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Biomedical subjects

M Nigam

Publications and source records attributed to M Nigam.

At least 19 recordsLinked to original sources
PubMed2004

Transcatheter closure of congenital muscular ventricular septal defect.

The success with occlusion devices for the closure of atrial septal defects and patent ductus arteriosus prompted the transcatheter closure of single and multiple muscular ventricular septal defects (VSD). The procedure for VSD was first attempted by Lock et al. in 1988 and devices originally designed for the closure of other intracardiac defects (Rashkind umbrella device, Lock clamshell, Cardioseal, coils, Sideris buttoned device etc.) were used with a variable success rate and a residual shunt. Recently, specially designed Amplatzer muscular VSD occluder and Sideris device are in use. The Amplatzer muscular VSD occluder has been undergoing clinical trial since 1998 after the animal experiments had shown 100% occlusion and complete endothelization at 3 months. The procedure was first attempted in August 1995 using the Rashkind umbrella device and since April 1998 only the Amplatzer muscular VSD occluder has been used. Of the149 patients who underwent transcatheter closure of VSD, 50 had muscular trabecular defects in various locations: mid-muscular, anterior, posterior, or apical. All cases were selected by detailed transthoracic and/or transesophageal echocardiography (TTE) and aneurysm of the muscular septum was observed in three of them. The age range was 3-28 years and the diameter of VSD was 4-11 mm. In all but one patient, the device was deployed from the venous side. Simultaneous TTE was done for proper positioning of the device and continuous electrocardiographic monitoring was also done for any arrhythmia/conduction defects. All patients were followed up every 3 months and received 3-5 mg/kg aspirin for 6 months. The procedure was successful in all patients. The Rashkind umbrella device (17 mm) was used in two and Amplatzer muscular VSD occluder (6-14 mm) in 48 patients. Forty-four devices were delivered by antegrade transvenous approach and six by the transjugular route. None had residual shunt, new aortic regurgitation, or tricuspid regurgitation. Transient complete heart block after 24 hours was noticed in one patient. On a follow-up of 2-90 months, the device was in position in all patients. There was no embolization of the device, and no late-conduction defects, infective endocarditis, or hemolysis. Transcatheter closure of muscular VSD is safe and efficacious, and should be considered as a procedure of choice as an alternative to surgery that avoids cardiopulmonary bypass.

Adolescent↗
PubMed2001

Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery.

OBJECTIVE: To compare 2 important techniques of blood conservation, use of a cell saver and low-dose aprotinin, in terms of blood loss and homologous blood usage in patients undergoing cardiac valve surgery. DESIGN: Prospective, randomized. SETTING: Tertiary care hospital. PARTICIPANTS: Sixty adult patients undergoing elective valve surgery. INTERVENTIONS: The patients were divided into 3 groups of 20 each. In group 1, aprotinin in the dose of 30,000 KIU/kg was added to the pump prime, with a further dose of 15,000 KIU/kg added at the end of each hour of cardiopulmonary bypass. In group 2, a cell-saver system was used to collect all blood at the operation site for processing in preparation for subsequent reinfusion. Group 3 patients acted as a control group and underwent routine management, which included collection of autologous blood during the pre-cardiopulmonary bypass period. A hemoglobin of <8 g/dL was considered as an indication for bank blood transfusion in the postoperative period. MEASUREMENTS AND MAIN RESULTS: The chest tube drainage was significantly less in group 1 compared with groups 2 and 3, with total drainage (median [interquartile range]) amounting to 250 mL [105 to 325 mL] vs. 700 mL [525 to 910 mL] in group 2 and 800 mL [650 to 880 mL] in group 3 (p < 0.001). The patients in groups 1 and 2 required significantly less bank blood (median [interquartile range]) as compared with group 3 (350 mL [0 to 525 mL], 350 mL [0 to 350 mL], and 1050 mL [875 to 1050 mL]; p < 0.001), respectively. Cell saver provided 410 +/- 130 mL of hemoconcentrated blood in group 2. The average preoperative hemoglobin concentration was 11.3 g/dL, and it was around 9 g/dL on the 7th postoperative day. The hemoglobin concentration at various stages during hospitalization in all 3 groups was similar. CONCLUSIONS: Low-dose aprotinin and a cell saver are effective and comparable methods of blood conservation. Aprotinin helps by decreasing the postoperative drainage, and a cell saver helps by making the patient's own blood available for transfusion.

Adult↗
PubMed2000

Mitral regurgitation following percutaneous transvenous mitral commissurotomy: a single-center experience.

BACKGROUND AND AIM OF THE STUDY: Percutaneous transvenous mitral commissurotomy (PTMC) has revolutionized the treatment of patients with symptomatic mitral stenosis and is now established as the procedure of choice. Despite high technical expertise in PTMC using the Inoue balloon, mitral regurgitation (MR) remains a major procedure-related complication. We retrospectively analyzed our data of PTMC using the Inoue balloon with regard to the incidence of MR, its likely causative mechanism, and follow up of these patients. METHODS: During the past ten years, PTMC was performed in 3,650 patients (median age 26 years; range: 8-76 years), of whom 910 (24.9%) were juveniles. Preprocedure mitral valve area (MVA) was 0.9 +/- 0.4 cm2 (range: 0.3-1.3 cm2); MR was mild in 1,396 cases (38.2%), moderate in 394 (10.8%) and severe in 22 (0.6%). None of the patients was rejected on the basis of echocardiographic score. RESULTS: The procedure was successful in 3,276 (89.8%), with post-procedure MVA of 1.7 +/- 0.6 cm2 (range: 1.4-2.6 cm2), and without development of any major complication. Severe MR was seen in 120 patients (3.3%), of whom 66 (1.8%) required urgent mitral valve replacement (MVR). Echocardiography in these latter patients showed leaflet rupture in 48 (72.7%), chordal rupture in 12 (18.2%) and excessive commissural tear in six (9.1%). Fifty-four patients (1.5%) with severe MR post PTMC were followed with medical treatment; echocardiography in these patients revealed chordal rupture in 40 (74.1%) and excessive commissural tear in 14 (25.9%). Follow up data were available in 49 patients (1.3%); 30 (0.8%) required MVR and 19 (0.5%) were in NYHA class II at a median follow up of 24 months. Moderate MR was seen in 188 cases (5.1%), with predominant causative mechanisms of excessive commissural tear in 120 (63.8%) and chordal rupture in 68 (36.2%). Severity of MR worsened in 30 cases (0.8%), of which 20 (0.6%) required elective MVR on follow up. MR decreased in 58 patients (1.6%), in whom excessive commissural tear was the causative mechanism. CONCLUSION: Significant MR (moderate or severe) after PTMC was seen in 308 patients (8.4%), of whom 116 (3.2%) required MVR urgently or on follow up. All patients with leaflet rupture during PTMC developed severe MR and required urgent MVR. There was a tendency for the severity of MR to decrease with time in cases where excessive commissural tear was the causative mechanism.

Adolescent↗
PubMed1998

Calcified subaortic left ventricular aneurysm causing right pulmonary artery obstruction in a child.

A 14-year old asymptomatic boy was diagnosed as having a large calcified subaortic left ventricular aneurysm that was found to obstruct flow across the right pulmonary artery during systole. Surgical patch closure of the neck of the aneurysm resulted in relief of obstruction. The case is reported for its rarity, massive calcification, absence of aortic regurgitation and dynamic compression of the right pulmonary artery.

Adolescent↗
PubMed1998

Successful nonsurgical removal of a knotted and entrapped pulmonary artery catheter.

Knotting of a balloon-tipped, flow-directed catheter leading to difficulty in its removal is a rare but serious complication. Several methods have been used to remove such catheters with nonsurgical techniques. A case of knotted catheter that was also entrapped in a surgical suture in a patient undergoing emergency mitral valve replacement is presented and a method for its nonsurgical removal is described.

Adult↗
PubMed1996

Balloon mitral commissurotomy: an intraoperative assessment.

OBJECTIVE: Advances in balloon catheter technology have revolutionized the management of obstructive cardiovascular diseases. For lesions like mitral stenosis, balloon commissurotomy has emerged as an alternative to surgical relief showing definite functional benefits in a few clinical trials, albeit with variable results. Such variability necessitated objective evaluation of the efficacy of balloon mitral commissurotomy. METHODS: The balloon mitral commissurotomy was carried out in 11 patients suffering from isolated mitral stenosis, under vision in a surgical setting. All patients were in NYHA class III/IV. Initially single balloon was used for mitral commissurotomy followed by double balloon, before completing the mitral valvotomy with surgical instruments whenever required. The commissural split was measured by firmly stretching the two commissures using nerve hooks and measuring the distance between the two hooks with the help of a caliper. Assessment of balloon dilation was made by calculating exact percentage of residual commissural split following balloon dilation as compared with completed mitral valvotomy. The exact percentage of commissural split was thus obtained by subtracting residual commissural split following balloon dilation from commissural split obtained after surgical open mitral valvotomy. RESULTS: Complete commissurotomy using the balloon technique was possible in two (18.2%) patients. In the remaining nine (81.8%) patients, balloon expansion provided only 50% to 80% of commissural split and required instrumental completion with good results. CONCLUSIONS: Balloon mitral commissurotomy, by virtue of its circumferential force, helps to develop a good cleavage and attains good hemodynamic improvement which may be life saving in critical mitral stenosis in selected group of patients with pliable mitral leaflets and minimal subvalvular pathology.

Adolescent↗
PubMed1996

Blood conservation in small adults undergoing valve surgery.

OBJECTIVES: A substantial reduction in transfusion requirements for cardiac surgical procedures has been reported. Many of these reports have been described in patients undergoing coronary artery bypass grafting. Patients suffering from rheumatic heart disease in India are usually small and also anemic. This study was conducted to assess blood conservation methods for cardiac valve surgery in this subset of patients. DESIGN: This was a prospective, randomized study. SETTING: The study was performed in a New Delhi tertiary care hospital, and the patients were referred from the northern states of India. PARTICIPANTS: One hundred fifty consecutive patients undergoing elective valve surgery using cardiopulmonary bypass were included. The mean age was 27.7 years and mean weight was 45.2 kg. INTERVENTIONS: The patients were divided into three groups of 50 each. Group 1 received autologous fresh blood donated before bypass, and both a cell saver and membrane oxygenator were used. The oxygenator contents at the end of perfusion were processed by cell saver. Group 2 patients were reinfused with autologous blood only, and group 3 was a control group. In groups 2 and 3, the blood that remained in the oxygenator at the conclusion of cardiopulmonary bypass was reinfused. A hematocrit of less than 25% was considered an indication for transfusion in the postoperative period. MEASUREMENTS AND MAIN RESULTS: The mean preoperative hematocrit was 35.5%. A mean of 361.1 mL of autologous blood was collected from group 1 and 303.3 mL from group 2. Group 1 required 15 units of bank blood, group 2, 90 units (p < 0.001), and group 3, 102 units (p < 0.001). Seventy-eight percent of group 1 patients did not receive any donor blood. There was no significant difference in chest tube drainage among the three groups. CONCLUSIONS: In this unique group of patients whose mean body weight was only 45 kg, autologous blood alone did not decrease blood bank requirements but when combined with a cell saver and membrane oxygenator greatly reduced the need for donor blood.

Adult↗
PubMed1995

Closed mitral valvotomy and elective ventilation in the postoperative period: effect of mild hypercarbia on right ventricular function.

OBJECTIVES: It is customary to extubate patients immediately after closed mitral valvotomy. These patients often have deranged respiratory function caused by chronic lung congestion. The left ventricular function may also be subnormal after valvotomy in some patients. Therefore, elective ventilation for some duration in the postoperative period can be beneficial to these patients. This work is an attempt to find whether elective ventilation should be preferred over immediate extubation in these patients. DESIGN: A prospective randomized study. SETTING: The study was performed in a tertiary care hospital, and the patients are referred from the northern states of India. PARTICIPANTS: One hundred patients undergoing elective closed mitral valvotomy were included in the initial part of the study. Ten more patients were studied to evaluate the effect of mild hypercarbia on right ventricular function after closed mitral valvotomy. INTERVENTIONS: One hundred patients were divided into two groups of 50 each. Group 1 consisted of patients in whom the neuromuscular blockade was reversed at the end of surgery with neostigmine and atropine and the trachea was extubated. In group 2, the residual neuromuscular paralysis was not reversed and the patients were electively ventilated in the postoperative period for an average duration of 5 hours and 29 minutes +/- 1 hour and 58 minutes. In all the patients in both the groups, electrocardiogram, direct arterial blood pressure, and oxygen saturation were continuously monitored, and arterial blood gases were measured intermittently throughout the study period. Because the results showed that there was mild hypercarbia, 30 minutes after extubation in group 1, 10 more patients were studied to evaluate the effect of mild hypercarbia on right ventricular function after surgery. Patients were ventilated after surgery (F1O2 = 1) to maintain normocarbia (PaCO238.6 +/- 3.4 mmHg). Mild hypercarbia PaCO251.5 +/- 3.7 mmHg) followed by normocarbia (PaCO2 40 +/- 2.5 mmHg) was induced by adjusting the ventilator rate with a constant tidal volume. Standard hemodynamic measurements were performed at each stage. MEASUREMENTS AND MAIN RESULTS: Although all the patients maintained satisfactory and stable hemodynamics in the postoperative period, the PaCO2 at the end of 30 minutes of extubation was significantly higher in group 1 (48.1 +/- 5.3 mmHg) as compared with group 2 (40.2 +/- 4.3 mmHg, p < 0.001). Mild hypercarbia significantly increased pulmonary vascular resistance (p < 0.01), mean pulmonary arterial pressure (p < 0.001), right ventricular stroke work (p < 0.01), right ventricular systolic pressure (p < 0.01), and right ventricular end-diastolic pressure (p < 0.001). The effect was not totally reversible with CO2 washout as all parameters except right ventricular end-diastolic pressure and pulmonary vascular resistance continued to remain significantly higher when normocarbia was restored. The significant changes in systemic hemodynamics produced by hypercarbia were increases in cardiac index, mean arterial pressure, and pulmonary capillary wedge pressure. CONCLUSIONS: Avoidance of even mild hypercarbia, therefore, appears advisable in the early postoperative period because of potential impedence to right ventricular ejection. Continuous monitoring of end-tidal CO2 and frequent blood gas analyses should be practiced, and elective ventilation should be considered in patients with long-standing disease and pulmonary hypertension.

Adolescent↗
PubMed1994

Percutaneous mitral commissurotomy for severe mitral stenosis during pregnancy.

Percutaneous mitral commissurotomy was performed in 27 pregnant females aged 24.9 +/- 3.14 years (range 20-30 years) with severe mitral stenosis at 22.2 +/- 4.3 weeks (range 18-32 weeks) of gestation. All patients were in New York Heart Association functional class IV at the time of procedure. The procedure was performed using the flow guided Inoue balloon in 25 patients and double balloon technique in 2 patients. Percutaneous mitral commissurotomy was successful in 26 patients. The mitral valve area assessed by Doppler echocardiography (pressure half time) increased from 0.78 +/- 0.19 cm2 (range 0.5-1.0 cm2) to 2.2 +/- 0.12 cm2 (range 1.9-2.6 cm2) (P < 0.001). The mean mitral gradient decreased from 30.5 +/- 7.6 mm Hg (range 22.5-41.4 mm Hg) to 6.1 +/- 2.6 mm Hg (range 4.2-12.3 mm Hg) (P < 0.001). The end diastolic gradient decreased from 28.3 +/- 4.2 mm Hg (range 23-37 mm Hg) to 2.8 +/- 1.5 mm Hg (range 0-5 mm Hg) (P < 0.001). The total fluoroscopy time was 5.6 +/- 2.2 min (range 2.7-8.9 min). Mitral regurgitation increased by one grade in 7 patients. One patient developed severe mitral regurgitation with anterior mitral leaflet tear needing immediate mitral valve replacement. Twenty-six patients improved to New York Heart Association class I after the procedure. Twenty-four patients had full-term, normal delivery and gave birth to healthy infants. The patients were followed up for 1-36 months (mean 16.6 +/- 7.8 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Transcatheter occlusion of patent ductus arteriosus by Rashkind umbrella device: follow-up results.

Seventy-six patients (36 boys and 40 girls) with patent ductus arteriosus who had successful ductal occlusion with a Rashkind umbrella device were monitored for a period of 6 to 60 months (mean 26.7 +/- 12.3 months). All patients were evaluated by pulsed and color Doppler echocardiography before and after the procedure. The prevalence of residual left-to-right shunt and main pulmonary artery flow pattern were assessed. Residual left-to-right shunt was seen in 12 (15.7%) patients 24 hours after the procedure, but the shunt was small with a pulmonary-to-systemic blood flow ratio of < 1.3:1. Repeat echo Doppler study at 14 days showed residual left-to-right shunt in 10 (13.1%) patients. None of these patients showed further decrease in prevalence of residual left-to-right shunt. The patients with residual left-to-right shunt had larger ductii (mean 5.17 +/- 0.88 mm, range 4.23 to 6.6 mm) as compared to patients with no residual left-to-right shunt (3.31 +/- 0.86 mm, range 1.8 to 4.69 mm; p < 0.001). Two patients with residual shunt had successful ductus reocclusion, with 12 and 17 mm devices, respectively, at 28 month of follow-up. The Rashkind umbrella device is effective in closing ducti with diameters of < 5 mm in majority of patients.

Adolescent↗
PubMed1994

Percutaneous transatrial mitral commissurotomy: immediate and intermediate results.

OBJECTIVES: The purpose of this study was to evaluate the immediate and follow-up results of percutaneous transatrial mitral commissurotomy in 600 patients with rheumatic mitral stenosis. BACKGROUND: Percutaneous transatrial mitral commissurotomy has emerged as an effective nonsurgical technique for patients with symptomatic mitral stenosis. Several studies have shown that the immediate results are comparable to closed and open mitral valvotomy. METHODS: Percutaneous transatrial mitral commissurotomy was performed in 600 patients with rheumatic mitral stenosis by the double-balloon (290 patients [48.3%]) and flow-guided Inoue balloon (310 patients [51.7%]) techniques. There were 154 male (25.6%) and 446 female (77.4%) patients with a mean [+/- SD] age of 27 +/- 8 years (range 8 to 60). Atrial fibrillation was present in 26 patients (4.3%), mitral regurgitation < or = grade 2 in 62 (10.3%) and densely calcific valve in 12 (2%). All patients had clinical and echocardiographic (two-dimensional, continuous wave Doppler, color flow imaging) follow-up at 3-month intervals. RESULTS: Percutaneous transatrial mitral commissurotomy was successful in 589 patients (98.1%), and optimal commissurotomy was achieved in 562 (93.6%), with an increase in mitral valve area from (mean +/- SD) 0.75 +/- 0.18 to 2.2 +/- 0.38 cm2 (p < 0.001) and a decrease in transmitral end-diastolic gradient from 27.3 +/- 6.1 to 3.8 +/- 4.2 mm Hg (p < 0.001). Mitral regurgitation developed or increased in 208 patients (34.6%). Six patients (1%) with mitral regurgitation required mitral valve replacement. Cardiac tamponade occurred in 8 patients (1.3%). Six patients (1%) died. Restenosis developed in 10 patients (1.7%) during a mean follow-up period of 37 +/- 8 months (range 6 to 66). CONCLUSIONS: Percutaneous transatrial mitral commissurotomy is an effective, safe procedure with gratifying intermediate results. It should be considered the treatment of choice for rheumatic mitral stenosis.

Adolescent↗
PubMed1993

Potent inhibition of human tumor p21ras farnesyltransferase by A1A2-lacking p21ras CA1A2X peptidomimetics.

The ras oncogene product p21ras requires farnesylation and subsequent plasma membrane association for its transforming activity. This key post-translational modification is catalyzed by p21ras farnesyltransferase, which transfers farnesyl from farnesylpyrophosphate to the cysteine of the CA1A2X carboxyl-terminal tetrapeptide of p21ras. In the present report, we describe potent inhibition of p21ras farnesyltransferase by CA1A2X peptidomimetics containing no peptidic amide bonds. We synthesized a series of CA1A2X analogues where the 2 aliphatic amino acids A1 and A2 were replaced by a hydrophobic spacer, 3-aminomethylbenzoic acid (AMBA). The peptidomimetic Cys-AMBA-Met, inhibits p21ras farnesyltransferase from human colon carcinoma (COLO-205) and Burkitt's lymphoma (Daudi) with IC50 values of 60 and 120 nM, respectively. Cys-AMBA-Met is 3-, 8-, and 9-fold (COLO-205) and 2-, 5-, and 7-fold (Daudi) more potent than the corresponding tetrapeptides of p21KB-ras (CVIM), p21N-ras (CVVM), and p21KA-ras (CIIM), respectively. Replacing methionine at the X position with negatively charged glutamate reduces its ability to inhibit the enzyme, whereas positively charged lysine at this position abolishes the inhibitory character of the peptidomimetic. A hydrophobic moiety at the X position, as in Cys-AMBA-Phe, retains potent inhibitory activity. Leucine in the X position of CA1A2X is a post-translational signal for protein geranylgeranylation rather than farnesylation, and, as expected, Cys-AMBA-Leu does not inhibit the enzyme. Furthermore, CVIM, CVVM, and CIIM are farnesylated by human p21ras farnesyltransferases and inhibit these enzymes by serving as alternative substrates. In contrast, the peptidomimetics described here are true p21ras farnesyltransferase inhibitors since none is farnesylated by this enzyme.

Alkyl and Aryl Transferases↗
PubMed1993

Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparative study.

Balloon mitral valvotomy (BMV) constitutes an important alternative to surgical closed mitral valvotomy (CMV) for the treatment of rheumatic mitral stenosis. To compare the immediate and long-term results of these procedures, 200 patients with rheumatic mitral stenosis were randomly assigned to undergo either BMV (n = 100) or CMV (n = 100). The age range was 10 to 30 (mean 19.4 +/- 6.5) years. Both procedures resulted in significant and similar increases in mitral valve area (BMV: 0.85 +/- 0.26 to 2.39 +/- 0.94 cm2; CMV: 0.79 +/- 0.21 to 2.2 +/- 0.85 cm2; p = NS). Mitral regurgitation developed in 14 patients after BMV and in 12 patients after CMV. Eighty patients in each group have now been followed for a mean period of 22 +/- 6.3 (range 6 to 38) months by repeat echocardiographic study. Restenosis (defined as a loss of more than 50% of the achieved increase in mitral valve area) was seen in four (5%) patients after BMV and in three (4%) after CMV. Symptomatic restenosis was seen in only one patient who at follow-up examination 20 months after CMV had a mitral valve area of 0.8 cm2 and underwent successful balloon valvotomy. We conclude that the immediate and long-term results obtained with percutaneous BMV and surgical closed mitral commissurotomy are comparable.

Adolescent↗
PubMed1992

Properties of immunoaffinity purified 106-kDa Ca2+ release channels from the skeletal sarcoplasmic reticulum.

The sulfhydryl-gated 106-kDa Ca(2+)-release channel (SG-106) was purified by biotin-avidin chromatography from skeletal sarcoplasmic reticulum (SR) vesicles and used as an antigen to raise polyclonal antibodies. Western blots showed that the antisera crossreacted with the antigenic SG-106 and not with SR Ca2+, Mg(2+)-ATPase or with junctional foot proteins (JFPs) (Zaidi et al., 1989, J. Biol. Chem. 264(36), 21, 725-21, 736; 21, 737-21, 747). Polyclonal antibody-affinity columns were used to selectively purify SG-106-kDa proteins which, upon incorporation in planar bilayers, revealed the presence of a cationic channels with properties similar to "native" Ca(2+)-release channels obtained through the fusion of SR vesicles with planar bilayers. In agreement with measurements of Ca2+ release from SR vesicles, sulfhydryl oxidizing and reducing agents (i.e., 2,2'-dithiodipyridine and dithiothreitol) respectively increased and decreased the open-time probability of 106-kDa Ca(2+)-release channels. In contrast with reports on JFPs, ryanodine at 0.5-1 nM increased the open-time probability and at 2-10 nM locked 106-kDa Ca(2+)-release channels in a closed state rather than an open subconductance state. The SG-106 was activated by millimolar ATP, inhibited by millimolar Mg2+, and blocked by micromolar ruthenium red. Adriamycin (2-10 microM) caused a transient activation of SG-106 Ca(2+)-release channels, followed by closure in about 5 min, and intermittent activation to a subconductance state. Polyclonal antibodies used to purify the SG-106 also activated the channel when added to the cis side but not the trans side of the bilayer. Thus, SG-106 channels possess features that are similar to "native" SR Ca(2+)-release channels, are immunologically distinct from JFPs, and interact in seconds with nanomolar ryanodine in planar bilayers.

Animals↗