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Up to Date Management of DCIS and Future Directions

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Advances in Breast Cancer Research 2020年第3期9卷 78-100页

作者： Rodrigo Arrangoiz Fernando Cordera eduardo moreno Enrique Luque-de-Leon Manuel Muñoz Sociedad Quirúrgica S.C. at the American British Cowdray Medical Center Colonia Tlaxala Delegación Cuajimalpa Mexico City Mexico

Ductal carcinoma in situ (DCIS) is a non-invasive malignancy confined within the basement membrane of the breast ductal system. There is a lot of disparity in the natural history of DCIS with an estimated incidence of progression to invasive ductal carcinoma between 20% to 53% over ten or more years after initial diagnosis. The surgical and adjuvant management of DCIS has advanced significantly in the last couple of decades. Nonetheless, surgeons, medical oncologists, and radiation oncologists, along with their patients, still depend on conventional clinical and pathologic risk factors to make management decisions. Irrespective of the management strategy, long-term survival is excellent. The debate around DCIS relates to preventing either under-treatment or over-treatment. In this paper, we will review the incidence and management options of DCIS. Additionally, we will focus on several current disputes related to the management of DCIS, including breast conserving surgery, the role of radiation in breast conservation surgery, sentinel node biopsy in DCIS, hor

关键词： Ductal Carcinoma in Situ DCIS Management of DCIS Treatment of DCIS Predictors of Recurrence of DCIS Risk Stratification Schemes for DCIS Active Surveillance for DCIS

Parathyroid Embryology,Anatomy,and Pathophysiology of Primary Hyperparathyroidism

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International Journal of Otolaryngology and Head & Neck Surgery 2017年第4期6卷 39-58页

作者： Rodrigo Arrangoiz Fernando Cordera David Caba Manuel Munoz Juarez eduardo moreno Enrique Luque American British Cowdray Medical Center México CityMexico

Unregulated overproduction of parathyroid hormone (PTH) from an abnormal parathyroid gland is the origin of primary hyperparathyroidism (PHPT). Patients who have an elevated serum calcium concentration have a problem in one or more of their parathyroid glands. To understand this disease state adequately and provide appropriate treatment, a thorough understanding of parathyroid embryology, anatomy, physiology, and pathophysiology is essential. In this manuscript, we review our current understanding of parathyroid gland embryology, anatomy, histology, physiology, and pathophysiology.

关键词： Parathyroid Anatomy Parathyroid Histology Parathyroid Pathophysiology

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

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

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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 Muñ 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

城市议程三十年(1976-2006):实现了什么?

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人类居住 2006年第3期 7-9页

作者： By eduardo López moreno Rasna Warah 王瀛（译）联合国人居署全球城市观测站城市问题报道不详

有人诬蔑城市是废物和污染的发生器，或是自然环境的主要威胁。有人赞颂城市是经济活动、文化和创新的中心。这些看法对城市议程的构成和表达有着重大的影响。城市议程是由不同的政治和文化倾向、意识形态立场以及科技能力塑造的。

关键词：城市自然环境经济活动科技能力意识形态发生器文化污染

Predictive models of drought tolerance indices based on physiological,morphological and biochemical markers for the selection of cotton(Gossypium hirsutum L.)varieties

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Journal of Integrative Agriculture 2022年第5期21卷 1310-1320页

作者： Yeison M QUEVEDO Liz P moreno eduardo BARRAGAN Colombian Corporation for Agricultural Research AGROSAVIA日Espinal 733529Colombia Faculty of Agricultural Sciences National University of ColombiaBogota D.C 111321Colombia

The use of tolerant crop varieties is a strategy that mitigates the water deficit effect in a sustainable *** generation of these varieties is more efficient when variables associated with this tolerance have been identified,since they can facilitate the breeding *** study aimed to establish the relationships between water deficit tolerance of four cotton varieties(Nevada-123,Oasis-129,Guatapuri,and Festivalle)and morphological variables(monopodial branches,boll weight,root/shoot ratio,and leaf and root dry matter),physiological variables(relative water content,net photosynthesis,stomatal conductance,electron transport rate,photochemical quenching,photochemical efficiency of PSII,chlorophyll a/b ratio(Chl a/b),C^(12)/C^(13)isotope ratio,and electrolyte leakage),and biochemical variables(contents of sugars,proline,carotenoids,and malondialdehyde).Furthermore,calibrated predictive models of the drought tolerance indices were developed based on the key variables *** this purpose,a pot experiment was established where plants were subjected to a moderate or severe water deficit during the blooming stage for 12 *** stress tolerance index(STI)and mean productivity(MP)were *** the evaluated variables,the differences between well-watered and water deficit plants(Δ)were calculated and ANOVA,partial least squares,Pearson’s correlation,and multiple linear regression analyzes were performed.A model was generated that explained 95% of the STI and was composed of Δmalondialdehyde,Δproline,and Δboll *** MP,the model was comprised of Δstomatal conductance,Δroot/shoot ratio,and ΔChl a/b,and explained 89% of the *** analysis of the assessed variables allowed the identification of key variables and the development of calibrated predictive models that can be used in screening to obtain cotton varieties with different levels of water deficit tolerance.

关键词： drought tolerance tolerance index proline chlorophyll stomatal conductance malondialdehyde yield multivariate analysis

Hepatitis C virus-specific cytotoxic T cell response restoration after treatment-induced hepatitis C virus control

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World Journal of Gastroenterology 2015年第12期21卷 3480-3491页

作者： Juan-Ramón Larrubia Elia moreno-Cubero Joaquín Miquel eduardo Sanz-de-Villalobos Translational Hepatology Unit Guadalajara University Hospital University of Alcalá Department of Medicine and Medical Specialties University of Alcalá Department of Biology of Systems University of Alcalá

Hepatitis C virus(HCV)-specific cytotoxic T cell(CTL) response plays a major role in viral control during spontaneous infection resolution. These cells develop an exhausted and pro-apoptotic status during chronic onset, being unable to get rid of HCV. The role of this response in contributing to sustained viral response(SVR) after anti-HCV is controversial. Recent studies show that after successful interferon-based anti-HCV treatment, HCV traces are still detectable and this correlates with a peak of HCV-specific CTL response activation, probably responsible for maintaining SVR by subsequent complete HCV clearing. Moreover, SVR patients' serum is still able to induce HCV infection in na?ve chimpanzees, suggesting that the infection could be under the control of the immune system after a successful treatment, being transmissible in absence of this adaptive response. At least theoretically, treatmentinduced viral load decrease could allow an effective HCV-specific CTL response reestablishment. This effect has been recently described with anti-HCV interferonfree regimes, based on direct-acting antivirals. Nevertheless, this is to some extent controversial with interferon-based therapies, due to the detrimental immunoregulatory α-interferon effect on T cells. Moreover, HCV-specific CTL response features during anti-HCV treatment could be a predictive factor of SVR that could have clinical implications in patient management. In this review, the recent knowledge about the role of HCV-specific CTL response in the development of SVR after anti-HCV treatment is discussed.

关键词： Hepatitis C virus Chronic hepatitis Hepatitis C vi