Christian Mönch

Agent-based configuration management of distributed applications

Mobile agents provide a new paradigm for distributed computation. Their unique properties appear well suited to the configuration management of large and complex distributed applications. After outlining our concept of configuration management, we describe a basic agent infrastructure and its extensions for configuration management of distributed applications. Then we consider aspects of concurrent agents and discuss the advantages of the agent based approach through an example.

Renal Function in De Novo Liver Transplant Recipients Receiving Different Prolonged‐Release Tacrolimus Regimens—The DIAMOND Study

DIAMOND: multicenter, 24‐week, randomized trial investigating the effect of different once‐daily, prolonged‐release tacrolimus dosing regimens on renal function after de novo liver transplantation. Arm 1: prolonged‐release tacrolimus (initial dose 0.2mg/kg/day); Arm 2: prolonged‐release tacrolimus (0.15–0.175mg/kg/day) plus basiliximab; Arm 3: prolonged‐release tacrolimus (0.2mg/kg/day delayed until Day 5) plus basiliximab. All patients received MMF plus a bolus of corticosteroid (no maintenance steroids). Primary endpoint: eGFR (MDRD4) at Week 24. Secondary endpoints: composite efficacy failure, BCAR and AEs. Baseline characteristics were comparable. Tacrolimus trough levels were readily achieved posttransplant; initially lower in Arm 2 versus 1 with delayed initiation in Arm 3. eGFR (MDRD4) was higher in Arms 2 and 3 versus 1 (p = 0.001, p = 0.047). Kaplan–Meier estimates of composite efficacy failure‐free survival were 72.0%, 77.6%, 73.9% in Arms 1–3. BCAR incidence was significantly lower in Arm 2 versus 1 and 3 (p = 0.016, p = 0.039). AEs were comparable. Prolonged‐release tacrolimus (0.15–0.175mg/kg/day) immediately posttransplant plus basiliximab and MMF (without maintenance corticosteroids) was associated with lower tacrolimus exposure, and significantly reduced renal function impairment and BCAR incidence versus prolonged‐release tacrolimus (0.2mg/kg/day) administered immediately posttransplant. Delayed higher‐dose prolonged‐release tacrolimus initiation significantly reduced renal function impairment compared with immediate posttransplant administration, but BCAR incidence was comparable.

Detection of a fatty liver after binge drinking: correlation of MR-spectroscopy, DECT, biochemistry and histology in a rat model.

RATIONALE AND OBJECTIVES The purpose of this study was to evaluate the possibility of detecting a fatty liver after binge drinking in an animal model using (1)H magnetic resonance spectroscopy ((1)H-MRS), dual-energy computed tomography (DECT), biochemistry, and the gold standard of histology. MATERIALS AND METHODS In 20 inbred female Lewis rats, an alcoholic fatty liver was induced; 20 rats served as controls. To simulate binge drinking, each rat was given a dose of 9.3 g/kg body weight 50% ethanol twice, with 24 hours between applications. Forty-eight hours after the first injection, DECT and (1)H-MRS were performed. Fat content as well as triglycerides were also determined histologically and biochemically, respectively. To assess specific liver enzymes, blood was drawn from the orbital venous plexus. RESULTS In all 20 animals in the experimental group, fatty livers were detected using (1)H-MRS, DECT, and biochemical and histologic analysis. The spectroscopic fat/water ratio and the biochemical determination were highly correlated (r = 0.892, P < .05). A significant correlation was found between (1)H-MRS and histologic analysis (r = 0.941, P < .001). Also, a positive linear correlation was found between the dual-energy computed tomographic density of ΔHU and the biochemical (r = 0.751, P < .05) and histologic (r = 0.786, P < .001) analyses. CONCLUSIONS Quantification of hepatic fat content on (1)H-MRS showed high correlation with histologic and biochemical steatosis determination. In comparison to DECT, it is more suitable to reflect the severity of acute fatty liver.

Delayed Bottom-Up and Amended Simple Method of Dosing with Once-Daily Tacrolimus Application to Achieve Stable Trough Levels in Liver Transplantation

BACKGROUND Tacrolimus once-daily formulation (TacOD) was introduced as an alternative to twice-daily formulations de novo. Dosing recommendations range between 0.1 to 0.2 mg/kg BW/d. MATERIAL AND METHODS Amended dosing with a simple bottom-up de novo algorithm is presented. Primary outcome measure was feasibility of establishing adequate target trough levels and avoidance of over-immunosuppression, with adequate safety and efficacy after liver transplantation (LT). RESULTS TacOD was given to 101 patients. Standard steroid-free immunosuppression consisted of MMF 2 g/d, basiliximab 20 mg on day 0 and 4, and delayed bottom-up IS with TacOD starting with 1 mg/d and doubling the dosage every day until target trough levels of 5 to 8 ng/ml were reached. By day 7 after LT, all except 3 patients had received TacOD. The earliest time point of introduction was day 2. A median of 9 mg/d (range: 0 to 25 mg/d) of TacOD were necessary to establish the trough levels by day 10, which was then 5.4 ng/ml (range: 1.5 to 20 ng/ml). Incidence of adverse events (AE), in particular neurological AEs (n=3), were low. Efficacy failure (acute rejection) was low (4.9%). Renal function was stable and did not deteriorate under CNI treatment. CONCLUSIONS This is the first report of bottom-up, amended, and simple dosing of TacOD in LT. The algorithm is feasible, safe, and efficient, avoiding trough level peaks and top-down strategies.

INDIGO - An Approach to Infrastructures for Digital Libraries

In this paper INDIGO, an approach to infrastructures for digital libraries is presented. It fulfills two crucial requirements to digital libraries: scalability and the ability to handle newly evolving document types. Based on a classification of digital library architectures, the main reasons for limited scalability and extensibility of digital libraries are identified. To overcome the identified problems the concept of mobile structure knowledge, on which INDIGO is based, is developed. The architecture of INDIGO is outlined and examples for the application of the concept are given.

Integrating new document types into digital libraries

Digital libraries store large amounts of documents of any media type and format. Due to the fast development of information technology, new media types and document formats will have to be integrated into existing digital libraries. We propose an infrastructure that supports the extensibility of digital libraries by new document types. A prototype has been implemented to prove the feasibility of our approach.

Inzidenz von Leberversagen und Galleleckagen nach Leberteilresektion

BACKGROUND The International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out. PATIENTS AND METHODS The study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum). RESULTS A total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. CONCLUSION The definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.ZusammenfassungHintergrundDie International Study Group of Liver Surgery (ISGLS) hat Leberversagen nach Leberresektion durch pathologische Werte für INR und Bilirubin an Tag 5 nach Resektion definiert. Das Auftreten einer Galleleckage wurde als Drainagebilirubin-Serumbilirubin-Ratio > 3 an Tag 3 oder später oder interventionelle/operative Revision aufgrund biliärer Peritonitis definiert. Es erfolgt eine konfirmatorische explorative Analyse.Patienten und MethodenAlle primären Leberresektionen in den Jahren 2009 und 2010 wurden ausgewertet. Hauptzielgrößen waren postoperatives Leberversagen und Galleleckage nach ISGLS-Definition. Nebenzielgrößen waren postoperative Komplikationen und 90-Tages-Letalität. Ergebnisse werden in Medianwerten (Min.; Max.) dargestellt.ErgebnisseEs konnten 214 primäre Leberresektionen ausgewertet werden. Die Patienten waren 61,5 Jahre (18; 83) alt. Die Inzidenz des Leberversagens lag bei 7,4 % (16 von 214); 7 verstarben. Bei 31 % (65 von 214) zeigte sich eine Galleleckage. 14 (23 %) entwickelten eine Typ-B-, ein Patient (5 %) eine Typ-C-Leckage. 50 Leckagen (Grad A) waren konservativ therapierbar. Die Inzidenz der klinisch relevanten Galleleckagen lag bei 7 % (15 von 214). Die Sensitivität der Definition war 100 %, die Spezifität 75 %. Komplikationen nach Dindo-Clavien > 3b traten bei 10,2 % auf, eine Sepsis bei 5,6 %. Die 90-Tages-Letalität betrug 6,5 %. Multivariate Analysen lieferten keine unabhängig prädiktiven Faktoren für das Auftreten von Galleleckage oder Leberversagens.SchlussfolgerungDie Definition der ISGLS für Leberversagen im postoperativen Verlauf ist in unserem Kollektiv valide. Die Inzidenz perioperativer Galleleckage wird mit der vorliegenden Definition überschätzt und führt zu einer großen Zahl an falsch-positiven klinisch irrelevanten Fällen.AbstractBackgroundThe International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out.Patients and methodsThe study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum).ResultsA total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. ConclusionThe definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.

QUEST - Querying Specialized Collections on the Web

Ensuring access to specialized web-collections in a fast evolving web environment requires flexible techniques for orientation and querying. The adoption of meta search techniques for web-collections is hindered by the enormous heterogeneity of the resources. In this paper we introduce QUEST -- a system for querying specialized collections on the web. One focus of QUEST is to unify search fields from different collections by relating the search concepts to each other in a concept-taxonomy. To identify the most relevant collections according to a user query, we propose an association-based strategy. Furthermore the Frankurt Core is introduced--a metadata-scheme for describing web-collections as a whole. Its fields are filled automatically by a metadata-collector component. Finally a prototype of QUEST is presented, demonstrating the integration of the techniques in an overall architecture.

[Incidence of posthepatectomy liver failure and biliary leakage : A cohort study].

BACKGROUND The International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out. PATIENTS AND METHODS The study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum). RESULTS A total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. CONCLUSION The definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.ZusammenfassungHintergrundDie International Study Group of Liver Surgery (ISGLS) hat Leberversagen nach Leberresektion durch pathologische Werte für INR und Bilirubin an Tag 5 nach Resektion definiert. Das Auftreten einer Galleleckage wurde als Drainagebilirubin-Serumbilirubin-Ratio > 3 an Tag 3 oder später oder interventionelle/operative Revision aufgrund biliärer Peritonitis definiert. Es erfolgt eine konfirmatorische explorative Analyse.Patienten und MethodenAlle primären Leberresektionen in den Jahren 2009 und 2010 wurden ausgewertet. Hauptzielgrößen waren postoperatives Leberversagen und Galleleckage nach ISGLS-Definition. Nebenzielgrößen waren postoperative Komplikationen und 90-Tages-Letalität. Ergebnisse werden in Medianwerten (Min.; Max.) dargestellt.ErgebnisseEs konnten 214 primäre Leberresektionen ausgewertet werden. Die Patienten waren 61,5 Jahre (18; 83) alt. Die Inzidenz des Leberversagens lag bei 7,4 % (16 von 214); 7 verstarben. Bei 31 % (65 von 214) zeigte sich eine Galleleckage. 14 (23 %) entwickelten eine Typ-B-, ein Patient (5 %) eine Typ-C-Leckage. 50 Leckagen (Grad A) waren konservativ therapierbar. Die Inzidenz der klinisch relevanten Galleleckagen lag bei 7 % (15 von 214). Die Sensitivität der Definition war 100 %, die Spezifität 75 %. Komplikationen nach Dindo-Clavien > 3b traten bei 10,2 % auf, eine Sepsis bei 5,6 %. Die 90-Tages-Letalität betrug 6,5 %. Multivariate Analysen lieferten keine unabhängig prädiktiven Faktoren für das Auftreten von Galleleckage oder Leberversagens.SchlussfolgerungDie Definition der ISGLS für Leberversagen im postoperativen Verlauf ist in unserem Kollektiv valide. Die Inzidenz perioperativer Galleleckage wird mit der vorliegenden Definition überschätzt und führt zu einer großen Zahl an falsch-positiven klinisch irrelevanten Fällen.AbstractBackgroundThe International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out.Patients and methodsThe study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum).ResultsA total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. ConclusionThe definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.

Inzidenz von Leberversagen und Galleleckagen nach Leberteilresektion@@@Incidence of posthepatectomy liver failure and biliary leakage: Eine Kohortenstudie@@@A cohort study

BACKGROUND The International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out. PATIENTS AND METHODS The study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum). RESULTS A total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. CONCLUSION The definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.ZusammenfassungHintergrundDie International Study Group of Liver Surgery (ISGLS) hat Leberversagen nach Leberresektion durch pathologische Werte für INR und Bilirubin an Tag 5 nach Resektion definiert. Das Auftreten einer Galleleckage wurde als Drainagebilirubin-Serumbilirubin-Ratio > 3 an Tag 3 oder später oder interventionelle/operative Revision aufgrund biliärer Peritonitis definiert. Es erfolgt eine konfirmatorische explorative Analyse.Patienten und MethodenAlle primären Leberresektionen in den Jahren 2009 und 2010 wurden ausgewertet. Hauptzielgrößen waren postoperatives Leberversagen und Galleleckage nach ISGLS-Definition. Nebenzielgrößen waren postoperative Komplikationen und 90-Tages-Letalität. Ergebnisse werden in Medianwerten (Min.; Max.) dargestellt.ErgebnisseEs konnten 214 primäre Leberresektionen ausgewertet werden. Die Patienten waren 61,5 Jahre (18; 83) alt. Die Inzidenz des Leberversagens lag bei 7,4 % (16 von 214); 7 verstarben. Bei 31 % (65 von 214) zeigte sich eine Galleleckage. 14 (23 %) entwickelten eine Typ-B-, ein Patient (5 %) eine Typ-C-Leckage. 50 Leckagen (Grad A) waren konservativ therapierbar. Die Inzidenz der klinisch relevanten Galleleckagen lag bei 7 % (15 von 214). Die Sensitivität der Definition war 100 %, die Spezifität 75 %. Komplikationen nach Dindo-Clavien > 3b traten bei 10,2 % auf, eine Sepsis bei 5,6 %. Die 90-Tages-Letalität betrug 6,5 %. Multivariate Analysen lieferten keine unabhängig prädiktiven Faktoren für das Auftreten von Galleleckage oder Leberversagens.SchlussfolgerungDie Definition der ISGLS für Leberversagen im postoperativen Verlauf ist in unserem Kollektiv valide. Die Inzidenz perioperativer Galleleckage wird mit der vorliegenden Definition überschätzt und führt zu einer großen Zahl an falsch-positiven klinisch irrelevanten Fällen.AbstractBackgroundThe International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out.Patients and methodsThe study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum).ResultsA total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. ConclusionThe definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.