Articles: function.
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Anesthesia and analgesia · Feb 2014
Functional Characterization of 2 Known Ryanodine Receptor Mutations Causing Malignant Hyperthermia.
Malignant hyperthermia (MH) is a potentially lethal pharmacogenetic disorder. More than 300 variants in the ryanodine receptor 1 (RYR1) have been associated with MH; however, only 31 have been identified as causative. To confirm a mutation in RYR1 as being causative for MH, segregation of the potential mutation in at least 2 unrelated families with MH susceptibility must be demonstrated and functional assays must show abnormal calcium release compared with wild-type RYR1. ⋯ We propose that R2355W is confirmed as being an MH-causative mutation and suggest that V2354M is a RYR1 mutation likely to cause MH.
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Curr Opin Crit Care · Feb 2014
ReviewSpontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome.
This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS). ⋯ Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but considered in mild-to-moderate ARDS.
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Semin Respir Crit Care Med · Feb 2014
ReviewIntegrated cardiothoracic imaging with computed tomography.
The respiratory and the cardiovascular systems are intimately connected. Because of the high degree of morphological and functional interaction, pathophysiological processes in one compartment are likely to induce adaptive changes in the other. ⋯ Up-to-date advanced imaging strategies allow for a combined assessment of the cardiopulmonary unit. Besides improved techniques of electrocardiogram (ECG)-synchronization for obtaining both morphological and functional information, latest advances of dual-source CT (DSCT) have shown great promise for even more comprehensive integrated cardiothoracic imaging.
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This article reviews the current diagnostic strategies for patients with suspected pulmonary embolism (PE) focusing on the current first choice imaging modality, computed tomographic pulmonary angiography (CTPA). Diagnostic strengths and weaknesses and associated cost-effectiveness of the diagnostic pathways will be discussed. The radiation dose risk of these pathways will be described and techniques to minimize dose will be reviewed. ⋯ Although current cost-effectiveness evaluations have established CT as integral in the PE diagnostic pathway, failure to acknowledge the impact of alternate diagnosis represents a current knowledge gap. The emerging dual energy capacity of current CT scanners offers the potential to evaluate both pulmonary vascular morphology and ventilation perfusion relationships within the lung parenchyma at high spatial resolution. This dual assessment of lung morphology and lung function at low (< 5 millisievert) radiation dose represents a substantial advance in PE imaging.
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Computed tomography (CT) is the core imaging modality for the evaluation of thoracic disorders. With the recently developed dual-energy CT (DECT) technique, the clinical utility of CT in the management of pulmonary diseases can be expanded. The most actively investigated principle of dual energy is material decomposition based on attenuation differences at different energy levels. ⋯ The second major possibility offered by DECT is virtual monochromatic imaging that represents a new option for standard chest CT in daily routine. In this review, imaging principles and clinical applications of dual-energy thoracic CT are described. Knowledge of the applications of DECT may lead to wider use of this technique in the field of respiratory disorders.