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Generalized megaviscera of lupus:Refractory intestinal pseudo-obstruction,ureterohydronephrosis and megacholedochus

World Journal of Gastroenterology 2009年第28期15卷 3555-3559页

作者： Frederick D Park jeffrey k lee Ganga D Madduri Pradipta Ghosh Department of Medicine University of California San Diego San Diego California 92103 United States Division of Gastroenterology and Hepatology University of California San Diego San Diego California92103 United States

Dilated dysfunction involving multiple visceral organs has been reported in patients with systemic lupus erythematosus （SLE）. Chronic intestinal pseudoobstruction （CIPO） resulting from intestinal smooth muscle damage has presented in conjunction with ureterohydronephrosis and, more rarely, biliary dilatation （megacholedochus）. While the molecular pathogenesis is largely unknown, observed histopathologic features include widespread myositis, myocyte necrosis in the intestinal muscularis propria with subsequent atrophy and fibrosis, preserved myenteric innervations and little vasculitis. High dose immunosuppression usually results in resolution of symptoms with recovery of smooth muscle function, indicative of an autoimmune etiology. We report a patient with SLE who presented with intestinal pseudo-obstruction, ureterohydronephrosis and megacholedochus, and present images that illustrate megaviscera simultaneously involving all 3 visceral organs. Since the co-manifestation of all 3 is unusual and has been reported only once previously, we have termed this rare clinical syndrome generalized megaviscera of lupus （GML）. Although the SLE disease-activity parameters responded to aggressive immunomodulative therapy in our patient, clinical evidence of peristaltic dysfunction persisted in all involved viscera. This is a variation from the favorable outcomes reported previously in SLE patients with GML and we attribute this poor clinical outcome to disease severity and, most importantly, delayed clinical presentation. Since inflammation followed by atrophy and fibrosis are key aspects in the pathogenesis and natural history of GML, the poor response in our patient who presented late in the clinical course may be the result of ＇burnt out＇ inflammation with irreversible end-stage fibrosis. Thus, early recognition and timely initiation of treatment may be the key to recover visceral peristaltic function in patients with GML.

关键词： Systemic lupus erythematosus Intestinalpseudo-obstruction Biliary tract diseases Hydroureter Hydronephrosis Smooth muscle Autoimmune myositis

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Evidence for colorectal sarcomatoid carcinoma arising from tubulovillous adenoma

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World Journal of Gastroenterology 2008年第27期14卷 4389-4394页

作者： jeffrey k lee Pradipta Ghosh Valerie McWhorter Misty Payne Ryan Olson Mary L krinsky Sonia Ramamoorthy John M Carethers Department of Medicine University of California San Diego California and Veteran Affairs Medical Center San Diego Healthcare System Department of Pathology University of CaliforniaSan Diego California Department of Surgery University of California

Sarcomatoid carcinomas of the colorectum are rare tu- mors that display both malignant epithelial and stromal components. Clinically, they are aggressive tumors with early metastasis. Due to their infrequent occurrence, the pathogenesis is poorly understood. We report a case of a 52-year-old woman who presented with a rectal mass and intermittent hematochezia. Superficial biopsies during colonoscopy revealed a tubulovillous adenoma with high-grade dysplasia. Endoscopic ultra- sonography confirmed an invasive nature of the mass, and deeper biopsies revealed the presence of neoplasm with mixed histological components. The surgically- excised specimen demonstrated the presence of poorly differentiated spindle cells underneath the tubulovillous adenoma and an intermediate stage of invasive adeno- carcinoma. Based on the histological appearance and immunohistochemical studies, a diagnosis of sarcoma- toid carcinoma was made. Only nine cases of sarcoma- toid carcinomas of the colorectum have been reported to date. As a result, the terminology and pathogenesis of sarcomatoid carcinoma remain speculative. To the best of our knowledge, this is the first report of co- existence of sarcomatoid carcinoma and invasive ad- enocarcinoma with tubulovillous adenoma; all stages represented within the same tumor. This observation supports the "monoclonal theory" of pathogenesis with an adenoma-sarcoma progression with or without an intermediate stage of carcinoma.

关键词： Sarcomatoid carcinoma Tubulovillous adenoma Adenocarcinoma Rectum Cytokeratin

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Endoscopy is of low yield in the identification of gastrointestinal neoplasia in patients with dermatomyositis: A cross-sectional study

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World Journal of Gastroenterology 2017年第26期23卷 4788-4795页

作者： Trilokesh D kidambi Gabriela Schmajuk Andrew J Gross James W Ostroff Jonathan P Terdiman jeffrey k lee Division of Gastroenterology University of California Division of Rheumatology University of California Division of Rheumatology San Francisco Veterans Affairs Medical Center

To determine the prevalence of gastrointestinal neoplasia among dermatomyositis patients who underwent an esophagogastroduodenoscopy and/or colonoscopy. METHODSA cross-sectional study examining the results of upper endoscopy and colonoscopy in adults with dermatomyositis at an urban, university hospital over a ten year period was performed. Chart review was performed to confirm the diagnosis of dermatomyositis. Findings on endoscopy were collected and statistical analyses stratified by age and presence of symptoms were performed. RESULTSAmong 373 adult patients identified through a code based search strategy, only 163 patients had dermatomyositis confirmed by chart review. Of the 47 patients who underwent upper endoscopy, two cases of Barrett’s esophagus without dysplasia were identified and there were no cases of malignancy. Of the 67 patients who underwent colonoscopy, no cases of malignancy were identified and an adenoma was identified in 15% of cases. No significant differences were identified in the yield of endoscopy when stratified by age or presence of symptoms. CONCLUSIONThe yield of endoscopy is low in patients with dermatomyositis and is likely similar to the general population; we identified no cases of malignancy. A code based search strategy is inaccurate for the diagnosis of dermatomyositis, calling into question the results of prior population-based studies. Larger studies with rigorously validated search strategies are necessary to understand the risk of gastrointestinal malignancy in patients with dermatomyositis.

关键词： Endoscopy Dermatomyositis Colon cancer Screening

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World Journal of Gastroenterology 2020年第11期26卷 1128-1141页

作者： Gandhi Lanke jeffrey H lee Department of Gastroenterology Hepatologyand NutritionUniversity of Texas MD Anderson Cancer CenterHoustonTX 77030United States

Accurate diagnosis of Pancreatic cysts(PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and surveillance of PC are all important in the diagnosis and management of PC. Currently, there are many guidelines for the management of PC. The optimal use of these guidelines with a patient-centered approach helps diagnose early cancer and prevent the spread of cancer.

关键词： Pancreatic cysts Serous cystadenoma Main pancreatic duct Intraductal papillary mucinous neoplasm Endoscopic ultrasound-guided fine needle aspiration Carcinoembryonic antigen

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Variation in female aggression in 2 three-spined stickleback populations with female throat and spine coloration

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Current Zoology 2018年第3期64卷 345-350页

作者： Lengxob YONG Brittney lee jeffrey S. MCkINNON Department of Biology East Carolina University Greenville NC 27858 USA

Despite growing interest in female ornament evolution, we still have a rudimentary understanding of female display traits relative to similar traits in males. Under one popular adaptive scenario, female ornaments are hypothesized to function in female-female competition and serve as badges of status, such that their expression is linked with elevated aggression in some cases. In this study, we investigated the relationship between 2 female ornaments--male-like red throat color and red spine coloration--and female aggression in 2 independently derived stream-resident populations of three-spined stickleback Gasterosteus aculeatus. Using simulated intrusions, we tested whether females with redder ornaments were generally more aggressive, and for variation in aggressive and social behaviors between the 2 populations. We found that the red intensity of the throat and spine did not predict aggression levels in either population, suggesting a limited role for both female ornaments during female-female interaction. The 2 populations exhibited different levels of aggressive behaviors, unrelated to the color patches. Our results suggest that variation in selective pressures between populations may promote interpopulation variance in aggressive behavior but not the correlation between female ornamentation and aggression, and raise the possibility that red coloration may have evolved through different mechanisms or processes in the 2 populations.

关键词： aggression animal coloration female ornaments Gasterosteus aculeatus stickleback.

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Is endoscopic ultrasound examination necessary in the management of esophageal cancer?

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World Journal of Gastroenterology 2017年第5期23卷 751-762页

作者： Tomas DaVee Jaffer A Ajani jeffrey H lee Department of Gastroenterology Hepatology and NutritionDivision of Internal MedicineThe University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology Division of Cancer MedicineThe University of Texas MD Anderson Cancer Center

Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer(EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970 s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound(EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection(ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography(PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis(over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, crosssectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.

关键词： Esophageal squamous cell carcinoma Endosonography Echoendoscope Esophagus cancer Esophageal adenocarcinoma

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Highly uniform carbon nanotube nanomesh network transistors

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Nano Research 2015年第4期8卷 1320-1326页

作者： Sung-Jin Choi Patrick Bennett Dongil lee jeffrey Bokor School of Electrical Engineering Kookmin University Seoul 136-702 Republic of Korea Department of Electrical Engineering and Computer Sciences University of California Berkeley CA 94720 USA Applied Science & Technology University of California Berkeley CA 94720 USA Department of Electrical Engineering Korea Advanced Institute of Science and Technology Daejeon 305-701 Republic of Korea Materials Sciences Division Lawrence Berkeley National Laboratories CA 94720 USA

A new type of single-walled carbon nanotube （SWNT） thin-film transistor （TFT） structure with a nanomesh network channel has been fabricated from a pre- separated semiconducting nanotube solution and simultaneously achieved both high uniformity and a high on/off ratio for application in large-scale integrated circuits. The nanomesh structure is prepared on a high-density SWNT network channel and enables a high on/off ratio while maintaining the excellent uniformity of the electrical properties of the SWNT TFTs. These effects are attributed to the effective elimination of metallic paths across the source/drain electrodes by forming the nanomesh structure in the high-density SWNT network channel. Therefore, our approach can serve as a critical foundation for future nanotube-based thin- film display electronics.

关键词： carbon nanotube network thin-film transistor nanomesh solution process highly uniform

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Pancreatic paraganglioma diagnosed by endoscopic ultrasoundguided fine needle aspiration: A case report and review of literature

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World Journal of Gastroenterology 2021年第37期27卷 6322-6331页

作者： Gandhi Lanke John M Stewart jeffrey H lee Department of Gastroenterology Hepatology and NutritionMD Anderson Cancer CenterLubbockTX 79407United States Pathology-lab Medicine Division MD Anderson Cancer CenterHoustonTX 77030United States Department of Gastroenterology Hepatology and NutritionMD Anderson Cancer CenterHoustonTX 77030United States

BACkGROUND Pancreatic paragangliomas(PPGL)are rare benign neuroendocrine neoplasms but malignancy can *** are often misdiagnosed as pancreatic neuroendocrine tumor or pancreatic *** SUMMARY We reviewed 47 case reports of PPGL published in PubMed to *** patients(15/47)with PPGL underwent endoscopic ultrasound-guided fine needle aspiration(EUS-FNA).Only six(6/15)were correctly diagnosed as *** patients with PPGL underwent surgical resection except three(one patient surgery was aborted because of hypertensive crisis,two patients had metastasis or involvement of major vessels).Our patient remained on close surveillance as she was *** Accurate preoperative diagnosis of PPGL can be safely achieved by EUS-FNA with *** team approach should be considered to bring the optimal results in the management of PPGL.

关键词： Pancreatic paraganglioma Endoscopic ultrasound-guided fine needle aspiration Meta-iodobenzylguanidine scan Metanephrines GATA-3 Immunohistochemistry Case report

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How best to manage gastrointestinal stromal tumor

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World Journal of Clinical Oncology 2017年第2期8卷 135-144页

作者： Gandhi Lanke jeffrey H lee Department of Gastroenterology Hepatology and NutritionUniversity of Texas MD Anderson Cancer Center

Gastrointestinal stromal tumors(GISTs) are rare but most common nonepithelial tumor of gastrointestinal tract. They are often found incidentally on computed tomography and endoscopic investigations. Increasing knowledge of the pathogenesis of GISTs and the advent of tyrosine kinase inhibitors revolutionized the management of GISTs. The newer advanced endoscopic techniques have challenged the conventional surgery although the true efficacy and safety of endoscopic approach is not clear at this time. This review article focuses on pathogenesis, diagnosis and management of GISTs.

关键词： Gastrointestinal stromal tumor Endoscopy Endoscopic ultrasound-fine-needle aspiration Tyrosine kinase inhibitor Imatinib

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Endoscopic management of esophageal cancer

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World Journal of Gastrointestinal Oncology 2019年第10期11卷 830-841页

作者： Osman Ahmed Jaffer A Ajani jeffrey H lee Department of Gastroenterology Hepatology and NutritionUniversity of Texas MD Anderson Cancer CenterHoustonTX 77030United States Department of Medical Oncology University of Texas MD Anderson Cancer CenterHoustonTX 77030United States

Esophageal cancer(EC)generally consists of squamous cell carcinoma(which arise from squamous epithelium)and adenocarcinoma(which arise from columnar epithelium).Due to the increased recognition of risk factors associated with EC and the development of screening programs,there has been an increase in the diagnosis of early *** EC is amenable to curative therapy by endoscopy,which can be performed by either endoscopic resection or endoscopic *** resection consists of either endoscopic mucosal resection(preferred in cases of adenocarcinoma)or endoscopic submucosal dissection(preferred in cases of squamous cell carcinoma).Endoscopic ablation can be performed by either radiofrequency ablation,cryotherapy,argon plasma coagulation or photodynamic therapy,amongst *** can also assist in the management of complications post-esophageal surgery,such as anastomotic leaks and ***,there is a growing role for endoscopy to manage end-of-life palliative symptoms,especially *** growing use of esophageal stents,debulking therapy and dilation can assist in improving a patient’s quality of *** this review,we examine the multiple roles of endoscopy in the management of patients with EC.

关键词： Esophageal cancer Endoscopy Resection Ablation Stent Barrett’s esophagus

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