STRL33, A novel chemokine receptor-like protein, functions as a fusion cofactor for both macrophage-tropic and T cell line-tropic HIV-1

The chemokine receptors CXCR4, CCR2B, CCR3, and CCR5 have recently been shown to serve along with CD4 as coreceptors for HIV-1. The tropisms of HIV-1 strains for subgroups of CD4(+) cells can be explained, at least partly, by the selective use of G protein-coupled receptors (GPCRs). We have identified a novel human gene, STRL33, located on chromosome 3 that encodes a GPCR with sequence similarity to chemokine receptors and to chemokine receptor-like orphan receptors. STRL33 is expressed in lymphoid tissues and activated T cells, and is induced in activated peripheral blood lymphocytes. When transfected into nonhuman NIH 3T3 cells expressing human CD4, the STRL33 cDNA rendered these cells competent to fuse with cells expressing HIV-1 envelope glycoproteins (Envs). Of greatest interest, STRL33, in contrast with CXCR4 or CCR5, was able to function as a cofactor for fusion mediated by Envs from both T cell line-tropic and macrophage-tropic HIV-1 strains. STRL33-transfected Jurkat cell lines also supported enhanced productive infection with HIV-1 compared with control Jurkat cells. Despite the sequence similarities between STRL33 and chemokine receptors, STRL33-transfected cell lines did not respond to any in a panel of chemokines. Based on the pattern of tissue expression of the STRL33 mRNA, and given the ability of STRL33 to function with Envs of differing tropisms, STRL33 may play a role in the establishment and/or progression of HIV-1 infection.

Set theoretic signal restoration using an error in variables criterion

The restoration of a signal degraded by a stochastic impulse response is formulated as a problem with uncertainties in both the measurements and the impulse response. The method of total least squares, and variants thereof, are effective techniques for solving this class of problems. However, unlike set theoretic estimation schemes, these methods do not allow the incorporation of other a priori information in the estimate. In this correspondence, two new sets motivated by total least squares are introduced for set theoretic estimation. The convexity of these sets is established and the projection operators onto these sets are given. Through simulations, the advantages of the new technique over conventional and older set theoretic schemes for restoration are demonstrated.

Figures of merit for color scanners

In the design and evaluation of color scanners and cameras, it is useful to have a single figure of merit that closely agrees with perceived color accuracy. In the past, several measures of goodness for color scanning filters have been proposed to fulfil such a requirement. Most of the proposed measures have had shortcomings in that they are either based on error metrics in color spaces that are not perceptually uniform, or in that they do not take into account the effects of measurement noise. An extension of the most promising measure, based on linearized CIELAB space, is proposed to obtain a new figure of merit that has a high degree of perceptual relevance and also accounts for the varying noise performance of different filters. The paper also provides a common framework for the different figures of merit and a comprehensive comparison of their computational complexity and reliability.

Digital color imaging

This paper surveys current technology and research in the area of digital color imaging. In order to establish the background and lay down terminology, fundamental concepts of color perception and measurement are first presented using vector-space notation and terminology. Present-day color recording and reproduction systems are reviewed along with the common mathematical models used for representing these devices. Algorithms for processing color images for display and communication are surveyed, and a forecast of research trends is attempted. An extensive bibliography is provided.

Interactions between two divalent ion binding sites in N-methyl-D-aspartate receptor channels

N-methyl-D-aspartate receptor channels exhibit a high permeability for calcium ions. In this report, we confirm that calcium ions permeate effectively through the wild-type channels, and find that their presence within the pore blocks the flux of sodium and other ions. Further proof for this ionic block comes from the analysis of the epsilon 1(N614Q) mutation where the high permeability of calcium is unchanged but the block by calcium ions is increased twofold. In both the wild-type and mutant channels, calcium ion block is independent of membrane voltage; therefore, the calcium binding site is outside the voltage gradient through the pore and must be close to the extracellular mouth of the ion conductance pathway. This calcium site is distinct from the magnesium binding site, which lies 80% into the pore's electrostatic field and thus exhibits a marked voltage dependence of binding. The epsilon 1(N614Q) mutation reduces the affinity of magnesium ion for its binding site but increases the affinity of calcium ion for its binding site. Since a single mutation perturbs two distinct binding sites in opposite ways, we postulate that binding of divalent ions at the two sites interact.

Meaningful features of voice range profiles from patients with organic vocal fold pathology: a preliminary study

This preliminary study identifies features that have the potential to be meaningful descriptors of voice range profiles (VRPs) for 15 patients with organic vocal fold pathologies before and after laryngeal surgery. This study also explores the utility of the VRP as an outcome measure of change in vocal function after surgery. Potentially meaningful features for these patients are the semitone range, intensity level of the lower contour, frequency locus of the lower frequency values, smoothness of the contours, and the presence of intermittencies in the VRP contours. These features are not suggested for differential diagnosis, but for aiding the understanding of each individual patient's phonatory status. Initial use of these features suggests that the VRP may be a useful outcome measure for these patients.

A mutation that alters magnesium block of N-methyl-D-aspartate receptor channels

N-Methyl-D-aspartate (NMDA) receptors are blocked at hyperpolarizing potentials by extracellular Mg ions. Here we present a detailed kinetic analysis of the Mg block in recombinant wild-type and mutant NMDA receptors. We find that the Mg binding site is the same in the wild-type and native hippocampal NMDA receptor channels. In the mutant channels, however, Mg ions bind with a 10-fold lower affinity. On the basis of these results, we propose that the energy well at the Mg binding site in the mutants is shallow and the binding is unstable because of an increase in the rate of dissociation. We postulate that the dipole formed by the amide group of asparagine 614 of the epsilon 1 subunit contributes to the structure of the binding site but predict that additional ligands will be involved in coordinating Mg ions.

The construction and characterization of colanic acid deficient mutants in an extraintestinal isolate of Escherichia coli (O4/K54/H5)

Extraintestinal strains of Escherichia coli possess a variety of virulence factors that enable them to cause disease. These strains express a group 2 capsular polysaccharide which is important in the pathogenic process. Extraintestinal strains evaluated to date are also capable of producing the group 1 capsular polysaccharide colanic acid. The blood isolate CP9 (O4/K54/H5) constitutively produces the group 2, K54 capsule but can be induced to produce colanic acid. In this report we assess whether colanic acid contributes to the pathogenesis of this extraintestinal pathogen. CP9 and its derivatives that are deficient in their ability to produce colanic acid (TR94), the K54 group 2 capsule +/- colanic acid (CP9.137, TR1374) and the O4 specific antigen +/- colanic acid (CP921,CP925) were used to test whether the group 1 capsule colanic acid conferred protection against the bactericidal effects of serum and recombinant bactericidal/permeability-increasing protein (rBPI-23) in vitro. Additionally, CP9, CP9.137 and TR94 were evaluated in the rat granuloma pouch, an in vivo model for localized infection, and by intraperitoneal inoculation into mice, a systemic infection model. In summary, the inability of CP9 to produce colanic acid in the presence or absence of its K54 and O4 antigens had no effect on its ability to survive these host defenses in vitro and did not affect its virulence in these two in vivo models of infection.

Loss of the O4 antigen moiety from the lipopolysaccharide of an extraintestinal isolate of Escherichia coli has only minor effects on serum sensitivity and virulence in vivo

The O-specific antigen in extraintestinal isolates of Escherichia coli is believed to be an important virulence factor. To assess its role in the pathogenic process, proven isogenic derivatives with either a complete (CP921) or nearly complete (CP920) deficiency of the O4 antigen were obtained by TnphoA'1-mediated transposon mutagenesis of an O4/K54/H5 blood isolate (CP9). By utilizing a previously reported isogenic K54 capsule-deficient derivative (CP9.137), additional isogenic derivatives deficient in both the K54 capsular antigen and either all (CP923) or nearly all (CP922) of the O4 antigen were also constructed. These strains and their wild-type parent were evaluated in vitro for serum sensitivity and in vivo by intraperitoneal challenge of outbred mice. The complete or nearly complete loss of the O4 antigen (CP920 and CP921) resulted in only a minor increase in serum sensitivity. In contrast, CP9.137 had a significant increase in serum sensitivity, and CP922 and CP923 were extremely serum sensitive. When tested in vivo, the complete or nearly complete loss of the O4 antigen resulted in a small but significant increase (P < or = 0.05), not the expected decrease, in virulence compared with its wild-type parent. In contrast, CP9.137 and CP922 were significantly less virulent (P < or = 0.05). These studies do not exclude a role for the O4 antigen moiety of lipopolysaccharide in the pathogenesis of extraintestinal E. coli infection; however, they demonstrate that the O4 antigen plays only a minor role in serum resistance in vitro and that its loss does not diminish and perhaps enhances the virulence of CP9 in vivo after intraperitoneal challenge.

Differential assembly of coexpressed glutamate receptor subunits in neurons of rat cerebral cortex

In the rat, subunits of the glutamate receptor family fall into three pharmacologically distinct groups: alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid preferring receptors (Glu R1-4), kainate preferring receptors (Glu R5-7, KA 1, KA 2), and N-methyl-D-aspartate preferring receptors (NMDA R1, NMDA R2A-2D). In the present study, we demonstrate immunocytochemically that the majority of neurons in rat cerebral cortex coexpress members of all three groups of glutamate receptor subunits, Glu R2/3, Glu R5/6/7, and NMDA R1. Using immunoaffinity purified or immunoprecipitated alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid, kainate and N-methyl-D-aspartate receptors, we show that alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors containing Glu R1-4, kainate receptors containing Glu R6, Glu R7, and KA 2 and N-methyl-D-aspartate receptors containing NMDA R1 each form distinct protein complexes that do not share subunits. Our data indicate that a mechanism exists which allows for the specific assembly of selected glutamate receptor subunits into functionally and structurally distinct heteromeric receptors.

[Permanent cardiac pacing in children. Personal experience]

Pacemaker implantation was performed in 26 children aged from 5 months to 15 years (mean 4.6). The indications for pacemaker implantation were: sick sinus syndrome in 4 patients, III degrees idiopathic A-V block in 2 both with congenital heart disease and III degrees post-op. A-V block in 20 patients. 34 pacemakers produced by seven different companies were implanted. Epicardial electrode was used in all but one patient in whom endocardial electrode was introduced. Demand for impulse voltage was 2.4-5.2 V (mean 4.4 V), impulse duration was from 0.25 ms to 1.65 ms (mean 0.62 ms). Three out of 26 pts. (11.5%) died (1-intraoperative bleeding, 1-ventricular rhythm disturbances, 1-sudden death). In seven children first exchange of the pacemaker (one for mechanic damage and 6 for exhausted batteries) was performed mean 4.3 years after previous implantation. In two children second battery exchange was necessary mean 7.5 years after previous (both exhausted batteries). In five children a damaged epicardial electrodes were exchanged (21%).

Background noise in healthy volunteers--a consideration in adverse drug reaction studies

In adverse drug reaction studies proper control over 'Back ground noise' is to be maintained to avoid erroneous conclusions to be drawn for adverse drug effects. Healthy volunteers, not taking any medication, were surveyed by a questionnaire to obtain data on the occurrence of any symptoms, often ascribed to side effects of drugs. Only 62 subjects out of a total of 236 (26.27%) stated experiencing none of these symptoms during the previous 3 days. The remaining subjects reported some symptoms, with an median number of symptoms experienced per person being 2; the most common being fatigue; headache, inability to concentrate and excessive sleepiness.

Tunicamycin resistance in Saccharomyces cerevisiae: genetic studies

Tunicamycin is a nucleoside antibiotic complex produced by Streptomyces lysosuperficus which inhibits glycosylation. Several mutants have been isolated in this laboratory that are resistant to tunicamycin, of which the majority are recessive and a few are dominant. The mutations are possibly due to some loss of transport function or alteration in the membrane. These recessive mutations have been mapped to chromosome 1 by the 2 mu mapping method. Studies are underway to map the dominant mutations as well and to group these mutations into its complementation groups and to characterize them biochemically. Both mating types of these mutant strains have been generated in our laboratory.

Cloning of a putative glutamate receptor: A low affinity kainate-binding subunit

Kainate, a glutamate receptor agonist, is a potent neuroexcitatory agent that produces epileptiform activity and selective neuronal degeneration. Binding studies using neuronal membrane homogenates or brain sections have identified sites having either high or low affinity for [3H]kainate. Here we report the cloning of a gene, GluR7, with approximately 75% sequence identity with the previously cloned GluR5 and GluR6 subunit genes. Transcripts of the GluR7 gene are evident in brain areas that bind [3H]kainate and are susceptible to kainate-induced neurotoxicity. We have performed ligand binding studies with membranes of transfected HeLa cells expressing GluR6 or GluR7 subunits. Our data show that the GluR6 and GluR7 subunits have a rank order of agonist affinity (domoate greater than kainate much greater than L-glutamate, quisqualate much greater than AMPA, NMDA) and a dissociation constant for kainate (95 and 77 nM, respectively) characteristic of the low affinity kainate-binding sites described in the brain.

Effect of ethanol on the distribution of cadmium between the cadmium metallothionein- and non-metallothionein-bound cadmium pools in cadmium-exposed rats

In an attempt to assess the effect of ethanol on cadmium accumulation, metallothionein (MT) synthesis, Cd-binding capacity and lipid peroxidation, rats were administered either Cd, ethanol or their combination for a period of 4 weeks. A significant increase in Cd accumulation was observed in all the organs of rats under study co-exposed to Cd and ethanol as compared to only Cd-treated rats. Increased MT levels in response to Cd were associated with a marked alteration in the distribution of Cd amongst the two pools of intracellular Cd i.e. Cd bound to MT (Cd-MT) and Cd not bound to MT (non-MT-Cd). Higher levels of non-MT-Cd were observed in liver, kidney and heart of Cd+ethanol-exposed rats as compared to only Cd-exposed rats. Lesser binding of 109Cd to the protein peak was observed in Cd+ethanol-exposed rats than the Cd-treated rats when hepatic supernatants from all the groups were chromatographed on Sephadex G-75 columns, suggesting that ethanol has a redistributing effect on Cd amongst the two pools. A marked increase in lipid peroxidation was observed which was linear to the increase in non-MT-Cd levels. A positive correlation between non-MT-Cd levels and lipid peroxidation was observed in liver, kidney and heart suggesting that non-MT-Cd levels are more crucial and toxicologically more important than total Cd levels.

Effect of ethanol on cadmium-induced lipid peroxidation and antioxidant enzymes in rat liver

We have investigated the effects of the intragastric administration of cadmium (10 mg/kg body weight) and ethanol (5.56 g/kg body weight) alone as well as in combination on hepatic lipid peroxidation, the antioxidant defense system, and the morphology of liver in rats. Cadmium given in combination with ethanol led to a marked increase in cadmium accumulation in liver compared to the level in rats treated only with cadmium. Further, cadmium and ethanol coexposure produced a more pronounced elevation in lipid peroxidation (L-px), which was associated with a significantly greater inhibition of antioxidant enzymes, glutathione peroxidase (GSH-px; EC 1.11.1.9), glutathione reductase (GR; EC 1.6.4.2) and superoxide dismutase (SOD; EC 1.15.1.1), than cadmium treatment alone. The levels of glutathione (GSH) and total thiols (TSH) also decreased significantly after cadmium and ethanol coexposure. On histopathological examination, it was observed that the livers of rats coexposed to cadmium and ethanol showed a marked degeneration of hepatocytes which was not seen in rats treated only with cadmium.

An influenza virus containing nine different RNA segments

The packaging mechanism of segmented RNA viruses has not been well studied. Specifically, it has not been clear whether influenza A viruses package only eight RNA segments or whether virus particles contain more than eight segments. Using a newly developed ribonucleoprotein (RNP) transfection method, we engineered an influenza virus which must contain nine different RNA segments rather than the usual eight in order to survive under the experimental growth conditions. This result is compatible with a mechanism of packaging which allows influenza virus to encapsidate more than eight RNA segments. We also suggest that the virus packages its RNAs randomly and that this random packaging results in infectious viruses with the required ("right") complement of RNA segments.

Effect of ethanol on cadmium uptake and metabolism of zinc and copper in rats exposed to cadmium

Effects of chronic administration of cadmium and ethanol, alone as well as in combination, on the uptake of cadmium and its interaction with other essential trace elements in various tissues of adult rats were investigated. Cadmium given in combination with ethanol led to a pronounced increase in cadmium absorption and accumulation in all the tissues studied relative to both non-exposed controls and rats treated with cadmium alone. Both cadmium and ethanol exhibited specific effects on copper and zinc levels of the tissues. These effects often were significantly altered when the animals were co-exposed to cadmium and ethanol. The results suggested that although both cadmium and ethanol individually pose a hazard to essential trace metal homeostasis of various organs, co-exposure can pose a major threat since animals exposed to ethanol absorb much more cadmium than their unexposed counterparts.

Remnant model of renal failure in the dog: avoidance of second surgery by chemical nephrectomy

Experimental chronic renal failure in the dog is usually studied by a two-step surgical procedure. However, it is becoming increasingly difficult, due to animal welfare concerns, to get permission for such procedures in Canada. We describe a method for obviating the need for second surgery by injecting absolute alcohol into a renal artery, which leads to immediate functional nephrectomy.

Involvement of an inducible factor in interferon-gamma-mediated accumulation of HLA gene transcripts

Earlier studies with a cDNA clone (C5-4) complementary to an interferon (IFN)-gamma-inducible mRNA showed that in human fibroblasts (FS-4), IFN-gamma induced the transcription of the cognate gene, but it required new protein synthesis (Caplen and Gupta, J. Biol. Chem. 263, 332-339, 1988). To determine whether such a strategy is used for the regulation of other cellular genes by IFN-gamma, the regulation of the HLA class I and class II genes and another cellular gene for which a cDNA clone was isolated (C13) was studied. The results indicate that: (i) HLA-B (class I) and C13 gene expression was transcriptionally activated by IFN-gamma and IFN-alpha 2, and it did not require new protein synthesis. (ii) In contrast, the transcription of the HLA-DR alpha was activated by IFN-gamma (and not by IFN-alpha 2), but the accumulation of -DR alpha gene transcripts was strongly inhibited by cycloheximide or anisomycin, which indicated that there was a requirement for some newly synthesized protein factor(s) in this process, apparently at a step subsequent to transcriptional activation. We obtained evidence indicating that the putative protein factor(s) required is actually induced by IFN-gamma. (iii) IFN-gamma-induced transcription of the HLA-B gene was not inhibited by anisomycin or cycloheximide, but the accumulation of HLA-B transcripts plateaued sooner. This latter effect was not due to any toxicity of these inhibitors because it was observed if cycloheximide was added together with IFN-gamma, but not if it was added a few hours later. Furthermore, if cycloheximide was added 24 h after IFN-gamma, it actually caused a superinduction of HLA-B transcripts. The results suggest that some newly synthesized protein factor(s) may be required also for maximal accumulation of HLA-B gene transcripts following treatment with IFN-gamma. The results indicate a dual regulation of HLA class I and class II genes by IFN-gamma, and involvement of multiple mechanisms in the regulation of cellular gene expression by IFN-gamma.

Evaluation of desferrioxamine mesylate on survival, and prevention of histopathological changes in the liver, in haemorrhagic shock: an experimental study in dogs

Desferrioxamine mesylate (desferal) an iron chelating agent was investigated in anaesthetized standard haemorrhagic shock (HS) dogs with elective hypotension at 35 +/- 5 mmHg for 4 h and return of withdrawn blood (ROWB) thereafter. Observations were made in respect of serum iron elevation over 4 h and survival and recovery pattern over 72 h after ROWB. Influence of the drug on histopathological changes of shock in liver were studied in non-survival experiments (dogs sacrificed after 4 h of elective hypotension). Desferal administration (25 mg/kg i.m.) at 30 min after initial bleeding, increased the 72 h survival from 10% (controls) to 50%, and reduced the serum iron elevation from 63.3% (controls) to 9.44%. The single control survivor remained unconscious till 24 h and sluggish in activity up to 72 h. Three of the drug treated survivors regained consciousness by 2 h, activity by 24 h and all were normally active by 72 h. Severe congestive and degenerative changes in liver, present in the controls, were markedly reduced in severity and incidence in those given desferal. It is suggested that iron decompartmentalization in the hypoxic tissues in HS with its consequent rise in serum and intracellular pool, plays a pivotal role in progression towards irreversibility. Desferal, an effective intracellular iron chelator, possibly arrests the widespread cellular damage caused through enhanced iron-catalysed .OH radical generation in shock state.

Protection by desferrioxamine against histopathological changes of the liver in the post-oligaemic phase of clinical haemorrhagic shock in dogs: correlation with improved survival rate and recovery

Haemorrhagic shock was produced in anaesthetized dogs, by rapid arterial bleeding to mean arterial blood pressure 35 mmHg, and maintained oligaemic for 4 h followed by return of withdrawn blood(ROWB). Dogs were observed for 72 h after ROWB for survival and recovery, and, for histopathological (HP) studies on liver, dogs were sacrificed 2 h after ROWB in non-survival experiments. Desferrioxamine mesylate (25 mg/kg) was administered intra-muscularly at 2,3 and 4 h after blood loss in survival experiments and for HP studies the drug was given at 4 h in one group and at 2 h plus 4 h after blood loss in the second group. With the drug given at 3 or 4 h, survival was 70% and 100% while in the 2 h and the untreated groups it was 50%. Recovery was rapid in all the drug treated survivors, few became conscious within 30 min, showed slight activity by 4-6 h, all were almost normally active by 24 and fully so by 72 h after ROWB. All the 5 control survivors remained unconscious/drowsy upto 24 h; 3 were sluggish at 72 h. By group analysis, serum iron elevation during the oligaemic and at the end of the post-oligaemic phase was less in the drug-treated animals. HP changes of shock in the liver studied by light microscopy, were markedly reduced in severity and were less prevalent in the drug-treated dogs. The salutory effects of desferrioxamine may be due to inhibition of iron catalyzed free-radical production and tissue damage, through its strong iron chelating action. It may have a therapeutic advantage in this emergency condition without the disadvantages of toxicity inherent in prolonged use.

Urinary aspartate transaminase (AST) activity and detection of its inhibitors in normal urine

Urinary aspartate-transaminase activity in the whole urine was found to be mean +/- S.D. = 8.46 +/- 0.69 l.U/l when measured immediately after urine collection. About 50% loss in enzyme activity was observed after 18 hours dialysis. An overall 176% increase in enzyme activity followed by Sephadex G-25 (fine) whole urine fractionation and a highly significant (P less than .001) partial inhibition by earlier Sephadex fractions and maximum inhibition by earlier Sephadex fractions and maximum inhibition of enzyme by fraction 7 have suggested the presence of both high and low molecular weight urinary inhibitors of aspartate-transaminase. Urea and ammonia presence and inhibitor activity in fraction 6 to 8 bear a close parallelism; both the substances produced 31% inhibition of partially purified goat liver GOT at concentrations approximating normal human urine. Therefore, low enzyme activity and its substantial loss in the whole urine and during dialysis may be due to the concomitant inhibitory effects of urea, ammonia and unidentified nature of high molecular weight substance(s). The present method may be effective in separating inhibitors and overcoming the disadvantages of dialysis in determining true urinary aspartate-transaminase activity.

Age-dependent changes in esterases of Callosobruchus maculatus Fab. (Bruchidae: Coleoptera)

Age-dependent changes, quantitative as well as qualitative, in esterase activity were found by assaying crude extracts of Callosobruchus maculatus. There is increase in esterase activity in both the sexes with advancing age in bruchids. Esterase from old bruchids showed several additional electrophoretic bands which did not appear in assays of young bruchids; in addition there is an increase in staining intensity of the bands. A rapid increase in esterase activity during the last days of life may be responsible for producing energy used in various metabolic processes in an attempt to escape death.

Age-related glycogen changes in bruchids

Quantitative measurements of glycogen in aging bruchids showed there was a considerable decrease (> 50%) with age except on the fifth day when an increase was observed, followed by a decrease on the sixth day. The variations in glycogen content with age suggests that glycogen serves as one of the energy sources responsible for the maintenance of metabolism in the process of aging in bruchids.

Cytogenetic effects of influenza virus infection on male germ cells of mice

Swiss albino male mice were administered two doses (1 and 2 HA units) of influenza A2 Hong Kong/68 virus IP. The incidence of chromosomal anomalies in spermatocytes was analysed at various times post infection and was found to be significantly higher than in controls, indicating that the influenza virus had induced these anomalies.

Recent advances in surgery of ongenital heart disease

In the cyanotic group palliative procedures for transposition of the great arteries are frequently life-saving in infancy, and the definitive operations such as the atrial baffle, and the Rastelli procedure for those with ventricular septal defect and pulmonic stenosis, are now firmly established. In tetralogy of Fallot shunting procedures continue to be employed in infancy and early childhood, and the complete repair is usually done after the age of five. Corrective operations for total anomalous venous return may have to be staged, and the results are more satisfactory in older children. The various forms of endocardial cushion defects can usually be recognized accurately preoperatively, and where the normal anatomical relationships can be restored, excellent results obtained. Brilliant operative success can now be had in some forms of truncus arteriosus and double outlet right ventricle. It is quite common to find congenital heart disease in adults, frequently after many years of having been treated as rheumatic heart disease. The operative risk in this group is less than 10 percent, and in most instances such patients are restored to their normal physiological age after operation.

Oesophageal Perforation

NA

Active management of third stage of labor: Assessment of standard of care in one of the training institute

Objective: To find out the quality of service (standard steps of the procedures) incorporated in the active management of the third stage of labor (AMTSL) in Maternity Hospital, Thapathali, Kathmandu, Nepal. Methods: Prospective (single blind) study, where the (uninformed) service providers had no knowledge that they were being assessed of their performances regarding the proper conduct of the AMTSL, in randomly selected 325 laboring women during all shifts of the day by 4 interns who carefully documented the findings in pre prepared standard 3 month duration reference during in the year 2061/2062 (2004/2005) in Maternity Hospital Thapathali, Kathmandu, Nepal. Results: (Pre) loading of oxytocin was correctly done immediately when the women were seen to bear down at second stage of labor. In 99.5% of cases (irrespective of duty shift). In 5.8 % of cases, the oxytocin doses were different from standard 10 units. The possibility of second twin was not ruled out in 81.9% before the administration of 10 units of IM oxytocin. Moreover, the study that controlled cord traction was revealed or showed applied in 50% of the cases without confirming uterine contraction while counter traction to the uterus was given in most of the cases (98.5%) along with effective examination of the placenta for its completeness in 98.2 % cases. Conclusion: This study shows that improvement in the standard AMTSL practices is still needed in the training providing institution, which demand ensuring the absence of twin tactfully before giving IM oxytocin within 2 minutes invariably after the delivery of the babies and also in giving slight traction on to the umbilical cord gently during uterine contraction along with counter traction to the uterus. Key words: Active management of third stage of labor AMTSL, oxytocin, uterine massage.   doi:10.3126/njog.v1i2.2394 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 28-30 Nov-Dec 2006