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Liu H, Zhang Z, Gao Y, Lin H, Zhu Z, Zheng H, Ye W, Luo Z, Qing Z, Xiao X, Hu L, Zhou Y, Zhang X. Leydig cell metabolic disorder act as a new mechanism affecting for focal spermatogenesis in Klinefelter syndrome patients: a real world cross-sectional study base on the age. Front Endocrinol (Lausanne) 2023; 14:1266730. [PMID: 38027184 PMCID: PMC10650597 DOI: 10.3389/fendo.2023.1266730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Klinefelter's syndrome (KS) was once considered infertile due to congenital chromosomal abnormalities, but the presence of focal spermatozoa changed this. The key to predict and promote spermatogenesis is to find targets that regulate focal spermatogenesis. Objective To explore the trend of fertility changes in KS patients at different ages and identify potential therapeutic targets. Methods Bibliometric analysis was used to collect clinical research data on KS from the Web of Science Core Collection (WoSCC) from 1992 to 2022. A cross-sectional study was conducted on 75 KS patients who underwent microscopic testicular sperm extraction (mTESE) from 2017 to 2022 in the real world. The reproductive hormones, testicular histopathology, androgen receptors, insulin-like factor 3 (INSL3) receptors and sperm recovery rate (SRR) were analyzed. Results Male infertility, dysplasia, Sertoli cells, Leydig cells, testosterone and spermatogenesis were the research focuses related to KS. Luteinizing hormone (LH), testosterone, and INSL3 were evaluation indicators of Leydig cell function that fluctuate with age. Testosterone and LH peaked at ages 13-19 and 30-45, while INSL3 only peaked at ages 13-19. 27 patients (27/75) recovered sperm through mTESE and experienced SRR peaks at the ages of 20, 28, 34, and 37. The SRR of fibrosis patients was 46.15%, fatty degeneration was 7.14%, and melanosis was 40.00%. The INSL3 and androgen receptors were highly expressed and roughly balanced in focal spermatogenesis. Conclusion Abnormal metabolism of Leydig cells led to imbalanced expression of INSL3 and androgen receptors, which might be a potential target for spermatogenesis in KS.
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Affiliation(s)
- Huang Liu
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Zhenhui Zhang
- Reproductive Medicine Center, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
| | - Yong Gao
- Department of Reproductive Medicine Center, Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangdong Provincial Clinical Research Center for Objective and Gynecological Diseases, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Hai Lin
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Zhiyong Zhu
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Houbin Zheng
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Wenjing Ye
- Reproductive Medicine Center, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Zefang Luo
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Zhaohui Qing
- Department of Anesthesiology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Xiaolan Xiao
- Department of Anesthesiology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Lei Hu
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Yu Zhou
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Xinzong Zhang
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
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Mendonça F, Souto S, Dória S, Carvalho D. Klinefelter syndrome: The characterization of the clinical and sociological features of 51 patients. Rev Int Androl 2023; 21:100349. [PMID: 37054629 DOI: 10.1016/j.androl.2023.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Klinefelter syndrome is the most frequently found aneuploidy among male patients. Its clinical presentation is very heterogeneous, and thus poses a challenge for a timely diagnosis. METHODS A retrospective study was carried out with 51 consecutively selected patients diagnosed with Klinefelter Syndrome from Jan/2010 to Dec/2019. The karyotypes were identified using high resolution GTL banding at the Genetics Department. Multiple clinical and sociological parameters were studied by collecting data from the clinical records. RESULTS 44 (86%) of the 51 patients presented a classical karyotype (47,XXY) and 7 (14%) showed evidence of mosaicism. The mean age at diagnosis was 30.2±14.3 years old. Regarding the level of education (N=44), 26 patients (59.1%) had no secondary education, with 5 (11.4%) patients having concluded university studies. Almost two thirds of the sample revealed learning difficulties (25/38) and some degree of intellectual disability was present in 13.6% (6/44). Half of the patients were either non-qualified workers (19.6%) or workers in industry, construction, and trades (30.4%), which are jobs that characteristically require a low level of education. The proportion of unemployed patients was 6.5%. The main complaints were infertility (54.2%), followed by hypogonadism-related issues (18.7%) and gynecomastia (8.3%). 10 patients (23.8%, N=42) were biological parents. With regards the question of fertility, assisted reproductive techniques were used in 39.6% of the studied subjects (N=48), with a success rate (a take home baby) of 57.9% (11/19), 2 with donor sperm and 9 with the patients' own gametes. Only 41% of the patients (17/41) were treated with testosterone. CONCLUSION This study identifies the most important clinical and sociological findings of Klinefelter syndrome patients that should be considered when deciding workout and disease management.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal.
| | - Selma Souto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Sofia Dória
- i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Department of Genetics, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
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Saacks NA, Eales J, Spracklen TF, Aldersley T, Human P, Verryn M, Lawrenson J, Cupido B, Comitis G, De Decker R, Fourie B, Swanson L, Joachim A, Brooks A, Ramesar R, Shaboodien G, Keavney BD, Zühlke LJ. Investigation of Copy Number Variation in South African Patients With Congenital Heart Defects. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003510. [PMID: 36205932 PMCID: PMC9770125 DOI: 10.1161/circgen.121.003510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is a leading non-infectious cause of pediatric morbidity and mortality worldwide. Although the etiology of CHD is poorly understood, genetic factors including copy number variants (CNVs) contribute to the risk of CHD in individuals of European ancestry. The presence of rare CNVs in African CHD populations is unknown. This study aimed to identify pathogenic and likely pathogenic CNVs in South African patients with CHD. METHODS Genotyping was performed on 90 patients with nonsyndromic CHD using the Affymetrix CytoScan HD platform. These data were used to identify large, rare CNVs in known CHD-associated genes and candidate genes. RESULTS We identified eight CNVs overlapping known CHD-associated genes (GATA4, CRKL, TBX1, FLT4, B3GAT3, NSD1) in six patients. The analysis also revealed CNVs encompassing five candidate genes likely to play a role in the development of CHD (DGCR8, KDM2A, JARID2, FSTL1, CYFIP1) in five patients. One patient was found to have 47, XXY karyotype. We report a total discovery yield of 6.7%, with 5.6% of the cohort carrying pathogenic or likely pathogenic CNVs expected to cause the observed phenotypes. CONCLUSIONS In this study, we show that chromosomal microarray is an effective technique for identifying CNVs in African patients diagnosed with CHD and have demonstrated results similar to previous CHD genetic studies in Europeans. Novel potential CHD genes were also identified, indicating the value of genetic studies of CHD in ancestrally diverse populations.
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Affiliation(s)
- Nicole A. Saacks
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
| | - James Eales
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom (J.E., B.D.K.)
| | - Timothy F. Spracklen
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
- Department of Medicine, Cape Heart Institute (T.F.S., G.S., L.J.Z.)
| | - Thomas Aldersley
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
| | - Paul Human
- Chris Barnard Division of Cardiothoracic Surgery, Department of Medicine, Faculty of Health Sciences (P.H., A.B.)
| | - Mark Verryn
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa (M.V., G.S.)
| | - John Lawrenson
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa (J.L., B.F.)
| | - Blanche Cupido
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences (B.C., L.J.Z.)
| | - George Comitis
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
| | - Rik De Decker
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
| | - Barend Fourie
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa (J.L., B.F.)
| | - Lenise Swanson
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
| | - Alexia Joachim
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
| | - Andre Brooks
- Chris Barnard Division of Cardiothoracic Surgery, Department of Medicine, Faculty of Health Sciences (P.H., A.B.)
| | - Raj Ramesar
- MRC Genomic & Precision Medicine Research Unit, Division of Human Genetics, Dept of Pathology, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa (R.R.)
| | - Gasnat Shaboodien
- Department of Medicine, Cape Heart Institute (T.F.S., G.S., L.J.Z.)
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa (M.V., G.S.)
| | - Bernard D. Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom (J.E., B.D.K.)
| | - Liesl J. Zühlke
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health (N.A.S., T.F.S., T.A., J.L., G.C., R.D.D., L.S., A.J., L.J.Z.)
- Department of Medicine, Cape Heart Institute (T.F.S., G.S., L.J.Z.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences (B.C., L.J.Z.)
- South African Medical Research Council, Cape Town (L.J.Z.)
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Stancampiano MR, Suzuki K, O'Toole S, Russo G, Yamada G, Faisal Ahmed S. Congenital Micropenis: Etiology And Management. J Endocr Soc 2022; 6:bvab172. [PMID: 35036822 PMCID: PMC8754418 DOI: 10.1210/jendso/bvab172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 01/23/2023] Open
Abstract
In the newborn, penile length is determined by a number of androgen dependent and independent factors. The current literature suggests that there are interracial differences in stretched penile length in the newborn and although congenital micropenis should be defined as a stretched penile length of less than 2.5 SDS of the mean for the corresponding population and gestation, a pragmatic approach would be to evaluate all boys with a stretched penile length below 2 cm, as congenital micropenis can be a marker for a wide range of endocrine conditions. However, it remains unclear as to whether the state of micropenis, itself, is associated with any long-term consequences. There is a lack of systematic studies comparing the impact of different therapeutic options on long-term outcomes, in terms of genital appearance, quality of life, and sexual satisfaction. To date, research has been hampered by a small sample size and inclusion of a wide range of heterogeneous diagnoses; for these reasons, condition-specific outcomes have been difficult to compare between studies. Lastly, there is a need for a greater collaborative effort in collecting standardized data so that all real-world or experimental interventions performed at an early age can be studied systematically into adulthood.
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Affiliation(s)
| | - Kentaro Suzuki
- Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Stuart O'Toole
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan 20132, Italy
| | - Gen Yamada
- Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Syed Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow G51 4TF, UK
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Nassau DE, Best JC, Cohen J, Gonzalez DC, Alam A, Ramasamy R. Androgenization in Klinefelter syndrome: Clinical spectrum from infancy through young adulthood. J Pediatr Urol 2021; 17:346-352. [PMID: 33726973 DOI: 10.1016/j.jpurol.2021.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022]
Abstract
Klinefelter syndrome (KS) is an uncommon chromosomal disorder in males that has a variable clinical appearance. Classic KS involves an extra X chromosome, (47, XXY), although other variations may exist, including a milder mosaic form as well as multiple extra sex chromosomes with more dramatic phenotypes. KS is underdiagnosed, especially pre-pubertally, owing to a paucity of concrete clinical signs; however, diagnostic rates increase during and after puberty, as the consequences of hypergonadotropic hypogonadism begin to manifest. Testicular failure causing decreased circulating testosterone (T) and germ cell depletion, a hallmark feature in KS, commonly begins shortly after the onset of puberty and leads to the most commonly recognized KS traits: small testes, azoospermia, gynecomastia, decreased facial and pubic hair. While many KS men maintain adequate T levels leading up to young adulthood, some may have lower T levels at an earlier age leading to varied levels of androgenization and clinical KS features. At certain critical time points, absent or decreased T may alter the development of normal male reproductive organs, external genitalia, development of secondary sexual characteristics and spermatogenesis. Testicular failure in utero may lead to ambiguous genitalia, cryptorchidism and/or hypospadias, all of which depend on fetal T production. In the neonatal period and childhood, decreased T levels during the mini-puberty of infancy may negatively impact germ cell differentiation and male neuropsychological development. Finally, decreased T during pubertal and young adulthood can lead to decreased virilization during puberty, eunuchoid skeleton and decreased spermatogenesis. Depending on the timing of the testicular failure, a reproductive window of sperm production may exist to achieve paternity for KS men. The presence or absence of clinical characteristics reflecting decreased androgenization provides an insight to the relative testicular function during these developmental time points for those with KS and contributes to variability within the syndrome.
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Affiliation(s)
- Daniel E Nassau
- Division of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA; Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Jordan C Best
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jordan Cohen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel C Gonzalez
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alireza Alam
- Division of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Dhangar S, Ghatanatti J, Vundinti BR. array-CGH revealed gain of Yp11.2 in 49,XXXXY and gain of Xp22.33 in 48,XXYY karyotypes of two rare klinefelter variants. Intractable Rare Dis Res 2020; 9:145-150. [PMID: 32844071 PMCID: PMC7441031 DOI: 10.5582/irdr.2020.01026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Klinefelter syndrome (KS) variants often share common features with classical syndrome but some of these variants present with a distinct phenotype. The incidence of sex chromosome tetrasomy and pentasomy are very less and generally diagnosed after prepubertal age. The early diagnosis of complex and unclassified syndromes and it's correlation with genotype is necessary for personalized treatment as well as genetic counselling of the affected families. We describe clinical presentation, and genetic diagnosis of two cases of variant KS. Our first case, a 4 year old male child presented with generalized tonic-clonic seizures (GTCSs), delayed milestones and dysmorphic features while case 2, a-21 years old male who had history of seizures and delayed puberty came to our lab for genetic diagnosis. The chromosomal analysis of case 1 and 2 showed 49,XXXXY and 48,XXYY karyotype respectively. The karyotype results were confirmed with fluorescence in situ hybridization (FISH) and array-CGH analysis. The FISH results were found to be consistent with karyotype but the array-CGH results showed the extra gain of region Yp11.2 in case 1 while the extra gain of region Xp22.33 in case 2. The cases were confirmed as variant KS on the basis of additional sex chromosomes and clinical presentation of deteriorated brain development. The present study suggests that the high doses of sex chromosome linked genes including pseudoautosomal region (PAR) caused the abnormal brain development. The combination of molecular techniques should be utilized for the diagnosis of such complex cases to understand the genotype-phenotype correlation and appropriate genetic counseling.
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Affiliation(s)
- Somprakash Dhangar
- Department of Cytogenetics, National Institute of Immunohaematology (ICMR), K.E.M Hospital campus, Parel, Mumbai, India
| | - Jagdeeshwar Ghatanatti
- Department of Cytogenetics, National Institute of Immunohaematology (ICMR), K.E.M Hospital campus, Parel, Mumbai, India
| | - Babu Rao Vundinti
- Department of Cytogenetics, National Institute of Immunohaematology (ICMR), K.E.M Hospital campus, Parel, Mumbai, India
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