JCSM clinical reports最新文献

Predictive influence of artificial intelligence-based body composition analysis in trauma patients with pelvic injuries 基于人工智能的身体成分分析对骨盆损伤患者的预测作用

JCSM clinical reports

Pub Date : 2023-04-13 DOI: 10.1002/crt2.61

Johannes Kolck, Frederik Maximilian Schäfer, Kirsten Labbus, Silvan Wittenberg, Clarissa Hosse, Timo Alexander Auer, Uli Fehrenbach, Dominik Geisel, Nick Lasse Beetz

Background

High-energy trauma patients represent the ultimate challenge to trauma care and are at risk of injury-related mortality and morbidity—a common cause of loss of productivity. The aim of this study was to implement computed tomography (CT)-derived, artificial intelligence (AI)-based body composition analysis (BCA) to identify predictors of morbidity.

Methods

Retrospectively, we enrolled 104 patients (38 females and 66 males) who underwent CT imaging for assessment of injuries caused by high-energy trauma (motor vehicle accidents, falls from significant height, or blast injury). We sought to identify risk factors for prolonged length of stay in hospital and intensive care unit (ICU) and fractures requiring pelvic surgery. Cox and logistic regression analysis were performed using BCA parameters as covariates besides conventional risk factors. Additionally, the effects of pre-existing conditions, obesity, and sarcopenia were analysed.

Results

Increased subcutaneous adipose tissue (SAT), determined by BCA, at hospital admittance is a predictor of prolonged hospital stay (P = 0.02) independent of treatment regime and occurrence of related complications, whereas muscle mass does not influence the length of stay. Individuals with sarcopenia and a decreased psoas muscle index (PMI) sustaining high-energy trauma are at risk of pelvic injuries requiring surgical treatment.

Conclusion

BCA parameters are easily available from routine CT and significantly predict outcomes in trauma patients with pelvic injuries. Patients with reduced muscle mass are at risk for injuries requiring pelvic surgery, and increased SAT is a risk factor for longer hospital stays. These findings underline the potential of BCA, which may be valuable in identifying trauma patients who require specific support to optimize their physiological reserves and clinical outcome.

高能创伤患者是创伤护理的终极挑战，他们面临着损伤相关死亡率和发病率的风险，这是导致生产力丧失的常见原因。本研究的目的是实施基于计算机断层扫描(CT)的、基于人工智能(AI)的身体成分分析(BCA)，以确定发病率的预测因素。

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引用次数: 0

A review of radiological definitions of sarcopenia in cancer 癌症中肌肉减少症的放射学定义综述

JCSM clinical reports

Pub Date : 2023-03-02 DOI: 10.1002/crt2.60

James W. Wang, Jiarong Chen, Alison H. McGregor, Matthew Williams

Background

Sarcopenia in cancer impacts overall survival, surgical complications, and side effects of oncological treatments. Cancer patients frequently receive cross-sectional imaging, allowing incidental capture of radiological sarcopenia biomarkers. These biomarkers vary by imaging modality, tumour group, patient demographics, and anatomy but lack a consensus with regard to clinical application. In this article, we provide an overview of radiology-based sarcopenia biomarkers by anatomy and their prevalence in the literature.

Methods

In accordance with previously published scoping review protocol, we searched PubMed/MEDLINE, Embase, Scopus, and Cochrane between 2007 and June 2021. Studies were independently reviewed by two authors with Cohen's kappa 0.81 and reported using descriptive statistics.

Results

There were 5649 titles and abstracts reviewed, including 459 full-text articles. There were 23 additions found through references, resulting in 482 total studies. There is a consistent year-on-year increase of new radiological sarcopenia landmarks since 2015, with 49.8% studies reporting novel definitions of sarcopenia. The majority of studies ranged between 50 and 300 participants and featured an abdominal sarcopenia marker (94.4%), of which 75.2% used the skeletal muscle index at L3 (L3SMI). Sarcopenia prevalence ranged from 8.33% to 89.66%. Biomarkers are often applied across genders and ethnicities, regardless of the original population the definition originated from, despite the emergence and availability of ethnic-specific alternatives.

Conclusion

There remains a need to incorporate demographics and age into predictive models derived from sarcopenia biomarkers obtained through routine clinical imaging. Use of individual biomarkers needs to be made with careful consideration of the population in which the biomarkers were generated.

癌症的肉瘤影响总体生存率、手术并发症和肿瘤治疗的副作用。癌症患者经常接受横断面成像，从而偶然捕获放射性少肌症生物标志物。这些生物标志物因成像方式、肿瘤组、患者人口统计和解剖结构而异，但在临床应用方面缺乏共识。在这篇文章中，我们通过解剖学对基于放射学的少肌症生物标志物及其在文献中的流行情况进行了概述。

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引用次数: 0

The impact of low muscle mass on prognosis following neoadjuvant chemotherapy for resectable locally advanced rectal cancer: a systematic review and meta-analysis 可切除局部晚期癌症新辅助化疗后低肌肉质量对预后的影响：系统回顾和荟萃分析

JCSM clinical reports

Pub Date : 2023-02-17 DOI: 10.1002/crt2.59

Jacob Hatt, Thomas F.F. Smart, Edward J. Hardy, Brett Doleman, Jonathan N. Lund, Bethan E. Philips

Background

Sarcopenia is characterized by the progressive and generalized loss of muscle mass and function. There is an increasing body of evidence to suggest that cancer patients with pre-existing sarcopenia are at a greater risk of both short- and long-term clinical complications. The aim of this review is to examine the impact of low muscle mass on prognostic outcomes in patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) prior to surgery.

Methods

MEDLINE, PubMed, and Embase databases were searched from inception to October 2021. Any comparative studies relating to the prognostic outcomes of sarcopenic versus non-sarcopenic patients with LARC who received nCRT prior to surgery were included. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). Meta-analysis was performed on reported hazard ratios (HR) and 95% confidence intervals (CI) using DerSimonian–Laird random-effects models.

Results

A total of 598 patients from five studies were included in the analysis of hazard ratios for overall survival, whereas 505 patients from four studies were available for analysis of HR for disease-free survival. Meta-regression analysis showed a significant association between pre-existing sarcopenia and worse overall survival (HR: 1.69, 95% CI: 1.15–2.48). The association between pre-existing sarcopenia and shorter disease-free survival was not statistically significant (HR: 1.07, 95% CI: 0.63–1.82).

Conclusions

The review highlights the role that body composition can play on prognostic outcomes in patients undergoing multimodal cancer treatment. Given the complex underpinnings of sarcopenia progression, more research is needed to develop strategies to mitigate this impact in a physiologically vulnerable population.

Sarcopenia的特点是肌肉质量和功能的进行性和全身性丧失。越来越多的证据表明，已有少肌症的癌症患者出现短期和长期临床并发症的风险更大。本综述的目的是研究低肌肉质量对局部晚期癌症（LARC）患者在手术前接受新辅助放化疗（nCRT）的预后的影响。

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引用次数: 0

Ankle flexor/extensor strength and muscle density are complementary determinants of balance during dual-task engagement: The ankle quality study 踝关节屈/伸肌力量和肌肉密度是双任务参与中平衡的互补决定因素:踝关节质量研究

JCSM clinical reports

Pub Date : 2023-01-12 DOI: 10.1002/crt2.58

Andy K. O. Wong, Hugo J. W. Fung, Steven P. Pretty, Andrew C. Laing, Adrian H. Chan, Sunita Mathur, Karl Zabjek, Lora Giangregorio, Angela M. Cheung

Background

This study investigated relative contributions of ankle flexor torque, muscle size, and density on balance and falls.

Methods

Men and women ≥50 years of age completed a peripheral quantitative computed tomography scan of the mid-leg to quantify muscle density (MD) and cross-sectional area; Biodex dynamometry to evaluate maximal isometric ankle flexor torque; and a single-leg balance test on a force platform with/without eyes closed and cognitive task. Ankle flexor torque, muscle size, and density individually, together, or as interactions were examined for associations with balance (mean step duration, steps/trial) in general linear models, or with falls in Poisson regression, adjusting for age, sex, BMI, glucocorticoid use, osteoarthritis, and physical activity. Visuo-cognitive conditions were compared.

Results

Among 105 participants (age: 63.3 ± 9.9 years, BMI: 25.8 ± 5.4 kg/m², 77.1% female), 41.8% experienced ≥1 fall in the last year. Balance on one leg was dependent on ankle flexor torque when eyes were open (r = −0.220 to −0.284) and on having leaner mid-leg muscles when eyes were closed (r = −0.123 to −0.142); cognitive challenge blunted these correlations. Individuals with leaner muscles tended to rely more on plantarflexors than dorsiflexors. A 2% lower step-free fraction in the eyes-closed paradigm associated with having 1 additional fall [−0.701(−1.235, −0.167)], but neither torque, muscle density, nor size related to number of falls.

Conclusions

Among ambulatory adults, ankle flexor torque and muscle density showed an interactive influence on balance that depended on visuo-cognitive input. The complementary roles of torque and muscle density on balance suggest redundancy is important under dual-tasking conditions.

本研究调查了踝关节屈肌扭矩、肌肉大小和密度对平衡和跌倒的相对贡献。

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引用次数: 1

The relationship between computed tomography-derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago-gastric cancer undergoing neoadjuvant treatment 接受新辅助治疗的食管胃癌症表现良好患者的计算机断层扫描引起的少肌症、心肺运动测试表现、全身炎症和存活率之间的关系

JCSM clinical reports

Pub Date : 2022-12-12 DOI: 10.1002/crt2.57

Josh McGovern, Jenna Delaney, Matthew J. Forshaw, Gerard McCabe, Andrew B. Crumley, David McIntosh, Barry J. Laird, Paul G. Horgan, Donald C. McMillan, Stephen T. McSorley, Ross D. Dolan

Background

Thought to capture the nutritional and functional reserve of the cancer patient, whether the computed tomography (CT)-derived sarcopenia score (CT-SS) has complimentary prognostic value to commonly utilized pre-treatment host assessments in patients with oesophago-gastric (OG) cancer is unknown. The aim of the present study was to examine if the CT-SS can stratify survival in OG cancer patients with good performance status [Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 0/1]. Furthermore, if the CT-SS had complimentary prognostic value to cardiopulmonary exercise testing (CPET) performance and systemic inflammation.

Methods

Consecutive patients with confirmed OG cancer and good performance status, who received neoadjuvant chemotherapy (NAC) with a view to surgical resection with curative intent, between 1 January 2010 and 31 December 2015, within NHS Greater Glasgow and Clyde (NHSGGC) and NHS Forth Valley (NHSFV), were identified from a prospectively maintained database. CT-SSs were grouped as 0/1/2. CPET variables recorded included VO₂ anaerobic threshold (AT) and peak. Systemic inflammatory response was determined by modified Glasgow prognostic score (mGPS) and neutrophil/lymphocyte ratio (NLR). Associations between categorical variables were examined using χ² test and binary logistics regression analysis.

Results

A total of 232 patients met the inclusion criteria. 75% (n = 174) of patients were male, 54% (n = 126) were 65 years or older, and 60% (n = 139) were overweight [body mass index (BMI) ≥25 kg/m²]; 33% (n = 77) of patients had CT-SS ≥ 1, 36% (n = 83) had a low VO₂ AT (≤11 ml/kg/min), and 57% (n = 132) had a low VO₂ peak (≤19 ml/kg/min). Of the 200 patients who had pre-NAC bloods facilitating calculation of the mGPS, 28% (n = 55) had mGPS ≥ 1. Of the 211 patients who had pre-NAC bloods facilitating calculation of NLR, 38% (n = 80) had an NLR ≥ 3; 82% (n = 190) and 53% (n = 122) were alive at 1 and 3 years post-NAC, respectively. On univariate analysis, CT-SS was significantly associated with sex (P < 0.05), histological cell type (P < 0.05), low VO₂ AT (P < 0.05), low VO₂ peak (P < 0.05), BMI (P < 0.05), mGPS (P < 0.05), and 3-year survival (P < 0.05). On multivariate analysis, tumour, node, and metastasis (TNM) stage (P < 0.05) and CT-SS (P < 0.05) remained significant

被认为可以捕捉癌症患者的营养和功能储备，计算机断层扫描（CT）衍生的少肌症评分（CT-SS）是否对癌症食管胃（OG）患者的治疗前宿主评估具有互补的预后价值尚不清楚。本研究的目的是检查CT-SS是否可以对表现良好的OG癌症患者的生存率进行分层[东部肿瘤协作组表现状态（ECOG-PS）0/1]。此外，CT‐SS是否对心肺运动测试（CPET）性能和全身炎症具有互补的预后价值。

{"title":"The relationship between computed tomography-derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago-gastric cancer undergoing neoadjuvant treatment","authors":"Josh McGovern, Jenna Delaney, Matthew J. Forshaw, Gerard McCabe, Andrew B. Crumley, David McIntosh, Barry J. Laird, Paul G. Horgan, Donald C. McMillan, Stephen T. McSorley, Ross D. Dolan","doi":"10.1002/crt2.57","DOIUrl":"10.1002/crt2.57","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Thought to capture the nutritional and functional reserve of the cancer patient, whether the computed tomography (CT)-derived sarcopenia score (CT-SS) has complimentary prognostic value to commonly utilized pre-treatment host assessments in patients with oesophago-gastric (OG) cancer is unknown. The aim of the present study was to examine if the CT-SS can stratify survival in OG cancer patients with good performance status [Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 0/1]. Furthermore, if the CT-SS had complimentary prognostic value to cardiopulmonary exercise testing (CPET) performance and systemic inflammation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with confirmed OG cancer and good performance status, who received neoadjuvant chemotherapy (NAC) with a view to surgical resection with curative intent, between 1 January 2010 and 31 December 2015, within NHS Greater Glasgow and Clyde (NHSGGC) and NHS Forth Valley (NHSFV), were identified from a prospectively maintained database. CT-SSs were grouped as 0/1/2. CPET variables recorded included VO<sub>2</sub> anaerobic threshold (AT) and peak. Systemic inflammatory response was determined by modified Glasgow prognostic score (mGPS) and neutrophil/lymphocyte ratio (NLR). Associations between categorical variables were examined using <i>χ</i><sup>2</sup> test and binary logistics regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 232 patients met the inclusion criteria. 75% (<i>n</i> = 174) of patients were male, 54% (<i>n</i> = 126) were 65 years or older, and 60% (<i>n</i> = 139) were overweight [body mass index (BMI) ≥25 kg/m<sup>2</sup>]; 33% (<i>n</i> = 77) of patients had CT-SS ≥ 1, 36% (<i>n</i> = 83) had a low VO<sub>2</sub> AT (≤11 ml/kg/min), and 57% (<i>n</i> = 132) had a low VO<sub>2</sub> peak (≤19 ml/kg/min). Of the 200 patients who had pre-NAC bloods facilitating calculation of the mGPS, 28% (<i>n</i> = 55) had mGPS ≥ 1. Of the 211 patients who had pre-NAC bloods facilitating calculation of NLR, 38% (<i>n</i> = 80) had an NLR ≥ 3; 82% (<i>n</i> = 190) and 53% (<i>n</i> = 122) were alive at 1 and 3 years post-NAC, respectively. On univariate analysis, CT-SS was significantly associated with sex (<i>P</i> < 0.05), histological cell type (<i>P</i> < 0.05), low VO<sub>2</sub> AT (<i>P</i> < 0.05), low VO<sub>2</sub> peak (<i>P</i> < 0.05), BMI (<i>P</i> < 0.05), mGPS (<i>P</i> < 0.05), and 3-year survival (<i>P</i> < 0.05). On multivariate analysis, tumour, node, and metastasis (TNM) stage (<i>P</i> < 0.05) and CT-SS (<i>P</i> < 0.05) remained significant","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"8 1","pages":"3-11"},"PeriodicalIF":0.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.57","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48251292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Malnutrition and nutritional screening in patients undergoing surgery in low and middle income countries: A systematic review 中低收入国家手术患者的营养不良和营养筛查：一项系统综述

JCSM clinical reports

Pub Date : 2022-10-25 DOI: 10.1002/crt2.55

Debra Jones, Stephen R. Knight, Jana Sremanakova, Marie Carmela M. Lapitan, Ahmad U. Qureshi, Thomas M. Drake, Stephen Tabiri, Dhruva Ghosh, Maria Thomas, Pamela A. Kingsley, Sudha Sundar, Mayaba Maimbo, Edwin Yenli, Catherine Shaw, Apple P. Valparaiso, Aneel Bhangu, Laura Magill, John Norrie, Tracey E. Roberts, Evropi Theodoratou, Thomas G. Weiser, Ewen M. Harrison, Sorrel T. Burden, NIHR Global Health Research Unit on Global Surgery

Background

There is a high incidence of preoperative undernutrition in hospitalised patients in low and middle-income countries (LMICs), leading to increased postoperative complications, length of hospital stay and early mortality. Review aims are to establish the prevalence of undernutrition and assess the use of validated nutritional screening tools in surgical patients across LMICs.

Methods

Protocol was PRISMA compliant and Prospero registered (CRD42019126765). Twelve international databases were searched from January 1990 to April 2021. Included studies were on nutritional screening in adults (≥16 years) undergoing surgery in LMICs. Two researchers screened studies and assessed quality. Prevalence of undernutrition was presented as a weighted percentage with confidence intervals (CI).

Results

Of the 4649 records identified, 16 studies (n = 4032) were eligible. Subjective global assessment (SGA) or patient generated (PG)-SGA were the tools used most widely. SGA and PG-SGA showed a high prevalence of undernutrition overall (0.61, 95% CI 0.50, 0.73), with a proportion identified with moderate undernutrition (0.44, 95% CI 0.31, 0.57) or severe undernutrition (0.32, 95% CI 0.19, 0.45).

Conclusions

Data show the prevalence of undernutrition in surgical patients as high as three in five patients within LMICs. Results indicate that the SGA is suitable for assessing this group of patients and that it may be the most appropriate tool to use due to its subjectivity and reliability. PG-SGA although similar includes more symptom assessment, which is important for nutritionally depleted cancer patients. The limited data on validity and reliability of nutritional screening tools in LMICs indicates further research is required.

中低收入国家（LMIC）住院患者术前营养不良的发生率很高，导致术后并发症、住院时间和早期死亡率增加。审查的目的是确定营养不良的患病率，并评估LMIC手术患者使用经验证的营养筛查工具的情况。

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引用次数: 0

Effects of nicotinamide adenine dinucleotide precursors on measures of physical performance and physical frailty: A systematic review 烟酰胺腺嘌呤二核苷酸前体对体能和体质虚弱测量的影响：系统综述

JCSM clinical reports

Pub Date : 2022-09-27 DOI: 10.1002/crt2.56

Fred J. Barker, Ashley Hart, Avan A. Sayer, Miles D. Witham

Background

Nicotinamide adenine dinucleotide (NAD) is a key molecule in muscle metabolism and energy production; skeletal muscle concentrations are low in older people with sarcopenia. Although preclinical data suggest beneficial effects of NAD precursor supplementation, the effects on skeletal muscle function and physical frailty in humans are unclear. This systematic review evaluated the effects of NAD precursor supplementation on measures of physical performance and physical frailty in humans.

Methods

We included randomized controlled trials assessing outcomes relevant to either physical performance or any of Fried's frailty phenotype domains: slowness, weakness, exhaustion, low physical activity and weight loss. All review stages were conducted independently by two separate authors. A systematic search strategy was used searching multiple databases (MEDLINE, EMBASE, CINAHL, CENTRAL, ISRCTN, ClinicalTrials.gov, NHS e-Library, and Google Scholar) to find appropriate trials. Risk of bias was assessed using the Cochrane Risk-of-Bias 2 tool. Results were grouped by intervention and phenotypic domain and were described through narrative synthesis. Sensitivity analyses were conducted for trials with a mean age >60 years and trials with low risk of bias.

Results

Twenty-six trial populations across 23 studies met inclusion criteria; size ranged from 2 to 77 participants. No trials assessed frailty as a composite outcome, though at least one Fried frailty domain was assessed in almost all included trials. A range of interventions were investigated; niacin (n = 8) and nicotinamide riboside (n = 7) were the most commonly assessed. Most trials examined short-term interventions of up to 6 months duration, with 13 out of 26 trials lasting 1 week or less. A total of 96 primary outcomes were assessed across trials, 10 of which were in favour of an NAD precursor whereas 1 was in favour of placebo; the remainder were not statistically significant in any clear direction. Methodological heterogeneity across trials precluded meta-analysis for any outcome. Trial populations were heterogeneous and only four trials enrolled participants with a mean age ≥60 years. Risk of bias analysis found unclear or high risk of bias in all but one trial. There was no clear pattern as to whether NAD precursors improved any measure of physical performance or any domain of the frailty phenotype; the majority of trials reported neutral findings for most outcomes.

Conc

烟酰胺腺嘌呤二核苷酸（NAD）是肌肉代谢和能量产生的关键分子；老年少肌症患者的骨骼肌浓度较低。尽管临床前数据表明补充NAD前体具有有益效果，但对人类骨骼肌功能和身体虚弱的影响尚不清楚。这项系统综述评估了补充NAD前体对人类身体表现和身体虚弱的影响。

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引用次数: 0

The combination of computed tomography-derived muscle mass and muscle density and relationship with clinicopathological characteristics and survival in patients undergoing potentially curative surgery for colorectal cancer 计算机断层扫描获得的肌肉质量和肌肉密度的结合及其与结肠直肠癌手术患者的临床病理特征和生存的关系

JCSM clinical reports

Pub Date : 2022-06-27 DOI: 10.1002/crt2.54

Josh McGovern, Allan M. Golder, Ross D. Dolan, Campbell S.D. Roxburgh, Paul G. Horgan, Donald C. McMillan

Background

Sarcopenia has been defined as a loss of muscle mass and function. CT-derived muscle measurements, skeletal muscle index (SMI) and density (SMD), taken together may provide an objective measure of sarcopenia. The aim of the present study was to examine the relationship between CT-derived sarcopenia (low SMI and SMD), clinicopathological characteristics, systemic inflammation and survival in patients undergoing surgery for colorectal cancer.

Methods

Consecutive patients who underwent resections for colorectal cancer (TNM I–III) at our institution, between April 2008 and 2018, were identified from a prospectively maintained database. CT-derived muscle mass (SMI) and density (SMD) measurements were combined to form the CT-Sarcopenia score (CT-SS). Thresholds for low SMI and SMD reported by Martin and co-workers and Caan/Xiao and co-workers were combined to form two iterations of the CT-SS. Patients were categorized as normal/high SMI (irrespective of SMD) = 0, low SMI and normal/high SMD = 1 and low SMI and low SMD = 2. The Pearson Chi square test was used to examine the associations between categorical variables and the Chi square test for linear trend was used for ordered variables with multiple categories. Survival data were analysed using univariate and multivariate Cox regression.

Results

One thousand and two patients met the study inclusion criteria. Fifty-five per cent (n = 554) of patients were male and 66% (n = 657) were aged 65 years or older. Twenty-four per cent (n = 240) of patients had TNM stage I disease, 40% (n = 404) stage II and 36% (n = 358) stage III. Eighteen per cent (n = 174) of patients were at risk of malnutrition. Forty-eight per cent (n = 479) of patients had an NLR ≥ 3 and 27% (n = 271) had an mGPS ≥ 1. Similar numbers of patients defined as CT-SS 0, 1 and 2 irrespective of thresholds applied (49%/12%/39% vs. 43%/19%/38%, respectively). Eight hundred and thirty four (n = 834) patients who underwent surgical resection for non-metastatic colorectal cancer with curative intent were alive at 3 years. On univariate analysis, both the CT-SS (Martin/Martin) and CT-SS (Caan/Xaio) were significantly associated with age (P < 0.001 and P < 0.001, respectively), ASA (P < 0.01 and P < 0.001, respectively), MUST (P < 0.001 and P < 0.005, respectively), mGPS (P < 0.001 and P < 0.001, respectively), NLR (P < 0.001 and P < 0.001, respectively), and overall survival (

Sarcopenia被定义为肌肉质量和功能的丧失。CT衍生的肌肉测量、骨骼肌指数（SMI）和密度（SMD）结合起来可以提供肌肉减少症的客观测量。本研究的目的是研究癌症大肠癌手术患者CT引起的少肌症（低SMI和SMD）、临床病理特征、全身炎症和生存率之间的关系。

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引用次数: 5

Body composition assessment by artificial intelligence from routine computed tomography scans in colorectal cancer: Introducing BodySegAI 用人工智能评估结直肠癌常规计算机断层扫描的身体成分:BodySegAI介绍

JCSM clinical reports

Pub Date : 2022-06-27 DOI: 10.1002/crt2.53

Dena Helene Alavi, Tomas Sakinis, Hege Berg Henriksen, Benedicte Beichmann, Ann-Monica Fløtten, Rune Blomhoff, Peter Mæhre Lauritzen

Background

Body composition is of clinical importance in colorectal cancer patients, but is rarely assessed because of time-consuming manual segmentation. We developed and tested BodySegAI, a deep learning-based software for automated body composition quantification from routinely acquired computed tomography (CT) scans.

Methods

A two-dimensional U-Net convolutional network was trained on 2989 abdominal CT slices from L2 to S1 to segment skeletal muscle (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular and intramuscular adipose tissue (IMAT). Human ground truth was established by combining segmentations from three human readers. BodySegAI was tested using 154 slices against the human ground truth and compared with a software named AutoMATiCA.

Results

Median Dice scores for BodySegAI against human ground truth were 0.969, 0.814, 0.986, and 0.990 for SM, IMAT, VAT, and SAT, respectively. The mean differences per slice for SM were −0.09 cm³, IMAT: −0.17 cm³, VAT: −0.12 cm³, and SAT: 0.67 cm³. Median absolute errors for SM, IMAT, VAT, and SAT were 1.35, 10.54, 0.91, and 1.07%, respectively. When analysing different anatomical levels separately, L3 and S1 demonstrated the overall highest and lowest Dice scores, respectively. On average, BodySegAI segmented 148 times faster than human readers (4.9 vs. 726.5 seconds, P < 0.001). Also, BodySegAI presented higher Dice scores for SM, IMAT, SAT, and VAT than AutoMATiCA (slices = 154).

Conclusions

BodySegAI rapidly generates excellent segmentation of SM, VAT, and SAT and good segmentation of IMAT in L2 to S1 among colorectal cancer patients and may replace semi-manual segmentation.

身体成分在结直肠癌患者中具有重要的临床意义，但由于耗时的人工分割，很少进行评估。我们开发并测试了BodySegAI，这是一款基于深度学习的软件，用于从常规获取的计算机断层扫描(CT)中自动量化身体成分。

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引用次数: 2

Are older adults with hip fractures a specific risk group for vitamin B12 deficiency? 髋部骨折的老年人是维生素B12缺乏症的特定风险群体吗?

JCSM clinical reports

Pub Date : 2022-04-01 DOI: 10.1002/crt2.48

José Luis Dinamarca-Montecinos, Alejandra Vásquez-Leiva

Background

Hip fractures (HF) are a high-impact geriatric syndrome. Vitamin B12 deficiency is an HF risk factor. There are few studies on prevalence of B12 deficiency in older adults with HF. The objectives are as follows: in older adults with HF, to describe/characterize plasma levels of vitamin B12 (PL-B12); to verify presence/absence of a subgroup with borderline, near-deficient PLB12; to describe HF incidence; and to analyse relationships between PL-B12 and studied variables.

Methods

Cross-sectional, observational study, analytical component. Complete Collection sample (01.08.2016–31.08.2018). Variables: PL-B12, age, sex, HF location, time of year, in-hospital stay length. Medians/percentiles, non-parametric tests. PL-B12 cut-off points according to the WHO, proposing new cut-off points to capture borderline values.

Results

A total of 580 subjects. HF incidence = 264/100 000 ≥ 65 years, 79% female, 72% extracapsular HF. Medians: age = 83 years; PL-B12 = 349 pg/cc; hospitalization = 13 days. Significantly lower PL-B12 in males (P = 0.023) and extracapsular fractures (P = 0.013). No significant differences between age groups, length of hospitalization, and season of the year. Thirty-five per cent B12 deficiency (16% deficiency and 19% mild deficiency). By increasing cut-off point for deficiency to 400 pg/cc, prevalence increased to 58%.

Conclusions

High prevalence of vitamin B12 deficiency among older adults with HF, significantly higher in men and extracapsular HF. Twenty-four per cent normal PL-B12 according to WHO criteria, but with borderline, near-deficient levels, at the time of HF. In older adults with HF, we recommend measuring PL-B12 and raising the cut-off level required to diagnose deficiency. We consider that older adults with HF are a specific risk group for vitamin B12 deficiency.

髋部骨折（HF）是一种影响很大的老年综合征。维生素B12缺乏是HF的危险因素。很少有关于老年HF患者B12缺乏患病率的研究。目标如下：在老年HF患者中，描述/表征血浆维生素B12（PL‐B12）水平；验证是否存在具有临界、近缺陷PLB12的亚组；描述HF发生率；并分析PL‐B12与研究变量之间的关系。

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