University of Minnesota Health Maple Grove Clinics

Background: Accurate and autonomous blood pressure (BP) monitoring remains a significant challenge in hypertension management. We evaluated a novel subcutaneous pulse-echo ultrasound (US) system designed to calculate arterial pressure waveforms, comparing its performance to intra-arterial (IA) catheter-based reference measurements in an acute preclinical study. Methods: In anesthetized sheep, continuous BP measurements were obtained via an IA catheter in the femoral artery. Simultaneously, 10-second US recordings (n = 38) were collected using a transducer placed near target arteries (carotid and femoral). These signals were processed through a proprietary algorithm to extract pressure waveforms based on arterial diameter changes. Calibration was performed by correlating time-varying diameters with reference pressure values over multiple heartbeats. The resulting calibration parameters were then used to estimate pressure values in subsequent beats. The accuracy of US-derived pressures was assessed by comparing systolic and diastolic values to IA readings using Bland-Altman analysis. Results: System accuracy was quantified by comparing systolic and diastolic pressures derived from US waveforms to IA references across multiple cardiac cycles and repeated measurements. As illustrated in Figure 1, US-derived waveforms (blue) closely resemble IA reference waveforms (red) and are capable of capturing key features such as the systolic upstroke, dicrotic notch, and diastolic decay. The Bland-Altman analysis (Figure 2) demonstrated strong agreement across a range of pressures, with mean absolute differences of 2.0 mmHg (systolic) and 2.2 mmHg (diastolic). Conclusions: The subcutaneous ultrasound BP system provides accurate and repeatable systolic and diastolic pressure measurements compared to the gold-standard IA catheter. These findings support the feasibility of using subcutaneously implanted ultrasound for BP monitoring and suggest potential for future diagnostic capabilities. Ongoing work will address chronic implantation and real-time algorithm optimization for use in freely moving subjects.

Cross-sectional associations between voice and psychological factors are known, but changes over time offer opportunities to refine our understanding of their interactions and consider customized treatment options. Study objectives were to measure relationships between voice and psychological factors using ecological momentary assessment and applying (1) group-level time series analysis and (2) group and (3) individual causal modeling to identify key psychological factors relevant for voice outcomes. Adults (N = 32) with primary muscle tension dysphonia completed multiple assessments daily for 10 days. Measures included items from the Voice Handicap Index-10, voice-adapted perceived present control scale, items from NIH PROMIS and the NIH Toolkit to assess distress, and the Positive and Negative Affect Scale. Group-level time series analysis was conducted using dynamic structural equation modeling; causal analysis utilized the Greedy Fast Causal Inference algorithm. In group-level time series analyses, neither perceived control nor distress predicted subsequent timepoint voice handicap scores. In group-level causal modeling, anxiety was causal for voice handicap, but perceived control was not. Individual-level analyses identified various causal factors for voice handicap including perceived control and negative affect, and to a lesser extent, serenity, anxiety, somatic arousal, and stress. Group-level analyses may obscure important heterogeneity that is identifiable using individual-level causal analyses. For example, perceived control was not identified as predictive or causal for voice handicap at the group level; but was a salient causal factor for voice handicap in some individuals. Causal modeling using intensive longitudinal datasets offers a potential avenue for individualized treatment approaches.

Canine atopic dermatitis (cAD) is a common, complex and multifactorial disease involving, among others, genetic predisposition, environmental factors and allergic sensitisation. This review summarises the current evidence on the role of genetic and environmental factors and allergic sensitisation in the pathogenesis of cAD since the last review by ICADA in 2015. Online citation databases and proceedings from international meetings on genetic factors, environmental factors and allergens relevant to cAD that had been published between 2015 and 2022 were reviewed. Despite intensive research efforts, the detailed genetic background predisposing to cAD and the effect of a wide range of environmental factors still need more clarification. Genome-wide association studies and investigations on genetic biomarkers, such as microRNAs, have provided some new information. Environmental factors appear to play a major role. Lifestyle, especially during puppyhood, appears to have an important impact on the developing immune system. Factors such as growing up in a rural environment, large size of family, contact with other animals, and a nonprocessed meat-based diet may reduce the risk for subsequent development of cAD. It appears that Toxocara canis infection may have a protective effect against Dermatophagoides farinae-induced cAD. House dust mites (D. farinae and D. pteronyssinus) remain the most common allergen group to which atopic dogs react. Currently, the major allergens related to D. farinae in dogs include Der f 2, Der f 15, Der f 18 and Zen 1. Canine atopic dermatitis remains a complex, genetically heterogeneous disease that is influenced by multiple environmental factors. Further, well-designed studies are necessary to shed more light on the role of genetics, environmental factors and major allergens in the pathogenesis of cAD.

During JADPRO Live 2022, Kirollos Hanna, PharmD, BCPS, BCOP, briefed advanced practitioners on key FDA approvals from late 2021 to late 2022. He described mechanisms of action that are unique across some malignancies, as well as mechanisms of action that clinicians can utilize through an expanded indication or across other solid malignancies. Finally, he discussed safety profiles and what advanced practitioners can and should do in monitoring across solid tumors.

Multiple myeloma, a malignant neoplasm of plasma cells that accumulate in bone marrow, accounts for approximately 18% of hematologic malignancies in the United States. Patients are often treated with triplet therapy and may undergo stem cell transplantation. Despite effective therapies, multiple myeloma remains incurable. Patients often require maintenance therapy, and many will progress or relapsed following upfront treatment. Selection of treatment in the relapse/refractory setting is complex due numerous active therapeutic agents and combinations. Treatment is often tailored to prior exposure and duration. In 2020, three novel pharmacological agents were approved in the relapsed setting. We highlight the clinical safety and efficacy of selinexor, isatuximab-irfc, and belantamab mafodotin for patients with multiple myeloma.

D-47 Clinical Case Slide - Shoulder and Elbow Thursday, May 30, 2019, 3: 45 PM - 5: 45 PM Room: CC-306

We develop a new Bayesian approach of sample size determination (SSD) for the design of noninferiority clinical trials. We extend the fitting and sampling priors of Wang and Gelfand (2002, Statistical Science 17, 193-208) to Bayesian SSD with a focus on controlling the type I error and power. Historical data are incorporated via a hierarchical modeling approach as well as the power prior approach of Ibrahim and Chen (2000, Statistical Science 15, 46-60). Various properties of the proposed Bayesian SSD methodology are examined and a simulation-based computational algorithm is developed. The proposed methodology is applied to the design of a noninferiority medical device clinical trial with historical data from previous trials.