Royal Hallamshire Hospital Research Articles

Pro-inflammatory stimuli and not reactive oxygen species regulate adhesion molecule expression upon human liver sinusoidal endothelial cells during hepatic ischaemia-reperfusion injury

Pro-inflammatory stimuli and not reactive oxygen species regulate adhesion molecule expression upon human liver sinusoidal endothelial cells during hepatic ischaemia-reperfusion injury

A randomised, partially observer blind, multicentre, head-to-head comparison of a two-dose regimen of Baxter and GlaxoSmithKline H1N1 pandemic vaccines, administered 21 days apart

A randomised, partially observer blind, multicentre, head-to-head comparison of a two-dose regimen of Baxter and GlaxoSmithKline H1N1 pandemic vaccines, administered 21 days apart

Extending the effects of pulmonary rehabilitation in a community setting

Does pulmonary rehabilitation produce better results if offered in a community setting, and can the effects be extended by regular telephone encouragement? These are key questions regularly posed by clinicians treating people with chronic obstructive pulmonary disease (COPD). A group of researchers (Waterhouse et al) from the Royal Hallamshire Hospital in Sheffield were commissioned by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme to investigate this by conducting a clinical trial to answer these questions. They have recently published their findings in the Health Technology Assessment Journal (2010).

The influence of increasing BMI in nulliparous women on pregnancy outcome

Objective The aim of the study was to demonstrate the influence of BMI in pregnancy on rates of adverse pregnancy outcome in overweight nulliparous women. Study design The study was a retrospective review of data from the local hospital database held at the Jessop Wing of the Royal Hallamshire Hospital in Sheffield. We reviewed all nulliparous women with recorded BMI at booking between January 2001 and November 2008 who delivered singleton babies. All the women were stratified into five groups (underweight, normal, overweight, obese, and morbidly obese). The different BMI range groups were compared with the group of women with a normal BMI (20–25). SPSS v15 was used for statistical analysis. Results The caesarean section rate rose from 18.2% in women of normal BMI to 40.6% in the morbidly obese women (RR 2.2 – CI 1.7–2.8). Morbidly obese women had three times that risk of macrosomia compared with normal BMI women (RR 3.1 – CI 2.1–4.8). The stillbirth rate was associated with increasing obesity with RR 16.7 (CI 4.9–56) for the morbidly obese women. Conclusions Increasing degrees of obesity are associated with increases in the incidence of caesarean section, fetal birth weight and adverse pregnancy outcomes. The increased risk shows an increment in a stepwise fashion among the different BMI groups.

Ertapenem administered as outpatient parenteral antibiotic therapy for urinary tract infections caused by extended-spectrum- -lactamase-producing Gram-negative organisms

Infections with extended-spectrum-beta-lactamase-producing organisms are an increasing public health concern. We reviewed the use of an outpatient parenteral antibiotic therapy (OPAT) programme to facilitate the early discharge from hospital of patients with ESBL-associated urinary tract infections. A retrospective review of patients treated for urinary tract infections caused by ESBL-producing organisms through the OPAT programme at the Royal Hallamshire Hospital, Sheffield, UK over a 4 year period to January 2010 was conducted. Data on patient demographics, clinical presentation and laboratory results were collected. Twenty-four OPAT episodes involving 11 patients were identified. Six patients (54.5%) had an underlying urological abnormality on presentation to OPAT. All patients were treated with parenteral ertapenem. Two patients had multiple infections treated by OPAT. The mean duration of the OPAT episodes was 9.9 days (range 3-42). A total of 238 inpatient bed days were avoided, with resultant cost savings. Ertapenem administration through OPAT may help to decrease the costs associated with ESBL infections by reducing the number of inpatient bed days required for their successful treatment.

PTH-092 Reproductive and hormonal risk factors for breast cancer among women with coeliac disease: a population-based questionnaire study

<h3>Introduction</h3> Several studies have observed that coeliac disease is associated with more than a 50% reduced risk of breast cancer1–4 though the reasons for this reduction are unclear. We determined the conventional breast cancer risk factors reported by women with coeliac disease in comparison to the general population. <h3>Methods</h3> 9000 women who were members of Coeliac UK, the national society for people with coeliac disease in the UK and 1193 women with coeliac disease who had attended Nottingham University Hospital, Royal Hallamshire Hospital, Derbyshire Royal Infirmary between January 2000 and December 2006 were invited to complete a questionnaire relating to known risk factors for breast cancer. Data from British birth cohort studies were used as a general population comparison.5–7 <h3>Results</h3> 7416 women (mean age 58.7 (SD 12.4) years) with coeliac disease completed the questionnaire. The mean age at adult diagnosis was 44.8 (SD 12.8) years with 424 (6%) being diagnosed in childhood. The higher proportion of women being parous (91% vs 88%, OR 1.39, 95% CI 1.11 to 1.73), having their first full-term pregnancy before 30 years (89% vs 79%, OR 2.00, 95% CI 1.75 to 2.29) and breastfeeding (73% vs 68%, OR 1.29, 95% CI 1.02 to 1.63) in addition to the younger mean age at menopause (47.8 vs 49.0 years, p=0.00001) suggests women with coeliac disease have favourable breast cancer risk profile features in comparison to the general population. However, the higher likelihood of being Caucasian (98% vs 90%, OR 7.22, 95% CI 5.90 to 8.83) and of affluent social class (26% vs 20%, OR 1.40, 95% CI 1.19 to 1.64) together with higher proportion having menarche before 11 years (15% vs 2%, OR 7.87, 95% CI 5.90 to 8.83) and irregular menstrual cycles (22% vs 19%, OR 1.22, 95% CI 1.05 to 1.43) suggests there are also potentially adverse breast cancer risk profile features associated with coeliac disease. Having similar height to the general population (162.8 (SD 7) cm) and BMI within normal range suggests anthropometric exposures may not explain the apparent reduced risk of breast cancer in women with coeliac disease to the general population. <h3>Conclusion</h3> The breast cancer risk profile suggests both protective and adverse associations of coeliac disease. Reduced risk of breast cancer in women with coeliac disease may be related to differences in menstrual and reproductive factors.

PTH-091 Is the diagnosis of coeliac disease associated with socio-economic status? A population-based study: Abstract PTH-091

Introduction The rate of diagnosis of coeliac disease in developed countries has increased dramatically since the introduction of serological tests without an obvious environmental precipitant. Little is known about the socio-economic distribution of coeliac disease; there is some evidence that it is less common in more deprived social groups.1 We quantified the incidence of new diagnoses of coeliac disease by socio-economic status in a large, contemporary and population-based cohort. Methods The postcode of residence at diagnosis in consecutive incident adult cases of coeliac disease (n = 837) between January 2000 and December 2006 at Nottingham University Hospital and Royal Hallamshire Hospital was used to determine the Index of Multiple Deprivation 2007 (IMD07) score.2 Incidence rates were calculated using the total adult population for Sheffield and Nottingham derived from UK 2001 National Census categorised into corresponding IMD07 quintiles and Poisson models were fitted. Results There was a strong, independent graded association between the incidence rate of new diagnoses of coeliac disease and socio-economic status. The incidence rate of coeliac disease was twice as high for the least deprived quintile (age- and sex-adjusted IRR* 1.93, 95% CI 1.61 to 2.44) compared with the most deprived quintile. Socio-economic status in incident coeliac disease was not associated with more severe coeliac disease (OR for quintile V to quintile I for presence of malabsorption 1.04, 95% CI 0.47 to 2.28; and for Marsh 3b, 3c histological change OR 0.87, 95% CI 0.56 to 1.34) (Abstract 091). Conclusion The rate of new diagnoses of coeliac disease was twice as high in people from affluent areas compared with that in people living in poorer areas. This striking difference could be due to variation in environmental exposures such as breastfeeding practices3 or could be accounted for by differences in uptake and utilisation of health services.

PTH-101 Mild enteropathy (Marsh 1 and 2) coeliac disease: a comparison with more severe disease using a population-based cohort

<h3>Introduction</h3> In a population-based screening study, adults with undetected coeliac disease had an increased risk of mild anaemia and osteoporosis though they did not regard themselves as being unwell in comparison to serological negative controls.1 While a recent randomised trial reported some benefits from gluten withdrawal in adults with mild enteropathy coeliac disease,2 the benefits and possible harm of early detection of mild enteropathy disease is not clear and only limited data exist on the occurrence and clinical features at diagnosis of this group. We compared the presenting features of coeliacs presenting with mild (Marsh 1, 2) vs severe (Marsh 3) enteropathy disease. <h3>Methods</h3> Consecutive incident cases of coeliac disease diagnosed between January 2000–December 2006 at Nottingham University Hospital and Royal Hallamshire Hospital were compared at diagnosis using χ² tests and following 12 months gluten-free diet (GFD) using paired t-tests. <h3>Results</h3> Of 724 coeliacs diagnosed during the study period, 51(7%) had mild enteropathy. Mean (SD) haemoglobin (13.9 (1.6) g/dl), ferritin (67.7 (53.2) μg/l), folate (11.0 (5.9) μg/l), B12 (415 (204.9) ng/l), albumin (40.9 (3.1) g/l) and cholesterol (4.6 (1.0) mmol/l) in coeliacs with mild enteropathy were within normal laboratory range and significantly higher than those with severe enteropathy disease. These measures did not change on exposure to a GFD in mild enteropathy disease while the expected beneficial improvements that were observed in severe enteropathy disease. Coeliacs with severe enteropathy had a 10-fold increased risk (OR 10.2, 95% CI 4.4 to 23.4) of presenting with iron deficiency anaemia (IDA) in comparison to those with mild enteropathy whereas there was no difference in odds of presenting with classic (such as weight loss) or non-classic features (such as irritable bowel like symptoms) between mild and severe enteropathy coeliac disease. There was no difference in age at diagnosis of coeliac disease or gender proportion between mild and severe enteropathy groups. Proportion of coeliacs that were EMA positive was lower in mild enteropathy (71% vs 92% in severe enteropathy, p&lt;0.05) disease with median tTG (iu) also lower in mild enteropathy (18.5 (IQR 6–300) vs 210.5 (IQR 43–300) in severe enteropathy, p&lt;0.05). <h3>Conclusion</h3> Coeliacs with mild enteropathy have few biochemical deficiencies at diagnosis of coeliac disease and show no important biochemical improvements following GFD treatment in comparison to those with severe enteropathy. Aside from the presence of IDA neither demographic nor presenting symptoms differed between the two groups.

Prognosis and survivorship in primary myelofibrosis

American Journal of HematologyVolume 85, Issue 1 p. 4-5 CommentaryFree Access Prognosis and survivorship in primary myelofibrosis† John T. Reilly, Corresponding Author John T. Reilly j.t.reilly@sheffield.ac.uk Department of Haematology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKDepartment of Haematology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKSearch for more papers by this author John T. Reilly, Corresponding Author John T. Reilly j.t.reilly@sheffield.ac.uk Department of Haematology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKDepartment of Haematology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKSearch for more papers by this author First published: 05 November 2009 https://doi.org/10.1002/ajh.21586 † Conflict of interest: Nothing to report. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume85, Issue1January 2010Pages 4-5 ReferencesRelatedInformation

The Duodenal Bulb Biopsy “Myth”: Is There Now Enough Evidence to Change Clinical Practice?

Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK There are no external funding grants or support. No conflicts of interest exist.

Melanoma complicating treatment with Natalizumab (Tysabri) for multiple sclerosis

Sirs, Natalizumab (Tysabri, Biogen Idec and Elan Pharmaceuticals) is a humanized monoclonal antibody which targets the a4 subunits of the cellular adhesion molecules a4b1 and a4b7 integrins, blocking their interaction with their co-receptors VCAM-1, CS-1 and MadCAM-1 [3, 15]. This action reduces leukocyte trafficking into the brain and gut and mediates the beneficial effect of natalizumab in multiple sclerosis (MS) and Crohn’s disease [3]. The efficacy of natalizumab in patients with relapsing remitting MS was demonstrated in two phase III studies, AFFIRM and SENTINAL [10, 12]. These studies showed that when natalizumab was used as mono therapy or in combination with interferon beta-1a (Avonex) it significantly reduced relapse rate and slowed the progression of disability. Natalizumab was well tolerated with the most common adverse effects being headache, infusion reactions and a modest increase in urinary and respiratory tract infections [10, 12]. Neither trial identified any apparent increase in cancer incidence. We report on a patient with MS who developed malignant melanoma following treatment with natalizumab. This was a 48-year-old female who was randomised into the active arm of the AFFIRM Study [10]. She received 30 infusions of natalizumab (300 mg every 4 weeks) and was subsequently enrolled in the open label phase of the trial and received an additional five infusions. The treatment was stopped thereafter when the trial was put on hold following the reporting of the three cases of progressive multifocal leukoencephalopathy (PML) [1]. Five months later, she noticed an increase in the size of a mole which was present on the lateral aspect of her right shin for many years. The patient had no previous history of melanoma or atypical naevi. She did not receive prior immunosuppressant therapy and had no history of melanoma. On examination, the lesion appeared flat, with a darker centre and regular borders. It was not ulcerated and there were no satellite lesions. She underwent local excision and histopathological examination revealed an in situ malignant melanoma with a potential invasive component. There was no evidence of metastasis. Margin re-excision of the biopsy site was undertaken. No recurrence has since been detected. Natalizumab was approved by the US Food and Drug Administration in 2004. Since then, three cases of melanoma associated with its use have been reported. Polman et al. [10] reported a patient in the AFFIRM study who died of malignant melanoma. This was a 38-year-old male with MS who had a past history of malignant melanoma excised from the left shoulder. Following the first dose of natalizumab, a new skin lesion was noticed. He received four additional doses before the diagnosis of malignant melanoma was confirmed. Mullen et al. [7] reported two further cases. The first was a 46-year-old woman with MS who had a mole on her shoulder. Shortly after the first infusion of natalizumab, she noticed a rapid change in its appearance. Further assessment confirmed this to be malignant melanoma with metastatic spread to her regional lymph nodes. The second patient was a 45-year-old woman with MS and a family history of melanoma who had a choroidal nevus in her right eye which had been stable for several years. After A. Ismail J. Kemp B. Sharrack (&) Department of Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK e-mail: b.sharrack@sth.nhs.uk

Patch testing to aeroallergens, especially house dust mite, is often positive in atopics with eczema of the face and hands

Journal of the European Academy of Dermatology and VenereologyVolume 23, Issue 6 p. 728-730 Patch testing to aeroallergens, especially house dust mite, is often positive in atopics with eczema of the face and hands N Hallai, N Hallai Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKSearch for more papers by this authorDJ Gawkrodger, DJ GawkrodgerSearch for more papers by this author N Hallai, N Hallai Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKSearch for more papers by this authorDJ Gawkrodger, DJ GawkrodgerSearch for more papers by this author First published: 27 May 2009 https://doi.org/10.1111/j.1468-3083.2009.03189.xCitations: 9 Correspondence: Prof DJ Gawkrodger. E-mail: [email protected] DOI: 10.1111/j.1468-3083.2009.03189.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume23, Issue6June 2009Pages 728-730 RelatedInformation

An Unusual Cause of the Neck-Tongue Syndrome

The neck-tongue syndrome (NTS) is a rare clinical entity characterized by paroxytic episodes of intense pain in upper cervical or occipital area associated with disorders of ipsilateral hemi-tongue presenting as numbness, pseudoathetosis, dysarthria, and lingual paralysis aggravated with neck movement1,2. We describe a case of NTS with an unusual etiology. A 74-year-old woman presented with severe pain at the back of the neck that improved spontaneously within 2 weeks. During this time she developed dysarthria and was observed to have a left-sided lingual paralysis. Systemic enquiry was unremarkable. No other focal neurological abnormality was detected. She had marked nodal osteoarthritis in her hands and her cervical … Address reprint requests to Dr. S. Wig, Department of Rheumatology, Royal Hallamshire Hospital, Sheffield, UK. E-mail: surabhiwig{at}gmail.com

Time taken to undetectable viral load, following the initiation of HAART

The notes of all HIV patients in Sheffield, registered at the Department of Genitourinary Medicine at the Royal Hallamshire Hospital, who had initiated HAART in 2005 and 2006, were audited. The aim was to determine what percentage of these patients acquired an undetectable viral load within 24 weeks and whether this was greater than 75% in accordance with the BHIVA guidelines. Twenty-nine (78.4%) of the 37 patients who were initiating treatment for the first time had an undetectable viral load after 24 weeks.

Cholesterol profile in people with newly diagnosed coeliac disease: a comparison with the general population and changes following treatment

Recent studies have suggested that untreated coeliac disease is associated with lower total cholesterol than in the general population while the effect of treatment with a gluten-free diet on the cholesterol profile of clinically apparent coeliac disease is not known. We measured the cholesterol profile at diagnosis, and compared this with Health Survey for England figures, and again following 12 months treatment with a gluten-free diet in 100 consecutive adults with coeliac disease attending the Royal Hallamshire Hospital, Sheffield, UK. The mean total cholesterol was 4.84 (SD 1.2) mmol/l in adults (mean age 51 (SD 16) years) newly diagnosed with coeliac disease. At diagnosis of coeliac disease, men had 21% lower and women had 9% lower mean total cholesterol in comparison to the general population (difference in age-adjusted mean total cholesterol -1.09 mmol/l (95% CI -0.97, - 1.21); -0.46 mmol/l (95% CI -0.24, -0.68), respectively). There was no change in mean total cholesterol following treatment. However, there was a small but statistically significant increase of 0.12 mmol/l (95% CI 0.05, 0.18) in the mean HDL-cholesterol. Total cholesterol was lower at diagnosis in coeliac patients than in the general population and did not increase with 1 year of a gluten-free diet while HDL-cholesterol increased following treatment. Any increase in risk of IHD or stroke in people with coeliac disease is unlikely due to an adverse cholesterol profile either before diagnosis or after treatment with a gluten-free diet.

Frontal fibrosing alopecia: clinical presentations and prognosis

Frontal fibrosing alopecia is an uncommon condition characterized by progressive frontotemporal recession due to inflammatory destruction of hair follicles. Little is known about the natural history of this disease. To determine the clinical features and natural history of frontal fibrosing alopecia. We studied the cases notes of patients diagnosed with frontal fibrosing alopecia from 1993 to 2008 at the Royal Hallamshire Hospital, Sheffield. There were 18 patients aged between 34 and 71 years. Three were premenopausal. All had frontotemporal recession with scarring. This was associated with partial or complete loss of eyebrows in 15 patients while four had hair loss at other sites. One had keratosis pilaris-like papules on the face, and one had follicular erythema on the cheeks. Three patients had oral lichen planus, of whom two also had cutaneous lichen planus affecting other sites of the body. Treatments given included intralesional triamcinolone acetonide, 0.1% tacrolimus ointment and oral hydroxychloroquine. Progression of frontotemporal recession was seen in some patients, but not all. In one patient the hair line receded by 30 mm over 72 months, whereas in another patient there was no positional change in the hair line after 15 years. Frontal fibrosing alopecia is more common in postmenopausal women, but it can occur in younger women. It may be associated with mucocutaneous lichen planus. Recession of the hair line may progress inexorably over many years but this is not inevitable. It is not clear whether or not treatment alters the natural history of the disease - the disease stabilized with time in most of the patients with or without continuing treatment.

What Is the Role of Serologic Testing in Celiac Disease? A Prospective, Biopsy-Confirmed Study With Economic Analysis

The optimal serologic tests for the detection of celiac disease and follow-up assessment remains controversial. Our aim was to evaluate all current immunologic assays for diagnosing celiac disease using the gold standard of duodenal biopsy. We also assessed whether tissue transglutaminase (tTG) antibody is a quantitative marker for histologic severity. Consecutive adult patients referred for gastroscopy without a previous known diagnosis of celiac disease were recruited (group 1). Concurrently, patients with a known diagnosis of celiac disease on a gluten-free diet for more than 1 year undergoing repeat duodenal biopsy were identified (group 2). All patients had duodenal biopsies and serologic analysis performed for immunoglobulin(Ig) A and antibodies to human immunoglobulin (Ig)A-tTG, IgA-gliadin, IgG-gliadin, and IgA-endomysial antibody. Two thousand patients were recruited in the first group. Seventy-seven (3.9%) patients were diagnosed with new celiac disease. The sensitivity, specificity, positive predictive value, and negative predictive value for IgA tTG were 90.9%, 90.9%, 28.6%, and 99.6%. When adopting a 2-step approach using tTG first and then EMA the sensitivity, specificity, positive predictive value, and negative predictive value was 85.7%, 98.6%, 71.7%, and 99.7%, respectively. The use of nondeamidated IgA/IgG gliadin antibodies conferred no additional diagnostic benefit when considering the detection of adult celiac disease. In the second group 48 patients with celiac disease on a gluten-free diet were identified. Sixteen of 48 of these patients had persisting villous atrophy, but 7 of 16 (44%) had a normal tTG level. IgA tTG alone is a sensitive marker for celiac disease. A normal tTG level does not predict recovery of villous atrophy in patients with celiac disease on a gluten-free diet.

An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study

Objective: To study the effect of Tai Chi on exercise tolerance in patients with moderate heart failure. Design: Randomised parallel group study balanced for baseline variables. Setting: Cardiology Department, Royal...

Development of a tool for risk assessment to facilitate safety and appropriate restraint

Restraint is a method of involuntarily restraining the movement of the whole or a portion of a patient's body to control behaviour and prevent injury to the patient or others. Restraint has been correlated with poor patient outcomes, higher mortality rates, increases in hospitalization, nosocomial infections, pressure sores, and increased levels of confusion. It can often be extremely difficult to maintain patient safety without acting in a way that might provoke an allegation of abuse. The aim of this article is to discuss some of the difficulties that presented themselves to nurses in the Royal Hallamshire Hospital's neuroscience unit following a decision to justify actions to use restraints. The development of a functional risk assessment tool for use in cases of challenging behaviour is explained and its use discussed in relation to legal and consent requirements.

Implications of the consensus definition of clinical resistance and intolerance to hydroxyurea for clinical practice

European Journal of HaematologyVolume 79, Issue s68 p. 32-34 Implications of the consensus definition of clinical resistance and intolerance to hydroxyurea for clinical practice John T. Reilly, John T. Reilly Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this author John T. Reilly, John T. Reilly Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this author First published: 23 August 2007 https://doi.org/10.1111/j.1600-0609.2007.00942.xCitations: 3 Professor John T. Reilly, Royal Hallamshire Hospital, Sheffield S10 2JF, UK. Tel: +44 114 271 1732; Fax: +44 114 271 1733; e-mail: j.t.reilly@sheffield.ac.uk Conflicts of interest The author has declared no conflicts of interest. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume79, Issues68Special Issue: New Horizons in HaematologyOctober 2007Pages 32-34 RelatedInformation