 1.75 mg/kg d1, 3, 5 and 6 mg/kg d1, 8) in severe combined immunodeficient (SCID) mouse models of acute myelogenous leukemia (AML) and acute lymphocytic leukemia (ALL) with early treatment (ET, days 6-8) or late treatment (LT, days 15-19), examining early and advanced disease, respectively. Due to the aggressive nature of the Molt-4 model, the ET and LT were accelerated to day 3 or 4 and day 8 post-implant, respectively. For each model, 2 x 10(7) (KBM-3B) or 1 x 10(7) (Molt-4, HL-60 and CEM) leukemia cells were injected intravenously into the tail vein. Each control and test group consisted of eight animals. All three schedules (1mg/kg qd1-5, 1.75 mg/kg d1, 3, 5 and 6 mg/kg d1, 8) increased the life span of OSI-211 treated animals in each model, with a tendency toward improved efficacy with the 6 mg/kg d1, 8 schedule. As a result, the activity of the 6 mg/kg d1, 8 schedule is detailed for each model. ET significantly (P0.005) increased survival in the KBM-3B model with 86% long-term survivors (LTS). Using PRC analysis, human beta-globin gene sequences in one or several tissues were amplified in all but 3 LTS, suggesting minimal residual disease in 26 of the 29 LTS. LT also significantly (P0.005) improved average life span in the KBM-3B model, with an average ILS=196+/-11% and one LTS. Treatment of HL-60 leukemia animals significantly (P0.005) increased life span, with an ILS=213+/-9% and two LTS for ET, and with an ILS=219+/-4% and no LTS for LT. Treatment of Molt-4 animals, the most aggressive leukemia model tested, significantly (P0.005) increased life span, with an average ILS=181+/-3% and no LTS for ET and an average ILS=172+/-1% with no LTS for LT. In the CEM model, ET resulted in a significantly (P0.005) improved ILS=244+/-24% with one LTS. In comparison to OSI-211, treatment with DaunoXome, the liposomal formulation of daunorubicin, a drug with clinical efficacy in AML and ALL, had no effect on survival in the KBM-3B, nor Molt-4 A4 leukemia models when administered at its maximum or near maximum tolerated doses of 3mg/kg d1, 8. These data demonstrate that OSI-211 has potent antileukemia activity in preclinical SCID mouse AML and ALL leukemia models, supporting the clinical investigation of OSI-211 for hematological malignancies.

We investigated the correlation between trough cyclosporine concentration in plasma measured by polyclonal fluorescence polarization immunoassay (FPIA) and polyclonal radioimmunoassay (RIA) or in whole blood measured by high-performance liquid chromatography (HPLC) and the risk of renal dysfunction or acute graft-versus-host disease in 29 patients undergoing allogeneic bone marrow transplantation for leukemia. The FPIA and RIA values were highly correlated (r = 0.93) and on the average CsA concentrations measured by FPIA were 1.56 times higher than those measured by RIA. Ten patients developed renal dysfunction and 10 developed grades II-IV acute GVHD. Although univariate analysis showed that plasma CsA concentrations measured by either FPIA or RIA were significantly correlated with renal dysfunction, the association was stronger with FPIA. Plasma CsA concentrations measured by FPIA but not RIA remained a significant risk factor for renal dysfunction in a multivariate relative risk model. Amphotericin therapy was significantly associated with renal dysfunction in the univariate analysis but not in the multivariate analysis. No significant associations were found between whole blood CsA or CsA M1 concentration, patients' age, gender, or CsA dose and the risk of renal dysfunction. None of the covariates analyzed significantly correlated with the development of acute GVHD. These data suggest that plasma CsA concentrations measured by nonspecific assays may more accurately correlate with renal dysfunction than whole-blood CsA concentrations measured by HPLC in marrow transplant recipients.

Objective: Bicuspid aortic valve is a common risk factor for thoracic aortic aneurysm and dissection. Guidelines for elective ascending aortic intervention (AAI) in bicuspid aortic valve are derived from limited evidence, and the extent of practice variation due to patient and provider characteristics is unknown. Using data from 2 large cardiovascular registries, we investigated factors that influence decisions for AAI. Methods: All bicuspid aortic valve cases with known aortic diameters and surgical status were included. We used multivariable logistic regression to profile predictors of isolated aortic valve replacement (AVR) or AVR+AAI, stratified by patient characteristics, surgical indications, and institution. Results: We studied 2861 subjects at 18 institutions from 1996 to 2015. The median aortic diameter of patients who underwent AVR+AAI varied widely across institutions (39-52 mm). Aortic diameters were