TTTS
MCID: TWN001
MIFTS: 48

Twin-to-Twin Transfusion Syndrome (TTTS) malady

Categories: Rare diseases, Blood diseases, Fetal diseases

Aliases & Classifications for Twin-to-Twin Transfusion Syndrome

Aliases & Descriptions for Twin-to-Twin Transfusion Syndrome:

Name: Twin-to-Twin Transfusion Syndrome 39 12 50 14
Twin to Twin Transfusion Syndrome 50 56
Fetal Blood Loss from Fetal Hemorrhage into Co-Twin 12
Fetus-to-Fetus Placental Transfusion Syndrome 69
Feto-Fetal Transfusion Syndrome 56
Twin Twin Transfusion Syndrome 39
Fetofetal Transfusion Syndrome 50
Fetal Hemorrhage into Co-Twin 12
Twin-to-Twin Blood Transfer 12
Fetal Transfusion Syndrome 50
Twin to Twin Transfusion 12
Fetofetal Transfusion 42
Ttts 50

Classifications:



External Ids:

Disease Ontology 12 DOID:13576
ICD10 33 O43.02 O43.029
MeSH 42 D005330
NCIt 47 C113824
SNOMED-CT 64 13404009 237299001
Orphanet 56 ORPHA95431
ICD10 via Orphanet 34 O43.0
UMLS 69 C2909036

Summaries for Twin-to-Twin Transfusion Syndrome

NIH Rare Diseases : 50 twin to twin transfusion syndrome (ttts) is a rare condition that occurs during a twin pregnancy when blood moves from one twin (the “donor twin”) to the other (the “recipient twin”) while in the womb. ttts is a complication that specifically occurs in identical (monozygotic) twin pregnancies that share the same "egg" sac (monochorionic) that may or may not share the same amniotic sac (monoamniotic). ttts usually develops between 15 and 26 weeks of pregnancy. the donor twin may be born smaller, with paleness, anemia, and dehydration. the recipient twin may be born larger, with redness, too much blood, and increased blood pressure, resulting in an increased risk for heart failure. treatment may require repeated amniocentesis during pregnancy. fetal laser surgery may be done to interrupt the flow of blood from one twin to the other. after birth, treatment depends on the infant's specific symptoms. the donor twin may need a blood transfusion to treat anemia. the recipient twin may need to have the volume of body fluid reduced. this may involve an exchange transfusion. medications may be given to treat heart failure in the recipient twin. last updated: 7/21/2016

MalaCards based summary : Twin-to-Twin Transfusion Syndrome, also known as twin to twin transfusion syndrome, is related to myocardial infarction and isolated plagiocephaly. An important gene associated with Twin-to-Twin Transfusion Syndrome is PGF (Placental Growth Factor), and among its related pathways/superpathways are TGF-Beta Pathway and Akt Signaling. The drugs Progesterone and Lenalidomide have been mentioned in the context of this disorder. Affiliated tissues include heart, placenta and brain, and related phenotypes are cardiovascular system and homeostasis/metabolism

Wikipedia : 71 Twin-to-twin transfusion syndrome (TTTS), also known as Feto-Fetal Transfusion Syndrome (FFTS) and Twin... more...

Related Diseases for Twin-to-Twin Transfusion Syndrome

Diseases related to Twin-to-Twin Transfusion Syndrome via text searches within MalaCards or GeneCards Suite gene sharing:

(show top 50) (show all 64)
id Related Disease Score Top Affiliating Genes
1 myocardial infarction 29.4 ANGPT1 NPPA PGF REN
2 isolated plagiocephaly 10.2 FLT1 PGF
3 pleural tuberculosis 10.2 FLT1 PGF
4 neuropathy with hearing impairment 10.2 FLT1 PGF
5 laryngeal adenoid cystic carcinoma 10.2 ENG FLT1
6 cerebritis 10.2
7 mitral valve stenosis 10.1 ENG FLT1
8 hypogonadism mitral valve prolapse mental retardation 10.1 NPPA REN
9 shaken baby syndrome 10.1 NPPA REN
10 iris disease 10.1 NPPA REN
11 eastern equine encephalitis 10.1 NPPA REN
12 myopia 10.1 NPPA REN
13 lymphadenitis 10.1 NPPA REN
14 pythiosis 10.1 NPPA REN
15 ophthalmia neonatorum 10.1 ENG FLT1 PGF
16 panuveitis 10.1 NPPA REN
17 welander distal myopathy 10.1 ENG FLT1 PGF
18 obstructive jaundice 10.1 ENG FLT1 PGF
19 polycythemia 10.1
20 polyhydramnios 10.1
21 heart disease 10.1
22 cervicitis 10.1
23 acute proliferative glomerulonephritis 10.1 ENG FLT1 PGF
24 familial nasal acilia 10.1 NPPA REN
25 radiation induced angiosarcoma of the breast 10.1 ANGPT1 ANGPT2
26 urinary bladder posterior wall cancer 10.0 NPPA REN
27 madras motor neuron disease 10.0 ANGPT1 ANGPT2
28 pituitary infarct 10.0 ANGPT2 ENG
29 clear cell adenocarcinoma 10.0 NPPA REN
30 high-grade dysplasia in patients with barrett esophagus 10.0 NPPA REN
31 vulvitis 10.0 ANGPT2 FLT1 PGF
32 citrullinemia, type ii, neonatal-onset 10.0 ANGPT2 FLT1 PGF
33 congenital cytomegalovirus 10.0
34 cytomegalovirus infection 10.0
35 acute lymphoblastic leukemia, childhood 10.0 NPPA REN
36 mental retardation, autosomal recessive 27 10.0 ANGPT1 ANGPT2
37 vernal conjunctivitis 10.0 ANGPT2 FLT1
38 epidermolysis bullosa simplex, sutosomal recessive 2 9.9 ANGPT2 FLT1
39 localized junctional epidermolysis bullosa, non-herlitz type 9.9 ANGPT1 ANGPT2 FLT1
40 albinism, oculocutaneous, type ib 9.9 ANGPT1 ANGPT2 FLT1
41 hemolytic anemia 9.9 ANGPT1 ANGPT2 FLT1
42 hydranencephaly 9.9
43 polymicrogyria 9.9
44 pyelonephritis 9.9 NPPA REN
45 hyperaldosteronism 9.8
46 peritonitis 9.8
47 pulmonary hypertension 9.8
48 arteriovenous fistula 9.8
49 cerebral palsy 9.8
50 pulmonary embolism 9.8

Graphical network of the top 20 diseases related to Twin-to-Twin Transfusion Syndrome:



Diseases related to Twin-to-Twin Transfusion Syndrome

Symptoms & Phenotypes for Twin-to-Twin Transfusion Syndrome

MGI Mouse Phenotypes related to Twin-to-Twin Transfusion Syndrome:

44
id Description MGI Source Accession Score Top Affiliating Genes
1 cardiovascular system MP:0005385 9.86 ANGPT1 ANGPT2 ENG FLT1 NPPA PGF
2 homeostasis/metabolism MP:0005376 9.76 NPPA PGF REN VEGFC ANGPT1 ANGPT2
3 immune system MP:0005387 9.43 ANGPT1 ANGPT2 FLT1 PGF REN VEGFC
4 muscle MP:0005369 9.02 ANGPT1 ENG FLT1 NPPA REN

Drugs & Therapeutics for Twin-to-Twin Transfusion Syndrome

Drugs for Twin-to-Twin Transfusion Syndrome (from DrugBank, HMDB, Dgidb, PharmGKB, IUPHAR, NovoSeek, BitterDB):

(show all 34)
id Name Status Phase Clinical Trials Cas Number PubChem Id
1
Progesterone Approved, Vet_approved Phase 3 57-83-0 5994
2
Lenalidomide Approved Phase 3 191732-72-6 216326
3 Progestins Phase 3
4 Hormone Antagonists Phase 3
5 Hormones Phase 3
6 Hormones, Hormone Substitutes, and Hormone Antagonists Phase 3
7 Estrogen Antagonists Phase 3
8 Anti-Bacterial Agents Phase 3
9 Estrogens Phase 3
10 11-hydroxyprogesterone Phase 3
11 17-alpha-hydroxy-progesterone caproate Phase 3
12 Epoetin alfa Phase 3 113427-24-0
13 Hematinics Phase 3
14 Angiogenesis Inhibitors Phase 3
15 Angiogenesis Modulating Agents Phase 3
16 Anti-Infective Agents Phase 3
17 Immunosuppressive Agents Phase 3
18 Caproate Nutraceutical Phase 3
19
Epinephrine Approved, Vet_approved 51-43-4 5816
20
Lidocaine Approved, Vet_approved 137-58-6 3676
21
Glucosamine Approved, Nutraceutical 3416-24-8 439213
22 Glucuronyl glucosamine glycan sulfate
23 Anesthetics
24 Epinephryl borate
25 Hypoglycemic Agents
26 Hypolipidemic Agents
27 Fibrinolytic Agents
28 Anticoagulants
29 Racepinephrine
30 Lipid Regulating Agents
31 Antimetabolites
32 Antibiotics, Antitubercular
33 Central Nervous System Depressants
34 Anesthetics, Local

Interventional clinical trials:

(show all 16)
id Name Status NCT ID Phase
1 Randomized Controlled Trial Comparing a Conservative Management and Laser Surgery Recruiting NCT01220011 Phase 4
2 Trial of Progesterone in Twins and Triplets to Prevent Preterm Birth (STTARS) Completed NCT00099164 Phase 3
3 Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia Active, not recruiting NCT00843882 Phase 3
4 Fetoscopic Selective Laser Photocoagulation in Twin-Twin Transfusion Syndrome Unknown status NCT00345852
5 Selective Laser Photocoagulation of Communicating Vessels in Twin-Twin Transfusion Syndrome Completed NCT01622049
6 Anesthetic Management in Fetoscopic Surgery and Incidence of Complications Completed NCT02434926
7 Sequential vs. Standard Laser Treatment of Twin-twin Transfusion Syndrome Recruiting NCT02122328
8 The Utility of MRI Scoring to Predict Neurodevelopmental Outcomes in Survivors of Twin-to-Twin Transfusion Syndrome Recruiting NCT02249624
9 The Trial of Pessary After Laser for TTTS Recruiting NCT01334489
10 Neonatal Outcome for Laser Coagulation in Twin-to-twin-transfusion Syndrome Recruiting NCT03151915
11 Austrian Registry on the Outcome of Monochorionic Pregnancies Recruiting NCT03171909
12 Pessary to Prevent Prematurity in Twins in Case of Short Cervix Recruiting NCT02328989
13 Unequal Placental Sharing in Monochorionic Diamniotic Twins: an Observational Study Recruiting NCT03024918
14 Monochorial-diamniotic Pregnancies Complicated With a Twin-to-twin Syndrome Active, not recruiting NCT02611856
15 Laser Photocoagulation in Twin to Twin Transfusion Syndrome Enrolling by invitation NCT02506049
16 The Value of Prenatal Ultrasound in Complicated Twin Pregnancy and Its Correlation With Chromosomal Anomalies Not yet recruiting NCT02732717

Search NIH Clinical Center for Twin-to-Twin Transfusion Syndrome

Cochrane evidence based reviews: fetofetal transfusion

Genetic Tests for Twin-to-Twin Transfusion Syndrome

Anatomical Context for Twin-to-Twin Transfusion Syndrome

MalaCards organs/tissues related to Twin-to-Twin Transfusion Syndrome:

39
Heart, Placenta, Brain, Bone, Eye, Liver, Cervix

Publications for Twin-to-Twin Transfusion Syndrome

Articles related to Twin-to-Twin Transfusion Syndrome:

(show top 50) (show all 286)
id Title Authors Year
1
Spontaneous resolution of mirror syndrome following fetal interventions for fetal anemia as a consequence of twin to twin transfusion syndrome. ( 27914652 )
2017
2
Increased Risk Of Early-Onset Neonatal Sepsis After Laser Surgery For Twin-to-Twin Transfusion Syndrome. ( 27137630 )
2016
3
Twin-to-Twin Transfusion Syndrome: From Observational Evidence to Randomized Controlled Trials. ( 27075108 )
2016
4
Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome. ( 26921842 )
2016
5
Monochorionic diamniotic inA vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome. ( 26690011 )
2016
6
Laser Treatment of Twin-to-Twin Transfusion Syndrome. ( 27203606 )
2016
7
The History of Treatment of Twin-to-Twin Transfusion Syndrome. ( 27203604 )
2016
8
Atypical twin-to-twin transfusion syndrome: prevalence inA aA populationA undergoing fetoscopic laser ablation of communicatingA placental vessels. ( 26827875 )
2016
9
The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence. ( 27098457 )
2016
10
Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution? ( 27087260 )
2016
11
Identifying families' shared disease experiences through a qualitative analysis of online twin-to-twin transfusion syndrome stories. ( 27422614 )
2016
12
Intra-arterial calcifications in the recipient twin in twin-to-twin transfusion syndrome. ( 27834168 )
2016
13
Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment. ( 27203605 )
2016
14
Long-Term Neurodevelopmental Outcome in Survivors of Twin-to-Twin Transfusion Syndrome. ( 27137794 )
2016
15
Fetoscopic laser photocoagulation in twin-to-twin transfusion syndrome: experience from a single institution. ( 27056209 )
2016
16
The 2016 Satellite Meeting of the International Society of Twin Studies: An Overview/Tribute to Irving I. Gottesman/Research: MZ Twinning After Single Embryo Transfer; Twin Study of Mononucleosis; Cerebral Injury After Twin-To-Twin Transfusion Syndrome Surgery/Human Interest: Sixteen Twin Pairs Born in a Single Hospital; Death of an Identical Twin Playwright; Twin Themes in Advertising; Conjoined Twins Separated in Saudi Arabia; Murder of One Twin By Her Co-Twin Disproved. ( 27524469 )
2016
17
A prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation. ( 27590373 )
2016
18
Early prediction of twin-to-twin transfusion syndrome: systematic review and meta-analysis. ( 27270878 )
2016
19
Future Directions in the Management of Twin-to-Twin Transfusion Syndrome. ( 27125296 )
2016
20
Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms. ( 26751570 )
2016
21
Cardiac Manifestations of Twin-to-Twin Transfusion Syndrome. ( 27087122 )
2016
22
Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis. ( 27137946 )
2016
23
Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience. ( 26117441 )
2015
24
Influences of Different Doses of Midazolam on Mother and Fetus in Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome. ( 26279077 )
2015
25
Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. ( 26517964 )
2015
26
Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review. ( 25613236 )
2015
27
Prediction of single fetal demise after laser therapy for twin-to-twin transfusion syndrome. ( 26395988 )
2015
28
Perinatal outcome after fetoscopic laser surgery for twin-to-twin transfusion syndrome in triplet pregnancies: systematic review. ( 26265264 )
2015
29
Short-Time Impact of Laser Ablation of Placental Anastomoses on Myocardial Function in Monochorionic Twins with Twin-to-Twin Transfusion Syndrome. ( 26331331 )
2015
30
Longitudinal annular displacement by M-mode (MAPSE and TAPSE) in twin-to-twin transfusion syndrome before and after laser surgery. ( 26256442 )
2015
31
Transient twin reversed arterial perfusion: a protective effect in twin-to-twin transfusion syndrome? ( 26360958 )
2015
32
Visualisation of the vascular equator in twin-to-twin transfusion syndrome by virtual fetoscopy. ( 26411581 )
2015
33
Congenital Cytomegalovirus Infection in Monozygotic Twins with Twin-to-twin Transfusion Syndrome. ( 26061933 )
2015
34
Hirschsprung's disease in twin to twin transfusion syndrome: a case report. ( 25516683 )
2014
35
Re: Iatrogenic perforation of intertwin membrane after laser surgery for twin-to-twin transfusion syndrome. S. H. P. Peeters, T. T. Stolk, F. Slaghekke, J. M. Middeldorp, F. J. Klumper, E. Lopriore and D. Oepkes. Ultrasound Obstet Gynecol 2014; 44: 550-556. ( 25363897 )
2014
36
Stage-Related Outcome after Fetoscopic Laser Ablation in Twin-to-Twin Transfusion Syndrome. ( 25096484 )
2014
37
Maternal plasma and amniotic fluid cytokines in monochorionic, diamniotic twin pregnancies complicated by twin-to-twin transfusion syndrome. ( 24802980 )
2014
38
Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome. ( 24834706 )
2014
39
Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. ( 24613024 )
2014
40
Congenital heart disease in monochorionic twins with and without twin-to-twin transfusion syndrome. ( 24827120 )
2014
41
Predictive value of cardiovascular parameters in twin-to-twin transfusion syndrome. ( 24585420 )
2014
42
Twin-to-Twin transfusion syndrome--30 years at the front. ( 24915564 )
2014
43
Twin born with a skeletonized hand in twin-to-twin transfusion syndrome treated with laser ablation in pregnancy. ( 24835476 )
2014
44
Is the Sequential Laser Technique for Twin-to-Twin Transfusion Syndrome Truly Superior to the Standard Selective Technique? A Meta-Analysis. ( 25139419 )
2014
45
Pediatric and Perinatal Pathology: SY21-1 LATE-ONSET AND REVERSED CHRONIC TWIN-TO-TWIN TRANSFUSION SYNDROME. ( 25188139 )
2014
46
Time-related analysis of ductus venosus flow velocity waveforms in twin to twin transfusion syndrome treated with laser surgery. ( 24975921 )
2014
47
Right ventricular failure with high echoic ventricular wall change after foetoscopic laser photocoagulation: a case report of a donor in twin-to-twin transfusion syndrome. ( 25522791 )
2014
48
Predictive value of cardiovascular parameters in stages 1 and 2 of twin-to-twin transfusion syndrome. ( 24760447 )
2014
49
Re: Fetal cardiac parameters for prediction of twin-to-twin transfusion syndrome. C. Zanardini, F. Prefumo, A. Fichera, E. Botteri and T. Frusca. Ultrasound Obstet Gynecol 2014; 44: 434-440. ( 25274544 )
2014
50
Twin-to-twin transfusion syndrome: knowing our boundaries. ( 24613025 )
2014

Variations for Twin-to-Twin Transfusion Syndrome

Expression for Twin-to-Twin Transfusion Syndrome

Search GEO for disease gene expression data for Twin-to-Twin Transfusion Syndrome.

Pathways for Twin-to-Twin Transfusion Syndrome

Pathways related to Twin-to-Twin Transfusion Syndrome according to GeneCards Suite gene sharing:

(show all 16)
id Super pathways Score Top Affiliating Genes
1
Show member pathways
13.18 ANGPT1 ANGPT2 FLT1 PGF VEGFC
2
Show member pathways
13.05 ANGPT1 ANGPT2 FLT1 PGF VEGFC
3
Show member pathways
12.9 ANGPT1 ANGPT2 FLT1 PGF VEGFC
4
Show member pathways
12.72 FLT1 PGF REN VEGFC
5
Show member pathways
12.36 ANGPT1 ANGPT2 FLT1 PGF VEGFC
6
Show member pathways
12.35 FLT1 PGF VEGFC
7 12.19 ANGPT1 ANGPT2 FLT1 PGF VEGFC
8
Show member pathways
12.03 FLT1 PGF VEGFC
9 11.73 ANGPT2 FLT1 VEGFC
10
Show member pathways
11.51 FLT1 PGF VEGFC
11 11.45 ANGPT1 ANGPT2 FLT1 NPPA
12 11.09 ANGPT1 ANGPT2
13 10.96 ANGPT2 ENG FLT1 REN VEGFC
14 10.89 ANGPT2 ENG
15 10.84 ANGPT1 FLT1
16
Show member pathways
10.34 FLT1 PGF VEGFC

GO Terms for Twin-to-Twin Transfusion Syndrome

Cellular components related to Twin-to-Twin Transfusion Syndrome according to GeneCards Suite gene sharing:

id Name GO ID Score Top Affiliating Genes
1 extracellular region GO:0005576 9.5 ANGPT1 ANGPT2 FLT1 NPPA PGF REN
2 extracellular space GO:0005615 9.23 ANGPT1 ANGPT2 ENG FLT1 NPPA PGF

Biological processes related to Twin-to-Twin Transfusion Syndrome according to GeneCards Suite gene sharing:

(show all 20)
id Name GO ID Score Top Affiliating Genes
1 multicellular organism development GO:0007275 9.91 ANGPT1 ANGPT2 FLT1 PGF VEGFC
2 cell differentiation GO:0030154 9.88 ANGPT1 ANGPT2 FLT1 PGF VEGFC
3 response to drug GO:0042493 9.76 ENG PGF REN VEGFC
4 regulation of blood pressure GO:0008217 9.59 NPPA REN
5 positive regulation of endothelial cell proliferation GO:0001938 9.58 PGF VEGFC
6 positive regulation of phosphatidylinositol 3-kinase signaling GO:0014068 9.58 ANGPT1 FLT1
7 vascular endothelial growth factor receptor signaling pathway GO:0048010 9.58 FLT1 PGF VEGFC
8 animal organ regeneration GO:0031100 9.57 ANGPT2 PGF
9 positive regulation of cell division GO:0051781 9.56 PGF VEGFC
10 response to hypoxia GO:0001666 9.56 ANGPT2 NPPA PGF VEGFC
11 positive chemotaxis GO:0050918 9.55 ANGPT1 VEGFC
12 blood vessel morphogenesis GO:0048514 9.54 ANGPT2 FLT1
13 positive regulation of blood vessel endothelial cell migration GO:0043536 9.52 ANGPT1 VEGFC
14 induction of positive chemotaxis GO:0050930 9.49 PGF VEGFC
15 positive regulation of mast cell chemotaxis GO:0060754 9.43 PGF VEGFC
16 glomerulus vasculature development GO:0072012 9.37 ANGPT1 ANGPT2
17 positive regulation of angiogenesis GO:0045766 9.35 ANGPT2 ENG FLT1 PGF VEGFC
18 sprouting angiogenesis GO:0002040 9.33 ANGPT1 ENG PGF
19 Tie signaling pathway GO:0048014 9.32 ANGPT1 ANGPT2
20 angiogenesis GO:0001525 9.1 ANGPT1 ANGPT2 ENG FLT1 PGF VEGFC

Molecular functions related to Twin-to-Twin Transfusion Syndrome according to GeneCards Suite gene sharing:

id Name GO ID Score Top Affiliating Genes
1 receptor tyrosine kinase binding GO:0030971 8.96 ANGPT1 ANGPT2
2 receptor binding GO:0005102 8.92 ANGPT1 ANGPT2 NPPA REN

Sources for Twin-to-Twin Transfusion Syndrome

3 CDC
7 CNVD
9 Cosmic
10 dbSNP
11 DGIdb
16 ExPASy
18 FMA
28 GO
29 GTR
30 HGMD
31 HMDB
32 HPO
33 ICD10
34 ICD10 via Orphanet
35 ICD9CM
36 IUPHAR
37 KEGG
38 LifeMap
40 MedGen
42 MeSH
43 MESH via Orphanet
44 MGI
46 NCI
47 NCIt
48 NDF-RT
51 NINDS
52 Novoseek
54 OMIM
55 OMIM via Orphanet
59 PubMed
60 QIAGEN
65 SNOMED-CT via Orphanet
67 TGDB
68 Tocris
69 UMLS
70 UMLS via Orphanet
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