Dor Group Research Articles

Abnormalities in copper status associated with diminished ovarian reserve: A case-control and cross-sectional study.

This study aimed to illustrate the copper status of diminished ovarian reserve in Chinese women, especially the effects of copper, ceruloplasmin, non-ceruloplasmin-bound copper (NCC) and CuZn superoxide dismutase (SOD1). This case-control, cross-sectional investigation included women with diminished ovarian reserve (DOR group, n = 35) and matched normal ovarian reserve (NOR group, n = 35). The serum levels of copper, ceruloplasmin, NCC, SOD1, follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, and anti-Müllerian hormone were tested and analyzed. The serum copper concentrations (60.88%), NCC (54.75%) and SOD1 (54.75%) in the DOR group were significantly higher than those in the NOR group (all P < 0.001), and the concentrations of the three markers were higher in most subgroups (P < 0.001). The correlation analysis verified the correlation between copper status and impaired ovarian function. Additionally, linear regression analysis showed that NCC and SOD1 levels were negatively correlated with anti-Müllerian hormone (P < 0.05 or 0.001). Our exploration found significant increases in copper, NCC and SOD1 levels in DOR and suggests a possible link. Copper status is expected to serve as the predictive marker for DOR.

KETOPRAK DOR: AWAL MULA KEBERADAANNYA DI ACEH TENGAH

This article presents how the origin of the Ketoprak Dor art in Central Aceh. This topic is interesting because the change or development of an art scene does not only occur from within the artist's creative process alone, but perhaps by the surrounding factors that influence it. So, a qualitative research approach with descriptive analysis method is the choice to investigate this phenomenon. As a result, the Ketoprak Dor art in Central Aceh, to be precise in the gampong (village) of Paya Tumpi - Kebayakan, originates from Deli, North Sumatra. There were two events that prompted its emergence: 1) in the decade of the '50s, the Ketoprak Dor group in Deli performed in Central Aceh, to be precise in Bies District. 2) still in the same decade, there were people from Medan who moved to Bies and brought the Ketoprak Dor musical instrument and wanted to sell it when they got there. Because the Bies residents were unable to make up for it, the Paya Tumpi residents agreed to it and a Ketoprak Dor arts group was formed named Langeng Madio Utomo which later changed its name to Sanggar Ketoprak Rahayu Cipto Rukun in the following decade. Even though they had been on hiatus for three decades (starting in the 1990s), in the past few years the group has been on the mend again. It can be concluded that external factors can change the motive (cause), form or style, to the meaning of the performance.

Association of Organizational Pathways With the Delay of Emergency Surgery

Delayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date. To examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France. This prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded. Emergency surgery. The main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1. A total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P < .001). The adjusted odds ratio for delay was 1.80 (95% CI, 1.17-2.78) when comparing NOR with DET. In this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.

The level distribution of serum AMH in different clinical manifestations of women of childbearing age

To investigate the distribution and diagnostic value of serum anti-Müllerian hormone (AMH) in healthy women of childbearing age, women with polycystic ovary syndrome (PCOS), ovarian dysfunction (DOR) and premature ovarian failure (POF). This study retrospectively selected female patients of childbearing age who were treated in the affiliated Obstetrics and Gynecology Hospital of Fudan University from January to December 2019. According to different clinical manifestations, they were divided into 133 cases in PCOS group, 120 cases in DOR group and 134 cases in POF group. 125 healthy women in the same period were selected as the control group. The values of serum AMH, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) were measured in the four groups. Single sample Kolmogorov-Smirnov test, one-way ANOVA, independent sample t-test, Kruskal-Wallis H test, Mann-Whitney U test, logistic regression analysis and ROC curve were used for comparative analysis. The serum AMH levels of PCOS group, DOR group, POF group and control group were 9.10 (6.67, 11.49) ng/ml, 0.11 (0.05, 0.29) ng/ml, 0.03 (0.02, 0.06) ng/ml and 2.99 (1.57, 4.98) ng/ml, respectively [M(Q1,Q3)], the differences were statistically significant (P<0.001). The basal endocrine levels including E2, FSH, LH and T also had significant differences between groups (P<0.001). The results of multiple comparisons showed that there were significant differences in AMH and LH between DOR, POF and PCOS groups and the control group. The T level of PCOS group was significantly higher than that of the control group, the E2, LH and T levels of DOR group were significantly higher than that of the control group, and the FSH level of POF group was significantly higher than that of the control group (P<0.05). The area under the curve (AUC) of AMH and AMH+LH in the diagnosis of PCOS were 0.905 and 0.922, the sensitivity was 82.7% and 85.0%, and the specificity was 88.0% and 88.8%. The AUC of DOR was 0.861 and 0.971, the sensitivity was 89.0% and 92.5%, and the specificity was 63.0% and 92.0%. The AUC of POF was 0.950 and 0.998, the sensitivity was 98.3% and 99.2%, and the specificity was 75.9% and 97.0%, respectively. The AUC of AMH and AMH+LH combined indexes in the differential diagnosis of DOR and POF were 0.768 and 0.937, the sensitivity was 70.3% and 95.5%, and the specificity was 73.9% and 80.8%.

Relationship between growth hormone levels and ovarian reserves

Purpose: The aim of this study was to investigate the relationship between serum anti mullerian hormone levels and serum growth hormone levels in patients with diminished ovarian reserve and unexplained infertility who are planned for in vitro fertilization.&#x0D; Materials and Methods: This prospective cohort study includes 154 women and comprises three study groups which include infertile women with diminished ovarian reserve (Group I), women with unexplained infertility (Group II) and healthy women (Group III) as control group. Prospectively recorded patient data comprehended age, body mass index (BMI), antral follicle count (AFC), gravidity and parity, education, occupation, smoking and alcohol use, and laboratory results (Anti-Mullerian hormone (AMH), Growth Hormone (GH), Follicle-Stimulating hormone, Luteinizing Hormone and Estradiol). &#x0D; Results: The study population consisted of 154 subjects, 52 in Group-I, 52 in Group-II, and 50 in Group-III. The mean women age was higher in DOR group than the other two groups (Respectively with quartiles; 35.5(25-40), 29.5(20-38), 33(19-39)). The other demographic parameters were similar between the groups. Median serum AMH levels was lower in DOR group. Growth hormone levels were similar between the groups.. &#x0D; Conclusion: Our results show that growth hormone has no relationship between ovarian reserve markers. Although lack of relation with ovarian reserve, it’s widely known that GH plays major role in granulosa cell function.

Maternal and Neonatal Complications in Patients With Diminished Ovarian Reserve in In-Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles.

BackgroundDiminished ovarian reserve (DOR) is one of the most intractable clinical issues in human reproduction and is reported to be associated with raised risk of recurrent pregnancy loss and aneuploid blastocysts. In this study, we aimed to explore whether DOR was also associated with maternal and neonatal complications in in-vitro fertilization/intracytoplasmic sperm injection cycles.MethodsA retrospective cohort study including women below 40 years of age who achieved singleton live birth after fresh embryo transfer in in-vitro fertilization/intracytoplasmic sperm injection cycles in a single center from January 2012 to June 2019 was conducted. Participants with DOR, defined as basal follicle-stimulating hormone (FSH) ≥ 10IU/L and antimullerian hormone (AMH) < 1.2ng/ml, were enrolled as the study group. The controls were 1:2 matched by age and body mass index with FSH < 10IU/L and AMH ≥ 1.2ng/ml. Maternal and neonatal complications were compared between the DOR group and the controls.ResultsA total of 579 women, 193 in the DOR group and 386 matched as controls, were included in this study. Compared to controls, the incidence of hypertensive disorders of pregnancy was significantly increased in the DOR group (5.7% vs. 2.1%, P = 0.021). DOR patients also presented slightly higher incidences of preterm birth (10.9% vs. 7.5%, P = 0.174) and low birthweight (6.2% vs. 5.4%, P = 0.704) yet without statistical significances. The incidences of gestational diabetes mellitus and placenta previa were comparable between the two groups.ConclusionCompared to women with normal ovarian reserve, women with diminished ovarian reserve might have elevated incidence of hypertensive disorders of pregnancy. Patients with diminished ovarian reserve might need more strict antenatal care.

Does quantity equal quality?—A morphokinetic assessment of embryos obtained from young women with decreased ovarian response to controlled ovarian stimulation

To assess oocyte quality in young patients with decreased ovarian response to controlled ovarian stimulation using time-lapse analysis. A retrospective cohort study conducted at five medical centers between 2013 and 2017. The "decreased ovarian response" (DOR) group consisted of 241 women who underwent controlled ovarian stimulation with ≤ 5 retrieved oocytes and 519 cultured embryos. The "normal response" (NOR) group consisted of 667 women with ≥ 6 retrieved oocytes resulting in 3633 embryos. Data included annotation of morphokinetic events of embryos cultured in a time-lapse incubator from time of pronuclei appearance to time of starting blastocyst formation (tSB). Comparison was made between morphokinetic parameters of DOR and NOR patients with additional subgroup analysis according to the implantation status. Implantation and clinical pregnancy rates were significantly higher in the NOR group compared with the DOR group (44.5% vs. 31.6% and 51.5% vs. 37.7%, respectively; p < 0.05). Embryos from the DOR group reached the morphokinetic milestones later than embryos obtained from NOR patients. In the DOR group, implanted embryos reached starting blastocyst formation (tSB) faster than embryos which failed to be implanted, however, manifested a protracted course compared with implanted embryos from the NOR group. In a multivariate analysis-decreased ovarian response, nulliparity, number of transferred embryos, and t4, and were predictive for implantation. The quantitative decrease in ovarian response is associated with reduced oocyte quality, reflected by a slower developmental rate and lower implantation and pregnancy rates.

The Pacopexy procedure for left ventricular aneurysm: a 10-year clinical experience.

To evaluate our 10-year clinical experience of performing the Pacopexy procedure for left ventricular aneurysm (LVA). Between January, 1998 and November, 2015, a cohort of 92 patients with LVA underwent surgery to reshape the left ventricle. Fifty-seven patients underwent the Dor procedure and 35 underwent the Pacopexy procedure to emphasize the conical shape, whereby patch placement followed an oblique trajectory between the left ventricular apex and the septum below the aortic valve. The early-mortality rate was 4.34% (4/92; n = 2 in each group). The 10-year survival rate was 70.4 ± 7.9% in the Pacopexy group vs 41.7 ± 7.2% in the Dor group (p < 0.05), and the rate of freedom from hospital re-admission for heart failure (HF) or cardiac death was 60.0 ± 8.6% vs 28.8 ± 6.8%, respectively (p < 0.05). The Dor procedure and left ventricular end systolic volume index (LVESVI) ≥ 60ml/m2 were strongly and significantly associated with long-term mortality and hospital re-admission for HF. The Pacopexy procedure is a reproducible surgical option for the treatment of LVA. The improved configuration achieved by the Pacopexy procedure has resulted in good long-term survival and a high degree of freedom from re-admission for HF in patients with advanced LVA.

Comparison of Dor and Nissen fundoplication after laparoscopic paraesophageal hernia repair

BackgroundFundoplication is performed routinely during laparoscopic repairs of a paraesophageal hernia, but the degree of fundoplication remains controversial. The purpose of this study is to assess postoperative dysphagia and reflux after a Dor versus a Nissen fundoplication in patients undergoing laparoscopic repair of giant paraesophageal hernias. MethodsWe performed a retrospective cohort study of all patients undergoing laparoscopic repair of giant paraesophageal hernias with Nissen or Dor fundoplication between January 2012 and December 2017 at a high-volume center, excluding revisional and emergency cases. Primary outcomes were reflux and dysphagia at 1 and 6 months. Severe dysphagia was defined as intolerance to liquids. Balanced cohorts were created using coarsened exact matching. ResultsA total of 106 patients were included, and 87 were matched (Dor = 48, Nissen = 58). Baseline characteristics were well balanced between matched groups. Mean follow-up duration was 17.7 months (standard deviation 16.4). The incidence of severe dysphagia at 1 month was less in the Dor group (0 of 48 vs 8 of 58, P = .02) with similar reflux symptoms. There was no difference in severe dysphagia and reflux symptoms at 6 months and at the latest visit. ConclusionDor fundoplication is associated with less severe, early postoperative dysphagia. Future studies assessing the relative importance of dysphagia and reflux on quality of life should be conducted to tailor the operative technique and optimize patient satisfaction.

Abstract P397: Living in Ethnic-enclave Neighborhoods May Attenuate the Negative Effect of Acculturation on Blood Pressure in Refugees and Maintain Immigrant Health Effect

Background: Researchers have long hypothesized that acculturation (duration of U.S. residence [DOR]) is associated with increases in blood pressure in immigrant populations. However, little is known about the potential effects of acculturation on hypertension (HTN) in refugees living in ethnic-enclave neighborhoods. We conducted a cross-sectional study of Somali refugees and immigrants (a largely enclaved population) living in Minneapolis-St. Paul, Minnesota. Method: We analyzed data from 1155 Somali refugees/immigrants who arrived in United States from 1990 to 2015 and are participating in an ongoing study of Somali refugees in the Twin Cities. Using 10 years as a threshold, the study population was divided into two groups based on DOR: short (&amp;lt 10 years) or long (&amp;gt= 10 years). Main outcome was HTN, which was defined using the protocol of international HTN studies. Differences between the two groups were determined by chi-squared test and t-test. Multivariate logistic regression was used to determine association between HTN and DOR. Results: Of 1155 subjects, 572 (49.6%) had DOR &amp;gt= 10 years. Mean DOR was 9.8 ± 6.0 years (median of 10), and 58.1% (559 of 1155) were women. The short DOR group was younger (mean age 44.6 ± 18.0 vs 51.4 ± 18.1 years, P&amp;lt 0.001. There was no difference in mean systolic blood pressure (SBP) between groups (117 mmHg vs 119 mmHg, P=0.087) and no correlation between SBP and DOR (linear R 2 =0.012). Prevalence of HTN was 29.5% (341 of 1155), with 179 of these 341 (52.5%) having uncontrolled HTN. HTN increased with aging: 4.1% (19 of 457) for age group 18-39, 15.3% (47 of 306) for ages 40-59, and 29.7% (114 of 384) for ages 60 + . After adjusting for body mass index, marital status, English language (written and spoken), health insurance, income / poverty ratio, language spoken at home, employment, education and DOR, age was the only predicator of HTN. Even after matching two groups by age, the distribution of HTN was similar between the two age-matched DOR groups (P=0.1879). Conclusions: DOR (acculturation) was not a predictor of HTN in this highly enclaved refugee/immigrant sample. Further studies are needed to identify which cultural and neighborhood environment factors may operate to blunt the effects of acculturation on blood pressure.

What are the likely IVF/ICSI outcomes if there is a discrepancy between serum AMH and FSH levels? A multicenter retrospective study

ObjectiveThe principal outcome was to assess the ovarian response to controlled hyperstimulation during in vitro fertilization (IVF) with or without micro-injection (ICSI) in patients whom ovarian reserve testing revealed a discrepancy between the serum levels of FSH and AMH. The secondary outcome was to determine whether AMH and FSH profiles could predict the IVF/ICSI response. Study designThis was a multicenter, retrospective study analysing all controlled ovarian hyperstimulation cycles with attempted fresh embryo transfer(s) carried out during IVF/ICSI treatment and in which the AMH level had been assayed between January 01, 2008 and December 31, 2011. This enabled us to form 2 control groups (NOR, normal ovarian reserve: normal AMH and FSH and DOR, diminished ovarian reserve: diminished AMH, increased FSH) and 2 study groups (DAMH: diminished AMH, normal FSH and NAMH: normal AMH, increased FSH). The principal assessment criterion was quantitative ovarian response to stimulation defined by the mean number of oocytes punctured, the secondary assessment criterion the qualitative response to stimulation defined by the pregnancy rate per cycle. ResultsWe were able to analyse 1803 stimulation cycles. The mean number of oocytes punctured was significantly reduced in the DAMH and DOR groups compared to the NAMH and NOR groups (5.2±3.9 and 4.1±3.3 vs. 11.5±7 and 9.5±5.6, respectively [P<0.01]). The pregnancy rate per initiated cycle was significantly reduced in the DAMH and DOR groups compared to the NAMH and NOR groups (20% and 24% vs. 32 and 35%, respectively [P<0.01]). Live birth rates did not differ between the groups however. Multivariate analysis with logistic regression revealed that AMH, FSH and age independently had an effect on the number of oocytes punctured, although the effect exerted by AMH seemed to be preponderant (OR: 2.75: 95%CI [2.39–3.19]). AMH appeared to be the sole factor independently predictive of pregnancy per cycle. ConclusionThe serum AMH level appears to provide an additional item of discriminatory information, which should not be overlooked. Ovarian reserve work-up should include routine AMH assay.

"Delay to operating room" fails to identify adverse outcomes at a Level I trauma center.

The American College of Surgeons Committee on Trauma devised process audit filters to identify opportunities for improvement (OFI), prevent adverse outcomes, and improve quality. Delay to the operating room for primary trauma laparotomy is a process audit filter that has not been definitively associated with improved outcomes. We sought to evaluate the effectiveness of delay to the operating room of greater than 2 hours (DOR) to independently identify an adverse outcome or an OFI at our Level I trauma center. Trauma patients who underwent primary exploratory laparotomy from July 2006 to March 2015 were reviewed. Those with DOR were identified and compared with those without DOR. To analyze the ability of DOR to independently identify an adverse outcome or an OFI, DOR patients were further divided into those with isolated DOR and those with DOR in conjunction with one or more other process audit filter. Primary outcome was the presence of a complication. Secondary outcome was an identified OFI. Medical records of patients with either outcome were reviewed to determine if the outcome resulted directly from DOR. Of 472 patients, 109 (23%) had DOR and 363 (77%) did not. There were no significant differences in age, sex, or injury severity between the two groups. The rates of complications among DOR patients and those without DOR were not significantly different (35% vs. 38%, p = 0.59). The DOR was the only process audit filter flagged in 31(28%) patients in the DOR group. This subgroup had no identified complications but incurred two OFIs; neither OFI was associated with an adverse outcome. In trauma patients undergoing primary exploratory laparotomy, DOR fails to independently identify adverse outcomes. These findings suggest that DOR, as a routinely collected process audit filter, is not an effective indicator of suboptimal care or adverse outcomes at a Level I trauma center. Therapeutic study, level IV; prognostic study, level III.

PLANETS AROUND LOW-MASS STARS (PALMS). VI. DISCOVERY OF A REMARKABLY RED PLANETARY-MASS COMPANION TO THE AB DOR MOVING GROUP CANDIDATE 2MASS J22362452+4751425*

ABSTRACT We report the discovery of an extremely red planetary-mass companion to 2MASS J22362452+4751425, a ≈0.6 M ⊙ late-K dwarf likely belonging to the ∼120 Myr AB Doradus moving group. 2M2236+4751 b was identified in multi-epoch NIRC2 adaptive optics imaging at Keck Observatory at a separation of , or 230 ± 20 AU in projection at the kinematic distance of 63 ± 5 pc to its host star. Assuming membership in the AB Dor group, as suggested from its kinematics, the inferred mass of 2M2236+4751 b is 11–14 M Jup. Follow-up Keck/OSIRIS K-band spectroscopy of the companion reveals strong CO absorption similar to other faint red L dwarfs and lacks signs of methane absorption, despite having an effective temperature of ≈900–1200 K. With a (J–K)MKO color of 2.69 ± 0.12 mag, the near-infrared slope of 2M2236+4751 b is redder than all of the HR 8799 planets and instead resembles the ≈23 Myr isolated planetary-mass object PSO J318.5–22, implying that similarly thick photospheric clouds can persist in the atmospheres of giant planets at ages beyond 100 Myr. In near-infrared color–magnitude diagrams, 2M2236+4751 b is located at the tip of the red L dwarf sequence and appears to define the “elbow” of the AB Dor substellar isochrone separating low-gravity L dwarfs from the cooler young T dwarf track. 2M2236+4751 b is the reddest substellar companion to a star and will be a valuable benchmark to study the shared atmospheric properties of young low-mass brown dwarfs and extrasolar giant planets.

Symptomatic outcome following laparoscopic Heller's cardiomyotomy with Dor fundoplication versus laparoscopic Heller's cardiomyotomy with angle of His accentuation: results of a randomized controlled trial.

The type of anti-reflux procedure to be used as an adjunct to laparoscopic Heller's cardiomyotomy (LHCM) in Achalasia cardia is controversial. We compared Angle of His accentuation and Dor fundoplication in a randomized controlled trial. From May 2010 to October 2013, 62 patients undergoing LHCM were randomized to receive either Dor fundoplication (Dor group) or Angle of His accentuation (AOH group) as an anti-reflux procedure. Symptomatic outcome was evaluated using modified Mellow and Pinkas scale for dysphagia and modified DeMeester's score for regurgitation and heartburn. Achalasia-specific quality-of-life (QOL) questionnaire was used to assess quality of life. The primary outcome was symptomatic relief and the secondary outcome was postoperative heartburn. Statistical analysis was done using SPSS software. All the procedures were completed laparoscopically with no mortality. Morbidity was similar in the two groups (6.4 %). Median operative time was higher in Dor group (170 vs 130 min). At a median follow-up of 21 months relief of dysphagia, regurgitation, and heartburn was seen in 87, 90.3, and 90.3 % patients in Dor group versus 93.5, 96.7, and 77.4 % in AOH group patients with significant improvement in symptom scores. Improvement was similar in both groups with no statistically significant difference in the symptom scores (p = 0.48 for dysphagia, p = 0.37 for regurgitation, and p = 0.19 for heartburn). The QOL improved in both groups [62.3 to 12.3 (p = 0.02) in Dor group and 63.9-13 (p = 0.02) in AOH group] with no statistically significant difference between the two groups (p = 0.96). There was no statistically significant difference in the postoperative heartburn between the two groups (p = 0.19). Laparoscopic Heller's cardiomyotomy with either Angle of His accentuation or Dor fundoplication leads to similar improvement in symptoms and quality of life.

Forty-eight-week efficacy and safety and early CNS tolerability of doravirine (MK-1439), a novel NNRTI, with TDF/FTC in ART-naive HIV-positive patients.

IntroductionDoravirine (DOR) is an investigational NNRTI (aka MK-1439) that retains activity against common NNRTI-resistant mutants. We have previously reported the Part 1 results from a two-part, randomized, double-blind, Phase IIb study in ART-naïve HIV-1-positive patients [1]. At doses of 25, 50, 100 and 200 mg qd, DOR plus open-label tenofovir/emtricitabine (TDF/FTC) demonstrated potent antiretroviral activity comparable to EFV 600 mg qhs plus TDF/FTC and was generally well tolerated at week 24. DOR 100 mg was selected for use in patients continuing in Part 1 and those newly enrolled in Part 2.MethodsPatients receiving DOR 25, 50 or 200 mg in Part 1 were switched to 100 mg after dose selection. In Part 2, 132 additional patients were randomized 1:1 to DOR 100 mg qd or EFV 600 mg qhs (each with TDF/FTC). We present week 48 efficacy and safety results for all patients in Part 1, and early (week 8) CNS tolerability only for patients randomized to DOR 100 mg or to EFV in Parts 1 and 2 combined. The primary safety endpoint is the % of patients with pre-specified CNS events (all causality) by week 8 for DOR 100 mg qd vs EFV (Parts 1 + 2 combined).ResultsPart 1 week 48 efficacy and safety results are shown below.The most common DR clinical AEs in the DOR and EFV groups, respectively, were abnormal dreams (10.2%; 9.5%), nausea (7.8%; 2.4%), fatigue (7.2%; 4.8%), diarrhoea (4.8%; 9.5%) and dizziness (3.0%; 23.8%), and were generally mild to moderate. Part 1 + 2 Week 8 CNS Event Analysis: One hundred thirty-two patients were randomized in Part 2, 66 to DOR 100 mg and 66 to EFV. Combining Part 1 and 2, a total of 108 patients received DOR 100 mg and 108 received EFV. By week 8, at least one CNS AE was reported in 22.2% of the DOR group and 43.5% of the EFV group (p<0.001). The most common CNS AEs were dizziness (DOR 9.3%; EFV 27.8%), insomnia (6.5%; 2.8%), abnormal dreams (5.6%; 16.7%) and nightmares (5.6%; 8.3%).ConclusionsIn ART-naïve, HIV-1-positive patients also receiving TDF/FTC, DOR 100 mg qd demonstrated potent antiretroviral activity and immunological effect at week 48 and was generally safe and well tolerated. Patients who received DOR 100 mg qd had significantly fewer treatment-emergent CNS AEs by week 8 than those who received EFV.

Toupet versus Dor as a procedure to prevent reflux after cardiomyotomy for achalasia: Results of a randomised clinical trial

BackgroundThe optimal anti-reflux procedure after Heller cardiomyotomy for oesophageal achalasia remains unclear. The most commonly used procedure is the anterior partial fundoplication according to Dor, although during recent years the posterior counterpart (Toupet) has become popular. MethodsPatients with newly diagnosed achalasia and referred for cardiomyotomy were randomised to receive either an anterior or partial posterior fundoplication following a classical cardiomyotomy. The effect of surgery was assessed during the first postoperative year by Eckardt scores, EORTC QLQ-OES18 scores and HRQL questionnaires. Timed barium oesophagogram (TBO) and ambulatory 24-h pH monitoring were performed to determine oesophageal emptying and the degree of reflux control, respectively. ResultsForty-two patients were randomised into Dor (n = 20) and Toupet (n = 22) groups. Eckardt scores improved dramatically with both procedures, but the EORTC QLQ-OES18 (functional scales) scores revealed significantly better relative improvements in the Toupet group compared to the Dor repair (P = 0.044). Corresponding advantages in favour of Toupet were observed postoperatively in the percentage of oesophageal emptying at TBO (P = 0.011 in height and P = 0.018 in area), an effect not observed in the Dor group. There were no other significant differences recorded between the study groups concerning HRQL evaluations and objective assessment of gastro-oesophageal acid reflux. ConclusionsA partial posterior fundoplication after cardiomyotomy seems to achieve more improvement in oesophageal emptying and EORTC QLQ-OES18 functional scale scores than the anterior fundoplication. Otherwise no differences between the two anti-reflux repairs were noted. Trial registration numberClinicalTrials.gov Identifier: NCT01933373.

PLANETS AROUND LOW-MASS STARS. III. A YOUNG DUSTY L DWARF COMPANION AT THE DEUTERIUM-BURNING LIMIT,

We report the discovery of an L-type companion to the young M3.5V star 2MASS J01225093-2439505 at a projected separation of 1.45" (~52 AU) as part of our adaptive optics imaging search for extrasolar giant planets around young low-mass stars. 2MASS 0122-2439 B has very red near-infrared colors similar to the HR 8799 planets and the reddest known young/dusty L dwarfs in the field. Moderate-resolution (R~3800) 1.5-2.4 $\mu$m spectroscopy reveals a near-infrared spectral type of L4-L6 and an angular H-band shape, confirming its cool temperature and young age. The kinematics of 2MASS 0122-2439 AB are marginally consistent with members of the ~120 Myr AB Dor young moving group based on the photometric distance to the primary (36 +/- 4 pc) and our radial velocity measurement of 2MASS 0122-2439 A from Keck/HIRES. We adopt the AB Dor group age for the system, but the high energy emission, lack of Li I $\lambda$6707 absorption, and spectral shape of 2MASS 0122-2439 B suggest a range of ~10-120 Myr is possible. The age and luminosity of 2MASS 0122-2439 B fall in a strip where "hot-start" evolutionary model mass tracks overlap as a result of deuterium burning. The implied mass of 2MASS 0122-2439 B is ~12-13 Mjup or ~22-27 Mjup if it is an AB Dor member, or possibly as low as 11 Mjup if the wider age range is adopted. Evolutionary models predict an effective temperature for 2MASS 0122-2439 B that corresponds to spectral types near the L/T transition (~1300-1500 K) for field objects. However, we find a mid-L near-infrared spectral type, indicating that 2MASS 0122-2439 B represents another case of photospheric dust being retained to cooler temperatures at low surface gravities, as seen in the spectra of young (8-30 Myr) planetary companions. [Abridged]

A KINE-CHEMICAL INVESTIGATION OF THE AB DOR MOVING GROUP “STREAM”

The AB Dor Moving Group consists of a "nucleus" of ~10 stars at d ~ 20 pc, along with dozens of purported "stream" members distributed across the sky. We perform a chemical and kinematic analysis of a subsample of AB Dor stream stars to test whether they constitute a physical stellar group. We use the NEMO Galactic kinematic code to investigate the orbits of the stream members, and perform a chemical abundance analysis using high resolution spectra taken with the Magellan Clay 6.5-m telescope. Using a chi^2 test with the measured abundances for 10 different elements, we find that only half of the purported AB Dor stream members could possibly constitute a statistically chemically homogeneous sample. Some stream members with 3D velocities were hundreds of parsecs from the AB Dor nucleus ~10^8 yr ago, and hence were unlikely to share a common origin. We conclude that the published lists of AB Dor moving group stream members are unlikely to represent the dispersed remnant of a single star formation episode. A subsample of the stream stars appears to be both statistically chemically homogeneous and in the vicinity of the AB Dor nucleus at birth. Their mean metallicity is [Fe/H] = 0.02 +/- 0.02 dex, which we consider representative for the AB Dor group. Finally, we report a strong lower limit on the age of the AB Dor nucleus of >110 Myr based on the pre-MS contraction times for K-type members which have reached the main sequence.

Improving Healthy Eating in Families With a Toddler at Risk for Overweight

To ascertain whether a parent education program based on Satter's division of responsibility in feeding children (DOR) is effective in enhancing parent/child feeding interactions for children with an overweight/obese parent. The primary hypothesis was that the intervention would decrease parental pressure to eat. Sixty-two families with a child between 2 and 4 years with at least 1 overweight/obese parent were randomly allocated using a cluster design to either the DOR intervention or a control group. The control group focused on increasing family consumption of healthy foods and activity levels and enhancing child sleep duration. The primary outcome was parent pressure on their child to eat. The DOR intervention was superior to the control group in reducing the pressure to eat. Two moderators of pressure to eat were found: disinhibition of eating and hunger. The parents in the DOR group, irrespective of disinhibition levels, lowered the pressure to eat, whereas those in the control group with low disinhibition increased the pressure to eat. There were similar findings for hunger. Gender moderated restrictive feeding with DOR parents lowering restriction more than parents of the control group in girls only. The DOR intervention was more effective in reducing the parent pressure to eat and food restriction (in girls only) than the control group.

Long-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation

We retrospectively analysed the long-term results and mid-term features of the surgical procedures on left ventricular (LV) volume, geometry, function and mitral regurgitation (MR) in patients with ischaemic cardiomyopathy (antero-septal dominant) who underwent LV reconstruction (LVR). The LVR was mainly accomplished by the Dor procedure, modified by the Fontan stitch maintained by the base of the LV septum prior to the flattened-out elliptical patch closure. Other techniques such as the linear closure or septal anterior ventricular exclusion (SAVE) were used when indicated. Sixty patients were divided into three groups, undergoing LVR with the Dor procedure (n = 40), linear closure (n = 12) or SAVE (n = 8). The LV function, volume and sphericity (eccentricity index) were logged before the operation and 1 year after. Survivors (79% at 7 years) showed a significant improvement in the LV ejection fraction from 35.1 ± 8.1 to 43.5 ± 11.5% and NYHA status from 2.9 ± 0.7 to 1.3 ± 0.6. The LV end-systolic volume index was significantly reduced from 110.3 ± 35.9 to 57.8 ± 20.7 ml/m(2) in the Dor, from 71.9 ± 10.3 to 52.9 ± 19.4 ml/m(2) in the linear closure and from 93.1 ± 14.5 to 47.9 ± 15.7 ml/m(2) in the SAVE group. The postoperative changes in the Dor group are characterized by the reduction in the significantly larger LV volume and a more spherical chamber (systolic eccentricity index from 0.82 ± 0.10 to 0.80 ± 0.09), although not significantly so compared with other techniques. The MR grade measured on echocardiography was reduced (from 1.9 ± 0.8 to 1.7 ± 0.8), with postoperative moderate MR in four Dor patients. Despite the more spherical LV change, LVR led to a significant volume reduction (45%), still maintaining its physiological shape that confirmed an improved LV function and better long-term results. The Dor procedure could significantly reduce the larger LV volume without losing the end-systolic elliptical shape and mitral valvular competence like other techniques without the Fontan stitch.