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Biomedical subjects

N C Saxena

Publications and source records attributed to N C Saxena.

At least 19 recordsLinked to original sources

Oral misoprostol for prevention of postpartum hemorrhage by paramedical workers in India.

OBJECTIVE: To study whether paramedical workers from rural primary health centers in India are able to administer oral misoprostol and actively manage the third stage of labor to prevent postpartum hemorrhage (PPH). METHOD: Cluster randomization was used to enroll 1200 women at 30 peripheral health centers from 5 states in India, 600 forming the study's intervention group (active management of the third stage of labor with 600 mug of oral misoprostol) and 600 forming the comparison group (in which the current government guidelines for the prevention of PPH were followed). The primary outcome was blood loss after delivery, which was measured using a calibrated blood collection drape. RESULTS: Age, literacy level, occupation, and gravidity were similar in the 2 groups. More than 70% of women in both groups had moderate anemia (hemoglobin level <10 g/dL). Paramedical workers followed instructions in almost all deliveries in the intervention group (99%). There was a significant reduction in duration of the third stage of labor (7.9 +/- 4.2 min vs. 10.9 +/- 4.3 min; p < .001) and median blood loss after delivery (100 mL vs. 200 mL; p < .001) in the intervention group. Overall, a low incidence of PPH was observed (<1%) in both groups. A greater number of women had moderate to severe shivering (12.7% vs. 0.5%) and a temperature higher than 38 degrees C (9.7% vs. 4.3%) in the intervention group, which was statistically significant. CONCLUSION: Simple interventions can be easily implemented in rural health care settings to reduce the blood loss during labor. This finding has significant implications for developing countries, in which the prevalence of anemia is high.

Administration, Oral↗

Reproductive health awareness of school-going, unmarried, rural adolescents.

OBJECTIVE: In 1996, India included Adolescent Health in Reproductive and Child Heatlh Programme. This Task-Force Study was planned to test the awareness level of adolescents regarding various reproductive health issues and to identify lacunae in knowledge, particularly in legal minimum age of marriage, number of children, male preference, contraceptive practices, about STIs /AIDS etc. METHODS: It was a multicentre study, done in rural co-education/higher secondary schools of 22 districts located in 14 states through Human Reproductive Research Centre (HRRC's) of the Indian Council of Medical Research (ICMR). A sample of 8453 school going adolescents (aged 10-19 years) was surveyed by means of open ended, self-administered questionnaires maintaining confidentiality. RESULTS: Mean age of adolescents was 14.3 +/- 3.4 years. Awareness of legal minimum age of marriage was present in more than half of adolescents. Attitude towards marriage beyond 21 years in boys and 18 years in girls was favorable. Mean number of children desired was 2.2 +/- 1.4. However, number of children desired by boys (2.2+/-1.6) was significantly more (p< 0.000) than those desired by girls (2.0+/-1.1). More boys (23.7%) than girls (9.4%) wanted three or more children with male preference. Only 19.8% of adolescents were aware of at least one method of contraception. Only two-fifth (39.5%) were aware of AIDS and less than one-fifth (18%) were aware of STDs and most of them thought it is same as AIDS. Awareness of at least one method of immunization was present in three-fifth (60.1%) of students. It was least for DPT (13.5%) and most (55%) were aware of polio only. Awareness of all Reproductive Health matters was more in boys than girls and more in late teens (15-19) than earlier teens (10-14). CONCLUSION: The study showed tremendous lacunae in awareness of all Reproductive Health (RH) matters. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young girls and boys.

Adolescent↗

Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study).

BACKGROUND: Despite a liberal Medical Termination of Pregnancy (MTP) act and awareness of family planning, maternal mortality attributable to induced abortion is high. AIMS: Assess attitude, behavior, practices and utilization of services by rural women for induced abortion and concurrent acceptance of contraception. SETTINGS AND DESIGN: Cross sectional survey of eligible married women in 13 states in India over one year. MATERIAL AND METHODS: A total of 1851 women who had an induced abortion during the previous 3 years were interviewed. STATISTICAL ANALYSIS USED: Includes proportions, rates and chi-square test. RESULTS: The main reason for seeking abortion was "don't need any more children" (42%), and in 12.4 per cent they specifically mentioned that they "don't need any more daughters". Around 46% of women accessed abortion services from private clinics as compared to government hospital (37.1%) and Primary Health Centre/Community Health Centre (14.0%). The decision to terminate the pregnancy and place of abortion was made by the husband in 42.8% and 52.5% respectively. Regret for abortion was expressed by 29.6% of the women. However, only 7.2% said they would not advice others for induced abortion. Nearly one half of the women undergoing abortion accepted a family planning method concurrently; of these Intra Uterine Device/oral contraceptives and a permanent method was adopted by 37.2% and 49.1% respectively. Acceptance of vasectomy by male partner was found to be low (1.3%). "Husband objected" (32.3%) was the main reason for not accepting post abortal contraception. Majority of the acceptors said they would recommend to others the same place where they had undergone abortion, thus indicating their satisfaction with the source and services received. CONCLUSIONS: Counselling for post-abortal contraceptive should be provided to the couple so that they can make an informed choice.

Abortion, Induced↗

Contraceptive knowledge, practices and utilization of services in the rural areas of India (an ICMR task force study).

To obtain information from rural women regarding their contraceptive knowledge, practices and utilization of services, a cross-sectional survey of 117,465 eligible women was carried out in the sampled areas of 28 districts from January 1996 to February 1997. From among the current contraceptive users all of IUD, OC and acceptors of a permanent method in the last one-year (14,276) were interviewed in detailed. In addition a systematically selected sample of 17,082 non users were also interviewed. Overall contraceptive prevalence was 45.2% of which 34.2% had used a permanent method. Among the current users, the contraceptive had been availed mainly from either PHC (31.5%) or hospital (42.1%). Around half the women (53.1%) had received counseling and in 20.3% information regarding other methods. Pelvic examination was done in 39.1% Most of the women (>97%) expressed satisfaction with the method, provider and services. Almost all the women (98.8%) were using a contraceptive method with the knowledge of their husband and had his support for continuing the same. There was no concept of using any family planning method for either postponing the first conception after marriage or spacing between the two child births. A large majority of women (70.5%) used a family planning method for the first time only after completing their desired family size. Among the never users, 73.5% mentioned at least one modern method of family planning available in the national programme and 64.3% mentioned the service source where it would be available. Fewer women in most of the districts mentioned spacing methods as compared to female sterilization. The main reason given for not using any family planning method was "family not complete" (34.6%). There is need to promote spacing methods by policy makers and field workers and motivate couples to accept them.

Adolescent↗

An application of the technique of density estimation in geographical epidemiology of goitre in the Muzaffarpur district of Bihar state of India.

The Gangetic plains in the Sub-Himalayan belt of India are known endemic areas for goitre. The districts of Muzaffarpur and Sitamarhi in the eastern zone in the Bihar state of India showed a prevalence of over 30 per cent of goitre in a survey conducted by the Indian Council of Medical Research (ICMR) during 1983-1986. In the present paper, the technique of density estimation is employed to estimate the probability density functions of goitre-affected and normal (non-goitre) populations of the district of Muzaffarpur. The likelihood ratio is then plotted against distance of the villages from the Indo-Nepal border keeping their distances from the headquarters in the district of Sitamarhi at fixed level. Using the odds form of Bayes rule, the posterior odds of goitre are calculated and compared at two given points.

Bayes Theorem↗

Mechanisms of aldosterone's action on epithelial Na + transport.

Aldosterone maintains total organism sodium balance in all higher vertebrates. The level of sodium reabsorption is primarily determined by the action of aldosterone on epithelial sodium channels (ENaC) in the distal nephron. Recent work shows that, in an aldosterone-sensitive renal cell line (A6), aldosterone regulates sodium reabsorption by short- and long-term processes. In the short term, aldosterone regulates sodium transport by inducing expression of the small G-protein, K-Ras2A, by stimulating the activity of methyl transferase and S-adenosyl-homocysteine hydrolase to activate Ras by methylation, and, possibly, by subsequent activation by K-Ras2A of phosphatidylinositol phosphate-5-kinase (PIP-5-K) and phosphatidylinositol-3-kinase (PI-3-K), which ultimately activates ENaC. In the long term, aldosterone regulates sodium transport by altering trafficking, assembly, and degradation of ENaC.

Aldosterone↗

A critical appraisal of cesarean section rates at teaching hospitals in India.

OBJECTIVES: To obtain an estimate of cesarean section rates and examine the indications and consequences at teaching hospitals in India. METHODS: Information was obtained on total number of normal and cesarean deliveries during 1993-1994 and 1998-1999 from 30 medical colleges/teaching hospitals. In addition, prospective data were recorded for a period of 2 months on 7017 consecutive cesarean sections on indications for cesarean delivery, associated complications and mortality. RESULTS: The overall rate of cesarean section increased from 21.8% in 1993-1994 to 25.4% in 1998-1999. Among the 7,017 cesarean section cases, 42.4% were primigravidas, 31% had come from rural areas, 20.8% were referred including 8% with history of interference, 66% were booked cases, period of gestation was less than 37 weeks in 21.7% and in 18% the surgery was elective. Major indications for cesarean section included dystocia (37.5%), fetal distress with or without meconium aspiration (33.4%), repeat section (29.0%), malpresentation (14.5%) and PIH (12.5%). Maternal and perinatal mortality was 299/100,000 and 493/1,000 deliveries, respectively, and is high in spite of the increase in the cesarean section rates. CONCLUSIONS: There is need for standardized collection of information on all aspects of childbirth to ascertain the incidence and indications of cesarean section nationally so that comparison and improvements of care can take place.

Adult↗

Air quality assessment along Dhanbad - Jharia road.

Road ambient air pollution status along Dhanbad - Jharia road is studied and presented in this article. The selection of this area is made considering the importance of the road in Dhanbad district and the nature of activities taking place along the road, which reflect that the portion of road upto Dhansar can be considered as having commercial areas on both sides and that from Dhansar to Jharia as having industrial areas on both sides. For the assessment of the ambient air quality along the road monitoring is done at the following five locations: Indian School of Mines (ISM), main gate; Bankmore; Dhansar police check post; Dhansar opencast project agent office and a residential house beside the Rajapur opencast project. The location of ISM, main gate is specially chosen as this represents a commercial shopping complexes and the situation can be compared with that at Bankmore. Monitoring of ambient air quality is done following the standard procedure prescribed in IS: 5182. In addition the concentration of lead, zinc, copper, iron, manganese, cadmium metals in SPM is also monitored. The ambient air quality is monitored in the months of September and November 1999, respectively, to represent monsoon and winter seasons. The SPM concentration observed at all the five locations in the winter season is more than the permissible limits for commercial and industrial areas. However, in the monsoon season, the SPM concentration is higher than the permissible limit at the two commercial locations, i.e., ISM gate and Bankmore, while it is less than the prescribed limit for industrial areas at the remaining three locations. At the ISM gate and Bankmore the SPM generation is mainly by vehicular traffic while at other three locations it was in addition due to mining and other activities.

Air Pollutants↗

Inhibition of GABA(A) receptor (GABAR) currents by arachidonic acid in HEK 293 cells stably transfected with alpha1beta2gamma2 GABAR subunits.

Agonist-stimulated liberation of arachidonic acid and subsequent generation of active metabolites are established components of several signal transduction pathways including pathways that regulate ion channels. We evaluated the role of arachidonic acid and some related unsaturated and saturated fatty acids in the modulation of a stably expressed recombinant gamma-aminobutyric acidA receptor (GABAR) isoform, the alpha1beta2gamma2 isoform. Whole-cell currents evoked by 10 microM GABA were inhibited in a concentration-dependent manner by arachidonic acid (0.1-100 microM). This effect of arachidonic acid to inhibit GABAR currents was not reproduced by the non-metabolizable analog of arachidonic acid, 5,8,11,14-eicosatetraynoic acid (ETYA) or by other monounsaturated or saturated fatty acids. However, another polyunsaturated fatty acid, linoleic acid, which is an essential fatty acid and an effective reductant like arachidonic acid, inhibited GABAR currents in a manner similar to arachidonic acid. Nordihydroguaiaretic acid (NDGA), indomethacin and 1-amonibenzotriazole (1-ABT) did not block the inhibitory effect of arachidonic acid, suggesting that arachidonic acid metabolites of the lipoxygenase, cyclooxygenase or P-450 pathways are unlikely to play a major role in the inhibitory effect of arachidonic acid on GABAR currents. However, the antioxidant N-acetyl cysteine (NAC), a scavenger of active oxygen radicals, reduced the inhibitory effect of arachidonic acid on GABAR currents significantly (P<0.01), suggesting that active oxygen radicals might mediate inhibition of GABAR currents by arachidonic acid.

5,8,11,14-Eicosatetraynoic Acid↗

Evaluating contraceptive choice through the method-mix approach. An Indian Council of Medical Research (ICMR) task force study.

The method-mix approach was used to evaluate informed contraceptive choices in the present study. A total of 8,077 potential clients were given a balanced presentation of all available contraceptive methods in the national program, ie, the CuT 200 intrauterine device (IUD), low-dose combined oral pills (OC), condom, and sterilization (female/male) along with a new method, Norplant(R).(1) The majority of women opted for spacing methods; among them, the IUD was preferred by about 60% of clients, followed by condoms (9%), OC (6%), and Norplant (5%). Sterilization, mainly female, was accepted by about 17% of the women making an informed choice. The economic status of couples did not influence the contraceptive choices, as all the methods were offered free of cost in the present study, which is the current practice in the national program. Illiterate women more often accepted sterilization (about 25%) than did literate women (15%). This is because illiterate women had more children; about 30% of illiterate women had three or more children, as opposed to 16.2% of literate women. However, literacy status did not influence the choice of any specific spacing method. The study also revealed that, by encouraging potential clients to make an informed choice, they could override the provider's bias while accepting a particular type of spacing method. This is evident from the observation that Norplant was the first choice of the provider for 35% of the women, whereas only 5% of women preferred and accepted Norplant. The present study stresses an urgent need to promote the practice of informed choices in the national program with a variety of contraceptive options-especially, spacing methods for improving contraceptive prevalence and reproductive health in the country.

Adolescent↗

Effects of elevating [Na]i on membrane currents of canine ventricular myocytes: role of intracellular Ca ions.

OBJECTIVES: Our first objective was to study how elevating [Na]i can modify the background membrane conductance in canine ventricular myocytes (CVM). In particular, we wanted to find evidence for a Nai-activated K current (IK,Na) in these cells. The second objective was to compare the effects of elevating [Na]i on membrane currents without and with intracellular Ca buffering. METHODS: Whole-cell currents were recorded and [Na]i was elevated either by using a pipette perfusion device that allowed [Na] in the pipette solution to be varied (from 0 to 50 mM), or by 50 microM ouabain. RESULTS: Although an outward current attributable to IK,Na was confirmed in guinea-pig ventricular myocytes (GPVM) under our recording conditions, no such current was seen in 29 CVM examined. With Cai buffering, the main effect of elevating [Na]i on CVM was an increase in inward current around and negative to the resting membrane potential. Based on the dependence of this Nai-induced inward current on K ions and its pharmacological properties, especially the effects of low concentrations of external Ba ions (< or = 5 microM) at strongly hyperpolarized voltages, we hypothesize that this current was carried by extracellular K ions through the inward rectifier (IK1) channels that had been modified by the high level of [Na]i. With Cai buffering, elevating [Na]i by ouabain had few or no effects on the L-type Ca channel current (ICa) or the slow delayed rectifier current (IKs). Without Cai buffering, ouabain induced a rapid reduction of both currents along with an increase in a time-independent outward current at voltages positive to -60 mV. CONCLUSION: Our data suggest that there are species variations in K channel expression and/or K channel modulation by intracellular Na ions. Furthermore, intracellular Ca ions play a crucial role in mediating the effects of Nai loading on membrane currents in canine ventricular myocytes.

Animals↗

Contrasting actions of lanthanum on different recombinant gamma-aminobutyric acid receptor isoforms expressed in L929 fibroblasts.

Functional studies have indicated that, unlike most divalent cations, lanthanum increases both native and recombinant gamma-aminobutyric acid (GABA) receptor (GABAR) currents. In the present study, we have examined whether lanthanum shows subunit-dependent selectivity for modification of currents from different GABAR isoforms. The effects of lanthanum on three different GABAR isoforms, alpha1beta3gamma2L, alpha6beta3gamma2L, and alpha6beta3delta, were determined by transient expression of combinations of alpha1, alpha6, beta3, gamma2L, and delta subunit cDNAs in L929 fibroblasts. Whole-cell recording was used to determine the concentration-response curves for lanthanum for the three different isoforms at submaximal concentrations of GABA. Lanthanum displayed strong potentiation of alpha1beta3gamma2L GABAR currents consistent with earlier reports of potentiation of GABAR currents by lanthanum in neurons and recombinant GABAR isoforms. However, in contrast to the potentiation of alpha1beta3gamma2L GABAR currents by lanthanum, alpha6beta3delta GABAR currents were strongly inhibited and alpha6beta3gamma2L GABAR currents were weakly inhibited by lanthanum. Interaction of lanthanum with GABAR isoforms was competitive, with lanthanum decreasing the EC50 value for GABA of alpha1beta3gamma2L GABARs without changing the maximum current and increasing the EC50 value for GABA of alpha6beta3delta and alpha6beta3gamma2L GABAR currents (greater shift in EC50 value in the alpha6beta3delta compared with the alpha6beta3gamma2L GABARs) without changing the maximum GABAR current. Neither potentiation nor inhibition of GABAR currents by lanthanum showed any voltage dependence. These results suggest that 1) changing the alpha-subunit subtype from alpha1 to alpha6 altered the effect of lanthanum from potentiation to inhibition, 2) changing the gamma2L subunit to the delta-subunit changed the level of maximal inhibition of alpha6 subtype-containing GABAR currents by lanthanum, and 3) the site for interaction with lanthanum probably was on the extracellular surface of GABARs.

Animals↗

Properties of putative cerebellar gamma-aminobutyric acid A receptor isoforms.

Analysis of the composition of cerebellar gamma-aminobutyric acidA (GABAA) receptors (GABARs) with in situ hybridization of GABAR subunit subtype mRNAs [J. Neurosci 12:1063-1076 (1992)] and Western blot analysis and quantitative binding of radioligands to immunopurified receptors from the rat cerebellum [J. Biol. Chem. 269:16020-16028 (1994)] have suggested that GABAR isoforms likely to occur in the cerebellum of adult rats are alpha1betaxgamma2, alpha6betaxgamma2, and alpha6betaxdelta isoforms. Based on these data, GABARs composed of different combinations of rat alpha1, alpha6, beta2, beta3, gamma2L, and delta subunits, corresponding to the three putative cerebellar GABAR isoforms, were transiently expressed in mouse fibroblast cells (L929 cells). Whole-cell currents were recorded from acutely transfected cells to determine whether the alpha1beta2/3gamma2L, alpha6beta2/3gamma2L, and alpha6beta2/3delta GABAR isoforms could form functional receptor channels in L929 cells and to compare their electrophysiological and pharmacological properties. All three putative cerebellar GABAR isoforms showed a high efficiency of expression of functional GABARs. We chose to study the beta3 and gamma2L subtypes as major representatives of the native subunit subtype proteins. The recombinant alpha1beta3gamma2L, alpha6beta3gamma2L, and alpha6beta3delta GABAR isoforms displayed different affinities (EC50 values) for GABA, differential sensitivity to block by the divalent cation zinc and methyl-6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate, and differences in enhancement by diazepam. Our results provide an initial characterization of the electrophysiological and pharmacological properties of possible in vivo cerebellar GABAR isoforms and demonstrate that subunit compositions of different GABAR isoforms play a crucial role in determining their properties.

Animals↗

Functional expression of recombinant GABAA receptor channels in L929 fibroblasts.

While GABAergic inhibition plays a major role in the regulation of neuronal excitability, a role for altered GABAergic inhibition in the pathogenesis of epilepsy remains to be proven. The demonstration that GABAA receptors are composed of multiple subunits and that the properties and pharmacology of GABAA receptors are different for different subunit combinations, suggests that GABAA receptor heterogeneity may be of importance in determining the properties of GABAergic inhibition in different regions of the nervous system. While it is clear that GABAA receptor heterogeneity is present in the nervous system, a role for receptor heterogeneity in the pathogenesis of epilepsy remains uncertain. GABAA receptor heterogeneity may have implications for the treatment of epilepsy. It is quite possible that drugs which regulate GABAergic function may have variable efficacy in different regions of the nervous system due to expression of receptors with subunits that have different sensitivity to allosteric regulators. In situ hybridization studies indicate the colocalization of alpha 1 beta 1 gamma 2L and delta subunit mRNAs in hippocampal dentate gyrus granule cells while only the alpha 1, beta 1 and gamma 2L and not the delta subunit mRNAs colocalize in the pyramidal cells of the hippocampus. The reduced rate of acute desensitization and the slow recovery of GABA-evoked currents typical of delta-containing subunit combinations could generate tonic inhibition via long-lasting IPSPs in the dentate gyrus and thus play a role in preventing seizures. By the same rationale, a reduction in the level of expression of the delta subunit mRNA in the dentate gyrus or its absence as in the hippocampal pyramidal cells could be associated with a reduced seizure threshold. Furthermore, it is likely that there are developmental changes in the stoichiometry or subunit composition of GABAA receptors rendering the developing nervous system more or less sensitive to the effects of GABAergic anticonvulsant drugs. In addition to the heterogeneous expression of GABAA receptors, other issues concerning the regulation of GABAergic function are of potential importance. The regulatory events that control the expression of specific receptor subtypes and levels of GABA receptors are unknown. To understand the role of GABAA receptor heterogeneity in the pathogenesis of epilepsy will require the combination of biophysical and molecular biological techniques. It will be important to determine not only whether the properties of GABAA receptors have been altered in a specific form of epilepsy but also whether gene expression has been altered.

Animals↗

Effects of n-dodecylguanidine on A-type potassium channels: role of external surface charges in channel gating.

n-Dodecylguanidine (C12-G) is an amphipathic compound with a guanidine moiety, which is positively charged at physiological pH, and a hydrophobic side chain. Its effects on an A-type K+ channel clone (rKv1.4) expressed in Xenopus oocytes were examined. C12-G caused a concentration-dependent (1-20 microM) positive shift in the voltage dependences of the following channel properties: activation, inactivation, rate of decay during depolarization, and rate of recovery from inactivation. C12-G was effective when added to the bath solution but was without effect when applied to the cytoplasm of oocytes, indicating an extracellular site of action. The effects of C12-G were antagonized by elevation of the extracellular Mg2+ concentration and by external guanidine ions but were augmented by lowering of the ionic strength of the external solution. C12-G did not affect the instantaneous current-voltage relationship for rKv1.4 or the time constant of decay during strong depolarizations, when the voltage dependence of channel activation approached a plateau. Our observations suggest that C12-G exerts its actions by causing a positive shift in the external surface potential around rKv1.4, without altering the ion permeation process or voltage-independent transition steps. In canine ventricular myocytes, C12-G caused changes in the function of a native A-type K+ channel similar to those seen with rKv1.4. However, C12-G had negligible effects on the voltage dependence of the slow delayed-rectifier K+ channel in the same cell type, suggesting that the actions of C12-G are not nonspecific.

Animals↗

Assembly of GABAA receptor subunits: role of the delta subunit.

GABAA receptor channels (GABARs) composed of different combinations of rat alpha 1, beta 1, gamma 2L, and delta subunits were expressed transiently in mouse fibroblast cells (L929 cells). Whole-cell recordings were obtained from transfected cells to determine which combinations of GABAR subunits formed functional receptor channels, and to compare the electrophysiological and pharmacological characteristics of GABAR channels expressed in the presence and absence of the delta subunit. Only alpha 1 beta 1 gamma 2L, alpha 1 beta 1 gamma 2L delta, and alpha 1 beta 1 delta subunit combinations assembled to form functional GABAR channels and the presence of the delta-subunit slowed the rate of acute desensitization of GABA-evoked current during GABA application and the rate of recovery of GABA-evoked current following GABA application. These three different GABAR channel isoforms also showed distinct pharmacological profiles with differential sensitivity to block by zinc. Zinc was a potent blocker of alpha 1 beta 1 delta GABAR channels, a moderate-strength blocker of alpha 1 beta 1 gamma 2L delta GABAR channels, and did not block the alpha 1 beta 1 gamma 2L GABAR channels. These findings suggest that GABAR isoforms containing the delta subunit constitute a novel GABAR channel with distinct electrophysiological and pharmacological characteristics.

Animals↗