Synchro-Modality and Slow Steaming: New Business Perspectives in Freight Transportation

The logistics sector faces substantial challenges in meeting customer demands for higher service quality, speed and flexibility under conditions of continued growth in world trade and worldwide transportation movements, increasing distances and vulnerabilities of the supply chain. Additional challenges relate to the economic and environmental sustainability of logistics operations. While a lot of attention was devoted in the past decades to the operational and technical aspects, the business development phase has been put aside, causing the market failure of several projects. The paper presents the SYNCHRO-modal supply chain eco-NET (SYNCHRO-NET) project, which will demonstrate the effectiveness of slow steaming combined with synchro-modality in reducing the cost and the emissions of international supply chains and improving reliability and sustainability through the optimization of the planning process. Differently from other similar projects, SYNCHRO-NET combines operational aspects with a business perspective and represents a stakeholder-driven approach aimed at developing a close-to-market solution over the timeframe of the project

Magnetization Transfer Ratio of Peripheral Nerve and Skeletal Muscle

Purpose!#!To assess the correlation of peripheral nerve and skeletal muscle magnetization transfer ratio (MTR) with demographic variables.!##!Methods!#!In this study 59 healthy adults evenly distributed across 6 decades (mean age 50.5 years ±17.1, 29 women) underwent magnetization transfer imaging and high-resolution T2-weighted imaging of the sciatic nerve at 3 T. Mean sciatic nerve MTR as well as MTR of biceps femoris and vastus lateralis muscles were calculated based on manual segmentation on six representative slices. Correlations of MTR with age, body height, body weight, and body mass index (BMI) were expressed by Pearson coefficients. Best predictors for nerve and muscle MTR were determined using a multiple linear regression model with forward variable selection and fivefold cross-validation.!##!Results!#!Sciatic nerve MTR showed significant negative correlations with age (r = -0.47, p < 0.001), BMI (r = -0.44, p < 0.001), and body weight (r = -0.36, p = 0.006) but not with body height (p = 0.55). The multiple linear regression model determined age and BMI as best predictors for nerve MTR (R!##!Conclusion!#!Peripheral nerve MTR decreases with higher age and BMI. Studies that assess peripheral nerve MTR should consider age and BMI effects. Skeletal muscle MTR is primarily associated with BMI but overall less dependent on demographic variables

Diffusion tensor imaging in anterior interosseous nerve syndrome – functional MR Neurography on a fascicular level

Purpose: By applying diffusor tensor imaging (DTI) in patients with anterior interosseous nerve syndrome (AINS), this proof of principle study aims to quantify the extent of structural damage of a peripheral nerve at the anatomical level of individual fascicles. Methods: In this institutional review board approved prospective study 13 patients with spontaneous AINS were examined at 3 Tesla including a transversal T2-weighted turbo-spin-echo and a spin-echo echo-planar-imaging pulse sequence of the upper arm level. Calculations of quantitative DTI parameters including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) for median nerve lesion and non-lesion fascicles as well as ulnar and radial nerve were obtained. DTI values were compared to each other and to a previously published dataset of 58 healthy controls using one-way Analysis of Variance with Bonferroni correction and p-values <.05 were considered significant. Receiver operating characteristic (ROC) curves were performed to assess diagnostic accuracy. Results: FA of median nerve lesion fascicles was decreased compared to median nerve non-lesion fascicles, ulnar nerve and radial nerve while MD, RD, and AD was increased (p < .001 for all parameters). Compared to median nerve values of healthy controls, lesion fascicles showed a significant decrease in FA while MD, RD, and AD was increased (p < .001 for all parameters). FA of median nerve non-lesion fascicles showed a weak significant decrease compared to healthy controls (p < .01) while there was no difference in MD, RD, and AD. ROC analyses revealed an excellent diagnostic accuracy of FA, MD and RD in the discrimination of median nerve lesion and non-lesion fascicles in AINS patients as well as in the discrimination of lesion fascicles and normative median nerve values of healthy controls. Conclusion: By applying this functional MR Neurography technique in patients with AINS, this proof of principle study demonstrates that diffusion tensor imaging is feasible to quantify structural nerve injury at the anatomical level of individual fascicles. Keywords: Anterior interosseous nerve syndrome, Diffusion tensor imaging, Functional MR Neurograph

Salvage High-dose Melphalan With Autologous Stem cell Transplantation as Bridge to Consolidation Therapy for Chemoresistant Aggressive B-cell Lymphoma

Background: Patients suffering from refractory aggressive B-cell lymphoma not responding to salvage chemotherapy have a dismal prognosis. CAR T-cells or allogeneic stem cell transplantation (SCT) are potentially curative approaches. However, obtaining a remission, and lowering tumor burden before consolidation seems crucial for long-term efficacy of both treatment modalities. Materials and Methods: In this retrospective analysis, we reviewed patients with chemoresistant aggressive B-cell lymphoma, defined as being refractory or progressive to at least second line salvage chemotherapy including the regimen immediately preceding autologous stem cell transplantation (ASCT), treated at 2 tertiary centers, who were eligible for intensive treatment using single agent high-dose (HD) melphalan to obtain a remission before consolidating therapy. Results: We identified 36 patients that received single agent HD melphalan and ASCT as remission induction followed by CAR T-cells or allogeneic stem cell transplantation (SCT). Thirteen of the evaluable patients (39.4%) achieved a partial remission and 9 patients (27.73%) a complete remission, resulting in an overall response rate (ORR) of 66.7%. High remission rates were seen across all subgroups including patients with primary refractory lymphoma (ORR 58.3%), uncontrolled disease and high tumor burden as indicated by increased LDH levels (ORR 66.7% for patients with elevated LDH above 2 times upper limit of norm). 22 patients proceeded to allogeneic SCT and 5 to CAR T-cell therapy. Treatment related mortality of ASCT was 5.5% (2 patients, both due to infections). Two-year overall survival of all patients was 15.8%, pr imar ily due to a high non-relapse mortality (45.5%) of allogeneic SCT patients treated with myeloablative conditioning chemotherapy. Conclusion: Single agent HD melphalan produces high remission rates in patients with chemoresistant, uncontrolled aggressive B-cell lymphoma and provides a window of opportunity for consolidation therapy.Microabstract: Patient with refractory/relapsed aggressive B-cell lymphoma after salvage therapy are an unmet medical need because of their very poor prognosis. In our retrospective analysis of 36 patients we showed that single agent high-dose melphalan can achieve high response rates (ORR 66.7%) even in uncontrolled disease enabling consolidation therapy e.g. with allogeneic stem cell transplantation or CAR T-cell therapy