Abnormal Pulmonary Artery Stiffness in Pulmonary Arterial Hypertension: In Vivo Study with Intravascular Ultrasound

BACKGROUND: There is increasing recognition that pulmonary artery stiffness is an important determinant of right ventricular (RV) afterload in pulmonary arterial hypertension (PAH). We used intravascular ultrasound (IVUS) to evaluate the mechanical properties of the elastic pulmonary arteries (PA) in subjects with PAH, and assessed the effects of PAH-specific therapy on indices of arterial stiffness. METHOD: Using IVUS and simultaneous right heart catheterisation, 20 pulmonary segments in 8 PAH subjects and 12 pulmonary segments in 8 controls were studied to determine their compliance, distensibility, elastic modulus and stiffness index β. PAH subjects underwent repeat IVUS examinations after 6-months of bosentan therapy. RESULTS: AT BASELINE, PAH SUBJECTS DEMONSTRATED GREATER STIFFNESS IN ALL MEASURED INDICES COMPARED TO CONTROLS: compliance (1.50±0.11×10(-2) mm(2/)mmHg vs 4.49±0.43×10(-2) mm(2/)mmHg, p<0.0001), distensibility (0.32±0.03%/mmHg vs 1.18±0.13%/mmHg, p<0.0001), elastic modulus (720±64 mmHg vs 198±19 mmHg, p<0.0001), and stiffness index β (15.0±1.4 vs 11.0±0.7, p = 0.046). Strong inverse exponential associations existed between mean pulmonary artery pressure and compliance (r(2) = 0.82, p<0.0001), and also between mean PAP and distensibility (r(2) = 0.79, p = 0.002). Bosentan therapy, for 6-months, was not associated with any significant changes in all indices of PA stiffness. CONCLUSION: Increased stiffness occurs in the proximal elastic PA in patients with PAH and contributes to the pathogenesis RV failure. Bosentan therapy may not be effective at improving PA stiffness

International MinD Conference 2019. Dresden, 19.-20.September 2019

Music has been shown to positively impact people living with advanced dementia, triggering fleeting recall and recollection and impacting emotional responses. Research and practice have focused on opportunities for people to engage with music by listening to playlists of favourite songs, revisiting existing skills by playing music, or by engaging in group music sessions or music therapy. Research has primarily focused on music and melodic sound, however our day-to-day lives are filled with ambient sound, soundscapes and percussive sound. Research in this area is limited. As is research in how to promote creative engagement with sound for those who do not have any existing musical skills. This paper will discuss a project to adapt an innovative electronic musical instrument, The AirSticks, invented by a professional musical performer for use in his own practice, to suit the needs of people living with advanced dementia. It will provide insights into workshops with a group of residents at two care homes and show the impact on one person in particular as she engaged in an emotive improvisation with the musician