A comparison among oscillometric waveforms in healthy nonpregnant women, pregnancy and hypertensive disorders of pregnancy.

OBJECTIVE: Understanding of how oscillometric waveforms (OMW) vary between pregnant and nonpregnant individuals remains low. An exploratory analysis was completed to assess for quantitative and qualitative changes in OMW and oscillometric envelope features in pregnancy. DESIGN AND METHODS: Eighteen pregnant individuals (over 20 weeks gestational age) and healthy, nonpregnant (HNP) women were recruited. Six HNP were matched to six healthy pregnant (HP) women, and six pregnant women with a hypertensive disorder of pregnancy (HDP) by age, arm circumference, and cuff size. Blood pressure measurements were completed per the International Organization for Standardization (ISO) protocol using a custom-built oscillometric device as the test device and two-observer mercury auscultation as the reference measurement. Auscultatory blood pressure and blood pressure derived from slope-based and fixed ratio algorithms were determined. OMW and envelope features were compared among groups. RESULTS: In HNP, HP, and HDP groups respectively: mean auscultatory blood pressure (systolic mean ± SD/diastolic mean ± SD) was 103.4 ±â€…12.2/67.1 ±â€…7.9; 109.5 ±â€…3.1/58.1 ±â€…6.4; 135.6 ±â€…18.9/85.1 ±â€…14.2 mmHg. HDP had significantly higher auscultatory systolic and diastolic blood pressure than the HP group ( P  = 0.001). The pregnant groups had a lower average pulse width (mean ± SD: HNP = 0.8 ±â€…0 s, HP = 0.6 ±â€…0.1 s, HDP = 0.6 ±â€…0.1 s; HP vs. HNP mean difference [adjusted P value]: 0.2 [ P  = 0.004], HDP vs. HNP 0.1 [ P  = 0.018]) compared with the HNP group. The HDP group had a larger area under the OMW envelope than the HNP group (mean ± SD: HNP = 22.6 ±â€…3.4; HDP = 28.5 ±â€…4.2; HDP vs. HNP mean difference [adjusted P value]: 5.9 P  = 0.05). CONCLUSION: In this exploratory work, differences in the OMW morphology and parameters were found in pregnancy and in hypertensive disorders of pregnancy compared with healthy controls. Even small differences may have important implications in algorithm development; further work comparing OMW envelopes in pregnancy is needed to optimize the algorithms used to determine blood pressure in pregnancy.

Effect of Elevated Ambient Temperature on Simulator-Derived Oscillometric Blood Pressure Measurement.

BACKGROUND: Oscillometric blood pressure (BP) devices are typically labeled for use up to 40 °C. Many geographic regions have ambient temperatures exceeding 40 °C. We assessed the effect of increased ambient temperature (40-55 °C) on simulator-derived oscillometric BP measurement. METHODS: Three Omron BP769CAN devices, 3 A&D Medical UA-651BLE devices, and accompanying cuffs were used. A custom heat chamber heated each device to the specified temperature. A noninvasive BP simulator was used to take 3 measurements with each device at differing temperatures (22, 40, 45, 50, and 55 °C) and BP thresholds: 80/50, 100/60, 120/80, 140/90, 160/110, and 180/130 mm Hg. Using each device as its own control (22 °C), we determined the relative differences in mean BP for each device at each temperature and BP setting, assessed graphical trends with increasing temperature, and examined variability. RESULTS: Graphical trends of mean simulator-subtracted BP differences from room temperature showed no discernable pattern, with differences clustered around zero. Overall mean difference in BP (combined elevated temperatures minus room temperature) was -0.8 ± 2.1 (systolic ± SD)/1.2 ± 3.5 (diastolic ± SD) mm Hg for the A&D device and 0.2 ± 0.4 (systolic ± SD)/-0.1 ± 0.1 (diastolic ± SD) mm Hg for the Omron. All individual elevated temperature differences (elevated temperature minus room temperature) except A&D diastolic BP at 50 °C were within 5 mm Hg. CONCLUSIONS: In this simulator-based study assessing within-device differences, higher ambient temperatures resulted in oscillometric BP measurements that were comparable to those performed at room temperature.

Peptide modification of polyimide-insulated microwires: Towards improved biocompatibility through reduced glial scarring.

The goal of this study is to improve the integration of implanted microdevices with tissue in the central nervous system (CNS). The long-term utility of neuroprosthetic devices implanted in the CNS is affected by the formation of a scar by resident glial cells (astrocytes and microglia), limiting the viability and functional stability of the devices. Reduction in the proliferation of glial cells is expected to enhance the biocompatibility of devices. We demonstrate the modification of polyimide-insulated microelectrodes with a bioactive peptide KHIFSDDSSE. Microelectrode wires were functionalized with (3-aminopropyl) triethoxy silane (APTES); the peptide was then covalently bonded to the APTES. The soluble peptide was tested in 2D mixed cultures of astrocytes and microglia, and reduced the proliferation of both cell types. The interactions of glial cells with the peptide-modified wires was then examined in 3D cell-laden hydrogels by immunofluorescence microscopy. As expected for uncoated wires, the microglia were first attracted to the wire (7days) followed by astrocyte recruitment and hypertrophy (14days). For the peptide-treated wires, astrocytes coated the wires directly (24h), and formed a thin, stable coating without evidence of hypertrophy, and the attraction of microglia to the wire was significantly reduced. The results suggest a mechanism to improve tissue integration by promoting uniform coating of astrocytes on a foreign body while lessening the reactive response of microglia. We conclude that the bioactive peptide KHIFSDDSSE may be effective in improving the biocompatibility of neural interfaces by both reducing acute glial reactivity and generating stable integration with tissue. STATEMENT OF SIGNIFICANCE: The peptide KHIFSDDSSE has previously been shown in vitro to both reduce the proliferation of astrocytes, and to increase the adhesion of astrocyte to glass substrates. Here, we demonstrate a method to apply uniform coatings of peptides to microwires, which could readily be generalized to other peptides and surfaces. We then show that when peptide-modified wires are inserted into 3D cell-laden hydrogels, the normal cellular reaction (microglial activation followed by astrocyte recruitment and hypertrophy) does not occur, rather astrocytes are attracted directly to the surface of the wire, forming a relatively thin and uniform coating. This suggests a method to improve tissue integration of implanted devices to reduce glial scarring and ultimately reduce failure of neural interfaces.