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Polycythemia vera-induced Budd-Chiari syndrome in an older patient The case of a 94-year-old patient with subacute Budd-Chiari syndrome (BCS) caused by a novel diagnosis of polycythemia vera (PV) is reported. BCS is mostly seen in young or middle-aged patients. The presentation in a nonagenarian is rare, making this case exceptional. BCS is defined by a hepatic venous outflow obstruction. Its clinical presentation is variable from fulminant liver failure to an insidious form with symptoms of cirrhosis at the time of the diagnosis. In western countries, primary BCS is mainly seen, which is caused by an endoluminal lesion. A hypercoagulable state provoked by myeloproliferative neoplasms (MPN) is mostly responsible. The patient presented with abdominal distention and anorexia since two months. Physical examination revealed hepatomegaly and ascites. Laboratory data indicated polycythemia and cholestasis. The CT scan of the abdomen was diagnostic for subacute BCS. A JAK2-V617F mutation was found. The therapy consisted of anticoagulation, low-dose acetylsalicylic acid, phlebotomies and supportive care with diuretics and paracentesis.

This paper makes important initial steps in the application of large-scale structural optimization to Rigidified Inflatable Structures (RIS) for cost competitive residential construction, and does so within the realistic framework of multiobjective optimization using the effective physical programming approach. Over the past two decades, structural optimization has proved to be an invaluable tool in numerous arenas. Its faint beginnings in civil engineering have given way to important applications in the aerospace industry, and more recently, in the automotive industry and many other areas. Importantly, structural optimization has given way to the broader field of Multidisciplinary Design Optimization (MDO). Within this context, this paper explores the feasibility of RIS design for residential construction with respect to cost, structural integrity (e.g., buckling, deformation), and other practical issues. A cylindrical structure is considered, and is subjected to code-specified snow and wind loads. Within a multiobjective framework, a physical-programming-based optimization approach is developed to examine the behavior and feasibility of reinforced and non-reinforced polymers as primary RIS materials. Using a finite element model of approximately 72000 degrees of freedom, we illustrate how the physical programming method effectively addresses the multiobjective and multiscale nature of the problem. Initial results indicate favorable feasibility of RIS use in housing. Further studies of broader scope are suggested.