9 results on '"Tisiana Low"'
Search Results
2. Association of Acute Anti-inflammatory Treatment With Medium-term Outcomes for Coronary Artery Aneurysms in Kawasaki Disease
- Author
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Kevin G. Friedman, MD, Brian W. McCrindle, MD, MPH, Kyle Runeckles, MSc, Nagib Dahdah, MD, Ashraf S. Harahsheh, MD, Michael Khoury, MD, Sean Lang, MD, Cedric Manlhiot, PhD, Adriana H. Tremoulet, MD, MAS, Geetha Raghuveer, MD, Elif Seda Selamet Tierney, MD, Pei-Ni Jone, MD, Jennifer S. Li, MD, MHS, Jacqueline R. Szmuszkovicz, MD, Kambiz Norozi, MD, PhD, Supriya S. Jain, MD, Angela T. Yetman, MD, Jane W. Newburger, MD, MPH, Carolyn A. Altman, MD, Brett R. Anderson, MD, MBA, MS, Mikayla Beckley, BS, Elizabeth Braunlin, MD, PhD, Jane C. Burns, MD, Michael R. Carr, MD, Nadine F. Choueiter, MD, Jessica H. Colyer, MD, MBA, Frederic Dallaire, MD, PhD, Sarah D. De Ferranti, MD, MPH, Laurent Desjardins, MD, Matthew D. Elias, MD, Anne Ferris, MBBS, Michael Gewitz, MD, Therese M. Giglia, MD, Steven C. Greenway, MD, Kevin C. Harris, MD, MHSc, Kevin D. Hill, MD, MSc, Michelle Hite, Thomas R. Kimball, MD, Shelby Kutty, MD, Lillian Lai, MD, MHA, Simon Lee, MD, Ming-Tai Lin, MD, PhD, Tisiana Low, MD, MSc, Andrew S. Mackie, MD, MSc, Wadi Mawad, MD, Mathew, MSc, Kimberly E. McHugh, MD, Tapas Mondal, MD, Kimberly Myers, MD, Michael A. Portman, MD, Claudia Renaud, MD, Rosie Scuccimarri, MD, S. Kristen Sexson Tejitel, MD, PhD, MPH, Karen M. Texter, MD, Deepika Thacker, MD, Sharon Wagner-Lees, RN-BC, BSN, Kenny Wong, MD, Mei-Hwan Wu, MD, PhD, and Varsha Zadokar, MBBS
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The impact of adjunctive anti-inflammatory treatment on outcomes for patients with Kawasaki disease (KD) and coronary artery aneurysms (CAAs) is unknown. Methods: Using data from the International KD Registry in patients with ≥ medium CAA we evaluate associations of treatment with outcomes and major adverse cardiac events (MACE). Results: Medium or large CAA was present in 527 (32%) patients. All were treated with intravenous immunoglobulin (IVIG), 70% were male, and the median age was 1.3 years (interquartile range: 0.4-4.0 years). The most common acute therapies included single IVIG alone in 243 (46%), multiple IVIG in 100 (19%), multiple IVIG + corticosteroids in 75 (14%), and multiple IVIG + infliximab + corticosteroids in 44 (8%) patients. Patients who received therapy beyond single IVIG had a larger CA z-score at baseline (P < 0.001) and a higher rate of bilateral CAA (P < 0.001). Compared with IVIG alone, early adjunctive treatments (within 3 days of initial IVIG) were not associated with time to CAA regression or MACE, whereas later adjunctive therapy was associated with MACE and longer time to CAA regression. Patients receiving IVIG plus steroids vs IVIG alone had a trend towards shorter time to CAA regression and lower risk of MACE (P = 0.07). A larger CAA z-score at baseline was the strongest predictor of an increase in the CAA z-score over follow-up, lower likelihood of CAA regression, and higher risk of MACE. Conclusions: Persistence of CAA and MACE are more strongly associated with baseline severity CAA than with acute adjuvant anti-inflammatory therapy. Patients who received late adjunctive therapy are at higher risk for worse outcomes. Résumé: Contexte: L’incidence d’un traitement anti-inflammatoire d’appoint chez les patients atteints de la maladie de Kawasaki (MK) compliquée d’anévrismes coronariens est inconnue. Méthodologie: À partir de données provenant du registre international de la maladie de Kawasaki portant sur les patients ayant subi des anévrismes coronariens modérés ou importants, nous avons évalué l’incidence des différents traitements sur les résultats cliniques et les événements cardiovasculaires indésirables majeurs (ECIM). Résultats: Des anévrismes coronariens modérés ou importants ont été relevés chez 527 patients (32 %). Tous les patients recevaient des immunoglobulines administrées par voie intraveineuse (IgIV); 70 % d’entre eux étaient de sexe masculin, et leur âge médian était de 1,3 an (écart interquartile : de 0,4 an à 4,0 ans). Les traitements d’urgence les plus fréquents comprenaient un seul traitement par IgIV chez 243 patients (46 %), plusieurs traitements par IgIV chez 100 patients (19 %), une association de plusieurs traitements IgIV et de corticostéroïdes chez 75 patients (14 %) et une association de plusieurs traitements IgIV, de corticostéroïdes et d’infliximab chez 44 patients (8 %). Les patients ayant reçu un traitement autre qu’un seul traitement IgIV présentaient des scores z initiaux plus élevés pour le diamètre des artères coronaires (P < 0,001) et un taux plus élevé d’anévrismes coronariens bilatéraux (P < 0,001). En comparaison d’un traitement par IgIV seulement, les traitements d’appoint précoces (administrés dans les trois jours suivant le début du traitement par IgIV) n’ont pas eu d’incidence sur la durée avant la régression des anévrismes coronariens ni sur la survenue d’ECIM, alors que les traitements d’appoint plus tardifs ont été associés à un risque plus élevé d’ECIM et à une régression plus tardive des anévrismes coronariens. Les patients ayant reçu une association d’IgIV et de corticostéroïdes avaient tendance à présenter une régression plus rapide des anévrismes coronariens et un plus faible risque d’ECIM que ceux recevant uniquement un traitement par IgIV (P = 0,07). Un score z initial plus élevé pour un anévrisme coronarien était le facteur prédictif le plus puissant d’une augmentation du score z pendant la période de suivi, d’une probabilité plus faible de régression de l’anévrisme et d’un risque plus élevé d’ECIM. Conclusions: La gravité initiale de l’anévrisme coronarien est plus fortement associée à la persistance de l’anévrisme et à la survenue d’ECIM que le recours à un traitement anti-inflammatoire d’urgence en appoint. Les patients recevant un traitement d’appoint tardif étaient par ailleurs plus susceptibles de présenter des résultats défavorables.
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- 2022
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3. Associations between the spatiotemporal distribution of Kawasaki disease and environmental factors: evidence supporting a multifactorial etiologic model
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Tisiana Low, Brian W. McCrindle, Brigitte Mueller, Chun-Po S. Fan, Emily Somerset, Sunita O’Shea, Leonard J. S. Tsuji, Hong Chen, and Cedric Manlhiot
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Medicine ,Science - Abstract
Abstract The etiology of Kawasaki Disease (KD), the most common cause of acquired heart disease in children in developed countries, remains elusive, but could be multifactorial in nature as suggested by the numerous environmental and infectious exposures that have previously been linked to its epidemiology. There is still a lack of a comprehensive model describing these complex associations. We present a Bayesian disease model that provides insight in the spatiotemporal distribution of KD in Canada from 2004 to 2017. The disease model including environmental factors had improved Watanabe-Akaike information criterion (WAIC) compared to the base model which included only spatiotemporal and demographic effects and had excellent performance in recapitulating the spatiotemporal distribution of KD in Canada (98% and 86% spatial and temporal correlations, respectively). The model suggests an association between the distribution of KD and population composition, weather-related factors, aeroallergen exposure, pollution, atmospheric concentration of spores and algae, and the incidence of healthcare encounters for bacterial pneumonia or viral intestinal infections. This model could be the basis of a hypothetical data-driven framework for the spatiotemporal distribution of KD. It also generates novel hypotheses about the etiology of KD, and provides a basis for the future development of a predictive and surveillance model.
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- 2021
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4. Medium‐Term Complications Associated With Coronary Artery Aneurysms After Kawasaki Disease: A Study From the International Kawasaki Disease Registry
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Brian W. McCrindle, Cedric Manlhiot, Jane W. Newburger, Ashraf S. Harahsheh, Therese M. Giglia, Frederic Dallaire, Kevin Friedman, Tisiana Low, Kyle Runeckles, Mathew Mathew, Andrew S. Mackie, Nadine F. Choueiter, Pei‐Ni Jone, Shelby Kutty, Anji T. Yetman, Geetha Raghuveer, Elfriede Pahl, Kambiz Norozi, Kimberly E. McHugh, Jennifer S. Li, Sarah D. De Ferranti, and Nagib Dahdah
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cardiovascular outcomes ,coronary artery ,Kawasaki disease ,risk factors ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Coronary artery aneurysms (CAAs) may occur after Kawasaki disease (KD) and lead to important morbidity and mortality. As CAA in patients with KD are rare and heterogeneous lesions, prognostication and risk stratification are difficult. We sought to derive the cumulative risk and associated factors for cardiovascular complications in patients with CAAs after KD. Methods and Results A 34‐institution international registry of 1651 patients with KD who had CAAs (maximum CAA Z score ≥2.5) was used. Time‐to‐event analyses were performed using the Kaplan–Meier method and Cox proportional hazard models for risk factor analysis. In patients with CAA Z scores ≥10, the cumulative incidence of luminal narrowing (>50% of lumen diameter), coronary artery thrombosis, and composite major adverse cardiovascular complications at 10 years was 20±3%, 18±2%, and 14±2%, respectively. No complications were observed in patients with a CAA Z score
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- 2020
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5. Comparison Between Currently Recommended Long-Term Medical Management of Coronary Artery Aneurysms After Kawasaki Disease and Actual Reported Management in the Last Two Decades
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Jane W. Newburger, Anji T. Yetman, Frederic Dallaire, Kyle Runeckles, Geetha Raghuveer, Michael A. Portman, Jonathon Osborne, Jacqueline R. Szmuszkovicz, Therese M. Giglia, Nagib Dahdah, Tapas Mondal, Andrew M. Crean, Ashraf S Harahsheh, Mathew Mathew, Brian W. McCrindle, Jane C. Burns, Andrew S. Mackie, Tisiana Low, Nadine Choueiter, Kambiz Norozi, Supriya Jain, and Kevin G. Friedman
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medicine.medical_specialty ,medicine.drug_class ,business.industry ,Warfarin ,Low molecular weight heparin ,Guideline ,030204 cardiovascular system & hematology ,Vascular surgery ,medicine.disease ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.anatomical_structure ,030228 respiratory system ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Kawasaki disease ,Cardiology and Cardiovascular Medicine ,business ,Artery ,medicine.drug - Abstract
In the 2017 American Heart Association (AHA) Kawasaki disease (KD) guidelines, risk levels (RLs) for long-term management are defined by both maximal and current coronary artery (CA) dimensions normalized as z-scores. We sought to determine the degree to which current recommended practice differs from past actual practice, highlighting areas for knowledge translation efforts. The International KD Registry (IKDR) included 1651 patients with CA aneurysms (z-score > 2.5) from 1999 to 2016. Patients were classified by AHA RL using maximum CA z-score (RL 3 = small, RL 4 = medium, RL 5 = large/giant) and subcategorized based on decreases over time. Medical management provided was compared to recommendations. Low-dose acetylsalicylic acid (ASA) use ranged from 86 (RL 3.1) to 95% (RL 5.1) for RLs where use was “indicated.” Dual antiplatelet therapy (ASA + clopidogrel) use ranged from 16% for RL 5.2 to 9% for RL 5.4. Recommended anticoagulation (warfarin or low molecular weight heparin) use was 65% for RL 5.1, while 12% were on triple therapy (anticoagulation + dual antiplatelet). Optional statin use ranged from 2 to 8% depending on RL. Optional beta-blocker use was 2–25% for RL 5, and 0–5% for RLs 3 and 4 where it is not recommended. Generally, past practice was consistent with the latest AHA guidelines, taking into account the flexible wording of recommendations based on the limited evidence, as well as unmeasured patient-specific factors. In addition to strengthening the overall evidence base, knowledge translation efforts may be needed to address variation in thromboprophylaxis management.
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- 2021
6. Bleeding risk associated with combination thromboprophylaxis therapy is low for patients with coronary artery aneurysms after Kawasaki disease
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Anusha Jegatheeswaran, Paul J. Devlin, Tisiana Low, Brian W. McCrindle, Leonardo R. Brandão, and Nita Chahal
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Male ,medicine.medical_specialty ,medicine.drug_class ,Low molecular weight heparin ,Mucocutaneous Lymph Node Syndrome ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Child ,business.industry ,Incidence (epidemiology) ,Anticoagulant ,Warfarin ,Anticoagulants ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,medicine.disease ,Clopidogrel ,Coronary Vessels ,Thrombosis ,Regimen ,Drug Therapy, Combination ,Female ,Kawasaki disease ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Kawasaki disease (KD) may lead to coronary artery aneurysms (CAA) with potential for thrombosis. We aimed to determine the bleeding risk during thromboprophylaxis regimens with dual and triple therapy.KD patients with medium to large CAAs receiving combination thromboprophylaxis therapy (dual or triple therapy with acetylsalicylic acid (ASA), clopidogrel, low molecular weight heparin (LMWH) or warfarin) were reviewed (1979-2017). Treatment periods30 days were excluded. Bleeding events were classified using the Bleeding Academic Research Consortium (BARC) Score. The incidence of bleeding events per patient year of exposure was determined for each regimen.n = 98 of 3022 KD (23 females:75 males) were included. Median age at diagnosis was 2.6 years (IQR: 0.6-6.2), median maximum CAA z-score was 18.0 (range: 5-65.5, IQR: 10.8-28.0, m = 6) and median follow-up duration was 6.5 years (IQR: 2.5-20.2). The incidence of type ≥2 bleeds per patient-year for each regimen was 0 (ASA + clopidogrel+LMWH), 0.03 (ASA + clopidogrel), 0.06 (ASA + warfarin), 0.06 (ASA + clopidogrel+warfarin), and 0.1 (ASA + LMWH) in ascending order. 31 bleeding events requiring medical attention (type ≥2) occurred in 30 patients (median age 7.8 years). Of the 17 type ≥2 bleeds on warfarin with an International Normalised Ratio (INR) available, 13 occurred with an INR3. For patients receiving triple therapy (dual antiplatelet with anticoagulant), there were 57 bleeding events over 20 treatment periods.The overall bleeding risk was low in KD patients receiving combination thromboprophylaxis, and not significantly different across all regimens. Type ≥2 bleeding events that occurred on warfarin were most frequently associated with high INR values.
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- 2020
7. Comparison Between Currently Recommended Long-Term Medical Management of Coronary Artery Aneurysms After Kawasaki Disease and Actual Reported Management in the Last Two Decades
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Jonathon, Osborne, Kevin, Friedman, Kyle, Runeckles, Nadine F, Choueiter, Therese M, Giglia, Frederic, Dallaire, Jane W, Newburger, Tisiana, Low, Mathew, Mathew, Andrew S, Mackie, Nagib, Dahdah, Anji T, Yetman, Ashraf S, Harahsheh, Geetha, Raghuveer, Kambiz, Norozi, Jane C, Burns, Supriya, Jain, Tapas, Mondal, Michael A, Portman, Jacqueline R, Szmuszkovicz, Andrew, Crean, Brian W, McCrindle, and Mei-Hwan, Wu
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Male ,Adolescent ,Aspirin ,Coronary Aneurysm ,Anticoagulants ,Venous Thromboembolism ,Mucocutaneous Lymph Node Syndrome ,Humans ,Female ,Guideline Adherence ,Registries ,Warfarin ,Child ,Retrospective Studies - Abstract
In the 2017 American Heart Association (AHA) Kawasaki disease (KD) guidelines, risk levels (RLs) for long-term management are defined by both maximal and current coronary artery (CA) dimensions normalized as z-scores. We sought to determine the degree to which current recommended practice differs from past actual practice, highlighting areas for knowledge translation efforts. The International KD Registry (IKDR) included 1651 patients with CA aneurysms (z-score 2.5) from 1999 to 2016. Patients were classified by AHA RL using maximum CA z-score (RL 3 = small, RL 4 = medium, RL 5 = large/giant) and subcategorized based on decreases over time. Medical management provided was compared to recommendations. Low-dose acetylsalicylic acid (ASA) use ranged from 86 (RL 3.1) to 95% (RL 5.1) for RLs where use was "indicated." Dual antiplatelet therapy (ASA + clopidogrel) use ranged from 16% for RL 5.2 to 9% for RL 5.4. Recommended anticoagulation (warfarin or low molecular weight heparin) use was 65% for RL 5.1, while 12% were on triple therapy (anticoagulation + dual antiplatelet). Optional statin use ranged from 2 to 8% depending on RL. Optional beta-blocker use was 2-25% for RL 5, and 0-5% for RLs 3 and 4 where it is not recommended. Generally, past practice was consistent with the latest AHA guidelines, taking into account the flexible wording of recommendations based on the limited evidence, as well as unmeasured patient-specific factors. In addition to strengthening the overall evidence base, knowledge translation efforts may be needed to address variation in thromboprophylaxis management.
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- 2020
8. Variation in Pharmacologic Management of Patients with Kawasaki Disease with Coronary Artery Aneurysms
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Anji T. Yetman, Patrick Gould, Annette L. Baker, Adriana H. Tremoulet, Tisiana Low, Lillian Lai, Kenny K. Wong, Tanveer H. Collins, Michael R. Carr, Mathew Mathew, Kyle Runeckles, Sean M. Lang, Sam Sabouni, Michael H. Gewitz, Frederic Dallaire, Cedric Manlhiot, Supriya Jain, Nagib Dahdah, Pei-Ni Jone, Claudia Renaud, Kambiz Norozi, Ming-Tai Lin, Geetha Raghuveer, Laurent Desjardins, Sarah D. de Ferranti, Thomas Thomas, Jane W. Newburger, Therese M. Giglia, Michael A. Portman, Elizabeth A. Braunlin, Thomas R. Kimball, Craig Sable, Andrew S. Mackie, Kevin C. Harris, Devin D. Tinker, Brian W. McCrindle, Sunita O’Shea, Karen Texter, Shelby Kutty, Jane C. Burns, Jennifer S. Li, Mei-Hwan Wu, Kevin G. Friedman, Kimberly E. McHugh, Rejane Dillenburg, Nadine Choueiter, Audrey Dionne, Adam A Dempsey, Tapas Mondal, Deepika Thacker, Kevin D. Hill, Elif Seda Selamet Tierney, Simon Lee, William T. Mahle, Sharon Wagner-Lees, S. Kristen Sexson Tejitel, Jacqueline R. Szmuszkovicz, Carolyn A. Altman, Jessica H. Colyer, Anne Fournier, and Ashraf S Harahsheh
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Male ,medicine.medical_specialty ,Pharmacological management ,Mucocutaneous Lymph Node Syndrome ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Abciximab ,Humans ,Immunologic Factors ,Registries ,cardiovascular diseases ,Practice Patterns, Physicians' ,Retrospective Studies ,Coronary artery aneurysm ,Aspirin ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Coronary Aneurysm ,Immunoglobulins, Intravenous ,Infant ,medicine.disease ,Clopidogrel ,Infliximab ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Kawasaki disease ,business ,medicine.drug ,Artery - Abstract
Objective To evaluate practice variation in pharmacologic management in the International Kawasaki Disease Registry (IKDR). Study design Practice variation in intravenous immunoglobulin (IVIG) therapy, anti-inflammatory agents, statins, beta-blockers, antiplatelet therapy, and anticoagulation was described. Results We included 1627 patients from 30 IKDR centers with maximum coronary artery aneurysm (CAA) z scores 2.5-4.99 in 848, 5.0-9.99 in 349, and ≥10.0 (large/giant) in 430 patients. All centers reported IVIG and acetylsalicylic acid (ASA) as primary therapy and use of additional IVIG or steroids as needed. In 23 out of 30 centers, (77%) infliximab was also used; 11 of these 23 centers reported using it in 20% of patients. Nonsteroidal anti-inflammatory agents were used in >10% of patients in only nine centers. Beta-blocker (8.8%, all patients) and abciximab (3.6%, all patients) were mainly prescribed in patients with large/giant CAAs. Statins (2.7%, all patients) were mostly used in one center and only in patients with large/giant CAAs. ASA was the primary antiplatelet modality for 99% of patients, used in all centers. Clopidogrel (18%, all patients) was used in 24 centers, 11 of which used it in >50% of their patients with large/giant CAAs. Conclusions In the IKDR, IVIG and ASA therapy as primary therapy is universal with common use of a second dose of IVIG for persistent fever. There is practice variation among centers for adjunctive therapies and anticoagulation strategies, likely reflecting ongoing knowledge gaps. Randomized controlled trials nested in a high-quality collaborative registry may be an efficient strategy to reduce practice variation.
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- 2022
9. Compound heterozygous variants in IFT140 as a cause of nonsyndromic retinitis pigmentosa
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Tisiana Low, Meena Balasubramanian, and Anastassios Kostakis
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0301 basic medicine ,Genetics ,Heterozygote ,business.industry ,DNA Mutational Analysis ,Genetic Variation ,medicine.disease ,Compound heterozygosity ,03 medical and health sciences ,Ophthalmology ,Young Adult ,030104 developmental biology ,Pediatrics, Perinatology and Child Health ,Retinitis pigmentosa ,Mutation ,Electroretinography ,Medicine ,Humans ,Female ,business ,Carrier Proteins ,Genetics (clinical) ,Retinitis Pigmentosa ,Tomography, Optical Coherence - Published
- 2017
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