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Aims: Tirzepatide is a first‐in‐class combination glucose‐dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon‐like peptide 1 receptor agonist (GLP1‐RA) approved for treatment of adults with type 2 diabetes mellitus (T2DM) and chronic weight management. The aim of this analysis was to assess the real‐world efficacy of tirzepatide in patients with T2DM. Methods: This retrospective observational study evaluated patients with T2DM from a large urban academic medical centre who received at least 3 months of continuous tirzepatide treatment. The primary outcome was change in A1C from following tirzepatide treatment. Secondary outcomes included change in body weight and body mass index (BMI) after tirzepatide was initiated. Results: A total of 1896 patient charts were reviewed, and 612 patients were evaluated for the primary outcome. Over a median time period of 10.4 months, treatment with tirzepatide resulted in a mean A1C reduction of 1.02 ± 1.48% (p < 0.001). A total of 570 patients were evaluated for the secondary outcomes. Tirzepatide was associated with a mean reduction in body weight of 7.3 ± 9.3 kg (p < 0.001) and a mean reduction in BMI of 2.5 kg/m2. Greater A1C lowering and weight loss was observed in patients without prior GLP1‐RA treatment compared to those switched to tirzepatide from GLP1‐RA. Conclusions: In a real‐world population of US patients with T2DM, tirzepatide was associated with clinically and statistically significant reductions in A1C and body weight. Greater reductions in both A1C and body weight were observed among patients who were GLP1‐RA naïve compared to patients switched from GLP1‐RA to tirzepatide. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of rodents with the AT1 blocker (ARB) telmisartan (TEL) has an anti-adipose effect. Among other mechanisms, we also have attributed the anti-adipose action to diet-independent alterations in gut microbiota. Thus, we aimed here to confirm this mechanism by using the fecal microbiota transfer (FMT) approach. Methods: Seven weeks after initiating a high-fat diet (HFD), C57BL/6N mice received fecal microbiota for 8 weeks from donor mice by oral gavage, continuing HFD feeding. Stool samples came from mice that were treated with TEL (8 mg/kg/d by gavage, 12 weeks), thus remaining lean despite HFD feeding (BL/6>fTEL), while controls received feces samples from vehicle/HFD-treated obese mice (BL/6>fVEH). Microbiota of the stool samples from these acceptor mice was analyzed by 16S rRNA gene amplicon sequencing. Results: Weight gain was lower in BL6>fTEL than in BL6>fVEH mice after 3 but not 8 weeks. Energy homeostasis, insulin sensitivity, and body composition did not differ between the two groups. β-diversity indicated group differences (F = 2.27, p = 0.005). Although the Firmicutes/Bacteroides ratio did not differ, abundances of distinct phyla, families, and genera varied. Among others, Ruminococcaceae and Desulfovibrionaceae, Desulfovibrionia uncl., and Lachnospiraceae uncl. were lower in BL/6>fTEL than in BL/6>fVEH mice. Moreover, the correlation between body weight and Lachnospiraceae, Desulfovibrionaceae, Desulfovibrionia uncl., or Desulfovibrio was positive in BL/6>fVEH and negative in BL/6>fTEL mice. Discussion: As FMT from TEL-pretreated mice influences the microbiota in acceptor mice with slight weight-reducing effects, we confirm the relevance of TEL-related microbiota changes for weight reduction, most likely independent of the transferred stool-residual TEL effect on the host metabolism. [ABSTRACT FROM AUTHOR]

Lowering passenger vehicle weight is a major contributor to improving fuel consumption and reducing greenhouse gas emissions. One fundamental method to achieving lighter cars is to replace heavy materials with lighter ones while still ensuring the required strength, durability, and ride comfort. Currently, there is increasing interest in hybrid structures obtained through adhesive bonding of high-performance fiber-reinforced polymers (FRPs) to high-strength steel sheets. The high weight reduction potential of steel/FRP hybrid structures is obtained by the thickness reduction of the steel sheet with the use of a lightweight FRP. The result is a lighter structure, but it is challenging to retain the stiffness and load-carrying capacity of an unreduced-thickness steel sheet. This work investigates the bending properties of a non-reinforced DP780 steel sheet that has a thickness of 1.45 mm (S1.45) and a hybrid structure (S1.15/ACFRP), and its mechanical properties are examined. The proposed hybrid structure is composed of a DP780 steel sheet with a thickness of 1.15 mm (S1.15) and a hybrid composite (ACFRP) made from two plies of woven hybrid fabric of aramid and carbon fibers and an epoxy resin matrix. The hybridization effect of S1.15 with ACFRP is investigated, and the results are compared with those available in the literature. S1.15/ACFRP is only 5.71% heavier than S1.15, but its bending properties, including bending stiffness, maximum bending load capacity, and absorbed energy, are higher by 29.7, 49.8, and 41.2%, respectively. The results show that debonding at the interface between S1.15 and ACFRP is the primary mode of fracture in S1.15/ACFRP. Importantly, S1.15 is permanently deformed because it reaches its peak plastic strain. It is found that the reinforcement layers of ACFRP remain undamaged during the entire loading process. In the case of S1.45, typical ductile behavior and a two-stage bending response are observed. S1.15/ACFRP and S1.45 are also compared in terms of their weight and bending properties. It is observed that S1.15/ACFRP is 16.47% lighter than S1.45. However, the bending stiffness, maximum bending load capacity, and absorbed energy of S1.15/ACFRP remain 34.4, 11.5, and 21.1% lower compared to S1.45, respectively. Therefore, several modifications to the hybrid structure are suggested to improve its mechanical properties. The results of this study provide valuable conclusions and useful data to continue further research on the application of S1.15/ACFRP in the design of lightweight and durable thin-walled structures. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from insulin resistance and pancreatic beta-cell dysfunction. With the global rise of obesity and sedentary lifestyles, T2DM has become a major public health concern, requiring a combination of pharmacological and lifestyle interventions for effective management. This systematic review explores the roles of exercise, diet, and weight reduction in improving glycemic control, enhancing insulin sensitivity, and reducing the need for pharmacological interventions. By synthesizing evidence from various clinical trials and cohort studies, this review highlights the critical importance of lifestyle modifications in reducing the burden of T2DM and prevent ing associated complications. The findings underscore the synergistic benefits of combining exercise, diet, and weight reduction strategies in managing T2DM, offering valuable insights for clinical practice and patient care. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the short-term effects of mini-gastric bypass (MGB) or one-anastomosis gastric bypass (OAGB) procedures on weight loss in individuals with obesity. Methods: This retrospective study was conducted in Medicano Hospital, Erbil, Iraq, from January 2019 to May 2020. Preoperative body mass index (BMI), age, height and preoperative weight were recorded as baseline measures. Weight-related changes were evaluated during a follow-up phase of 48 weeks. Results: A total of 104 patients with obesity underwent MGB or OAGB surgery. The mean baseline parameters of the subjects before surgery included 1.64 m for height, 122.9 kg for weight and 45.6 kg/m2 for BMI. During the 48-week follow-up period, there was a substantial reduction in mean weight, which dropped from 122.9 kg at baseline to 75.5 kg at week 48. The weight change (in percentage) gradually increased from -11.8% at week 12 to -37.9% at week 48, without statistically significant association with demographic factors or chronic diseases. From week 12 to week 48, the percentage of excess weight loss (%EWL) increased substantially from 26.8% to 86.1%. The results of the subgroup analysis indicated that the %EWL was considerably higher among those aged 30 or older at week 36 and singles at week 48. Conclusion: This study's results illustrate the efficacy of MGB or OAGB procedures in significantly reducing weight in the short term. The %EWL increased with the follow-up time and was significantly associated with age and marital status. [ABSTRACT FROM AUTHOR]

Background & objectives: Obesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide's impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure. Methods: A retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control). Results: Among 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions. Conclusions: Semaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction. [ABSTRACT FROM AUTHOR]

Background: fasting-based strategies (FBS) and continuous caloric restriction (CCR) are popular methods for weight loss and improving metabolic health. FBS alternates between eating and fasting periods, while CCR reduces daily calorie intake consistently. Both aim to create a calorie deficit, but it is still uncertain as to which is more effective for short- and long-term weight and metabolic outcomes. Objectives: this systematic review and meta-analysis aimed to compare the effectiveness of FBS and CCR on these parameters in obese adults. Methods: after screening 342 articles, 10 randomized controlled trials (RCTs) with 623 participants were included. Results: both interventions led to weight loss, with a reduction of 5.5 to 6.5 kg observed at the six-month mark. However, the results showed that FBS led to slightly greater short-term reductions in body weight (−0.94 kg, p = 0.004) and fat mass (−1.08 kg, p = 0.0001) compared to CCR, although these differences are not clinically significant. Both interventions had similar effects on lean mass, waist and hip circumference, blood pressure, lipid profiles, and glucose metabolism. However, FBS improved insulin sensitivity, with significant reductions in fasting insulin (−7.46 pmol/L, p = 0.02) and HOMA-IR (−0.14, p = 0.02). Conclusions: despite these short-term benefits, FBS did not show superior long-term outcomes compared to CCR. Both strategies are effective for weight management, but more research is needed to explore the long-term clinical relevance of FBS in obese populations. [ABSTRACT FROM AUTHOR]

Objectives: Obesity is a chronic, multifaceted, leading health problem causing numerous non-communicable diseases with a huge burden on the global healthcare system and economies. Worldwide, multiple interventions have been familiarized for weight reduction strategies, however, in recent years, mobile health applications (mHealth apps) for reshaping weight reduction have been introduced. Therefore, this study aimed to investigate the role of mobile health applications in reducing weight among users in Riyadh, Saudi Arabia. Methods: This questionnaire-based cross-sectional study was conducted in the Department of Family and Community Medicine, and Medical Education, College of Medicine, King Saud University, Riyadh from May 2019 to December 2022. A total of 502 participants, 332 (66.1%) females and 170 (33.9%) males aged 18-50 years, using smartphones, residing in Riyadh, Saudi Arabia were recruited. The questionnaire was distributed via social media platforms including WhatsApp, and emails and information were recorded. Results: Among 502 participants, 221 (44.02%) were using mobile health applications and 281 (55.98%) did not use mobile health applications. The results revealed that the participants who have been using mHealth apps for the last six months had significantly decreased body weight compared to those who did not use the mHealth apps (p=0.001). Conclusions: The study participants using mobile health applications (mHealth apps) had significantly reduced their body weight and felt healthier. The mHealth apps provide health-related information regularly to individuals to track their weight, monitor diet, and physical activity, and information about their overall health. [ABSTRACT FROM AUTHOR]

Background The introduction of injectable glucagon-like peptide-1 (GLP-1) receptor agonists such as Ozempic (Novo Nordisk, Plainsboro, NJ) and Wegovy (Novo Nordisk Inc.) has transformed weight loss in plastic surgery patients, often leading to excess skin and soft tissue amenable to body contouring procedures. Objectives The aim of this study was to examine the relationship between injectable GLP-1 receptor agonist use and the growing need for body contouring surgeries, focusing on trunk and extremity procedures. Methods A retrospective analysis of the PearlDiver database (PearlDiver, Inc. Colorado Springs, CO) was conducted, examining prescription data for Ozempic, Wegovy, and liraglutide, and correlating these with body contouring procedures across 30 US states from 2011 to 2022. Multimodal statistics were used to compare surgery rates and assess dosage and time interval patterns among GLP-1 receptor agonist users and nonusers. Results Significant correlations between GLP-1 receptor agonist use (881 Ozempic, 59 Wegovy, and 4655 liraglutide users) and increased body contouring surgeries were found. Ozempic showed weak correlations with brachioplasty (r = 0.23) and panniculectomy (r = 0.21), and Wegovy with breast procedures (r = 0.28), while liraglutide showed consistent correlations across surgeries. Time to surgery varied from 87 days (Wegovy) to 1018 days (liraglutide), with higher surgery rates among users (P <.01) and dose-related differences, especially in Ozempic and Wegovy users. Conclusions This study demonstrates a dose-dependent link between the use of GLP-1 receptor agonists and an increase in subsequent aesthetic body contouring surgeries, highlighting the need for surgeons to adapt to the merging of medicinal body transformation and aesthetic plastic surgery. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background: Living donor liver transplantation using hepatic steatosis-improved grafts mitigates donor shortage. Herein, we aimed to evaluate the safety and feasibility of right-lobe adult-to-adult living donor liver transplantation using grafts improved through donor weight loss. Methods: In this retrospective study conducted in a single institution in the Republic of Korea, we reviewed the medical records of living liver donors who lost ≥ 10% of their body weight to improve steatosis before right lobe donation between January 2015 and December 2020. Overall, 1040 right-lobe donors were included, with 150 and 890 donors in the weight loss and control (non-steatosis) groups, respectively. Results: We performed 1:1 individual matching using the greedy matching method, by which 124 patients were included in each group. The median period from the date of the first visit to donation was 113 (interquartile range: 78–184) days in the weight loss group. As body weight changed from 82.8 ± 13.7 kg to 70.8 ± 11.8 kg (p < 0.0001), body mass index also improved from 27.8 ± 3.9 kg/m2 to 23.8 ± 3.1 kg/m2 (p < 0.0001). No significant between-group differences existed in the postoperative laboratory data for living donors and recipients. The incidence of postoperative complications in donors was comparable between the groups (control group, 9.7%; weight loss group, 13.7%; p = 0.3185). The graft and recipient survival rates were comparable between the groups (p = 1.000). Conclusion: Weight loss through diet and exercise significantly could improve hepatic steatosis in living donor candidates for liver transplantation, with the surgical outcomes in recipients and donors being equivalent to those in recipients and non-steatotic donors. [ABSTRACT FROM AUTHOR]

A concrete slab is one of the chief structural members in buildings, considered the most prominent member consuming concrete. Structural engineers are challenged to work on the new trend introduced using different slabs. One-way ribbed slabs are commonly used in construction due to their efficiency in spanning long distances while maintaining a low overall depth and giving the least possible number of columns. The main limitation of slab design in the construction of a reinforced concrete structure is the span between columns; a greater span between columns necessitates more supported beams or increased slab thickness; these requirements lead to an increase in the structure weight due to other concrete and steel which make the structure more costly. On the other hand, any increase in the structure’s self-weight limits the horizontal slab’s span, increases the structure’s stress, and raises the inertia forces that must be resisted. Lightweight aggregate concrete has been effectively utilized for structural applications for a long time. The density of lightweight concrete (LWC) is sometimes more essential than its strength in structural applications. The dead load is reduced for structural design and foundations when the density is lower for the same strength level. Reinforced concrete ribbed slabs have become increasingly popular in industry construction as an alternative to solid slabs in building structures. The incorporation of steel fibers facilitates flexural softening, which takes longer than sudden brittle failure, indicating its ability to increase energy absorption and improve crack behavior. Designing structures requires materials with higher strength-to-weight ratios. Ribs and LWCs are two leading sustainable assets. The world is moving toward sustainability by reducing the amount of concrete used and the overall weight of the unit. Studies have shown that the drop in compressive strength was about 4.85–65.55%. The structural performance of lightweight fiber-reinforced concrete slabs is influenced by the concrete mix ratio, fiber type and content, reinforcement detail, and rib geometry. The study provides valuable insights into the properties and performance of key effects on the structural behavior of fiber-reinforced LWC-ribbed slabs. It provides recommendations for future research and advancement of sustainable building methods.

Abstract Background & objectives Obesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide’s impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure. Methods A retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control). Results Among 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p

ABSTRACT Aims/Introduction To compare the percent weight change and metabolic outcomes among diabetic participants with obesity on intermittent fasting (IF) 16:8, IF 14:10, or normal controlled diets. Materials and Methods A randomized controlled trial was conducted to randomize participants into three groups. Each group followed IF 16:8, IF 14:10, according to the protocol 3 days/week for 3 months or a control group. Results A total of 99 participants completed the study. The percentage weight change from baseline was −4.02% (95% CI, −4.40 to −3.64) in IF 16:8, −3.15% (95% CI, −3.41 to −2.89) in IF 14:10, and −0.55% (95% CI, −1.05 to −0.05) in the control group. The percentage weight loss from baseline was significantly more in both IF groups (P

Introduction: According to the data from the World Health Organization, polycystic ovarian syndrome (PCOS) may affect as many as 116 million women worldwide (3.4%). The main objective of the study was to determine the effectiveness of treatment on the body mass index (BMI) of overweight PCOS patients. Materials and Methods: This prospective, observational study was conducted from December 2022 to February 2023 and 252 PCOS patients were included in the study. Results: A detailed analysis of the risk factors in the study population concluded that a family history of the PCOS, lack of exercise, regular consumption of fast food, broiler chicken, high sugar, soft drinks, and packed foods had contributed to the lifestyle syndrome, where each showed a P = 0.0001. Conclusion: The comparative analysis of the treatment effectiveness in terms of BMI among three treatment strategies—(1) medication, (2) lifestyle, and (3) medication along with lifestyle established the conclusion that the treatment with lifestyle alone and lifestyle along with medication together showed similar extend in weight reduction in overweight PCOS patients after performing post hoc statistical analysis. However, a greater proportion of people who experienced weight reduction falls under lifestyle + exercise.

OBJECTIVES This study is aimed to investigate the effect of short term weight control by High Intensity Endurance Training(HIET) on body composition, muscle mass and functions male college in male wrestling athletes. METHODS Fifteen male college wrestlers with at least 5 years of career were participated and measured body composition, muscle mass and functions after weight reduction through 6 days of HIET intervention. RESULTS First, WRG (weight reduction group, n=7) showed significant changes after HIET -induced weight reduction in work fatigue at 60 degree/sec during flexion in elbow joints, it showed not significant changes after training-induced weight reduction in peak torque, avg. power, work fatigue at 60 degree/sec and 180 degree/sec during extension and flexion in elbow and knee joints. Second, CG (control group, n=8) showed no significant changes after training-induced weight reduction in peak torque, avg. power, work fatigue at 60 degree/sec and 180 degree/sec during extension and flexion in elbow and knee joints. CONCLUSIONS Taken together, relatively short-term, or 6 days weight loss with HIET may not negatively affect muscle mass and function and may be accompanied by fat loss. Additionally, compared to other short-term weight loss methods, this method would be better not only for wrestling athletes but also the weight division athletes. However, it is important to note that weight loss can partially induce muscle fatigue, and athletes should be prepared for a possible decrease in muscular endurance, depending on their individual characteristics.

AbstractThe efficacy of probiotics, prebiotics, or synbiotics in children and adolescents with overweight or obesity remains uncertain. This systematic review evaluates their intervention effects through a network meta-analysis of randomized clinical trials (RCTs). Searches of 4 electronic databases until January 7, 2024, yielded 17 papers reporting on 15 RCTs involving 820 participants. Multiple-strain probiotics (MSP) showed significant efficacy in reducing BMI (Mean Difference (MD) −2.13 kg/m2, 95% credible interval (CrI) [−2.7, −1.57]), waist circumference (MD −1.34 cm, 95% CrI [−2.33, −0.35]), total cholesterol (MD −6.55 mg/dL, 95% CrI [−10.61, −2.45]), triglycerides (MD −3.71 mg/dL, 95% CrI [−5.76, −1.67]), leptin (MD −3.99 ng/mL, 95% CrI [−4.68, −3.3]), and hypersensitive C-reactive protein (Hs-CRP) (MD −1.21 mg/L, 95% CrI [−1.45, −0.97]). Synbiotics were effective in reducing BMI-z score (MD −0.07, 95% CrI [−0.10, −0.04]) and LDL-C (MD −1.54 mg/dL, 95% CrI [−1.98, −1.09]) but led to a slight increase in fasting glucose (MD 1.12 mg/dL, 95% CrI [0.75, 1.49]). Single-ingredient prebiotics and single-strain probiotics also had some beneficial effects on BMI and Hs-CRP, respectively. Moderate to low evidence suggests MSP may be a potential choice for improving BMI and reducing lipids, leptin, and Hs-CRP levels, implying that MSP could aid in managing pediatric obesity and related metabolic issues by modulating the gut microbiota. Although synbiotics show their favorable effects on body metrics and lipid control, their potential impact on blood glucose currently prevents them from being an alternative to MSP for treating pediatric obesity. Further large-scale, well-designed studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Microcellular injection molding (MuCell®) using supercritical fluid (SCF) as a foaming agent to achieve weight reduction has become popular in carbon emission reduction. In the typical MuCell® process, SCF N2 is commonly used. Although SCF CO2 exhibits high solubility and can achieve a high weight reduction, controlling the foaming is not easy, and its foaming cells are usually larger and less uniform, which limits its industrial application. Our previous studies have shown that gas counter pressure (GCP) can improve the foaming quality effectively. Here, we investigated whether or not the CO2 SCF foaming quality could be improved, and weight reduction was achieved for polycarbonate (PC) material. This is quite important for the electronics industry, in which most of the housing for devices is made of PC materials. MuCell® was subjected to molding experiments using the parameters of the SCF dosage, melt temperature, mold temperature, and injection speed. The results revealed that using CO2 gas for the PC material can reduce the size of microcellular cells to 40 µm and increase the cell densities to 3.97 × 106 cells/cm3. Using GCP significantly improved the microcellular injection-molded parts by reducing the cell size to 20.9 µm (a 45.41% improvement) and increasing the cell density to 8.04 × 106 cells/cm3 (a 102.48% improvement). However, implementing GCP may slightly decrease the target weight reduction. This study reveals that microcellular injection molding of PC parts using SCF CO2 can achieve high-quality foaming and reduce the weight by about 30%. [ABSTRACT FROM AUTHOR]

Summary: Adherence is key for achieving the optimal benefits from a weight loss intervention. Despite the number of studies on factors that promote adherence, their findings suggest inconsistent and fragmented evidence. The aim of this study was to review the existing factors of adherence to weight loss interventions and to find factors that facilitate the design of effective intervention programs. Six databases were searched for this umbrella review; after the screening process, 21 studies were included. A total of 47 factors were identified in six groups as relevant for adherence: (i) sociodemographic (n = 7), (ii) physical activity (n = 2), (iii) dietary (n = 8), (iv) behavioral (n = 4), (v) pharmacological (n = 3), and (vi) multi‐intervention (n = 23). In addition, a map of adherence factors was created. The main findings are that with respect to demographic factors, the development of personalized intervention strategies based on the characteristics of specific populations is encouraged. Moreover, self‐monitoring has been shown to be effective in behavioral, dietary, and multi‐interventions, while technology has shown potential in dietary, behavioral, and multi‐interventions. In addition, multi‐interventions are adherence‐promoting strategies, although more evidence is required on adherence to pharmacological interventions. Overall, the factor map can be controlled and modified by researchers and practitioners to improve adherence to weight loss interventions. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To compare the percent weight change and metabolic outcomes among diabetic participants with obesity on intermittent fasting (IF) 16:8, IF 14:10, or normal controlled diets. Materials and Methods: A randomized controlled trial was conducted to randomize participants into three groups. Each group followed IF 16:8, IF 14:10, according to the protocol 3 days/week for 3 months or a control group. Results: A total of 99 participants completed the study. The percentage weight change from baseline was −4.02% (95% CI, −4.40 to −3.64) in IF 16:8, −3.15% (95% CI, −3.41 to −2.89) in IF 14:10, and −0.55% (95% CI, −1.05 to −0.05) in the control group. The percentage weight loss from baseline was significantly more in both IF groups (P < 0.001, both) when compared with the control group. Weight loss was significantly more in the IF 16:8 group than in that of the IF 14:10 group (P < 0.001). Metabolic outcomes (decrease in FBS and HbA1C, and improvement in lipid profiles) were significantly improved from baseline in both IF groups in comparison with the control group. Conclusions: Either IF 16:8 or 14:10 had a benefit in the percentage weight change, glucose and lipid profiles in obese diabetic patients compared with the control group when consumed for 3 days a week for 3 months. [ABSTRACT FROM AUTHOR]

Introduction The War-Related Illness and Injury Study Center at the VA New Jersey Health Care System (WRIISC-VANJ) serves as one of the three tertiary referral centers for combat deployed Veterans of all eras with medically unexplained or difficult-to-diagnose conditions that may be related to deployment-related exposures. Many of the Veterans seen at the WRIISC experience chronic multisymptom illness (CMI), also known as Gulf War Illness (GWI). Given the complexity and interconnectedness of symptoms, Veterans with GWI are often unlikely to produce meaningful results when addressing single symptoms. Further, Veterans with GWI often have co-morbid cognitive and behavioral health conditions (e.g. TBI, PTSD, Depression), which further compromise their self-efficacy in following treatment recommendations. Thus, the WRIISC-NJ, in collaboration with Wellness Solutions Group, developed a virtual Functional Medicine-based Interdisciplinary and Integrative Intervention to improve the health of Veterans by assisting them in implementing lifestyle changes. Methods The 6-month telehealth program included functional medicine assessments, nutrition and adaptive exercise coaching, mindfulness meditation and yoga, guest health lectures, character strength coaching, and targeted nutritional supplements. Aspects of the program were tailored to the unique clinical needs of each Veteran. Participants completed baseline and 6 month follow-up assessments of physical and emotional symptoms and overall functioning. Follow-up scores were compared with baseline data. Results The program was well received by Veterans with attendance across all offered sessions ranging from 70 to 100%. Further, at the end of the clinical pilot program, improvements were demonstrated in physical and mental health symptoms, intentional weight loss/gain, functional movement, and sleep quality. Conclusions These preliminary results demonstrate the possibility of creating positive health outcomes across multiple health indicators in medically complex combat-deployed Veterans. Our early success and participant enthusiasm for this clinical pilot program also illustrate an opportunity to provide individualized, innovative solutions for the evaluation and treatment of Veterans with GWI. [ABSTRACT FROM AUTHOR]

Introduction The Weight Loss Readiness Test (WLRT) was developed to encourage consideration of factors influencing readiness to engage in weight loss. The WLRT is used clinically, most notably to assess motivation before initiating Navy weight management programs, yet little is known about its psychometric properties. Materials and Methods This study examined the reliability, convergent and predictive validity, and factor structure of the WLRT in a sample of active duty service members enrolling in a Navy-based weight management program (N  = 178, identified as female = 61%, mean age = 29.7 years, mean baseline body mass index = 33.1 kg/m2). All procedures were approved by the respective Institutional Review Boards and research committees. Results Exploratory factor analysis revealed a 5-factor structure explaining 52% of the variance that best fit the data with low to moderate correlations between factors: (1) Motivation, (2) Exercise-Related Confidence, (3) Non-Exercise Confidence, (4) Cues, and (5) Anticipated Satisfaction. Internal reliability of subscales was acceptable to good (α  = 0.755-0.903). Generally, convergent validity was found between the identified subscales and other measures of motivation, confidence, and disinhibited eating in expected directions. No relationships were found between the subscales and predictive validity outcomes (weight change, program attendance). Conclusions Results indicate adequate structural and convergent validity in the WLRT, but that weight loss readiness, as measured by the WLRT, does not provide predictive validity regarding weight loss or attendance outcomes in this sample. Nonetheless, this measure offers clinical utility in fostering thoughtful conversations about weight loss. The WLRT uniquely focuses on long-term maintenance of behavior change and differentiates between exercise-related and non-exercise confidence. Future studies should further probe the utility of this measure in other populations and the contexts in which it is being used. [ABSTRACT FROM AUTHOR]

The present research describes a design of an overhead crane using different materials with a prestress method, which corresponds to an external compression force with the aim of reducing the displacement of the beam due to the external load. This study concerns a bridge crane with a span length of 10 m, with a payload equal to 20,000 N and an estimated fatigue life of 50,000 cycles. Three different materials are studied: steel S355JR, aluminium alloy 6061-T6 and carbon fibre-reinforced polymer (CFRP). These materials are analysed with and without the contribution of the prestress method. In reference to the prestressed steel solution (which has a weight equal to 79% of the non-prestressed configuration), this study designed an aluminium solution that is 50.7% of the weight of the steel one and a composite solution that is always 20.3% of the steel configuration. In combining the methods, i.e., the materials and prestress, compared to the non-prestressed steel solution with a weight evaluated to be 758 kg, the weight of the aluminium configuration is equal to 40% of the traditional one, and the composite value is reduced to 16%, with a weight of 121 kg. [ABSTRACT FROM AUTHOR]

Geometric optimization for the optimal use of material and the weight reduction of gear is possible by removing material from the gear teeth. The current research focuses on the stress analysis of gear with radial holes drilled through the gear tooth to reduce the weight of standard gear. The radial holes from the tip of the gear tooth for different depths are introduced. A standard gear with holes is analyzed using ANSYS, and the magnitude of stresses near the root of the gears for similar loading and boundary conditions are studied. New efforts have been made to study the stress distribution by photoelastic technique to supplement FEA results and confirm the stress distribution of gear with and without radial holes. This process achieves a volume reduction of up to 6.1% compared to an AGMA standard spur gear without affecting much of the stress distribution. These holes may be helpful for adequate lubrication and cooling of gears by fluid circulation. [ABSTRACT FROM AUTHOR]

Introduction: The swallowable intragastric balloon (IGB) has recently emerged as a popular alternative for weight loss in Malaysia. It can reduce total body weight loss (TBWL) by 6–15%. We aim to observe positive weight loss up to a year after the swallowable IGB is implanted. Methods: A total of 486 consecutive patients with overweight or obesity who underwent swallowable IGB insertion were included in this prospective data collection. Results: Out of 486 patients, 404 patients (83%) had complete data at the end of 4 and 12 months. Patients included in the study had a starting mean body mass index of 35.3 ± 7.2 kg/m2 which decreased to 31.5 ± 5.7 kg/m2 (p < 0.0001) at the end of 4 months and further reduced to 30.3 ± 5.4 kg/m2 (p < 0.0001) at the end of 12 months. At 4 months, the overall average weight loss was 9.8 kg, meanwhile, at 12 months, the average weight loss increased to 12.9 kg. At 4 months, the average TBWL was 10.5%, while at the end of 1 year, the combined %TBWL increased to 13.7%. Conclusion: Most weight loss is typically observed within the first 4 months following the procedure. However, it is important to note that patients can continue to experience ongoing weight loss for up to 1 year. The swallowable IGB is a safe and effective option for patients seeking weight loss solutions. It offers numerous advantages, especially its non-invasive procedureless nature, which makes it more appealing to individuals considering this treatment. [ABSTRACT FROM AUTHOR]

Collision welding is a promising approach for joining conventional materials in identical or dissimilar combinations without heat-related strength loss, thereby opening up new lightweight potential. Widespread application of this technology is still limited by an insufficient state of knowledge with respect to the underlying joining mechanisms. This paper applies collision welding to a material combination of DC04 steel and EN AW 6016 aluminium alloy. Firstly, the welding process window for the combination is determined by varying the collision speed and the collision angle, the two main influencing variables in collision welding, using a special model test rig. The process window area with the highest shear tensile strength of the welded joint is then determined using shear tensile tests and SEM images of the weld zone. The SEM investigations reveal four distinct metallographic structures in the weld zones, the area fractions of which are determined and correlated with collision angle and shear tensile strength. [ABSTRACT FROM AUTHOR]

Topology optimization is a well known and sophisticated method for designing structures. Through a finite element analysis, this method optimizes the design and material distribution to obtain an ideal strength-to-weight ratio and improved strain-to-weight ratio. This study involves the development of a comprehensive model for a brake using the ANSYS Parametric Design Language. The purpose of the model is to accurately characterize the geometry of the disc or drum. The technique of a complex eigenvalue analysis is used to identify the presence of unstable modes occurring at distinct frequencies, indicating instability. A braking force of 17,492 kN was exerted at a rotational velocity of 55 rad/s for 10 s. The optimization process resulted in significant mass reduction while maintaining structural integrity. In the drum brake, the mass was reduced from 114.01 kg to 104.07 kg, while the disc brake's mass decreased from 68.81 kg to 56.68 kg. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life )HRQOL( is increasingly acknowledged as a significant endpoint in research on the effectiveness of bariatric surgery. Aim of the Study: Assessment of the role of pharmacist educational intervention & training in weight reduction, improvement of dietary practice, and enhancement of HRQOL after bariatric surgery. Patient and Method: A randomized comparative interventional study was conducted in Najaf Governorate, Iraq. The Intervention group included 58 patients who received standard care and training educational and support programs. The standard care group included 58 patients who received standard care after bariatric surgery. The required information included age, gender, practice recommended physical activity, cause and type of surgery. In addition to body mass index, dietary practices, and quality of life (assessed by MOOREHEAD-ARDEL score) were assessed at 3 and 6 months after surgery. Results: There reduction of the body mass index was larger in the intervention than the standard care group at 3 months and 6 months. The overall total mean MOOREHEAD-ARDEL score a significantly higher in the intervention than standard care group at 6 months, (P<0.001). The mean total scores of dietary practices was significantly higher in the intervention group at 6 months compared to the standard care group at 6 months (P-value<0.001). Conclusion: The pharmacist intervention leads to larger weight reduction, better dietary practice, and better quality of life at six months after surgery. [ABSTRACT FROM AUTHOR]

This study investigates the effects of a ketogenic low-carbohydrate high-fat (LCHF) diet on body composition in healthy, young, normal-weight women. With the increasing interest in ketogenic diets for their various health benefits, this research aims to understand their impact on body composition, focusing on women who are often underrepresented in such studies. Conducting a randomized controlled feeding trial with a crossover design, this study compares a ketogenic LCHF diet to a Swedish National Food Agency (NFA)-recommended control diet over four weeks. Seventeen healthy, young, normal-weight women adhered strictly to the provided diets, with ketosis confirmed through blood β-hydroxybutyrate concentrations. Dual-energy X-ray absorptiometry (DXA) was utilized for precise body composition measurements. To avoid bias, all statistical analyses were performed blind. The findings reveal that the ketogenic LCHF diet led to a significant reduction in both lean mass (−1.45 kg 95% CI: [−1.90;−1.00]; p < 0.001) and fat mass (−0.66 kg 95% CI: [−1.00;−0.32]; p < 0.001) compared to the control diet, despite similar energy intake and physical activity levels. This study concludes that while the ketogenic LCHF diet is effective for weight loss, it disproportionately reduces lean mass over fat mass, suggesting the need for concurrent strength training to mitigate muscle loss in women following this diet. [ABSTRACT FROM AUTHOR]

Weed control is one of the biggest challenges in agriculture, given the considerable variations in the shape, size, speed, and type of weed growth. Weeding robots present a promising solution, as they do not require human labor and can operate under various conditions. In this study, a first of its kind, we propose a multipurpose weeding robot that is designed to remove weed from under trees and on the soil surface. Mechanical weeding techniques were considered for the development of the desired robot. Initially, we developed the kinematics of the robot's arm, which has five degrees of freedom, to facilitate weeding under trees and along narrow paths. A rotating blade, capable of adjusting its height, was subsequently designed to effectively remove weeds from the ground. Given that weight is a critical factor in evaluating robots, this study aims to minimize the weight of the robot. To achieve this, we optimized the design of the robot's components while considering design constraints to minimize mass and load. To this end, we determined the dimensions, weights, and loads acting on the components of 60 existing weeding robots. Artificial neural network (ANN) models were then trained based on the dataset from these 60 specimens. The optimized dimensions and masses were derived using a multi-objective genetic algorithm (MGA), and a finite element method (FEM) analysis of the resulting models was performed in Ansys R18.2. The results indicated that the maximum weight reduction for the suspension system and the increase in the safety factor for the wheels achieved were 24.6 % (from 1.75 kg to 1.32 kg) and 36.0 % (from 1.50 to 2.51), respectively. Furthermore, the maximum absolute difference between the ANN and FEM models was

IntroductionTreatment of rodents with the AT1 blocker (ARB) telmisartan (TEL) has an anti-adipose effect. Among other mechanisms, we also have attributed the anti-adipose action to diet-independent alterations in gut microbiota. Thus, we aimed here to confirm this mechanism by using the fecal microbiota transfer (FMT) approach.MethodsSeven weeks after initiating a high-fat diet (HFD), C57BL/6N mice received fecal microbiota for 8 weeks from donor mice by oral gavage, continuing HFD feeding. Stool samples came from mice that were treated with TEL (8 mg/kg/d by gavage, 12 weeks), thus remaining lean despite HFD feeding (BL/6>fTEL), while controls received feces samples from vehicle/HFD-treated obese mice (BL/6>fVEH). Microbiota of the stool samples from these acceptor mice was analyzed by 16S rRNA gene amplicon sequencing.ResultsWeight gain was lower in BL6>fTEL than in BL6>fVEH mice after 3 but not 8 weeks. Energy homeostasis, insulin sensitivity, and body composition did not differ between the two groups. β-diversity indicated group differences (F = 2.27, p = 0.005). Although the Firmicutes/Bacteroides ratio did not differ, abundances of distinct phyla, families, and genera varied. Among others, Ruminococcaceae and Desulfovibrionaceae, Desulfovibrionia uncl., and Lachnospiraceae uncl. were lower in BL/6>fTEL than in BL/6>fVEH mice. Moreover, the correlation between body weight and Lachnospiraceae, Desulfovibrionaceae, Desulfovibrionia uncl., or Desulfovibrio was positive in BL/6>fVEH and negative in BL/6>fTEL mice.DiscussionAs FMT from TEL-pretreated mice influences the microbiota in acceptor mice with slight weight-reducing effects, we confirm the relevance of TEL-related microbiota changes for weight reduction, most likely independent of the transferred stool-residual TEL effect on the host metabolism.

INTRODUCTION AND PURPOSE. While obesity and type 2 diabetes mellitus (T2DM) are defined (according to WHO) as civilization diseases we are still searching for the ideal tool to fight them. Recently, the Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved tirzepatide subcutaneous injections as monotherapy or combination therapy, with diet and physical exercise, to achieve better glycemic blood levels in patients with diabetes and weight reduction among obese and overweighted patients. This review evaluates the efficacy and safety of using tirzepatide based on GIP/GLP-1 agonists clinical trials. MATERAILS AND METHODS. Literature available in the PubMeb Database and Google Scholar Databases was reviewed using keywords. RESULTS AND CONCLUSIONS. Tirzepatide is a novel medicine which stands against type 2 diabetes and obesity pandemic. Combining two agonists of GIP and GLP-1 receptors helps decrease glycemic blood levels, HbA1c levels and reducing body weight in more efficient way than the GLP-1 receptor agonists. All these effects have also resulted in minimizing cardiovascular risk which is observed as an improvement in heart failure, hyperlipidemia and hypertension. Beyond that, the recent data present possible positive long-term effect of tirzepatide in such diseases as MAFLD (metabolic associated fatty liver disease) and OSA (obstructive sleep apnea). However, triagonists, achieving a concurrent activation of GLP-1, GIP, and glucagon receptors, normalize body weight in a manner superior to that of monoagonists and dual agonists. Therefore, the triple agonism or other than GIP/GLP-1 combinations could soon represent a new standard for pharmaceutical interventions. KEYWORDS: tirzepatide; obesity; type 2 diabetes; weight reduction; GIP; GLP-1.

Abstract This study aimed to investigate the association between obesity and herpes zoster (HZ) occurrence. This study used data covering 2 million people in Taiwan in 2000, which were obtained from the National Health Insurance Research Database. The cohort study observed aged 20–100 years with obesity from 2000 to 2017 (tracking to 2018). Obesity was indicated by the presence of two or more outpatient diagnoses or at least one admission record. And, obesity was categorized into non-morbid obesity and morbid obesity. Patients with HZ before the index date were excluded. The obesity cohort and control cohort were matched 1:1 according to age, sex, comorbidities, and index year. There were 18,855 patients in both the obesity and control cohorts. The obesity cohort [adjusted hazard ratio (aHR) 1.09] had a higher risk of HZ than the control cohort. Further analysis, the morbid obesity group (aHR 1.47), had a significantly higher risk of HZ than the non-morbid obesity group. Among the patients without any comorbidities, the patients with obesity had a significantly higher risk of developing HZ than the patients without obesity (aHR 1.18). Obese patients are at a higher risk of HZ development, especially in the patients with morbid obesity. Weight reduction is critical for preventing the onset of chronic diseases and decreasing the risk of HZ in patients with obesity.

Resumen: Introducción: El tratamiento de la obesidad infanto-juvenil, basado en modificaciones higiénico-dietéticas, ofrece habitualmente un éxito limitado y presenta una alta tasa de abandono del seguimiento por parte de los pacientes. La investigación de los predictores de éxito terapéutico (ET) y abandono precoz (AP) del seguimiento facilitaría una individualización terapéutica que podría determinar mejores resultados de la intervención. Pacientes y métodos: Estudio retrospectivo realizado en 1.300 pacientes con obesidad, atendidos en consultas de atención especializada durante un máximo de cinco años, de forma ambulatoria, recibiendo tratamiento conservador. Se estudiaron las características demográficas, familiares, comportamentales, psicosociales, antropométricas y metabólicas diferenciales de los pacientes que abandonaron el seguimiento antes del primer año de intervención y las de aquellos que alcanzaron una reducción ponderal significativa, diferenciando aquellos con reducción ponderal particularmente intensa, respecto al resto de la cohorte. Resultados: La cohorte presentaba una edad e IMC-Z-score medios de 10,46 ± 3,48 años y 4,01 ± 1,49, respectivamente (52,8% sexo masculino; 53,3% prepuberales; 75,8% etnia caucásica y 19% hispana). Se observó mayor prevalencia de etnia hispana e ingesta compulsiva entre los pacientes que abandonaban precozmente el seguimiento. Entre los que conseguían una reducción ponderal particularmente intensa, había una mayor prevalencia del sexo masculino y control domiciliario de la ingesta, así como mayor gravedad de su obesidad, siendo esto último, una constante entre los pacientes con reducción ponderal significativa en cualquier momento del seguimiento. Conclusiones: Algunas características de los niños afectos de obesidad pueden orientar acerca de un mayor riesgo de AP del seguimiento o de una mayor probabilidad de ET, debiendo considerarse en el diseño de la estrategia de intervención y pauta de seguimiento, aunque la capacidad predictora de estas variables es limitada. Abstract: Introduction: Management of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. Patients and methods: We conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. Results: The mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latino. We found a higher proportion of Latino ethnicity and compulsive eating in the group of patients with early attrition from the weight management followup. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow up. Conclusions: Some family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from followup or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Introduction: Due to the lack of cadavers, anatomists across the nation are facing trouble in teaching. Plastinated specimens can be used to get around this deficiency and reliance. Aim: To assess the change in weight during plastination using melamine. Materials and Methods: A cross-sectional cadaveric study was conducted in the Department of Anatomy at GMC Kota, Rajasthan, India, using nine specimens from cadavers obtained between June 2016 and June 2017. Freshly dissected specimens from a fresh cadaver were used for plastination. The weight reduction after dehydration using acetone (three changes of seven days each), degreasing using xylene (three changes of seven days each), impregnation with a melamine-xylene mixture (10 days in a vacuum), and curing was recorded. Weight was measured using a digital weighing balance and recorded after each step. All statistical analyses were performed using Analysis of Variance (ANOVA) in MedCalc software version 22.009. Results: There was a gradual weight loss after each step except for impregnation. The percentage of mean weight after dehydration was 58.59±4.03%, after degreasing was 56.21±2.55%, after impregnation was 66.06±4.69%, and after curing was 48.26±5.39% and p-value was highly significant (

Background: Moxibustion has been used in the treatment and prevention of obesity. However, there has been no systematic review or meta-analysis conducted on the use of moxibustion on obesity treatment. This study aimed to evaluate the role of moxibustion in the treatment of obesity. Methods: The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE/PubMed databases were searched to identify all randomized controlled trials (RCTs) that evaluated the effect of moxibustion on obesity. The primary outcome was body weight. The secondary outcomes were the body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The risk of bias assessment and meta-analysis were conducted using the Cochrane Collaboration tool. Results: Eleven RCTs involving 761 participants were included in this systematic review and meta-analysis. Other interventions that were included in the analyses were manual acupuncture, electroacupuncture, embedding therapy, herbal medicine, and diet control. Moxibustion combined with other interventions resulted in a significant improvement in body weight reduction (mean difference [MD] −3.32, 95% confidence interval [CI: −4.25 to −2.38]; I2 = 17%), BMI (MD −1.51, 95% CI [−1.88 to −1.14]; I2 = 76%), and WC (MD −2.82, 95% CI [−3.50 to −2.13]; I2 = 75%), but did not improve HC (MD −2.05, 95% CI [−4.21 to 0.11]; I2 = 0%) or WHR (MD −0.01, 95% CI [−0.03 to 0.01]; I2 = 57%). Conclusions: Moxibustion can be used with other interventions to improve body weight, BMI, and WC in people with obesity. However, the conclusions of this review should be cautiously applied to clinical practice because most of the included studies had a high or unclear risk of bias. [ABSTRACT FROM AUTHOR]

Ampulla of Vater (AOV) is typically located in the second part of the duodenum. There are few reported cases of ectopic AOV over the line extending from the pylorus of the stomach down to the distal part of the duodenum. However, to the best of our knowledge, there are only five cases reported in the English literature of an ectopic AOV in the fourth part of the duodenum, with only one of them having adenocarcinoma of the ampulla. Hereby, we report the first case of ectopic AOV in the fourth part of the duodenum, presenting with obstructive due to adenocarcinoma with focal squamous differentiation. This is the case a 42-year-old lady who had a sleeve gastrectomy for morbid obesity in the past. She presented with right upper quadrant pain for one month associated with subjective fever, unintentional weight loss, pale stool, and dark urine. The physical examination revealed a deeply jaundiced lady with an unremarkable abdominal exam. A computed tomography scan of the abdomen revealed intrahepatic and extrahepatic biliary dilation with ectopic insertion of the distal CBD into the fourth part of the duodenum with no evidence of biliary stones. She underwent pancreaticoduodenectomy after difficult biliary decompression. Histopathological diagnosis was moderately differentiated adenocarcinoma, pancreaticobiliary type with focal squamous differentiation. Ectopic AOV is a very rare entity, especially when it is associated with adenosquamous carcinoma changes. [ABSTRACT FROM AUTHOR]

Early slow weight loss during treatment is associated with less weight loss overall. The impact of an augmented intervention designed for early slow weight loss responders compared with a standard diabetes prevention intervention was evaluated following 12 months of treatment and 6 months of no contact. The impact of standard vs. augmented intervention sequences on weight and glycemia also was determined. Adults were ≥21 years old with overweight or obesity and prediabetes (n = 174). Slow responders were stratified to augmented treatment if they failed to achieve >2.5% weight loss (%WL) at Week 5. Matched within-sex pairs of participants were created based on %WL at Month 5 following the intensive intervention phase, and each person within the pair was randomly assigned to treatment for Months 5–12 during the extended intervention phase. Both 12-month interventions included a ≥7%WL goal. Mean 12-month %WL was 5.29% (95% CI: 4.27%–6.31%; P <.0001) and 18-month %WL was 3.34% (95% CI: 2.01%–4.66%; P <.0001) overall. %WL was greater for the standard (9.55%) than the augmented (4.0%) intervention (P =.0001); no differences occurred in weight regain between early and slow responders (P =.9476). No differences occurred in mean %WL at 12 months between the standard and augmented groups after controlling for %WL at Week 5 and sex (P =.23) nor in the change in glycemia (all P >.05). WL following the first month of treatment predicted 12- and 18-month WL success regardless of intervention sequence; however, even early slow responders achieved significant WL during treatment. Further research is needed to support effective WL maintenance for people with prediabetes. [ABSTRACT FROM AUTHOR]

Recently, the demand for electric tractors has grown substantially in efforts to achieve carbon neutrality. To successfully introduce electric tractors into the market, ensuring sufficient working duration on a single charge is crucial. Increasing the battery capacity is one approach to extend the working duration. However, structural weight reduction strategies for tractors should be explored to mitigate potential issues associated with excessive weight, such as soil compaction. To increase the working duration of electric tractors, this paper proposes methods for structural weight reduction, to predict working duration per agricultural work based on tractor weight reduction, and to predict the appropriate battery weight for electric tractors. The proposed method involves implementing topology optimization on the rear axle housing of tractors to achieve weight reduction. The allocation of weight reduction resulting from structural improvements to the battery weight is determined using a dynamic model of a tractor to calculate the increase in working duration. Additionally, the extended working duration for various agricultural works is estimated, considering different types of batteries and battery weight ratios. Notably, light-weighting achieved a 20.21% reduction in weight when compared with the initial model. The findings of this study indicate an increase in the working duration, with approximately 56.2 and 7.1 min additional for road driving and rotavator work when using Li-S batteries, respectively. Furthermore, the battery weight required to achieve the targeted working duration is calculated, accounting for variations in power demand across different agricultural works. Finally, a method for predicting the optimal battery weight for electric tractors based on the specific power needs and targeted working duration for various agricultural activities is proposed. [ABSTRACT FROM AUTHOR]

The rising prevalence of obesity in children calls for new strategies for the provision of effective care by a multidisciplinary team. Telemedicine has overall proven to be an effective tool for promoting a healthy lifestyle. The main objective of the current paper is to present the protocol of our ongoing CardioMetabolic Prevention (CAMP) study and compare its design with published studies on telemedicine in paediatric obesity. Additionally, we analysed the preliminary anthropometric and laboratory data to test the efficacy of our 12-week intensive program that combines in-person and telemedicine support. The program demonstrated a positive impact on body mass index (BMI) and its z-scores in 21 adolescents, and BMI in 18 participating parents. However, we found no effect on body composition, waist circumference, cardiometabolic parameters, or fitness evaluated via a 6-min walk test in adolescents. In conclusion, the combination of in-person and telemedicine intensive support over 35 h delivered by a multidisciplinary team can be beneficial not only for adolescents with obesity but also for their parents. The ongoing CAMP study serves as a platform for precision medicine in future decisions regarding anti-obesity medication in adolescents with obesity. [ABSTRACT FROM AUTHOR]

This research paper discusses a case in which stomach cancer was incidentally discovered during a bariatric surgery procedure. Bariatric surgery is well-known for its significant effects on weight loss and overall health enhancement, and its prevalence has been rising globally. While its primary aim is weight reduction, it also offers the chance for surgeons to detect and manage other medical conditions. In this specific case, a patient scheduled for bariatric surgery was incidentally discovered with stomach cancer, underscoring the significance of comprehensive operative assessments and vigilant monitoring during surgery. [ABSTRACT FROM AUTHOR]

Wilkie's syndrome is an unusual cause of upper intestinal obstruction due to mechanical compression of the superior mesenteric artery (SMA) to the duodenum, with nonspecific symptoms, whose diagnosis is confirmed by angiotomography. Initially, the treatment is conservative to regain weight and restore mesenteric adipose tissue, associated with postural changes of the patient. If this fails, surgical treatment is indicated, being laparoscopic duodenojejunostomy described as the gold standard. Robotics' assistance is feasible and safe to carry out the procedure. We present the case of a 21-year-old male patient who comes with stabbing abdominal pain and persistent postprandial vomiting that has caused weight loss of 11 kilograms in the last 2 years without apparent cause, associated with gastroesophageal reflux. During the procedure, we evidenced open diaphragmatic pillars and duodenal compression due to SMA, and robotic-assisted laparoscopic hyatoplasty + Nissen fundoplication + duodenojejunostomy were performed without complications, with excellent post-surgical results. [ABSTRACT FROM AUTHOR]

Introduction: Due to the lack of cadavers, anatomists across the nation are facing trouble in teaching. Plastinated specimens can be used to get around this deficiency and reliance. Aim: To assess the change in weight during plastination using melamine. Materials and Methods: A cross-sectional cadaveric study was conducted in the Department of Anatomy at GMC Kota, Rajasthan, India, using nine specimens from cadavers obtained between June 2016 and June 2017. Freshly dissected specimens from a fresh cadaver were used for plastination. The weight reduction after dehydration using acetone (three changes of seven days each), degreasing using xylene (three changes of seven days each), impregnation with a melamine-xylene mixture (10 days in a vacuum), and curing was recorded. Weight was measured using a digital weighing balance and recorded after each step. All statistical analyses were performed using Analysis of Variance (ANOVA) in MedCalc software version 22.009. Results: There was a gradual weight loss after each step except for impregnation. The percentage of mean weight after dehydration was 58.59±4.03%, after degreasing was 56.21±2.55%, after impregnation was 66.06±4.69%, and after curing was 48.26±5.39% and p-value was highly significant (<0.05). Conclusion: Continuous reduction in weight without distortion of anatomy resulted in lightweight plastinates which were odorfree and aesthetically pleasing. [ABSTRACT FROM AUTHOR]

Background The off-label use of glucagon-like peptide 1 (GLP-1) agonists for cosmetic weight loss has captured the interest of the public. However, there is a paucity of published data on their utilization, implications, and management, particularly in the plastic surgery community. Objectives This study aims to explore the current practice patterns of aesthetic plastic surgeons regarding the off-label implementation of GLP-1 agonists. Methods A 35-question survey was sent to the 2600 members of The Aesthetic Society in July 2023. The survey collected physician demographics, practice settings, patient population demographics, and the use and management of GLP-1 agonists in their practice. No identifying variables were collected; all responses were anonymous. Results A total of 368 respondents were included. A quarter of respondents (25.3%) prescribed or utilized GLP-1 agonists in their practice. Nearly a third (29.9%) reported personal use of the medication, of which 71 (70.3%) indicated it was for cosmetic weight loss. Many aspects of the current treatment, counseling, and follow-up practices were similar among prescribing plastic surgeons. However, there were discrepancies in screening, nutrition counseling, and perioperative management. The majority believed that GLP-1 agonists were effective for weight loss (68.9%), profitable for business (57.8%), and would recommend its implementation to other plastic surgeons (68.5%). Conclusions As leaders in the aesthetic field, it behooves plastic surgeons to take charge of shaping public opinion surrounding the growing off-label use of GLP-1 agonists for cosmetic weight loss. Plastic surgeons' leadership is imperative in establishing safe and ethical guidelines and protocols for proper screening, management, and patient care. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background Weight loss leads to excessive flaccidity, volume loss, and tissue descent in the gluteal region. Translated autologous flaps during lower body lifting have been utilized in patients; they address sagging tissue and the lack of volume. However, sometimes use of these autologous flaps does not provide adequate gluteal projection, and a second procedure with fat injection may be required. Objectives The authors describe their technique of a lower body lift with a lumbosacral flap in association with liposuction and lipofilling for gluteoplasty. Methods A prospective series of 23 post–bariatric surgery individuals who underwent a lower body lift with lumbosacral flap gluteal augmentation, liposuction, and lipofilling between January 2021 and September 2022 were described. The satisfaction rate and complications were assessed 6 months postoperatively with a validated questionnaire (BODY-Q scale). Results The patients had a mean age of 38.18 (range, 28-56 years) and median body mass index of 26. Four patients with dehiscence were diagnosed and treated conservatively. All wound breakdowns were observed in the paramedian plane of the torsoplasty. No reoperations were performed. The mean satisfaction percentage of the BODY-Q scale transformed score was 97.5. Conclusions A technique for a lower body lift with buttock augmentation combined with liposuction and fat grafting was presented. In future studies other techniques to maximize gluteal contouring should be investigated. [ABSTRACT FROM AUTHOR]

The impact of the orientation angle and stacking order of the composite material on the torsional strength, buckling, and natural frequency of the drive shaft was demonstrated in a number of investigations. When designing and analyzing various composite materials, carbon/epoxy and Kevlar/epoxy were further looked at for their suitability in terms of torsional strength, torsional buckling, and bending natural frequency of the drive shaft. However, the fatigue life of these materials is not student very well. This, study will analysis the property of carbon/epoxy and Kevlar/epoxy composites automobile drive shaft fatigue life in addition to weight, bending natural frequency and equivalent stresses analysis. Before designing composite materials, the steel drive shaft will be designed and analysis based on weight, torsional strength, torsional buckling, bending natural frequency and fatigue life as a reference for comparison. Then, utilizing a modeling equation, ANSYS 18 and Solid work 16 as a tool, numerical and analytical analysis is carried out. Analytical and numerical results are contrasted as part of the validation process. The driveshaft made of carbon/epoxy composite material greatly reduces the weight of the driveshaft when compared to steel and Kevlar/epoxy drive shafts by comparing both analytical and numerical data. In contrast, the increased number of plies in the Kevlar/epoxy drive shaft gives it a longer fatigue life than the steel, carbon, and epoxy drive shafts. As a result, it is stronger against shearing and buckling loads. [ABSTRACT FROM AUTHOR]