An Unusual Case Presentation of Non-Pathergy Induced Severe Pyoderma Gangrenosum Localized to the Perianal and Intragluteal Regions.

Pyoderma gangrenosum is a rare neutrophil based disorder presenting as a painful sterile ulcer usually below the knee. The disease is also linked to comorbid conditions including inflammatory bowel disease (IBD) and pathergy. Mainstay treatment begins with high dose steroids, either topical for limited disease or systemic for extensive or rapidly progressing disease. This report presents a patient who had perianal and intragluteal cleft pyoderma gangrenosum, not related to IBD or pathergy, where high dose steroids were contraindicated due to history of steroid induced psychosis.

Cardiovascular remodeling during long-term nocturnal home hemodialysis.

BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in patients with kidney failure. Nocturnal home hemodialysis (NHD) is a form of kidney replacement therapy whereby hemodialysis is performed for at least 6-h overnight, at least 4 days per week. Little is known about the effects of NHD on cardiovascular remodeling as assessed by transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR). OBJECTIVES: The primary objective of the study was to determine the long-term effects of NHD on cardiovascular remodeling using different imaging modalities over a one-year follow-up. METHODS AND RESULTS: A total of 11 patients were included in the study (6 males, mean age 48 ± 16 years) between 2009 and 2011 inclusive at a single tertiary care center. All patients underwent TTE and CMR at baseline and after 1 year of NHD. Left ventricular mass index decreased significantly at 1 year by both TTE (152 ± 7-129 ± 8 g/m(2), p < 0.05) and CMR (162 ± 4-124 ± 4 g/m(2), p < 0.05). There was also a significant decrease in both left and right atrial volume as well as in right ventricular mass index over 1 year of follow-up. Diastolic dysfunction, graded from 0 to 4, improved from a baseline grade of 3.4 to 1.2 at 1-year follow-up. CONCLUSIONS: Long-term nocturnal hemodialysis leads to favorable cardiovascular remodeling with a reduction in cavity dimensions, regression of left ventricular hypertrophy, and an improvement in diastolic function, as assessed by both TTE and CMR.

Physics-informed attention-based neural network for hyperbolic partial differential equations: application to the Buckley-Leverett problem.

Physics-informed neural networks (PINNs) have enabled significant improvements in modelling physical processes described by partial differential equations (PDEs) and are in principle capable of modeling a large variety of differential equations. PINNs are based on simple architectures, and learn the behavior of complex physical systems by optimizing the network parameters to minimize the residual of the underlying PDE. Current network architectures share some of the limitations of classical numerical discretization schemes when applied to non-linear differential equations in continuum mechanics. A paradigmatic example is the solution of hyperbolic conservation laws that develop highly localized nonlinear shock waves. Learning solutions of PDEs with dominant hyperbolic character is a challenge for current PINN approaches, which rely, like most grid-based numerical schemes, on adding artificial dissipation. Here, we address the fundamental question of which network architectures are best suited to learn the complex behavior of non-linear PDEs. We focus on network architecture rather than on residual regularization. Our new methodology, called physics-informed attention-based neural networks (PIANNs), is a combination of recurrent neural networks and attention mechanisms. The attention mechanism adapts the behavior of the deep neural network to the non-linear features of the solution, and break the current limitations of PINNs. We find that PIANNs effectively capture the shock front in a hyperbolic model problem, and are capable of providing high-quality solutions inside the convex hull of the training set.

Anterior disc derangement with reduction of the temporomandibular joint: a case report.

BACKGROUND: Temporomandibular dysfunction involving anterior disc derangement with or without reduction, secondary to posterior ligament insufficiency is typically managed conservatively with success in a majority of patients. When conservative management fails, the next step in the continuum of care is unclear. Platelet-rich plasma injection combined with a 3-week immobilization period may be effective in treating posterior ligament insufficiency following a period of physical therapy. The result of this case was exceptionally successful, with the patient reporting 100% improvement 6 months post-injection. Prior to this case, we predicted a 20% success rate based on her inability to maintain the effects of conservative management over the long term. CASE PRESENTATION: A 33-year-old white woman presented with temporomandibular dysfunction, which responded to an initial course of physical therapy aimed at restoring the mechanics of her temporomandibular joint, exercise management, and education on self-management strategies. She returned 20 months later and responded well to another course of physical therapy. Despite improvement in pain, range of motion, and mechanics, she continued to present with a reduction click at the end range of opening. The crisp and loud nature of the reduction click indicated a viable posterior ligament and reduction of the anteriorly displaced disc. She opted for platelet-rich plasma injection, provided by a chronic pain specialist with the assistance of a physical therapist. She was immobilized for 3 weeks, followed by a weaning period with reduced posterior support for an additional 5 weeks. Follow-up appointments with a physical therapist occurred at 3 weeks, 8 weeks, and 6 months post-injection. CONCLUSIONS: At 6 months, she reported 100% improvement. Objectively, there was no indication that the disc condyle relationship was disrupted. At 6 months post-platelet-rich plasma injection, preceded by a period of conservative physical therapy management, and followed with appropriate physical therapy follow-up, this individual had complete resolution of her anterior disc derangement with reduction.

Multimodality imaging of intramyocardial fat in tuberous sclerosis.

Here, we report about a 34-year-old man with tuberous sclerosis. During routine surveillance, a CT scan of the chest incidentally showed a low-attenuation streak within the left ventricle. Cardiac magnetic resonance imaging confirmed intramyocardial lipid deposition within the left ventricle. Tuberous sclerosis is an autosomal dominant neurocutaneous disorder characterized by tumor-like malformations that involve many organ systems, including the heart. In patients with intramyocardial fat deposition detected on CT or cardiac magnetic resonance, other signs of tuberous sclerosis complex should be considered in the differential diagnosis.