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01) and Tokyo severity grades II (p=0.04) and III (p=0.001) were significant factors associated with mortality. CONCLUSIONS Early identification of risk factors, administration of appropriate antibiotics and establishing early biliary drainage were found to be the key management steps to reduce cholangitis-related mortality.Objective To compare half-thickness tragal cartilage graft with temporalis fascia graft in terms of graft take-up and acoustic outcomes in type-I tympanoplasty. METHODS The randomised control trial was conducted at Lady Reading Hospital, Peshawar, Pakistan, from January to December 2017, and comprised patients aged 16-60 years undergoing tympanoplasty. The patients were divided into two equal groups using systemic random sampling method. In Group A, tympanoplasty type-I was done using half-thickness tragal cartilage graft, while in Group B, it was done using temporalis fascia graft. Data was analysed using SPSS20. RESULTS Of the 40 patients, there were 20(50%) in each of the two groups. Overall, there were 24(50%) males and 16(40%) females. The mean age of Group A was 28.57±8.00 years, and in Group B it was 27.14±6.18 years. The graft success rate in Group A was 19(95%) and in Group B it was 18(90%) (p>0.05). Conclusion The graft success rates for half-thickness tragal cartilage and temporalis fascia were statistically non-significant.OBJECTIVE To assess the impact of a partnership between a nursing school and a large-scale urban hospital on healthcare education, practice and research. METHODS The qualitative study was conducted from April 2013 to January 2014 at a nursing school and an urban hospital at University of Pennsylvania, Philadelphia in the United States, and comprised health professionals including nursing faculty members, nurse clinicians and nurse managers from the two institutions. Data was collected through in-depth interviews using an open-ended questionnaire. Data was subjected to qualitative content analysis. RESULTS Of the 16 health professionals, 8(50%) were faculty members at the school of nursing, and 8(50%) were nurse clinicians/manager at the hospital. Major themes that emerged were mutual gains and benefits; clinical educators as the cornerstones of the partnership; leaders as key actors; and roadblocks to sustaining collaboration. The partnership benefitted both parties, particularly those in clinical practice, despite some challenges to long-term sustainability. selleck chemical The roles of clinical educator and team leader were critical in both settings. CONCLUSIONS The partnership between academics and practice carried critical importance in terms of enhancing quality patient care, student training, professional development and increasing research capacity.OBJECTIVE To compare the outcome of induction-remission in acute lymphoblastic leukaemia patients treated according to two different guidelines. METHODS The descriptive retrospective cohort study was conducted at The Children's Hospital Lahore, Pakistan, and comprised clinical information sheets of acute lymphoblastic leukaemia patients from September 2014 to August 2015. Data regarding demographics, risk categorisation, rapid early response and induction-remission assessment was collected separately for Group 1 patients treated with Lahore protocol and Group 2 patients using United Kingdom acute lymphoblastic leukaemia-2011 interim guidelines. Data was analysed using SPSS version 20.0. RESULTS Of the 98 patients who had a median age of 6.4 years (interquartile range 1.5-16 years), 48(49%) were in Group 1 and 50(51%) in Group 2. There were 14(29%) patients with standard risk in Group 1 while 34(71%) were high-risk. The corresponding numbers in Group 2 were 30(60%) and 20(40%) in Group 2. Rapid early response was noted in 18(37.5%) patients in Group 1 and 11(28%) in Group 2. Remission was achieved in 38(79%) patients in Group 1 and 36(72%) in Group 2. There was significant association of rapid early response with induction-remission in Group 2 (p0.05). CONCLUSIONS Induction-remission rate was comparable in the two treatment groups, but significant association of rapid early response with induction-remission was observed only in patients treated using United Kingdom acute lymphoblastic leukaemia-2011 interim guidelines.Objectives To examine whether Ephrin type A receptor 2 gene polymorphisms are associated with susceptibility to age-related cataract. METHODS The case-control study was conducted from January to May 2014 in Multan, Pakistan, and comprised patients of age-related cataract enrolled from Nishtar Hospital, Multan, and age-matched healthy controls without any type of cataract from the local population. A questionnaire was used to gather clinical and epidemiological data. Deoxyribonucleic acid was extracted from blood samples, and analysis of rs11260867, rs3568293 and rs7543472 single nucleotide polymorphisms was performed by using tetra amplification-refractory mutation system polymerase chain reaction protocol. Data was analysed using SPSS 17. RESULTS Of the 230 subjects, 129(%) were patients and 101(%) were controls. Among the three polymorphisms analysed, rs7543472 was associated with age-related cataract. Among the epidemiological and clinical factors, age, diabetes, blood pressure, smoking, radiation exposure, steroids usage and use of tranquilisers were associated with age-related cataract (p less then 0.05 each). CONCLUSIONS Polymorphism rs7543472 was found to be associated with age-related cataract.OBJECTIVE To find prevalence of preterm birth in Pakistan and to explore its related risk factors. METHODS This analytical cross-sectional study was conducted from October 1, 2016, to September 30, 2017, at Hajvery University, Lahore, Pakistan, and data was collected from Obstetrics and Gynaecology departments of various hospitals in four provinces of the country. To find risk factors of preterm birth, data was divided into two groups Group-1 consisted cases with preterm birth defined as gestational age less then 37 weeks on ultrasonography; and Group-2 consisted controls with full-term birth defined as gestational age 37-41 weeks. Data was analysed using SPSS 22. RESULTS There were 1,691 females with mean gestational age of 37.3±2.062 weeks. The prevalence of preterm birth was 366(21.64%). Top 5 major risk factors identified were Placenta Previa (odds ratio 51.97), maternal thyroid disease (odds ratio 18.46), being a minority (odds ratio 7.73), foetal distress (odds ratio 7.19), and maternal asthma (odds ratio 6.23). CONCLUSIONS The prevalence of preterm birth was found to be high with several modifiable and controllable risk factors.OBJECTIVE To evaluate the efficacy of combining an oral chemotherapeutic agent temozolamide with radiotherapy in the management of the un-resectable non-metastatic soft tissue sarcomas compared with radiotherapy alone. METHODS The randomised controlled phase 3, double-arm study was conducted at King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from December 2012 to July 2017. Patients with all sub-types of locally advanced un-resectable soft tissue sarcomas were randomised into two groups. Group-A received radiotherapy alone while Group-B received concomitant chemoradiotherapy with temozolamide after receiving two cycles of standard chemotherapy. Response was evaluated according to response evaluation criteria in solid tumours through computed tomography scan or magnetic resonance imaging after 6 weeks following completion of radiotherapy. SPSS 21 was used for data analysis. RESULTS Of the 64 patients, 32(50%) were assigned to each group. The mean age of Group-A was 36.25±20.31 and of Group-B 37.84±15.79 years .There were 18(56.3%) males in Group-A and 20(62.5%) in Group-B. Improvement in trends of overall response rate was observed in Group-B 24(75%) compared to 18(56.3%) in Group-A (p=0.12).. CONCLUSIONS Though not statistically significant, there was improvement in response rate with the addition of temozolamide to standard radiation therapy.Nitrogen is the main constituent of the Earth's atmosphere, but its provenance in the Earth's mantle remains uncertain. The relative contribution of primordial nitrogen inherited during the Earth's accretion versus that subducted from the Earth's surface is unclear1-6. Here we show that the mantle may have retained remnants of such primordial nitrogen. We use the rare 15N15N isotopologue of N2 as a new tracer of air contamination in volcanic gas effusions. By constraining air contamination in gases from Iceland, Eifel (Germany) and Yellowstone (USA), we derive estimates of mantle δ15N (the fractional difference in 15N/14N from air), N2/36Ar and N2/3He. Our results show that negative δ15N values observed in gases, previously regarded as indicating a mantle origin for nitrogen7-10, in fact represent dominantly air-derived N2 that experienced 15N/14N fractionation in hydrothermal systems. Using two-component mixing models to correct for this effect, the 15N15N data allow extrapolations that characterize mantle endmember δ15N, N2/36Ar and N2/3He values. We show that the Eifel region has slightly increased δ15N and N2/36Ar values relative to estimates for the convective mantle provided by mid-ocean-ridge basalts11, consistent with subducted nitrogen being added to the mantle source. In contrast, we find that whereas the Yellowstone plume has δ15N values substantially greater than that of the convective mantle, resembling surface components12-15, its N2/36Ar and N2/3He ratios are indistinguishable from those of the convective mantle. This observation raises the possibility that the plume hosts a primordial component. We provide a test of the subduction hypothesis with a two-box model, describing the evolution of mantle and surface nitrogen through geological time. We show that the effect of subduction on the deep nitrogen cycle may be less important than has been suggested by previous investigations. We propose instead that high mid-ocean-ridge basalt and plume δ15N values may both be dominantly primordial features.The charge-conjugation and parity-reversal (CP) symmetry of fundamental particles is a symmetry between matter and antimatter. Violation of this CP symmetry was first observed in 19641, and CP violation in the weak interactions of quarks was soon established2. Sakharov proposed3 that CP violation is necessary to explain the observed imbalance of matter and antimatter abundance in the Universe. However, CP violation in quarks is too small to support this explanation. So far, CP violation has not been observed in non-quark elementary particle systems. It has been shown that CP violation in leptons could generate the matter-antimatter disparity through a process called leptogenesis4. Leptonic mixing, which appears in the standard model's charged current interactions5,6, provides a potential source of CP violation through a complex phase δCP, which is required by some theoretical models of leptogenesis7-9. This CP violation can be measured in muon neutrino to electron neutrino oscillations and the corresponding ahether leptonic CP violation is larger than the CP violation in quarks.Generating quantum entanglement in large systems on timescales much shorter than the coherence time is key to powerful quantum simulation and computation. Trapped ions are among the most accurately controlled and best isolated quantum systems1 with low-error entanglement gates operated within tens of microseconds using the vibrational motion of few-ion crystals2,3. To exceed the level of complexity tractable by classical computers the main challenge is to realize fast entanglement operations in crystals made up of many ions (large ion crystals)4. The strong dipole-dipole interactions in polar molecule5 and Rydberg atom6,7 systems allow much faster entangling gates, yet stable state-independent confinement comparable with trapped ions needs to be demonstrated in these systems8. Here we combine the benefits of these approaches we report a two-ion entangling gate with 700-nanosecond gate time that uses the strong dipolar interaction between trapped Rydberg ions, which we use to produce a Bell state with 78 per cent fidelity.