Tangeohlsen4621

ries. We show some scenarios where it has already been used. We expect it will help to reduce the effort for doing studies or providing services in this area, leading to advances in reproducibility and comparison of results.Recently, a multitude of conceptual architectures and theoretical foundations for fog computing have been proposed. Despite this, there is still a lack of concrete frameworks to setup real-world fog landscapes. In this work, we design and implement the fog computing framework FogFrame-a system able to manage and monitor edge and cloud resources in fog landscapes and to execute Internet of Things (IoT) applications. FogFrame provides communication and interaction as well as application management within a fog landscape, namely, decentralized service placement, deployment and execution. For service placement, we formalize a system model, define an objective function and constraints, and solve the problem implementing a greedy algorithm and a genetic algorithm. The framework is evaluated with regard to Quality of Service parameters of IoT applications and the utilization of fog resources using a real-world operational testbed. The evaluation shows that the service placement is adapted according to the demand andvices; (iii) and in case of overloads, services are migrated in order to release resources.In this era of advancements in deep learning, an autonomous system that recognizes handwritten characters and texts can be eventually integrated with the software to provide better user experience. Like other languages, Bangla handwritten text extraction also has various applications such as post-office automation, signboard recognition, and many more. A large-scale and efficient isolated Bangla handwritten character classifier can be the first building block to create such a system. This study aims to classify the handwritten Bangla characters. find more The proposed methods of this study are divided into three phases. In the first phase, seven convolutional neural networks i.e., CNN-based architectures are created. After that, the best performing CNN model is identified, and it is used as a feature extractor. Classifiers are then obtained by using shallow machine learning algorithms. In the last phase, five ensemble methods have been used to achieve better performance in the classification task. To systematically assess the outcomes of this study, a comparative analysis of the performances has also been carried out. Among all the methods, the stacked generalization ensemble method has achieved better performance than the other implemented methods. It has obtained accuracy, precision, and recall of 98.68%, 98.69%, and 98.68%, respectively on the Ekush dataset. Moreover, the use of CNN architectures and ensemble methods in large-scale Bangla handwritten character recognition has also been justified by obtaining consistent results on the BanglaLekha-Isolated dataset. Such efficient systems can move the handwritten recognition to the next level so that the handwriting can easily be automated.

The cyclicity (CIC) of cortisol spontaneously occurs in a minority of patients with Cushing syndrome (CS). When it arises, diagnostic and therapeutic approaches become more challenging. This study aimed to report a patient with Cushing disease (CD) who achieved normalization of cortisol and CIC pattern with pasireotide long-acting release (pasi/LAR).

A 43-year-old female patient related an 8-month history of CS. An 8-mm pituitary nodule depicted by magnetic resonance imaging, serum cortisol suppression of >50% after 8 mg of dexamethasone therapy, and the absence of other lesions were compatible with a CD diagnosis. The patient presented with a CIC pattern with 1 episode before and 17 episodes after an unsuccessful pituitary surgery.

Medical treatment with cabergoline alone up to 3.5 mg/wk and a combined treatment with ketoconazole 400 mg/d did not improve CIC CS. Pasi/LAR was initiated at a dose of 20 mg/mo. A few days after the first dose, the patient experienced symptoms suggestive of adrenal insufficiency. The medication and dose were maintained for 24 months. During this period, there was a normalization of UFC levels and progressive clinical improvement. Additionally, new episodes of CIC were not observed.

A CD patient with a challenging issue of CIC was reported. The condition was not controlled after pituitary surgery and by the combined treatment with cabergoline and ketoconazole, although hypercortisolism was abated by the continuous use of pasi/LAR. To our knowledge, this is the first report as regards the use of this medication to control CIC in a patient with CD.

A CD patient with a challenging issue of CIC was reported. The condition was not controlled after pituitary surgery and by the combined treatment with cabergoline and ketoconazole, although hypercortisolism was abated by the continuous use of pasi/LAR. To our knowledge, this is the first report as regards the use of this medication to control CIC in a patient with CD.

To describe a 4-year-old girl with Graves disease and methimazole allergy who underwent desensitization, allowing continued methimazole use when other treatments were contraindicated.

We formulated a desensitization plan utilizing cetirizine and prednisone for a patient with previously diagnosed Graves disease who developed urticaria and arthralgias from methimazole. She was admitted for monitoring of rash, urticaria, angioedema, and anaphylaxis. Her methimazole dose was increased as tolerated and then titrated as an outpatient.

A 4-year-old girl presented with a heart rate of 195 beats/minute, blood pressure of 145/108, and subsequent labs of undetectable thyroid stimulating hormone (TSH), free T4 5.8 ng/dL, thyroid peroxidase antibody 11.5 IU/ml, and TSH receptor antibody 39.03 IU/L, consistent with Graves disease. She developed urticaria and arthralgias after 2.5 weeks on methimazole, which resolved with drug cessation. Because of her age, the risks of radioactive iodine ablation and surgery were concerning; therefore, methimazole desensitization was attempted. Prednisone (1 mg/kg/day) and cetirizine (5 mg/day) were started prior to low-dose methimazole reintroduction and continued for 7 days. Methimazole was then gradually increased to a final dose of 15 mg daily (0.8 mg/kg/day). Free T4 normalized within a month (1.12 ng/dL), and her TSH normalized within 10 months (4.61 mcU/mL). Except for 2 possible breakthrough allergic responses that resolved with pulse steroids, she continues to tolerate methimazole.

We describe a case of methimazole desensitization. In this patient, pretreatment with prednisone, coupled with daily cetirizine, successfully induced methimazole tolerance when other treatment modalities were contraindicated.

We describe a case of methimazole desensitization. In this patient, pretreatment with prednisone, coupled with daily cetirizine, successfully induced methimazole tolerance when other treatment modalities were contraindicated.

Metastatic chest wall tumors resulting from thyroid carcinomas are not unusual; however, the late onset of metastasis of a follicular thyroid carcinoma (FTC) is extremely rare. We aim to present a report of a case with chest wall metastasis of an FTC 10 years following thyroidectomy.

Among the studies performed were chest wall tumor imaging, serum thyroid stimulating hormone determination, and histopathology of the chest wall tumor and thyroid tissue examination.

An asymptomatic 28-year-old woman was noted to have a left-sided chest wall mass on a chest X-ray performed for a job application. She had a history of right hemithyroidectomy 10 years prior to her admission, which had been reported as a thyroid follicular adenoma. Computed tomography showed a tumor measuring 75× 50 mm in diameter localized at the left paravertebral region. The maximum standardized uptake value of the tumor was seven in positron emission tomography. Histopathologic finding of the trucut biopsy of the chest wall tumor revealed metastasis of a differentiated thyroid carcinoma. The patient underwent a completion left hemithyroidectomy with chest wall resection and reconstruction. Previous right hemithyroidectomy material was examined and diagnosed as minimally invasive FTC. Histopathologic finding of the resected chest wall tumor was consistent with metastasis of an FTC.

Although extremely rare, the late metastasis of a thyroid carcinoma should be considered in the differential diagnosis of patients with chest wall tumors who have a previous history of thyroidectomy even with a diagnosis of benign tumor.

Although extremely rare, the late metastasis of a thyroid carcinoma should be considered in the differential diagnosis of patients with chest wall tumors who have a previous history of thyroidectomy even with a diagnosis of benign tumor.

To describe the presentation, work up, and treatment of a giant parathyroid adenoma presenting as hypercalcemic crisis that ultimately weighed 57 g and extended into the mediastinum, requiring hand-assisted thoracoscopic resection.

The patient is a 68-year-old man with a prior history of parathyroidectomy, who initially presented with a severe hypercalcemia of 16.3 mg/dL and a parathyroid hormone (PTH) level of 2692 pg/mL on routine labs.

Diagnostic and staging work up revealed a 7.2-cm mass extending from just superior to the sternal notch into the right posterior mediastinum to the carina, causing esophageal displacement. No evidence of local invasion or distant metastasis was observed on further imaging, and cytology demonstrated hypercellular parathyroid tissue. The PTH level of the aspirate was >5000 pg/mL. The patient subsequently underwent a right hand-assisted video-assisted thoracoscopic resection of the intrathoracic mass. Final pathology identified a 7.0-cm, 57-g parathyroid adenoma, without any pathologic findings suspicious for malignancy. However, the endocrine surgery team plans for annual laboratory assessment to ensure no recurrence.

Primary hyperparathyroidism is most commonly caused by a single adenoma. However, in the setting of severe hypercalcemia and elevated PTH, one must have a high suspicion for malignancy, and care should be taken to remove the mass en bloc. For extremely large adenomas extending into the mediastinum, a minimally invasive, hand-assisted, thoracoscopic approach is a safe and effective method of resection.

Primary hyperparathyroidism is most commonly caused by a single adenoma. However, in the setting of severe hypercalcemia and elevated PTH, one must have a high suspicion for malignancy, and care should be taken to remove the mass en bloc. For extremely large adenomas extending into the mediastinum, a minimally invasive, hand-assisted, thoracoscopic approach is a safe and effective method of resection.

Ovarian neoplasms in children are rare. The objective of this report is to emphasize the importance of considering those neoplasms in the differential diagnosis of hyperandrogenism even with negative diagnostic imaging.

We report the case of a 12-year-old girl who presented with virilization and elevated 17 hydroxyprogesterone (17-OHP) and who was subsequently diagnosed with an ovarian neoplasm.

The patient was initially seen for hirsutism and deepening of the voice. Elevated 17-OHP, androstenedione, and testosterone prompted the initial diagnosis of nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency, but those levels failed to suppress on corticosteroid therapy. Ultrasound, computed tomography scan, and magnetic resonance imaging of the abdomen and pelvis were normal. Genetic testing for congenital adrenal hyperplasia was negative. Bilateral selective adrenal and ovarian venous sampling confirmed the ovarian origin of her hyperandrogenism. A unilateral salpingo-oophorectomy revealed a steroid cell tumor.