Tracking Changes in Global Longitudinal Strain in Lung Cancer Patients Receiving Thoracic Radiation

PURPOSE/OBJECTIVE(S)

Thoracic radiation improves survival in many lung cancer patients. However, radiation-induced cardiotoxicity is a major source of morbidity and mortality in such patients. Global longitudinal strain (GLS), a novel echocardiography (ECHO) method of assessing left ventricular function, has been shown to predict long-term adverse cardiovascular risk in diverse patient populations. We hypothesized that receipt of thoracic radiation is associated with GLS changes in lung cancer patients.

MATERIALS/METHODS

We retrospectively identified patients with lung cancer treated at our institution between 2005-2020 who had ECHOs performed both before and after RT, and in whom GLS was extractable. ECHO Board-Certified cardio-oncologists measured GLS and left ventricular ejection fraction (LVEF) from these ECHOs.

RESULTS

A total of 40 patients met inclusion criteria. Median time to ECHO was 78 days prior and 172 days after RT. Two chamber (2C), 3C, 4C, and average GLS were significantly decreased after RT on paired t-test [mean difference (SD) 2.23 (3.29), 2.99 (2.78), 2.25 (3.63), 2.51 (2.66) respectively, all p < 0.001]. Thirteen patients (32.5%) had abnormal GLS (<18%) prior to RT. 5 of those 13 patients (38.5%) had abnormal LVEF (< 50%). 27/40 patients (67.5%) had an abnormal GLS or clinically significant (≥15%) drop in GLS after RT. This difference (32.5% patients pre-RT vs 67.5% post-RT) was statistically significant (p < 0.01). Among patients (n = 27) who had normal LVEF before RT, 1 patient (3.7%) developed abnormal LVEF (<50%) after RT. Backwards logistic regression showed significant interaction between heart volume receiving 5 Gray and change in GLS.

CONCLUSION

This cohort exhibited a significant decrease in 2C, 3C, 4C, and average GLS after RT. ∼1/3 of patients had abnormal GLS at baseline (suggesting a high-risk group for cardiac complications) and 67.5% of patients had clinically significant decrease in GLS after RT. Among the patients with normal GLS before RT, although 51.9% of patients demonstrated a clinically significant drop in GLS after RT, only 3.7% of patients developed abnormal LVEF, suggesting that this is a late occurrence. GLS changes may serve as a valuable tool for early identification of patients who are at high risk for future cardiac complications after receiving thoracic radiation.

Designing sustainable sanitation in urban planning proposed for Changzhou, China

China is undergoing rapid urbanization and economic development. This requires a new approach on spatial planning and environmental infrastructure. In the presented project an example of this approach is given for the city of Changzhou (China) where a new residential area (Qinglong district) will be developed for 100.000 inhabitants. Key issue within the formulation of sustainable sanitation concepts is the integration and management of water, waste and energy in such a way that they will become beneficial to the establishment of the envisaged green city. Starting point was the closing of material cycles focusing on possibilities to recover and reuse valuable resources and energy from "waste" produced in an urban setting. Four different scenarios focusing on water, nutrient and energy recovery were compared with the baseline wastewater management practice. Besides environmental benefits, the economical benefits of sustainable sanitation concepts are attractive, the break even point with the baseline scenario, is already after 5 years, provided that recovered resources will be sold for a marketable price. We believe that presented concepts are applicable for a wide range of new urban development initiatives in China and similar rapidly developing densely populated regions worldwide.

Objective assessment of limb tissue elasticity: development of a manual indentation procedure

An ultrasound indentation system with a pen-size hand-held probe was developed and used to obtain the effective Young's moduli of forearm and lower limb soft tissues in 12 subjects. Since the probe is manually driven, the alignment of the probe and control of the rate of indentation are parameters upon which the results obtained depend. This paper addresses whether manual indentation tests with the probe are sufficiently acceptable and repeatable for objective biomechanical characterization of limb tissues. Forearms of three normal subjects were tested in two states of muscular contraction. Six different indentation rates, ranging from 0.75 mm/s to 7.5 mm/s, were imposed. The load-indentation responses obtained were shown to be well represented by quadratic functions. A linear elastic indentation solution was used to extract the effective Young's modulus. The material parameters extracted were repeatable and rather rate-insensitive for the range of rates used. The effective Young's modulus obtained was found to significantly increase as a result of contraction of the underlying muscles. Indentor misalignment experiments demonstrated that misalignment affects the measurement from which the effective Young's modulus of soft tissues is calculated. This effect, however, was found to decrease as the tissue thickness increased. With the investigation of the above issues, a procedure has been established for the extraction of effective Young's moduli of limb soft tissues from manual cyclic indentation responses. Tests on experimental subjects' lower limbs further demonstrated that the ultrasonic indentor is a feasible instrument for characterization of the biomechanical properties of limb soft tissues. Paired-t tests showed that the effective Young's moduli of the lower limb soft tissues of three elderly persons with transtibial amputation were significantly smaller than those of six unimpaired young subjects.