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Exencephaly results from failure to close the cranial portion of the neural tube in early development during the primary neurulation (Wallingford et al., 2013), whereas spina bifida results from a more distal closure failure.
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Residual volume increases with age, which is thought to reflect increased distal airway closure [ 9].
Atelectasis and distal airway closure are common clinical entities of general anaesthesia.
In addition, surfactant dysfunction leads to an increase in luminal surface tension, which also promotes distal airway closure.
An additional probable contributor to decreased compliance is thought to be distal airway closure leading to an increase in the trapped gas volume [ 25].
Even though obesity decreases baseline pulmonary capacity by altering respiratory physiology [ 31], the contribution of distal airway closure to the change in FEV1 has been shown to be affected by obesity.
Distal airway closure was estimated by the FVC DRS. These DRS were obtained from a calculation based on the last value minus the baseline value, divided by the last methacholine dose in mg.
There have been concerns that in an injured lung, where there is distal airway closure (see above) and increased gas trapping, the repetitive opening and closing by MV could induce high shear stress [ 57] and pressure gradients leading to epithelial damage [ 58].
The complete space closure distal to the upper left canine would have increased the size of the prosthetic 2.2 with obvious asymmetry of the smile.
Possibly, the poorly ventilated or non-ventilated gas volume in this type of diffuse ARDS might reflect gas contained in lung units distal to airway closure and/or obstruction.
A longitudinal closing wedge osteotomy was then performed in the distal phalanx allowing primarily closure with precise alignment of the nailbed edges.
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