I'm very happy today to attend the CNCF conference today and today we're going to talk about Thanos today and I want to thank the previous speakers for the introduction for kind of like a background for us and today we are going to talk about how we use Thanos to achieve high availability and capability. So self-introduction, so my name is Ting Guan and I joined Alibaba in 2016 and I work in container or a bad container in the host and now I work for Kubernetes and SRE and my colleague joined our team in 2018 and made me responsible for the data deployment ecological system and he's mainly responsible for that part and today we're going to go through four parts. Firstly we're going to make a brief background introduction why we do this, what is the meaning and secondly we're going to talk about the construction process and the third how we use decentralization data and how it evolves and falls under the divisions that we have for the future. I will be responsible for the first two parts and my colleague Li Tao will go through the last two parts and firstly what is the background? Before we start I want to do some scenario in NASA's how can we use that data and this is the policy engine and this is what Alibaba wants to do at the project that we are going to have in Krusta and what is the meaning of it so it's that when there's conflicts we can adjust the QS to ensure the stability of our resources and our business and the second is the central schedule so for instance in there are a lot of scenarios we need online and offline deployment at the same time and all those offline deployment can be used and how can we better execute those data and also we have an algorithm team to analyze whether the algorithm that we use is reasonable and also next we have a resource operation and it can see that for the business crisis and the business change that we can actually plan the server and because every year Alibaba will buy a lot of server and our resource operation can make sure that what kind of server that we need to buy to catch the need to meet the needs of our future servers and also dashboard is mainly responsible for our data management and this is kind of like a use case scenario analysis and next what is our plan and what is the capability that we are trying to have first so we want to have this kind of instrumentation we need to have this capability to identify problems and we need to analyze and solve the problems and also on the left you can see that we have a lot of data on the time series and including hardware metrics OS metrics application metrics and they are all stored in the time series server and on that basis you could see that the time series implementation and we can have we can monitor the dashboard and we can have these kind of like data coverage and we can build a lot of capabilities and this kind of like expansion of our automation and we can have monitoring and arrow alerting and use this data to optimize our container and achieve higher sales and the turnover rate so how can we use this data to solve our problems you may see that all those you may know that all those problems are larger scale so we have those problems on some version of Kono and the time series database have this kind of aggregate capability and it can be stored in the database it not only include metrics but also include event so okay so all those qubit native system metrics are also installed in there so it's kind of like an offline database so on that basis we will have these other capabilities our algorithm engineer and we'll do their work and our data analysis team will also do that work on those basis and our DevOps engineer can do some operations on the analysis that we have so this deployment system and all those key capabilities that we want to have so those are the analysis that we have next so on the capabilities that we have and what is the architecture that we're going to have actually we have these two parts the first part is the customer end so for the customer end it consists of team so it's called Wali so you might actually see they have actually watched the the movie so Wali in robot in Wali so actually in Wali this movie it's just that's how we get the name and we get these kind of like a storage and we have persistent data and and with this data we'll be pinched in the observability database and we use this a paper data that matrix and we do it and this we need to ensure a long life cycle to have a long-serving lifetime and if we have a problem so we need to make sure that data stays there so this retainer storage we have a lot of those containers and a cobalt fails we cannot see that those cobalt fails so we need to make sure the data is successfully can be successfully retrieved and we have this adapter and inference star and the matrix server and the vpa they are actually connected all those seven systems so that was the first part we introduced the background and the second we are going to talk about the not agent so how we actually achieve the functions of Wali so the design principles so we actually have several design principles and the first is availability we need to ensure high availability and it will not fail easily so there are three small principles so we need to have independent matrix and also we need to have this kind of low dependency and you will not have any effect on that and if there's no accident we will never restart the system and the second is high performance that's also an important principle that we have and we if we have like a policy engine that needs to use our data we have this qs adjustment and we need to have this high performance local query capability and a future projection capability and you have this kind of like a real-time query and this kind of like a future prediction and the third principle is low cost because for everyone who are for agent if we run an agent it costs a lot of resources it's just not reasonable so we need to control the cost so there are also two small sub principles so we need to use less cpu and we need to make sure that we only pool one metric for one time and maybe there are a lot of duplicates but maybe like a lot of people are doing it and i'm doing it so but for us in alibaba we only do it for one time so we have first is the area data sources and they're all i need to do it for example but the database seems we have a lot of we can do it all maybe the second one is that we want to support this kind of capability so in our host machine for example the cpu use time it's kind of a counter so when i show you this all showing them we need to have a kind of aggregated accumulation of computation of it so to reduce the kind of these are the design principles that we have thought so next we're going to use the overracks architecture so these are mainly divided into two types first is the main versus they just collect the data from different data source and they are full components under it first the emulator which is mainly responsible for aggregates many of the data into a new one for example the encounter to aggregate into a gauge one or for example you have many containers you want to do an average of them we can do them in this and exporter api is mainly used for our centralized storage so for example expo promises so our central storage can get the data easily and the query api can just check the data change in the past or predict the change of the data in the future and the inspector is mainly used to to collect different kinds of data through our various plugins and for the second in our plugins we have support many kinds of plugins like node a kernel container storage and later on we will have like network we have many plugins and i would like to use node plugins as an example we have achieved several interval and the name interval and clamp according to my previous introductions you can predict that actually these are the intervals that uh scrapper ma use so every time scrapper wants to uh collect they will just according to this interval to define how long to collect next time and root is uh copyright with aggregator and they can just get all the rules that we are using today and according to some of the database to do the aggregation export example today i've already have too much data according whether it is original or the one that got later on and they can be defined export for example i have got 20 of the cpu and only two to three of them can be used today so uh these are the two parts one is our main process and second is the plugins how to use so when the main process needs to visit the plugins and the plugins can be started and once they have visited finished the visiting and these plugins will just be closed you can imagine that every time uh they will be launched and to be used in socket and once i have operated this function and these plugins can be closed these can also reduce our system overhead in the maximum extent and all the container function once you have upgraded and next time you use it they can be upgraded automatically and these are an introduction and next i would like to introduce the practice ways and first of all we have chosen the primitives tstp engines and use the storage of primitives we have put them into our single machine to do some odd changes so that to guarantee the current data uh that we're going to use or start so actual tstv tstv engine has a quite excellent performance and also they have um many of the simple function embedded in it and they have realized the tst um this kind of construction and compress and later on for our plugins we have chosen go plugins and you can just search it online also we have achieved the the standardization of all the intervals interface of the plugins and this this um look at we have also achieved a combined tstv api that is the primitives query ability because they need to be used for the local query and also when our central in centralize the storage they are grasping data we can provide them the data that they need and also we have achieved and stored uh functionality we know that some of the format of the data cannot be stored and we need to store them in another way for example like these events like gnsp and whether what kind of formats they are they can just store locally these are the some of the implications that we are using now and lastly i'd like to um appreciate our open source committee and also all our engineers contribute to this open source community so since we can achieve this kind of fast developing and aggregation because we have already sent being a very high standing point we have leveraged advantage we have used go long and we have used go plugin to achieve the of the reformation renovation and also we have used the frame ql and some of the technologies there so in these slides i would like to briefly introduce that many of us here today you shouldn't have data locally so what is the meaning of it and this graph can briefly introduce that actually for our quality engine how to adjust the qs to guarantee the stability of the business we can see that actually for this the response time of these businesses normal but once this resource sharing is appearing and it has some changes so actually we can use the technology to discover some of the irregular things and these kind of some changes and differences in it to guarantee is normal function to guarantee the stability of the business so these are some of the process that we have gained if you have the interest in the policy engine and you can see the craze this uh of the open source speaks and next i would like to invite my partner li tao to introduce our how can we use premises and thenals in our center lies the storage well hello everyone and i would like to introduce in ali baba and some of our experience in using premises and thenals first of all i would like to introduce promises because initially they are a kind of system monitoring and alarming a package and in 2016 they have cncf joined cncf which is an independent open source program and also many of the companies and the organizations they have joined the promise this and they have very active developers and the users community also through Kubernetes and console or documents they can just identify our object and based on the ATP through pool to get the data object data and also promises support the alarm system and can send the alarm data to an independent management tool and also promises is sporting a very flexible checking language and can can be used for many despots and as for our promises this kind of multi-dimension um language but not only for the monitor of the machine but also for the microservice architecture and next so from the kind of a scalability plan of promises i would like to illustrate on this while we are deploying the promises the commonly used uh ways we will just just consider from different clusters and schedule the different resource for them and this is usable suitable for the scenario that we have thousands of machines and for this kind of working mode they don't need to go to the public network and can reduce the and necessary overhead in the network also this kind of deployment method can satisfy the many SMEs but in the scenario of Alibaba we have several thousands of the clusters and we have over 100 000 of the parts so we cannot maintain it through this way and also a very big problem of is that if we want to check a service of its current function in all the machines we cannot do it we don't have a general view and another way of scalability is that maybe your cluster is not big enough but still you're facing the kind of loading pressure of a promise so we can build a promise for every application so if your application is also enlarging then this method is not suitable because for Alibaba we have over tens of thousands of applications so this message cannot be used in this scenario also for promise this in order to solve this kind of general view problem they have used a federation and they can just input the data from another architecture and to have a hierarchy monitoring system so if we want to see the request of every second per second in every machine and we can just collect the data all of the data in this machine in this room and also in the core machine room we can just deploy promise this and to get the data after the application so Senus can check the relevant data from the general promise this and to get the sum and to know the request per second of this service but the problem is that first of all you need to manage the aggregation rule when you have too many aggregation rules it's a problem for you to maintain and manage them and also for the federation they are more useful for getting the data after the aggregation so you can see that it also has something to do with the performance and scalability issue and because the data storage is just huge and when you pull the data out and they will face a problem there will be a bottleneck of calculating the data and so you will have a lot of like monitoring so you need cannot support or the server state you need to provide and additionally so this kind of like federation it also has a lot of problems so if you pull the whole data out and they will have the data query and it will pull all the data out and it's kind of like queuing of the texts and the cost will be behind and there will be some reliability issue so when we were doing this so we were talking about we need to lower the dependence on the outside and if we introduce another Prometheus then there's another point that might have a failure so if we transfer data on the public website the risk is even higher so when you use federation you need to consider how can you use this kind of like data monitoring mechanism on the higher data and instead of using higher Prometheus and also it's kind of for the federation to work there will be a problem so the data you pull might be behind and you might lose your data for instance if you use public network and when it ran out of time the data might be lost and when if it's just a demo you can tolerate this kind of error but if you pull out all the data the error will be magnified and this is not acceptable another thing is another thing that we could use to scale Prometheus is actually have this kind of like federation and use this kind of like scalability and this plan also has a problem because for each Prometheus when you have this kind of like algorithm to pull the node of metrics and on each case scenario you have this kind of like a different aggregating rows and on the central Prometheus we pull this out and then the biggest problem there is that the maintenance cost is extremely high and the plan would be super complicated and so in the mechanical room we have like tens of thousands of like this kind of similar structures so the issue would be quite complicated so if we want to achieve this kind of like high availability you can see that in our environment in every minute we cannot accept this kind of like status because we need to we need a higher availability so we need to have multiple Prometheus and have this kind of like similar data and use similar convex to pull similar data out and use this kind of like a federate so the the biggest issue here is that for the case each case that you run is independent there will be a latency in each case and there will be minor differences and if we use this kind of like global view and have this kind of data acquiring there will be some difference maybe for instance if you refresh the page it turned out to be different and we need to align this kind of like Prometheus so to connect the different Prometheus and send the required send the query to a same Prometheus but this also brings another problem so this will waste the resources of other Prometheus and all the query can only go to one Prometheus and other Prometheus are only responsible for pulling out data and the resources are not fully utilized so Prometheus actually has a lot of tools that can be useful scalability but it does have a lot of problems and in the community we do have solutions so in the end we decided to use Thanos. Thanos actually have this kind of a compatible API so they have this long-term matrix retention engine and they have unlimited data retention and the storage so I will not go into details I just want to tell you how we use Thanos for our global view and what is our experience so this is how Thanos work with Prometheus so this is the most common deployment so it actually has two parts sidecar and quarrier so sidecar is deployed with Prometheus and the quarrier can be put in all those different clusters so they are compatible and so when you send a query required to the quarrier and you can and those will be further sent to the sidecar which will pull out the data and send it to the central cubanases notes and send it back to the customers and because of the instability of federation and these actually effectively solve the problems of availability and they can help us to get all the data and I also want to add that when you when we use Prometheus there was one problem that if you have like kind of like a service needs to work across like different segments and the functions that we had could not work in that case of net scenario but Thanos could work and that's how that's kind of like global view deployment that we have so in our mechanical room we have this quarry deployment and it connects to different quarry systems and forms this entire system and all the data will be sent from the main cluster to the sub clusters in different mechanical rooms and will be returned to the client and this actually helped to address Alibaba's issue in most of our cases and Thanos could help us to support our data storage requirements also some other works that we did and in the customer target discovery so you can see that because for instance we have not enough data storage or some other issues so we need Prometheus to stop automatically pulling our data so for cubanases and that is kind of like discovery system so actually Thanos could help us to address the issue it supports cubanatus and in Alibaba because our business and our some other historical issues because of all those elements so we have this cubanatus and other discovery system so we developed this kind of like components the custom-made target discovery so it can verify all the data it will work with the same format same as Prometheus and Prometheus can then answer our requirements accordingly and also configuration management so if it's just one or two Prometheus you can manage it manually but we have so many Prometheus and also we have this kind of like change of configurations of Prometheus and there's no centralization tool for Prometheus so we actually developed a tool ourselves so we have this kind of like central management tool and users could actually send this kind of like change of configuration and we use sidecar to put in on the side of the Prometheus and it will synchronize all the data and put it locally and Prometheus can load the data when you send the request so it actually helps us to address the issue last part is thinking about the future so when we use Thanos and Prometheus it's been a while now so we've been thinking that what are the enhancement what are the things of like they can improve so we think like the most important thing is authentication because security is our priority and it is quite important for us to use this kind of a authentication process and help us to authenticate who are the users that we have and that you have this authorized request and that you authorize them to only use part of the data and to have these kind of like targeted management methods and to have a more precise target and flow control and the second we about query cache and we actually when we rewrite these kind of like data we need them to be cannot be like remodified and whenever you check it the data should be the same and we need to for the time nuts and every data we need to return the data and store it locally so we can go back to the data quickly and third is query safeguards I think Thanos and Prometheus both have this kind of function but we need more precise management force we want them to be integrated with APAC flink so the calculating capability of us can be enhanced so we can integrate with APAC flink and support more calculating capabilities there's a problem with Prometheus is that it's a single like it's a single host and then when you run it they will have some bottlenecks in terms of the calculating so this is all we want to share thank you very much any question so actually I do have a question because we are monitoring so what is what are the strategies when you monitor the code and womb and heart data and what is the differences between online and offline data so for the first question so actually what is the strategies that we what are the strategies that we use actually for the data that we have so actually it has actually run from 10 seconds two minutes and even two hours they are different but then we can make sure that for the important data the the particle need to be small and that it need to be fine grade monitoring and the grain need to be finer so it's just not like one-time data or alerting data if it's like a long time away from this maybe we will have a compact sample and the retention maybe we'll delete the data so actually the strategies are quite complicated so if you have specific request we can talk later in details because I cannot summarize it in one or two sentences the second question I can't remember it could you please repeat it so the second question is so what is the like the particle the grain and also for the online and offline data the what is the response time so for the online data so it's actually real time data so we actually pour the data every 10 seconds so latency is quite low and when we so we have opportunity for another question so I'll just answer this question one so when we send the data to question q and we don't have this kind of like but we were just to have this long term and the promissious local retention so it's within seconds the latency will not be long and also the a pack of flink so we will have more alerting and aggregating rules in the future one more question so in I noticed that you didn't use object storage by fairness so you actually locally store the data by promissious so for every data center how do you store the data by like by segments or I mean how is the deployment or Kubernetes or is it on the Kubernetes or physical or virtual host so actually for long term storage our cloud we actually have our own object storage we have status it has long term storage but the interface is not connected so we have this pangu interface and in alerting object storage and also for these kind of like data we want to store it locally but we do have some problems that when we have replication we actually for every one of us we store a lot of storage and when a paker is broken and we need to copy paste it one-on-one and we don't have a lot of like original sources and we do have a have this kind of like a long-term retention and also for cuba it is whether we run it on kubernetes or physical host so actually on a lot of scenarios if it's just a small scenario and if you scale it up and if it's like tens of thousands the prometheus can be managed on kubernetes and also the tennis can be also you're used to manage all those data but in our case we have so much data and we cannot run the data on kubernetes we have like thousands or tens of thousands of cases the capability will be too small and also second because the link is actually connected to stability of the whole system if we have failure we need to make sure that the link will be not affected and we and we don't put kubernetes on the business side with us and so we have these kind of independent kubernetes and to actually change and to make it adapt to a large-case scenario and we're still in revolution and we're still running it if you have any question please contact us thank you


Yeah, I'm G.C. I'm the CEO and the chairman of the BenQ material. And hi, so who are you? Oh, I'm C.K. I'm a R.D. Guy in BenQ material. So what do you show here at the show? Yeah, you know, BenQ material is a very innovative material maker focused on the display solution. So we will have automotive solution, OLED solution, and we will have innovative projection material. This will be a very fantastic solution for the entire life. What is this? Oh, it's just decoration. Decoration? Decoration that simulates a car.  So you have a smart window? The smart window is transparent and has to switch by PDOC. And if it's like this, you can still look through? Yeah. It's normal transparent and no power on is transparent. Power on is the case. It's a reverse type. And then you can see it's a different type. It's PDOC. So it's a power on is the transparent and it's head. Now we switch it to it. You can see that spotlight. Because your company, you're from Taiwan, right? Yeah, from Taiwan. It's very, very sunny. You want to have a shade in the car? In the car and also another solution for CIP. You can stay here and see the different. So this is about the viewing angle? Yeah, viewing angle solution. And then we also anti-reflection solution in the service. Nice. So no reflection? Yeah, no reflection. Better viewing angles? Yeah. Light control film. Light control film? Yes. And then let's gas-reflection. So this is very important for the automotive market? Yeah. So you already have a, let me go over here. So you have a big share in the automotive already? Yeah, because you know, this light control coming, growing importance due to the larger screen is used in the car. So the reflection management becomes extremely important for the safety. So this is especially for the future? Yes. Not yet? Yes. But it's coming, it's available now? Yeah. It's not really available. This is, people are using it but they are causing trouble. So that's why we make such material for the future. And a lot of companies are now talking to us to, we are doing some collaboration with them. So if we go over here, you have some more demos right here? Yeah. This is, what is this? This is our, our, our own watch. So this is a flexible display? Yeah. It's a curved display. Curved display? And which part do you do here? Yes. Which part is your technology? Your services, the circular polarizer theme, article theme on the service. Nice. So you have a, what do you call it, polarizer, the film that does what? You can reduce the pressure. Reduce the reflection. Yeah. Anti-reflective coating. Yeah. It's always matte, right? It's not glossy. Yeah. Take away the glossy. Make a matte reflection. Effect. How does it work to take away reflection? What is the magic to do that? You always use the sunshine and you can reduce, you gain better image quality. So we can see the image is clear. Do you also provide this on TV? Yes. TV use or the same, circular polarizer on TV is a film type. You can see this area and that area is more black. So it's more black? Yeah. So we use a true black functional film and enhance the picture quality. So it's very important to take away the reflections on the TV, right? Yeah. Are you already doing a big market for this? I think for the ordinary TV you don't see the difference between reflection or a large but when you go up to 4K or 8K, the reflection will influence the resolution of the TV. So the anti-reflection becomes very important. And the reflection depends on the reflection index. You should not have too big reflection index on the top of the film. So what we are going to do is we make the reflection index difference gradually changed. So that we need a lot of coating in between. So my dream from this show is to see a screen where there's no reflection. Is it possible? No reflection. It's possible. No reflection. Yeah, it's possible. It's just because many people have their TV not in a dark room. Yeah. There's always a window open or there's a light. Yeah. And you want to have no reflection. Yeah. How to do? We can make a film and we gradually change the reflection index. Then you don't see the reflection. So far they use the most eye film. Most eye film they can reduce the reflection by different kind of angles. So far now we are developing a view angle independence film for anti-reflections. On the TV or on the car use. Are you the best to do anti-reflection in the world? I'm not saying we are the best part. We are one of the best. One of the best. Yeah. And over here we have another flexible curve display. Display, yeah. And we go around here. Yeah. And we are more for the... To stand here, yeah. So this is for the foldable AMOLED? Not... It's OLED. It's also comfortable. But with demonstration we use the plain AMOLED. And then when viewing from the side, this one has some color... I don't know if it's called color fringing or something like that. Yeah. And then this one is just purely white. Yeah. This one is doing weird colors. So we use our color solution. So inside one structure of film inside is the polarizer. So you do a lot of films. Yeah. We are film company. You film. Yeah. We are load to load film. So what all the films you have here? Yes. Part coating. Part coating. Color CGI. And the polarizer. And every other film. And every other film. And between that we use the optical clear adhesive to combine it. One thing that's very important from the film is to not take away the light too much, right? Yeah. So what is the secret? How does that work? How do you make really nice films that keep all the light go through? But still it's improving everything. Yeah. It's a couple of things. Of course we make it as thin as possible to reduce the absorption of the light. And the other is we have some different ingredients inside. I mean it's not only to avoid the reflection but we also can manipulate with the microstructure. So microstructure, is it to do with nanotechnology or no? Something else? Something else. Yeah. Some process. Yeah, some process. Yeah. It's all in house. How long time you've been doing this? We have been in the business for 10 years. But BenQ is doing many different things? Yeah, we are material. We are BenQ material. Just material? Yeah. And there's also BenQ projector, right? You show something with projector over here? Yes. And we are not... This is also a film. It's a very... It's an amazing film. You will see. With the projector you see when the projector project on the film it shows still transparent but it's a very high resolution and a very saturated color. So when people do projection it's very important to have a nice screen. Yeah. But this one is transparent so it's a real projection. Yes. And has good viewing angles. Yes. How? How do you do that? Well, that's a lot of secret inside. We have... A lot of secret inside. Yeah, we have too many ingredients. It's a very complicated process. And I think this will be a very... Amazing product to kill a lot of competitors in the market. Kill what? For which market? First, you can put for the display of the merchandise. You see some... You can put the clothes in or some pottery but you still can see the... Transparency. Yeah. And one of the killer products is you can put on the car, window and then you can display the advertisement on the window. On the window? Yes. When the car for the car sharing, when the car is sitting on the parking lot, you can display not very nice picture and still you see something inside or you can still go inside to drive the car or you can sit inside and then you can watch something similar outside people are watching. This is going to be big for self-driving cars, right? Yeah, exactly. Still driving or the car sharing also. And you can project behind the windows on the building? Both ways. On the building? Behind? No, you see it's project from behind but you can also project from the front. Both. And how soon is this available? It will come in maybe one year. And it's going to change a lot for the market? Yeah, I'm sure. I'm pretty sure it will change the game rule. So what kind of other things you do in the company? What's the... How many materials do you have? This is our biggest product group. That's display material, optical material. But we are also working on the DCM battery separator, aluminum laminated film. And also we are working on healthcare product. You said battery? Yes, battery. What for what? For the DCM battery, for electrical car. Electric car? Yeah, exactly. You make the battery for the car? Yes, battery material. We are making the material for the battery. So lithium something? Yeah, separator. Separator. It's very important the battery to have good separator. It's very important for the safety of the battery. Safety and for the capacity or no, it's just safety. Not many safety. And you said battery and what else you say? Healthcare. Healthcare? Yes, healthcare. What is the product for the healthcare? We are working on the wound care. We are working on the hemostatic product that stops bleeding. And we are working on medical packaging. So all this has to do with chemistry? Yes. Chemistry, physics? Mostly chemistry, material science. And you have the top experts in the world? Yes, over here. Right here at the booth. Cool. And with coming with new inventions, lots of patents and everything? Oh yes, exactly. We have more than 400 patents. But BenQ is a big group? Yes. We are making projector, TV, this kind of things. But we are one of the company in the group. And they focus only on the film material.


Okay, so, I think you all know me, I'm the Neuroloftomology Fellow. I was a little ambitious when I first made this title, so I'm gonna have to change it just a bit and add that it's just going to be Neurologic Accompaniment to an Autonomic Disease. So our patient presented with a chief complaint of, I think I have a floater, and she's a 24-year-old graduate student in Manny. We already knew her well because she had just had a five-day history of loss of vision in the left upper quadrant of both eyes. She came in from triage and she had been in the ER. She had gotten an MRI scan for this, and this was about three days prior to her new chief complaint, and basically she was describing almost a kaleidoscope effect in the left upper quadrant of both eyes with loss of vision. So her MRI scan at that time was normal, no sign of infarction, and she had a history of migraine, so that's what we thought was going on, but then, much to my dismay, she calls and says I have a new problem, and this is a white spot with a blue outline that I see just in my left eye, and I think it's a floater, but it doesn't float. Her past medical history, as I said, she has a history of migraine since 2003, although she's never had a headache, so her migraines currently are occurring about once a week, and she gets basically loss of central vision, and then it spreads to take away all her vision, and then she gets tingling on the left side of her body, and then sometimes she has trouble speaking, and this whole process takes about 30 minutes. And then she also has frequent nausea, not necessarily associated with these migranous spells. She has trouble with panic attacks, and her sister was actually killed in a tsunami in Thailand in 2004, and her mother died from CNS lymphoma at age 40, and so she has a lot of stress and panic attacks, sort of PTSD. She was started on topomax and aspirin three months ago by a neurologist who was trying to control her migranous spells, and in evaluation for these migranous spells, she had an echocardiogram, which showed the patent frame and ovale, which was closed, and then after that, she started having the spells three times a week rather than once a week, so she had to get revision of that, and ever since, she's had shortness of breath with irregular heartbeats occurring several times a day. Other than that, she takes max salt as needed for her migraines, and she doesn't use alcohol tobacco, well, she rarely uses alcohol, no tobacco or drugs. On examination, her visual acuity was 2020, her people exam was normal, motility, muscle balance were normal, pressure was normal, and this is what she drew on the Amsler grid as her spot. She said that basically within this area here, she can't see any of the lines, it's sort of just blighted out, and then it has like a blue outline. This is her visual field test from the few days prior, and she says that seems just exactly the same as it seems at all. And this is her funness exam, and it looks pretty normal on this photograph, but in real life, there was a little spot right around here, and I can show you some more pictures where you might believe me. And on red free, she didn't have any changes to her funness, but this is her infrared, and you can kind of see that spot. And we did the infrared just because we got an OCT, but we happened to get the infrared image. So, here's her OCT, and at first it's like, okay, no fluid, but then if you're looking right here, there's an abnormality in the outer retina, and on zooming in, you can kind of appreciate that better. So I think this is like the inner outer segment, and then I think this is the outer nuclear layer. Correct me if I'm wrong, retina people, but. So our impression is we have this 24-year-old woman who has a persistent visual aura without infarct, and a new photopsy on the left eye, which corresponds perfectly to this macular lesion. So we had gotten the MRI scan, and it had diffusion-weighted images, but we hadn't really imaged her vessels, so we decided, because of this new lesion in the macula and the possibility of maybe ischemia, that we'll just go ahead and image her vessels in her brain. So we did that, and then we started thinking, maybe something like some unusual presentation of ampy, just because ampy is well-known to cause cerebral vasculopathy, and retina changes, so we were thinking about that. So when she went to get her imaging, I read up on ampy, and basically the pathophysiology isn't known, but it's thought that it could be due to some kind of infectious process that causes some kind of hypersensitivity reaction that causes some inflammation in the coroid, and maybe a partial corridor infarction, and then changes in the overlying RPE. And we all know that ampy occurs most common in white young adults, and it occurs equally in both sexes, and they often are preceded by a flu-like illness, and they often have changes in their central or paracentral vision. So, and on exam, generally with ampy, you see sort of discreet, multiple-round subretinal lesions, like in this picture, and this is in the acute phase, and in the chronic phase, you can see changes in RPE, coarser, or fine granular pigmentation. I didn't really remember the other ocular findings that can occur with ampy, like, of course, well, anterior and posterior chambers cell, but also corneal melting, subepithelial infiltrate, episcleritis, papillitis, optic neuritis, retinal vasculitis, engorgement of the retinal veins, and even vein occlusions have been reported. And the most common neurologic complications with ampy have been headache and CSF pleocytosis, but rarely there can be a cerebral vasculopathy, which we all hear about, and that can sometimes cause a stroke. And it can generally occurs either simultaneously with the diagnosis of ampy, or a few weeks after the diagnosis of ampy.  And it can affect the small or large arteries in the brain, and it can also cause a venous thrombosis. And there's been one case report of someone who had subacute sclerosis panencephalitis preceded by ampy. And so, in this literature review that was published in the Journal of Neuroophthalmology, they looked at 19 published cases of ampy associated with cerebral vasculitis, or venous thrombosis. And the most common symptoms of patients with cerebral vasculitis or venous thrombosis were headache, weakness, or hemiparesis, homonymous hemianopia, which is sort of what our patient had, numbness, seizure, and less common symptoms were aphasia, dysarthria, ataxia, stupor, slurred speech, and nystagmus. So, that same literature review actually looked at follow-up of patients with neurologic complications from ampy, and six were eventually better, completely, five had persistence of their neurologic defects, and then four had either progression of their defects or relapse when their drugs, their immune suppressant drugs were tapered, and three actually died. And those patients were young men, age 23, 24, and 25, who had one patient presented with headaches and seizure and didn't have any neuroimaging and didn't have any treatment, and then one patient presented with infarction of his MCA, received oral prednisone and died from cerebral herniation, and then one patient had infarction of the PCA, and also had an oral prednisone and died. And so the main recommendations for patients with ampy and neurologic symptoms or headaches would be a brain MRI with diffusion-weighted images, which our patient already had. And treatment based on the severity of their clinical presentation, so it's corticosteroids if they just have headaches or other immune suppressive agents for patients with imaging evidence of cerebral vasculopathy. So I was all ready to look at our patients' MRI and see if she had a vasculitis and considered treatment, but luckily for her, her MR, AMRV were all completely normal and again, her MRI showed no evidence of infarct on diffusion-weighted images, so good for her, but we still didn't really know what was going on. And she had a hypercoagulable workup that was all normal. Oh, so at this point, we decided to get the FA, and so this is for Dr. Bernstein. We got her autofluorescence first, which I've learned to do, but unfortunately, it wasn't very helpful. So we got a fluorescein angiogram, and again, this was completely normal, and as was the ICG. And we still had one test pinning, which was serial ansler grids, which we like to do, and basically her spot didn't change. So, does anyone have any thoughts about what could be going on? We came up with something, so I showed Dr. Vitale, and so we think that probably she has acute macular neuroretinopathy, and this was first described by Boss and Dewman in 1975. They thought that the lesions were affecting the inner retina, so that's why they called it neuroretinopathy. It's rare, it can cause permanent or transient visual impairment, and it can be either unilateral or bilateral. And generally, the lesions are petaloid, and they make a flower shape around the fovea. They're flat, they're well circumscribed. They can be brown, red, or even purple, depending on the pigmentation of the patient's fundus. And they're wedge-shaped. Oh, and they tend to correspond exactly with the patient's ansler grid. And they're most best seen on infrared imaging, so here's a patient from just last month in the Archives of Ophthalmology, and you can't really see too much on the fundus exam, but on infrared, it really stands out. And it tends to show decreased cone responses on multifocal ERG, which kind of indicates involvement of the photoreceptors, and so this is just an example from 2009 in the Survey of Ophthalmology. And on OCT, it tends to show involvement, just like our patient, of the inner outer segment and thinning of the outer nuclear layer. Oh, and so because of that involvement, some people have proposed to change the name to acute macular outer retinopathy, or a more, which means love in Spanish. So, and then this is just a picture showing resolution of the changes in the inner outer segment over time improvement, but maintaining some thinning of the outer nuclear layer. And that's from Ratna from 2011, and this is as well. And this shows changes in the infrared over time. This is at baseline one month and three months, and it just shows that the defect lessens a little bit. So AMN has been described, this is from a review of 41 cases from 1975 to 2002, and about 80% were found in women, and about 50% of the women were using oral contraceptives, which may or may not be important, but and then it was associated with epinephrine about 10% of the time, but about 15% of the time involved epinephrine plus some shock, clinical shock, and then rarely like 5% of the cases involved trauma or iodine contrast media. And interestingly for our patients, 7% of the cases were associated with headache or migraine headache with or without aura. So our patient had the aura and she'd been using her max salt almost every day for like five days, which has a sympathetic effect similar to epinephrine, so we're not sure if that was significant or not. So we do all this research and everything, but unfortunately for our patient, it doesn't really help with her treatment because there's limited follow up documented and we know that defects can get less noticeable with time and sometimes they're permanent, sometimes they're transient, and we think there's persistent of the thinning of the outer nuclear layer, but treatment isn't really known, but it's still good to learn about it and also because it's really easily identified, I think, on our OCT. So maybe with more cases identified, we can figure out what's going on systemically. So any comments or questions? Yeah, no run. Oh, no, I didn't read about like any persistent homonymous defects, just the fact that there was a paper from 1975 that talked about ORAS and associated with AMN, but I actually wasn't able to pull that article yet, so yeah, I don't know about like permanent homonymous defect or anything with AMN. She did, she had a closure and then she had a revision of her closure. No, her migraines got worse after the closure of the first time. They went from once a week to three times a week and then after the second time, they went back to once a week. Yeah, all ORAS, no headache. Oh, yeah, I don't, I don't... Oh, there you are. Any of the retina people have...


Patients can have confidence in the PMC Lawson Cancer Center from our diagnostic capabilities to advanced genetic testing, clinical trials and dedicated oncology pharmacy services. Our purpose is saving lives. Williamson, West Virginia held their Christmas festivities on Saturday, November 26 starting with their Mary Little Market, tree lighting and Christmas parade. We've got everything from woodworking to t-shirts to activities for the kids. We're getting ready to start the candy cane hunt. We've got letters to Santa down here that the kids can write and take over to the fire department to be delivered directly to the North Pole. Many vendors and businesses turned out decked in holiday cheer to spread joy and assist market-goers in checking off gifts from their holiday lists. Most of our vendors went ahead and decorated their booths. I know the collective put some work into their windows and the outside as well. They've got a Christmas tree up in here that you can see when you come into town. I said candy cane is just kind of adorning the streets and then with the lighting of the tree later tonight. So I think just collectively it's really going to help put everybody in the Christmas spirit. And it's a really good time to start checking things off of your list, too. The street was teeming with festive folks out to eat good, buy gifts and watch the stellar Christmas parade. For Mountain Top News, I'm Kelsey Dean.


This is stock number 9640. We are here at Summit Automotive in Fond du Lac, Wisconsin. You're new and used Jeep headquarters. Today we are checking out this super clean 2016 Jeep Cherokee Limited. This vehicle has the 2.4 liter four cylinder motor. From this HD video you will be able to tell that this Jeep is extremely clean all the way around. Brilliant black crystal pearl is the color. We shoot all of our videos in 1080p, so if you have HD capabilities on your computer tablet or smartphone device, turn them around right now because it is like you're right here looking at the vehicle with me. This one comes with the 18 inch polished aluminum rims. Continental pro contact tires. These are 225 55 R18s and they have right around half the tread left. On them. A little bit of a ding on that front fender, but other than that this thing is pretty much perfect all the way around. Has the LED running lights, the projector lamp headlamps, the factory fog lamp. The hood is in really nice condition. Past new side rim is in nice shape. As we go down this side of the Jeep, you can see just how clean that body is, how reflective and mirror-like that paint is. We take these videos so if you are far away or even if you're close by and just cannot make the trip down, you can still see the vehicle, hear the vehicle, and have confidence in what you're looking at before you even get here. We want to make sure you get the most accurate representation so that when you do get here, there are absolutely no surprises and you'll be at 100% ready to go. Four-wheel disc brakes on all the Cherokees. Back rim is in excellent shape. No scuffs or scrapes on that. The back tires have just as much tread as the front tires. You can see that brilliant black crystal pearl. It's got a lot of nice metal flake in it. As we come around to the back, you can see the rear bumper is in nice shape. No dense ding, scuffs or cracks on that. The tailgate is in excellent shape as well. It does come with the LED running lights. They have been proven to shine brighter, faster and farther than normal halogen lights and they take less energy. Back storage area is very clean. No rips or tears back here and those seats do fold down almost completely flat.  It does have the backup camera. You can really see that metal flake in the paint. Really a good-looking color and as you go down this side of the vehicle very very clean as well. This back rim is in nice shape too. You can see any denser dings on these doors or that back quarter and it does have the heated mirrors with the built-in directional signals enter and goes system.  There are no rips. There are no tears on these seats. Power driver seat. Both of these seats are heated and you do get driver side lumbar. Factory floor mats throughout, auto headlamps, power windows, power locks and power mirrors and as we hop inside the vehicle you can see the 7-inch TFT display and that this one does have 21,900 miles. Digital speedometer, outside temperature display, miles to empty. You can change all those corners to pretty much whatever you want. It does come with the heated leather wrapped steering wheel. Cruise controls on that side, Bluetooth audio controls on that side. Very nice and clean on that wheel. No scuffs or scrapes. It does come with the 8.4 touchscreen radio. What is nice about this radio is that it does not have a nav, but you can add nav to this radio for $5.95. This is the second last year that you could do that. You can do your heated seats and heated steering wheel buttons. This is also where your backup camera shows up. So like I said, this one does have the enter-and-go system so you get the key fob that looks like that with the push-button start and remote start on it, dual-climate control. You get the USB SD card and AUG's jack, the 9-speed automatic transmission and the passenger seat is very clean as well. No rips or tears on that. And it does have the factory format on that side. You do get in-seat storage, which is a pretty cool feature. A lot of people like that to keep valuables in so that they're kind of out of sight, out of mind. We'll take a quick look at the back seats and then we will check out under the hood. The back seats are just as clean as the front seats in this vehicle. No rips or tears back here. By the way, this vehicle smells very clean. I don't think it's ever been smoked in. No rips or tears on the backs here. It does come with 10 airbags in this vehicle, so including the knee bolster airbag. So very safe vehicle. You get the latch child safety system. You get a hundred and fifteen volt, hundred ten watt plug-in, or a hundred fifty watt plug-in, I should say. Factory floor mats and the carpeting is nice and clean. These seats do fold down, almost completely flat for extra storage and they fold up nice and easy as well. We'll take a quick look under the hood. I'd like to thank you for checking out the video on this Jeep. Hopefully it's convinced you that it is a very nice vehicle inside and out. Engine bay is very clean as well. Runs very good. No belt squeaking or anything like that. This vehicle has been fully safe and inspected by our service shop, has a fresh oil and filter change. All the fluids have been checked and topped off. Very clean underneath here. And this one is 100% ready to go. To see more pictures of this Jeep or one of our other 400 new and used cars, trucks, SUVs, minivans, Wranglers. You name it, we got it.  Videos of every single used vehicle that we have all at SummitAuto.com. If you want to make this Jeep yours, give us a call right now<PHONE_NUMBER>. Ask for one of our sales associates to make this Jeep Cherokee yours today. Once again, that number is<PHONE_NUMBER>. And if you'd like to check out more videos of this vehicle or like this vehicle, you can go to www.youtube.com. SummitAuto, remember to like, subscribe, and share on this vehicle and all the videos that you see there. In fact, in a second, you will see a link to subscribe to our YouTube channel on your left. A link to more used inventory videos like this one on your right. And if you haven't been to our website, on the bottom, a link to this vehicle on our website, click those checks out and we really look forward to helping with this super clean 2016 Jeep Cherokee Limited Front Wheel Drive. Thanks again.


Now, Oregon State stakeholders have agreed to work together with government and security agencies to ensure that the increasing waves of crime and criminality is reduced to the barest minimum. The maid is known during a security summit organized by the Oregon State Police Community Relations Committee and the State Chapter of the National Youth Council of Nigeria. Now, participants joined from different parts of the society used the opportunity to share their views on how to reduce crime and criminality. The organizers said with collective effort, ritual killings, internet fraud, armed robbery, autism and drug abuse were reduced in the state. Let's be factual and straight in our dealings with our young ones, lest all of us bury our shame and accept responsibility. Let me abolish the pastors, the prophets and the ma'am, stop deceiving these young ones about short cuts to wealth. Let's reduce prosperity propagation and concentrate on preaching hard work, dedication, patriotism and resilience, let's mentor positively and reduce unscrupulous living. We all have a very important part to play in ensuring that we have a peaceful and huddled society. It has to do with all categories of people in the society, the elderly, the young adults, the youths and what have you. So we must take care of each of them, you know, as it relates to them. I am actually making a deal that let all of us come together to ensure a safer, a more conducive environment. Hello, hope you enjoyed the news. Please do subscribe to our YouTube channel and don't forget to hit the notification button so you get notified about fresh news updates.