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We obtained five clusters for each sex, the concordant cluster (assigned to 78.64% of men and 78.92% of women, Table 2) and four distinct clusters

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and second, further weight loss or gain after surgery can affect the result

The terminology is contested, but the underlying observation is not: the metabolic deterioration of neurons, their diminishing capacity to produce and manage energy, appears to be an early and potentially modifiable feature of the disease process, not merely a downstream consequence of it