Sustainable Balanced Scorecard for Kaizen Evaluation: Comparative Study between Egypt and Japan

Continuous improvement activities are becoming a key organizational success factor; those improvement activities include but are not limited to kaizen, six sigma, lean production, and continuous improvement projects. Kaizen is a Japanese philosophy of continuous improvement by making small incremental changes to improve an organization’s performance, reduce costs, reduce delay time, reduce waste in production, etc. This research aims at proposing a measuring system for kaizen activities from a sustainable balanced scorecard perspective. A survey was developed and disseminated among kaizen experts in both Egypt and Japan with the purpose of allocating key performance indicators for both kaizen process (critical success factors) and result (kaizen benefits) into the five sustainable balanced scorecard perspectives. This research contributes to the extant literature by presenting a kaizen measurement of both kaizen process and results that will illuminate the benefits of using kaizen. Also, the presented measurement can help in the sustainability of kaizen implementation across various sectors and industries. Thus, grasping the full benefits of kaizen implementation will contribute to the spread of kaizen understanding and practice. Also, this research provides insights on the social and cultural differences that would influence the kaizen success. Determining the combination of the proper kaizen measures could be used by any industry, whether service or manufacturing for better kaizen activities measurement. The comparison between Japanese implementation of kaizen, as the pioneers of continuous improvement, and Egyptian implementation will help recommending better practices of kaizen in Egypt and contributing to the 2030 sustainable development goals. The study results reveal that there is no significant difference in allocating kaizen benefits between Egypt and Japan. However, with regard to the critical success factors some differences appeared reflecting the social differences and understanding between both countries, a single integrated measurement was reached between the Egyptian and Japanese allocation highlighting the Japanese experts’ opinion as the ultimate criterion for selection.

Adaptive Control Strategy of Robot Polishing Force Based on Position Impedance

Manual polishing has problems such as high labor intensity, low production efficiency and difficulty in guaranteeing the consistency of polishing quality. The use of robot polishing instead of manual polishing can effectively avoid these problems. Polishing force directly affects the quality of polishing, so accurate tracking and control of polishing force is one of the most important conditions for improving the accuracy of robot polishing. The traditional force control strategy is difficult to adapt to the strong coupling of force control and position control during the robot polishing process. Therefore, based on the analysis of force-based impedance control and position-based impedance control, this paper proposed a type of adaptive controller. Based on force feedback control of active compliance control, the controller can adaptively estimate the stiffness and position of the external environment and eliminate the steady-state force error produced by traditional impedance control. The simulation results of the model show that the adaptive controller has good adaptability to changing environmental positions and environmental stiffness, and can accurately track and control polishing force.

Trial of Fecal Microbial Transplantation for the Prevention of Canine Atopic Dermatitis

The skin-gut axis defines the relationship between the intestinal microbiota and the development of pathological skin diseases. Low diversity within the gut can predispose to the development of allergic skin conditions, and a greater diversity of the gastrointestinal microflora has been associated with a reduction of skin flares in people with atopic dermatitis. Manipulation of the gut microflora has been used as a treatment option for several conditions in people, but there is limited data available on the use of fecal transplantation as a preventative measure in either people or dogs. Six, 4-month-old pups from a litter of 10 were presented for diarrhea and/or signs of skin disease (chronic scratching, otitis externa). Of these pups, two were given probiotics with a resultant resolution of diarrhea. The other four pups were given fecal transplantation, either as a sole treatment or in combination with other treatments. Follow-up on the litter of 10 pups was performed at 18 months of age. At this stage, three out of the four pups that had received fecal transplantation had resolved all clinical signs and had no recurrence of either skin or gastrointestinal symptoms, the other pup had one episode of Malassezia otitis. Of the remaining six pups from the litter, all had developed at least one episode of Malassezia otitis externa within the period of five to 18 months of age. Two pups had developed two Malassezia otitis infections, and one had developed three Malassezia otitis infections during this period. Favrot’s criteria for the diagnosis of canine atopic dermatitis include chronic or recurrent Malassezia infections by the age of three years. Early results from this litter predict a reduction in the development of canine atopic disease in dogs given fecal microbial transplantation. Follow-up studies at three years of age and within a larger population of dogs can enhance understanding of the impact of early fecal transplantation in the prevention of canine atopic dermatitis.

Method for Tuning Level Control Loops Based on Internal Model Control and Closed Loop Step Test Data

This paper describes a two-stage methodology derived from IMC (Internal Model Control) for tuning a PID (Proportional-Integral-Derivative) controller for levels or other integrating processes in an industrial environment. Focus is ease of use and implementation speed which are critical for an industrial application. Tuning can be done with minimum effort and without the need of time-consuming open-loop step tests on the plant. The first stage of the method applies to levels only: the vessel residence time is calculated from equipment dimensions and used to derive a set of preliminary PI (Proportional-Integral) settings with IMC. The second stage, re-tuning in closed-loop, applies to levels as well as other integrating processes: a tuning correction mechanism has been developed based on a series of closed-loop simulations with model errors. The tuning correction is done from a simple closed-loop step test and application of a generic correlation between observed overshoot and integral time correction. A spin-off of the method is that an estimate of the vessel residence time (levels) or open-loop process gain (other integrating process) is obtained from the closed-loop data.

Effect of Type of Pile and Its Installation Method on Pile Bearing Capacity by Physical Modeling in Frustum Confining Vessel

Various factors such as the method of installation, the pile type, the pile material and the pile shape, can affect the final bearing capacity of a pile executed in the soil; among them, the method of installation is of special importance. The physical modeling is among the best options in the laboratory study of the piles behavior. Therefore, the current paper first presents and reviews the frustum confining vessel (FCV) as a suitable tool for physical modeling of deep foundations. Then, by describing the loading tests of two open-ended and closed-end steel piles, each of which has been performed in two methods, “with displacement" and "without displacement", the effect of end conditions and installation method on the final bearing capacity of the pile is investigated. The soil used in the current paper is silty sand of Firuzkuh, Iran. The results of the experiments show that in general the without displacement installation method has a larger bearing capacity in both piles, and in a specific method of installation the closed ended pile shows a slightly higher bearing capacity.

Incorporating Lexical-Semantic Knowledge into Convolutional Neural Network Framework for Pediatric Disease Diagnosis

The utilization of electronic medical record (EMR) data to establish the disease diagnosis model has become an important research content of biomedical informatics. Deep learning can automatically extract features from the massive data, which brings about breakthroughs in the study of EMR data. The challenge is that deep learning lacks semantic knowledge, which leads to impracticability in medical science. This research proposes a method of incorporating lexical-semantic knowledge from abundant entities into a convolutional neural network (CNN) framework for pediatric disease diagnosis. Firstly, medical terms are vectorized into Lexical Semantic Vectors (LSV), which are concatenated with the embedded word vectors of word2vec to enrich the feature representation. Secondly, the semantic distribution of medical terms serves as Semantic Decision Guide (SDG) for the optimization of deep learning models. The study evaluates the performance of LSV-SDG-CNN model on four kinds of Chinese EMR datasets. Additionally, CNN, LSV-CNN, and SDG-CNN are designed as baseline models for comparison. The experimental results show that LSV-SDG-CNN model outperforms baseline models on four kinds of Chinese EMR datasets. The best configuration of the model yielded an F1 score of 86.20%. The results clearly demonstrate that CNN has been effectively guided and optimized by lexical-semantic knowledge, and LSV-SDG-CNN model improves the disease classification accuracy with a clear margin.

A Numerical Study of the Interaction between Residual Stress Profiles Induced by Quasi-Static Plastification

One of the most relevant phenomena in manufacturing is the residual stress state development through the manufacturing chain. In most cases, the residual stresses have their origin in the heterogenous plastification produced by the processes. Although a few manufacturing processes have been successfully approached by numerical modeling, there is still lack of understanding on how these processes' interactions will affect the final stress state. The objective of this work is to analyze the effect of the grinding procedure on the residual stress state generated by a quasi-static indentation. The model consists in a simplified approach of shot peening, modeling four cases with variations in indenter size and force. This model was validated through topography, measured by optical 3D focus-variation. The indentation model configured with two loads was then exposed to two grinding procedures and the result was analyzed. It was observed that the grinding procedure will have a significant effect on the stress state.

Study of Eatable Aquatic Invertebrates in the River Dhansiri, Dimapur, Nagaland, India

A study has been conducted on the available aquatic invertebrates in the river Dhansiri at Dimapur site. The study confirmed that the river body composed of aquatic macroinvertebrate community in two phyla viz., Arthropods and Molluscs. Total ten species have been identified from there as the source of alternative protein food for the common people. Not only the protein source they are also the component of aquatic food chain and indicators of aquatic ecosystem. Proper management and strategies to promote the edible invertebrates can be considered as the alternative protein and alternative income source for the common people for sustainable livelihood improvement.

An Approach to Capture, Evaluate and Handle Complexity of Engineering Change Occurrences in New Product Development

This paper represents the conception that complex problems do not necessary need similar complex solutions in order to cope with the complexity. Furthermore, a simple solution based on established methods can provide a sufficient way dealing with the complexity. To verify this conception, the presented paper focuses on the field of change management as a part of new product development process in automotive sector. In the field of complexity management, dealing with increasing complexity is essential, while, only non-flexible rigid processes that are not designed to handle complexity are available. The basic methodology of this paper can be divided in four main sections: 1) analyzing the complexity of the change management, 2) literature review in order to identify potential solutions and methods, 3) capturing and implementing expertise of experts from change management filed of an automobile manufacturing company and 4) systematical comparison of the identified methods from literature and connecting these with defined requirements of the complexity of the change management in order to develop a solution. As a practical outcome, this paper provides a method to capture the complexity of engineering changes (EC) and includes it within the EC evaluation process, following case-related process guidance to cope with the complexity. Furthermore, this approach supports the conception that dealing with complexity is possible while utilizing rather simple and established methods by combining them in to a powerful tool.

Physicochemical and Thermal Characterization of Starch from Three Different Plantain Cultivars in Puerto Rico

Plantain contains starch as the main component and represents a relevant source of this carbohydrate. Starches from different cultivars of plantain and bananas have been studied for industrialization purposes due to their morphological and thermal characteristics and their influence in food products. This study aimed to characterize the physical, chemical, and thermal properties of starch from three different plantain cultivated in Puerto Rico: Maricongo, Maiden and FHIA 20. Amylose and amylopectin content, color, granular size, morphology, and thermal properties were determined. According to the amylose content in starches, FHIA 20 presented lowest content of the three cultivars studied. In terms of color, Maiden and FHIA 20 starches exhibited significantly higher whiteness indexes compared to Maricongo starch. Starches of the three cultivars had an elongated-ovoid morphology, with a smooth surface and a non-porous appearance. Regardless of similarities in their morphology, FHIA 20 exhibited a lower aspect ratio since its granules tended to be more elongated. Comparison of the thermal properties of starches showed that initial starch gelatinization temperature was similar among cultivars. However, FHIA 20 starch presented a noticeably higher final gelatinization temperature (87.95°C) and transition enthalpy than Maricongo (79.69°C) and Maiden (77.40°C). Despite similarities, starches from plantain cultivars showed differences in their composition and thermal behavior. This represents an opportunity to diversify plantain starch use in food-related applications.

A 3D Numerical Environmental Modeling Approach for Assessing Transport of Spilled Oil in Porous Beach Conditions under a Meso-Scale Tank Design

Shorelines are vulnerable to significant environmental impacts from oil spills. Stranded oil can cause potential short- to long-term detrimental effects along beaches that include injuries to ecosystem, socio-economic and cultural resources. In this study, a three-dimensional (3D) numerical modeling approach is developed to evaluate the fate and transport of spilled oil for hypothetical oiled shoreline cases under various combinations of beach geomorphology and environmental conditions. The developed model estimates the spatial and temporal distribution of spilled oil for the various test conditions, using the finite volume method and considering the physical transport (dispersion and advection), sinks, and sorption processes. The model includes a user-friendly interface for data input on variables such as beach properties, environmental conditions, and physical-chemical properties of spilled oil. An experimental meso-scale tank design was used to test the developed model for dissolved petroleum hydrocarbon within shorelines. The simulated results for effects of different sediment substrates, oil types, and shoreline features for the transport of spilled oil are comparable to that obtained with a commercially available model. Results show that the properties of substrates and the oil removal by shoreline effects have significant impacts on oil transport in the beach area. Sensitivity analysis, through the application of the one-step-at-a-time method (OAT), for the 3D model identified hydraulic conductivity as the most sensitive parameter. The 3D numerical model allows users to examine the behavior of oil on and within beaches, assess potential environmental impacts, and provide technical support for decisions related to shoreline clean-up operations.

Analysing the Renewable Energy Integration Paradigm in the Post-COVID-19 Era: An Examination of the Upcoming Energy Law of China

China’s declared transformation towards a ‘new electricity system dominated by renewable energy’ requires a cleaner electricity consumption mix with high shares of renewable energy sourced-electricity (RES-E). Unfortunately, integration of RES-E into Chinese electricity markets remains a problem pending more robust legal support, evidenced by the curtailment of wind and solar power due to integration constraints. The upcoming Energy Law of the PRC (Energy Law) is expected to provide such long-awaiting support and coordinate the existing diverse sector-specific laws to deal with the weak implementation that dampening the delivery of their desired regulatory effects. However, in the shadow of the COVID-19 crisis, it remains uncertain how this new Energy Law brings synergies to RES-E integration, mindful of the significant impacts of the pandemic. Through the theoretical lens of the interplay between China’s electricity market reform and legislative development, this paper investigates whether there is a paradigm shift in Energy Law regarding renewable energy integration compared with the existing sector-specific energy laws. It examines the 2020 Draft for Comments on the Energy Law and analyses its relationship with sector-specific energy laws focusing on RES-E integration. The comparison is drawn upon five critical aspects of the RES-E integration issue, including the status of renewables, marketisation, incentive schemes, consumption mechanisms, access to power grids and dispatching. The analysis shows that it is reasonable to expect a more open and well-organised electricity market, enabling the absorption of high shares of RES-E. The present paper concludes that a period of prosperous development of RES-E in the post-COVID-19 era can be anticipated with the legal support by the upcoming Energy Law. It contributes to understanding the signals China is sending regarding the transition towards a cleaner energy future.

User’s Susceptibility Factors to Malware Attacks: A Systemic Literature Review

Users’ susceptibility to malware attacks have been noticed in the past few years. Investigating the factors that make a user vulnerable to those attacks is critical because they can be utilized to set up proactive strategies such as awareness and education to mitigate the impacts of those attacks. Demographic, behavioral, and cultural vulnerabilities are the main factors that make users susceptible to malware attacks. It is challenging, however, to draw more general conclusions based on those factors due to the varieties in the type of users and different types of malware. Therefore, we conducted a systematic literature review (SLR) of the existing research for user susceptibility factors to malware attacks. The results showed that all demographic factors are consistently associated with malware infection regardless of the users' type except for age and gender. Besides, the association of culture and personality factors with malware infection is consistent in most of the selected studies and for all types of users. Moreover, malware infection varies based on age, geographic location, and host types. We propose that future studies should carefully take into consideration the type of users because different users may be exposed to different threats or targeted based on their user domains’ characteristics. Additionally, as different types of malware use different tactics to trick users, taking the malware types into consideration is important.

The Effects of an Online Career Intervention on University Students’ Levels of Career Adaptability

People’s ability to adapt to a constantly changing environment is essential. Career adaptability is central to Career Construction Theory, where proper adaptation to new situations, changing environments, and jobs require adequate career development. Based on current career theories and the possibilities offered by digital technology, the primary goal of this study is to develop career adaptability through an online tool. Its secondary goal is to apply for an online career intervention program and explore its developmental possibilities. A total of 132 university students from the bachelor program took part in the study, from which 65 students received a four-week online career intervention, while 67 participants formed the control group. Based on the results, it can state that career adaptability can be developed, and there is a great demand and interest from university students to use career-related programs on online platforms. Career interventions should be performed online as well if there is suitable software and a well-constructed program. Limitations and further implications are discussed.

Double Clustering as an Unsupervised Approach for Order Picking of Distributed Warehouses

Planning the order picking lists for warehouses to achieve some operational performances is a significant challenge when the costs associated with logistics are relatively high, and it is especially important in e-commerce era. Nowadays, many order planning techniques employ supervised machine learning algorithms. However, to define features for supervised machine learning algorithms is not a simple task. Against this background, we consider whether unsupervised algorithms can enhance the planning of order-picking lists. A double zone picking approach, which is based on using clustering algorithms twice, is developed. A simplified example is given to demonstrate the merit of our approach.

Effect of Non-Metallic Inclusion from the Continuous Casting Process on the Multi-Stage Forging Process and the Tensile Strength of the Bolt: A Case Study

The paper presents the influence of non-metallic inclusions on the multi-stage forging process and the mechanical properties of the dodecagon socket bolt used in the automotive industry. The detected metallurgical defect was so large that it directly influenced the mechanical properties of the bolt and resulted in failure to meet the requirements of the mechanical property class. In order to assess the defect, an X-ray examination and metallographic examination of the defective bolt were performed, showing exogenous non-metallic inclusion. The size of the defect on the cross section was 0.531 mm in width and 1.523 mm in length; the defect was continuous along the entire axis of the bolt. In analysis, a finite element method (FEM) simulation of the multi-stage forging process was designed, taking into account a non-metallic inclusion parallel to the sample axis, reflecting the studied case. The process of defect propagation due to material upset in the head area was analyzed. The final forging stage in shaping the dodecagonal socket and filling the flange area was particularly studied. The effect of the defect was observed to significantly reduce the effective cross-section as a result of the expansion of the defect perpendicular to the axis of the bolt. The mechanical properties of products with and without the defect were analyzed. In the first step, the hardness test confirmed that the required value for the mechanical class 8.8 of both bolt types was obtained. In the second step, the bolts were subjected to a static tensile test. The bolts without the defect gave a positive result, while all 10 bolts with the defect gave a negative result, achieving a tensile strength below the requirements. Tensile strength tests were confirmed by metallographic tests and FEM simulation with perpendicular inclusion spread in the area of the head. The bolts were damaged directly under the bolt head, which is inconsistent with the requirements of ISO 898-1. It has been shown that non-metallic inclusions with orientation in accordance with the axis of the bolt can directly cause loss of functionality and these defects should be detected even before assembling in the machine element.

Farming Production in Brazil: Innovation and Land-Sparing Effect

Innovation and technology can be determinant factors to ensure agricultural and sustainable growth, as well as productivity gains. Technical change has contributed considerably to supply agricultural expansion in Brazil. This agricultural growth could be achieved by incorporating more land or capital. If capital is the main source of agricultural growth, it is possible to increase production per unit of land. The objective of this paper is to estimate: 1) total factor productivity (TFP), which is measured in terms of the rate of output per unit of input; and 2) the land-saving effect (LSE) that is the amount of land required in the case that yield rate is constant over time. According to this study, from 1990 to 2019, it appears that 87% of Brazilian agriculture product growth comes from the gains of productivity; the remaining 13% comes from input growth. In the same period, the total LSE was roughly 400 Mha, which corresponds to 47% of the national territory. These effects reflect the greater efficiency of using productive factors, whose technical change has allowed an increase in the agricultural production based on productivity gains.

Effect of Needle Height on Discharge Coefficient and Cavitation Number

Cavitation inside diesel injector nozzle is investigated using Reynolds-Stress-Navier stokes equations. Schnerr-Sauer cavitation model is used for modeling cavitation inside diesel injector nozzle. The carrying fluid utilized in the current study is diesel fuel. The flow is verified at the beginning by comparing with the previous experimental data and it was found that K-Epsilon turbulent model could lead to a better accuracy comparing to K-Omega turbulent model. Moreover, mass flow rate obtained numerically is compared with the experimental value and discrepancy was found to be less than 5% - which shows the accuracy of the current results. Finally, a real-size four-hole nozzle is investigated and the flow inside it is visualized based on velocity profile, discharge coefficient and cavitation number. It was found that the mesh density could be reduced significantly by utilizing periodic boundary condition. Velocity contour at the mid nozzle showed that maximum value of velocity occurs at the end of the needle before entering the orifice area. Last but not least, at the same boundary conditions, when different needle heights were utilized, it was found that as needle height increases with an increase in cavitation number, discharge coefficient increases, while the mentioned increases is more tangible at smaller values of needle heights.

Associations among Fetuin A, Cortisol and Thyroid Hormones in Children with Morbid Obesity and Metabolic Syndrome

Obesity is a disease with an ever-increasing prevalence throughout the world. The metabolic network associated with obesity is very complicated. In metabolic syndrome (MetS), it becomes even more difficult to understand. Within this context, hormones, cytokines, and many others participate in this complex matrix. The collaboration among all of these parameters is a matter of great wonder. Cortisol, as a stress hormone, is closely associated with obesity. Thyroid hormones are involved in the regulation of energy as well as glucose metabolism with all of its associates. Fetuin A has been known for years; however, the involvement of this parameter in obesity discussions is rather new. Recently, it has been defined as one of the new generation markers of obesity. In this study, the aim was to introduce complex interactions among all to be able to make clear comparisons, at least for a part of this complicated matter. Morbid obese (MO) children participated in the study. Two groups with 46 MO children and 43 with MetS were constituted. All children included in the study were above 99th age- and sex-adjusted body mass index (BMI) percentiles according to World Health Organization criteria. Forty-three morbid obese children in the second group also had MetS components. Informed consent forms were filled by the parents of the participants. The institutional ethics committee has given approval for the study protocol. Data as well as the findings of the study were evaluated from a statistical point of view. Two groups were matched for their age and gender compositions. Significantly higher body mass index (BMI), waist circumference, thyrotropin, and insulin values were observed in the MetS group. Triiodothyronine concentrations did not differ between the groups. Elevated levels for thyroxin, cortisol, and fetuin-A were detected in the MetS group compared to the first group (p > 0.05). In MO MetS- group, cortisol was correlated with thyroxin and fetuin-A (p < 0.05). In the MO MetS+ group, none of these correlations were present. Instead, a correlation between cortisol and thyrotropin was found (p < 0.05). In conclusion, findings have shown that cortisol was the key player in severely obese children. The association of this hormone with the participants of thyroid hormone metabolism was quite important. The lack of association with fetuin A in the morbid obese MetS+ group has suggested the possible interference of MetS components in the behavior of this new generation obesity marker. The most remarkable finding of the study was the unique correlation between cortisol and thyrotropin in the morbid obese MetS+ group, suggesting that thyrotropin may serve as a target along with cortisol in the morbid obese MetS+ group. This association may deserve specific attention during the development of remedies against MetS in the pediatric population.

Relationship between Hepatokines and Insulin Resistance in Childhood Obesity

Childhood obesity is an important clinical problem, because it may lead to chronic diseases during the adulthood period of the individual. Obesity is a metabolic disease associated with low-grade inflammation. The liver occurs at the center of metabolic pathways. Adropin, fibroblast growth factor-21 (FGF-21) and fetuin A are hepatokines. Due to the immense participation of the liver in glucose metabolism, these liver derived factors may be associated with insulin resistance (IR), which is a phenomenon discussed within the scope of obesity problems. The aim of this study is to determine the concentrations of adropin, FGF-21 and fetuin A in childhood obesity, to point out possible differences between the obesity groups and to investigate possible associations among these three hepatokines in obese and morbid obese children. A total of 132 children were included in the study. Two obese groups were constituted. The groups were matched in terms of mean±SD values of ages. Body mass index values of the obese and morbid obese groups were 25.0±3.5 kg/m2 and 29.8±5.7 kg/m2, respectively. Anthropometric measurements including waist circumference, hip circumference, head circumference, and neck circumference were recorded. Informed consent forms were taken from the parents of the participants and the Ethics Committee of the institution approved the study protocol. Blood samples were obtained after an overnight fasting. Routine biochemical tests including glucose- and lipid-related parameters were performed. Concentrations of the hepatokines (adropin, FGF-21, fetuin A) were determined by enzyme-linked immunosorbent assay. Insulin resistance indices such as homeostasis model assessment for IR (HOMA-IR), alanine transaminase-to aspartate transaminase ratio (ALT/AST), diagnostic obesity notation model assessment laboratory index, diagnostic obesity notation model assessment metabolic syndrome index as well as obesity indices such as diagnostic obesity notation model assessment-II index, and fat mass index were calculated using the previously derived formulas. Statistical evaluation of the study data as well as findings of the study were performed by SPSS for Windows. Statistical difference was accepted significant when p < 0.05. Statistically significant differences were found for insulin, triglyceride, high density lipoprotein cholesterol levels of the groups. A significant increase was observed for FGF-21 concentrations in the morbid obese group. Higher adropin and fetuin A concentrations were observed in the same group in comparison with the values detected in the obese group (p > 0.05). There was no statistically significant difference between the ALT/AST values of the groups. In all of the remaining IR and obesity indices, significantly increased values were calculated for morbid obese children. Significant correlations were detected between HOMA-IR and each of the hepatokines. The highest one was the association with fetuin A (r = 0.373, p = 0.001). In conclusion, increased levels observed in adropin, FGF-21 and fetuin A have shown that these hepatokines possess increasing potential going from the obese to morbid obese state. Out of the correlations found with IR index, the most affected hepatokine was fetuin A, the parameter possibly used as the indicator of the advanced obesity stage.