Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CLAMPS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed1989

Estimates of in vivo insulin action in man: comparison of insulin tolerance tests with euglycemic and hyperglycemic glucose clamp studies.

We compared estimates of in vivo insulin action derived from insulin tolerance tests (ITT) and euglycemic and hyperglycemic glucose clamp studies in 17 normal subjects and 19 patients with various diseases characterized by insulin resistance. Fifteen subjects underwent an ITT and a euglycemic clamp study, 17 subjects underwent an ITT and a hyperglycemic clamp study, and 4 subjects underwent all 3 tests. The ITT consisted of a bolus iv injection of regular insulin (0.1 U/kg BW). The plasma glucose disappearance rate during the 3- to 15-min period following the insulin injection was taken as a measure of insulin action. In both euglycemic and hyperglycemic clamp studies, which were carried out with standard techniques, the ratio between the amount of glucose infused to maintain glycemia at the desired level and the mean plasma insulin concentration from 60-120 min (M) (euglycemic clamp studies) or 20-120 min (I) (hyperglycemic clamp studies) was used as a measure of insulin action. A close correlation was found between plasma glucose disappearance rate and the M/I ratio during either the euglycemic (r = 0.811; P less than 0.001) or the hyperglycemic (r = 0.826; P less than 0.001) clamp studies. These results suggest that the 15-min ITT is suitable as a simple and rapid estimation of in vivo insulin action when glucose clamp studies are not feasible, as in large series of subjects or serial studies.

Adult↗
PubMed1989

Unbiased and flexible iterative computer program to achieve glucose clamping.

Glucose clamping has become a widely used test for assessing insulin sensitivity and beta-cell function. We present a new method of achieving a reliable and unbiased clamp using an iterative computer program. After initial parameter estimation, the program uses no fixed algorithm or physiological preconceptions but makes predictions according to previous glycemic responses to infusion rates. The program can be used for human or animal studies and for euglycemic or hyperglycemic clamps. The program has flexible data entry, graphic display, running statistics of mean infusion data, and mean glucose levels and their standard deviations. These form part of the criteria for the assessment of glucose clamping, which includes the sampling interval, the duration of the clamp, the achieved glucose concentration (together with its coefficient of variation), and the percent change of glucose infused at the end of the clamp. Data for 151 consecutive clamp studies were analyzed. Median coefficient of variation of glucose values at the end of the clamp was 2%.

Algorithms↗
PubMed1995

Prevention of renal cortical ischemia during aortic clamping with prostaglandin E1.

OBJECTIVES: To investigate the effects of aortic clamping and prostaglandin E1 on systemic hemodynamics and renal cortical and medullary blood flow by means of continuous intraparenchymal laser Doppler fluorometry. DESIGN: Experimental animal study in a porcine model. With the animal under general anesthesia after hemodynamic monitoring was instituted, surgical exposure was obtained through a small left retroperitoneal incision. The kidney was left undisturbed. Intraparenchymal laser Doppler probes (0.44 mm in diameter) were inserted in the renal cortex and medulla. In the first group of six animals, systemic hemodynamic variables, urine output and renal cortical and medullary flow were measured at baseline after 60 minutes of equilibration, and after 15 minutes of aortic clamping and unclamping. Data are given as mean +/- SE. INTERVENTION: In another six animals, prostaglandin E1 (20-micrograms intravenous bolus given over 1 minute) was given before clamping, and the same variables were recorded. RESULTS: In the first group, aortic clamping caused no change in cardiac output or filling pressures. Cortical blood flow decreased from 40.4 +/- 3.7 to 33.3 +/- 2.7 mL/100 g per minute (P < .0004) after clamping, and to 27 +/- 2.3 mL/100 g per minute (P < .0001) after unclamping, and was associated with a decrease in urine output from 3.2 +/- 0.5 to 2 +/- 0.2 mL/min (P < .0013). Medullary flow remained the same at 9.2 +/- 0.8, 10 +/- 0.3, and 9.8 +/- 0.6 mL/100 g per minute, respectively. These adverse effects were prevented when prostaglandin E1 was given before clamping. There was an initial drop in blood pressure (100 +/- 4 to 89 +/- 5 mm Hg, P < .0004), but cardiac output (43.3 +/- 5.8 L/min) and filling pressures (6 +/- 1 mm Hg) were unchanged. Cortical flow was preserved during the entire period of clamping and unclamping (43.3 +/- 5.8 mL/100 g per minute). Medullary flow remained unchanged (10 +/- 0.8 mL/100 g per minute). Urine output increased from 2 +/- 0.3 to 3.4 +/- 0.6 mL/min (P < .006). CONCLUSIONS: In this animal model, infrarenal aortic clamping causes a significant decrease in renal cortical flow and urine output with no significant changes in filling pressures, cardiac output, or medullary blood flow. These adverse effects are prevented by pretreatment with prostaglandin E1, which prevents cortical ischemia and maintains brisk diuresis.

Alprostadil↗
PubMed2005

"Parallel" and "antiparallel tail-clamps" increase the efficiency of triplex formation with structured DNA and RNA targets.

Sequence-specific triple-helix structures can be formed by parallel and antiparallel DNA clamps interacting with single-stranded DNA or RNA targets. Single-stranded nucleic acid molecules are known to adopt secondary structures that might interfere with intermolecular interactions. We demonstrate the correlation between a secondary structure involving the target--a stable stem predicted by in silico folding and experimentally confirmed by thermal stability and competition analyses--and an inhibitory effect on triplex formation. We overcame structural impediments by designing a new type of clamp: "tail-clamps". A combination of gel-shift, kinetic analysis, UV thermal melting and thermodynamic techniques was used to demonstrate that tail-clamps efficiently form triple helices with a structured target sequence. The performance of parallel and antiparallel tail-clamps was compared: antiparallel tail-clamps had higher binding efficiencies than parallel tail-clamps both with structured DNA and RNA targets. In addition, the reported triplex-stabilizing property of 8-aminopurine residues was confirmed for tail-clamps. Finally, we discuss the possible use of this improved triplex technology as a new tool for applications in molecular biology.

Animals↗
PubMed2004

Role of peg formation in clamp cell fusion of homobasidiomycete fungi.

In most filamentous basidiomycetes, clamp cells are found at the septa of dikaryotic mycelia. Clamp cell formation starts at hyphal tip cells with the development of a lateral bulge at a position slightly apical to the future septum. Relative to the growth direction of the hypha, the protrusion expands backwards into a hook-like structure. Next, the two genetically different haploid nuclei within the hyphal tip cell divide. A septum appears between clamp cell and hyphal tip cell, thereby trapping one nucleus within the clamp cell. Another septum is laid within the hypha, separating a nucleus of the other type in the newly generated subapical hyphal cell from the two different nuclei kept together in the new apical hyphal cell. Through fusion of clamp and subapical cell, the two solitary nuclei become united within the subapical hyphal compartment. In 1933, Buller described subapical formation of a peg to which the clamp cell fuses as an additional, subsequently neglected step in this series of events. In this study, we represent evidence for subapical peg formation and its role in clamp cell fusion. Our observations potentially indicate a B mating type regulated extracellular communication between clamp and subapical hyphal cell.

Agaricales↗
PubMed1982

Intracellular [Ca2+] transients in voltage clamped cardiac Purkinje fibers.

The Ca2+-activated bioluminescent protein aequorin was used to observe intracellular [Ca2+] transients in voltage clamped canine Purkinje fibers. The pattern of luminescence during a voltage clamp pulse was characterized by two components: L1, which is a rapid initial increase in luminescence and L2, which is a slower, secondary rise of variable configuration. 1. L1, L2, inward current, and contraction were abolished by D 600 (2 microM). 2. Paired clamp pulses. L1 reprimes more rapidly than L2; L1 reprimes within 100 ms, L2 does not. 3. Clamp pulse duration. Peak inward current was the same for 50 ms or 500 ms clamp pulses; L1 was either the same or slightly reduced in 50 ms clamp pulses compared to 500 ms clamp pulses. L2, however, was abolished in repetitively given 50 ms pulses compared compared to repetitively given 500 ms pulses. When 500 ms pulses were alternated with 50 ms pulses, L2 was greater in the 50 ms pulse than in the 500 ms pulse. 4. Clamp pulse potential. In the range-35 to O mV, peak L1 and peak inward current occurred at nearly the same time, had the same threshold potential, and had a similar dependence on membrane potential. In the presence of L2, contractions develop severalfold greater peak tension, time to peak tension is longer, and relaxation is more rapid than in the absence of L2. It is concluded that Ca2+ released from stores accounts for L2 and most of the 'activator calcium'. Ca2+ from another source accounts for L1 and activates a small early component of the contraction. L1 has some properties expected for a signal related to Ca2+ entering via slow inward current, but not via Na/Ca exchange.

Aequorin↗
PubMed2006

[Use of the pelvic clamp in polytraumatised patients with unstable disruption of the posterior pelvic ring. Modified technique--risks--problems].

BACKGROUND: Unstable fractures of the posterior pelvic ring are frequently combined with severe hemorrhage. In 80% of cases the bleeding originates in the ruptured presacral venous plexus or the fracture itself. Arterial bleeding is less common. The pelvic clamp introduced by Ganz can make it possible to stabilise the pelvis, with subsequent compression of the fracture planes and reduction of the intrapelvic volume in such cases, so improving the prognosis. Use of the pelvic clamp can be integrated into the management in the emergency room with no problem. METHODS: This paper presents the authors' own modification of the technique for using the pelvic clamp in the emergency situation when only a clinical examination of the patient has been possible and also analyses specific problems that arise in this situation. To this end, the data relating to 29 polytraumatised patients with unstable posterior pelvic ring fractures were analysed in a retrospective study. RESULTS: In all, 8 complications were seen in 6 patients. There were 2 cases of pin malposition and 2 of over-compression of the ossa coxae and local wound problems. Secondary pin dislocation was observed in 1 case. In all these cases it was possible to correct the pelvic clamp, so that emergency stabilisation was practicable without further surgical intervention. Minor complications were found in 2 patients. These took the form of bleeding at the pin-insertion site. In 1 case an unstable transiliacal fracture was found, and in this case it was not possible to stabilise the posterior pelvic ring with the pelvic clamp. No iatrogenic lesions were detected following application of the pelvic clamp. CONCLUSION: In the hands of an experienced and practised user application of the pelvic clamp is a safe method for emergency stabilisation of the posterior pelvic ring in polytraumatised patients, even without blood volume control. Problems can be solved and do not generally mean the pelvic clamp cannot be used. The immediate radiological check (e.g. during the emergency CT -scan performed for primary diagnosis) is a must, however.

Adolescent↗
PubMed1995

Human mammary artery endothelial sparing with fibrous jaw clamping.

BACKGROUND: Temporary clamping of the internal mammary artery pedicle is required for visualization during coronary artery bypass grafting. A nylon fibril jaw surface has been developed for these clamps that exerts pressure only at discrete sites on the pedicle surface. The effect of this new jaw surface on endothelial cell function and integrity after compression is investigated in this study. METHODS: Internal mammary artery specimens from 10 patients each were divided into three separate rings, and two of these rings were clamped for 30 minutes with either a smooth or fibrous jaw clamp. Isometric tensions were measured in organ chambers after contraction by relaxing the rings with the endothelium-dependent agent acetylcholine followed by the endothelium-independent agent sodium nitroprusside. The intimal surfaces of similar rings were silver stained to assess the percentage of intact endothelium. RESULTS: Endothelium-dependent relaxation was spared after fibrous jaw clamping (75% versus 89%) but significantly impaired after smooth jaw clamping (25% versus 89%; p < 0.001). Endothelium-independent relaxation was unaffected by either intervention. The percentage of remaining intact endothelium upon silver staining was significantly less after smooth than after fibrous jaw clamping (24% versus 48%; p < 0.01). CONCLUSIONS: Foam silicone with nylon fibrils on the jaw surface of internal mammary artery clamps preserves endothelial cell function and integrity. The remaining undamaged cells also may facilitate the subsequent regeneration of a confluent endothelial cell layer.

Acetylcholine↗
PubMed1991

Voltage clamp analysis of intact stomatogastric neurons.

Two-electrode voltage clamp of intact, identified pyloric neurons of the spiny lobster stomatogastric ganglion reveals two major outward currents. A rapidly inactivating, tetraethylammonium- (TEA) insensitive, 4-aminopyridine- (4AP) sensitive, outward current resembles IA of molluscan neurons; it activates rapidly on depolarizations above rest (e.g. -45 mV), delaying both the axonal-sodium and the neuropil-calcium spikes which escape voltage-clamp control. We infer that A-current is distributed both in a space clamped region (on or near the soma) and in a non-space clamped region with access to the generators for sodium and calcium spikes. A calcium-dependent outward current, IO(Ca), activates rapidly at clamp steps above -25 mV and inactivates at depolarizing holding voltages. Increasing depolarization results in an increase in both IO(Ca) and firing rate but a reduction in the amplitude of the sodium spike current. Blockage of IO(Ca) with Cd2+ causes little change in spike firing pattern. These observations are consistent with IO(Ca) being activated primarily in the soma and nearby regions which are under good control with a soma voltage clamp (and distant from the Na(+)-spike trigger zone). While the lack of space clamp limits resolution of charging transients and tail currents, the identification of the major current subgroups can still be readily accomplished, and inferences about the location and function of currents can be made which would not be possible if the cells were space clamped or truncated.

4-Aminopyridine↗
PubMed1981

Use of the single electrode voltage clamp to perform noise and relaxation studies of acetylcholine-activated channels in Aplysia neurons.

The single electrode voltage clamp has been used to perform fluctuation analysis ("noise" analysis) and relaxation experiments in order to study the average lifetime and conductance of ACh-activated sodium channels in Aplysia neurons. Measured values of average channel lifetime, which is approximately 20 msec at --80 mV and 11 degrees C, and elementary conductance, which is approximately 8 pS, are consistent with previously published results using two electrode clamping. The frequency response of the clamp was evaluated to determine its capabilities and limitations for the study of membrane currents. Sinusoidal currents injected into a voltage-clamped model membrane to simulate the frequency components of membrane noise are accurately reproduced at frequencies up to 500 Hz. Following a voltage clamp command, the new membrane potential is established in less than 2 msec, and current relaxations recorded after that time can be used to determine average channel lifetime. Since the frequency response of the clamp is much greater than the average lifetime of ACh-activated channels in Aplysia neurons, the single electrode voltage clamp is comparable to conventional two-electrode systems for investigating the properties of these channels, and may also be useful in other systems in which the time course of membrane currents is much slower than the frequency response of the clamp.

Acetylcholine↗
PubMed1989

Biodistribution of misonidazole and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in rats bearing unclamped and clamped 9L subcutaneous tumors.

The biodistribution of misonidazole (MISO) and 1,3bis(2-chloroethyl)-1-nitrosourea (BCNU) was studied using the subcutaneous (s.c.) 9L tumor model in male Fisher 344 rats. A transient hypoxia in these tumors was created by clamping the blood supply to the tumor. Reoxygenation occurred upon release of the clamp. The plasma and tumor concentrations of MISO and BCNU were quantitated by high pressure liquid chromatography. When 12 mg/kg of BCNU was given i.p. without MISO, the peak plasma concentration was about 6 micrograms/ml, and the elimination half-time was about 16 min. When 2.5 mmole/kg of MISO was given i.p. 150 min before the BCNU, the peak plasma concentration of BCNU increased by approximately 33%, and the plasma elimination half-time increased by approximately 57%. Clamping the tumor for 120 min did not significantly change the BCNU concentration in plasma, but in tumors the time to reach the peak level was delayed slightly, and the peak concentration was reduced when compared to that in the unclamped tumors. MISO pretreatment decreased the BCNU peak concentration in both unclamped and clamped tumors, but the decrease was more pronounced in the unclamped tumors. In both unclamped and clamped tumors, the BCNU concentration and its rate of disappearance were identical about 30 min after BCNU administration, with or without MISO pretreatment. The elimination half-time of MISO from the plasma (approximately 142 min) was identical for rats with unclamped or clamped tumors. The half-time for the disappearance of MISO from unclamped tumors was about 98 min. BCNU had no effect on the MISO concentration in plasma and unclamped tumors. MISO disappeared in the clamped tumors with a half-time of about 40 min. When the clamp was released, the MISO concentration returned to the level in the unclamped tumors after about 45 min. BCNU delayed the return of the MISO concentration to the unclamped tumor level by about 60 min. Two conclusions can be drawn from this study. First, the pharmacokinetics of each drug changed when the two drugs were combined. Second, the data indicate that alterations in the tumor BCNU pharmacokinetics are not the major mechanism responsible for the chemopotentiation previously measured in s.c. 9L tumors.

Animals↗
PubMed2005

Laparoscopic partial nephrectomy: is it advantageous and safe to clamp the renal artery?

OBJECTIVES: To compare the outcomes of laparoscopic partial nephrectomy (LPN) performed with and without vascular clamping and to evaluate the impact of clamping on postoperative renal function. METHODS: A total of 45 patients underwent LPN, 29 with and 16 without vascular occlusion. The two groups were compared regarding complication rates, blood loss, conversion rates, operative time, mean tumor size, and incidence of positive margins. Renal function was evaluated by postoperative dimethyl mercaptosuccinic acid scans. RESULTS: The mean blood loss was lower when vascular clamping was applied (320 versus 510 mL, P <0.05) than when it was not. The conversion rates were similar (10.3% versus 12.5%), and the mean operative time was shorter in the nonclamped group (115 versus 126 minutes). Urinary leakage occurred in 2 patients, 1 from each group. The mean tumor diameter was 3.2 cm in the clamped and 1.9 cm in the nonclamped group (P <0.05). In 2 patients (12.5%) in the nonclamped and 1 patient (3.4%) in the clamped group, the surgical margins were focally positive for tumor. The mean warm ischemia time was 28 minutes, and dimercaptosuccinic acid scans performed in 18 patients showed normal ipsilateral renal function (mean relative function 48%). CONCLUSIONS: LPN without vascular clamping is feasible in selected cases. However, clamping of the artery seems to be associated with reduced blood loss and a lower incidence of positive margins. Moreover, according to the postoperative dimercaptosuccinic acid scan findings, limited warm ischemia does not seem to result in permanent renal damage. We suggest that clamping of the renal artery should be considered during LPN, even for very small, superficial tumors.

Adult↗
PubMed2002

High-efficiency DNA ligation for clamp attachment without polymerase chain reaction.

We coupled ligation with mass action to achieve high-efficiency clamp attachment without polymerase chain reaction (PCR). Using a 10-fold molar excess of a GC-rich clamp of synthesized and hybridized oligonucleotides, we achieved the maximum clamp-ligation efficiency in which the clamp was ligated to >95% of 10(10)-10(12) restriction ends of a PCR-amplified fragment. The maximum efficiency was confirmed by ligating the clamp to 10(11)-10(12) restriction ends of human genomic DNA. Our approach can be added to a constant denaturant capillary electrophoresis (CDCE)-based method of analyzing rare point mutants at fractions as low as 10(-6); such mutants appear as small copy numbers in the initial samples. This CDCE-based method alone is applicable to only those DNA sequences juxtaposed with an internally occurring clamp of a higher melting temperature in genomic DNA. Since such sequences represent 9% of the human genome, the addition of clamp ligation significantly increases the scanning range for the human genome without reducing the initial mutant copy numbers. Furthermore, clamp ligation/attachment without PCR prevents PCR-created mutants from interfering with rare mutational analysis. In addition to those applications seeking high-efficiency DNA ligation, our approach can be generally applied to ligation of restriction ends.

Base Composition↗
PubMed1984

Prevention of ischemic spinal cord injury following aortic cross-clamping: use of corticosteroids.

Prior to proximal aortic cross-clamping, baseline measurements of spinal cord blood flow and function were done. Blood flow was evaluated with radioactive microspheres and function determined by assessment of somatosensory evoked potential (SEP). Group 1 (N = 6) animals had aortic cross-clamping for 5 minutes after ischemic spinal cord dysfunction (SEP loss) was documented. Group 2 (N = 9) underwent aortic cross-clamping for 10 minutes after loss of SEP. Group 3 (N = 6) also underwent 10 minutes of cross-clamping after initial SEP loss, but were treated intravenously with methylprednisolone (30 mg per kilogram of body weight) 10 minutes prior to cross-clamping and again 4 hours postoperatively. After release of the cross-clamp, the animals were allowed to recover and serial evaluations of spinal cord blood flow and neurological status were carried out for seven days. Group 1 animals recovered uneventfully without evidence of neurological injury. Group 2 animals sustained a 67% incidence of permanent spastic paraplegia (p = 0.02 versus Group 1). In contrast, methylprednisolone-treated animals sustained no clinically detectable neurological injury (p = 0.02 versus Group 2). Measurements of spinal cord blood flow at the time of SEP loss revealed similar degrees of spinal cord ischemia in all groups. No significant differences were observed in the duration of aortic cross-clamping prior to SEP loss among the three groups. The data indicate that short periods of cross-clamping (5 minutes) following SEP loss are well tolerated, whereas longer periods (10 minutes) are associated with a high incidence of paraplegia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1997

Hardness and stress-corrosion of rubber dam clamps.

Rubber dam clamps fracture infrequently during use. There are no American National Standards Institute or International Standards Organization standards for their manufacture. The purpose of this study was to measure the hardness of the clamps and test their resistance to a stress-corrosion test. Upper molar, lower molar, and premolar clamps were obtained from two manufacturers (A, B). The Rockwell C hardness at four sites on the bow of each clamp was then determined. Fresh clamps were placed on blocks corresponding to the average buccal-lingual dimension of the tooth on which they would be used. These blocks were then submerged in room temperature 5.25% sodium hypochlorite for 20 min and then allowed to air dry for 30 min. This was repeated 10 times. Rockwell C hardness values ranged from C30 to 38, with the clamps of manufacturer B being significantly harder. None of the clamps from manufacturer B cracked or corroded. When a third batch received from manufacturer A was tested in the same manner, none of the clamps fractured or corroded either.

Analysis of Variance↗
PubMed2006

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial.

BACKGROUND: Delayed clamping of the umbilical cord increases the infant's iron endowment at birth and haemoglobin concentration at 2 months of age. We aimed to assess whether a 2-minute delay in the clamping of the umbilical cord of normal-weight, full-term infants improved iron and haematological status up to 6 months of age. METHODS: 476 mother-infant pairs were recruited at a large obstetrics hospital in Mexico City, Mexico, randomly assigned to delayed clamping (2 min after delivery of the infant's shoulders) or early clamping (around 10 s after delivery), and followed up until 6 months postpartum. Primary outcomes were infant haematological status and iron status at 6 months of age, and analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00298051. FINDINGS: 358 (75%) mother-infant pairs completed the trial. At 6 months of age, infants who had delayed clamping had significantly higher mean corpuscular volume (81.0 fL vs 79.5 fL 95% CI -2.5 to -0.6, p=0.001), ferritin (50.7 mug/L vs 34.4 mug/L 95% CI -30.7 to -1.9, p=0.0002), and total body iron. The effect of delayed clamping was significantly greater for infants born to mothers with low ferritin at delivery, breastfed infants not receiving iron-fortified milk or formula, and infants born with birthweight between 2500 g and 3000 g. A cord clamping delay of 2 minutes increased 6-month iron stores by about 27-47 mg. INTERPRETATION: Delay in cord clamping of 2 minutes could help prevent iron deficiency from developing before 6 months of age, when iron-fortified complementary foods could be introduced.

Adult↗
PubMed1998

Cerebral effects of aortic clamping during coarctation repair in children: a transcranial Doppler study.

OBJECTIVE: Haemodynamic changes as a consequence of application and release of aortic clamps for surgical repair of aortic coarctation are compensated by cerebrovascular autoregulation. Transcranial Doppler was used to study the effect of these haemodynamic changes upon brain circulation in children during aortic coarctation repair. METHOD: A 2-MHz transcranial Doppler system continuously recorded mean cerebral blood flow velocities from the left middle cerebral artery in 13 children (aged from 5 days to 14 years) during repair of their coarctation. Measurements were performed: prior to aortic clamping (baseline); during the first 5 min after clamp application; 1 min before declamping; at 1, 2, 4 and 6 min after the release of both proximal and distal aortic clamps; and at initial chest closure. A contralateral upper-limb non-invasive blood pressure cuff measured systemic blood pressures. Haemodynamic and anaesthetic parameters were monitored. Patients were stratified by age into two groups: age < 6 months (group A) and age > 6 months (group B). RESULTS: With aortic clamping, systemic blood pressures (range from: -16 to +54%) and cerebral blood flow velocities (range from -40 to +19%) changed slightly (P > 0.05) from initiation to end of aortic clamping. In group A, release of aortic clamps resulted in moderate fluctuations in systemic blood pressures (range from -34 to +15%) (P > 0.05) and a marked reduction in cerebral blood flow velocities (range from -63 to -33%) (P < 0.01). At the time of surgical closure, flow velocities had improved in all infants except one. Group B did not show major reductions in either cerebral blood flow velocity or systemic blood pressures throughout all measurements (P > 0.05). During aortic clamp release, young infants responded with lower brain blood flow velocities as compared to older children (r = 0.68; P < 0.05). CONCLUSION: Transient central nervous system hypotension results as a consequence of flow redistribution during aortic declamping in young infants. Older children usually show a faster autoregulatory compensation to these haemodynamic changes. The observed age-related physiologic differences, suggest that young infants may require higher systemic blood pressures during declamping to prevent the cerebral blood flow reduction. Transcranial Doppler appears to be a valuable monitor of these cerebral haemodynamic changes.

Adolescent↗
PubMed1995

Supraceliac, but not infrarenal, aortic cross-clamping upregulates neutrophil integrin CD11b.

OBJECTIVE: To evaluate the effects of supraceliac and infrarenal aortic cross-clamping on the expression of neutrophil integrin in CD11b (a marker of systemic cytokine release). DESIGN: Two groups, determined by anatomic placement of aortic cross-clamp. Laboratory personnel were blinded as to group assignment. SETTING: University teaching and community hospitals. Laboratory facilities used were university and Veteran's Affairs medical centers. PARTICIPANTS: Patients scheduled for aortic surgery. INTERVENTIONS: Blood sampling was performed at baseline, after 30 minutes of aortic cross-clamp duration, 30 and 90 minutes after reperfusion (for tumor necrosis factor-alpha plasma levels in infrarenal cross-clamp group), and at baseline and 90 minutes reperfusion (for neutrophil CD11b expression quantification) in both groups. MEASUREMENTS AND MAIN RESULTS: Tumor necrosis factor-alpha measured by ELISA technique did not change at any time period in the infrarenal clamping group. Neutrophil CD11b expression, measured by double antibody staining and FACScan analysis, did not change significantly at 90 minutes of reperfusion in the infrarenal group, but increased significantly (p < 0.05) in the supraceliac aortic cross-clamp group. CONCLUSION: Neutrophil integrin CD11b has been demonstrated to be the primary adhesive glycoprotein responsible for neutrophil organ entrapment and subsequent neutrophil-mediated reperfusion injury. These results suggest that upregulation of neutrophil integrin CD11b after supraceliac aortic clamping may in part be responsible for the higher incidence of acute lung injury after thoracic aortic aneurysm repair requiring supraceliac clamping when compared with infrarenal aneurysm surgery.

Aged↗