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Overall, multiple mechanisms including inflammation and reduced FA re-esterification likely explain the impaired buffering capacity in adipocytes during obesity that leads to the spillover of FAs, buildup of toxic lipid metabolites and allosteric regulators that suppress insulin action and increased hepatic glucose output, respectively (Figure 5)

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The L45 intervertebral disk was desiccated with diffuse disk bulging causing severe reduction of both L45 intervertebral foramina and severe spinal canal stenosis at the same level