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Sarcopenic obesity in patients awaiting liver transplant: Unique challenges for nutritional recommendations

World Journal of Transplantation 2024年第2期14卷 40-47页

作者： Darya M Herscovici Katherine M Cooper Alessandro Colletta Michelle Rightmyer alexandra shingina Lauren D Feld Department of Medicine UMass Chan Medical SchoolWorcesterMA 01655United States Division of Transplant Nutrition UMass Chan Medical SchoolWorcesterMA 01655United States Department of Medicine Vanderbilt University Medical CenterNashvilleTN 37215United States Division of Gastroenterology UMass Chan Medical SchoolWorcesterMA 01655United States

Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period.Nutrition recommendations for individuals with sarcopenia differ from recommendations for patients with obesity or sarcopenic obesity.While these nutrition guidelines have been established in non-cirrhotic patients,established guidelines for liver transplant candidates with sarcopenic obesity are lacking.In this paper,we review existing literature on sarcopenic obesity in patients with chronic liver disease and address opportunities to improve nutritional counseling in patients awaiting liver transplantation.

关键词： Nutrition Sarcopenia Sarcopenic obesity Liver transplant Cirrhosis Chronic liver disease Body composition Myostatin

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Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy:Canadian tertiary center experience

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World Journal of Gastrointestinal Endoscopy 2016年第20期8卷 770-776页

作者： alexandra shingina George Ou Oliver Takach Sigrid Svarta Ricky Kwok Jessica Tong Kieran Donaldson Eric Lam Robert Enns Department of Gastroenterology Faculty of MedicineUniversity of TorontoToronto General Hospital Department of Gastroenterology Faculty of MedicineUniversity of British Columbia Division of Gastroenterology Saint Paul Hospital

AIM To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy.METHODS A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St.Paul's Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives.Potential predictor variables including age,gender,endoscopy indication,high sedation requirements during previous endoscopies,difficulty of the procedure,bowel preparation quality,interventions,findings as well as current use of benzodiazepines,opioids and alcohol were analyzed.The outcome of study was the use ofhigh dose of sedation agents for the procedure.In particular,the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 mg.RESULTS Analysis of 5282 patients(mean age 57 ± 12,49% female) was performed.Most common indication for the procedure was screening colonoscopy(57%).Almost half of our patients received doses exceeding Fentanyl 50 mcg and Midazolam 3 mg.Logistic regression models identified the following variables associated with high sedation:Younger age(OR=0.95 95%CI:0.94-0.95;P < 0.0001);abdominal pain(OR=1.45,95%CI:1.08-1.96);P=0.01) and Inflammatory Bowel Disease(OR=1.45,95%CI:1.04-2.03;P=0.02) as indications for the procedure;difficult procedure as defined by gastroenterologist(OR=1.73,95%CI:1.48-2.03;P < 0.0001);past history of abdominal surgery(OR=1.33,95%CI:1.17-1.52;P <0.0001) and previous colonoscopy(OR=1.39,95%CI:1.21-1.60;P=0.0001) and alcohol use(OR=1.26,95%CI:1.03-1.54;P=0.02).Age and gender adjusted analysis yielded inflammatory bowel disease as an indication(OR=3.17,95%CI:1.58-6.37;P=0.002);difficult procedure as defined by an endoscopist(OR=5.13 95%CI:2.97-8.85;P=0.0001) and current use of opioids,benzodiazepines or antidepressants(OR=2.88,95%CI:1.74-4.77;P=0.001) having the highest predictive value of high sedation requirements.Our prediction model using the following p

关键词： Colonoscopy Sedation Sedation tolerance Fentanyl Midazolam Predictive model

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