Constraint Programming-Based Heuristics for the Multi-Depot Vehicle Routing Problem with a Rolling Planning Horizon

Der Transportmarkt ist sowohl durch einem intensiven Kostenwettbewerb als auch durch hohe Erwartungen der Kunden an den Service geprägt. Die vorliegende Dissertation stellt zwei auf Constraint Programming basierende heuristische Frameworks vor, die eine Reoptimierung bereits geplanter Touren zu festgelegten Zeitpunkten erlauben und so eine Reaktion auf die gesteigerte Wettbewerbsdynamik und den Kostendruck ermöglichen.Actors on the transportation market currently face two contrary trends: Cost pressure caused by intense competition and a need for prompt service. We introduce two heuristic solution frameworks to enable freight carriers to deal with this situation by reoptimizing tours at predefined points in time. Both heuristics are based on Constraint Programming techniques

Papillary Thyroid Cancer in Childhood and Adolescence with Specific Consideration of Patients After Radiation Exposure

Non

eleRecombinant human thyrotropin to help confirm lack of evidence of radiation-induced differentiated thyroid cancer in young women seeking pregnancy

BACKGROUND: Women with a history of differentiated thyroidcarcinoma who are contemplating pregnancy may wish reassuranceregarding apparent remission. However, the thyroidhormone withdrawal needed to obtain serum thyroglobulintesting (Tg) results in weeks-long biochemical and clinical hypothyroidism,which could increase miscarriage and fetal deathrates if pregnancy occurred during withdrawal of thyroxine orsoon thereafter. Recombinant human thyrotropin (rhTSH) elevates thyrotropin exogenously, allowing uninterrupted thyroidhormone therapy and avoids hypothyroidism.MATERIAL AND METHODS: Thirty female radiation-inducedpapillary thyroid carcinoma survivors who had undergonetotal- or near-total thyroidectomy and who were now seekingpregnancy (mean age 23.9 ± 1.8 years), and who were consideredcancer-free by local standards, underwent rhTSH-aided Tgtesting to help confirm remission. At the time of rhTSH testing,mean follow-up after primary surgical treatment was 11.1 ±3.9 years, and all patients had negative neck ultrasonography,undetectable unstimulated serum Tg (< 0.2 ng/mL) and nointerfering anti-Tg antibodies. However, based on T3, N1 or M1status, 28/30 (93.3%) patients had high recurrence risk.RESULTS: rhTSH produced no serum Tg increase in 27/30women (90.0%). Serum Tg increases to 0.4-0.9 ng/ml wereobserved in 3 women, but careful neck ultrasonography foundno lymphadenopathy. Reassured about their remission, 14/30women (46%) have become pregnant and delivered healthychildren in the 3 years since rhTSH-aided testing.CONCLUSIONS: rhTSH-aided Tg testing is useful in confirmingabsence of tumor in female patients with a history of radiation-inducedthyroid cancer who are seeking pregnancy, but who alsohave a high risk of thyroid cancer recurrenceBACKGROUND: Women with a history of differentiated thyroidcarcinoma who are contemplating pregnancy may wish reassuranceregarding apparent remission. However, the thyroidhormone withdrawal needed to obtain serum thyroglobulintesting (Tg) results in weeks-long biochemical and clinical hypothyroidism,which could increase miscarriage and fetal deathrates if pregnancy occurred during withdrawal of thyroxine orsoon thereafter. Recombinant human thyrotropin (rhTSH) elevates thyrotropin exogenously, allowing uninterrupted thyroidhormone therapy and avoids hypothyroidism.MATERIAL AND METHODS: Thirty female radiation-inducedpapillary thyroid carcinoma survivors who had undergonetotal- or near-total thyroidectomy and who were now seekingpregnancy (mean age 23.9 ± 1.8 years), and who were consideredcancer-free by local standards, underwent rhTSH-aided Tgtesting to help confirm remission. At the time of rhTSH testing,mean follow-up after primary surgical treatment was 11.1 ±3.9 years, and all patients had negative neck ultrasonography,undetectable unstimulated serum Tg (< 0.2 ng/mL) and nointerfering anti-Tg antibodies. However, based on T3, N1 or M1status, 28/30 (93.3%) patients had high recurrence risk.RESULTS: rhTSH produced no serum Tg increase in 27/30women (90.0%). Serum Tg increases to 0.4-0.9 ng/ml wereobserved in 3 women, but careful neck ultrasonography foundno lymphadenopathy. Reassured about their remission, 14/30women (46%) have become pregnant and delivered healthychildren in the 3 years since rhTSH-aided testing.CONCLUSIONS: rhTSH-aided Tg testing is useful in confirmingabsence of tumor in female patients with a history of radiation-inducedthyroid cancer who are seeking pregnancy, but who alsohave a high risk of thyroid cancer recurrence

Der Einfluss von Recyclingmaterial auf die Eigenschaften von Beton

In den vergangenen Jahren hat die zunehmende Knappheit von Ressourcen, insbesondere im Bereich der Gesteinskörnung im Bauwesen, sowie die Anerkennung der Notwendigkeit von Kreislaufwirtschaft im Betonbau dazu geführt, dass der Fokus verstärkt auf der Nutzung von Recyclingmaterialien liegt. Vor allem rezyklierte Gesteinskörnungen werden vermehrt eingesetzt. Da diese jedoch Auswirkungen auf die Frisch- und Festbetoneigenschaften haben können, ist es wichtig, ihren Einfluss zu untersuchen. Dieser Artikel befasst sich daher mit der Herstellung, dem mechanischen Verhalten, den Dauerhaftigkeitseigenschaften sowie dem Brandverhalten von Betonen, die rezyklierte Gesteinskörnung enthalten. Zusätzlich werden wissenschaftliche Begleitprogramme wie ein AiF Verbundforschungsprojekt am VDZ/KIT vorgestellt. Da eine positive Ökobilanz das Ziel bei der Verwendung von Recyclingmaterialien ist, wird dieser Aspekt ebenfalls in diesem Beitrag beleuchtet. Weil vor allem der Zement entscheidend für die Ökobilanz von Betonen ist, wird zudem der Ansatz der Verwendung von Recyclingmehlen als Zementhauptbestandteil betrachtet

Direct Flow Medical vs. Edwards Sapien 3 Prosthesis: A Propensity Matched Comparison on Intermediate Safety and Mortality

Aims: To compare intermediate performance and mortality rates in patients, who underwent transcatheter aortic valve implantation (TAVI) with two different types of prostheses: Edwards Sapien 3 (ES3) and Direct Flow Medical (DFM).Methods and Results: 42 consecutive patients implanted with a DFM prosthesis for severe aortic stenosis were matched 1:1 with an equal number of patients, who received an ES3 during the same period. Primary endpoint was mortality. MACE, as a composite of all-cause death, stroke, and re-do-procedure (valve-in-valve), was defined as secondary endpoint. Moreover, we compared NYHA class, NT-proBNP-levels and the extent of restenosis. Patients were followed for 2 years. DFM patients showed echocardiographic elevated mean pressure gradients compared to ES3 patients before discharge (11.2 mmHg ± 5.3 vs. 3.5 mmHg ± 2.7; p < 0.001) and upon 6-months follow-up (20.3 mmHg ± 8.8 vs. 12.3 mmHg ± 4.4; p < 0.001). ES3 candidates showed superior NYHA class at follow-up (p = 0.001). Kaplan-Meier analysis revealed significantly worse survival in patients receiving a DFM prosthesis compared to ES3 (Breslow p = 0.020). MACE occurred more often in DFM patients compared to ES3 (Breslow p = 0.006).Conclusions: Patients receiving DFM valve prostheses showed worse survival and higher rates in MACE compared to ES3. Prosthesis performance regarding mean pressure gradients and patients' NYHA class also favored ES3

Tumor size and presence of metastases in differentiated thyroid cancer:comparing cohorts from two countries

Objective: Incidence of thyroid cancer varies widely, even across neighboring countries. Data on this phenomenon are largely lacking but are likely related to differences in health care systems. Therefore, we explored whether there are differences between populations from these 2 countries with respect to the relationship between tumor size and advanced disease. Methods: We retrospectively studied 2 cohorts of adult differentiated thyroid cancer (DTC) patients from a Dutch and a German university hospital. We analyzed the presence of lymph node metastases with respect to tumor size for papillary thyroid cancer (PTC), and the presence of distant metastases for DTC, and PTC and follicular thyroid cancer (FTC) separately. Results: We included 1771 DTC patients (80% PTC, 20% FTC; 24% lymph node and 8% distant metastases). For PTC, the proportion of patients with lymph node metastases was significantly higher in the Dutch than in the German population for tumors ≤ 1 cm (45% vs. 14%; P &lt; .001). For DTC, distant metastases occurred particularly significantly more frequently in the Dutch than in the German population for tumors ≤ 2 cm (7% vs. 2%; P = .004). Conclusion: The presence of lymph node and distant metastases is significantly higher in pT1 DTC cases in the Dutch compared to the German cohort, which might be caused by differences in the indication for and application of diagnostic procedures eventually leading to DTC diagnosis. Our results implicate that one should be cautious when extrapolating results and guidelines from 1 country to another.</p