Between 1981 and 1985, the authors studied 21 Tunisian patients with alpha chain disease. Twenty of 21 underwent laparotomy. According to Galian ef al. six patients were classified Stage A, two Stage B, and 13 Stage C. The therapeutic regimen included the following: (1) Antibiotics: In the case of intestinal bacterial overgrowth (IBO), antibiotics selected by their antibiograms were delivered; in absence of IBO, metronidazole plus ampicillin were first given. The antibiotic treatment was changed in case of therapeutic failure. (2) Chemotherapy: From 1981 to 1983 a cyclophosphamide, Adriamycin (doxorubicin), teniposide (VM-26), prednisone (CHVP) protocol (Adriamycin 35 mg/m2, teniposide 50 mg/m2 day 2, cyclophos-phamide 300 mg/m2 days 2 through 4, prednisone 40 mg/m2 days 1 through 10) was used. After 1983 bleomycine 15 mg, Adriamycin 30 mg, vinblastim: 10 mg were given on day 15. Serum immunoelectro-phoresis and immunohistochemical study of duodenojejunal specimens were made on a 3-month and 6-month basis, respectively. Survival curve analysis was made according to Kaplan and Meier. Results were as follows: (1) Stage A: Six patients were first treated by antibiotics alone; two complete responses (CR) persisting 42 and 55 months later were observed, respectively. The four antibiotic failures were submitted to further chemotherapy with four subsequent failures and two deaths. (2) Stage B-C. Chemotherapy led to nine CR with one precocious relapse, a salvage chemotherapy allowing to one more CR. (3) All stages mixed, percentage of survival reached 90 f 12% at 2 years and 67 f 25% at 3 years, all patients alive beyond 3.5 years being disease-free.

This paper addresses the problem of designing a collaborative 4.0 distribution network using blockchain to ensure coordination between partners and the secure transfer of transactions. In this study, we compare the performance of horizontal collaboration and that of non-collaboration in terms of sustainability. The economic level is considered by the reduction of the logistics costs, while the environmental level is evaluated by the reduction of CO2 emissions from vehicles through their use and depreciation as well as those from the hubs' operation and construction. The social level is addressed by maximizing the created job opportunities and by reducing the accident risk and the noise level. Both mono-and multi-objective optimization approaches are proposed to solve the problem of exact and meta-heuristic optimization using the genetic algorithm and the NSGA-II. The obtained results show that horizontal collaboration is more efficient and promising at all levels.

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By creating new job opportunities and developing the regional economy, the transport of goods generates significant costs, environmental and sanitary nuisances, and high greenhouse gas (GHG) emissions. In this context, collaboration is an interesting solution that can be used to enable companies to overcome some problems such as globalization, economic crisis, health crisis, issues related to sustainability, etc. This study deals with the design of a multiperiod multiproduct three-echelon collaborative distribution network with a heterogeneous fleet. By applying the mixed integer linear problem (MILP) formulations, it was possible to study the three dimensions of sustainability (economic, environmental, and social/societal). Since the examined problem was NP-hard, it was solved using four metaheuristic approaches to minimize the different logistics costs or CO2 emissions. The social/societal aspect evaluated the accident rate and the noise level generated by the freight transport. Four algorithms were developed to achieve our objectives: a genetic algorithm, a simulated annealing, a particle swarm algorithm, and a vibration damping optimization algorithm. Considering a French distribution network, these algorithms overcame the limits of the exact solution method by obtaining optimal solutions with reasonable execution time.