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

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

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

Clinical considerations for the treatment of secondary differentiated thyroid carcinoma in childhood cancer survivors

The incidence of differentiated thyroid carcinoma (DTC) has increased rapidly over the past several years. Thus far, the only conclusively established risk factor for developing DTC is exposure to ionizing radiation, especially when the exposure occurs in childhood. Since the number of childhood cancer survivors (CCS) is increasing due to improvements in treatment and supportive care, the number of patients who will develop DTC after surviving childhood cancer (secondary thyroid cancer) is also expected to rise. Currently, there are no recommendations for management of thyroid cancer specifically for patients who develop DTC as a consequence of cancer therapy during childhood. Since complications or late effects from prior cancer treatment may elevate the risk of toxicity from DTC therapy, the medical history of CCS should be considered carefully in choosing DTC treatment. In this paper, we emphasize how the occurrence and treatment of the initial childhood malignancy affects the medical and psychosocial factors that will play a role in the diagnosis and treatment of a secondary DTC. We present considerations for clinicians to use in the management of patients with secondary DTC, based on the available evidence combined with experience -based opinions of the authors

Long-term strategies for thyroid health monitoring after nuclear accidents : recommendations from an Expert Group convened by IARC

International audience[No abstract available