Cavernous sinus thrombosis elicited by a central retinal vein venous stasis retinopathy

Background: Central retinal vein occlusion is a relatively common retinal disorder in the elderly, and those with cardiovascular or thrombophilic risk factors are at increased risk. Although still unsatisfying, some treatments for the acute and chronic phases have been established based on randomized studies. However, for rare conditions mimicking central retinal vein occlusion, treatment of the acute phase should be targeted at etiology. A rare condition mimicking central retinal vein occlusion in a 70-year-old man is presented and discussed. Methods: A 70-year-old man was admitted to the hospital for isovolemic hemodilution related to a central retinal vein occlusion of the elderly, after a sudden decrease in visual acuity to 0.1. Results: Clinical and laboratory work-up demonstrated a venous stasis retinopathy, related to an atypical cavernous sinus thrombosis of undetermined origin. The patient had experienced in the past 6 months intermittent diplopia and an irreducible conjunctival hyperemia. Hemodilution was dismissed. Soon after initiation of anticoagulation therapy, the patient's clinical signs and symptoms improved. Final visual acuity was 0.8. Conclusion: Venous stasis retinopathy secondary to cavernous sinus thrombosis is rare. However, careful clinical examination and extensive laboratory work-up is needed to exclude central retinal vein occlusion not associated with common vascular pathologies of the elderl

Multi-Objective Optimization of Electric Arc Furnace Using the Non-Dominated Sorting Genetic Algorithm II

Combining classical technologies with modern intelligent algorithms, this paper introduces a new approach for the optimisation and modelling of the EAF-based steel-making process based on a multi-objective optimisation using evolutionary computing and machine learning. Using a large amount of real-world historical data containing 6423 consecutive EAF heats collected from a melt shop in an established steel plant this work not only creates machine learning models for both EAF and ladle furnaces but also simultaneously minimises the total scrap cost and EAF energy consumption per ton of scrap. In the modelling process, several algorithms are tested, tuned, evaluated and compared before selecting Gradient Boosting as the best option to model the data analysed. A similar approach is followed for the selection of the multi-objective optimisation algorithm. For this task, six techniques are tested and compared based on the hypervolume performance indicator to just then select the Non-dominated Sorting Genetic Algorithm II ( NSGA-II ) as the best option. Given this applied research focus on a real manufacturing process, real-world constraints and variables such as individual scrap price, scrap availability, tap additives and ambient temperature are used in the models developed here. A comparison with an equivalent EAF model from the literature showed a 13% improvement using the mean absolute error in the EAF energy usage prediction as a comparative metric. The multi-objective optimisation resulted in reductions in the energy consumption costs that ranged from 1.87% up to 8.20% among different steel grades and scrap cost reductions ranging from 1.15% up to 5.2%. The machine learning models and the optimiser were ultimately deployed with a graphical user interface allowing the melt-shop staff members to make informed decisions while controlling the EAF operation

Percutaneous cementoplasty in multiple myeloma: a valuable adjunct for pain control and ambulation maintenance

Goals of work: Bone pain and functional impairment are major concerns for multiple myeloma (MM) patients. The goal of this study was to better define the role of percutaneous cementoplasty (PC) in improving their quality of life. Materials and methods: This retrospective analysis included 28 consecutive heavily pretreated MM patients managed at our institution between 1996 and 2002. They underwent a total of 34 PC procedures for the treatment of 117 vertebrae and 2 iliac sites and were evaluated at 1month. Main results: Significant pain reduction of >50% was obtained after 83% of the procedures, with a mean visual analogous score decreasing from 7.48/10 to 2.1/10 (p < 0.001). It resulted in a complete interruption of opiate analgesic consumption after 59.3% of the procedures, with a mean decrease of 70.4% in the opiate dose. Functional impairment was evaluated with the Eastern Cooperative Oncology Group (ECOG) performance status scale, with mean scores improving from 1.9 to 0.86 after the procedures (p = 0.001). There was no major complication. Conclusion: PC is a safe, feasible, and efficient approach for the treatment of bone pain and disability in MM patient

Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models

Introduction: Cerebral embolism is the principal cause of cerebral infarction. Recently, mechanical embolectomy has been proposed as an effective method. We performed a preclinical evaluation of a new mechanical clot-retrieving wire. Methods: This clot-retrieving wire consisted of three nitinol loops at the tip of a microguidewire. These three loops could be collapsed into a 0.018-inch wire compatible microcatheter. Each loop was 8mm long and 3.5mm wide. For simulation, polyvinyl alcohol (PVA) vascular anatomical models of the human carotid (eight models) and vertebrobasilar (three models) circulation were constructed. A pulsatile flow circulation system was used. Embolic clots were produced using pig blood plasma. The microcatheter and the microguidewire were advanced beyond the clot. The wire was then exchanged for the retrieving wire. The microcatheter was then pulled slightly back to open the loops. The clot was then caught by withdrawal of the system. Once caught, the clot was retrieved to the guiding catheter tip. We investigated the following points: ease of device deployment, clot capture ability, clot removal against blood flow and removal of the clot out of the introducer system. Results: A total of 104 procedures were performed in 11 PVA models and evaluated. The drop rate was 19%. We succeeded in partial and total recanalization in 51.0% of the procedures (53/104) within 30minutes. Conclusion: This new clot-retrieving wire could be useful for mechanical clot extraction in strok

Percutaneous cementoplasty in multiple myeloma: a valuable adjunct for pain control and ambulation maintenance

GOALS OF WORK: Bone pain and functional impairment are major concerns for multiple myeloma (MM) patients. The goal of this study was to better define the role of percutaneous cementoplasty (PC) in improving their quality of life. MATERIALS AND METHODS: This retrospective analysis included 28 consecutive heavily pretreated MM patients managed at our institution between 1996 and 2002. They underwent a total of 34 PC procedures for the treatment of 117 vertebrae and 2 iliac sites and were evaluated at 1 month. MAIN RESULTS: Significant pain reduction of >50% was obtained after 83% of the procedures, with a mean visual analogous score decreasing from 7.48/10 to 2.1/10 (p < 0.001). It resulted in a complete interruption of opiate analgesic consumption after 59.3% of the procedures, with a mean decrease of 70.4% in the opiate dose. Functional impairment was evaluated with the Eastern Cooperative Oncology Group (ECOG) performance status scale, with mean scores improving from 1.9 to 0.86 after the procedures (p = 0.001). There was no major complication. CONCLUSION: PC is a safe, feasible, and efficient approach for the treatment of bone pain and disability in MM patients