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.     

22q11微缺失与先天性心脏病的关系的研究

应用染色体荧光原位杂交（FISH）技术,对25例不同表型的先天性心脏病患者外周血标本进行22q11微缺失的检测,以探讨先天性心脏病与22q11微缺失的关系。受检的23例单纯性先天性心脏病患者,无22q11缺失者为19例,发生缺失者为4例;2例法鲁氏四联症伴心外多发畸形患者,有22q11缺失。上述结果表明,先天性心脏病与22q11微缺失有关。     

Transvenous pacing in complex post-operative congenital heart disease guided by angiography: A case report

Transvenous pacing in patients with postoperative complex congenital heart disease (CHD) can be challenging and pose technical challenges to lead placement because of the complex anatomy, distortions produced by the surgical procedures, and the altered relationship of cardiac chambers. We describe the utility of angiography for transvenous dual chamber pacemaker implantation in a post-operative complex congenital heart disease.     

超声检测胎儿先天性心脏病存在问题分析

目的探讨并分析产前超声筛查胎儿先天性心脏病临床应用中存在的问题。方法回顾性分析本院近三年来599例胎儿先天性心脏病超声检查情况。结果确诊49例先天性心脏病,43例于产前确诊,产前心超敏感性为87．7％。漏诊5例,漏诊率10．2％。误诊1例,误诊率2．04％。49例先心病者中,产前确诊后失访的32例,失访率高达65％。检查孕周为17周-39．5周,平均28．4周。结论虽然超声筛查胎儿先天性心脏病具有无创性、敏感性高等优点,但仍存在漏诊、误诊、诊断时间过晚等问题,值得引起注意。     

基于表达谱芯片和下一代测序技术筛选先天性心脏病胎儿心肌组织差异表达的miRNA

目的 联合采用表达谱芯片和下一代测序技术同时高通量筛选先天性心脏病胎儿心肌组织表达差异的miRNA.方法 实验组为孕中期先天性畸形胎儿,对照组为同胎龄无心脏畸形的难免流产的胎儿,取胎儿心室心肌组织,联合采用Agilent Human 2.0 microRNAs表达谱芯片和SOLiD下一代测序技术同时观察心肌组织microRNA的表达变化,数据采用生物信息学方法进行分析,并用实时PCR方法验证芯片结果.结果 通过差异miRNA筛选,发现先天性心脏畸形组在表达谱芯片和下一代测序中共同差异的24个miRNA,生物信息学预测到1 606个靶基因,靶基因Gene Ontology分析表明其中与细胞进程、代谢过程、生物调控相关的靶基因为主,Pathway显著性分析表明,部分靶基因为生物信号通路中的关键因子;随机挑选共同表达差异的4个miRNA进行验证,结果表明定量PCR检测结果与芯片与下一代测序共同筛选结果基本相符.结论 这些在先天性心脏病中异常表达的miRNA为研究先天性心脏病分子水平上的发病机制提供了重要的线索,将有可能为心脏相关疾病的诊断和治疗提供新的靶点和研发新的药物.     

Sinus Node Dysfunction as the First Manifestation of Left Ventricular Noncompaction with Multiple Cardiac Abnormalities

Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which may remain undiagnosed till adulthood due to the late presentation of typical symptoms such as dyspnea, congestion, ventricular arrhythmias and thromboembolism. Symptomatic bradycardia secondary to persistent sinus node dysfunction is very rare. Coexistent cardiac defects are common in children however in adults the disease is usually in isolated form. Here, we present a case of twenty-three year-old female LVNC patient with patent ductus arteriosus, bicuspid aortic valve and persistent sinus node dysfunction who presented with dizziness as the first manifestation of the disease.     

冠状动脉粥样硬化性心脏病8号染色体基因扫描

冠状动脉粥样硬化性心脏病(Coronary heart disease,CHD)的全基因组扫描研究在世界各大研究中心展开,关于CHD易感基因位点的报道多集中于1号、3号、9号、11号、16号染色体,对8号染色体的研究报道甚少。在汉族人群中未见关于CHD的8号染色体的基因扫描研究。文章旨在查找汉族人群中CHD易感基因位点,选取8号染色体上间隔10 cM遗传距离的13个微卫星遗传位点,采用DNA混合池的方法对CHD患者组156例和正常对照组1 000例DNA样本进行基因扫描,经卡方检验分析患者组和对照组每个位点的等位基因频率差异。发现在患者组与对照组中D8S264位点(8p23.3-p23.2)及D8S285位点(8q12.1)的等位基因频率差异有统计学意义(P<0.05)。汉族人群中CHD患者8号染色体上8p23.3-p23.2、8q12.1区域可能存在CHD易感基因,需要进行候选基因突变筛查。     

X/XY/XYY mosaicism as a cause of subfertility in boars: a single case study

Sex chromosome abnormalities are common in mammals and humans and are often associated with subfertility. In this study a boar with normal sperm parameters was indicated to have reduced prolificacy from figures obtained for return rate, farrowing rate and total number of piglets born. G-banded cytogenetic analysis of peripheral blood identified an abnormal mosaic sex chromosome constitution 39,XYY[74]/38,XY[23]/37,X[3]. Cytogenetic analysis of fibroblasts confirmed this mosaic karyotype with similar percentages of cell lines observed 39,XYY[76]/38,XY[19]/37,X[5]. External genitalia revealed a poorly developed scrotum with the right testicle being smaller than the left. To the best of our knowledge this is the first time that this chromosome constitution has been reported in the pig. It is of particular interest that this karyotype is associated with reduced boar fertility, which could lead to potential economic losses if such a boar were selected for breeding purposes.     

血红蛋白200g/L以上紫绀型先天性心脏病患者手术效果分析

目的:明确血红蛋白200 g/L以上紫绀型先天性心脏病患者的手术效果。方法:选取2009年3月至2012年3月于我中心就诊手术治疗的紫绀型先天性心脏病患者,按血红蛋白计数≥200 g/L和200 g/L分为A组和B组,完善术前检查后进行手术治疗。记录患者手术效果和随访情况;观察比较两组患者手术中情况包括:手术方式、手术时间、体外循环时间、心脏停搏时间、心脏自动复跳情况;记录并比较两组患者手术后恢复情况,包括机械通气时间、监护室滞留时间、手术后24小时内出血量、二次开胸止血例数和血管活性药物评分,以及监护室内肝肾功能异常和肺部并发症发生例数。结果:A组死亡3例(5.2%),23例术后3个月随访效果良好;B组死亡2例(5.8%),12例术后3个月随访效果良好。两组患者手术方式、手术时间、体外循环时间和心脏停搏时间、自动复跳例数均无明显差异(P0.05)。与B组比较,A组患者术后机械通气和监护室滞留时间长,术后24小时出血量多,血管活性药物使用评分高,肝肾功能异常例数和肺部并发症发生例数较多有统计学意义(P0.05),两组间二次开胸止血例数无统计学差异(P0.05)。结论:血红蛋白200 g/L以上紫绀型先天性心脏病患者与其他紫绀型先天性心脏病患者手术效果相似,但手术后恢复慢,并发症较多。     

DNA methylation abnormalities in congenital heart disease

Congenital heart defects represent the most common malformation at birth, occurring also in ∼50% of individuals with Down syndrome. Congenital heart defects are thought to have multifactorial etiology, but the main causes are largely unknown. We have explored the global methylation profile of fetal heart DNA in comparison to blood DNA from control subjects: an absolute correlation with the type of tissue was detected. Pathway analysis revealed a significant enrichment of differential methylation at genes related to muscle contraction and cardiomyopathies in the developing heart DNA. We have also searched for abnormal methylation profiles on developing heart-tissue DNA of syndromic and non-syndromic congenital heart defects. On average, 3 regions with aberrant methylation were detected per sample and 18 regions were found differentially methylated between groups. Several epimutations were detected in candidate genes involved in growth regulation, apoptosis and folate pathway. A likely pathogenic hypermethylation of several intragenic sites at the MSX1 gene, involved in outflow tract morphogenesis, was found in a fetus with isolated heart malformation. In addition, hypermethylation of the GATA4 gene was present in fetuses with Down syndrome with or without congenital heart defects, as well as in fetuses with isolated heart malformations. Expression deregulation of the abnormally methylated genes was detected. Our data indicate that epigenetic alterations of relevant genes are present in developing heart DNA in fetuses with both isolated and syndromic heart malformations. These epimutations likely contribute to the pathogenesis of the malformation by cis-acting effects on gene expression.     

组蛋白修饰在先天性心脏病中的作用

先天性心脏病(congenital heart disease, CHD)是包括心肌壁、瓣膜和主要血管缺陷在内的心脏先天性结构异常疾病。虽然胚胎发生过程中的基因突变和异常基因表达等遗传因素会导致CHD,但这些只能解释一部分CHD的发病原因。表观遗传中的组蛋白修饰在CHD中的研究越来越多,提示其在CHD发病机制中愈发重要。随着基于质谱的蛋白质组学技术发展,一系列新型组蛋白翻译后修饰,包括琥珀酰化、糖基化、乳酸化和β-羟基丁酰化等在疾病中发挥的作用被揭示,而这些新型修饰如何调控CHD的发生发展过程中的基因表达以及病理进程并不得知。本文将分别从经典组蛋白修饰和新型组蛋白修饰出发阐述不同的组蛋白修饰参与调控心脏发育基因的作用机制,以期揭示组蛋白驱动的表观遗传机制在CHD病因学中的重要性,也为CHD的临床治疗及时预防提供理论依据。     

先天性心脏病相关综合征的遗传学研究

先天性心脏病(congenitalheartdisease,CHD)是儿科常见的疾病,现已发现约有300多种临床综合征伴有CHD.对Alagille综合征、CHARGE联合征、Holt-Oram综合征、Noonan综合征、Turner综合征、VACTERL联合征、Williams综合征、22q11缺失综合征和13、18、21三体综合征与CHD相关流行病学、临床表型、遗传病因和诊断及其再发风险进行了综述,为产前和产后临床诊断,了解疾病预后和再发概率提供资料.