Abstract: Ischemic events can culminate in acute myocardial infarction with irreversible cardiac lesions that cannot be restored due to the limited regenerative capacity of the heart. Tissue engineering proposes therapeutic alternatives by using biomaterials to resemble the native extracellular medium combined with healthy and functional cells. This research focused on developing a natural thermosensitive hydrogel, its physical-chemical characterization and in vitro biocompatibility determination. Hydrogels’ morphological characterization was carried out through scanning electron microscopy and its chemical characterization by employing Infrared Spectroscopy technic. In addition, the biocompatibility was determined using fetal human ventricular cardiomyocytes cell line RL-14 and the MTT cytotoxicity test according to the ISO 10993-5 standard. Four biocompatible and thermosensitive hydrogels were obtained with a three-dimensional internal structure and two gelation times. The results show the potential of the hydrogel to increase the cell survival rate to the cardiac cell therapies under investigation and lay the foundations to continue with its characterization and biological evaluation both in vitro and in vivo models.
Abstract: This cross-sectional study aims to explore the differences among adults with somatic symptom disorder (SSD) versus adults without SSD, in terms of attachment and emotion regulation strategies. A total sample of 80 participants (40 people with SSD and 40 healthy controls), aged 20-57 years old (M = 31.69, SD = 10.55), were recruited from institutions and online groups. They completed the Romanian version of the Experiences in Close Relationships Scale – Short Form (ECR-S), Regulation of Emotion Systems Survey (RESS), Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Disorder – B Criteria Scale (SSD-12). The results indicate significant differences between the two groups in terms of attachment and emotion regulation strategies. Adults with SSD have a higher level of attachment anxiety and avoidance compared to the nonclinical group. Moreover, people with SSD are more prone to use rumination and suppression and less prone to use reevaluation compared to healthy people. Implications for SSD prevention and treatment are discussed.
Abstract: The average daily screen time (ST) has been increasing in children, even at young ages. This seems to be associated with a higher incidence of neurodevelopmental disorders, and as the time of exposure increases, the greater is the functional impact. This study aims to compare the daily ST of toddlers and preschoolers previously and during the COVID-19 pandemic. A questionnaire was applied by telephone to parents/caregivers of children between 1 and 5 years old, followed up at four primary care units belonging to the Group of Primary Health Care Centers of Western Porto, Portugal. A total of 520 children were included: 52.9% male, mean age 39.4 ± 13.9 months. The mean age of first exposure to screens was 13.9 ± 8.0 months, and most of the children were exposed to more than one screen daily. Considering the WHO recommendations, before the COVID-19 pandemic, 385 (74.0%) and 408 (78.5%) children had excessive ST during the week and the weekend, respectively; during the lockdown, these values increased to 495 (95.2%) and 482 (92.7%). Maternal education and both the child's median age and the median age of first exposure to screens had a statistically significant association with excessive ST, with OR 0.2 (p = 0.03, CI 95% 0.07-0.86), OR 1.1 (p = 0.01, 95% CI 1.05-1.14) and OR 0.9 (p = 0.05, 95% CI 0. 87-0.98), respectively. Most children in this sample had a higher than recommended ST, which increased with the onset of the COVID-19 pandemic. These results are worrisome and point to the need for urgent intervention.
Abstract: In this paper, the comparison of composite programming and compromise programming for the aircraft selection problem is discussed using the multiple criteria decision analysis method. The decision making process requires the prior definition and fulfillment of certain factors, especially when it comes to complex areas such as aircraft selection problems. The proposed technique gives more efficient results by extending the composite programming and compromise programming, which are widely used in modeling multiple criteria decisions. The proposed model is applied to a practical decision problem for evaluating and selecting aircraft problems.A selection of aircraft was made based on the proposed approach developed in the field of multiple criteria decision making. The model presented is solved by using the following methods: composite programming, and compromise programming. The importance values of the weight coefficients of the criteria are calculated using the mean weight method. The evaluation and ranking of aircraft are carried out using the composite programming and compromise programming methods. In order to determine the stability of the model and the ability to apply the developed composite programming and compromise programming approach, the paper analyzes its sensitivity, which involves changing the value of the coefficient λ and q in the first part. The second part of the sensitivity analysis relates to the application of different multiple criteria decision making methods, composite programming and compromise programming. In addition, in the third part of the sensitivity analysis, the Spearman correlation coefficient of the ranks obtained was calculated which confirms the applicability of all the proposed approaches.
Abstract: Farm management and operations will drastically change due to access to real-time data, real-time forecasting and tracking of physical items in combination with Internet of Things (IoT) developments to further automate farm operations. Dairy farms have embraced technological innovations and procured vast amounts of permanent data streams during the past decade; however, the integration of this information to improve the whole farm decision-making process does not exist. It is now imperative to develop a system that can collect, integrate, manage, and analyze on-farm and off-farm data in real-time for practical and relevant environmental and economic actions. The developed systems, based on machine learning and artificial intelligence, need to be connected for useful output, a better understanding of the whole farming issue and environmental impact. Evolutionary Computing (EC) can be very effective in finding the optimal combination of sets of some objects and finally, in strategy determination. The system of the future should be able to manage the dairy farm as well as an experienced dairy farm manager with a team of the best agricultural advisors. All these changes should bring resilience and sustainability to dairy farming as well as improving and maintaining good animal welfare and the quality of dairy products. This review aims to provide an insight into the state-of-the-art of big data applications and EC in relation to smart dairy farming and identify the most important research and development challenges to be addressed in the future. Smart dairy farming influences every area of management and its uptake has become a continuing trend.
Abstract: In a task to assist NASA in analyzing the dynamic forces caused by operational countermeasures of an astronaut’s exercise platform impacting the spacecraft, an active proportional-integral-derivative controller commanding a linear actuator is proposed in a vibration isolation system to regulate the movement of the exercise platform. Computer simulation shows promising results that most exciter forces can be reduced or even eliminated. This paper emphasizes on parameter uncertainties, variations and exciter force variations. Drift and variations of system parameters in the vibration isolation system for astronaut’s exercise platform are analyzed. An active controlled scheme is applied with the goals to reduce the platform displacement and to minimize the force being transmitted to the spacecraft structure. The controller must be robust enough to accommodate the wide variations of system parameters and exciter forces. Computer simulation for the vibration isolation system was performed via MATLAB/Simulink and Trick. The simulation results demonstrate the achievement of force reduction with small platform displacement under wide ranges of variations in system parameters.
Abstract: In this paper, a suitable measurement setup is presented to conduct force and pressure measurements for transient contact cases at the example of lathe machine tending. Empirical measurements were executed on a selected collaborative robot’s behavior regarding allowable operating speeds under consideration of sensor- and workpiece-specific factors. Comparisons between the theoretic calculations proposed in ISO/TS 15066 and the practical measurement results reveal a basis for future research. With the created database, preliminary risk assessment and economic assessment procedures of collaborative machine tending cells can be facilitated.
Abstract: This work presents the particle swarm optimization trained neural network (PSO-NN) supervisory proportional integral derivative (PID) control method to monitor the pressurized water reactor (PWR) core power for safe operation. The proposed control approach is implemented on the transfer function of the PWR core, which is computed from the state-space model. The PWR core state-space model is designed from the neutronics, thermal-hydraulics, and reactivity models using perturbation around the equilibrium value. The proposed control approach computes the control rod speed to maneuver the core power to track the reference in a closed-loop scheme. The particle swarm optimization (PSO) algorithm is used to train the neural network (NN) and to tune the PID simultaneously. The controller performance is examined using integral absolute error, integral time absolute error, integral square error, and integral time square error functions, and the stability of the system is analyzed by using the Bode diagram. The simulation results indicated that the controller shows satisfactory performance to control and track the load power effectively and smoothly as compared to the PSO-PID control technique. This study will give benefit to design a supervisory controller for nuclear engineering research fields for control application.
Abstract: Identification of plant diseases has been performed using machine learning and deep learning models on the datasets containing images of healthy and diseased plant leaves. The current study carries out an evaluation of some of the deep learning models based on convolutional neural network architectures for identification of plant diseases. For this purpose, the publicly available New Plant Diseases Dataset, an augmented version of PlantVillage dataset, available on Kaggle platform, containing 87,900 images has been used. The dataset contained images of 26 diseases of 14 different plants and images of 12 healthy plants. The CNN models selected for the study presented in this paper are AlexNet, ZFNet, VGGNet (four models), GoogLeNet, and ResNet (three models). The selected models are trained using PyTorch, an open-source machine learning library, on Google Colaboratory. A comparative study has been carried out to analyze the high degree of accuracy achieved using these models. The highest test accuracy and F1-score of 99.59% and 0.996, respectively, were achieved by using GoogLeNet with Mini-batch momentum based gradient descent learning algorithm.
Abstract: This paper presents a software product quality evaluation model based on the ISO/IEC 25010 quality model. The evaluation characteristics and sub characteristics were identified from the ISO/IEC 25010 quality model. The multidimensional structure of the quality model is based on characteristics such as functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability, and associated sub characteristics. Random numbers are generated to establish the decision maker’s importance weights for each sub characteristics. Also, random numbers are generated to establish the decision matrix of the decision maker’s final scores for each software product against each sub characteristics. Thus, objective criteria importance weights and index scores for datasets were obtained from the random numbers. In the proposed model, five different software product quality evaluation datasets under three different weight vectors were applied to multiple criteria decision analysis method, preference analysis for reference ideal solution (PARIS) for comparison, and sensitivity analysis procedure. This study contributes to provide a better understanding of the application of MCDMA methods and ISO/IEC 25010 quality model guidelines in software product quality evaluation process.
Abstract: 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.
Abstract: 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.
Abstract: 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.
Abstract: 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.
Abstract: 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.
Abstract: 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.
Abstract: Run-of-river (RoR) hydropower projects represent a viable, clean, and cost-effective alternative to dam-based plants and provide decentralized power production. However, RoR schemes’ cost-effectiveness depends on the proper selection of site and design flow, which is a challenging task because it requires multivariate analysis. In this respect, this study presents the development of an investment decision support tool for assessing the optimal size of an RoR scheme considering the technical, environmental, and cost constraints. The net present value (NPV) from a project perspective is used as an objective function for supporting the investment decision. The tool has been tested by applying it to an actual RoR project recently proposed in Colombia. The obtained results show that the optimum point in financial terms does not match the flow that maximizes energy generation from exploiting the river's available flow. For the case study, the flow that maximizes energy corresponds to a value of 5.1 m3/s. In comparison, an amount of 2.1 m3/s maximizes the investors NPV. Finally, a sensitivity analysis is performed to determine the NPV as a function of the debt rate changes and the electricity prices and the CapEx. Even for the worst-case scenario, the optimal size represents a positive business case with an NPV of 2.2 USD million and an internal rate of return (IRR) 1.5 times higher than the discount rate.
Abstract: 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.
Abstract: 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.
Abstract: 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.