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1. Shortcutting the diagnostic odyssey: the multidisciplinary Program for Undiagnosed Rare Diseases in adults (UD-PrOZA)

Author

Schuermans, Nika, Hemelsoet, Dimitri, Terryn, Wim, Steyaert, Sanne, Van Coster, Rudy, Coucke, Paul J., Steyaert, Wouter, Callewaert, Bert, Bogaert, Elke, Verloo, Patrick, Vanlander, Arnaud V., Debackere, Elke, Ghijsels, Jody, LeBlanc, Pontus, Verdin, Hannah, Naesens, Leslie, Haerynck, Filomeen, Callens, Steven, Dermaut, Bart, and Poppe, Bruce

Published
2022
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2. Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Published
2022
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3. IRF2BPL Is Associated with Neurological Phenotypes

Author

Marcogliese, Paul C, Shashi, Vandana, Spillmann, Rebecca C, Stong, Nicholas, Rosenfeld, Jill A, Koenig, Mary Kay, Martínez-Agosto, Julián A, Herzog, Matthew, Chen, Agnes H, Dickson, Patricia I, Lin, Henry J, Vera, Moin U, Salamon, Noriko, Graham, John M, Ortiz, Damara, Infante, Elena, Steyaert, Wouter, Dermaut, Bart, Poppe, Bruce, Chung, Hyung-Lok, Zuo, Zhongyuan, Lee, Pei-Tseng, Kanca, Oguz, Xia, Fan, Yang, Yaping, Smith, Edward C, Jasien, Joan, Kansagra, Sujay, Spiridigliozzi, Gail, El-Dairi, Mays, Lark, Robert, Riley, Kacie, Koeberl, Dwight D, Golden-Grant, Katie, Diseases, Program for Undiagnosed, Callens, Steven, Coucke, Paul, Hemelsoet, Dimitri, Terryn, Wim, Van Coster, Rudy, Network, Undiagnosed Diseases, Adams, David R, Alejandro, Mercedes E, Allard, Patrick, Azamian, Mahshid S, Bacino, Carlos A, Balasubramanyam, Ashok, Barseghyan, Hayk, Batzli, Gabriel F, Beggs, Alan H, Behnam, Babak, Bican, Anna, Bick, David P, Birch, Camille L, Bonner, Devon, Boone, Braden E, Bostwick, Bret L, Briere, Lauren C, Brown, Donna M, Brush, Matthew, Burke, Elizabeth A, Burrage, Lindsay C, Chen, Shan, Clark, Gary D, Coakley, Terra R, Cogan, Joy D, Cooper, Cynthia M, Cope, Heidi, Craigen, William J, D’Souza, Precilla, Davids, Mariska, Dayal, Jyoti G, Dell’Angelica, Esteban C, Dhar, Shweta U, Dillon, Ani, Dipple, Katrina M, Donnell-Fink, Laurel A, Dorrani, Naghmeh, Dorset, Daniel C, Douine, Emilie D, Draper, David D, Eckstein, David J, Emrick, Lisa T, Eng, Christine M, Eskin, Ascia, Esteves, Cecilia, Estwick, Tyra, Ferreira, Carlos, Fogel, Brent L, Friedman, Noah D, Gahl, William A, Glanton, Emily, Godfrey, Rena A, Goldstein, David B, Gould, Sarah E, Gourdine, Jean-Philippe F, and Groden, Catherine A

Subjects
Neurodegenerative, Brain Disorders, Neurosciences, Human Genome, Genetics, Biotechnology, 2.1 Biological and endogenous factors, Aetiology, Neurological, Program for Undiagnosed Diseases, Undiagnosed Diseases Network, C3HC4 RING finger, CG11138, Drosophila, EAP1, ataxia, developmental regression, hypotonia, neurodegeneration, pits, seizures, Biological Sciences, Medical and Health Sciences, Genetics & Heredity
Abstract

Interferon regulatory factor 2 binding protein-like (IRF2BPL) encodes a member of the IRF2BP family of transcriptional regulators. Currently the biological function of this gene is obscure, and the gene has not been associated with a Mendelian disease. Here we describe seven individuals who carry damaging heterozygous variants in IRF2BPL and are affected with neurological symptoms. Five individuals who carry IRF2BPL nonsense variants resulting in a premature stop codon display severe neurodevelopmental regression, hypotonia, progressive ataxia, seizures, and a lack of coordination. Two additional individuals, both with missense variants, display global developmental delay and seizures and a relatively milder phenotype than those with nonsense alleles. The IRF2BPL bioinformatics signature based on population genomics is consistent with a gene that is intolerant to variation. We show that the fruit-fly IRF2BPL ortholog, called pits (protein interacting with Ttk69 and Sin3A), is broadly detected, including in the nervous system. Complete loss of pits is lethal early in development, whereas partial knockdown with RNA interference in neurons leads to neurodegeneration, revealing a requirement for this gene in proper neuronal function and maintenance. The identified IRF2BPL nonsense variants behave as severe loss-of-function alleles in this model organism, and ectopic expression of the missense variants leads to a range of phenotypes. Taken together, our results show that IRF2BPL and pits are required in the nervous system in humans and flies, and their loss leads to a range of neurological phenotypes in both species.

Published
2018

4. Additional file 2 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 2. Statistical analysis plan.

Published
2022
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5. Additional file 2 of Shortcutting the diagnostic odyssey: the multidisciplinary Program for Undiagnosed Rare Diseases in adults (UD-PrOZA)

Author

Schuermans, Nika, Hemelsoet, Dimitri, Terryn, Wim, Steyaert, Sanne, Van Coster, Rudy, Coucke, Paul J., Steyaert, Wouter, Callewaert, Bert, Bogaert, Elke, Verloo, Patrick, Vanlander, Arnaud V., Debackere, Elke, Ghijsels, Jody, LeBlanc, Pontus, Verdin, Hannah, Naesens, Leslie, Haerynck, Filomeen, Callens, Steven, Dermaut, Bart, and Poppe, Bruce

Abstract

Additional file 2. An overview of all genetic diagnoses is provided (Table S3).

Published
2022
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6. Additional file 6 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 6: Figure S2. Laboratory Values. Medians are represented by triangles, with an upward point for Zilucoplan and a downward point for Control, respectively. CRP, C-reactive protein; LDH, lactate dehydrogenase.

Published
2022
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7. Additional file 1 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 1. Study protocol.

Published
2022
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8. Additional file 5 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 5: Figure S1. Primary Outcome. GeoMean, Geometric Mean; LSGeoMean, Least Square Geometric Means; LSMean, Least Square Means.

Published
2022
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9. Additional file 4 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 4. Additional statistical explanation.

Published
2022
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10. Additional file 7 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 7: Table S1. Primary and supportive endpoints in the full analysis data set. LSMean, least square mean; PaO2, arterial partial pressure of oxygen; FiO2, fraction of inspired oxygen; PaO2, partial pressure of arterial oxygen; ARDS, acute respiratory distress syndrome; CRP, C-reactive protein; CI, confidence interval; SD, standard deviation. *Based on the highest temperature in 24 h. Table S2. Follow-up endpoints. SD, standard deviation; DLCO, diffusing capacity of lung for carbon monoxide; HRCT, high-resolution computed tomography; WHO, world health organisation. 6-point ordinal scale: 2 on invasive mechanical ventilation; 3 on non-invasive ventilation or high flow oxygen devices; 4 hospitalized, requiring supplemental oxygen; 5 hospitalized, not requiring supplemental oxygen, 6 not hospitalized.

Published
2022
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11. Additional file 1 of Shortcutting the diagnostic odyssey: the multidisciplinary Program for Undiagnosed Rare Diseases in adults (UD-PrOZA)

Author

Schuermans, Nika, Hemelsoet, Dimitri, Terryn, Wim, Steyaert, Sanne, Van Coster, Rudy, Coucke, Paul J., Steyaert, Wouter, Callewaert, Bert, Bogaert, Elke, Verloo, Patrick, Vanlander, Arnaud V., Debackere, Elke, Ghijsels, Jody, LeBlanc, Pontus, Verdin, Hannah, Naesens, Leslie, Haerynck, Filomeen, Callens, Steven, Dermaut, Bart, and Poppe, Bruce

Abstract

Additional file 1. Supplementary methods, figures and tables (Figures S1, S2, S3 and Tables S1, S2).

Published
2022
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12. Additional file 3 of Efficacy and safety of the investigational complement C5 inhibitor zilucoplan in patients hospitalized with COVID-19: an open-label randomized controlled trial

Author

De Leeuw, Elisabeth, Van Damme, Karel F. A., Declercq, Jozefien, Bosteels, Cedric, Maes, Bastiaan, Tavernier, Simon J., Detalle, Laurent, Smart, Trevor, Glatt, Sophie, Debeuf, Nincy, Deckers, Julie, Lameire, Sahine, Vandecasteele, Stefaan J., De Neve, Nikolaas, Demedts, Ingel K., Govaerts, Elke, Knoop, Christiane, Vanhove, Karolien, Moutschen, Michel, Terryn, Wim, Depuydt, Pieter, Van Braeckel, Eva, Haerynck, Filomeen, Hendrickx, Tine C. J., Parrein, Vanessa, Lalla, Marianna, Brittain, Claire, and Lambrecht, Bart N.

Abstract

Additional file 3. Overview secondary and exploratory endpoints.

Published
2022
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13. Screening for Fabry Disease in Male Patients With Arrhythmia Requiring a Pacemaker or an Implantable Cardioverter–Defibrillator

Author

Hemelsoet, Dimitri, primary, De Keyser, Jan, additional, Van Heuverswyn, Frederic, additional, Willems, Rik, additional, Vandekerckhove, Hans, additional, Bondue, Antoine, additional, de Asmundis, Carlo, additional, Saenen, Johan, additional, Van de Walle, Stefaan, additional, Godart, Pascal, additional, Kampmann, Christoph, additional, Stepman, Hedwig, additional, Poppe, Bruce, additional, and Terryn, Wim, additional

Published
2021
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22. Screening, diagnosis, and management of patients with Fabry disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference

Author

Schiffmann, Raphael, primary, Hughes, Derralynn A., additional, Linthorst, Gabor E., additional, Ortiz, Alberto, additional, Svarstad, Einar, additional, Warnock, David G., additional, West, Michael L., additional, Wanner, Christoph, additional, Bichet, Daniel G., additional, Christensen, Erik Ilsø, additional, Correa-Rotter, Ricardo, additional, Elliott, Perry M., additional, Feriozzi, Sandro, additional, Fogo, Agnes B., additional, Germain, Dominique P., additional, Hollak, Carla E.M., additional, Hopkin, Robert J., additional, Johnson, Jack, additional, Kantola, Ilkka, additional, Kopp, Jeffrey B., additional, Kröner, Jürgen, additional, Linhart, Aleš, additional, Martins, Ana Maria, additional, Matern, Dietrich, additional, Mehta, Atul B., additional, Mignani, Renzo, additional, Najafian, Behzad, additional, Narita, Ichiei, additional, Nicholls, Kathy, additional, Obrador, Greg T., additional, Oliveira, João Paulo, additional, Pisani, Antonio, additional, Politei, Juan, additional, Ramaswami, Uma, additional, Ries, Markus, additional, Terryn, Wim, additional, Tøndel, Camilla, additional, Torra, Roser, additional, Vujkovac, Bojan, additional, Waldek, Stephen, additional, and Walter, Jerry, additional

Published
2017
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26. Recommendations for initiation and cessation of enzyme replacement therapy in patients with Fabry disease: the European Fabry Working Group consensus document

Author

Biegstraaten, Marieke, primary, Arngrímsson, Reynir, additional, Barbey, Frederic, additional, Boks, Lut, additional, Cecchi, Franco, additional, Deegan, Patrick B, additional, Feldt-Rasmussen, Ulla, additional, Geberhiwot, Tarekegn, additional, Germain, Dominique P, additional, Hendriksz, Chris, additional, Hughes, Derralynn A, additional, Kantola, Ilkka, additional, Karabul, Nesrin, additional, Lavery, Christine, additional, Linthorst, Gabor E, additional, Mehta, Atul, additional, van de Mheen, Erica, additional, Oliveira, João P, additional, Parini, Rossella, additional, Ramaswami, Uma, additional, Rudnicki, Michael, additional, Serra, Andreas, additional, Sommer, Claudia, additional, Sunder-Plassmann, Gere, additional, Svarstad, Einar, additional, Sweeb, Annelies, additional, Terryn, Wim, additional, Tylki-Szymanska, Anna, additional, Tøndel, Camilla, additional, Vujkovac, Bojan, additional, Weidemann, Frank, additional, Wijburg, Frits A, additional, Woolfson, Peter, additional, and Hollak, Carla EM, additional

Published
2015
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28. Aggressive extensive cardiac mass in an HIV-1-infected patient: should we go for comfort therapy?

Author

Vervloet, Delphine MTF, De Pauw, Michel, Demulier, Laurent, Vercammen, Jan, Terryn, Wim, Steel, Eva, and Vandekerckhove, Linos

Abstract

Cardiac masses are rare, the differential diagnosis includes infections with vegetations or abscesses, neoplasms, thrombi, and structural abnormalities. A pathology specimen is essential in therapeutic strategy planning for a cardiac mass, also if the primary imaging findings look dramatic at the start. Even in an inoperable setting, a life-saving therapy might be available. We report a case of a 49-year-old man, known with HIV-1, who was several times admitted with pericarditis. Now he was hospitalized with progressive lower limb edema, atrial fibrillation and detection of a giant cardiac mass in left and right atrium with infiltration of surrounding tissues. Given the extent and invasiveness of the mass, he was inoperable. Biopsy specimen was obtained and staging was performed by PET-CT scan. The diagnosis of stage IV Burkitt lymphoma with predominant extranodal cardiac involvement was withheld wherefore promptly aggressive therapy was started according to the GMALL B-NHL86 protocol. The therapy was downgraded to R-CHOP due to tolerance problems. He achieved a complete remission and during follow-up no relapse was detected.

Published
2017
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29. Fabry nephropathy: indications for screening and guidance for diagnosis and treatment by the European Renal Best Practice

Author

Andreas L. Serra, Christoph Wanner, Wim Van Biesen, Raymond Vanholder, Wim Terryn, Bruce Poppe, Alberto Ortiz, Roseline Froissart, Yves Pirson, Pierre Cochat, University of Zurich, and Terryn, Wim

Subjects
Male, Nephrology, medicine.medical_specialty, 2747 Transplantation, medicine.medical_treatment, 142-005 142-005, Nephropathy, Atheromatosis, Internal medicine, medicine, Humans, Mass Screening, Dialysis, Mass screening, Transplantation, 2727 Nephrology, business.industry, Enzyme replacement therapy, medicine.disease, Fabry disease, Surgery, Europe, Practice Guidelines as Topic, 570 Life sciences, biology, Fabry Disease, Female, Kidney Diseases, business, Kidney disease
Abstract

Fabry disease (FD) is an X-linked disorder of glycosphingolipid catabolism resulting in the accumulation of glycolipids including globotriaosylceramide in cells of various tissues resulting in end-organ manifestations. Initially, FD is typically characterized by angiokeratoma and recurrent episodes of neuropathic pain in the extremities occurring during childhood or adolescence. Most affected patients also exhibit a decreased ability to sweat. Later in life, FD results in left ventricular hypertrophy, proteinuria, renal failure and stroke. These later disease manifestations are non-specific and also common in diabetes, hypertension and atheromatosis and thus for most practitioners do not point into the direction of FD. As a consequence, FD is under-diagnosed and screening of high-risk groups is important for case finding, as is a thorough pedigree analysis of affected patients. In the nephrology clinic, we suggest to screen patients for FD when there is unexplained chronic kidney disease in males younger than 50 years and females of any age. In men, this can be performed by measuring α-galactosidase A activity in plasma, white blood cells or dried blood spots. In women, mutation analysis is necessary, as enzyme measurement alone could miss over one-third of female Fabry patients. A multidisciplinary team should closely monitor all known Fabry patients, with the nephrologist screening kidney impairment (glomerular filtration rate and proteinuria) on a regular basis. Transplanted Fabry patients have a higher mortality than the regular transplant population, but have acceptable outcomes, compared with Fabry patients remaining on dialysis. It is unclear whether enzyme replacement therapy (ERT) prevents deterioration of kidney function. In view of the lack of compelling evidence for ERT, and the low likelihood that a sufficiently powered randomized controlled trial on this topic will be performed, data of all patients with FD should be collected in a central registry.

Published
2012

30. Two-tier approach for the detection of alpha-galactosidase A deficiency in kidney transplant recipients.

Author

De Schoenmakere G, Poppe B, Wuyts B, Claes K, Cassiman D, Maes B, Verbeelen D, Vanholder R, Kuypers DR, Lameire N, De Paepe A, and Terryn W

Subjects
Adult, Aged, Child, DNA Mutational Analysis, Fabry Disease complications, Fabry Disease enzymology, Fabry Disease genetics, Female, Genetic Testing, Humans, Kidney Failure, Chronic enzymology, Kidney Failure, Chronic etiology, Kidney Failure, Chronic genetics, Male, Mutation, Missense, Pedigree, Young Adult, alpha-Galactosidase genetics, Fabry Disease diagnosis, Kidney Transplantation
Abstract

Background: Anderson-Fabry disease (AFD) is an X-linked condition originating from a deficiency in alpha-galactosidase, a lysosomal enzyme. Multi-organ involvement ensues in early adulthood and vital organs are affected: the kidneys, brain, heart. Several reports however suggest that AFD is underdiagnosed., Methods: We screened a kidney transplant population using a two-tier approach. The first tier was the determination of alpha-galactosidase A (AGALA) activity using a dried blood spot on filter paper (DBFP); in the second tier, patients with the lowest alpha-galactosidase levels were further subjected to mutation analysis of the GLA gene., Results: From the database of 2328 patients, 1233 subjects met the inclusion criteria. Finally, after informed consent, 673 patients were screened (54.5%-395 women and 278 men). DBFP analysis resulted in a mean AGALA of 2.63 +/- 2.48 micromol/L/h (2.5 and 97.5 percentile were 0.0001 and 5.07 micromol/L/h, respectively). Eleven patients were subjected to further genetic analysis. In a male patient a pathogenic missense mutation p.Ala143Thr (c.427A>G) was identified., Conclusions: Our results show that the proposed approach can detect AFD patients in a until now seldomly screened high-risk group: kidney transplant patients. We conclude that screening for AFD in high-risk populations is a cost-effective, technically feasible and clinically valuable objective.

Published
2008
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