Outcomes of Preimplantation Genetic Diagnosis Cycles by Fluorescent Hybridization of Infertile Males with Nonmosaic 47,XYY Syndrome / 中华医学杂志(英文版)

Background@#The 47,XYY syndrome could result in fertility problems. However, seldom studies reported comprehensive researches on the embryonic development and pregnancy outcomes of these patients. This study aimed to evaluate the clinical outcomes of nonmosaic 47,XYY patients performed with fluorescent in situ hybridization (FISH) and preimplantation genetic diagnosis (PGD) treatment.@*Methods@#This was a retrospective study. Between January 2012 and May 2017, 51 infertile males with nonmosaic 47,XYY syndrome underwent FISH-PGD were included in the study. According to sex chromosomal FISH results, embryos were classified as normal signal, no nuclei fixed, no signal in fixed nuclei, suspensive signal, and abnormal signal groups, respectively. The incidence of each group, the fixation rate, and hybridization rate were calculated. Embryonic development and pregnancy outcomes were also analyzed. The measurement data were analyzed with Student's t-test. The comparison of categorical data was analyzed with the Chi-square test and Fisher's exact test when expected cell count was 0.05), and were significantly lower than the normal signal group (66.4%, P < 0.001). The clinical pregnancy rates of fresh and frozen embryos transferred cycles were 70.6% and 85.7%, respectively.@*Conclusions@#Among embryos with a clear diagnosis of sex chromosome, about one-fifth showed abnormal signals. Embryos with two sex chromosomal signals are more likely to develop into good-quality ones. The application of the PGD by FISH may help to improve the clinical outcome s.

Analysis of genetics mechanism for the phenotypic diversity in a patient carrying a rare ring chromosome 9 / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the genetics mechanism for the phenotypic variability in a patient carrying a rare ring chromosome 9.</p><p><b>METHODS</b>The karyotype of the patient was analyzed with cytogenetics method. Presence of sex chromosome was confirmed with fluorescence in situ hybridization. The SRY gene was subjected to PCR amplification and direct sequencing. Potential deletion and duplication were detected with array-based comparative genomic hybridization (array-CGH).</p><p><b>RESULTS</b>The karyotype of the patient has comprised 6 types of cell lines containing a ring chromosome 9. The SRY gene sequence was normal. By array-CGH, the patient has carried a hemizygous deletion at 9p24.3-p23 (174 201-9 721 761) encompassing 30 genes from Online Mendelian Inheritance in Man.</p><p><b>CONCLUSION</b>The phenotypic variability of the 9p deletion syndrome in conjunct with ring chromosome 9 may be attributable to multiple factors including loss of chromosomal material, insufficient dosage of genes, instability of ring chromosome, and pattern of inheritance.</p>

Cytogenetic and molecular genetic analysis of a case with mosaic marker chromosomes / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the source of small supernumerary marker chromosome in a case.</p><p><b>METHODS</b>G-banded karyotyping, fluorescence in situ hybridization, multiple sequence tagged sites (STS) of the Y chromosome, and Illumima Human Cyto SNP-12 Beadchip analysis were carried out.</p><p><b>RESULTS</b>The karyotype was mos 46,X,+mar1[21]/46,X,+mar2[78]. Y chromosome STS analysis has displayed the presence of sy84, sY86, USP9Y and DDX3Y genes from the AZFa region, and sY1227 of the AZFb region, while sY1228, sY1015, sY127, sY134 from the AZFb region, and sY254 and sY255 from the AZFc region were missing. FISH analysis has verified both of the marker chromosomes to be Y chromosome fragments. Mar1 was ish.idic(Y)(q11.2)(SRY++,DXZ1+,DYZ3++,DYZ1-), while mar2 was ish.del(Y)(q11.2)(SRY+,DXZ1+,DYZ3+,DYZ1-). Single nucleotide polymorphism (SNP) microarray analysis showed that the Yq11.2-Yq12 has lost a 10.81 Mb fragment.</p><p><b>CONCLUSION</b>The marker chromosomes were verified to be aberrant Y chromosomes, with the breakage and recombination occurring in Yq11.2. Mar 1 was an isodicentric Y chromosome (idic(Y)pter to q11.2::q11.2 to pter), and mar2 was del(Y)(q11.2). The karyotype was mos 46,X,ish idic(Y)(q11.2)(DYZ3++,SRY++,DXZ1+,DYZ1-)[21]/46,X,ish del(Y)(q11.2)(DYZ3+,SRY+,DXZ1+,DYZ1-)[78]. Combined FISH, Y chromosome STS analysis, SNP microarray analysis and other technologies can facilitate determination of the nature of marker chromosomes.</p>

Genetic analysis of a child with XYY syndrome mainly featuring mental retardation / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the genetic cause for a boy featuring mainly with mental retardation.</p><p><b>METHODS</b>G-banding karyotyping and fluorescence in situ hybridization (FISH) were carried out for the child and his parents. The child was also analyzed with chromosome microarray (CMA). Suspected microdeletion was validated with quantitative PCR.</p><p><b>RESULTS</b>The proband was found to have a 47,XYY karyotype by both chromosome and FISH analyses, while both of his parents had a normal karyotype. CMA suggested that the proband had one copy of X chromosome and two copies of Y chromosome. In addition, CMA has also detected deletion of the KYNU gene (mapped at 2q22.2), which could be pathogenic. The result was confirmed by qPCR.</p><p><b>CONCLUSION</b>For its high resolution, CMA can be used to identify potential microdeletion/duplications among children with chromosome aneuploidy and unusual phenotypes.</p>

XYY syndrome: a 13-year-old boy with tall stature

When evaluating the underlying causes of tall stature, it is important to differentiate pathologic tall stature from familial tall stature. Various pathologic conditions leading to adult tall stature include excess growth hormone secretion, Marfan syndrome, androgen or estrogen deficiency, testicular feminization, and sex chromosome anomaly, such as Klinefelter syndrome and XYY syndrome. Men with 47,XYY syndrome can exhibit multiple phenotypes. A 13-year-old boy visited the hospital for evaluation of tall stature. The boy had no other physical abnormalities except tall stature. All biochemical and imaging studies were within the normal ranges. He was diagnosed with XYY syndrome in this chromosome study. When evaluating men with tall stature, XYY syndrome should be ruled out.

Morphology and pathogenesis of 47, XYY/47, XY, +mar identified in patients with super male syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the source and morphology of supernumerary markers from patients with 47,XYY/47,XY, +mar and supermale syndrome.</p><p><b>METHODS</b>Conventional GTG banded karyotyping and dual-color fluorescence in situ hybridization (FISH) were performed on 21 such patients.</p><p><b>RESULTS</b>Among these cases, 18 had their small supernumerary marker derived from the Y chromosome. Three were derived from autosomal chromosomes. Those derived from Y chromosome were small fragments with centromeres, while those derived from autosomes were in the ring form.</p><p><b>CONCLUSION</b>In children with supermale syndrome and 47,XYY/47,XY,+ mar, the supernumerary marker chromosomes primarily derive from sex chromosomes. These small chromosomes mainly have the forms of small segments with centromeres or rings. For such children, molecular cytogenetic analysis can facilitate genetic counseling and prenatal diagnosis.</p>

Genetic analysis of a family with super-male syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the genetic cause for a family featuring language retardation using combined cytogenetic and molecular genetic methods.</p><p><b>METHODS</b>Following conventional G-banded karyotype analysis, the additional Y chromosome was identified by fluorescence in situ hybridization (FISH) and multiplex ligation dependent probe amplification (MLPA). Whole genome array comparative genomic hybridization (aCGH) was also carried out to detect minor structural chromosomal abnormalities.</p><p><b>RESULTS</b>The proband's karyotype was determined as 47,XY,+?, and the unknown aberrant chromosome was identified as Yqh+ with FISH, MLPA and aCGH. No other chromosomal abnormality was found in the pedigree.</p><p><b>CONCLUSION</b>Cytogenetic methods combined with FISH, MLPA, and aCGH can efficiently identify the origin of unknown chromosomes and provide accurate clues for clinical diagnosis and treatment.</p>

Trastornos de la fertilidad y aberraciones cromosómicas asociadas / Fertility disorders and associated chromosomal aberrations

En la actualidad, a pesar de contar con herramientas diagnósticas moleculares, el cariotipo en sangre periférica es la primera línea de estudio para detectar problemas cromosómicos en la pareja infértil. Objetivo: describir los resultados del diagnóstico citogenético postnatal, realizado a pacientes con trastornos de la fertilidad en los que se sospecha la presencia de una cromosomopatía como causa de los mismos. Método: se realizó una investigación descriptiva y retrospectiva a partir de los resultados del diagnóstico cromosómico en sangre periférica y los motivos de indicación para el mismo. El universo estuvo constituido por doscientos ochenta y siete pacientes remitidos al Laboratorio de Citogenética del Centro Provincial de Genética Médica, entre los años 1987 y 2009. Los datos primarios se obtuvieron de los registros del Laboratorio de Citogenética y fueron vertidos en un modelo de recolección, procesados estadísticamente y mostrados en gráficos y tablas de distribución de frecuencias. Resultados: se describen 91 cromosomopatías, en sujetos mayormente femeninos (fenotípica y cromosómicamente). Entre ellas el síndrome Turner y sus variantes fue el más representado. Los trastornos reproductivos y la confirmación o exclusión de síndromes genéticos fueron los motivos de indicación más frecuentes para el examen citogenético. Conclusiones: el diagnóstico cromosómico constituye una importante herramienta para la detección de anomalías cromosómicas involucradas en los trastornos de la fertilidad.

Nowadays, in spite of the development of molecular diagnostic tools, the karyotype in peripheral blood is the first line of study to detect chromosomal abnormalities in the unfertile couple. Objective: to describe the results of postnatal cytogenetic diagnoses performed on patients with fertility disorders when the presence of a chromosomopathy is suspected to be the cause. Method: a retrospective and descriptive research was performed from the results of chromosomal studies in peripheral blood and the indications of those studies. The studied universe included two hundred and eighty-seven patients referred to the Cytogenetics Laboratory of the Provincial Center of Medical Genetics, from 1987 to 2009. The obtained data were processed, analyzed and displayed in charts and tables of frequencies’ distribution. Results: ninety-one chromosomopathies are described, mainly in female subjects (phenotypically and chromosomally). Turner´s syndrome and its variants were the most represented. The reproductive disorders and the confirmation or exclusion of genetic syndromes were the most frequent indication of a cytogenetic study. Conclusions: chromosomal diagnosis constitutes an important tool for the detection of chromosomal anomalies involved in fertility disorders.

A Sri Lankan child with 49,XXXXY syndrome.

Pentasomy 49,XXXXY is a rare sex chromosome disorder usually presenting with ambigous genitalia, facial dysmorphism, mental retardation and a combination of cardiac, skeletal and other malformations. The incidence of the condition is estimated to be 1 in 85,000 male births. Previously, this condition was identified as a Klinefelter variant. The condition is suspected in a patient, by a combination of characteristic clinical findings, and the diagnosis is confirmed by chromosome culture and karyotyping. In the case we report here, the main presentation of ambiguous genitalia led to a suspicion of a sex chromosome aneuploidy which was subsequently confirmed by chromosomal analysis.

Variabilidad fenotípica en pacientes 47, XXX: presentación de cuatro casos nuevos / Phenotypic variability in 47, XXX patients: clinical report of four new cases

El síndrome 47, XXX se debe a un cromosoma extra del par sexual; su incidencia es de 1 en 1000 recién nacidas vivas. Sin embargo, este síndrome no suele sospecharse al nacimiento ni en la infancia. Muchas de estas pacientes son diagnosticadas durante la edad adulta por falla ovárica precoz o esterilidad, debido a la falta de características clínicas específicas .Este trabajo describe cuatro casos de pacientes 47, XXX y su variabilidad fenotípica.

The 47, XXX karyotype has a frequency of 1 in 1000 female newborns. However, this karyotype is not usually suspected at birth or childhood. These patients are usually diagnosed duringadulthood when they develop premature ovarian failure or infertility, because the early phenotype doesn't have anyspecific features. The study describes four cases and the clinical variability of the 47, XXX karyotype.

Quimerismo genético un nuevo paradigma para la medicina legal / Genetic chimerism a new paradigm for legal medicine

El quimerismo genético un concepto no bien esclarecido en la comunidad científica, aún confundido con mosaicismo. En la presente revisión pretendemos definirlo con un enfoque legal y ejemplificarlo con una serie de casos descritos en la literatura médica, los cuales nos orientan a la diferencia clara entre mosaicismo y quimerismo. Dentro de esta serie separamos los casos que se relacionan con hermafroditismo y los no relacionados. Además, hacemos referencia a un nuevo concepto que genera polémica en la investigación, el microquimerismo, relacionado con transfusiones sanguíneas, transplantes y la génesis de las enfermedades autoinmunes.

Genetic chimerism is a not well defined concept among the scientific community; it is still confused with mosaicism. In the following review we intend to define the concept with a legal point of view and exemplify it with a series of cases described in medical texts. The cases lead us to find the clear difference between mosaicism and chimerism. Contained in these series of cases we have separated the ones related with hemaphroditism from the ones that are not related. We also make reference to a new concept that generates controversy in the investigation; microchimerism, which is related with blood transfusions, transplants and genesis of autoimmune diseases..

The investigation of the relationship between the phenotypes of 46, XX males and the SRY gene / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between the phenotypes in XX male patients and the sex determining region(SRY) gene.</p><p><b>METHODS</b>Multiple polymerase chain reactions were carried out in 6 male patients with karyotype of 46, XX, and then the PCR products were sequenced directly.</p><p><b>RESULTS</b>Three cases of male infertility were positive for the SRY gene without evident malformation in their extra genitalia, while 3 cases with testes were negative for the SRY gene, with evident malformation in their extra genitalia.</p><p><b>CONCLUSION</b>The SRY gene is key in sex determination and development, yet there might be other important genes involved.</p>

49, xxxxy syndrome with autoimmune diabetes and ocular manifestations

We report a rare case of 49,XXXXY syndrome with autoimmune diabetes [requiring insulin therapy], bilateral cataracts and unilateral glaucoma. A 25-year-old man with mental retardation presented with multiple skeletal abnormalities, polyuria and polydipsia. He had high glucose concentrations, without ketonuria, and hypergonadotropichypogonadism. Ophthalmic examination revealed a polar cataract in both eyes and increased intraocular pressure in the left eye. The anti-islet cell antibody test was positive, and antiglutamic acid decarboxylase autoantibody levels were elevated. Karyotype analysis revealed 49,XXXXY. Intensive insulin therapy and testosterone replacements were started. The autoimmune nature of diabetes that we observed in our patient seems to be predisposed by hypogonadism. Cataract and glaucoma in this case seem to be the result of diabetes, and an association of these ocular manifestations with the syndrome 49,XXXXY seems unlikely

Rapid sex determination using PCR technique compared to classic cytogenetics

Fetal sexual differentiation relies on the translation of chromosomal sex established at fertilization into gonadal sex and somatic sex as development proceeds. In cases where chromosomal, gonadal, and somatic sex are incongruent in human infants and children, rapid establishment of the diagnosis and implementation of medical and surgical management is of paramount importance, since the gender identity is so important to the psychological well-being throughout life. This work was done in order to test the value of PCR technique for rapid sex determination compared to classic cytogenetic technique. Subjects included 20, cases including 10 neonates with ambiguous genitalia, 2 adult females with delayed puberty and 8 adult males with infertility, in addition to 20 normal infants of both sexes as a control group. The diagnosis of sex was attempted through examination, cytogenetic study, ultrasonography, gonadal biopsy and hormonal analysis, in addition to PCR amplification for the detection of SRY and ATL1 gene loci on Y and X chromosomes respectively. Four neonates were diagnosed as partial testicular feminization showed both positive bands for the Y and X chromosomes and a karyogram of 46/XY. Three neonates were diagnosed as true hermaphrodites showed positive amplification for both Y and X chromosomes with a mosaic karyogram 46, XX/XY. Three neonates were diagnosed as cases of adrenogenital syndrome showed positive amplification of only the Xchromosome and had a karyogram of 46/XX. One of the two adult females was diagnosed as Turner syndrome showed positive amplification of the X chromosome and a karyogram of 45/XO; the other one was diagnosed as complete testicular feminization had a positive amplification of X and Y chromosomes and a karyogram of 46/XY. The 8 adult males with infertility showed a positive amplification of X and Y chromosome and a karyogram of 47/XXY [Klinefelter syndrome] in 7 cases and 46/XY gonadal dysgenesis in one case. We concluded that PCR as a simple, rapid and reliable technique can complement and also confirm cytogenetic studies in the diagnosis of sex in cases of sex chromosome disorders

Trastornos de la diferenciación sexual: presentación de un caso de genitales ambiguos y revisión del tema / Inconveniences of the sexual differentiation: presentation of a case of ambiguous genitals and review of the theme

Los trastornos de la diferenciación sexual constituyen un grupo complejo de entidades y síndromes. El término estados intersexuales hace referencia a aquellos recién nacidos que presentan genitales ambiguos, esto es, sin evidencia clara sobre sexo asignable. Su frecuencia en nuestro medio es relativamente escasa. Se presenta el caso de un recién nacido en el que, en el examen físico, presenta micropenisomía y escroto bífido. La fusión labioescrotal está alterada con rodetes separados que semejan labios mayores y una estructura que remeda un introito vaginal. En el estudio ultrasonográfico se descartó la presencia de útero y ovarios y se constató la presencia de testículos en canal inguinal. La cromatina sexual de células en interfase de la mucosa oral reveló la presencia de 0 de cuerpo Barr y el estudio cromosómico mostró un cariotipo masculino normal (46, XY), por lo que se interpreta el caso como un pseudohermafroditismo masculino. Se realiza una revisión de los trastornos de la diferenciación sexual.

Sexual differentiation disorders constitute a group of complex syndromes and entities. The term intersexual states makes reference to those newborns that present with ambiguos genitalia, that is, without any clear evidence of defined sex. Intersexuality may be classified as masculine and femenine pseudohermaphroditism and true hermaphroditism, which is caused by incomplete sexual differentiation in the male or virilization in the female. This disorder is relatively rare in our context, though knowledge increases more and more about it thanks to the development of molecular biology and the discovered involvement of genes in the normal sexual differentiation process. This article presented the case of a newborn whose dysmorphological exam at birth indicated positive findings in external genitalia such as micropenis and bifid scrotum. Labioscrotal fusion was upset with separated folds resembling labia majoris and a structure that seemed to be vaginal introitus. The ultrasonographic study eliminated the possibility of uterus and ovaria and showed the presence of testis in the inguinal canal. Sexual chromatin in interphase cells of the oral mucosa indicated 0 Barr corps and the chromosomal study showed normal male cariotype (46, XY), so this case was considered as male pseudohermaphroditism. Sexual differentiation disorders were reviewed.

Cytogenetic studies in amenorrhea

To study the frequency of the chromosomal abnormality [CA], referred for karyotyping, and counseling in individuals with primary amenorrhea [PA] and secondary amenorrhea [SA]. We report on a retrospective survey of 865 women with amenorrhea [620-PA and 245-SA] at the Division of Human Genetics, Department of Anatomy, St. John's Medical College, Bangalore, India from 1973 to 2005. The frequency of the CA in amenorrhea was 23.35%, while PA was 26.13%, and SA was 16.33%. Numerical CA was prevalent in 45.54% of the total; 43.83% in PA, and 52.5% in SA. In numerical chromosomal abnormality, the observed karyotypes were: 45,X; 47,XXX; X mosaicism [45,X/46,XX; 45,XX/46,XX/47,XXX; 45,X/47,XXX; 46,XX/47,XXX]; Y mosaicism [45,X/46,XY; 45,X/47,XYY]; and others: 46,XX/47,XX+10; 46,XX/46,XY; 46,XX/47,XXY. In addition, is the presence of 46,XY female condition in 63 cases [31.19%], out of which 34.57% were detected to be associated with primary, and 17.5% with SA. Included in the structural chromosomal anomaly were: 46,X,i[Xq]; reciprocal translocation [46,XX,t[9;14]]; Robertsonian translocation [13;14]; X; autosomal translocations [X;12 and X;14]; deletion/duplication/ fragment/isochromosome/marker/ring formation associated either with the long or the short arms of X chromosome; 46,XX,9q-; 46,XX/46,XX,3p[break]; in a pure free status or mostly in mosaic status. The present study has emphasized that karyotyping is one of the fundamental investigations in the evaluation of amenorrhea. It has highlighted CA, one of the genetic etiology as the causal factor in amenorrhea

Analysis of SRY gene in 8 cases of sex abnormality / 华中科技大学学报（医学）（英德文版）

In order to investigate the relationship between sex dysplasia and sex-determining region Y (SRY) gene, 8 patients with sexual abnormality were analyzed by cytogenetic and molecular genetic methods. Fluorescence in situ hybridization (FISH) using PY3.4, X alpha satellite, and SRY probes was performed in each case to analyze the sex chromosome translocation and gene translocation. SRY gene was amplified by polymerase chain reaction (PCR) and its mutation was detected by direct sequencing. The results showed that among 8 patients, 5 were positive for SRY and the remaining negative for SRY. In the patients positive for SRY genes, 3 presented testes and the left 2 streak ovaries. In the patients negative for SRY, only one case presented testes, while 2 ovaries. Direct sequencing demonstrated that all SRY genes were normal in the patients positive for SRY genes. FISH technique demonstrated that SRY genes translocated from Ypter to Xpter in 2 46,XX phenotypic males positive for SRY genes. It was concluded that SRY gene is strongly involved in male sex determination, while a sequence of other genes may be taken into account in sexual development.

Analysis of SRY gene in 8 cases of sex abnormality / 华中科技大学学报（医学）（英德文版）

In order to investigate the relationship between sex dysplasia and sex-determining region Y (SRY) gene, 8 patients with sexual abnormality were analyzed by cytogenetic and molecular genetic methods. Fluorescence in situ hybridization (FISH) using PY3.4, X alpha satellite, and SRY probes was performed in each case to analyze the sex chromosome translocation and gene translocation. SRY gene was amplified by polymerase chain reaction (PCR) and its mutation was detected by direct sequencing. The results showed that among 8 patients, 5 were positive for SRY and the remaining negative for SRY. In the patients positive for SRY genes, 3 presented testes and the left 2 streak ovaries. In the patients negative for SRY, only one case presented testes, while 2 ovaries. Direct sequencing demonstrated that all SRY genes were normal in the patients positive for SRY genes. FISH technique demonstrated that SRY genes translocated from Ypter to Xpter in 2 46,XX phenotypic males positive for SRY genes. It was concluded that SRY gene is strongly involved in male sex determination, while a sequence of other genes may be taken into account in sexual development.

Detection of embryo sex chromosome by dual color fluorescent in-situ hybridization / 华中科技大学学报（医学）（英德文版）

In order to evaluate the effects of sex chromosomal mosaicism on the accuracy of single-cell gender diagnosis, sex chromosomes of 21 normal fertilized embryos were detected by dual color fluorescent in-situ hybridization (FISH). The results showed that 4 embryos had sex chromosomal mosaicism (19%) and the remaining 17 showed uniformly XX or XY signals in all blastomeres. In conclusion, identification of sex by dual color FISH analysis of a single cell was accurate and efficient, and sex chromosomal mosaicism would not affect preimplantation gender diagnosis.