Surgery of hyperthyroidism. Personal experience

The Authors report their experience in the management of surgical hyperthyroidism, evaluating the different clinical pictures and the possibility of non surgical treatment. Advantages and disadvantages of both hemithyroidectomy and total thyroidectomy, are also described. The Authors conclude affirming their preference for techniques such as total hemithyroidectomy or thyroidectomy in some types of hyperthyroidism.     

The liver in transforming growth factor-Beta-1 (TGF-beta 1) null mutant mice

Transforming growth factor-beta-1 (TGF-beta 1) null mutant mice have no gross developmental abnormalities at birth but succumb to multifocal inflammatory lesions that lead to organ failure and death about 20 days after birth. Treatment with anti-inflammatory and immune suppressive agents, such as rapamycin, reduces the severity and extent of inflammatory infiltrates in the liver and can prolong the life of knockout (KO) mice compared to untreated null mice. To determine whether there is an associated hepatic phenotype, livers of "young" (< 3 weeks), "old" (> 3 weeks), and age-matched wild-type (WT) mice were studied using light and electronmicroscopy. On light microscopy, old KO mice had foci of mononuclear cells in liver parenchyma in addition to scattered foci of megalocytosis. Intracytoplasmic vacuoles, some of which were juxtanuclear in location, were also seen but these were most prominent in the oldest (10 weeks) rapamycin-treated mouse. In the untreated young KO mice, there were only foci of mononuclear cells in the liver parenchyma and portal tracts and variable numbers of binucleated hepatocytes. Ultrastructurally, there was a significant increase in the number of mitochondria in livers of the old KO mice, when compared either to the age-matched wild-type or to the young KO mice (p > .001). Hepatocytes from all KO mice showed increased numbers of hypertrophied or enlarged Golgi complexes compared to age-matched wild-type mice. Intracytoplasmic canaliculi lined with microvilli were seen in livers of old KO mice, but were absent in the young KO and wild-type mice. Primary cultures of hepatocytes, derived from livers of both young and old KO mice, showed similar changes on phase contrast and electronmicroscopy. These included juxtanuclear vacuoles, intracytoplasmic canaliculi, enlarged Golgi vesicles, and increased numbers of autolysosomes. Phenotypic abnormalities of mitochondria were either minimal or absent in cultured KO hepatocytes. The findings demonstrate, for the first time, that targeted disruption of the TGF-beta 1 gene in mice results in an altered ultrastructural phenotype of hepatocytes. The data suggest that TGF-beta 1 may be required for normal development and regulation of subcellular organelles in hepatocytes and may be essential for physiological functions involving mitochondria and Golgi complex.     

Iterated local search and simulated annealing algorithms for the inventory routing problem

This paper addresses the inventory routing problem (IRP), which consists in defining the customer visit schedule, the delivery quantities, and the vehicle routing plan to meet the demands of a set of customers over a given time horizon. We consider the variant with a single item, a single supplier, multiple vehicles, and a finite multiperiod planning horizon, minimizing the sum of inventory and travel costs. In addition, we address an alternative objective function that minimizes the logistic ratio, defined as the total travel cost divided by the total quantity delivered to customers. This second objective function, while more realistic in some logistics settings, poses a challenge for integer programming models and exact methods because of its nonlinearity. To our knowledge, no heuristic method has been proposed to address this objective in the IRP variant addressed in this paper. To solve this problem with each of these objective functions, we propose effective metaheuristic algorithms based on iterated local search and simulated annealing. Computational experiments show that these algorithms provide reasonably high‐quality solutions in relatively short running times for both objective functions when compared to other methods for well‐known instances from the literature. Moreover, the algorithms produce new best solutions for some of these instances.     

Regional citrate anticoagulation in CVVH: A new protocol combining citrate solution with a phosphate‐containing replacement fluid

Regional citrate anticoagulation (RCA) is a valid anticoagulation method in continuous renal replacement therapies (CRRT) and different combination of citrate and CRRT solutions can affect acid‐base balance. Regardless of the anticoagulation protocol, hypophosphatemia occurs frequently in CRRT. In this case report, we evaluated safety and effects on acid‐base balance of a new RCA‐ continuous veno‐venous hemofiltration (CVVH) protocol using an 18 mmol/L citrate solution combined with a phosphate‐containing replacement fluid. In our center, RCA‐CVVH is routinely performed with a 12 mmol/L citrate solution and a postdilution replacement fluid with bicarbonate (protocol A). In case of persistent acidosis, not related to citrate accumulation, bicarbonate infusion is scheduled. In order to optimize buffers balance, a new protocol has been designed using recently introduced solutions: 18 mmol/L citrate solution, phosphate‐containing postdilution replacement fluid with bicarbonate (protocol B). In a cardiac surgery patient with acute kidney injury, acid‐base status and electrolytes have been evaluated comparing protocol A (five circuits, 301 hours) vs. protocol B (two circuits, 97 hours): pH 7.39 ± 0.03 vs. 7.44 ± 0.03 (P < 0.0001), bicarbonate 22.3 ± 1.8 vs. 22.6 ± 1.4 mmol/L (NS), Base excess ?2.8 ± 2.1 vs. ?1.6 ± 1.2 (P = 0.007), phosphate 0.85 ± 0.2 vs. 1.3 ± 0.5 mmol/L (P = 0.027). Protocol A required bicarbonate and sodium phosphate infusion (8.9 ± 2.8 mmol/h and 5 g/day, respectively) while protocol B allowed to stop both supplementations. In comparison to protocol A, protocol B allowed to adequately control acid‐base status without additional bicarbonate infusion and in absence of alkalosis, despite the use of a standard bicarbonate concentration replacement solution. Furthermore, the combination of a phosphate‐containing replacement fluid appeared effective to prevent hypophosphatemia.     

A rate control scheme for adaptive real-time applications in IP networks with lossy links and long round trip times

Currently there is no control for real-time traffic sources in IP networks. This is a serious problem because real-time traffic can not only congest the network but can also cause unfairness and starvation of TCP traffic. However, it is not possible to apply current solutions for Internet to the networks with high bandwidth-delay products and high bit error rates. The channel errors may result in inaccurate congestion control decisions and unnecessary rate throttles leading to severe performance degradation. This problem is amplified in the links with high bandwidth-delay products, since the link is inefficiently utilized for a very long time until the unnecessary rate throttle is recovered. In this paper, a new Rate Control Scheme, RCS, is introduced for real-time interactive applications in networks with high bandwidth-delay products and high bit error rates. RCS is based on the concept of using dummy packets to probe the availability of network resources. Dummy packets are treated as low priority packets and consequently they do not affect the throughput of actual data traffic. Therefore, RCS requires all the routers in the connection path to support some priority policy. A new algorithm is also proposed to improve the robustness of the RCS to temporal signal loss conditions. The delay-bound considerations for real-time traffic sources using RCS rate control scheme are also investigated. Simulation experiments show that in environments with high bandwidth-delay products and high bit error rates, RCS achieves high throughput performance without penalizing TCP connections.     

TCP-Peach: a new congestion control scheme for satellite IPnetworks

Current TCP protocols have lower throughput performance in satellite networks mainly due to the effects of long propagation delays and high link error rates. In this paper, a new congestion control scheme called TCP-Peach is introduced for satellite networks. TCP-Peach is composed of two new algorithms, namely Sudden Start and Rapid Recovery, as well as the two traditional TCP algorithms, Congestion Avoidance and Fast Retransmit. The new algorithms are based on the novel concept of using dummy segments to probe the availability of network resources without carrying any new information to the sender. Dummy segments are treated as low-priority segments and accordingly they do not effect the delivery of actual data traffic. Simulation experiments show that TCP-Peach outperforms other TCP schemes for satellite networks in terms of goodput. It also provides a fair share of network resources     

Transmission of adaptive MPEG video over time-varying wireless channels: modeling and performance evaluation

Wireless channels are characterized by high time-varying bit-error rates (BERs). To cope with this problem, several adaptive forward-error-correction (AFEC) schemes have been proposed in the literature. They work locally at the wireless link, adding a variable amount of redundancy to the transmitted data in order to maintain the packet error rate below an acceptable level. However, when such schemes are utilized, the bandwidth offered to the applications changes when channel conditions change. In this paper, the effects of these bandwidth variations are investigated in the case of real-time Motion Picture Experts Group (MPEG) video transmission. The MPEG encoder is controlled in order to adapt its emission rate to the current bandwidth offered by the wireless link. To this end, the encoding quality is diminished by the source rate controller when the transmission rate has to be decreased due to an increase in the channel BER, whereas it is improved when the transmission rate can be increased due to a decrease in the channel BER. A Markov-based model, denoted as SBBP/SBBP/1/K, has been introduced to model the scenario being considered. The analytical framework allows evaluation of the performance of the system and can be used to optimize the design of a video transmission system for wireless channels, providing the instruments to derive the tradeoff between information corruption in the wireless channel and MPEG video encoding quality.     

Optimizing the cutting of stock plates in a furniture company

In this study we analysed practical aspects of the application of a cutting stock model to a Brazilian company that manufactures furniture on a large scale with a high degree of standardization. The model is based on the classical approach of Gilmore and Gomory (1965, Operations Research, 14, 94-120), which combines a linear program and a column generation procedure. Besides the two-stage and three-stage guillotine cutting patterns, we also considered one-group guillotine patterns that improve the productivity of the cutting equipment. Examples derived from the furniture company are used to illustrate some of the trade-offs involved, in particular the trade-off between cutting simpler patterns and patterns that yield less waste material, but reduce the productivity of the cutting machine.     

Relax and fix heuristics to solve one-stage one-machine lot-scheduling models for small-scale soft drink plants

The production planning of regional small-scale soft drink plants can be modeled by mixed integer models that integrate lot sizing and scheduling decisions and consider sequence-dependent setup times and costs. These plants produce soft drinks in different flavors and sizes and they have typically only one production line. The production process is carried out basically in two main stages: liquid preparation (stage I) and bottling (stage II). However, since the production bottleneck of these plants is often in stage II, in this study we represent the problem as a one-stage one-machine lot-scheduling model that considers stage II as the bottleneck but also takes into account a capacity constraint of stage I. To solve the problem, we propose relax and fix heuristics exploring the model structure and we evaluate their computational performances solving different problem instances based on real data of a Brazilian small-scale soft drink company. The solutions obtained are compared to the company solutions and the solutions of a general-purpose optimization software.