MCID: TWN001
MIFTS: 50

Twin-to-Twin Transfusion Syndrome

Categories: Rare diseases, Blood diseases, Fetal diseases

Aliases & Classifications for Twin-to-Twin Transfusion Syndrome

MalaCards integrated aliases for Twin-to-Twin Transfusion Syndrome:

Name: Twin-to-Twin Transfusion Syndrome 41 12 76 53 15
Twin to Twin Transfusion Syndrome 53 59
Fetal Blood Loss from Fetal Hemorrhage into Co-Twin 12
Fetus-to-Fetus Placental Transfusion Syndrome 73
Feto-Fetal Transfusion Syndrome 59
Twin Twin Transfusion Syndrome 41
Fetofetal Transfusion Syndrome 53
Fetal Hemorrhage into Co-Twin 12
Twin-to-Twin Blood Transfer 12
Fetal Transfusion Syndrome 53
Twin to Twin Transfusion 12
Fetofetal Transfusion 44
Ttts 53

Classifications:



External Ids:

Disease Ontology 12 DOID:13576
ICD10 33 O43.02 O43.029
MeSH 44 D005330
NCIt 50 C113824
SNOMED-CT 68 13404009 237299001
Orphanet 59 ORPHA95431
ICD10 via Orphanet 34 O43.0
UMLS 73 C2909036

Summaries for Twin-to-Twin Transfusion Syndrome

NIH Rare Diseases : 53 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.

MalaCards based summary : Twin-to-Twin Transfusion Syndrome, also known as twin to twin transfusion syndrome, is related to limb ischemia and myocardial infarction. An important gene associated with Twin-to-Twin Transfusion Syndrome is PGF (Placental Growth Factor), and among its related pathways/superpathways are ERK Signaling and TGF-Beta Pathway. The drugs Progesterone and 11-hydroxyprogesterone have been mentioned in the context of this disorder. Affiliated tissues include heart, placenta and cervix, and related phenotypes are cardiovascular system and homeostasis/metabolism

Wikipedia : 76 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 57)
# Related Disease Score Top Affiliating Genes
1 limb ischemia 29.7 ANGPT2 PGF
2 myocardial infarction 28.7 ANGPT1 ENG PGF REN
3 pulmonary hypertension 28.2 ANGPT1 ENG FLT1 PGF REN
4 renal tubular dysgenesis 11.6
5 mild pre-eclampsia 10.4 FLT1 PGF
6 epithelioid hemangioendothelioma 10.4 FLT1 PGF
7 glomeruloid hemangioma 10.4 ENG FLT1
8 cancer-associated retinopathy 10.4 FLT1 PGF
9 placenta disease 10.3
10 vascular cancer 10.2 ENG FLT1
11 cerebritis 10.2
12 cervicitis 10.2
13 heart disease 10.1
14 polycythemia 10.1
15 polyhydramnios 10.1
16 congenital cytomegalovirus 10.0
17 depression 10.0
18 cytomegalovirus infection 10.0
19 placental abruption 10.0 ENG FLT1 PGF
20 hydranencephaly 10.0
21 polymicrogyria 10.0
22 eclampsia 10.0 ENG FLT1 PGF
23 hellp syndrome 10.0 ENG FLT1 PGF
24 pyogenic granuloma 9.9 ANGPT1 ANGPT2
25 macrophage activation syndrome 9.9 ANGPT1 ANGPT2
26 down syndrome 9.9
27 enterocolitis 9.9
28 aging 9.9
29 anxiety 9.9
30 preterm premature rupture of the membranes 9.9
31 hydrops fetalis, nonimmune, and/or atrial septal defect 9.9
32 arteriovenous fistula 9.9
33 cerebral palsy 9.9
34 arteriovenous malformation 9.9
35 oligohydramnios 9.9
36 post-traumatic stress disorder 9.9
37 ischemia 9.9
38 peritonitis 9.9
39 perinatal necrotizing enterocolitis 9.9
40 pulmonary embolism 9.9
41 amniotic band syndrome 9.9
42 fetal edema 9.9
43 hydrops fetalis 9.9
44 pandas 9.9
45 transposition of the great arteries 9.9
46 microvascular complications of diabetes 1 9.8 ANGPT2 FLT1
47 epileptic encephalopathy, childhood-onset 9.8 ANGPT1 ANGPT2
48 placental insufficiency 9.8 ANGPT2 FLT1 PGF
49 retinal vascular disease 9.8 ANGPT2 FLT1
50 microvascular complications of diabetes 5 9.7 ANGPT2 FLT1 PGF

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:

46
# Description MGI Source Accession Score Top Affiliating Genes
1 cardiovascular system MP:0005385 9.8 PGF REN VEGFC ANGPT1 ANGPT2 ENG
2 homeostasis/metabolism MP:0005376 9.7 PGF REN VEGFC ANGPT1 ANGPT2 ENG
3 immune system MP:0005387 9.43 PGF REN VEGFC ANGPT1 ANGPT2 FLT1
4 mortality/aging MP:0010768 9.17 REN TUBB3 VEGFC ANGPT1 ANGPT2 ENG

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 27)
# Name Status Phase Clinical Trials Cas Number PubChem Id
1
Progesterone Approved, Vet_approved Phase 3 57-83-0 5994
2 11-hydroxyprogesterone Phase 3
3 17-alpha-hydroxy-progesterone caproate Phase 3
4 Estrogen Antagonists Phase 3
5 Estrogens Phase 3
6 Hormone Antagonists Phase 3
7 Hormones Phase 3
8 Hormones, Hormone Substitutes, and Hormone Antagonists Phase 3
9 Progestins Phase 3
10 Caproate Nutraceutical Phase 3
11
Epinephrine Approved, Vet_approved 51-43-4 5816
12
Lidocaine Approved, Vet_approved 137-58-6 3676
13
Racepinephrine Approved 329-65-7 838
14
Glucosamine Approved, Investigational, Nutraceutical ,Not Applicable 3416-24-8 439213
15 Anesthetics ,Not Applicable
16 Anti-Bacterial Agents
17 Antibiotics, Antitubercular
18 Anticoagulants ,Not Applicable
19 Antimetabolites ,Not Applicable
20 Epinephryl borate
21 Fibrinolytic Agents ,Not Applicable
22 Glucuronyl glucosamine glycan sulfate ,Not Applicable
23 Hypoglycemic Agents ,Not Applicable
24 Hypolipidemic Agents ,Not Applicable
25 Lipid Regulating Agents ,Not Applicable
26 Central Nervous System Depressants
27 Anesthetics, Local Not Applicable

Interventional clinical trials:

(show all 17)
# Name Status NCT ID Phase Drugs
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 17 alpha-hydroxyprogesterone caproate (17P)
3 Fetoscopic Selective Laser Photocoagulation in Twin-Twin Transfusion Syndrome Unknown status NCT00345852 Not Applicable
4 The Value of Prenatal Ultrasound in Complicated Twin Pregnancy and Its Correlation With Chromosomal Anomalies Unknown status NCT02732717
5 Selective Laser Photocoagulation of Communicating Vessels in Twin-Twin Transfusion Syndrome Completed NCT01622049
6 Neonatal Outcome for Laser Coagulation in Twin-to-twin-transfusion Syndrome Completed NCT03151915
7 Anesthetic Management in Fetoscopic Surgery and Incidence of Complications Completed NCT02434926
8 Sequential vs. Standard Laser Treatment of Twin-twin Transfusion Syndrome Recruiting NCT02122328 Not Applicable
9 Ductus Venosus Doppler at 16 Weeks in Monochorial Pregnancy Recruiting NCT03579069
10 The Trial of Pessary After Laser for TTTS Recruiting NCT01334489 Not Applicable
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 Not Applicable
13 Unequal Placental Sharing in Monochorionic Diamniotic Twins: an Observational Study Recruiting NCT03024918
14 Renal Artery Dopplers in Twin Twin Transfusion Syndrome Active, not recruiting NCT03449823
15 The Utility of MRI Scoring to Predict Neurodevelopmental Outcomes in Survivors of Twin-to-Twin Transfusion Syndrome Active, not recruiting NCT02249624
16 Monochorial-diamniotic Pregnancies Complicated With a Twin-to-twin Syndrome Active, not recruiting NCT02611856
17 Laser Photocoagulation in Twin to Twin Transfusion Syndrome Enrolling by invitation NCT02506049 Not Applicable

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:

41
Heart, Placenta, Cervix, Brain, Eye, Bone, Liver

Publications for Twin-to-Twin Transfusion Syndrome

Articles related to Twin-to-Twin Transfusion Syndrome:

(show top 50) (show all 300)
# Title Authors Year
1
Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy. ( 29353282 )
2018
2
Fetal Doppler changes one week after endoscopic equatorial laser for twin-to-twin transfusion syndrome: a longitudinal study. ( 29436718 )
2018
3
Impact of laser therapy for Twin-to-twin transfusion syndrome on subsequent pregnancy. ( 29417606 )
2018
4
Unusual course of hyperreactio luteinalis in twin pregnancy complicated by twin to twin transfusion syndrome. ( 29363826 )
2018
5
Does the Site of The Cord Insertion increase the risk of Adverse Outcome, Twin-To-Twin Transfusion Syndrome and Discordant Growth in monochorionic twin pregnancies? ( 29024208 )
2017
6
Late-onset transient adrenal insufficiency in preterm twins with twin-to-twin transfusion syndrome: A case report. ( 29381949 )
2017
7
Arabin cervical pessary for prevention of preterm birth in cases of twin-to-twin transfusion syndrome treated by fetoscopic LASER coagulation: the PECEP LASER randomised controlled trial. ( 28764674 )
2017
8
Virtual three-dimensional placentoscopy: a new approach to assess residual anastomoses following laser photocoagulation in twin-to-twin transfusion syndrome. ( 28114847 )
2017
9
Doppler assessment of patients with twin-to-twin transfusion syndrome and survival following fetoscopic laser surgery. ( 28281301 )
2017
10
Modified diagnostic criteria for twin-to-twin transfusion syndrome prior to 18 weeks' gestation: time to change? ( 28236371 )
2017
11
Spontaneous resolution of mirror syndrome following fetal interventions for fetal anemia as a consequence of twin to twin transfusion syndrome. ( 27914652 )
2017
12
Aortic and pulmonary artery calcification: An unusual manifestation of twin-to-twin transfusion syndrome. ( 28163434 )
2017
13
Musical Interests and Talent: Twin Jazz Musicians and Twin Studies/Twin Research: Loss of a Preterm Multiple; Conjoined Twin Conception; Depression in Fathers of Twins; Twin-to-Twin Transfusion Syndrome/Twin News: High-Achieving Twins; Twin Children of a Tennis Star; Conjoined Twin Separation; Twin Delivery to a Giant Panda. ( 29103407 )
2017
14
Different patterns of left ventricular "rigid body rotation" in 8-year-old twins with anamnestic twin-to-twin transfusion syndrome (from the MAGYAR-Twin Study). ( 28275566 )
2017
15
Fetoscopic laser coagulation in 1020 pregnancies with twin-to-twin transfusion syndrome demonstrates improvement of double survival rates. ( 28477345 )
2017
16
Atypical twin-to-twin transfusion syndrome: prevalence inA aA populationA undergoing fetoscopic laser ablation of communicatingA placental vessels. ( 26827875 )
2016
17
Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment. ( 27203605 )
2016
18
Long-Term Neurodevelopmental Outcome in Survivors of Twin-to-Twin Transfusion Syndrome. ( 27137794 )
2016
19
Laser Treatment of Twin-to-Twin Transfusion Syndrome. ( 27203606 )
2016
20
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
21
Monochorionic diamniotic inA vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome. ( 26690011 )
2016
22
The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence. ( 27098457 )
2016
23
A prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation. ( 27590373 )
2016
24
Cardiac Manifestations of Twin-to-Twin Transfusion Syndrome. ( 27087122 )
2016
25
Twin-to-Twin Transfusion Syndrome: From Observational Evidence to Randomized Controlled Trials. ( 27075108 )
2016
26
The History of Treatment of Twin-to-Twin Transfusion Syndrome. ( 27203604 )
2016
27
Intra-arterial calcifications in the recipient twin in twin-to-twin transfusion syndrome. ( 27834168 )
2016
28
Early prediction of twin-to-twin transfusion syndrome: systematic review and meta-analysis. ( 27270878 )
2016
29
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
30
Future Directions in the Management of Twin-to-Twin Transfusion Syndrome. ( 27125296 )
2016
31
Identifying families' shared disease experiences through a qualitative analysis of online twin-to-twin transfusion syndrome stories. ( 27422614 )
2016
32
Increased Risk Of Early-Onset Neonatal Sepsis After Laser Surgery For Twin-to-Twin Transfusion Syndrome. ( 27137630 )
2016
33
Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms. ( 26751570 )
2016
34
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
35
Fetoscopic laser photocoagulation in twin-to-twin transfusion syndrome: experience from a single institution. ( 27056209 )
2016
36
Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis. ( 27137946 )
2016
37
Perinatal outcome after fetoscopic laser surgery for twin-to-twin transfusion syndrome in triplet pregnancies: systematic review. ( 26265264 )
2015
38
Short-Time Impact of Laser Ablation of Placental Anastomoses on Myocardial Function in Monochorionic Twins with Twin-to-Twin Transfusion Syndrome. ( 26331331 )
2015
39
Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. ( 26517964 )
2015
40
Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience. ( 26117441 )
2015
41
Longitudinal annular displacement by M-mode (MAPSE and TAPSE) in twin-to-twin transfusion syndrome before and after laser surgery. ( 26256442 )
2015
42
Congenital Cytomegalovirus Infection in Monozygotic Twins with Twin-to-twin Transfusion Syndrome. ( 26061933 )
2015
43
Influences of Different Doses of Midazolam on Mother and Fetus in Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome. ( 26279077 )
2015
44
Transient twin reversed arterial perfusion: a protective effect in twin-to-twin transfusion syndrome? ( 26360958 )
2015
45
Visualisation of the vascular equator in twin-to-twin transfusion syndrome by virtual fetoscopy. ( 26411581 )
2015
46
Prediction of single fetal demise after laser therapy for twin-to-twin transfusion syndrome. ( 26395988 )
2015
47
Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review. ( 25613236 )
2015
48
11p15 DNA-methylation analysis in monozygotic twins with discordant intrauterine development due to severe twin-to-twin transfusion syndrome. ( 24678997 )
2014
49
Twin-to-twin transfusion syndrome: knowing our boundaries. ( 24613025 )
2014
50
Outcome of fetoscopic laser ablation for twin-to-twin transfusion syndrome in dichorionic-triamniotic triplets compared with monochorionic-diamniotic twins. ( 24659447 )
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 19)
# Super pathways Score Top Affiliating Genes
1
Show member pathways
13.5 ANGPT1 ANGPT2 FLT1 PGF TUBB3 VEGFC
2
Show member pathways
13.17 ANGPT1 ANGPT2 FLT1 PGF VEGFC
3
Show member pathways
13.05 ANGPT1 ANGPT2 FLT1 PGF VEGFC
4
Show member pathways
12.91 ANGPT1 ANGPT2 FLT1 PGF TUBB3 VEGFC
5
Show member pathways
12.73 FLT1 PGF REN VEGFC
6
Show member pathways
12.63 ANGPT1 ANGPT2 FLT1 PGF VEGFC
7 12.39 ANGPT1 ANGPT2 FLT1 PGF VEGFC
8
Show member pathways
12.38 FLT1 PGF VEGFC
9
Show member pathways
12.3 ANGPT1 ANGPT2 FLT1 PGF VEGFC
10
Show member pathways
12.12 FLT1 PGF VEGFC
11 11.82 ANGPT2 FLT1 VEGFC
12 11.63 ANGPT1 ANGPT2 FLT1
13
Show member pathways
11.57 FLT1 PGF VEGFC
14
Show member pathways
11.57 ANGPT1 ANGPT2 FLT1 PGF VEGFC
15 11.14 ANGPT1 ANGPT2
16 10.97 ANGPT2 ENG FLT1 REN VEGFC
17 10.92 ANGPT2 ENG
18 10.87 ANGPT1 FLT1
19
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:

# Name GO ID Score Top Affiliating Genes
1 extracellular region GO:0005576 9.43 ANGPT1 ANGPT2 FLT1 PGF REN VEGFC
2 extracellular space GO:0005615 9.17 ANGPT1 ANGPT2 ENG FLT1 PGF REN

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

(show all 20)
# Name GO ID Score Top Affiliating Genes
1 multicellular organism development GO:0007275 9.89 ANGPT1 ANGPT2 FLT1 PGF VEGFC
2 cell differentiation GO:0030154 9.85 ANGPT1 ANGPT2 FLT1 PGF VEGFC
3 response to drug GO:0042493 9.73 ENG PGF REN VEGFC
4 response to hypoxia GO:0001666 9.69 ANGPT2 PGF VEGFC
5 positive regulation of endothelial cell proliferation GO:0001938 9.59 PGF VEGFC
6 positive regulation of phosphatidylinositol 3-kinase signaling GO:0014068 9.58 ANGPT1 FLT1
7 vasculogenesis GO:0001570 9.58 ENG FLT1
8 positive regulation of blood vessel endothelial cell migration GO:0043536 9.57 ANGPT1 VEGFC
9 positive regulation of cell division GO:0051781 9.56 PGF VEGFC
10 animal organ regeneration GO:0031100 9.55 ANGPT2 PGF
11 positive regulation of angiogenesis GO:0045766 9.55 ANGPT2 ENG FLT1 PGF VEGFC
12 positive chemotaxis GO:0050918 9.54 ANGPT1 VEGFC
13 vascular endothelial growth factor receptor signaling pathway GO:0048010 9.54 FLT1 PGF VEGFC
14 blood vessel morphogenesis GO:0048514 9.52 ANGPT2 FLT1
15 induction of positive chemotaxis GO:0050930 9.48 PGF VEGFC
16 positive regulation of mast cell chemotaxis GO:0060754 9.4 PGF VEGFC
17 glomerulus vasculature development GO:0072012 9.32 ANGPT1 ANGPT2
18 Tie signaling pathway GO:0048014 9.26 ANGPT1 ANGPT2
19 sprouting angiogenesis GO:0002040 9.26 ANGPT1 ENG FLT1 PGF
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:

# Name GO ID Score Top Affiliating Genes
1 signaling receptor binding GO:0005102 9.13 ANGPT1 ANGPT2 REN
2 receptor tyrosine kinase binding GO:0030971 8.62 ANGPT1 ANGPT2

Sources for Twin-to-Twin Transfusion Syndrome

3 CDC
7 CNVD
9 Cosmic
10 dbSNP
11 DGIdb
17 ExPASy
19 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 LOVD
42 MedGen
44 MeSH
45 MESH via Orphanet
46 MGI
49 NCI
50 NCIt
51 NDF-RT
54 NINDS
55 Novoseek
57 OMIM
58 OMIM via Orphanet
62 PubMed
64 QIAGEN
69 SNOMED-CT via HPO
70 SNOMED-CT via Orphanet
71 TGDB
72 Tocris
73 UMLS
74 UMLS via Orphanet
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