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Siegel C, Aboud O, Brown M, Chung HJ, Raffeld M, Crandon S, Ji M, Levine J, Vera E, Patel S, Reyes J, Armstrong T, Xi L, Acquaye A, Boris L, Briceno N, Garren N, Romo C, Quezado M, Wu J, Theeler B, Gilbert M. PATH-52. UTILIZING NEXT GENERATION SEQUENCING REPORTS IN CLINICAL DECISION MAKING: REPORT FROM THE NATIONAL INSTITUTES OF HEALTH (NIH) NEURO-ONCOLOGY BRANCH (NOB) NATURAL HISTORY STUDY (NHS) PRIMARY BRAIN TUMOR PANEL (PBTP). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Anderson K, Holmes S, Siegel C. VIRTUAL CARE FARMS: A CREATIVE APPROACH TO ADDRESSING LONELINESS AND BUILDING COMMUNITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ranjan S, Quezado M, Garren N, Boris L, Siegel C, Lopes Abath Neto O, Theeler BJ, Park DM, Nduom E, Zaghloul KA, Gilbert MR, Wu J. Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases. BMC Cancer 2018; 18:239. [PMID: 29490632 PMCID: PMC5831705 DOI: 10.1186/s12885-018-4131-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 02/14/2018] [Indexed: 01/05/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICPIs) are being investigated in clinical trials for patients with glioblastoma. While these therapies hold great promise, management of the patients receiving such treatment can be complicated due to the challenges in recognizing immune-related adverse events caused by checkpoint inhibitor treatment. Brain imaging changes that are the consequence of an inflammatory response may be misinterpreted as disease progression leading to inappropriate premature cessation of treatment. The aim of this study was to, by way of a series of cases, underscore the challenges in determining the nature of contrast-enhancing masses that develop during the treatment of patients with glioblastoma treated with ICPIs. Case presentation We reviewed the clinical course and management of 4 patients on ICPIs who developed signs of tumor progression on imaging. These findings were examined in the context of Immunotherapy Response Assessment in Neuro-Oncology (iRANO) guidelines. Although all 4 patients had very similar imaging findings, 2 of the 4 patients were later found to have intense inflammatory changes (pseudoprogression) by pathologic examination. Conclusions A high index of suspicion for pseudoprogression needs to be maintained when a patient with brain tumor on immunotherapy presents with worsening in an area of a pre-existing tumor or a new lesion in brain. Our findings strongly suggest that pathological diagnosis remains the gold standard for distinguishing tumor progression from pseudoprogression in patients receiving immunotherapy. There is a large unmet need to develop reliable non-invasive imaging diagnostic techniques. Trial registration ClinicalTrials.gov NCT02311920. Registered 8 December 2014.
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Vera E, Mendoza T, Crandon S, Lisa B, Garren N, Siegel C, Park DM, Sul JH, Theeler B, Wu J, Gilbert MR, Armstrong T. QLIF-31. SYMPTOM BURDEN AND HEALTH STATUS OF PATIENTS WITH RARE VERSUS COMMON BRAIN TUMORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lisa B, Vera E, Wu J, Park DM, Bryla C, Crandon S, Garren N, McCoy A, Siegel C, Theeler BJ, Sul JH, Gilbert M, Armstrong T. QLIF-03. UNUSUAL ADVERSE DRUG REACTIONS IN HIGH GRADE GLIOMA PATIENTS TREATED WITH TEMOZOLOMIDE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wu J, Bryla C, McCoy A, Lisa B, Garren N, Siegel C, Grajkowska E, Theeler B, Park DM, Parrott T, Armstrong TS, Yuan Y, Gilbert MR. ACTR-69. PHASE I TRIAL OF TG02 PLUS DOSE-DENSE OR METRONOMIC TEMOZOLOMIDE FOR ADULTS WITH RECURRENT ANAPLASTIC ASTROCYTOMA AND GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Siegel C, Armstrong T, Chung HJ, Crandon S, Patel S, Powers A, Quezado M, Ray-Chaudhury A, Vera E, Wu J, Xi L, Raffeld M, Gilbert M. PATH-40. STANDARDIZED MOLECULAR ANALYSIS OF PRIMARY CENTRAL NERVOUS SYSTEM (CNS) TUMORS IN A RESEARCH BASED CLINICAL PRACTICE. AN INTRODUCTION TO THE PRIMARY CNS TUMOR NEXT GENERATION SEQUENCING (NGS) PANEL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Acquaye AA, Garren N, Vera E, Lisa B, Siegel C, Park DM, Wu J, Crandon S, Theeler BJ, Sul JH, Gilbert MR, Armstrong T. QLIF-17. ASSESSING DEPRESSION IN GLIOMA PATIENTS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Garren N, Acquaye AA, Vera E, Lisa B, Siegel C, Park DM, Sul JH, Theeler BJ, Wu J, Crandon S, Gilbert M, Armstrong T. QLIF-13. EVALUATION OF ANXIETY SYMPTOMS AMONG BRAIN TUMOR PATIENTS; ARE WE PROVIDING APPROPRIATE, EFFECTIVE CARE? Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pfister G, Schatz AK, Siegel C, Steichele E, Waschkowski W, Bücherl T. Nondestructive Testing of Materials and Components by Computerized Tomography with Fast and Thermal Reactor Neutrons. NUCL SCI ENG 2017. [DOI: 10.13182/nse92-a23905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Alahmadi A, Lee R, Siegel C, Gholam P. Utility of multidisciplinary tumor board (MTB) in the management of hepatocellular cancer (HCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Broughton D, Anderson K, Jungheim E, Siegel C. The incidence of renal anomalies in patients with septate uteri. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laska E, Meisner M, Siegel C. Contributions to the theory of optimal resource allocation. J Appl Probab 2016. [DOI: 10.2307/3212803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A problem in optimal resource allocation is considered for n jobs with identically distributed service times admitting a monotone hazard function. If the hazard function is increasing, it is shown that the procedure of allocating the full resource individually to each job until its completion minimizes the expected completion time of the jth job. The procedure which at any instant of time equally allocated the resource among all of the remaining jobs is shown to minimize the expected total cumulative waiting time if the hazard is decreasing.
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Draper K, Siegel C, White J, Solis CM, Mishna F. Preschoolers, Parents, and Teachers (PPT): A Preventive Intervention with an At Risk Population. Int J Group Psychother 2015; 59:221-42. [DOI: 10.1521/ijgp.2009.59.2.221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Leibfarth S, Eckert F, Welz S, Siegel C, Schmidt H, Schwenzer N, Zips D, Thorwarth D. Automatic delineation of tumor volumes by co-segmentation of combined PET/MR data. Phys Med Biol 2015; 60:5399-412. [DOI: 10.1088/0031-9155/60/14/5399] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hallström T, Siegel C, Mörgelin M, Kraiczy P, Skerka C, Zipfel P. CspA from Borrelia burgdorferi inhibits the terminal complement pathway. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Leibfarth S, Mönnich D, Welz S, Siegel C, Schwenzer N, Schmidt H, Zips D, Thorwarth D. A strategy for multimodal deformable image registration to integrate PET/MR into radiotherapy treatment planning. Acta Oncol 2013; 52:1353-9. [PMID: 23879651 DOI: 10.3109/0284186x.2013.813964] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Combined positron emission tomography (PET)/magnetic resonance imaging (MRI) is highly promising for biologically individualized radiotherapy (RT). Hence, the purpose of this work was to develop an accurate and robust registration strategy to integrate combined PET/MR data into RT treatment planning. Material and methods. Eight patient datasets consisting of an FDG PET/computed tomography (CT) and a subsequently acquired PET/MR of the head and neck (HN) region were available. Registration strategies were developed based on CT and MR data only, whereas the PET components were fused with the resulting deformation field. Following a rigid registration, deformable registration was performed with a transform parametrized by B-splines. Three different optimization metrics were investigated: global mutual information (GMI), GMI combined with a bending energy penalty (BEP) for regularization (GMI+ BEP) and localized mutual information with BEP (LMI+ BEP). Different quantitative registration quality measures were developed, including volumetric overlap and mean distance measures for structures segmented on CT and MR as well as anatomical landmark distances. Moreover, the local registration quality in the tumor region was assessed by the normalized cross correlation (NCC) of the two PET datasets. RESULTS LMI+ BEP yielded the most robust and accurate registration results. For GMI, GMI+ BEP and LMI+ BEP, mean landmark distances (standard deviations) were 23.9 mm (15.5 mm), 4.8 mm (4.0 mm) and 3.0 mm (1.0 mm), and mean NCC values (standard deviations) were 0.29 (0.29), 0.84 (0.14) and 0.88 (0.06), respectively. CONCLUSION Accurate and robust multimodal deformable image registration of CT and MR in the HN region can be performed using a B-spline parametrized transform and LMI+ BEP as optimization metric. With this strategy, biologically individualized RT based on combined PET/MRI in terms of dose painting is possible.
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Siegel C, McCullough LD. NAD+ depletion or PAR polymer formation: which plays the role of executioner in ischaemic cell death? Acta Physiol (Oxf) 2011; 203:225-34. [PMID: 21091637 DOI: 10.1111/j.1748-1716.2010.02229.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Multiple cell death pathways are activated in cerebral ischaemia. Much of the initial injury, especially in the core of the infarct where cerebral blood flow is severely reduced, is necrotic and secondary to severe energy failure. However, there is considerable evidence that delayed cell death continues for several days, primarily in the penumbral region. As reperfusion therapies grow in number and effectiveness, restoration of blood flow early after injury may lead to a shift towards apoptosis. It is important to elucidate what are the key mediators of apoptotic cell death after stroke, as inhibition of apoptosis may have therapeutic implications. There are two well described pathways that lead to apoptotic cell death; the caspase pathway and the more recently described caspase-independent pathway triggered by poly-ADP-ribose polymers (PARP) activation. Caspase-induced cell death is initiated by release of mitochondrial cytochrome c, formation of the cytosolic apoptosome, and activation of endonucleases leading to a multitude of small randomly cleaved DNA fragments. In contrast caspase-independent cell death is secondary to activation of apoptosis inducing factor (AIF). Mitochondrial AIF translocates to the nucleus, where it induces peripheral chromatin condensation, as well as characteristic high-molecular-weight (50 kbp) DNA fragmentation. Although caspase-independent cell death has been recognized for some time and is known to contribute to ischaemic injury, the upstream triggering events leading to activation of this pathway remain unclear. The two major theories are that ischaemia leads to nicotinamide adenine dinucleotide (NAD+) depletion and subsequent energy failure, or alternatively that cell death is directly triggered by a pro-apoptotic factor produced by activation of the DNA repair enzyme PARP. PARP activation is robust in the ischaemic brain producing variable lengths of poly-ADP-ribose (PAR) polymers as byproducts of PARP activation. PAR polymers may be directly toxic by triggering mitochondrial AIF release independently of NAD+ depletion. Recently, sex differences have been discovered that illustrate the importance of understanding these molecular pathways, especially as new therapeutics targeting apoptotic cell death are developed. Cell death in females proceeds primarily via caspase activation whereas caspase-independent mechanisms triggered by the activation of PARP predominate in the male brain. This review summarizes the current literature in an attempt to clarify the roles of NAD+ and PAR polymers in caspase-independent cell death, and discuss sex specific cell death to provide an example of the possible importance of these downstream mediators.
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Thonhofer R, Trummer M, Siegel C. Capillaroscopy shows an active pattern of scleroderma in coeliac disease. Scand J Rheumatol 2010; 39:438-9. [DOI: 10.3109/03009742.2010.489230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Quaas A, Odem R, Narra V, Siegel C. Differentiation of adenomyomas from leiomyomas and normal myometrium on pelvic MR imaging- the role of Gadolinium enhancement. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thonhofer R, Siegel C, Hafner F, Gotschuli G, Brodmann M. Successful bosentan treatment of critical ischaemia induced by vasculitis in an SCLE patient. Rheumatology (Oxford) 2008; 47:1729-30. [DOI: 10.1093/rheumatology/ken354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nguyen T, Lawrence L, Ratts V, Odem R, Siegel C, Merritt D. Diagnosis and management of didelphic uterus, obstructed hemivagina and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome): the Washington University experience. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Blanchard SS, Gerrek M, Siegel C, Czinn SJ. Significant morbidity associated with RSV infection in immunosuppressed children following liver transplantation: case report and discussion regarding need of routine prophylaxis. Pediatr Transplant 2006; 10:826-9. [PMID: 17032430 DOI: 10.1111/j.1399-3046.2006.00583.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection in infants and young children. In immunocompromised children, RSV infection poses a serious health threat with significantly increased and prolonged virus shedding and the development of severe respiratory disease. We report two patients, eight months and 20 months of age, who were admitted with severe RSV infection two months and 10 months post-transplant respectively. Major risk factors for severe infection is the degree of immunosuppression and the age of the patient (<24 months). Based on the significant morbidity associated with RSV infection in these patients, we recommend randomized trials in larger pediatric solid organ transplant centers to evaluate the use of palivizumab prophylaxis is efficacious to prevent morbidity in patients under the age of 24 months, while we emphasize good hygienic practices to prevent RSV nosocomial infection.
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Schwing W, Erhard P, Holloman C, Weigel K, Blankshaen S, Anderson J, Siegel C, Seaman D, Valente J, DeOreo P, Weiss M. Thrombotic Events and Pentosidine in Hemodialysis. Hemodial Int 2004. [DOI: 10.1111/j.1492-7535.2004.0085f.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, León CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178:506-17. [PMID: 11388966 DOI: 10.1192/bjp.178.6.506] [Citation(s) in RCA: 561] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS Historic prospective study. Standardised assessments of course and outcome. RESULTS About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
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