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Harrold L, Gandhi K, Etzel C, Nadkarni A, Saunders K, Kelly S, Greenberg J. OP0160 The Impact of Rheumatoid Arthritis on Patient Reported Outcomes and Quality of Life Prior to Biologic Initiation. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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De Groof A, Humby F, Ducreux J, Kelly S, Nzeusseu Toukap A, Pitzalis C, Durez P, Lauwerys B. OP0129 Higher Expression of TNF Alpha-Induced Genes in the Synovium of Early RA Patients Correlates with Disease Activity, and Predicts Absence of Response to First Line Therapy. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nerviani A, Humby F, Kelly S, Bombardieri M, Pitzalis C. THU0033 A Functional Inhibitory Role for the GAS6/MERTK Axis in Modulating Synovial Inflammation in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bhatt N, Sheridan G, Connolly M, Kelly S, Gillis A, Conlon K, Lane S, Shanahan E, Ridgway PF. Postoperative exercise training is associated with early discharge: A case-control study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sadlier C, Carr A, Kelly S, Bergin C. Strategies to address poor influenza vaccine compliance in healthcare workers. IRISH MEDICAL JOURNAL 2015; 108:157. [PMID: 26062250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Salt E, Wright C, Kelly S, Soundy A. A randomised controlled trial on the effectiveness of a lateral glide cervical spine mobilisation on cervicobrachial (neck and arm) pain. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Kelly S, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond) 2015; 29:721-31. [PMID: 25882328 DOI: 10.1038/eye.2015.48] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/01/2015] [Indexed: 11/09/2022] Open
Abstract
The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made significant impact on the reduction of the visual loss due to neovascular age-related macular degeneration (n-AMD). There are significant inter-individual differences in response to an anti-VEGF agent, made more complex by the availability of multiple anti-VEGF agents with different molecular configurations. The response to anti-VEGF therapy have been found to be dependent on a variety of factors including patient's age, lesion characteristics, lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in acuity or morphology, despite therapy or require very frequent re-treatment. There is currently no consensus as to how to classify optimal response, or lack of it, with these therapies. There is, in particular, confusion over terms such as 'responder status' after treatment for n-AMD, 'tachyphylaxis' and 'recalcitrant' n-AMD. This document aims to provide a consensus on definition/categorisation of the response of n-AMD to anti-VEGF therapies and on the time points at which response to treatment should be determined. Primary response is best determined at 1 month following the last initiation dose, while maintained treatment (secondary) response is determined any time after the 4th visit. In a particular eye, secondary responses do not mirror and cannot be predicted from that in the primary phase. Morphological and functional responses to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in an individual eye. Furthermore, there is a ceiling effect that can negate the currently used functional metrics such as >5 letters improvement when the baseline VA is good (ETDRS>70 letters). It is therefore important to use a combination of both the parameters in determining the response.The following are proposed definitions: optimal (good) response is defined as when there is resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal thickening), and/or improvement of >5 letters, subject to the ceiling effect of good starting VA. Poor response is defined as <25% reduction from the baseline in the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal or change in VA (that is, change in VA of 0+4 letters). Non-response is defined as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared with the baseline and/or loss of >5 letters compared with the baseline or best corrected vision subsequently. Poor or non-response to anti-VEGF may be due to clinical factors including suboptimal dosing than that required by a particular patient, increased dosing intervals, treatment initiation when disease is already at an advanced or chronic stage), cellular mechanisms, lesion type, genetic variation and potential tachyphylaxis); non-clinical factors including poor access to clinics or delayed appointments may also result in poor treatment outcomes. In eyes classified as good responders, treatment should be continued with the same agent when disease activity is present or reactivation occurs following temporary dose holding. In eyes that show partial response, treatment may be continued, although re-evaluation with further imaging may be required to exclude confounding factors. Where there is persistent, unchanging accumulated fluid following three consecutive injections at monthly intervals, treatment may be withheld temporarily, but recommenced with the same or alternative anti-VEGF if the fluid subsequently increases (lesion considered active). Poor or non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if necessary switch to alternative therapies including other anti-VEGF agents and/or with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require treatment with PDT monotherapy or combination with anti-VEGF. A committee comprised of retinal specialists with experience of managing patients with n-AMD similar to that which developed the Royal College of Ophthalmologists Guidelines to Ranibizumab was assembled. Individual aspects of the guidelines were proposed by the committee lead (WMA) based on relevant reference to published evidence base following a search of Medline and circulated to all committee members for discussion before approval or modification. Each draft was modified according to feedback from committee members until unanimous approval was obtained in the final draft. A system for categorising the range of responsiveness of n-AMD lesions to anti-VEGF therapy is proposed. The proposal is based primarily on morphological criteria but functional criteria have been included. Recommendations have been made on when to consider discontinuation of therapy either because of success or futility. These guidelines should help clinical decision-making and may prevent over and/or undertreatment with anti-VEGF therapy.
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Albayati M, Kelly S, Gallagher D, Dourado R, Patel A, Saha P, Bajwa A, El-Sayed T, Salter R, Gkoutzious P, Carrell T, Abisi S, Modarai B. Angulation of the C-Arm During Complex Endovascular Aortic Procedures Increases Radiation Exposure to the Head. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Li A, Keely B, Chan S, Baxter M, Rees G, Kelly S. Verifying the provenance of rice using stable isotope ratio and multi-element analyses: a feasibility study. QUALITY ASSURANCE AND SAFETY OF CROPS & FOODS 2015. [DOI: 10.3920/qas2013.0378] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Romão VC, DiCicco M, Mahto A, Lazarou I, Fonseca JE, Kelly S, Humby F, Pitzalis C. A7.6 Clinical and pathological differences of elderly- and younger-onset rheumatoid arthritis in an early arthritis cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carter S, Kelly S, Caples E, Grogan B, Doyle J, Gallagher CG, McKone EF. Ivacaftor as salvage therapy in a patient with cystic fibrosis genotype F508del/R117H/IVS8-5T. J Cyst Fibros 2015; 14:e4-5. [PMID: 25698453 DOI: 10.1016/j.jcf.2015.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
Ivacaftor is a novel CFTR potentiator that increases CFTR activity and improves clinical outcomes in cystic fibrosis (CF) patients with at least one copy of CFTR-G551D. Clinical trials have shown an improvement in lung function, weight and CF pulmonary exacerbation in adults with CFTR-G551D leading to the approval of ivacaftor as a novel CF therapy [1]. In vitro studies of ivacaftor have also shown significant improvements in CFTR chloride channel opening time in other non-G551D CFTR mutations suggesting that ivacaftor may be of benefit to patients with mutations other than gating mutations [2]. R117H-CFTR is a relatively common CFTR mutation that demonstrates an in-vitro response to ivacaftor [2,3]. A clinical trial has suggested that there may be a role for ivacaftor in older patients with R117H-CFTR although this trial did not include patients with very severe CF lung disease [4]. In 2014, ivacaftor was approved in the United States as a treatment for CF subjects aged greater than 6 years old with a copy of R117H-CFTR. We present a case demonstrating a substantial therapeutic effect of ivacaftor in a CF patient with genotype F508del/R117H and advanced lung disease.
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Albayati MA, Kelly S, Gallagher D, Dourado R, Patel AS, Saha P, Bajwa A, El-Sayed T, Salter R, Gkoutzios P, Gkoutzious P, Carrell T, Abisi S, Modarai B. Editor's choice--Angulation of the C-arm during complex endovascular aortic procedures increases radiation exposure to the head. Eur J Vasc Endovasc Surg 2015; 49:396-402. [PMID: 25655805 DOI: 10.1016/j.ejvs.2014.12.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/28/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/BACKGROUND The increased complexity of endovascular aortic repair necessitates longer procedural time and higher radiation exposure to the operator, particularly to exposed body parts. The aims were to measure directly exposure to radiation of the bodies and heads of the operating team during endovascular repair of thoracoabdominal aortic aneurysms (TAAA), and to identify factors that may increase exposure. METHODS This was a single-centre prospective study. Between October 2013 and July 2014, consecutive elective branched and fenestrated TAAA repairs performed in a hybrid operating room were studied. Electronic dosimeters were used to measure directly radiation exposure to the primary (PO) and assistant (AO) operator in three different areas (under-lead, over-lead, and head). Fluoroscopy and digital subtraction angiography (DSA) acquisition times, C-arm angulation, and PO/AO height were recorded. RESULTS Seventeen cases were analysed (Crawford II-IV), with a median operating time of 280 minutes (interquartile range 200-330 minutes). Median age was 76 years (range 71-81 years); median body mass index was 28 kg/m(2) (25-32 kg/m(2)). Stent-grafts incorporated branches only, fenestrations only, or a mixture of branches and fenestrations. A total of 21 branches and 38 fenestrations were cannulated and stented. Head dose was significantly higher in the PO compared with the AO (median 54 μSv [range 24-130 μSv] vs. 15 μSv [range 7-43 μSv], respectively; p = .022), as was over-lead body dose (median 80 μSv [range 37-163 μSv] vs. 32 μSv [range 6-48 μSv], respectively; p = .003). Corresponding under-lead doses were similar between operators (median 4 μSv [range 1-17 μSv] vs. 1 μSv [range 1-3 μSv], respectively; p = .222). Primary operator height, DSA acquisition time in left anterior oblique (LAO) position, and degrees of LAO angulation were independent predictors of PO head dose (p < .05). CONCLUSIONS The head is an unprotected area receiving a significant radiation dose during complex endovascular aortic repair. The deleterious effects of exposure to this area are not fully understood. Vascular interventionalists should be cognisant of head exposure increasing with C-arm angulation, and limit this manoeuvre.
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Abt B, Morlandt A, DeVilliers P, Kelly S, Rosenthal E. Chondrosarcoma of the temporomandibular joint - one institutions experience: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2014. [DOI: 10.1016/j.oooo.2014.05.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Glauser TA, Ruderman EM, Kummerle D, Kelly S. Current Practice Patterns and Educational Needs of Rheumatologists Who Manage Patients with Rheumatoid Arthritis. Rheumatol Ther 2014; 1:31-44. [PMID: 27747761 PMCID: PMC4883259 DOI: 10.1007/s40744-014-0004-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION As the therapeutic landscape for rheumatoid arthritis (RA) continues to change, it is relevant to examine current treatment patterns among rheumatologists. The purpose of this study was to identify attitudes and practices of US rheumatologists with respect to RA. METHODS Nine-hundred and one US-practicing rheumatologists were sent electronic invites (via email or fax) to participate in a case-vignette survey in April 2013. All respondents were currently practicing rheumatology and seeing at least one RA patient per week. The survey examined current attitudes, existing knowledge, management choices and perceived barriers in the management of RA. Data collection stopped once 125 responses were received. RESULTS Approximately half of the 125 respondents were very familiar with current clinical practice guidelines for RA diagnosis and management. There was no consensus on which validated tools to use when assessing RA severity, with 54% using Physician Global Assessment and 34% using Disease Activity Score 28 at initial assessment. Most respondents (74%) used methotrexate (MTX) as initial therapy for a newly diagnosed RA patient. Eighty-six percent of respondents would add a tumor necrosis factor inhibitor (TNFi) when MTX alone could not control RA. There was no consensus on which treatment should be used when a TNFi is ineffective. The majority of respondents (66% of respondents) would prescribe TNFis indefinitely in patients with continued response. If a patient was in stable remission on MTX and a TNFi, respondents were most likely to maintain this regimen (53% of respondents); a notable minority (43%) would lower the MTX dose. When prescribing biologics, respondents were most concerned with infection; infection was considered a very significant barrier to biologic use. Although 98% of respondents indicated that they personally educate patients about RA, only 42% provide written material. CONCLUSIONS The lack of consistency in responses suggests that rheumatologists may benefit from continuing medical education on; clinical practice guidelines; the most recent evidence for management of patients in remission; the use of biologic agents after infection; and management of patients with RA and comorbidities.
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Brazier PJ, Durand A, Tierney R, Kelly S. Discontinuities Between Health Technology Assessment (HTA) and Health Care Service Objectives of the NHS. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A450. [PMID: 27201237 DOI: 10.1016/j.jval.2014.08.1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Albayati M, Kelly S, Gallagher D, Dourado R, Salter R, Gkoutzious P, Carrell T, Abisi S, Modarai B. Angulation of the C-arm During Complex Endovascular Aortic Procedures Increases Radiation Exposure to the Head. Eur J Vasc Endovasc Surg 2014. [DOI: 10.1016/j.ejvs.2014.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Debruyne P, Johnson P, Pottel L, Daniels S, Greer R, Hodgkinson E, Kelly S, Lycke M, Samol J, Simpson J, Kimber D, Loucaides E, Parmar M, Harvey S. The United Kingdom (Uk) National Cancer Research Network (Ncrn) Chemotherapy and Pharmacy Advisory Service (Cpas): Service Development and Quality Control Experience of Pharmacy Aspects in Clinical Research Protocols. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.21] [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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Vanegas-Arroyave MI, Blangero A, Kelly S. Direct neurophysiological measurement of surround suppression in humans. J Vis 2014. [DOI: 10.1167/14.10.50] [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] Open
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Azam F, Chatterjee M, Kelly S, Pinto M, Aurangabadkar A, Latif MF, Marshall E. Multifocal calcifying fibrous tumor at six sites in one patient: a case report. World J Surg Oncol 2014; 12:235. [PMID: 25070647 PMCID: PMC4127171 DOI: 10.1186/1477-7819-12-235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/20/2014] [Indexed: 10/28/2022] Open
Abstract
Calcifying fibrous tumors (CFT) are rare benign tumors. They usually affect children and young adults and the incidence is equal in males and females. The usual clinical presentation is that of a painless mass. A computed tomography scan typically reveals a well-demarcated calcified lesion. CFT usually presents as a solitary mass and the commonest sites of occurrence are in soft tissues, the pleura, or the peritoneum. Multifocal occurrences at the same site have also been reported. The first case of CFT was reported in 1988. We present a rare case of multiple calcifying fibrous tumors at multiple sites in the same patient. To the best of our knowledge, this is the first ever reported case of multifocal CFT atsix different anatomical sites in one patient.
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Di Cicco M, Humby F, Kelly S, Ng N, Mahto A, Hands R, Rocher V, Zou L, Bombardieri M, Pitzalis C. FRI0020 Presence of Synovial Lymphocyte Aggregates Predicts Clinical Response to DMARD Therapy in Patients with Early Rheumatoid Arthritis:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pervez A, Kelly S, Kidd B. THU0235 Global Tenderness and Anxiety/Depression as a Component of the DAS28. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lazarou I, Zou L, Mahto A, Di Cicco M, Ng N, Humby F, Pitzalis C, Kelly S. FRI0243 Ultrasound-Guided Synovial Biopsy Does not Alter Subsequent Ultrasound Assessments. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ng N, Kelly S, Humby F, DiCicco M, Rocher V, Hands R, Bombardieri M, Pitzalis C. OP0054 Ultrasound Synovitis Reflects Synovial Inflammation at A Histopathological Level: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Di Cicco M, Kelly S, Humby F, Ng N, Nerviani A, Rocher V, Hands R, Bombardieri M, Pitzalis C. SAT0048 Synovial Lymphocytic Aggregates Predict Clinical Response to Certolizumab Pegol in Rheumatoid Arthritis (Clinical and Pathological Response to Certolizumab-Pegol (Clip-Cert) Study): Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bystrom J, Taher T, Al-Bogami M, Alzabin S, Kelly S, Mangat P, Williams R, Jawad A, Mageed R. THU0500 Cytokine Production Identifies A Subset of Rheumatoid Arthritis Patients T Lymphocytes That is Associated with Responsiveness to Biologic Anti-TNF-Alpha Agents. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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