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Management Approach to Thyroid Nodules

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International Journal of Otolaryngology and Head & Neck Surgery 2018年第4期7卷 214-227页

作者： Rodrigo Arrangoiz Fernando Cordera David Caba Eduardo Moreno enrique luque de leon Manuel Munoz Sociedad Quirúrgica S.C.at the American British Cowdray Medical Center Mexico CityMexico

Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine. High resolution neck and thyroid ultrasound can detect thyroid nodules in a significant proportion of randomly selected individuals, with higher frequencies in women and the elderly population. The importance of thyroid nodules lies in the need to rule out cancer. The majority of thyroid nodules are benign, clinically irrelevant, and can be safely managed with a good surveillance program. The detection and diagnosis of differentiated thyroid cancer have evolved over the years with increased use of high resolution cervical and thyroid ultrasound, fine needle aspiration biopsy (FNAB), molecular testing, and thyroglobulin as a serum tumor marker. An algorithm that utilizes high resolution ultrasound and, when indicated, FNAB, and molecular testing for the diagnosis of thyroid nodules, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing. Our paper reviews the current, evidence-based management of newly diagnosed thyroid nodules.

关键词： Thyroid Nodules Thyroid Cancer Thyroid FNA Thyroid Nodule Workup

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Thyroid Cancer

International Journal of Otolaryngology and Head & Neck Surgery 2019年第6期8卷 217-270页

作者： Rodrigo Arrangoiz Fernando Cordera David Caba Eduardo Moreno enrique luque-de-leon Manuel Mu&ntilde oz Sociedad Quirúrgica S.C. American British Cowdray Medical Center Mexico City Mexico

Thyroid tumors include those that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary carcinoma, follicular carcinoma, oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic carcinoma. The incidence of thyroid cancer has been increasing significantly, with an estimated incidence in the United States of America of 53,990 cases by the year 2018. This neoplasm is listed as the most common endocrine tumor and represents approximately 3% of all malignant tumors in humans, with 75% of cases occurring in women, and two-thirds of cases occurring in people under 55 years. The increase in the prevalence/incidence of low-risk thyroid cancer over the last 10 to 20 years has required a re-appraisal of the standard one-size-fits-all approach to differentiated thyroid cancer. This adaptation to a more individualized management of the patient with thyroid cancer has led to a much more risk-adapted approach to the diagnosis, initial therapy, adjuvant therapy, and follow-up of patients with differentiated thyroid cancer. This paper with review the current understanding of the clinical presentation, diagnostic workup, and management of thyroid cancer centered on evidence-based and personalized medicine.

关键词： Thyroid Nodules Thyroid Cancer Thyroid FNA Thyroid Nodule Workup Thyroid Cancer Treatment Molecular Studies for Thyroid Cancer

Metastatic Lobular Carcinoma of the Breast Presenting with Small Bowel Metastases:Case Report and Literature Review

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Advances in Breast Cancer Research 2020年第1期9卷 1-11页

作者： Rodrigo Arrangoiz María Cristina Ornelas Janet Pineda-Díaz Fernando Cordera David Caba Eduardo Moreno enrique luque-de-leon Manuel Munoz Sociedad Quirúrgica S.C.at the American British Cowdray Medical Center Mexico CityMexico

Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operat

关键词： Invasive Lobular Carcinoma of the Breast Metastatic Lobular Carcinoma of the Breast Metastatic Disease to the Small Bowel from Breast Cancer

Wilson's disease in two siblings from Ecuador:Two case reports

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World Journal of Clinical Cases 2025年第3期13卷 50-60页

作者： enrique Carrera Jonathan Alvarado Martina Astudillo Galo Pillajo department of Gastroenterology and Hepatology Hospital de Especialidades Eugenio EspejoQuito 170136PichinchaEcuador Faculty of Medicine Pontificia Universidad Catolica del EcuadorQuito 170143PichinchaEcuador department of Radiology Hospital de Especialidades Eugenio EspejoQuito 170136PichinchaEcuador

BACKGROUND Wilson's disease(WD)is a rare metabolic disorder of copper accumulation in organs such as liver,brain,and *** and treatments are challenging in settings,where advanced diagnostic tests are unavailable,copper chelating agents are frequently scarce,healthcare professionals lack disease awareness,and medical follow-ups are *** diagnoses and treatments help prevent complications,improve patients’quality of life,and ensure a normal life *** clinical presentations and outcomes of WD can vary within a single *** SUMMARY We present the cases of two siblings(19 and 27 years)from a consanguineous family in rural Ecuador,diagnosed as having WD during a family *** male patient,diagnosed at age 19 after his brother’s death from acute liver failure,presented with compensated cirrhosis,neurological symptoms,and bilateral Kayser-Fleischer *** developed progressive neurological deterioration during an irregular treatment with D-penicillamine due to medication *** condition improved upon switching to trientine tetrahydrochloride,and his neurological symptoms improved over an 8-year period of *** female patient,diagnosed at age 10,exhibited only biochemical *** treatment history was similar;however,she remained asymptomatic without disease progression over the same follow-up *** discuss the potential influence of epigenetic mechanisms and modifier genes on the various phenotypes,emphasizing the need for research in these areas to optimize therapeutic *** Our patients’medical histories show how early diagnosis and treatment can prevent disease progression;and,how suboptimal treatments impact disease outcomes.

关键词： Wilson disease Kayser-Fleischer rings Copper chelator D-penicillamine Trientine tetrahydrochloride Case report

Data-driven drug repositioning using olfactory omics profiles:challenges and perspectives in neurodegeneration

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Neural Regeneration Research 2025年第7期20卷 1997-1998页

作者： Paz Cartas-Cejudo Adriana Cortés Mercedes Lachén-Montes Elena Anaya-Cubero Joaquín Fernández-Irigoyen enrique Santamaría Clinical Neuroproteomics Unit Proteomics PlatformNavarrabiomedHospitalario Universitario de Navarra(HUN)Universidad Pública de Navarra(UPNA)IdiSNANavarra Institute for Health ResearchPamplonaSpain

Data-driven drug repositioning using olfactory omics profiles-challenges and perspectives in neurodegeneration:Neurodegenerative diseases are characterized by progressive degeneration and loss of neuronal function in the central nervous *** diseases are often characterized as proteinopathies,which are disorders primarily driven by the aggregation or misfolding of specific amyloid proteins within cells,leading to their dysfunction and eventual *** the gain-of-function hypothesis related to the aggregation of these proteins,recently,an alternative hypothesis regarding the loss-of-function of the soluble monomeric proteins during the process of aggregation into amyloids is gaining *** last event is called proteinopenia and refers to conditions characterized by a deficiency or decrease in the levels of specific soluble proteins in the body(Ezzat et al.,2023).It has been demonstrated that levels of soluble proteins involved in neurodegenerative diseases are decreased.

关键词： diseases drug amyloid

Using the endocannabinoid system as a neuroprotective strategy in perinatal hypoxic-ischemic brain injury

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Neural Regeneration Research 2013年第8期8卷 731-744页

作者： Lara-Celador I. Goi-de-Cerio F. Antonia Alvarez enrique Hilario department of Cell Biology and Histology School of Medicine and DentistryUniversity of the Basque Country GAIKER Technology Centre Bizkaia Science and Technology Park

One of the most important causes of brain injury in the neonatal period is a perinatal hypoxicischemic *** devastating condition can lead to long-term neurological deficits or even *** hypoxic-ischemic brain injury,a variety of specific cellular mechanisms are set in motion,triggering cell damage and finally producing cell *** therapeutic treatments against this phenomenon are still unavailable because of complex molecular mechanisms underlying hypoxic-ischemic brain *** a thorough understanding of the mechanism underlying neural plasticity following hypoxic-ischemic brain injury,various neuroprotective therapies have been developed for alleviating brain injury and improving long-term *** them,the endocannabinoid system emerges as a natural system of *** endocannabinoid system modulates a wide range of physiological processes in mammals and has demonstrated neuroprotective effects in different paradigms of acute brain injury,acting as a natural *** aim of this review is to study the use of different therapies to induce long-term therapeutic effects after hypoxic-ischemic brain injury,and analyze the important role of the endocannabinoid system as a new neuroprotective strategy against perinatal hypoxic-ischemic brain injury.

关键词： neural regeneration reviews perinatal hypoxia-ischemia brain injury brain plasticity,neuroprotective strategies cannabinoid system grants-supported paper photographs-containingpaper neuroregeneration

Caving performance through the integration of microseismic activity and numerical modeling at DOZ-PT Freeport,Indonesia

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International Journal of Minerals,Metallurgy and Materials 2009年第1期16卷 1-6页

作者： Rubio enrique Napitupulu Daulat Mining Engineering department Universidad de Chile Geotechnical Engineering department PT Freeport IndonesiaTembagapuraIndonesia

This article describes an undergoing research at PT Freeport, Indonesia, in which the main goal is to use the microseismic information recorded as a result of mining to analyze cave propagation and stress performance on the actual production and fixed infrastructure. At the moment, several numerical experiments have been conducted to correlate the mining activity with the microseismic events using the data collected during year 2005 and 2006. As a result of the preliminary analysis a micro- and a macrocracking envelop were proposed on the basis of computation of stress behavior at the location of the events. Stresses have been computed using standard elastic continuous boundary element models. The correlation between the average source radius and the stress performance has provided a method to propose a macrocracking criterion. Several techniques have been tested to nucleate the microseismic activity around different geological features. This last attempt was aimed to look at potential overstresses induced over the undercut and extraction level drifts. A method was devised to integrate the microseismicity into a 3-dimensional ride distribution model. This model has shown to be very effective to quantify the overstress induced as a result of computing volumetric microseismicity density. The volumetric microseismic model showed to induce overstress up to 10 MPa over a period of two months. The future work will concentrate on the calibration of the integrated model with actual damage observations made at the current mining infrastructure.

关键词： microseism underground mining block caving stress distribution microcrack criterion

Comprehensive Review of Thyroid Embryology,Anatomy,Histology,and Physiology for Surgeons

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International Journal of Otolaryngology and Head & Neck Surgery 2018年第4期7卷 160-188页

作者： Rodrigo Arrangoiz Fernando Cordera David Caba Manuel Munoz Eduardo Moreno enrique luque de León department of Surgical Oncology/Head and Neck Division of the American British Cowdray Medical Center Mexico CityMexico

Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.

关键词： Thyroid Gland Embryology Thyroid Gland Anatomy Thyroid Gland Histology Thyroid Gland Physiology Thyroid Gland

Viability,behavior,and color expression in the offspring of matings between common wall lizard Podarcis muralis color morphs

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Current Zoology 2022年第1期68卷 41-55页

作者： Javier ABALOS Guillem PEREZ I de LANUZA Alicia BARTOLOME Fabien AUBRET Tobias ULLER enrique FONT Ethology Lab Instituto Cavanilles de Biodiversidad y Biologı´a EvolutivaUniversitat de ValenciaValenciaSpain CIBIO/InBIO Centro de Investigacao em Biodiversidade e Recursos Geneticos da Universidade do PortoPortoPortugal SETE Station d’Ecologie Theorique et ExperimentaleUPR2001Centre National de la Recherche ScientifiqueParisFrance department of Biology Lund UniversityLundSweden

Color polymorphisms are widely studied to identify the mechanisms responsible for the origin and maintenance of phenotypic variability in *** of the mechanisms of balancing selection currently thought to explain the long-term persistence of polymorphisms are the evolution of alternative phenotypic optima through correlational selection on suites of traits including color and *** of these mechanisms can generate differences in offspring viability and fitness arising from different morph ***,we examined the effect of parental morph combination on fertilization success,embryonic viability,newborn quality,antipredator,and foraging behavior,as well as inter-annual survival by conducting controlled matings in a polymorphic lacertid Podarcis muralis,where color morphs are frequently assumed to reflect alternative phenotypic optima(e.g.,alternative reproductive strategies).Juveniles were kept in outdoor tubs for a year in order to study inter-annual growth,survival,and morph *** agreement with a previous genome-wide association analysis,morph frequencies in the year-old juveniles matched the frequencies expected if orange and yellow expressions depended on recessive homozygosity at 2 separate *** findings also agree with previous literature reporting higher reproductive output of heavy females and the higher overall viability of heavy newborn lizards,but we found no evidence for the existence of alternative breeding investment strategies in female morphs,or morphcombination effects on offspring viability and *** conclude that inter-morph breeding remains entirely viable and genetic incompatibilities are of little significance for the maintenance of discrete color morphs in *** from the Pyrenees.

关键词： alternative breeding strategies color polymorphism controlled matings lizard behavior morph ontogeny newborn viability