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While the prevalence of overweight and obesity has been increasing annually, the accessibility of on-site treatment programs is not rising correspondingly. Digital, evidence-based obesity treatment programs could potentially alleviate this situation. The application zanadio has been developed to enable patients with obesity (BMI 30–45 kg/m2) to participate in a digital, multimodal weight reduction program based on current treatment guidelines. This article is divided into two parts: (I) it introduces zanadio, its aims and therapeutic concept, and (II) provides a first impression and demographic data on more than 11,000 patients from across the country who have used zanadio within the last 16 months, which demonstrates the demand for a digital obesity treatment. zanadio has the potential to partially close the current gap in obesity care. Future work should focus on identifying predictors of successful weight loss to further individualize digital obesity treatment, and an important next step would be to prevent obesity, i.e., to start the treatment at lower BMI levels, and to invent digital treatment programs for children and adolescents.

Obesity is associated with automatically approaching problematic stimuli, such as unhealthy food. Cognitive bias modification (CBM) could beneficially impact problematic approach behavior. However, it is unclear which mechanisms are targeted by CBM in obesity. Candidate mechanisms include: (1) altering reward value of food stimuli; and (2) strengthening inhibitory abilities. Thirty-three obese adults completed either CBM or sham training during functional magnetic resonance imaging (fMRI) scanning. CBM consisted of implicit training to approach healthy and avoid unhealthy foods. At baseline, approach tendencies towards food were present in all participants. Avoiding vs. approaching food was associated with higher activity in the right angular gyrus (rAG). CBM resulted in a diminished approach bias towards unhealthy food, decreased activation in the rAG, and increased activation in the anterior cingulate cortex. Relatedly, functional connectivity between the rAG and right superior frontal gyrus increased. Analysis of brain connectivity during rest revealed training-related connectivity changes of the inferior frontal gyrus and bilateral middle frontal gyri. Taken together, CBM strengthens avoidance tendencies when faced with unhealthy foods and alters activity in brain regions underpinning behavioral inhibition.

Obesity is associated with automatically approaching problematic stimuli, such as unhealthy food. Cognitive bias modification (CBM) could beneficially impact on problematic approach behavior. However, it is unclear which mechanisms are targeted by CBM in obesity: Candidate mechanisms include (1) altering reward value of food stimuli or (2) strengthening inhibitory abilities. 33 obese people completed either CBM or sham training during fMRI scanning. CBM consisted of an implicit training to approach healthy and avoid unhealthy foods. At baseline, approach tendencies towards food were present in all participants. Avoiding vs. approaching food was associated with higher activity in the right angular gyrus (rAG). CBM resulted in a diminished approach bias towards unhealthy food, decreased activation in the rAG, and increased activation in the anterior cingulate cortex. Relatedly, functional connectivity between the rAG and right superior frontal gyrus increased. Analysis of brain connectivity during rest revealed training-related connectivity changes of the inferior frontal gyrus and bilateral middle frontal gyri. Taken together, CBM strengthens avoidance tendencies when faced with unhealthy foods and alters activity in brain regions underpinning behavioral inhibition.

Much of our behaviour is driven by two motivational dimensions - approach and avoidance. These have been related to frontal hemispheric asymmetries in clinical and resting-state EEG studies: approach was linked to higher activity of the left relative to the right hemisphere, while avoidance was related to the opposite pattern. Increased approach behaviour, specifically towards unhealthy foods, is also observed in obesity and has been linked to asymmetry in the framework of the right-brain hypothesis of obesity. Here, we aimed to replicate previous EEG findings of hemispheric asymmetries for self-reported approach/avoidance behaviour and to relate them to eating behaviour. Further, we assessed whether resting fMRI hemispheric asymmetries can be detected and whether they are related to approach/avoidance, eating behaviour, and BMI. We analysed 3 samples: Sample 1 (n=117) containing EEG and fMRI data from lean participants, and Samples 2 (n=89) and 3 (n=152) containing fMRI data from lean, overweight, and obese participants. While in Sample 1 approach in women was related to EEG and fMRI hemispheric asymmetries, in Samples 2 and 3 this effect was not significant. Here, hemispheric asymmetries were neither related to BMI nor eating behaviour. Our study partly replicates previous EEG findings regarding hemispheric asymmetries and indicates that this relationship could also be captured using fMRI. Our findings suggest that eating behaviour and obesity are likely to be mediated by mechanisms not directly relating to frontal asymmetries in neuronal activation quantified with EEG and fMRI.

Background: Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years. Methods: 50 patients underwent EC-IC standard bypass surgery with translocation of the superficial temporal artery to an M2 segment of the medial cerebral artery. Criteria for bypass surgery were presence of symptomatic occlusive cerebrovascular disease of the anterior circulation and proof of a severely restricted or abrogated reserve capacity (detected by H 2 O-photon emission tomography or single photon emission computer tomography - before and after forced vessel dilatation by diamox). The incidence of perioperative neurological and surgical complications, bypass patency, bypass function and short-term outcome were retrospectively analyzed. Results: The study cohort consisted of 16 patients ≥70 years (mean = 74.3 years, SE 1.3). It was compared to a cohort of 34 patients <70 years (mean = 61.2 years, SE 1.0). Both groups underwent EC-IC bypass surgery after careful preoperative work-up. Both patient groups did not differ significantly in gender, vascular pathology, previous history of diseases/comorbidity or clinical symptoms. The number of patients which underwent stenting or other endovascular treatments of the internal or common carotid artery prior to EC-IC bypass surgery was significantly higher in the group of patients ≥70 years (37.5 vs. 0%, p < 0.001). Perioperative stroke rate was 0% in both groups and mild morbidity occurred in 18.8 and 14.7%, respectively (p = 0.699). One 84-year-old female patient died due to perioperative endocarditis. Initial bypass patency was 93.8% in patients above the age of 70 years and 97.1% in the younger group (p = 0.542). Secondary occlusion rate was low in both groups (≥70 years: 0% vs. <70 years 3.7%). No new neurologic deficit occurred in patients with a patent bypass during the follow-up period (median 18 ± 13.1 months). Two patients with an initially occluded bypass and one with a secondary bypass occlusion suffered from new neurological symptoms. Conclusions: Our data show comparable safety and efficiency of EC-IC bypass surgery in patients under and above the age of 70 years due to a careful preoperative work-up and a strict indication for bypass surgery.

The first systematic research on the funerary record at the Río Bote 1 (RB1) rockshelter, located next to the Bote River, a tributary of the Santa Cruz River in southern Patagonia, has revealed at least three human burial events dating to the very early Late Holocene and one dating to the middle Late Holocene. The RB1 site appears to have been used for both subsistence and inhumation activities. All of the burials uncovered postdate the deposition of a prominent volcanic ash layer. Technological information indicates that RB1 was used by groups that were also using spaces to the west and south. Mortuary evidence indicates connections with groups living in areas extending from the Última Esperanza region to the Pali Aike volcanic field, at least at the beginning of the Late Holocene. The selection of the same place for multiple burials may explain why so few human burials are known in southern Patagonia from the beginning of the Late Holocene and earlier periods, as it is possible that sites like RB1 are yet to be discovered. El abrigo rocoso de Río Bote 1 (RB1) está localizado en la margen derecha del río Bote, un afluente del río Santa Cruz. Las primeras investigaciones sistemáticas sobre el registro arqueológico en este lugar han mostrado la presencia de al menos tres episodios de entierros humanos correspondientes a la parte inicial del Holoceno tardío y uno correspondiente a la parte media de este período. El sitio parece haber sido utilizado tanto para actividades de subsistencia como funerarias. Todos los entierros son posteriores a la depositación de un nivel de ceniza volcánica en el sitio. La información tecnológica indica que RB1 fue utilizado por grupos que también emplearon los espacios ubicados al oeste y al sur. La evidencia mortuoria señala conexiones con grupos que vivían en áreas localizadas hacia el sur, desde la región de Última Esperanza hasta el campo volcánico de Pali Aike, al menos al inicio del Holoceno tardío. La selección del mismo lugar para estos entierros múltiples podría explicar por qué se conocen tan pocos entierros humanos en Patagonia meridional correspondientes a principios del Holoceno tardío y períodos anteriores, ya que se considera posible que resten por descubrir más sitios semejantes a Río Bote 1.

The first systematic research on the funerary record at the Río Bote 1 (RB1) rockshelter, located next to the Bote River, a tributary of the Santa Cruz River in southern Patagonia, has revealed at least three human burial events dating to the very early Late Holocene and one dating to the middle Late Holocene. The RB1 site appears to have been used for both subsistence and inhumation activities. All of the burials uncovered postdate the deposition of a prominent volcanic ash layer. Technological information indicates that RB1 was used by groups that were also using spaces to the west and south. Mortuary evidence indicates connections with groups living in areas extending from the Última Esperanza region to the Pali Aike volcanic field, at least at the beginning of the Late Holocene. The selection of the same place for multiple burials may explain why so few human burials are known in southern Patagonia from the beginning of the Late Holocene and earlier periods, as it is possible that sites like RB1 are yet to be discovered.