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As part of a project to develop predictive ecosystem models of United Kingdom woodlands we have collated data from two United Kingdom woodlands - Wytham Woods and Alice Holt. Here we present data from 582 individual trees of eight taxa in the form of summary variables relating to the allometric relationships between trunk diameter, height, crown height, crown radius and trunk radial growth rate to the tree's light environment and diameter at breast height. In addition the raw data files containing the variables from which the summary data were obtained. Large sample sizes with longitudinal data spanning 22 years make these datasets useful for future studies concerned with the way trees change in size and shape over their life-span.

Global change is impacting forests worldwide, threatening biodiversity and ecosystem services including climate regulation. Understanding how forests respond is critical to forest conservation and climate protection. This review describes an international network of 59 long-term forest dynamics research sites (CTFS-ForestGEO) useful for characterizing forest responses to global change. Within very large plots (median size 25 ha), all stems ≥ 1 cm diameter are identified to species, mapped, and regularly recensused according to standardized protocols. CTFS-ForestGEO spans 25 °S-61 °N latitude, is generally representative of the range of bioclimatic, edaphic, and topographic conditions experienced by forests worldwide, and is the only forest monitoring network that applies a standardized protocol to each of the world's major forest biomes. Supplementary standardized measurements at subsets of the sites provide additional information on plants, animals, and ecosystem and environmental variables. CTFS-ForestGEO sites are experiencing multifaceted anthropogenic global change pressures including warming (average 0.61 °C), changes in precipitation (up to ± 30% change), atmospheric deposition of nitrogen and sulfur compounds (up to 3.8 g N m(-2) yr(-1) and 3.1 g S m(-2) yr(-1)), and forest fragmentation in the surrounding landscape (up to 88% reduced tree cover within 5 km). The broad suite of measurements made at CTFS-ForestGEO sites makes it possible to investigate the complex ways in which global change is impacting forest dynamics. Ongoing research across the CTFS-ForestGEO network is yielding insights into how and why the forests are changing, and continued monitoring will provide vital contributions to understanding worldwide forest diversity and dynamics in an era of global change., (© 2014 John Wiley & Sons Ltd.)

An organocatalyzed asymmetric tandem reaction of cyclic N-sulfonylimines and α,β-unsaturated aldehydes was developed. These substrates follow an alternative reaction pathway to that of reactions involving saturated aldehydes, affording similar piperidine derivatives.

Background: Mineral trioxide aggregate (MTA) fulfills many of the ideal properties of the root-end filling material. However, its low cohesive property often makes it difficult to handle. Biodentine, new calcium-silicate-based cement has been developed to improve some MTA drawbacks such as its difficult handling property and long-setting time., Aim: The objective of this study was to compare at different times the microleakage of roots filled with Biodentine and white MTA (WMTA)-Angelus and to investigate their setting time, handling properties and compressive strength., Materials and Methods: Root canals of single-rooted teeth were instrumented, filled with either Biodentine or WMTA-Angelus (n=15 each) with two positive and two negative control roots and stored at 37°C. Sealing was assessed at 4, 24 h, 1, 2, 4, 8, and 12 weeks by a fluid filtration method. The initial setting time, handling properties, and compressive strength of the test groups were investigated by a vicat needle, questionnaire of operational hand feel, and universal instron machine, respectively., Results: Significant differences in microleakage were found between two groups at 4-h and 24 h (P<0.05) and no difference at 1, 2, 4, 8, and 12 weeks. No significant difference was seen in the setting time of MTA-Angelus and Biodentine, though latter was found to have better handling consistency. Compressive strength of Biodentine was significantly higher than MTA-Angelus., Conclusions: The results suggest that the new calcium-silicate-based endodontic cement provides improvement in sealing ability as well as clinical manageability of dental filling materials.

An asymmetric domino reaction was developed utilizing readily available cyclic N-sulfonylimines and simple aldehydes to construct biologically important and synthetically challenging piperidine derivatives consisting of three contiguous stereocenters. trans-Perhydroindolic acid proved to be an efficient organocatalyst in this reaction (up to 89% yield, 80:20 dr, and 99% ee). The absolute configuration of the catalytic product was determined by X-ray crystallography studies. The product could be conveniently converted to synthetically useful intermediates, such as (3R,4S)-4-ethyl-3-methyl-6-phenylpiperidinyridin-2-one (8), via a simple transformation.

Objective: To find out the frequency of HDV seroprevalence and the demographic characteristics or HBsAg-HDV positive patients., Study Design: Cross-sectional analytical study., Place and Duration of Study: Jinnah Postgraduate Medical Centre and Civil Hospital, Medical Unit-III, Karachi, from March 2007 to April 2011., Methodology: Patients with positive HBsAg were included in the study. Those having co-infection with HCV or HIV, autoimmune hepatitis, alcoholic hepatitis, Wilson's disease and haemochromatosis were excluded. After detailed history and physical examination all the patients underwent laboratory workup including complete blood count, liver function test, viral profile (HAV, HCV, HIV and anti-HDV) and prothrombin time. While in selected patients, HBc (core) antibodies, ultrasound abdomen, serum iron profile, ANA and liver biopsy were also carried out whenever needed to establish a clinical stage of liver disease., Results: There were 374 patients with 266 (71.1%) males and 108 (28.9%) females with overall mean age of 31.64 ± 8.66 years. Overall frequency of anti-HDV antibodies positivity was found in 28.1% (n = 105) patients. HDV seropositivity was slightly more prevalent in males as compared to females (28.57% vs. 26.57%). HDV seropositivity frequency was significantly higher in patients who presented with acute hepatitis/hepatic failure as compared to other clinical diagnoses (p = 0.027) and in those sub-sets of patients who had raised ALT levels (p = 0.012)., Conclusion: There was a high frequency of HDV seropositivity in the studied population particularly in males with acute hepatitis or hepatic failure, having raised ALT levels. The emphasis should be on preventive measures taken by other countries to reduce the prevalence of these treatment challenging infections.

Objectives: Patients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, nonocclusive stent thrombosis with microembolization. In this paper, we illustrate possible mechanisms both with optical coherence tomography (OCT) and histology., Design: We present two cases with ACS from very late stent thrombosis who have been previously treated with first-generation drug-eluting stents (DES)., Results: The first patient had ACS 15 months after DES implantation. The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities including thrombus not visible on CAG. These are findings that may explain the ACS. The second patient had subclinical episodes with chest pain after DES implantation. The patient died from stent thrombosis in a DES. Postmortem histological examination of the coronary arteries revealed stent struts with little or no neointimal coverage, persistent peri-strut fibrin deposition, inflammatory cells, malapposition, and small luminal platelet-rich thrombi. Old spotty myocardial infarctions were found in the supplied territory possibly caused by earlier episodes of embolizing thrombus., Conclusions: In patients with previous implanted DES presenting with ACS, OCT may detect abnormalities and thrombus formation not visible on CAG. Such findings may impact the treatment strategy in these patients.

Global climate change is already impacting species and ecosystems across the planet. Trees, although long-lived, are sensitive to changes in climate, including climate extremes. Shifts in tree species' distributions will influence biodiversity and ecosystem function at scales ranging from local to landscape; dry and hot regions will be especially vulnerable. The Australian continent has been especially susceptible to climate change with extreme heat waves, droughts, and flooding in recent years, and this climate trajectory is expected to continue. We sought to understand how climate change may impact Australian ecosystems by modeling distributional changes in eucalypt species, which dominate or codominate most forested ecosystems across Australia. We modeled a representative sample of Eucalyptus and Corymbia species (n = 108, or 14% of all species) using newly available Representative Concentration Pathway (RCP) scenarios developed for the 5th Assessment Report of the IPCC, and bioclimatic and substrate predictor variables. We compared current, 2025, 2055, and 2085 distributions. Overall, Eucalyptus and Corymbia species in the central desert and open woodland regions will be the most affected, losing 20% of their climate space under the mid-range climate scenario and twice that under the extreme scenario. The least affected species, in eastern Australia, are likely to lose 10% of their climate space under the mid-range climate scenario and twice that under the extreme scenario. Range shifts will be lateral as well as polewards, and these east-west transitions will be more significant, reflecting the strong influence of precipitation rather than temperature changes in subtropical and midlatitudes. These net losses, and the direction of shifts and contractions in range, suggest that many species in the eastern and southern seaboards will be pushed toward the continental limit and that large tracts of currently treed landscapes, especially in the continental interior, will change dramatically in terms of species composition and ecosystem structure.

Chiral β-aryl-α,β-unsaturated amino alcohols were synthesized via a Pd-catalyzed asymmetric allylic amination of 4-aryl-1,3-dioxolan-2-one using planar chiral 1,2-disubstituted ferrocene-based phosphinooxazolines as ligands. Under the optimized reaction conditions, a series of substrates were examined and the products were obtained in good to excellent yields (up to 92%) and enantioselectivities (up to 98% ee) under mild reaction conditions. The desired products were determined to be of (R)-configuration and could subsequently be transformed into compounds with interesting biological activity using simple transformations.

First hand: The first example of a palladium-catalyzed asymmetric hydrogenation of α-acyloxy ketones (1) was accomplished to give the hydrogenated products 2 with by far the highest catalytic efficiency in up to quantitative conversions and excellent enantioselectivities. The hydrogenated products could serve as important intermediates for the preparation of many drug candidates. TFE=2,2,2-trifluoroethanol., (Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A typical way to quantify aboveground carbon in forests is to measure tree diameters and use species-specific allometric equations to estimate biomass and carbon stocks. Using "citizen scientists" to collect data that are usually time-consuming and labor-intensive can play a valuable role in ecological research. However, data validation, such as establishing the sampling error in volunteer measurements, is a crucial, but little studied, part of utilizing citizen science data. The aims of this study were to (1) evaluate the quality of tree diameter and height measurements carried out by volunteers compared to expert scientists and (2) estimate how sensitive carbon stock estimates are to these measurement sampling errors. Using all diameter data measured with a diameter tape, the volunteer mean sampling error (difference between repeated measurements of the same stem) was 9.9 mm, and the expert sampling error was 1.8 mm. Excluding those sampling errors > 1 cm, the mean sampling errors were 2.3 mm (volunteers) and 1.4 mm (experts) (this excluded 14% [volunteer] and 3% [expert] of the data). The sampling error in diameter measurements had a small effect on the biomass estimates of the plots: a volunteer (expert) diameter sampling error of 2.3 mm (1.4 mm) translated into 1.7% (0.9%) change in the biomass estimates calculated from species-specific allometric equations based upon diameter. Height sampling error had a dependent relationship with tree height. Including height measurements in biomass calculations compounded the sampling error markedly; the impact of volunteer sampling error on biomass estimates was +/- 15%, and the expert range was +/- 9%. Using dendrometer bands, used to measure growth rates, we calculated that the volunteer (vs. expert) sampling error was 0.6 mm (vs. 0.3 mm), which is equivalent to a difference in carbon storage of +/- 0.011 kg C/yr (vs. +/- 0.002 kg C/yr) per stem. Using a citizen science model for monitoring carbon stocks not only has benefits in educating and engaging the public in science, but as demonstrated here, can also provide accurate estimates of biomass or forest carbon stocks.

Aim: Organic acids have the potential to decrease the strength of mineral trioxide aggregate (MTA) during retreatment. However, this might cause alterations in dentin composition and structure. The aim of this study was to assess the efficacy of chemicals on surface microhardness of white MTA (WMTA) and dentin., Materials and Methods: White MTA-Angelus(®) was mixed and packed into tooth molds. Six experimental groups (n = 15) were formed and exposed to 2% carbonic acid, 2% chlorhexidine gluconate, 5.25% sodium hypochlorite, 10% citric acid, 20% tartaric acid, and normal saline for 10 min and 20 min intervals on 1 and 21 days of setting, respectively. Vickers microhardness of WMTA and dentin for each specimen was measured before and after exposure. Data were subjected to repeated-analysis of variance (ANOVA) and post-hoc tests., Results: Carbonic acid was effective in significantly reducing the surface hardness of WMTA on both 1 and 21 days; followed by citric and tartaric acid (P < 0.05). Two percent chlorhexidine gluconate and NaOCl were effective on 1-day set WMTA. All chemicals, except 2% chlorhexidine, decreased microhardness of dentin significantly (P < 0.05) at 20 min interval., Conclusion: Cautious use of these chemicals not exceeding 10 min is mandatory to prevent significant alterations in mechanical properties of tooth during MTA retrieval.

Objective: To evaluate liver histology of chronic hepatitis C patients, who were relapsers or non-responders to previous conventional therapy., Methods: The descriptive case series was conducted in the Hepatology section of Medical Unit-III at the Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January to December 2008. The study had 109 hepatitis C patients who had relapsed or not responded to the conventional interferon and ribavirin for at least 24 weeks. All the patients were subjected to liver biopsy. The inflammatory activity and fibrosis shown by the liver biopsies were assessed according to the Batts-Ludwig classification. SPSS version 15 was used to analyse data., Results: A majority (n = 57; 52.3%) of the 109 patients were female with hepatitis C virus genotype 3. Among these, 100 (91.7%) patients were non-responders and 9 (8.3%) were relapsers. The mean age of the patients was 38.9 +/- 8.8 years. The non-responders had elevated levels of serum aminotransferase. According to Batts-Ludwig classification, Grade 0 inflammation was not present in the non-responders and relapsers; grade 1 in 51 (46.8%); grade 2 in 47 (43.1%); grade 3 in 10 (9.2%); and grade 4 in 1(0.9%). Stage 0 fibrosis was present in 10 (9.2%); stage 1 in 34 (31.2%); stage 2 in 36 (33.0%); stage 3 in 13 (11.9%); and stage 4 in 16 (14.7%)., Conclusion: Results suggested that even if it failed to eradicate hepatitis C virus, the conventional interferon and ribavirin therapy was able to halt the progress of necroinflammation and fibrosis.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal (GI) tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extraGI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers.We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan (CT) revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening.

The guideline group regarding the diagnosis and management of myelofibrosis was selected to be representative of UK-based medical experts, together with a contribution from a single expert from the USA. MEDLINE and EMBASE were searched systematically for publications in English from 1966 until August 2011 using a variety of key words. The writing group produced the draft guideline, which was subsequently revised by consensus of the members of the General Haematology and Haemato-oncology Task Forces of the British Committee for Standards in Haematology (BCSH). The guideline was then reviewed by a sounding board of UK haematologists, the BCSH and the British Society for Haematology Committee and comments incorporated where appropriate. The criteria used to state levels and grades of evidence are as outlined in the Procedure for Guidelines commissioned by the BCSH; the 'GRADE' system was used to score strength and quality of evidence. The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of primary myelofibrosis, as well as post-polycythaemic myelofibrosis (post-PV MF) and post-thrombocythemic myelofibrosis (post-ET MF) in both adult and paediatric patients., (© 2012 Blackwell Publishing Ltd.)

Objective: To determine the association of serum cholesterol levels with Child-Pugh class in patients with decompensated chronic liver disease due to viral hepatitis., Study Design: Cross-sectional analytical study., Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from June to December 2010., Methodology: Consecutive patients attending outpatient department or admitted in medical unit III were eligible if they had a diagnosis of cirrhosis secondary to viral hepatitis. Patients were excluded if alcoholic, diabetic, hypertensive, or with non-alcoholic fatty liver disease, autoimmune, metabolic, cardiovascular, cerebrovascular or kidney diseases and recent use of lipid-regulating drugs. Serum lipid profile was determined after an overnight fast of 12 hours. On the basis of serum total cholesterol, patients were divided into four groups; Group I with serum total cholesterol ² 100 mg/dl, Group II with level of 101-150 mg/dl, Group III with level of 151-200 mg/dl and Group IV with serum total cholesterol level of > 200 mg/dl. Hepatic dysfunction was categorized according to Child-Pugh scoring system. Chi-square and Spearman's correlation testing with p < 0.05 was accepted as significant., Results: One hundred and fourteen patients met the inclusion criteria with a mean age of 40.32 ± 13.59 years. Among these 32 were females (28.1%) while 82 were males (71.9%). According to Child-Pugh class; 34 patients (29.8%) presented with Child-Pugh class A, 34 (29.8%) in class B and 46 (40.4%) were in class C. Serum cholesterol (total) and triglycerides had significant association with Child-Pugh class (p = 0.0001 and p = 0.004 respectively) suggesting that as severity of liver dysfunction increases; serum cholesterol and triglycerides levels decrease. Results also revealed that males were significantly more hypocholesterolemic than females (p = 0.006)., Conclusion: Hypocholesterolemia is a common finding in decompensated chronic liver disease and has got significant association with Child-Pugh class. It may increase the reliability of Child-Pugh classification in assessment of severity and prognosis in chronic liver disease patients.

Objective: To determine the correlation of hepatic venous waveform changes with severity of hepatic dysfunction and grading of oesophageal varices., Methods: A cross-sectional analytical study was conducted at Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January 2009 to December 2009. Cirrhotic patients with portal hypertension were included in study. Patients presented with acute variceal bleeding, previous treatment with beta blockers or nitrates, sclerotherapy endoscopic band ligation, portal vein thrombosis, severe clotting defects, hepatic encephalopathy grade III or IV and noncirrhotic portal hypertension; were excluded from the study. Upper G I endoscopy was carried out in all patients after informed consent. Oesophageal varices were classified according to Baveno III while hepatic function was assessed and grouped by Child-Pugh classification. Colour Doppler ultrasound was carried out on all patients. Their waveforms were classified as monophasic, biphasic triphasic and the correlation of these hepatic vein waveforms with Child-Pugh class and size of oesophageal varices was evaluated. Statistical significance was defined as P?0.05., Results: Total of 65 patients who met the inclusion criteria and included in the study with mean age of 47.39 +/- 10.91 (range 23-70) years. Among these 51 (78.5%) were males while 14 (21.5%) were females. On the basis of hepatic function 32 (49.2%) patients presented in Child-Pugh Class A, 23 (35.4%) with Class B and 10 (15.4%) patients had Class C. Hepatic venous waveform was triphasic in 5 (7.7%), biphasic in 18 (27.7%), and monophasic in 42 (64.6%) cases. The relationship of these waveforms had significant relation with hepatic dysfunction (p < 0.012) while insignificant with grading of oesophageal varices (p 0.29). Upper GI endoscopy revealed large grade varices in 37 (56.9%) patients, 17 (26.2%) patients had small grade varices while no varices were found in 11 (16.9%) patients., Conclusion: Hepatic venous waveform pressure changes have significant relation with severity of hepatic dysfunction but insignificant relation with grading of oesophageal varices. Further studies using a combination of various Doppler parameters are required to create indices with a better predictive value.

Objective: To determine the correlation of elevated serum Alpha feto-protein with tumour size in hepatocellular carcinoma., Methods: A cross-sectional analytical study was done at Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January 2009 to June 2010. Patients enrolled in study were known cases of chronic liver disease and were complicated by development of hepatocellular carcinoma; those having metastasis in liver from any where were excluded. Demographic data such as age, gender, residence, were recorded. Detailed clinical history and examination were carried out and recorded in a preformed Performa. Complete blood count, liver function test, total protein, Albumin/Globulin (A/G) ratio, serum Albumin, HBsAg, anti HCV, alpha fetoprotein, ultrasound guided liver biopsy, ultrasound whole abdomen and/or CTscan Abdomen for size and number of tumour were also done. On the basis of alfa fetoprotein level patients were divided in to 3 groups; Group I with normal AFP (< or = 20IU/ml), Group II with moderately elevated AFP (20-399IU/ml), and Group III with markedly elevated AFP (> or =400 iu/ml). On the basis of tumour size patients were also divided in to 3 groups; group A <3 cm, group B 3-5 cm and group C >5 cm. Correlation of serum AFP levels with tumor size was analyzed by applying Spearman's rank correlation with r-values of 0.01 being considered significant., Results: Review of the clinical data of 98 patients male 69 (70.4%) and female were 29 (29.6%) with mean age of 53.89 +/- 12.511 ranging from 32 to 82 years was done. Of these there were 22 (22.4%), 25 (25.5%), 51(52%) cases in group 1, 2, 3 respectively. While in tumour size groups, 17 (17.3%) were in group A, 35 (35.7%) in group B and 46 (46.9%) in group C. There was a significant correlation of serum AFP level with tumour size in hepatocellular carcinoma. (r=0.472, 0.0001)., Conclusion: Our study suggests that serum AFP has significant correlation with the size of tumour. AFP level may serve as a useful marker for detection of Hepatocellular carcinoma and to differentiate between early and advance stage. On the basis of this proper treatment strategy can be planned.

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature.

Objective: To determine the frequency of portal hypertensive gastropathy (PHG) and its relation with biochemical, haematological and endoscopic findings in cirrhotic patients., Study Design: Cross-sectional analytical study., Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7, from June 2009 to December 2010., Methodology: Patients with diagnosis of cirrhosis and either undergoing screening upper gastrointestinal (GI) endoscopy or presented with acute upper GI bleeding were included in the study. Portal hypertensive gastropathy and oesophageal varices were classified using Baveno scoring system. The severity of cirrhosis was classified according to the Child-Pugh criteria. Hypersplenism was assessed by the reduction of haemoglobin, leucocytes and platelets., Results: Out of 217 patients, 148 were males (68.2%) and 69 were females (31.8%) with ages ranging from 15-85 years, (mean 48.06 years). There were 144 HCV +ve patients (66.4%), 36 HBV +ve patients (16.6%), 15 HCV/HBV co-infected patients (6.9%) and only 1 (0.5%) had co-infection of HBV/HDV. Twenty-one patients (9.7%) were classified as having cryptogenic cirrhosis. Out of 172 patients (79.27%), 56 patients (25.8%) had mild and 116 patients (53.5%) were suffering from severe PHG. Significant positive correlation was found between esophageal variceal grade and PHG (r=0.46, p < 0.001) but not with etiology (r=0.05, p=0.41) or hypersplenism (r=0.08, p=0.22)., Conclusion: The frequency of PHG was 79.27% in the studied group. The grade of oesophageal varices had significant relation with PHG that is the severity of PHG increased with the grade of oesophageal varices, suggesting common pathophysiology of both entities.

We investigate the effect of target familiarity on the construction of facial composites, as used by law enforcement to locate criminal suspects. Two popular software construction methods were investigated. Participants were shown a target face that was either familiar or unfamiliar to them and constructed a composite of it from memory using a typical 'feature' system, involving selection of individual facial features, or one of the newer 'holistic' types, involving repeated selection and breeding from arrays of whole faces. This study found that composites constructed of a familiar face were named more successfully than composites of an unfamiliar face; also, naming of composites of internal and external features was equivalent for construction of unfamiliar targets, but internal features were better named than the external features for familiar targets. These findings applied to both systems, although benefit emerged for the holistic type due to more accurate construction of internal features and evidence for a whole-face advantage. STATEMENT OF RELEVANCE: This work is of relevance to practitioners who construct facial composites with witnesses to and victims of crime, as well as for software designers to help them improve the effectiveness of their composite systems.

Background: Endothelial dysfunction is associated with increased risk for cardiovascular events in patients with coronary artery disease and may predict in-stent restenosis after percutaneous coronary intervention. We evaluated if endothelial dysfunction could predict clinical and angiographic restenosis in patients after percutaneous coronary intervention with stent implantation for angina pectoris or acute coronary syndrome., Methods: One hundred patients were consecutively included after successful percutaneous coronary intervention with stenting for angiographic single vessel disease. All patients were evaluated with ultrasound detection of brachial artery reactivity at four weeks and with a symptom limited exercise stress test at six months and were followed for the occurrence of clinical or angiographic restenosis for 18 ± 6 months., Results: Twenty patients showed clinical signs of restenosis during 18 months follow-up and were referred to re-angiography. Patients with clinical restenosis had impaired flow mediated vasodilation compared to patients without clinical restenosis (5.8 ± 3.4 vs. 9.0 ± 4.8, p = 0.005). In multivariate analysis flow mediated vasodilation was the only independent predictor for the risk of clinical restenosis (OR 4.5, 95% CI 1.11 to 17.8)., Conclusions: Impaired flow mediated vasodilation four weeks after percutaneous coronary intervention independently predicts the risk of clinical restenosis.

Objective: To determine the efficacy of interferon-ribavirin therapy for chronic viral Hepatitis C (HCV) patients., Study Design: A quasi-experimental study., Place and Duration of Study: Medical Unit-III, Ward-7, Jinnah Postgraduate Medical Centre, Karachi, from August 2006 to December 2007., Methodology: Adult patients who had not received any prior anti-HCV therapy and had been infected with positive anti- HCV antibodies and detectable HCV RNA were enrolled in the study. Patients were excluded from the study if there was evidence of decompensated cirrhosis, coexistent HIV, or HBV infection, previous organ transplantation, psychiatric disease, seizure disorder, serious cardiovascular disease and other co-morbid diseases like uncontrolled Diabetes. Patients were given Interferon-alfa-2b 3 million international units three times a week sub-cutaneously and oral ribavirin at 1000-1200 mg in two to three divided doses a day for a 6-month period. At the end of treatment over all efficacy as depicted by non-detectable HCV RNA by PCR and its relation with factors of like age, gender, and serum ALT were assessed., Results: A total of 404 patients with mean age of 36.03±9.30 years, ranging from 13 to 60 years, were offered combination therapy that satisfied the inclusion criteria. Among these, females were 243 (61.1%) and males were 161 (39.9%), age range 13-60 years with mean of 36.03 years. Out of 404, 336 (83.2%) showed response to combined interferon and ribavirin therapy depicted by HCV RNA by PCR at the end of 24 weeks treatment. Age under 40 years (p < 0.001) was significantly associated with favourable response., Conclusion: Combination therapy of interferon and ribavirin in chronic hepatitis C patients has still better response rate in our set-up. Younger age and female gender were the favourable predictors.

Background: Growth differentiation factor-15 (GDF-15) is considered to be a cardioprotective cytokine possessing antiapoptotic and antiproliferative properties. If GDF-15 plasma levels are influenced by percutanenous coronary intervention (PCI) or regular exercise training is currently not known., Methods: After successful revascularization by PCI with stent implantation 36 consecutive patients with stable angina pectoris were randomized to an exercise training program or to a control group. Patients were followed by serial measurements of GDF-15, high-sensitivity Troponin T (hsTNT) and N-terminal pro brain natriuretic peptide (NT-proBNP) levels in peripheral blood after PCI and during six months follow-up., Results: Plasma levels of GDF-15 showed an early response to PCI with a modest, but significant increase after 30 minutes (p = 0.007) peaking three hours after PCI. Levels of hsTNT rose 5-fold from baseline to 24 hours (p < 0.001) with a normalization at seven days post PCI. Changes in plasma levels of GDF-15, hsTNT and NT-proBNP were not significantly different between the training and control group during follow-up., Conclusions: GDF-15 levels show a modest transient increase in response to coronary intervention with stent implantation. Exercise training over six months does not affect plasma levels of GDF-15, hsTNT or NT-proBNP in patients with stable coronary artery disease.

Objective: To describe the clinico-pathological and radiological profile of hepatocellular carcinoma., Study Design: A case series., Place and Duration of Study: Medical Unit-III Ward-7, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2008., Methodology: All consecutive patients suspected of having hepatocellular carcinoma (HCC), were admitted and included in this study. Diagnosis of HCC was established by clinical, biochemical, ultrasonographic and histopathologic findings. Patients with primary carcinoma elsewhere in the body, metastatic in the liver, fibrolamellar carcinoma and benign tumours were excluded from the study. At ultrasonography, the details of tumour size and number, portal vein thrombosis and presence of ascites were recorded. Patients were staged according to Okuda staging system. Results were described in mean and percentage values., Results: There were 82 patients with hepatocellular carcinoma including 58 males and 24 females, with male to female ratio of 2.8:1. The mean age of patients was 56.24+/-13.65 years. Right hypochondrial pain was the main symptom in 52 (63.4%) patients. The duration of symptoms varied from 1 month to 2 years. Tumour size was larger than 50% of liver size in 42 (51.2%) with portal vein thrombosis in 10 (12.19%). Anti HCV was positive in 44 (53.7%), HBsAg in 26 (31.7%) and both were found positive in 2 (2.44%) patients. Ten patients (12.2/%) found negative both for anti-HCV and HBsAg. According to Okuda staging system 18 patients had stage 1, 50 had stage 2 and 14 had stage 3 hepatocellular carcinoma., Conclusion: The mean age of presentation of hepatocellular carcinoma was younger as compared to western countries with potentially large non-resectable lesions. Chronic hepatitis C and B was found to be the major known factors. Patients with chronic hepatitis C and B should undergo vigorous HCC surveillance to detect early, potentially respectable HCC.

Objective: To determine the severity of thrombocytopenia in different grades of esophageal varices., Study Design: Cross-sectional analytical study., Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January to December 2008., Methodology: Subjects were eligible if they had a diagnosis of cirrhosis. Patient with advanced cirrhosis (Child-Pugh class C), human immunodeficiency virus (HIV) infection, hepatocellular carcinoma, portal vein thrombosis, parenteral drug addiction, current alcohol abuse and previous or current treatment with b-blockers, diuretics and other vasoactive drugs were excluded from the study. All patients under went upper gastrointestinal endoscopy after consent. On the basis of platelet count patients were divided into four groups. Group I with platelets (2) 20000/mm(3), Group II with values of 21000- 50000/mm(3), Group III with count of 51000-99000/mm(3) and Group IV with count of 100000-150000/mm(3). Correlation of severity of thrombocytopenia with the grading of esophageal varices was assessed using Spearman's correlation with r-values of 0.01 considered significant., Results: One hundred and two patients with thrombocytopenia and esophageal varices were included in the study. There were 62 (60.8%) males and 40 (39.2%) females. The mean age of onset of the disease in these patients was 49.49 + or - 14.3 years with range of 11-85 years. Major causes of cirrhosis were hepatitis C (n=79, 77.5%), hepatitis B (n=12, 11.8%), mixed hepatitis B and C infection (n=8, 7.8%) and Wilson's disease (n=3,2.9%). Seven patients had esophageal grade I, 24 had grade II, 35 had grade III, and 36 had grade IV. Gastric varices were detected in 2 patients. Portal hypertensive gastropathy were detected in 87 patients. There was an inverse correlation of platelet count with grading of esophageal varices (r=-0.321, p < 0.001)., Conclusion: The severity of thrombocytopenia increased as the grading of esophageal varices increased. Thrombocyte count was significantly and inversely correlated with the grade of esophageal varices.

Background: High-intensity interval training has been shown to be superior to moderate continuous exercise training in improving exercise capacity and endothelial function in patients with coronary artery disease. The objective of this study was to evaluate this training model on in-stent restenosis following percutaneous coronary intervention for stable or unstable angina., Methods and Results: We prospectively randomized 40 patients after percutaneous coronary intervention with implantation of a bare metal stent (n = 30) or drug eluting stent (n = 32) to a 6-month supervised high-intensity interval exercise training program (n = 20) or to a control group (n = 20). At six months, restenosis, measured as in-segment late luminal loss of the stented coronary area, was smaller in the training group 0.10 (0.52) mm compared to the control group 0.39 (0.38) mm (P = .01). Reduction of late luminal loss in the training group was consistent with both stent types. Peak oxygen uptake increased in the training and control group by 16.8% and 7.8%, respectively (P < .01). Flow-mediated dilation improved 5.2% (7.6) in the training group and decreased -0.1% (8.1) in the control group (P = .01). Levels of high-sensitivity C-reactive protein decreased by -0.4 (1.1) mg/L in the training group and increased by 0.1 (1.2) mg/L in the control group (P = .03 for trend)., Conclusions: Regular high-intensity interval exercise training was associated with a significant reduction in late luminal loss in the stented coronary segment. This effect was associated with increased aerobic capacity, improved endothelium function, and attenuated inflammation.

Laurence-Moon-Bardet-Biedl syndrome is a rare, genetically heterogeneous autosomal recessive disorder, characterized by progressive retinal dystrophy, polydactyly, obesity, hypogonadism, mental retardation, and renal dysfunction. Other manifestations include diabetes mellitus, heart disease, hepatic fibrosis and neurological features. Herein, 2 patients with Laurence-Moon-Bardet-Biedl syndrome are described, who had features of persistent hypokalemia and megaloblastic anemia.

Objective: To find out clinical features, diagnostic techniques and management outcome of patients having dual dengue and malaria infection., Study Design: A case series., Place and Duration of Study: Medical Unit-III, Ward- 7, Jinnah Postgraduate Medical Centre, Karachi, from September 2007 to January 2008., Methodology: Patients presented with fever of less than or equal to 10 days duration, severe body aches, rash and bleeding manifestations were included. Patients with obvious features of other diseases like typhoid, hereditary bleeding diathesis and hematological malignancies and only malarial parasite positive with high grade intermittent fever without rash and myalgia were excluded from the study. Diagnosis of dengue and malaria was based on history, clinical features, laboratory parameters and malarial parasite test by thin and thick films. Serological evaluation was done by dengue IgM and IgG by ELISA test kit. Patients were divided into three groups. Group A was dengue IgM positive plus MP positive, group B was dengue IgM positive and MP negative and group C was dengue IgM negative and MP negative and were clinically suspected dengue and malaria. The clinical manifestations and laboratory parameters of dual dengue and malaria positive patients were compared with malaria and dengue negative patients., Results: One hundred and fourteen patients were seen during the study period. Antibody titer (IgM) tested in all patients was found positive in 78 patients (69.64%). Among those 78 patients, 26 (23.21%) were concomitantly positive for malarial parasite (Group A). Plasmodium vivax was positive in 25 patients and falciparum in one patient. Fifty-two patients (46.42%) were dengue IgM positive and MP negative (Group B). Thirty four (30.35%) patients were MP and dengue IgM negative (Group C) but were strongly suspected for DHF and malaria on clinical and hematological basis. The hemoglobin of 34.61% of patients of group A, 5.76% of group B and 14.7% of group C were low, hematocrit level was also low in group A (92.3%), group B (15.38%) and group C (70.58%) patients. The platelet count was markedly low in 84.61% of patients of group A, 57.69% of group B and 94.11% of group C. Leukopenia was found in 34.61% of patients of group A, 78.84% in group B and 29.411% in group C. The liver function tests were deranged in all groups., Conclusion: The frequency of dual dengue and malaria infection was 23.21%. The serology of the dengue and malaria showed negative results in 30.35%. The diagnosis of dual infections could be made on the basis of history, clinical examination supported by hematological results. It is recommended that all the patients suspected for dual infections should be treated concomitantly for dengue and malaria in malaria endemic areas.

Objective: To determine the haematological and biochemical indicators for the early diagnosis of dengue viral infection., Study Design: A case series., Place and Duration of Study: At Medical Unit-III, Ward 7, Jinnah Postgraduate Medical Centre and referred cases from Faiz-e-Rehman Hospital, Metroville, Karachi from September to November 2007., Patients and Methods: Patients presenting with a fever of less than 2 weeks duration, generalized morbiliform rash and bleeding manifestations were included. Clinical history was recorded and patients were placed on fluid and haematological support. Diagnosis was established by Polymerase Chain Reaction (PCR) for dengue virus or detection of dengue virus specific IgM and IgG., Results: One hundred and four patients met the inclusion criteria during the study period. Sixty six patients had clinical and haematological features suggestive of grade I Dengue Hemorrhagic Fever (DHF); 34 patients had grade II DHF and 4 had grade III DHF out of whom 3 progressed to grade IV DHF. All the patients presented with fever followed by generalized morbiliform rash (81.73%), vomiting (79.8%), abdominal pain (65.38%), backache (62.5%), depression (60.6%) and mucosal bleeding manifestations (34.6%). Clinically, conjunctival infection was present in 93 patients (89.4%), hepatomegaly 59 (56.7%), lymphadenopathy in 17 (16.3%), splenomegaly in 13 (12.5%), pleural effusion in 11 (10.5%) and ascites in 8 (7.6%). Common laboratory findings were thrombocytopenia in 100% patients, leucopenia in 55 (52.8%), raised hematocrit in 52 (50%), and elevated aminotransferases, gamma GT in 100 (96%) patients. The overall mortality was 2.88%., Conclusion: In this series clinical history and examination supported by the triad of thrombocytopenia, raised hematocrit and elevated liver enzymes was sufficient for the early diagnosis of dengue hemorrhagic fever without waiting for dengue serology.

Objective: To investigate whether urologists in UK utilise and adhere to recently published renal trauma guidelines., Methods: A one-page anonymous questionnaire was created based on recently published guidelines. Thirteen questions were used to investigate the current patterns of practice. The questionnaire was posted to 500 consultants in UK., Results: Out of 500 questionnaires, 152 (30%) were returned; 109 (70%) respondents saw an estimated five or less cases of renal trauma per year; 104 (71%) respondents used guidelines but these differed; 79 (52%) respondents believed that the published guidelines were appropriate for UK practice; 8 (5%) did not feel that they were appropriate and 48 (32%) were unsure, and 30 (20%) used local guidelines. In stable patients with dipstick hematuria, 121 (80%) respondents requested imaging with ultrasound (76) the most popular. In stable patients with gross hematuria, all respondents requested imaging with CT scanning (126) the most popular. In stable children with suspected renal trauma, all respondents who managed pediatric cases would request imaging. Re-imaging following initial ultrasound was common. Imaging was described as easy or possible to obtain during regular working hours by 147 (97%) respondents. This fell to 131 (86%) out of hours with 14 (9%) respondents having difficulty with obtaining imaging. Only 27 (18%) respondents had interdepartmental protocols to facilitate the imaging process in suspected renal trauma., Conclusion: Only 74 (50%) responding urologists utilized the recently published guidelines in the management of renal trauma, and adherence to the recommendations - by those urologists who claimed to use the guidelines - was very variable. To facilitate the best practice in the management of renal trauma, it would be ideal if urologists and trauma surgeons were encouraged to adhere to established guidelines. As diagnostic imaging has a crucial role in the majority of cases, informed discussion with the local radiology department would probably help in achieving the standards required.

We report the case of a 9-year-old girl with bilaterally reduced pedal pulses following emergency surgery for unilateral subtrochanteric femoral fracture. This incidental postoperative finding of differential blood pressures between the upper and lower limbs led to the diagnosis of aortic coarctation and subsequent karyotype analysis confirmed the rare diagnosis of Turner syndrome.

Dysphagia is an unusual presentation of pleural mesothelioma and carries a grim prognosis. A case of an elderly patient is presented herein, in whom the diagnosis was confirmed histologically, and the patient was still surviving 6 months after palliation.

A variety of piperidines (2-12, 14-26) with variable substituents at N-atoms have been synthesized and evaluated as urease inhibitors. The synthesized compounds showed varying degree of urease inhibitory activity ranging from 31.97 to 254 microM. The size and electron-donating or -withdrawing effects of substituents influence the activity, which lead to the formation of urease inhibitors.

Two series of variably N-substituted biperidines were synthesized by condensing various acid chlorides, alkyl halides and anhydrides with 1,4-bipiperidine. The new compounds were tested as tyrosinase inhibitors and a structure-activity relationship (SAR) study was carried out. Potent inhibition was observed in the case of the 4'-methylbenzyl substitution on this atom (IC50 = 1.72 microM) with this compound being a lead for future drug design. Additionally, calculations of the important QSAR molecular descriptors were done on the biperidine analogues after their 2 ps molecular dynamics (MD) simulations using molecular mechanics force field (MMFF) approaches. Using MD simulations potential and total energies were calculated for the energy minimized models of bipiperidine and the most active analogs 2, 3, 4, 6, 8 and 10.

The term unstable coronary syndromes represents a continuum of patients with unstable chest pain with or without small or large acute myocardial infarctions. There is a tendency towards an epidemiological shift to fewer large infarctions with ST elevation in the ECG (STEMI) to increased numbers of small infarctions without ST elevation (nSTEMI). Patients with unstable angina or nSTEMI should start antithrombotic medication with aspirin, heparin and clopidogrel upon arrival in hospital. Patients with medium or high risk of death or cardiac events will benefit from therapy with IIb/IIIa glycoprotein receptor inhibitors and should be referred for coronary angiography within 6-48 hours after arrival. Final therapy with percutaneous coronary intervention or coronary artery bypass surgery is indicated immediately after angiography or within a few days. Close follow-up with respect to epidemiological risk factors, diet, use of medication according to the results of large randomised studies will further reduce mortality and morbidity, in the short as well as the long term.

A rapid, precise and time saving high performance liquid chromatographic method has been developed and validated for the simultaneous determination of nicotinamide and 4-aminobenzoic acid in pharmaceutical preparation. The method involves isocratic elution of mobile phase through column in a reverse phase chromatography with UV detection at 254 nm. The ranges of quantification for nicotinamide and 4-aminobenzoic acid were 11-34 microg ml(-1) and 37-113 microg ml(-1), respectively. Investigating specificity, linearity, precision, accuracy, robustness and ruggedness performed the validation of the method.

A novel DNA purification technology is described that enables the purification of pure dsDNA from blood. When compared to existing DNA purification methods, the Whatman BioScience Purification System (WBPS) offers a fast and convenient way to recover high yields of DNA. WBPS is based on a unique filter system that entraps DNA within a matrix. This allows the process to be performed in a single unidirectional reaction vessel, reducing user interaction and multiple centrifugation steps.

In the context of limited effectiveness of iron supplementation programs, intermittent iron supplementation is currently under debate as a possible alternative strategy that may enhance the effectiveness of operational programs. This field-based trial assessed the outcome of twice weekly iron supplementation compared to daily in Pakistan. A double-blind, randomized, clinical trial was conducted in Northern Pakistan. Anemic pregnant women (n = 191) were assigned to receive daily (200 mg ferrous sulfate) or twice weekly (2 x 200 mg ferrous sulfate) iron supplementation. Hemoglobin was measured at baseline and at 4-wk intervals for up to 12 wk. Serum ferritin was measured at baseline and 8 or 12 wk. Analysis was by intention to treat. The two groups did not differ in age, parity, sociodemographic characteristics, hemoglobin or serum ferritin concentrations at baseline. Women who received iron daily had a greater rise in hemoglobin compared with women who received iron twice weekly (17.8 +/- 1.8 vs. 3.8 +/- 1.2 g/L, P < 0.001). The serum ferritin concentrations increased by 17.7 +/- 3.9 microgram/L (P < 0.001) in the daily supplemented group and did not change in the twice weekly group. Daily iron supplementation remained superior to twice weekly supplementation after controlling initial hemoglobin Z-scores and duration of treatment. The body mass index (BMI) modified the effect of daily versus twice weekly iron supplementation. For every unit increase in BMI, the difference between the two treatment groups was reduced by 0.0014 (final hemoglobin Z-score; P = 0.027). We recommend continuation of daily iron supplementation as opposed to intermittent iron supplementation in pregnant women in developing countries.

Very severe aplastic anaemia (vSAA) is rare. We report a case of Ecstasy-induced very severe aplastic anaemia which did not respond to immunosuppressive therapy, developing invasive pulmonary mucormycosis. The patient underwent an HLA-identical sibling peripheral blood progenitor cell transplant (PBPCT) with rapid neutrophil engraftment. During engraftment he developed life-threatening adult respiratory distress syndrome (ARDS). This case serves to illustrate a novel aetiology of vSAA where the infective complications responded to prompt haematopoietic engraftment.

An Arabidopsis thaliana gene (UBC6) encoding a homologue to ubiquitin-conjugating enzymes has been isolated which is capable of encoding a protein of 183 amino acids of ca. 21 kDa. Northern analysis indicates that the gene is expressed in flowers, seeds and, to a somewhat lesser extent, in 10-day seedlings but not in mature leaves, callus and pre-flowering plants. This pattern of expression is confirmed using transgenic Arabidopsis plants containing a UBC6 promoter-GUS gene fusion construct. These plants display GUS activity in mature anthers prior to dehiscence, in developing embryos, sepals and the style after pollination.