Obesity is the fifth leading cause of global deaths. The efficacy and safety of obesity treatment is still controversial. The objective of the thesis is to evaluate the efficacy and safety of bariatric surgery, through a systematic review of the current evidence and meta- analysis of important outcomes. Nineteen (19) randomized controlled trials (RCTs) with 1346 participants were included. Bariatric surgery resulted in greater weight loss when compared to non-surgical treatment. Weight loss was also associated with resolution and/or improvement of obesity related comorbidites such as diabetes, hypertension, hyperlipidemia, and sleep apnea. Weight loss and safety varied across the surgical procedures. Biliopancreatic diversion/duodenal switch had the greatest weight loss, followed by sleeve gastrectomy and Roux-en-Y gastric bypass, purely restrictive procedures such as vertical banded gastroplasty and adjustable gastric banding resulted in the least weight loss. Long term, high quality, and adequately powered trials are still needed to support the available evidence

The aim of this thesis is going to concentrate on the issues associated with the technology of mechanically anchored coating waterproofing of roofs. Today the mechanical anchoring belongs to the most widespread way of how to stabilize the layers of roofing material against the effects of wind uplift particularly in indoor buildings. However some malfunctions occur more and more frequently which cause leaking into the constructions or even the destruction of the whole roof in the worse cases. The practical part of this thesis is going to concentrate on the fasterners which belong to the most important elements of the mechanical anchored system. The aim of the experimental measurement is to draw a comparison of the quality of fasteners which are distributed on the Czech market. Thereafter the obtained figures are going to be compared with the theoretical calculating procedures according to the valid designed standards.

CPTU is one of the most sophisticated geotechnical investigation methods. However, there is a large amount of uncertainties related to this method. The uncertainties depend on different types of factors, for instance lack of accuracy in performance and equipment. The objective of this master thesis is to compare the CPTU-results from a number of commercial actors in Stockholm/Mälardalen in order to analyze these results with respect to the current standards and guidelines. The comparison was made in order to highlight the difference in results which may appear due to different equipment, performance of the operator and evaluation method. Based on this, an invite was sent to the commercial actors in Stockholm/Mälardalen, resulting in the participation of five different commercial actors in this investigation. Execution in the field was conducted over a six week period. During this time 26 CPTU were performed in total in a small area in Hagby, Stockholm, by these different actors. Once the data was collected from all of the actors, the results were evaluated with the aid of the computer softwares Conrad and Excel. The main conclusions from this study are: Not one of the performed CPTU in this master thesis fulfills the requirements for CPT class 1 according to the European standards. The quality of the education of operators should be improved and geotechnical engineers and the clients need to be more familiar with CPTU. The evaluated results from different commercial actors differ, and this can depend on the choice of equipment and performance of the operator during penetration, but it can also depend on systematic errors in the cone penetrometers / CPTU-sonderingar är en av de mest sofistikerade undersökningsmetoderna för geoteknisk analys och bedömning. Det finns emellertid en hög grad av osäkerhet i denna metod. Osäkerheten beror på olika typer av faktorer, bland annat brist på noggrannhet i handhavande och utrustning. Syftet med detta examensarbete är att jämföra CPTU-resultat från de kommersiella aktörerna i Stockholm/Mälardalen för att senare analysera dessa resultat i förhållande till gällande ramverk och riktlinjer. Jämförelsen gjordes med avsikt att lyfta fram skillnaderna i resultat som kan uppstå på grund av olika utrustning, handhavande och utvärderingsmetod. Baserat på detta skickades en inbjudan till de kommersiella aktörerna i Stockholm/Mälardalen, vilket ledde till att fem olika kommersiella aktörer deltog i undersökningen. Utförande i fält genomfördes under en period på sex veckor. Under denna tid utfördes totalt 26 sonderingar i ett avgränsat område i Hagby, Stockholm, av dessa olika aktörer. När all data samlats in från alla aktörer utvärderades resultaten med hjälp av mjukvarorna Conrad och Excel. De viktigaste slutsatserna i denna studie är: Ingen utav de utförda CPTU-sonderingarna uppfyller kraven för CPT klass 1 enligt den europeiska standarden. Kvaliteten på utbildning av fältgeotekniker bör förbättras och geotekniska ingenjörer och även beställare bör bli mer bekanta med CPT. De utvärderade resultaten från de olika aktörerna skiljer sig åt, och detta kan bero på valet av utrustning och fältgeoteknikerns prestation vid sondering men det kan också bero på systematiska fel i de använda sonderna.

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Ο αυξημένος σπλαχνικός λιπώδης ιστός αποτελεί σημαντικό παράγοντα κινδύνου για μεταβολικές επιπλοκές, που συσχετίζονται με την παχυσαρκία, και προάγει μία ήπιου βαθμού χρόνια φλεγμονώδη διαδικασία. Το επίπλουν έχει από καιρό εμπλακεί στη, σχετιζόμενη με την παχυσαρκία, μεταβολική δυσλειτουργία. Αυτό βασίζεται στη σημαντική του λειτουργία, της έκκρισης αντιποκινών. Η ιδέα της εκτομής του μείζονος επιπλόου, στον ίδιο χρόνο με μία βαριατρική επέμβαση, έχει προταθεί για την βελτίωση των μεταβολικών μεταβολών και την μεγιστοποίηση της απώλειας βάρους. Ο σκοπός της συγκεκριμένης μελέτης ήταν να προσδιορίσει εάν η εκτομή του μείζονος επιπλόου, στον ίδιο χρόνο με τη λαπαροσκοπική επιμήκη γαστρεκτομή, έχει κάποια επίδραση στο μεταβολικό προφίλ, την έκκριση των αντιποκινών, το στάτους της φλεγμονής και την απώλεια βάρους, σε βραχύ ή μακρό βάθος χρόνου. ΜΕΘΟΔΟΙ: Τριάντα – ένας παχύσαρκοι ασθενείς (Δείκτης Μάζας Σώματος (ΒΜΙ): 42.49±2.03 Kg/m2 ) τυχαιοποιήθηκαν σε δύο ομάδες, λαπαροσκοπικής επιμήκους γαστρεκτομής, με ή χωρίς επιπλεκτομή. Αντιπονεκτίνη, Ομεντίνη, Ιντερλευκίνη-6 (IL-6), tumor necrosis factor-α ((TNF-α), C-αντιδρώσα πρωτεΐνη υψηλής ευαισθησίας (hs-CRP), high-density lipoprotein (HDL) χοληστερόλη, γλυκόζη νηστείας, ινσουλίνη και αντίσταση στην ινσουλίνη (εκτιμωμένη με εφαρμογή -­‐ 106 -­‐ Quickie Test) μετρήθηκαν και εκτιμήθηκαν προεγχειρητικά και 7 μέρες, 1, 3 και 12 μήνες μετεγχειρητικά. ΑΠΟΤΕΛΕΣΜΑΤΑ: Κατά τη μετεγχειρητική παρακολούθηση, στη διάρκεια του πρώτου χρόνου, ο δείκτης μάζας σώματος μειώθηκε αξιοσημείωτα και συγκριτικά και στις δύο ομάδες (Ρ<0.001). Τα επίπεδα της ινσουλίνης, IL-6 και hs-CRP, μειώθηκαν σημαντικά σε σχέση με τις τιμές αναφοράς (προεγχειρητικά) (Ρ<0.05) και στις δύο ομάδες, χωρίς στατιστικά σημαντική διαφορά μεταξύ τους. Τα επίπεδα αντιπονεκτίνης και HDL αυξήθηκαν ομοίως και σημαντικά, συγκρινόμενα με τα επίπεδα αναφοράς (Ρ<0.001) και στις δύο ομάδες. Τα επίπεδα της Ομεντίνης αυξήθηκαν σημαντικά (Ρ<0.05) στην ομάδα ελέγχου (επιμήκης γαστρεκτομή, χωρίς εκτομή του επιπλόου) και παρέμειναν χαμηλά στην ομάδα της επιπλεκτομής (επιμήκης γαστρεκτομή + επιπλεκτομή), στο ένα έτος μετεγχειρητικά. Δεν υπήρξε στατιστικά σημαντική διαφορά στη μεταβολή των επιπέδων TNF-α σε κάθε ομάδα. ΣΥΜΠΕΡΑΣΜΑΤΑ: Τα, μέχρι τώρα, θεωρητικά πλεονεκτήματα της επιπλεκτομής, όσον αφορά την απώλεια βάρους και το μεταβολικό σύνδρομο, δεν αντικατοπτρίζονται στην προοπτική αυτή μελέτη. Επιπλέον, δοθέντος του προστατευτικού ρόλου της ομεντίνης σε συνδυασμό με τη θετική συσχέτισηή της με τα επίπεδα αντιπονεκτίνης πλάσματος και HDL, ήδη γνωστών καρδιοπροστατευτικών πρωτεϊνών, ανακύπτουν ερωτήματα γύρω από την αρνητική επίδραση της επιπλεκτομής και καρδιαγγειακής φυσιολογίας, σε βάθος χρόνου. / Increased visceral adipose tissue is a risk factor for the metabolic complications associated with obesity and promotes a low-grade chronic inflammatory process. Resection of the great omentum in patients submitted to a bariatric procedure has been proposed for the amelioration of metabolic alterations and the maximization of weight loss. The aim of the present study was to investigate the impact of omentectomy performed in patients with morbid obesity undergoing sleeve gastrectomy (SG) on metabolic profile, adipokine secretion, inflammatory status and weight loss. Methods: Thirty-one obese patients were randomized into two groups, SG alone or with omentectomy. Adiponectin, omentin, interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), high sensitivity C-reactive protein (hs-CRP), blood lipids, fasting glucose, insulin and insulin resistance were measured before surgery and at 7 days, and 1, 3 and 12 months after surgery. Results: During the one year follow up BMI decreased markedly and comparably in both groups (P<0.001). Insulin, IL-6 and hs-CRP levels decreased significantly compared to baseline (P<0.05) in both groups with no significant difference between groups. Adiponectin and high-density lipoprotein choresterol levels were significantly and similarly increased compared to baseline (P<0.001) in both groups. Omentin levels increased significantly (p<0.05) in the control group and decreased in -­‐ 108 -­‐ the omentectomy group one year postoperatively. There was no significant change in TNF-α levels in either group. Conclusions: The theoretical advantages of omentectomy in regard to weight loss and obesity related abnormalities are not confirmed in this prospective study. Furthermore, omentectomy does not induce important changes in the inflammatory status in patients undergoing SG.

Introducción: La obesidad es un problema de salud pública y la cirugía bariátrica es considerada como un tratamiento efectivo a largo plazo. Estos procedimientos tienen una mortalidad de hasta el 0.08% dentro de los 30 días postoperatorios y una tasa de complicaciones de hasta el 17%. El índice neutrófilo linfocito (INL) es un marcador de inflamación que ha sido utilizado como marcador pronóstico en diversas patologías inflamatorias y cirugías. Objetivo: El presente estudio tuvo el objetivo de evaluar el rendimiento del índice neutrófilo-linfocito (INL) preoperatorio como predictor de complicaciones tempranas posterior a la gastrectomía en manga. Métodos: Se realizó un estudio de cohorte retrospectivo a partir del análisis de la base de datos institucional de la Clínica Avendaño durante los años 2017 a 2020. El índice neutrófilo linfocito se calculó a partir del hemograma preoperatorio. Se cálculo el área bajo la curva para determinar el rendimiento del INL preoperatorio como predictor de complicaciones tempranas post gastrectomía en manga y se presentaron diferentes escenarios de acuerdo a los puntos de corte de INL con sus respectivos parámetros estadísticos. Resultados: Se estudiaron 387 pacientes operados por gastrectomía en manga en la Clínica Avendaño. De dichos pacientes, 45 pacientes presentaron complicaciones en los 30 primeros días postoperatorios (11.6%). El área bajo la curva para INL como predictor de complicaciones generales tempranas post gastrectomía en manga fue de 0.423 y para complicaciones severas fue de 0.392. Conclusión: El INL preoperatorio no es un buen predictor de complicaciones tempranas por gastrectomía en manga. / Background: Obesity is a public health problem. Bariatric surgery is an effective long term treatment for obesity. This procedure has a mortality up to 0.08% during the 30 days postoperative and up to 17% of complications. The neutrophil to lymphocyte ratio (NLR) is an inflammatory marker used for prognostic of inflammatory diseases and surgery. Objectives: The objective of our study is to evaluate the utility of preoperative neutrophil to lymphocyte ratio (NLR) as a predictor of early postoperative complications of sleeve gastrectomy. Methods: We performed a retrospective cohort study by the analysis of the institutional data base of Clinica Avendaño between 2017 and 2020. NLR values were obtained from the preoperative complete blood count. We calculated the ROC curve and different cut points with their statistic parameters for NLR as predictor of early postoperative complications after sleeve gastrectomy. Results: A total of 387 patients went under sleeve gastrectomy. Of the patients, 45 patients (11.6%) had early postoperative complications. The Receiver Operating Characteristic Curve (ROC curve) for NLR as predictor of early complications post sleeve gastrectomy was 0.423 and 0.392 for severe complications. Conclusion: Preoperative NLR it’s not a good predictor for early postoperative complications for sleeve gastrectomy. / Tesis

Das Krankheitsbild der Adipositas hat sich weltweit zu einem relevanten Gesundheitsproblem entwickelt. Die bariatrische Chirurgie wird zunehmend als wirkungsvolle Behandlung bei schwer ausgeprägter Adipositas eingesetzt. Jedoch ist über die Rolle psychologischer Variablen im bariatrischen Behandlungsverlauf noch wenig bekannt. Die vorliegende Dissertation untersucht Einfluss und Veränderung patientenberichteter Gesundheitsmerkmale in der chirurgischen Adipositastherapie. Dazu werden in einer naturalistischen Beobachtungsstudie Patienten mit schwerer Adipositas vor und im Durchschnitt zwei Jahre nach einer bariatrischen Operation (OP) befragt. Ziele der Arbeit sind 1) die Charakterisierung adipöser Patienten vor OP hinsichtlich bio-psycho-sozialer Variablen; 2) die Identifikation möglicher Einflussvariablen auf den gewichtsbezogenen Behandlungserfolg nach OP; 3) die Untersuchung von Auswirkungen der OP auf das Essverhalten; und 4) die Analyse von Veränderungen in der essstörungsbezogenen Psychopathologie und in der gesundheitsbezogenen Lebensqualität nach OP. Die Ergebnisse der bariatrischen Patienten werden im Vergleich zu denen konservativ behandelter Patienten betrachtet. Die Ergebnisse zeigen, dass Patienten mit bariatrischem Behandlungswunsch eine somatisch und psychisch belastete Patientengruppe darstellen. Die bariatrische OP führt im zweiten postoperativen Jahr zu einer nachhaltigen und klinisch bedeutsamen Gewichtsreduktion. Der präoperative Body-Maß-Index, das Bildungsniveau und aktives Problembewältigungsverhalten sind mit dem Gewichtsverlust nach OP assoziiert. Im Vergleich zur konservativen Behandlung berichten die Patienten, die sich der OP unterziehen, über stärker ausgeprägte Verbesserungen in ihrem Essverhalten und eine Steigerung ihrer Lebensqualität. Auf Basis der Befunde wird ein routinemäßiges Monitoring der somatischen und psychischen Situation der Patienten nach bariatrischer OP empfohlen, um die gezeigten Behandlungserfolge optimal zu sichern. / Obesity has become a relevant global health problem. Bariatric surgery is an effective treatment for severe obesity. However, while the number of operations performed continues to increase, the role of psychological variables throughout the bariatric surgery pathway remains uncertain. The present dissertation investigates the patient-reported health status as it impacts and results from bariatric surgery. In a naturalistic observational study, patients with severe obesity are assessed before and, on average, two years after the surgical treatment. Main aims are 1) to characterize obese patients prior to bariatric surgery in terms of biological, psychological and socio-demographic variables; 2) to identify possible predictors for the postoperative weight-related treatment success after bariatric surgery; 3) to examine changes in eating behaviors; and 4) to analyze changes in eating-related psychopathology and in health-related quality of life (HRQoL). The outcomes of surgical patients are compared with those of conservatively treated patients for the same follow-up period. The findings show that bariatric surgery candidates represent a vulnerable patient group with high physical and psychological burden. In the second postoperative year after bariatric surgery, a sustainable and clinically meaningful weight reduction is achieved. The preoperative body mass index, education level and active coping behavior are associated with weight loss after surgery. Compared with conservative treatment, patients who undergo bariatric surgery report not only greater improvements in their eating behavior and eating-related psychopathology but also an increase in their HRQoL. Based on the results, the provision of a routine monitoring of the somatic and psychological situation of patients following bariatric surgery is recommended to secure longer-term treatment success.

The diploma thesis focuses on manufacturing carbon fiber and epoxy composite material using filament winding method. Material properties of manufactured composite are ap-proximated using analytical and numerical homogenization models. Calculated material properties are applied to design and evaluate reserve factor of retaining sleeve for high speed brushless permanent magnet synchronous motor. Margin of safety of designed rotor is evaluated using composite failure criteria. Test stand for both static and dynamic testing is designed, static test stand is manufactured and assembled. Static strength test is carried out.