Use of 3D-CT-derived psoas major muscle volume in defining sarcopenia in colorectal cancer.

BACKGROUND: Sarcopenia is characterized by reduced skeletal muscle volume and is a condition that is prevalent among elderly patients and associated with poor prognosis as a comorbidity in malignancies. Given the aging population over 80 years old in Japan, an understanding of malignancies, including colorectal cancer (CRC), complicated by sarcopenia is increasingly important. Therefore, the focus of this study is on a novel and practical diagnostic approach of assessment of psoas major muscle volume (PV) using 3-dimensional computed tomography (3D-CT) in diagnosis of sarcopenia in patients with CRC. METHODS: The subjects were 150 patients aged ≥ 80 years with CRC who underwent primary tumor resection at Juntendo University Hospital between 2004 and 2017. 3D-CT measurement of PV and conventional CT measurement of the psoas major muscle cross-sectional area (PA) were used to identify sarcopenia (group S) and non-sarcopenia (group nS) cases. Clinicopathological characteristics, operative results, postoperative complications, and prognosis were compared between these groups. RESULTS: The S:nS ratios were 15:135 for the PV method and 52:98 for the PA method. There was a strong positive correlation (r = 0.66, p < 0.01) between PVI (psoas major muscle volume index) and PAI (psoas major muscle cross-sectional area index), which were calculated by dividing PV or PA by the square of height. Surgical results and postoperative complications did not differ significantly in the S and nS groups defined using each method. Overall survival was worse in group S compared to group nS identified by PV (p < 0.01), but not significantly different in groups S and nS identified by PA (p = 0.77). A Cox proportional hazards model for OS identified group S by PV as an independent predictor of a poor prognosis (p < 0.05), whereas group S by PA was not a predictor of prognosis (p = 0.60). CONCLUSIONS: The PV method for identifying sarcopenia in elderly patients with CRC is more practical and sensitive for prediction of a poor prognosis compared to the conventional method.

Risk Factors Associated with Poor Computer-based Testing (CBT) Scores - Comparing Students' Performance "Without/With COVID-19" and Backgrounds.

Objective: The present study compared students' CBT scores during the 2-year period before ("without COVID-19") and 2-year period during ("with COVID-19") the COVID-19 pandemic, and analyzed factors associated with poor results. Materials: A total of 530 students (368 males and 162 females), who had taken CBT within the period between 2018 and 2021. Methods: Analysis was performed based on the questionnaire results, and the students' performance was compared between "without/with COVID-19" to identify the causes of poor CBT scores. Results: The overall mean IRT score was 515.5±85.4. The without and with COVID-19 groups' scores were 495.7±85.9 and 534.4±80.8, respectively (p<0.01). Among all students, 43 (8.1%) had IRT scores lower than 400 as poor CBT scores; 27 (10.4%) without and 16 (5.9%) with COVID-19, revealing a decrease in the latter. The multivariate analysis of the risk of students having poor CBT scores showed that students with poor performance during the third year (odds ratio:7.02), starting preparation for CBT late (2.19), and not taking any practice examination (4.58) are more likely to have poor CBT results. Conclusions: Due to the COVID-19 pandemic, students spent more time on online home study, and this may have consequently improved their CBT scores. Such learning performance is desirable for medical students, but they have lost the opportunity to gain valuable experiences that they could have acquired through extracurricular activities, such as club activities. In this respect, we cannot simply be pleased by the improvement in students' CBT scores.