Kaiser (Czechia)

Abstract Background Biological therapy has revolutionized the treatment of inflammatory bowel disease (IBD); however, a subset of patients still requires therapy optimization to achieve therapeutic goals. This study aimed to identify patients who underwent biological therapy optimization (TO) and compare their characteristics with those who did not require such adjustments. Methods A retrospective study was conducted using data from the national patient registry of GEDIIB (Brazilian Crohn's and Colitis Organization). A total of 1,660 patients with Crohn's disease (CD) and 530 patients with ulcerative colitis (UC) undergoing biological therapy were included. The need for TO was determined based on clinical or endoscopic criteria specific to each participating center. Statistical analyses included association tests and Poisson regression. Results The need for TO was more frequent among patients with CD(33.3%) compared to those with UC (26.2%) (p=0.003). In CD, optimization was associated with younger age (p=0.016), stenosing (p=0.03) or penetrating behavior (p=0.015), perianal disease (p<0.001), presence of fistula (p=0.019), and prior surgery (p=0.044). Table 1 displays the adjusted frequency ratio (FR) for TO in CD patients. After adjusting for confounding factors, the most significant predictors for optimization in CD were younger age, perianal disease, and prior surgery. In UC, optimization was associated with younger age (p=0.013), pancolitis extent (p<0.001), previous surgery (p=0.037), hospitalization (p=0.025), and chronic liver disease (p=0.024). Table 2 presents the adjusted FR for therapy optimization in UC patients. After adjustment, the factors most strongly associated with optimization in UC were prior surgery and chronic liver disease. Conclusion Approximately 30% of patients required optimization of biological therapy. This need was associated with younger age, a more severe disease profile, and the presence of complications, such as perianal disease in CD, as well as a history of surgery and hospitalization in UC. References Papamichael K, Cheifetz AS, Melmed GY, Irving PM, Vande Casteele N, Kozuch PL, Raffals LE, Baidoo L, Bressler B, Devlin SM, Jones J, Kaplan GG, Sparrow MP, Velayos FS, Ullman T, Siegel CA. Appropriate Therapeutic Drug Monitoring of Biologic Agents for Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2019 Aug;17(9):1655-1668.e3. doi: 10.1016/j.cgh.2019.03.037. Fróes RSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep. 2024 Feb 21;14(1):4314. doi: 10.1038/s41598-024-54332-1.

Keratopigmentation (KTP), or corneal tattooing, has evolved from a treatment for disfigured blind eyes to addressing functional pathologies and, more recently, cosmetic enhancement in sighted eyes. Advances in KTP now include the use of femtosecond laser-assisted intrastromal pockets, originally designed for intrastromal corneal ring segments and later adapted for pigment implantation. Various femtosecond laser platforms are used to create these precise stromal tunnels for femtosecond laser-assisted annular KTP. We introduce a novel technique using a femtosecond laser platform to join 2 adjacent small circular stromal tunnels, creating a large, unified, and consistent circular stromal pocket for pigment implantation. This method minimizes the need for manual dissection and holds promise for various clinical applications. A longer follow-up period is necessary to evaluate the potential refractive effects associated with the creation of complete 360-degree tunnels.

This paper explores the influence of the drain current variation in crossbars of different scaled FeFET devices for IMC macro design. Several methods are proposed to mitigate the increased device variability in highly scaled memory devices by improvements on circuit, architectural, and algorithmic levels to reduce the associated accuracy loss. The efficiency of these new techniques is demonstrated on various relevant image classification benchmarks.


 
 
 Akademija združenih (Academia unitorum) ali bratovščina sv. Dizme je v pripravi na srečno smrt ter v molitvi in darovanju maš za pokojne člane od leta 1688 do začetka 19. stoletja povezovala predvsem plemiče, a tudi akademsko izobražene ljudi, cerkvene odličnike in visoke uradnike na Kranjskem, posebej v Ljubljani. Prispevek obravnava zadnjo znano sestavo članstva po seznamu iz leta 1801, na katerem je 52 imen oseb, sprejetih v bratovščino med letoma 1755 in 1801. Glavni namen je kratek prikaz njihovih življenjskih poti, s čimer bo zapolnjena velika vrzel v védenju o kranjski družbeni eliti 18. stoletja, med katero glede na njeno duhovno naravnanost najdemo tako dejanske kot potencialne na­ ročnike umetniških del. Zadnja sestava članstva je bila zelo heterogena, od zunaj dežele živečih častnikov iz rodbin, ki so bile tradicionalno povezane z bratovščino, prek različno premožnih in dejavnih graščakov ter uradnikov do visokih duhovnikov in pomembnih osebnosti za kulturno zgodovino, muzealstvo in domoznanstvo. Naročništvo umetnostnih del si je pri članih Dizmove bratovščine vse bolj podajalo roko z zavestnim ohranjanjem umetnostne in kulturne dediščine.
 
 

Abstract Es wird ein Einblick in die Vorgehensweise zur Fertigung von Knotenstrukturen im Stahlbau mittels Wire and Arc Additive Manufacturing (WAAM) und der numerischen und experimentellen Untersuchung der Knotenstrukturen gegeben. Ausgehend von der geometrischen Komplexität sich schneidender Profilstäbe aus Stahl werden wesentliche Punkte bei der simulationsgestützten Ermittlung von Knotenstrukturen beschrieben. In Abhängigkeit von den Lastfällen können unterschiedliche Strukturen in der Topologieoptimierung gefunden werden. Für die Herstellung der Knotenstruktur durch das Wire and Arc Additive Manufacturing müssen die numerisch gefundene Geometrie angepasst sowie Varianten der Bahnplanung entwickelt und bewertet werden. Dabei wird auch der Einfluss von Prozessparametern auf Verzug, Endkonturnähe und mechanische Eigenschaften der Bauteile untersucht. Für die Prognose von Spannungs‐ und Verformungszuständen des Knotens wird eine vereinfachte thermische und mechanische Analyse des Herstellungsprozesses durchgeführt. Weiter wird ein Verfahren für eine In‐situ‐Bauteilprüfung vorgestellt, welche Prozessunregelmäßigkeiten anhand von Sensordaten erkennt und deren Einflüsse auf die mechanischen Eigenschaften des Bauteils bewertet, wodurch frühzeitig im Prozess Maßnahmen zur Fehlerkorrektur getroffen oder Kosten durch Ausschuss reduziert werden können.

Introduction: The optimal revascularization strategy for left main disease in very elderly patients is unclear given under-representation in randomized trials. Therefore, we sought to compare percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for left main disease in very elderly patients presenting with acute myocardial infarction (AMI). Methods: Retrospective study of patients aged ≥ 80 years undergoing invasive coronary angiography (ICA) for AMI at Kaiser Permanente Los Angeles Medical Center between June 2009 and February 2019. Patients were grouped by treatment decision: PCI, CABG, or medical therapy. Inverse Probability Treatment of Weighting (IPTW) was used to balance baseline characteristics. All-cause mortality and non-fatal myocardial infarction (MI) was evaluated. Results: A total of 172 patients (average age 84.4 ± 3.6 years, 37% female) were analyzed. Of these 54 (31.4%) underwent PCI, 67 (39%) underwent CABG, and 51 (29.7%) were treated with medical therapy. Compared to CABG, the PCI group was significantly older, with more history of CAD, COPD, previous CABG, and previous PCI. Median follow-up was 22.4 months (interquartile range 5.1-46.8 months). After IPTW adjustment, there were no differences in mortality between PCI vs CABG (Hazard Ratio [HR] 1.40, 95% Confidence Interval [CI] 0.97-2.01), but an increase in non-fatal MI with PCI (HR 2.6, 95% CI 1.02-6.69). Both PCI and CABG reduced mortality (PCI: HR 0.46, 95% CI 0.32-0.66; CABG: HR 0.71, 95% CI 0.52-0.96) and non-fatal MI (PCI: HR 0.22, 95% CI 0.11-0.41; CABG: HR 0.09, 95% CI 0.4-0.23) compared to medical therapy. Conclusion: In very elderly patients with left main disease presenting with AMI, there was no difference in mortality between PCI and CABG, but an increased risk for non-fatal MI with PCI. However, both PCI and CABG were superior to medical therapy. Either revascularization strategy may be reasonable in this population.

We developed a polymer-encapsulated DNase, n(DNase), which can efficiently accumulate in biofilm and expose the DNase to cleave the eDNA of the biofilm. CLSM and crystal violet staining results demonstrated effective biofilm disintegration (92.2%) when treated with n(DNase). This work demonstrated a general approach for coating matrix-dispersion enzymes to achieve biofilm disintegration and provided a promising strategy for treating biofilm-associated infections.

Taking the Alpine region of Churraetia as a case study, this paper investigates processes of fiscal delegation, their preconditions, their legal construction, and their consequences. As Churraetia maintained many features of Roman provincial administration and statehood well into the Carolingian period, the article’s first part traces how fiscal revenues and rights came to be delegated to the episcopal church of Chur via royal privilege from the mid-9th century until 960. The delegation of fiscal rights usually happened in special situations when kings and grantees agreed on a closer cooperation in the future. In the course of this process, which in the case of Churraetia eventually turned a former Roman province into an ecclesiastical principality, the episcopal church became a governance actor that would play a crucial rule in exercising public functions such as tax collection, jurisdiction and military recruitment. Ecclesiastical property (often deriving from royal munificence) and fiscal income became indispensable means for performing these functions. The article’s second part focuses on the situation of 912 when the newly elected East Frankish king Conrad I, the first ruler of non-Carolingian stock, conferred two special privileges on the episcopal church of Chur: Conrad’s grant of the right to conduct inquisition procedure by compulsory witness in order to protect ecclesiastical property effectively meant that procedural law typical for the »public sphere« now came into the hands of the bishop of Chur. Conrad’s second stipulation, that the thirty-year period of proscription should not to be applied against the interest of the bishop of Chur, has to be seen against the background of legal pluralism in this region, in which several legal traditions were in conflict: while Roman law allowed a slave to rid himself of his master after thirty years, Aleman law forbade this, just as the idea that ecclesiastical property was regarded as inalienable spoke against the application of the thirty-years rule to the detriment of the church. Responding to ecclesiastical networks supporting his rule, Conrad thus had the Roman legal rule of prescription branded as a »bad custom« (mala consuetudo). As is finally argued in a more general perspective, in historical situations of political transition legal pluralism and legal change could lead to a new qualification of what had formerly been seen in more positive terms as »custom«.

Abstract Seismic safety verification can be performed by maintaining constructive rules or by calculation. Verification by calculation can be performed with a linear simplified or linear multi‐modal response spectrum analysis. Alternatively, a non‐linear quasi‐static verification is also possible according to DIN EN 1998‐1, which was not available in DIN 4149. In this article, the non‐linear quasi‐static earthquake verification according to DIN EN 1998‐1 is presented in practice, using the example of a building in Mittenwald/Germany. The verification has been checked and accepted by an independent building supervision report.

Background: For management of heart failure, the value of the CardioMems device remains uncertain. We assessed the cost-effectiveness of the CardioMems device. Methods: We developed a Markov model to determine quality-adjusted life-years (QALYs), cost, and cost-effectiveness of patients with heart failure receiving CardioMems implantation compared to those with routine care. In the main case analysis, we modeled the intervention in the CHAMPION trial cohort, which included patients with NYHA Class III heart failure with a heart failure hospitalization within the past twelve months. We also performed subgroup analyses of patients with preserved ejection fraction or reduced ejection fraction, and a scenario analysis of a second cohort of patients from the CHARM trials with a previous heart failure hospitalization. We obtained event rates and utilities from published trial data; we used costs from literature estimates and Medicare payment data. The main case analysis was calibrated to the hospitalization and survival rates of the CHAMPION trial. Results: In the CHAMPION trial main case analysis, CardioMems reduced lifetime hospitalizations (2.37 versus 3.27), increased months of survival (67 versus 62), increased QALYs (2.66 versus 2.38) and increased costs ($171,132 versus $154,084), yielding a cost of $59,520 per QALY gained or $40,301 per life-year gained. The cost per QALY gained was $71,964 in patients with reduced ejection fraction compared to $34,899 in those with preserved ejection fraction. In less ill patients from the CHARM trials, which included patients with NYHA Class II heart failure, the device cost increased to $110,565 per QALY gained. If the device cost decreased from $17,500 in the main case analysis to $15,000, the intervention would cost less than $50,000 per QALY gained. The duration of effectiveness was initially assumed to be lifelong; if less than 29 months, CardioMems would cost more than $150,000 per QALY gained. Conclusion: The CardioMems device is cost-effective in populations similar to the CHAMPION trial, with a cost of less than $100,000 per QALY gained, if durability of device effectiveness is sustained. Post-marketing surveillance data on the device’s durability will further clarify its value.