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Kanagaratnam P, Francis DP, Chamie D, Coyle C, Marynina A, Katritsis G, Paiva P, Szigeti M, Cole G, de Andrade Nunes D, Howard J, Esper R, Khan M, More R, Barreto G, Meneguz-Moreno R, Arnold A, Nowbar A, Kaura A, Mariveles M, March K, Shah J, Nijjer S, Lip GY, Mills N, Camm AJ, Cooke GS, Corbett SJ, Llewelyn MJ, Ghanima W, Toshner M, Peters N, Petraco R, Al-Lamee R, Boshoff ASM, Durkina M, Malik I, Ruparelia N, Cornelius V, Shun-Shin M. A RANDOMISED CONTROLLED TRIAL TO INVESTIGATE THE USE OF ACUTE CORONARY SYNDROME THERAPY IN PATIENTS HOSPITALISED WITH COVID-19: THE C19-ACS TRIAL. J Thromb Haemost 2023:S1538-7836(23)00428-2. [PMID: 37230416 DOI: 10.1016/j.jtha.2023.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Patients hospitalised with COVID-19 suffer thrombotic complications. Risk factors for poor outcomes are shared with coronary artery disease. OBJECTIVES To investigate efficacy of an acute coronary syndrome regimen in patients hospitalised with COVID-19 and coronary disease risk factors. PATIENTS/METHODS A randomised controlled open-label trial across acute hospitals (UK and Brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28-days. Primary efficacy and safety outcomes were 30-day mortality and bleeding. The key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, death). RESULTS 320 patients from 9 centres were randomised. The trial terminated early due to low recruitment. At 30 days there was no significant difference in mortality (intervention: 11.5% vs control: 15%, unadjusted OR 0.73, 95%CI 0.38 to 1.41, p=0.355). Significant bleeds were infrequent and not significantly different between the arms (intervention: 1.9% vs control 1.9%, p>0.999). Using a Bayesian Markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (OR 1.46, 95% CrI 0.88 to 2.37, Pr(Beta>0)=93%; adjusted OR 1.50, 95% CrI 0.91 to 2.45, Pr(Beta>0)=95%) and median time to discharge home was two days shorter (95% CrI -4 to 0, 2% probability that it was worse). CONCLUSIONS Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.
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Affiliation(s)
- Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK.
| | - Darrel P Francis
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Daniel Chamie
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Clare Coyle
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Patricia Paiva
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Matyas Szigeti
- Imperial College, London, UK; Physiological Controls Research Centre, Obuda University, Budapest, Hungary
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - James Howard
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Ranjit More
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
| | | | - Rafael Meneguz-Moreno
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil; Centro de Ensino e Pesquisa da Rede Primavera, Aracaju, Brazil; Universidade Federal de Sergipe, Lagarto, Brazil
| | - Ahran Arnold
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Amit Kaura
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Jaymin Shah
- London North West University Healthcare NHS Trust, UK
| | | | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nicholas Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A John Camm
- St George's University of London, London, UK
| | - Graham S Cooke
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Martin J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Waleed Ghanima
- Østfold Hospital: Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Mark Toshner
- Heart and Lung Research Institute, Dept of Medicine, University of Cambridge
| | - Nicholas Peters
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Rasha Al-Lamee
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Margarita Durkina
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, London, UK; Royal Berkshire Hospital NHS Trust, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London
| | - Matthew Shun-Shin
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
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Zadori A, Kis Z, Toth T, Szigeti M, Temesvari A, Fontos G, Nyolczas N, Andreka P. Long-Term Efficacy and Safety of Left Atrial Appendage Closure Procedures. Int Heart J 2023; 64:188-195. [PMID: 36927928 DOI: 10.1536/ihj.22-639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The aim of the present single-center, nonrandomized, retrospective study was to assess the safety and long-term efficacy of percutaneous left atrial appendage closure (LAAC) procedures and to compare the different LAAC devices and therapeutic regimes in this respect.Medical data of 136 patients (pts) (mean age, 72.5 ± 7.6 years; score for atrial fibrillation stroke risk estimation [CHA2DS2-VASc], 4.6 ± 1.6; and score for estimation of major bleeding risk for patients on anticoagulant therapy [HAS-BLED], 2.6 ± 0.9) who underwent percutaneous LAAC procedures in Gottsegen National Cardiovascular Center from January 2010 to January 2020 were analyzed.The rates of outpatient cardiac mortality, ischemic brain event, and major bleeding were 3.8, 1, and 1.9/100 pt years, respectively. The rate of successful device deployment was 96.4%. There was one case of procedural mortality (0.7%), one case of device dislocation (0.7%), one case of ischemic stroke (0.7%), and one case of myocardial infarction (0.7%). Two cases of pericardial tamponades (1.5%) and four cases of major femoral complications (3%) occurred. Although the implantation success of different occluder types was similar, significant differences were found concerning procedural characteristics. Patients on single antiplatelet therapy (SAPT) in the first 3 months after the LAAC procedure did not suffer from stroke or embolic events.The present study confirmed the safety and effectivity of percutaneous LAAC. Robust relative stroke risk reduction and less pronounced but significant bleeding risk reduction were observed. Device implantation success was high. The perioperative complication rate was relatively low. The results of long-term observations regarding ischemic events confirmed the safety of using a simplified antithrombotic regime after LAAC in pts with high bleeding risk.
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Affiliation(s)
| | | | | | - Matyas Szigeti
- Imperial Clinical Trials Unit, Stadium House.,Physiological Controls Research Center
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3
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Maher TM, Tudor VA, Saunders P, Gibbons MA, Fletcher SV, Denton CP, Hoyles RK, Parfrey H, Renzoni EA, Kokosi M, Wells AU, Ashby D, Szigeti M, Molyneaux PL. Rituximab versus intravenous cyclophosphamide in patients with connective tissue disease-associated interstitial lung disease in the UK (RECITAL): a double-blind, double-dummy, randomised, controlled, phase 2b trial. Lancet Respir Med 2023; 11:45-54. [PMID: 36375479 DOI: 10.1016/s2213-2600(22)00359-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/22/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Rituximab is often used as rescue therapy in interstitial lung disease (ILD) associated with connective tissue disease (CTD), but has not been studied in clinical trials. This study aimed to assess whether rituximab is superior to cyclophosphamide as a treatment for severe or progressive CTD associated ILD. METHODS We conducted a randomised, double-blind, double-dummy, phase 2b trial to assess the superiority of rituximab compared with cyclophosphamide. Patients aged 18-80 years with severe or progressive ILD related to scleroderma, idiopathic inflammatory myositis, or mixed CTD, recruited across 11 specialist ILD or rheumatology centres in the UK, were randomly assigned (1:1) to receive rituximab (1000 mg at weeks 0 and 2 intravenously) or cyclophosphamide (600 mg/m2 body surface area every 4 weeks intravenously for six doses). The primary endpoint was rate of change in forced vital capacity (FVC) at 24 weeks compared with baseline, analysed using a mixed-effects model with random intercepts, adjusted for baseline FVC and CTD type. Prespecified secondary endpoints reported in this Article were change in FVC at 48 weeks versus baseline; changes from baseline in 6 min walk distance, diffusing capacity of the lung for carbon monoxide (DLCO), physician-assessed global disease activity (GDA) score, and quality-of-life scores on the St George's Respiratory Questionnaire (SGRQ), King's Brief Interstitial Lung Disease (KBILD) questionnaire, and European Quality of Life Five-Dimension (EQ-5D) questionnaire at 24 and 48 weeks; overall survival, progression-free survival, and time to treatment failure; and corticosteroid use. All endpoints were analysed in the modified intention-to-treat population, which comprised all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov (NCT01862926). FINDINGS Between Dec 1, 2014, and March 31, 2020, we screened 145 participants, of whom 101 participants were randomly allocated: 50 (50%) to receive cyclophosphamide and 51 (50%) to receive rituximab. 48 (96%) participants in the cyclophosphamide group and 49 (96%) in the rituximab group received at least one dose of treatment and were included in analyses; 43 (86%) participants in the cyclophosphamide group and 42 (82%) participants in the rituximab group completed 24 weeks of treatment and follow-up. At 24 weeks, FVC was improved from baseline in both the cyclophosphamide group (unadjusted mean increase 99 mL [SD 329]) and the rituximab group (97 mL [234]); in the adjusted mixed-effects model, the difference in the primary endpoint at 24 weeks was -40 mL (95% CI -153 to 74; p=0·49) between the rituximab group and the cyclophosphamide group. KBILD quality-of-life scores were improved at 24 weeks by a mean 9·4 points (SD 20·8) in the cyclophosphamide group and 8·8 points (17·0) in the rituximab group. No significant differences in secondary endpoints were identified between the treatment groups, with the exception of change in GDA score at week 48, which favoured cyclophosphamide (difference 0·90 [95% CI 0·11 to 1·68]). Improvements in lung function and respiratory-related quality-of-life measures were observed in both treatment groups. Lower corticosteroid exposure over 48 weeks of follow-up was recorded in the rituximab group. Two (4%) of 48 participants who received cyclophosphamide and three (6%) of 49 who received rituximab died during the study, all due to complications of CTD or ILD. Overall survival, progression-free survival, and time to treatment failure did not significantly differ between the two groups. All participants reported at least one adverse event during the study. Numerically fewer adverse events were reported by participants receiving rituximab (445 events) than those receiving cyclophosphamide (646 events). Gastrointestinal and respiratory disorders were the most commonly reported adverse events in both groups. There were 62 serious adverse events of which 33 occurred in the cyclophosphamide group and 29 in the rituximab group. INTERPRETATION Rituximab was not superior to cyclophosphamide to treat patients with CTD-ILD, although participants in both treatment groups had increased FVC at 24 weeks, in addition to clinically important improvements in patient-reported quality of life. Rituximab was associated with fewer adverse events. Rituximab should be considered as a therapeutic alternative to cyclophosphamide in individuals with CTD-ILD requiring intravenous therapy. FUNDING Efficacy and Mechanism Evaluation Programme (Medical Research Council and National Institute for Health Research, UK).
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Affiliation(s)
- Toby M Maher
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | | | - Peter Saunders
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Michael A Gibbons
- Academic Department of Respiratory Medicine, Royal Devon & Exeter Foundation NHS Trust, Exeter, UK; College of Medicine & Health, University of Exeter, UK
| | - Sophie V Fletcher
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Christopher P Denton
- Centre for Rheumatology, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Rachel K Hoyles
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Helen Parfrey
- Interstitial Lung Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Elisabetta A Renzoni
- Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Maria Kokosi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athol U Wells
- Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, London, UK
| | - Matyas Szigeti
- Imperial Clinical Trials Unit, Imperial College London, London, UK; Physiological Controls Research Center, Obuda University, Budapest, Hungary
| | - Philip L Molyneaux
- Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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4
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Vadon NB, Elek LP, Szigeti M, Erdelyi-Hamza B, Smirnova D, Fountoulakis KN, Gonda X. Association between Lifestyle- and Circadian Rhythm-Related Changes, and Different Depression Symptom Clusters during COVID-19. Psychiatr Danub 2022; 34:81-89. [PMID: 36170708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic brought along a new situation for the population worldwide. The most important safety measures and lockdown expected extreme adaptability and flexibility impacting mental well-being. The aim of our study was to identify associations between changes in lifestyle and circadian rhythm and depression during the pandemic. SUBJECTS AND METHODS Our analysis has been carried out on the Hungarian data set of the COMET-G study including information on lifestyle and circadian rhythm-associated factors and severity of depression and its 3 symptom clusters. Associations were assessed using linear regression models adjusted for age and sex. RESULTS All variables reflecting changes in quality and quantity of sleep showed significant associations with overall depression scores and the three distinct symptom cluster scores. All variables reflecting importance and changes in physical activity during the pandemic were similarly significantly associated with all depression measures. However, only changes in quality of diet, but not quantity was associated with depression scores. CONCLUSIONS Our results may confirm the association of circadian rhythm and lifestyle-related environmental factors in deterioration of mental health during COVID and help devise prevention and intervention methods and targets for similar situations.
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Affiliation(s)
- Nikolett Beata Vadon
- Department of Psychiatry and Psychotherapy, Semmelweis University, St. Rokus Clinical Centre, Gyulai Pál utca 2., Budapest, 1085, Hungary
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5
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Elek LP, Szigeti M, Erdelyi-Hamza B, Smirnova D, Fountoulakis KN, Gonda X. What you see is what you get? Association of belief in conspiracy theories and mental health during COVID-19. Neuropsychopharmacol Hung 2022; 24:42-55. [PMID: 35451591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: The COVID-19 pandemic brought about great uncertainty and significant changes in our people's everyday lives. In times of such crises, it is natural to seek explanations to overcome our fears and uncertainties, contributing to an increase to believe in conspiracy theories which, by yielding explanations, decrease uncertainty and ambiguity and may thus have an effect on mental well-being. In spite of this, the majority of research on conspiracy theories focused on their social effects with little attention to psychological effects. Thus, the aim of our present study was to examine the association between belief in conspiracy theories and different aspects of mental health during the COVID-19 pandemic in a general population sample. Methods: Our analyses included data from the Hungarian leg of the COMET-G (COVID-19 MEntal health international for the General population) study. The Hungarian sample included participants who completed a detailed questionnaire assessing belief in seven conspiracy theory items, as well as STAI-S and CES-D to measure state anxiety and depression, respectively, and answered questions related to their change in depression, anxiety and suicidal thoughts during the pandemic. Association between the individual beliefs as well as a composite Conspiracy Theory Belief Score (CTBS) and mental health measures was analysed using linear regression models. Results: Overall, belief in conspiracy theories was relatively moderate in our sample. Sex and age appeared to have a significant effect on the Overall Conspiracy Theory Belief Score (CTBS), with women having a higher score and scores increasing with age. Some of the individual beliefs also showed associations with age and sex. State anxiety and depression was not significantly associated with CTBS, however in case of depression some individual items were, and symptom clusters within CES-D also showed a pattern of association with some of the individual items. As far as changes in mental health during the pandemic is concerned, no association between overall beliefs and changes in anxiety or depression was found. However, higher overall belief in conspiracy theories was associated with a decrease in suicidal thoughts. Discussion: In our study, we explored the association between conspiracy theories and mental well-being as well as its changes during the COVID-19 pandemic. We found a specific pattern of association between belief in distinct theories and some aspects of depression, as well as lower increase in suicidal ideation in association with increased belief in conspiracy theories. Understanding the role of belief in theories can be key to designing mental health interventions when reacting to unforeseen events in the future. (Neuropsychopharmacol Hung 2022; 24(1): 42-55).
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Affiliation(s)
| | - Matyas Szigeti
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Physiological Controls Research Center, Budapest, Hungary
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Daria Smirnova
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
| | | | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Samara, Russia
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6
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Gohel MS, Mora MSc J, Szigeti M, Epstein DM, Heatley F, Bradbury A, Bulbulia R, Cullum N, Nyamekye I, Poskitt KR, Renton S, Warwick J, Davies AH. Long-term Clinical and Cost-effectiveness of Early Endovenous Ablation in Venous Ulceration: A Randomized Clinical Trial. JAMA Surg 2021; 155:1113-1121. [PMID: 32965493 PMCID: PMC7512122 DOI: 10.1001/jamasurg.2020.3845] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance One-year outcomes from the Early Venous Reflux Ablation (EVRA) randomized trial showed accelerated venous leg ulcer healing and greater ulcer-free time for participants who are treated with early endovenous ablation of lower extremity superficial reflux. Objective To evaluate the clinical and cost-effectiveness of early endovenous ablation of superficial venous reflux in patients with venous leg ulceration. Design, Setting, and Participants Between October 24, 2013, and September 27, 2016, the EVRA randomized clinical trial enrolled 450 participants (450 legs) with venous leg ulceration of less than 6 months' duration and superficial venous reflux. Initially, 6555 patients were assessed for eligibility, and 6105 were excluded for reasons including ulcer duration greater than 6 months, healed ulcer by the time of randomization, deep venous occlusive disease, and insufficient superficial venous reflux to warrant ablation therapy, among others. A total of 426 of 450 participants (94.7%) from the vascular surgery departments of 20 hospitals in the United Kingdom were included in the analysis for ulcer recurrence. Surgeons, participants, and follow-up assessors were not blinded to the treatment group. Data were analyzed from August 11 to November 4, 2019. Interventions Patients were randomly assigned to receive compression therapy with early endovenous ablation within 2 weeks of randomization (early intervention, n = 224) or compression with deferred endovenous treatment of superficial venous reflux (deferred intervention, n = 226). Endovenous modality and strategy were left to the preference of the treating clinical team. Main Outcomes and Measures The primary outcome for the extended phase was time to first ulcer recurrence. Secondary outcomes included ulcer recurrence rate and cost-effectiveness. Results The early-intervention group consisted of 224 participants (mean [SD] age, 67.0 [15.5] years; 127 men [56.7%]; 206 White participants [92%]). The deferred-intervention group consisted of 226 participants (mean [SD] age, 68.9 [14.0] years; 120 men [53.1%]; 208 White participants [92%]). Of the 426 participants whose leg ulcer had healed, 121 (28.4%) experienced at least 1 recurrence during follow-up. There was no clear difference in time to first ulcer recurrence between the 2 groups (hazard ratio, 0.82; 95% CI, 0.57-1.17; P = .28). Ulcers recurred at a lower rate of 0.11 per person-year in the early-intervention group compared with 0.16 per person-year in the deferred-intervention group (incidence rate ratio, 0.658; 95% CI, 0.480-0.898; P = .003). Time to ulcer healing was shorter in the early-intervention group for primary ulcers (hazard ratio, 1.36; 95% CI, 1.12-1.64; P = .002). At 3 years, early intervention was 91.6% likely to be cost-effective at a willingness to pay of £20 000 ($26 283) per quality-adjusted life year and 90.8% likely at a threshold of £35 000 ($45 995) per quality-adjusted life year. Conclusions and Relevance Early endovenous ablation of superficial venous reflux was highly likely to be cost-effective over a 3-year horizon compared with deferred intervention. Early intervention accelerated the healing of venous leg ulcers and reduced the overall incidence of ulcer recurrence. Trial Registration ClinicalTrials.gov identifier: ISRCTN02335796.
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Affiliation(s)
- Manjit S Gohel
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jocelyn Mora MSc
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Matyas Szigeti
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - David M Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
| | - Francine Heatley
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Andrew Bradbury
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Richard Bulbulia
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, United Kingdom.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nicky Cullum
- University of Manchester & Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Isaac Nyamekye
- Worcestershire Acute Hospitals National Health Service Trust, Worcestershire, United Kingdom
| | - Keith R Poskitt
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, United Kingdom
| | - Sophie Renton
- North West London Hospitals National Health Service Trust, London, United Kingdom
| | - Jane Warwick
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom.,Warwick Clinical Trials Unit, University of Warwick, Warwick, United Kingdom
| | - Alun H Davies
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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7
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Tan PT, Cro S, Van Vogt E, Szigeti M, Cornelius VR. A review of the use of controlled multiple imputation in randomised controlled trials with missing outcome data. BMC Med Res Methodol 2021; 21:72. [PMID: 33858355 PMCID: PMC8048273 DOI: 10.1186/s12874-021-01261-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/30/2021] [Indexed: 01/21/2023] Open
Abstract
Background Missing data are common in randomised controlled trials (RCTs) and can bias results if not handled appropriately. A statistically valid analysis under the primary missing-data assumptions should be conducted, followed by sensitivity analysis under alternative justified assumptions to assess the robustness of results. Controlled Multiple Imputation (MI) procedures, including delta-based and reference-based approaches, have been developed for analysis under missing-not-at-random assumptions. However, it is unclear how often these methods are used, how they are reported, and what their impact is on trial results. This review evaluates the current use and reporting of MI and controlled MI in RCTs. Methods A targeted review of phase II-IV RCTs (non-cluster randomised) published in two leading general medical journals (The Lancet and New England Journal of Medicine) between January 2014 and December 2019 using MI. Data was extracted on imputation methods, analysis status, and reporting of results. Results of primary and sensitivity analyses for trials using controlled MI analyses were compared. Results A total of 118 RCTs (9% of published RCTs) used some form of MI. MI under missing-at-random was used in 110 trials; this was for primary analysis in 43/118 (36%), and in sensitivity analysis for 70/118 (59%) (3 used in both). Sixteen studies performed controlled MI (1.3% of published RCTs), either with a delta-based (n = 9) or reference-based approach (n = 7). Controlled MI was mostly used in sensitivity analysis (n = 14/16). Two trials used controlled MI for primary analysis, including one reporting no sensitivity analysis whilst the other reported similar results without imputation. Of the 14 trials using controlled MI in sensitivity analysis, 12 yielded comparable results to the primary analysis whereas 2 demonstrated contradicting results. Only 5/110 (5%) trials using missing-at-random MI and 5/16 (31%) trials using controlled MI reported complete details on MI methods. Conclusions Controlled MI enabled the impact of accessible contextually relevant missing data assumptions to be examined on trial results. The use of controlled MI is increasing but is still infrequent and poorly reported where used. There is a need for improved reporting on the implementation of MI analyses and choice of controlled MI parameters. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01261-6.
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Affiliation(s)
- Ping-Tee Tan
- School of Public Health Imperial College London, Medical School Building, St Mary's Hospital, Norfolk Place, London, UK
| | - Suzie Cro
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK.
| | - Eleanor Van Vogt
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK
| | - Matyas Szigeti
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK
| | - Victoria R Cornelius
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK
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8
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Poulter NR, Savopoulos C, Anjum A, Apostolopoulou M, Chapman N, Cross M, Falaschetti E, Fotiadis S, James RM, Kanellos I, Szigeti M, Thom S, Sever P, Thompson D, Hatzitolios AI. Randomized Crossover Trial of the Impact of Morning or Evening Dosing of Antihypertensive Agents on 24-Hour Ambulatory Blood Pressure. Hypertension 2018; 72:870-873. [DOI: 10.1161/hypertensionaha.118.11101] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Some data suggest that nocturnal dosing of antihypertensive agents may reduce cardiovascular outcomes more than daytime dosing. This trial was designed to evaluate whether ambulatory blood pressure monitoring levels differ by timing of drug dosing. Patients aged 18 to 80 years with reasonably controlled hypertension (≤150/≤90 mm Hg) on stable therapy of ≥1 antihypertensive agent were recruited from 2 centers in London and Thessaloniki. Patients were randomized to receive usual therapy either in the morning (6
am
–11
am
) or evening (6
pm
–11
pm
) for 12 weeks when participants crossed over to the alternative timing for a further 12 weeks. Clinic blood pressures and a 24-hour recording were taken at baseline, 12, and 24 weeks and routine blood tests were taken at baseline. The study had 80% power to detect 3 mm Hg difference in mean 24-hour systolic blood pressure (α=0.05) by time of dosing. A 2-level hierarchical regression model adjusted for center, period, and sequence was used. Of 103 recruited patients (mean age, 62; 44% female), 95 patients (92%) completed all three 24-hour recordings. Mean 24-hour systolic and diastolic blood pressures did not differ between daytime and evening dosing. Similarly, morning and evening dosing had no differential impact on mean daytime (7
am
–10
pm
) and nighttime (10
pm
–7
am
) blood pressure levels nor on clinic levels. Stratification by age (≤65/≥65 years) or sex did not affect results. In summary, among hypertensive patients with reasonably well-controlled blood pressure, the timing of antihypertensive drug administration (morning or evening) did not affect mean 24-hour or clinic blood pressure levels.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01669928.
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Affiliation(s)
- Neil R. Poulter
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Christos Savopoulos
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Aisha Anjum
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Martha Apostolopoulou
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Neil Chapman
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Mary Cross
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Emanuela Falaschetti
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Spiros Fotiadis
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Rebecca M. James
- William Harvey Clinical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (R.M.J.)
| | - Ilias Kanellos
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Matyas Szigeti
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Simon Thom
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Peter Sever
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - David Thompson
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
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Johnston SL, Szigeti M, Cross M, Brightling C, Chaudhuri R, Harrison T, Mansur A, Robison L, Sattar Z, Jackson D, Mallia P, Wong E, Corrigan C, Higgins B, Ind P, Singh D, Thomson NC, Ashby D, Chauhan A. Azithromycin for Acute Exacerbations of Asthma : The AZALEA Randomized Clinical Trial. JAMA Intern Med 2016; 176:1630-1637. [PMID: 27653939 DOI: 10.1001/jamainternmed.2016.5664] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Guidelines recommend against antibiotic use to treat asthma attacks. A study with telithromycin reported benefit, but adverse reactions limit its use. OBJECTIVE To determine whether azithromycin added to standard care for asthma attacks in adults results in clinical benefit. DESIGN, SETTING, AND PARTICIPANTS The Azithromycin Against Placebo in Exacerbations of Asthma (AZALEA) randomized, double-blind, placebo-controlled clinical trial, a United Kingdom-based multicenter study in adults requesting emergency care for acute asthma exacerbations, ran from September 2011 to April 2014. Adults with a history of asthma for more than 6 months were recruited within 48 hours of presentation to medical care with an acute deterioration in asthma control requiring a course of oral and/or systemic corticosteroids. INTERVENTIONS Azithromycin 500 mg daily or matched placebo for 3 days. MAIN OUTCOMES AND MEASURES The primary outcome was diary card symptom score 10 days after randomization, with a hypothesized treatment effect size of -0.3. Secondary outcomes were diary card symptom score, quality-of-life questionnaires, and lung function changes, all between exacerbation and day 10, and time to a 50% reduction in symptom score. RESULTS Of 4582 patients screened at 31 centers, 199 of a planned 380 were randomized within 48 hours of presentation. The major reason for nonrecruitment was receipt of antibiotics (2044 [44.6%] screened patients). Median time from presentation to drug administration was 22 hours (interquartile range, 14-28 hours). Exacerbation characteristics were well balanced across treatment arms and centers. The primary outcome asthma symptom scores were mean (SD), 4.14 (1.38) at exacerbation and 2.09 (1.71) at 10 days for the azithromycin group and 4.18 (1.48) and 2.20 (1.51) for the placebo group, respectively. Using multilevel modeling, there was no significant difference in symptom scores between azithromycin and placebo at day 10 (difference, -0.166; 95% CI, -0.670 to 0.337), nor on any day between exacerbation and day 10. No significant between-group differences were observed in quality-of-life questionnaires or lung function between exacerbation and day 10, or in time to 50% reduction in symptom score. CONCLUSIONS AND RELEVANCE In this randomized population, azithromycin treatment resulted in no statistically or clinically significant benefit. For each patient randomized, more than 10 were excluded because they had already received antibiotics. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01444469.
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Affiliation(s)
| | - Matyas Szigeti
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - Mary Cross
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | | | - Rekha Chaudhuri
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, Scotland.,Respiratory Medicine, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - Timothy Harrison
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England
| | - Adel Mansur
- Respiratory Medicine, Heart of England Foundation Trust, Birmingham, England.,Severe and Brittle Asthma Unit, University of Birmingham, Birmingham, England
| | - Laura Robison
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - Zahid Sattar
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - David Jackson
- National Heart and Lung Institute, Imperial College London, London, England
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College London, London, England
| | - Ernie Wong
- National Heart and Lung Institute, Imperial College London, London, England
| | - Christopher Corrigan
- Respiratory Medicine and Allergy, King's College London School of Medicine, London, England.,Department of Asthma, Allergy and Respiratory Science, Guy's and St. Thomas' NHS Foundation Trust, London, England
| | - Bernard Higgins
- Respiratory Medicine, Newcastle University, Newcastle, England
| | - Philip Ind
- National Heart and Lung Institute, Imperial College London, London, England.,Respiratory Medicine, Imperial College Healthcare NHS Trust, London, England
| | - Dave Singh
- Centre for Respiratory Medicine and Allergy, Medicines Evaluation Unit, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, England
| | - Neil C Thomson
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, Scotland
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - Anoop Chauhan
- Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, England
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10
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Abbara A, Jayasena CN, Christopoulos G, Narayanaswamy S, Izzi-Engbeaya C, Nijher GMK, Comninos AN, Peters D, Buckley A, Ratnasabapathy R, Prague JK, Salim R, Lavery SA, Bloom SR, Szigeti M, Ashby DA, Trew GH, Dhillo WS. Efficacy of Kisspeptin-54 to Trigger Oocyte Maturation in Women at High Risk of Ovarian Hyperstimulation Syndrome (OHSS) During In Vitro Fertilization (IVF) Therapy. J Clin Endocrinol Metab 2015; 100:3322-31. [PMID: 26192876 PMCID: PMC4570165 DOI: 10.1210/jc.2015-2332] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In vitro fertilization (IVF) treatment is an effective therapy for infertility, but can result in the potentially life-threatening complication, ovarian hyperstimulation syndrome (OHSS). OBJECTIVE This study aimed to investigate whether kisspeptin-54 can be used to effectively and safely trigger oocyte maturation in women undergoing IVF treatment at high risk of developing OHSS. SETTING AND DESIGN This was a phase 2, multi-dose, open-label, randomized clinical trial of 60 women at high risk of developing OHSS carried out during 2013-2014 at Hammersmith Hospital IVF unit, London, United Kingdom. INTERVENTION Following a standard recombinant FSH/GnRH antagonist protocol, patients were randomly assigned to receive a single injection of kisspeptin-54 to trigger oocyte maturation using an adaptive design for dose allocation (3.2 nmol/kg, n = 5; 6.4 nmol/kg, n = 20; 9.6 nmol/kg, n = 15; 12.8 nmol/kg, n = 20). Oocytes were retrieved 36 h after kisspeptin-54 administration, assessed for maturation, and fertilized by intracytoplasmic sperm injection with subsequent transfer of one or two embryos. Women were routinely screened for the development of OHSS. MAIN OUTCOME MEASURE Oocyte maturation was measured by oocyte yield (percentage of mature oocytes retrieved from follicles ≥ 14 mm on ultrasound). Secondary outcomes include rates of OHSS and pregnancy. RESULTS Oocyte maturation occurred in 95% of women. Highest oocyte yield (121%) was observed following 12.8 nmol/kg kisspeptin-54, which was +69% (confidence interval, -16-153%) greater than following 3.2 nmol/kg. At all doses of kisspeptin-54, biochemical pregnancy, clinical pregnancy, and live birth rates per transfer (n = 51) were 63, 53, and 45%, respectively. Highest pregnancy rates were observed following 9.6 nmol/kg kisspeptin-54 (85, 77, and 62%, respectively). No woman developed moderate, severe, or critical OHSS. CONCLUSION Kisspeptin-54 is a promising approach to effectively and safely trigger oocyte maturation in women undergoing IVF treatment at high risk of developing OHSS.
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Affiliation(s)
- Ali Abbara
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Channa N Jayasena
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Georgios Christopoulos
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Shakunthala Narayanaswamy
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Chioma Izzi-Engbeaya
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Gurjinder M K Nijher
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Alexander N Comninos
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Deborah Peters
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Adam Buckley
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Risheka Ratnasabapathy
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Julia K Prague
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Rehan Salim
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Stuart A Lavery
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Stephen R Bloom
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Matyas Szigeti
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Deborah A Ashby
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Geoffrey H Trew
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Waljit S Dhillo
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
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Jarvas G, Szigeti M, Hajba L, Furjes P, Guttman A. Computational Fluid Dynamics-Based Design of a Microfabricated Cell Capture Device. J Chromatogr Sci 2014; 53:411-6. [DOI: 10.1093/chromsci/bmu110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Szigeti M, Fekete G, Szollár J. The effect of regular cytostatic handling on the sister-chromatid exchanges in hospital nurses. ACTA ACUST UNITED AC 1982. [DOI: 10.1016/0165-1161(82)90175-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jacotot B, Beaumont JL, Monnier G, Szigeti M, Robert B, Robert L. Role of elastic tissue in cholesterol deposition in the arterial wall. Nutr Metab 1973; 15:46-58. [PMID: 4576166 DOI: 10.1159/000175422] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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