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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was archived by Ian Rose via FACBot (talk) 10 September 2021 [1].

Trisomy X

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Nominator(s): Vaticidalprophet 02:36, 21 June 2021 (UTC)[reply]

Trisomy X is one of the more common genetic syndromes you probably haven't heard of. Affecting one in a thousand women, the highest estimates for how many know they have it are around 10%, and it goes down a lot from there. It helps that the presentation is so variable -- how often do people get their chromosomes tested when they have no symptoms at all? And yet, sometimes those 'no symptoms at all' are the result of an entire extra chromosome. Fantastic how the human body works.

This is the main article of a series I've been working on extensively over the past few months. It's the first article I've taken to FAC; a previous article in the same series has gone through pre-FAC PR, which I've leaned on heavily while writing this to keep the article tight, accessible, and educational. I'm as happy with it as I can ever be with my own writing (you know how it is) and only a little crippled by self-doubt. I hope you find this an enjoyable and educational read on a sparsely-written topic, which I've gained the confidence to say is perhaps now the most comprehensive piece on the subject available to a general audience. Vaticidalprophet 02:36, 21 June 2021 (UTC)[reply]

Support by User:Neopeius

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What an excellent article this is! I shall be doing a text review, enjoying all the while. My first suggestion is, in the lead:

*"Beginning in the 1960s, cohort studies following people with sex chromosome aneuploidies from birth to adulthood found that people with these disorders are often mildly affected, fitting in with the general population, and that many cases never come to diagnostic attention."

How about "...and that many cases never came to diagnostic attention." to keep the tenses consistent and also to avoid simply duplicating the last sentence of the first paragraph (i.e. this sentence is about the historical context, not specifically just about the disorder.)
Tenses fixed. Vaticidalprophet 23:46, 21 June 2021 (UTC)[reply]
  • You blue link aneuploidy, but it's such a fundamental part of the article, I'd define it both in the summary and when it first appears. It was only when I got to the end of the article that I saw the definition was notated -- I'd put it in the text proper (ditto karyotype). Indeed, the problem with notes is they're essentially invisible -- they definitely shouldn't be used for fundamental definitions but rather (if at all -- I kind of hate notes in WP articles) for anecdotal asides not critical to the piece.
    This, I think, might be more in the realm of personal disagreement. One consideration I've used while writing that's similar to the mobile one (i.e. "most readers know this but most writers don't") is that logged-out editors have a gadget similar to navigation popups turned on by default -- assuming the leads for the given articles aren't terrible (that might be worth checking...) they can see the definitions of bluelinked terms simply by hovering without having to follow to the next article. I've used annotations because the definitions worth giving are somewhat long, and I worry it would distract from the text to give them in full. I recognize the concerns about notes bleeding into the references; I use {{NoteTag}} for them to try minimize this, as it stands out a lot more than a more subtle marker does. Vaticidalprophet 23:46, 21 June 2021 (UTC)[reply]

Presentation

  • Your first paragraph sort of throws people into the deep end and is highly jargon-heavy. I recognize that difficult terms are blue-linked, but as someone who writes abstruse articles (spaceflight, primarily) it's good to simplify. Down syndrome is an example of a more approachable article.
    Broadly simplified. Vaticidalprophet 23:46, 21 June 2021 (UTC)[reply]
  • Physiological is jargon-heavy but you do a good job of parenthetically explaining things. One exception is "Endocrinological research in trisomy X is sparse, but implies a high luteinizing hormone response.[6][22]"
    Simplified that section. Vaticidalprophet 23:46, 21 June 2021 (UTC)[reply]

Neurodevelopmental

*"Though intellectual disability is rare, it is more prevalent than in the general population, occurring in about 5–10% of females with trisomy X[3] compared to approximately 1% of the broader population.[26] Although the average is depressed, some women with trisomy X are highly intelligent,[27] and some patients in the medical literature have acquired advanced degrees or worked in cognitive fields.[25]"

Though followed by Although. A bit awkward.
Switched out for 'while' in the latter use. Vaticidalprophet 04:23, 21 June 2021 (UTC)[reply]
  • "Epilepsy in sex chromosome aneuploidies generally is mild,"
How about "Epilepsy in sex chromosome aneuploidies (like trisomy X) generally is mild,"
Ah, this was poor wording on my part -- I was trying for 'in general'. I've reworded to "sex chromosome aneuploidies as a whole". Vaticidalprophet 04:23, 21 June 2021 (UTC)[reply]
  • "Autism spectrum disorders are more common in trisomy X, occurring in approximately 15% of patients[28] compared to less than 1% of girls in the general population.[32] Adult women with trisomy X appear to have higher rates of autistic symptomatology than control women.[33] "
This confuses me. Are these two sentences redundant? (it was my understanding autism lasts a lifetime; it doesn't disappear with adulthood).
It is indeed a lifetime experience, but our research, unfortunately, focuses overwhelmingly on autistic children. I wanted to express that we know about autistic adults here too, rather than the all-too-common mistake of assuming autistic children and autistic adults are "basically the same", and I've reworded to hopefully clarify. Vaticidalprophet 04:23, 21 June 2021 (UTC)[reply]
  • "Executive dysfunction is more prevalent amongst those with trisomy X than the general population.[25][28]"

I went to Executive dysfunction and that didn't help me understand the sentence, either. :) Explanation, if you could.

Gave a quick explanation -- it's an inconveniently vague term sometimes. Vaticidalprophet 04:23, 21 June 2021 (UTC)[reply]

Psychological

* "The psychological portrait of trisomy X is not entirely clear, and appears to be complicated by a more severe phenotype in postnatally than prenatally diagnosed groups.[20]"

Delete the comma after clear or add "it" before "appears" (dependent clauses generally don't take commas)
Done. Vaticidalprophet 04:27, 21 June 2021 (UTC)[reply]
  • "Dysthymia and cyclothymia are more common than in the general population.[3][6]" I'd perhaps use more general terms and/or say "Mood disorders such as persistent depressive disorder and cyclothymia (similar to bipolar disorder but with lesser extremes)..."
    Re-worded as Dysthymia and cyclothymia, milder forms of depression and bipolar disorder respectively (a bit of an oversimplification but, I think, one I can get away with here). Vaticidalprophet 04:27, 21 June 2021 (UTC)[reply]
  • "Compared to control women, women with trisomy X average higher schizotypy, reporting higher levels of introversion, magical thinking, and impulsivity.[25] Approximately one-fifth of women with trisomy X report clinically significant levels of anxiety.[28] Women with trisomy X are often "late bloomers", experiencing high rates of psychological distress into early adulthood, but by their mid-thirties having stronger interpersonal bonds and healthy relationships.[25]"
I cite these sentences as good models. The first introduces a hard word but follows it up with context that makes it accessible. The latter sentence is utterly free of advanced jargon. :)
  • "schizophrenic women are more likely"
link schizophrenia
Linked in the following sentence. Vaticidalprophet 04:27, 21 June 2021 (UTC)[reply]
  • "The study of mental health in trisomy X is impacted by an apparent gap in severity between prenatal and postnatal diagnosis. "
How about "The severity of mental health issues associated with trisomy X appears to correlate with whether or not the condition is diagnosed before or after birth."
Reworded as The study of mental health in trisomy X is complicated by the fact girls and women who were diagnosed before birth seem to be more mildly affected by those diagnosed after. Vaticidalprophet 04:27, 21 June 2021 (UTC)[reply]

Mosaic Forms

* "The simplest form of mosaic trisomy X, with a 46,XX/47,XXX karyotype, has an attenuated presentation compared to full trisomy X"

I know what you mean by attenuated, but since it's just a fancy word and not specifically a medical term, perhaps this sentence construction is overly abstruse. :) "The simplest form of mosaic trisomy X, with a 46,XX/47,XXX karyotype, generally presents lesser symptoms than full trisomy X" for instance.
Have simplified 'attenuated' to 'milder', which I think loses a bit of nuance but nonetheless is slightly more readable. Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]
  • "Although the general profile is milder than that of a non-mosaic 47,XXX karyotype, 46,XX/47,XXX mosaicism is associated with a higher risk of chromosome anomalies in offspring than full trisomy X; some writers have recommended screening during pregnancy. The increased risk of abnormal offspring in mosaicism has been hypothesized to be a consequence of oocyte abnormality in 46,XX/47,XXX women not seen in full 47,XXX.[3][41][42]"
How about "Although the general profile is milder than that of a non-mosaic 47,XXX karyotype, 46,XX/47,XXX mosaicism is associated with a higher risk of chromosome anomalies in offspring than full trisomy X. The increased risk of abnormal offspring in mosaicism has been hypothesized to be a consequence of oocyte abnormality in 46,XX/47,XXX women not seen in full 47,XXX. Thus, some writers have recommended screening during pregnancy.[3][41][42]"
I mean, I like semi-colons, but sometimes they just make a sentence too long/awkward.
Rewritten a bit (Some writers have recommended women with 46,XX/47,XXX karyotypes undergo screening for chromosomal disorders during pregnancy as new last sentence). Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]
  • "Non-mosaic Turner syndrome is characterized by failure to begin or complete puberty and primary amenorrhea, "
Non-mosaic Turner doesn't cause people to fail to fail to develop secondary sexual characteristics. :) How about "Non-mosaic Turner syndrome is characterized by failure to begin or complete puberty and development of secondary sexual characteristics."
Hm -- not sure what you mean here. I've flipped the order of 'primary amenorrhea' and 'failure to begin or complete puberty' in the sentence, does that work? Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]
It does work, but I just wonder if the word may be too sophisticated.

* "Turner's women with 47,XXX cell lines are more likely to be fertile than the condition as a whole"

Not sure what this sentence clause means.
Clarified to "women with non-mosaic Turner syndrome". Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]

Causes

  • I wonder if this paragraph might be better suited before Presentation, analogous to the Background section in my spaceflight articles or Early life for biographies.
    WP:MEDMOS recommends putting Presentation first; there's a fair amount of leeway to shuffle the orders, but a condition's symptoms are the big draw of the article, so I'm inclined to keep them at the front. Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]
This is my first medical article, so I wasn't sure.

Diagnosis and differential diagnosis

  • "As postnatal karyotyping generally occurs in the setting of clinical concern, postnatally diagnosed trisomy X tends to have a more severe phenotype than prenatal.[5][20]"
"in the setting of clinical concern" could probably be less abstruse. Also, this is somewhat duplicative of the passage at the end of Psychological (in which you imply the reason there's a difference in severity but never outright say it, as you do here.)
It's a bit duplicative, but there's a method to the madness. Most (~60%, I think?) of readers are on mobile, where they only see the section they've expanded to read and all the rest are collapsed by default. I'm more comfortable repeating content between sections than potentially losing context because the reader can only see the one. Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]
In that event, you'll want to repeat the implications of the difference in timing of diagnosis as well as the bare fact that it exists. :)

* You define karyotype testing. You might as well define differential testing, too.

History

  • "The children with trisomy X and Klinefelter's had their karyotypes disclosed to their parents, but due to the then-present perception that XYY syndrome was associated with violent criminality, the diagnosis in that case was hidden from the family.[75]"
In which case? You mean all the cases in that study? Or one particular case?
In the case where the children (in all the cohort studies, AFAICT) were diagnosed with XYY, the diagnosis was hidden from the family. Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]
Can you clarify that? The issue is that case has multiple meanings (like "level" in Dungeons and Dragons ;) )

* " That same year, Nicole Tartaglia founded the eXtraordinarY Kids Clinic in Denver to study children with sex chromosome aneuploidies; around one-fifth of patients at the clinic have trisomy X as of 2015.[15] In 2020, "

"around one-fifth of patients at the clinic had trisomy X as of 2015." (past tense, particularly since you follow the sentence up with 2020.)
Tense fixed. Vaticidalprophet 04:53, 21 June 2021 (UTC)[reply]




I'll be adding more as I read. --Neopeius (talk) 03:08, 21 June 2021 (UTC)[reply]

Thank you muchly! (Procedural note: I've shrunk the section header on this so it renders properly on WP:FAC.) I've adjusted the tense in the lead's last paragraph; the statement is still true, but you're right that it's a more historically-focused paragraph and so shouldn't necessarily jump around in tense. Will experiment a bit with the introduction in Presentation. Vaticidalprophet 03:17, 21 June 2021 (UTC)[reply]
Have clarified the terminology in the first paragraph somewhat, with more introductory terms and definitions of the unavoidable ones. Vaticidalprophet 03:20, 21 June 2021 (UTC)[reply]
@Vaticidalprophet: Alright -- I have finished my text review! Really lovely piece. Just needs a bit of elaboration to make it more accessible to the lay person (I mean, I'm kind of a lay person with regard to biology, but my vocabulary is pretty unusual.) --Neopeius (talk) 04:14, 21 June 2021 (UTC)[reply]
Thank you! Responded to all the comments (the ones without written responses were fixed while you were typing). Vaticidalprophet 05:02, 21 June 2021 (UTC)[reply]
@Vaticidalprophet: Can you do me a favor and respond to those anyway just so I have an easily viewed record? I've struck out all the resolved issues. Thank you for being a most pleasant reviewee! --Neopeius (talk) 14:08, 21 June 2021 (UTC)[reply]
Thank you! Replies made. Vaticidalprophet 23:46, 21 June 2021 (UTC)[reply]
@Vaticidalprophet: Just two unresolved issues. :) --Neopeius (talk) 14:36, 23 June 2021 (UTC)[reply]
Have clarified 'clinical concern' with "such as obvious symptoms", which hopefully gets across the ideas more smoothly. The other sentence I think is as clear as it's going to be for now; the term is bluelinked to permit navigational popups, and it's not very jargony all told. Thank you for your comments and assistance! Vaticidalprophet 02:11, 24 June 2021 (UTC)[reply]
Thank you. :) I still feel the article is a touch too abstrusely written for the average consumer, particularly as the topic is not that esoteric, but I also recognize your style is your style. You have my support. If others bounce off the style, you may want to smooth some corners. --Neopeius (talk) 03:06, 24 June 2021 (UTC)[reply]
I'm sure there are corners to smooth still -- all in good time :) Thank you so much again for your help and support! Vaticidalprophet 03:21, 24 June 2021 (UTC)[reply]

Image review

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  • Can we get a source for the info in File:XXX syndrome (male).svg?
  • Image licensing looks good (t · c) buidhe 03:35, 21 June 2021 (UTC)[reply]
    The nondisjunction images were made in 2011 by an editor who hasn't edited Commons or enwiki since 2014 (has some more recent nlwiki edits, but sparse enough I'm not confident a talk page message or email would find anyone). I've added a couple references to the caption describing the process in a way that fits with the image's depiction -- does that work? Vaticidalprophet 03:43, 21 June 2021 (UTC)[reply]
    OK, I think that's fine. I will AGF that they support the content of the image. (t · c) buidhe 04:54, 21 June 2021 (UTC)[reply]

HF

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Don't see many medical articles at FAC, will take a look at this. Hog Farm Talk 19:34, 27 June 2021 (UTC)[reply]

  • "Speech therapy is indicated for between 40% and 90% of girls with trisomy X.[25] Expressive language skills tend to be more affected than receptive skills" - Can a comparison to average rates of speech therapy in a control population be indicated?
    There is a problem with how these rates were added … it is original research. SandyGeorgia (Talk) 22:19, 4 September 2021 (UTC)[reply]
  • " the resulting karyotype is generally mosaic, with both 47,XXX and other cell lines" - Don't think it's necessary to link mosaic here, as this section is immediately preceded by a lengthy discussion of mosaicism
  • epicanthic folds is linked twice in the diagnosis section; IMO its generally not useful to link a term multiple times in the same section
    • Both above unlinked. Vaticidalprophet 01:46, 28 June 2021 (UTC)[reply]
      • Aha, actually -- I mixed up which you were referring to in the first. The use in "Causes" is not (yet) unliked, on account of the 'separate section' issue; a mobile reader only opening "Causes" doesn't know we've just been through a discussion of mosaicism, and so risks having the term lost on them. I self-confess to overlinking even within my framework of "we should link jargon generously so readers looking at isolated sections can follow", so there may be an argument for omitting it, but there's a real risk many readers will be introduced to that section without being aware of what's before it. I did unlink the use at the beginning of "Mosaic forms", though, because any reader looking at that is about to get into a big discussion of them better than that article/its navigation popup would give. Vaticidalprophet 01:49, 28 June 2021 (UTC)[reply]
  • " Marfan syndrome may be considered due to the disproportion between limb and torso length observed in both syndromes, as well as the joint issues." - Is the joint issues the hyperflexibility mentioned earlier? Or is this issues for Marfan syndrome? The use of "the" here makes it seem that a specific set of joint issues is being referred to, and I'm having
  • "Data from the Danish Cytogenetic Central Register, which covers 13% of women with trisomy X in Denmark,[67] suggests a life expectancy of 71 for women with full trisomy X and 78 for mosaics" - Is there some sort of control number to compare this to? It's hard to determine the meaning of statistical samples without knowing what the control results are.
    • Added control numbers. I omitted them the first time around because they're presented in a somewhat odd way; there seem to have been two separate "control groups", one who died almost three years younger than the other on average, and I wasn't confident presenting the "all controls" data would give an accurate representation. Have added that now, though. Vaticidalprophet 02:32, 28 June 2021 (UTC)[reply]
  • Are block quotes like that normal for medical articles? It seems kinda anecdotal to me
  • "Odle, Christine. "The story of Christine, born in 1967, dx shortly after birth". Triple-X Syndroom. Retrieved 23 May 2021." - What makes this source RS? Also, what part of the preceding is it intended to support? Because it seems to be referring to the Denver one and says that the program was cancelled shortly before the researcher died and implies funding was what ended it while the article suggests that it was the death
    • As regards both these points: they were both intended to tie more smoothly in with something I was absolutely certain I'd added to the society and culture section (sex chromsosome aneuploidies and abortion) and promptly found out I had not, which is now in there. The source you pick at is used for "what women with trisomy X think about the condition" purposes (which I think might be able to be expanded a little more -- will double-check some of the sociological studies), which as the section indeed mentions is more often in single-case informal descriptions than in widespread study, because there just isn't much written on the karyotype from a non-medical perspective. (It's also, to note a specific note, not self-published but rather vetted by a major trisomy X organization.) I've since cut the use of it for this statement, which I thought at first was interesting detail but on review is more extraneous detail. The blockquote I like -- it's a solid summary of "where the research is" presented in a way more understandable/relatable to general readers than the admittedly dense remainder of that section -- but I'm agnostic on precisely where it goes; there's a good argument for putting it in "Society and culture", where the abortion discussions it ties into are, and where the fact it's written from a sociological rather than medical perspective doesn't pose an issue. Vaticidalprophet 04:15, 29 June 2021 (UTC)[reply]
  • " though the latter in particular is now discouraged" - is it worth saying why without becoming undue detail?
    • The source is a bit sparse on this, just recommending it without reason. In context it's rather clear that the reason is "because searching 'triple x women' on the internet isn't exactly going to put results on trisomy X front and centre", but taking this from the source is technically OR. (On an amusing note on that, I hear so many stories of high school biology teachers accidentally searching 'xxx women' in front of a class of teenagers...) Vaticidalprophet 04:33, 2 July 2021 (UTC)[reply]
  • Not familiar enough with WP:MEDRS to really judge most of the sources

I think that's it from me. Expect to support, but it'll probably be over fewer FACR components than normal because I just am too unfamiliar with the subject matter to assess MEDRS or comprehensiveness, for instance. Hog Farm Talk 20:30, 27 June 2021 (UTC)[reply]

Source review

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I'm pleased to see another medicine article, and will happily do a source review.

Some of the reviews cited here are a bit older than we'd see at the typical medicine FA, but I'm guessing that's due to a paucity of existing sources. I'll take a look later this week, but if there's nothing more recent written in textbooks or journals I think we can safely assume those slightly older reviews still reliably represent medical knowledge.

Currently checking uses of primary sources...

  • It seems a bit odd to cite "Several factors can affect... with other chromosomes are present" to a retrospective study of 36 people in a niche journal (at least I think it's niche? I've never heard of it before but can't find much info on it...). Seems the same info could be cited to one of your more obviously reliable sources.
  • ref 10 is nicely contextualized.
  • ref 12 (increased enamel thickness and root length) is presumably not covered in other sources, and is contextualized as "... have all been connected to the condition", which seems fine to me.

... stepping away from the computer, but will be working on this in jumps and starts over the next few days. Feel free to respond to any issues as I go, or to wait. As you prefer. Ajpolino (talk) 01:04, 4 July 2021 (UTC)[reply]

Thank you, Ajpolino! :) You're pretty right on the source limitations here (I remember you being pretty shocked by the ones at the tetrasomy X PR, heh); the Unique guide updated this year still uses Tartaglia 2010 and Otter 2009, as well as a few much older than those, as its major sources, and I'm broadly not expecting anything big and new to be published on non-Klinefelter sex chromosome aneuploidies until the eXtraordinarY Babies studies get into swing, which is a decades-off matter. Will take another look at my use of ref 4; it's mostly an attempt to contextualize early in the article something that gets discussed in fuller depth later (including with better studies) without following it with a million citations. Vaticidalprophet 04:26, 4 July 2021 (UTC)[reply]
Ping to Ajpolino a week later just to check how this is going. Vaticidalprophet 13:44, 10 July 2021 (UTC)[reply]
Thanks for the ping. Finally got back to it today. All the other primary sources are explicitly called out as such in the text. The rest is to secondary sources. I won't pretend to know the field well enough to know each of the journals, but the ones cited here are from publishers with a reputation for running legitimate peer review operations. On the edge of that label are ref 58 from Bentham and ref 92 from MDPI. Each of those publishers has attracted some criticism for at-times uninspiring peer review. In general, I think their papers are fine to use with some added scrutiny. I'll leave you to look into it (and perhaps you already have) and decide if you trust each for the material you've sourced to them. I'll move on to verification spot-checks, which I believe is customary for first-time nominators (though now that I mention it I can't find that written anywhere...) Ajpolino (talk) 00:16, 12 July 2021 (UTC)[reply]
I recall the custom being written too -- at any rate, thank you! Regarding the more borderline cases, I've had my eye on the Bentham source for a while and have been seriously considering switching it out, which I'll probably do. MDPI is...one I'd probably drop in a more mainstream context, but animal cytogenetics is not a sexy field and it's really a miracle we have a literature review from 2021 on the matter. If it were supporting a different part of the article I'd be looking for a better publisher, but "flawed-but-not-actively-predatory publisher for a very niche matter" is one where I think the rest of it works out to acceptable. The authors are also published on similar topics in better journals, which helps. Vaticidalprophet 00:54, 12 July 2021 (UTC)[reply]

Spotchecks (numbers picked by RANDOM.org):

  • 3 (Tartaglia, et al. 2010) - The major source used in the article. [a-m, o, s, t, v, x-ab] all check out perfectly. Minor comments for the others:
    • [n] - This sentence A minority of patients... intellectually disabled patients has fairly confusing citations. The way it's written it appears as if this ref is for the end of the sentence, but I don't see either of the facts in that half of the sentence -- trisomy X patients mostly have partial seizures (if they have seizures) and that epilepsy/EEG abnormalities are more common in those with intellectual disability -- in the ref. Perhaps in Roubertie, et al. (currently ref 32) next to it? But I don't have access to that journal.
      • The focus on intellectual disability is in ref 32, yes (I leaned towards ending the sentence with both because I don't like cutting up with refs too much, and both focus on the partial-seizures part); if you can't access the full text, it's mentioned in the abstract (Although a specific electro-clinical pattern could not be defined, the epileptic phenotypes of these patients share many features; we suggest that the association 47,XXX/epilepsy/mental retardation may not be coincidental). Partial seizures do come up in ref 3 (Medical history should include questions regarding staring spells or atypical movements, since seizure disorders and electroencephalogram (EEG) abnormalities can be present in females with trisomy X and may present as partial or absence seizures. In these cases, EEG studies should be performed to rule out possible seizure activity). Vaticidalprophet 05:22, 12 July 2021 (UTC)[reply]
        • Not to split hairs, but I think either the text or the referencing (or my brain) is still unclear: "... and may present as partial or absence seizures." (source) vs "epilepsy or EEG abnormalities, particularly partial seizures..." (our article) are not getting across the same thing. Ajpolino (talk) 16:47, 17 July 2021 (UTC)[reply]
          • This is one that does trip me up a bit. Source #3 discusses absence seizures, but I have no clue where it's getting that from, because more or less everything else (including the primary sources in it) overwhelmingly focus on partial seizures, and the other sources supplementing that one inline only discuss partial seizures. I think the balance of the evidence works out to focusing on partial seizures gives readers a more accurate impression of the literature. Vaticidalprophet 17:22, 19 July 2021 (UTC)[reply]
    • [p] (first par. of mosaic forms section)- not a big deal, but our current text implies that 45,X/46,XX/47,XXX mosaicism is less common than the other mosaics. Best I can tell, the source doesn't make that distinction. Does some other source explicitly distinguish them as less common? I get that the triple mosaic genotype is probably less common than the doubles, but if none of the reviews explicitly comment on it, perhaps we're better rephrasing to avoid the implication?
      • If not less common, than at least less core, if that makes sense. It's a hard thing to dredge up explicitly-less-common sources for, as searches are pretty thrown off by complex mosaicism in autosomes and double-trisomies (e.g. 48,XXX+21 karyotypes). I've found a couple things explicitly calling it less common, but they're primary and often preprints. The wording here is a bit evasive/general, so there might be a direction it can be tweaked in to get the idea across even if those sources wind up unusable? Vaticidalprophet 15:01, 12 July 2021 (UTC)[reply]
    • [q] (The 46,XX/47,XXX subsection) - would you mind being more precise with the reference placement in this paragraph? It's a bit of a verification challenge. All this source says on the topic is that 46,XX/47,XXX happens, and that outcomes are better than 47,XXX.
    • [r] ("Between 3% and 15%... have a 47,XXX cell line") - Just a note this source says 5-15%, the other source's (Lim, et al. 2017) discussion says 3-4% so I'm assuming this is your compromise? Disagreeing numbers is a perennial trick for writing medicine articles, so I feel your pain. Just flagging this in case it's a typo and you meant to go with the 5-15% range. It's odd the sources have such a broad disagreement, but what're you gonna do.
      • It's a compromise, yeah. I might tweak it lower -- more sources lean towards the lower numbers than the higher ones -- but I'm not totally confident on that yet (only just beginning a rewrite of Turner syndrome) and so it's pending further reading in Turner-focused sources, because they disagree with each other here too. Vaticidalprophet 05:22, 12 July 2021 (UTC)[reply]
    • [u] ("Nondisjunction is related to... average maternal age was 33.") - I don't see the part about the cohort of women born in the '60s.
      • Huh, you're right -- I've certainly read this somewhere, but apparently not here. I suspect I might've been moving around refs at a prior point and accidentally cut where I got that from. Have cut the second line for now, pending its verification. Vaticidalprophet 05:22, 12 July 2021 (UTC)[reply]
    • [w] ("As trisomy X generally has... routinely performed for advanced maternal age.") - I don't see the bit about routine testing with advanced maternal age. But perhaps I just missed it? Hard to guess what section it would be in.
      • The routine testing here is that amniocentesis/CVS are routinely performed for pregnant women in that age range, and trisomy X is picked up on those tests; the tests are brought up a few times (e.g. Diagnosis during the prenatal period by amniocentesis or chorionic villi sampling is common). Should "these are tests used in advanced maternal age" be cited somewhere else? It's a bit sky-is-blue within the field, so it isn't explicitly mentioned in literature at this level, but it'll probably be in patient-targeted stuff I can find relatively easy -- those things just won't tend to mention trisomy X specifically. Vaticidalprophet 05:22, 12 July 2021 (UTC)[reply]
  • 4 (Butnariu, et al. 2013) - What a coincidence! This is one I flagged earlier. My opinion is that this should be replaced by a more reliable source. The claim it sources is basically that mosaicism can affect the trisomy X phenotype. Should be able to find that elsewhere.
  • Phew! I've got 15 more numbers from the generator, but I'm going to sign off for the day. Will get back to this asap. Cheers! Ajpolino (talk) 04:14, 12 July 2021 (UTC)[reply]
  • 5 (Otter, et al. 2009) - [a-f, h, i, k, m-q] all check out. Notes on the others:
    • [g] "A minority[ref] of patients have epilepsy or EEG abnormalities..." - I'm confused as to what this is referencing. The source says "EEG abnormalities seem to be rather common" and doesn't give a sense of epilepsy prevalence. Could you clarify?
      • Have changed to 'a subset' and moved the ref around. I think the wording of this source is fairly intended to be read that epilepsy specifically is a minority thing, though (e.g. mentioning its relatively low prevalence in newborn screening samples). Vaticidalprophet 19:05, 16 July 2021 (UTC)[reply]
    • [j] "behavioral issues in children with trisomy X... emotional maturity encouraging hard-to-reach expectations." - Could you clarify the source text this is based on?
      • It seemed that the physical phenotype (being the tallest but immature and somewhat clumsy girl in the peer group, sometimes with precocious puberty) and the behavioural phenotype (speech and language disorders, sensory-integration disorders and academic difficulties) could explain some social problems. Vaticidalprophet 19:05, 16 July 2021 (UTC)[reply]
        • I could be missing obvious subtext here, but I read the source text to simply mean that being physically and behaviorally distinct from your peers makes social life difficult. The article text describes a more complex situation. Ajpolino (talk) 16:47, 17 July 2021 (UTC)[reply]
    • [l] could you quote the source text for "Adult employment is generally in lower-skill pink-collar occupations"? It also cites Bender, et al. 2002 but I don't seem to have access to that. The only thing I see in this source is "The 47,XXX women most often find jobs that reflect their performance abilities." but maybe I'm looking in the wrong place.
      • Lower-skill employment comes up several times (They planned to take jobs requiring low academic and linguistic skills; These girls found unskilled labour after leaving school). The phrase in general is also backed up in the latter source. Vaticidalprophet 19:05, 16 July 2021 (UTC)[reply]
  • Time for another big reference! Will try to get these other ones done asap. Ajpolino (talk) 21:02, 15 July 2021 (UTC)[reply]
  • 21 Stagi, et al. 2016 - Checks out. Any reason to mention LH but not FSH? I only skimmed the source, but it seemed to imply both were elevated. Ajpolino (talk) 17:03, 17 July 2021 (UTC)[reply]
  • 23 Cordts, et al. 2011 - [a&b] both look good.
  • 28 Black, et al. 2015 - I'm not sure where the 3% floor came from (maybe the other source?) but I trust your judgment here. This is always a hard kind of thing to cite.
  • 30 Grosso, et al. 2004 - Good.
  • 33 Maenner, et al. 2020 - Good.
  • 41 Neri and Opitz 1984 - I assume this is just to cite "Some writers have recommended... during pregancy"? If so, checks out.
  • 53 Graves, et al. 2009 - Good.
  • 55 O'Connor 2008 - Sure.
  • 57 Meazza, et al. 2017 - [a&b] good
  • 59 Otteson, et al. 2010 - I'm not really sure what this is verifying. It seems like the two preceding sentences "Pentasomy X, with... and short stature." are backed up by the rarediseases.org source. Otteson et al only addresses the relationship between height and chrom. X copies.
  • 65 Berglund, et al. 2019 - [a, b] Good.
  • 77 Tartaglia, et al. 2020 - Good.
  • 91 O'Connor, et al. 2011 - basically good, but pardon the quibble: maybe "trisomy X is strongly linked to infertility" is worded just a bit strong? The source says "In dogs, the few reports of trisomy X in the current literature had... either primary anestrus or infertility...".
  • 94 Prakash, et al. 1994 - I can't seem to access this one. The title just about says it all, so I'll trust your judgment on this one.

Alright, all done. Thanks for your quick responses, and apologies for my extreme slowness. I've got a couple of outstanding quibbles that you're welcome to consider. Regardless, I think this is a source review pass, and I'll happily support on the basis of that. If you need another prose reviewer or anything else here feel free to ping me. Ajpolino (talk) 03:29, 20 July 2021 (UTC)[reply]

In response to GB's comments and VP's retirement, I've had an opportunity to look more deeply at the sourcing here and have come to the opinion that a bit more work is needed to bring this up to the FA standard. In the interest of space, I've left specific comments at the talk page rather than here. But in general, the outstanding issues as I see them are:
  1. Where possible, primary sources should be replaced with secondary ones. Older sources should be replaced with newer ones. This isn't just a fetishistic adherence to the letter of WP:MEDRS, rather it's how we ensure that our articles are as reliable as possible.
  2. In a few places, the article text implies something based on the author's impression, even when it stretches the sources. Examples are references #53 and #54 mentioned at the article talk page.
  3. There are many places where a single primary study is contextualized as "One study showed...". All primary sources should be contextualized in this way. Even better, these should be used very sparingly as an author can more easily use them to draw a misleading picture of the medical literature. If information can only be found in a primary source, perhaps it's better to wait for a relevant review or textbook chapter to be published before we comment.
All in all the article is in very nice shape, it just needs a dedicated hand to put a bit more work into it before it meets the FA criteria. I've spent some time with the source material now, so if there's some way I can help going forward, don't hesitate to reach out. Ajpolino (talk) 00:14, 10 September 2021 (UTC)[reply]

Prose review

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Just signalling that I see this is falling down the list a bit, so I'll give a review either tomorrow (Tuesday 13) or this weekend. — ImaginesTigers (talk∙contribs) 23:52, 12 July 2021 (UTC)[reply]

ImaginesTigers ? Gog the Mild (talk) 21:39, 19 July 2021 (UTC)[reply]
Hey Gog. I'm sorry – I just don't have the time anymore. There are no striking issues to me, glancing over the article. — ImaginesTigers (talk∙contribs) 01:31, 20 July 2021 (UTC)[reply]
No problem, ImaginesTigers; just so long as we know. Gog the Mild (talk) 14:01, 20 July 2021 (UTC)[reply]

Support by Lee Vilenski

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I'll begin a review of this article very soon! My reviews tend to focus on prose and MOS issues, especially on the lede, but I will also comment on anything that could be improved. I'll post up some comments below over the next couple days, which you should either respond to, or ask me questions on issues you are unsure of. I'll be claiming points towards the wikicup once this review is over.

Lede
Prose
Additional comments

Additionally, if you liked this review, or are looking for items to review, I have some at my nominations list. Best Wishes, Lee Vilenski (talk • contribs) 22:33, 16 July 2021 (UTC)[reply]

  • As regards the "should this be at the thing the article is titled at" comments in general: I think, per WP:NOTBROKEN, they shouldn't be. Everything I've used is a valid and frequent term for the relevant anatomy, disorder, etc. NOTBROKEN explicitly opposes changing redirects from valid alternative terms, because it obscures how often those terms are used onwiki and accordingly whether they would make for better article titles than the current one. (In at least one such case, I'd open the RM myself.) Vaticidalprophet 04:16, 2 August 2021 (UTC)[reply]
Hi Lee Vilenski, are you ready to declare on this one? Thanks. Gog the Mild (talk) 19:21, 3 August 2021 (UTC)[reply]
I am leaning support, but there is still a few things above that haven't been addressed, or commented on. Whilst I'm ok with linking to items that aren't the direct title of a page, there's quite a lot of occasions where this article links to redirects unnecessarily - whilst reasonably trivial, I would recommend fixing them before becoming a FA. Best Wishes, Lee Vilenski (talk • contribs) 20:16, 3 August 2021 (UTC)[reply]
Thanks Lee. Vaticidalprophet ? ||||
Lee Vilenski, I've tweaked some of the redirects into non-redirects ("little finger" and "dysmorphic feature"). Vaticidalprophet 05:00, 6 August 2021 (UTC)[reply]

Comments Support by Gerald Waldo Luis

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I don't excel in biology, so forgive me if I misunderstand something. I'll probably make comments more on prose stuff than the scientific bit. GeraldWL 06:21, 21 July 2021 (UTC)[reply]

Resolved comments from GeraldWL 00:58, 3 August 2021 (UTC)[reply]
  • "Diagnosis of trisomy X is complicated by its mild presentation"-- I'd remove "of trisomy X" here to avoid repetition. However, I see that this sentence has a better duplicate-- "As the symptoms of trisomy X are often not serious enough to inspire a karyotype test"-- so I don't think this sentence is needed.
  • "The average IQ"-- it's encouraged to have the long version first, then bracket the abbr. So in this case, "The average intelligence quotient (IQ)".
  • "research on girls and women with the disorder" --> "research on patients"
  • I think para 3 can be merged with para 1, as it covers the same thing.
    • They don't. The first paragraph is "the lead of the lead" and summarizes quick glance "what is it, how common is it, why have I never heard of it if it's so common". The third paragraph is a relatively technical discussion of the etiology. Vaticidalprophet 23:02, 25 July 2021 (UTC)[reply]
  • "Women with trisomy X" --> "Patients"
  • "Minor skeletal and craniofacial"-- link craniofacial
  • "daily lives of girls and women with the condition." Condition or disorder? I think it should be consistent.
  • "Premature ovarian failure is defined" --> "POS is defined". Also do this for other following mentions of the condition.
  • "with an average intelligence quotient"-- add "(IQ) after that.
  • "Some writers"-- what kind of writers? It should be more specific here.
  • "experience premature ovarian failure" --> "experience POF"
  • "where it occurs after conception. When nondisjunction occurs after conception, the resulting" -- > "where it occurs after conception; in this case the resulting"
  • "Chromosome aneuploidies"-- unlink.
  • There are more duplicate links throughout the article.
    • The duplicate links are intentional per my comment to Lee Vilenski; indeed, the TFA at the time of writing is a medical FA with plenty that were kept at FAC and are restored when they're removed. Vaticidalprophet 19:49, 21 July 2021 (UTC)[reply]
  • "The prognosis of trisomy X is, broadly speaking, good"-- what does good mean here?

Oppose

[edit]

I have some reservations. The article seems to be written for clinicians because there are expressions like "clinical portrait", "frank microcephaly", "one study..", "with the condition", "a literature review found", and – the dreadful – "control women"! I am also concerned about the number of primary studies cited, which goes against WP:MEDRS. Are they all adding value? Lastly, the prose needs some polishing; for example, I saw "outside of" rather than just "outside". I am happy to revisit. Graham Beards (talk) 16:50, 5 August 2021 (UTC)[reply]

Noting for posterity that I've seen this and will be working to address it. I've had relatively limited opportunities for editing over the past few days, so I'm unsure what schedule changes will be on, but they will be made. Vaticidalprophet 05:24, 6 August 2021 (UTC)[reply]
@Graham Beards: I have given the prose a once over -- though an English prose expert I am not. If you could highlight anything you see as remaining areas for work, I'd be much obliged. I'm looking into the primary sources now. Ajpolino (talk) 23:18, 23 August 2021 (UTC)[reply]
@Ajpolino: I have made a few changes with a view to improving the prose.[2] Graham Beards (talk) 09:52, 24 August 2021 (UTC)[reply]
@Graham Beards: Ok, I've gone through and scraped out most of the unneeded primary sources. Quite a few remain, which I've listed here for further consideration. The two major reviews that underlie this article are from 2009 and 2010, so some of the primary sources do add information that is likely reliable but hasn't yet been covered by reviews. Whether it's a good idea for this article to cover such info rather than wait for new secondary sources is a fair question (frankly, my leaning is that it should not, but I'm not willing to do that level of deconstruction/re-envisioning on this article). Happy to hear your thoughts. Ajpolino (talk) 21:15, 2 September 2021 (UTC)[reply]
To have so many non-WP:MEDRS compliant sources in a FA sets an unwanted precedent. I think your work on this abandoned nomination is admirable, but we cannot allow these unusual circumstances to be an excuse for lowering the bar. (Sorry for the tardy reply). Graham Beards (talk) 15:18, 5 September 2021 (UTC)[reply]
Understood, of course. Thanks for your time and input. Ajpolino (talk) 20:21, 5 September 2021 (UTC)[reply]

Comments by Ajpolino

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I did a source review, but GB's comment above piqued my interest in looking at the prose as well. I'm no prose wizard, but below are some suggestions for de-clinicalizing and improving the flow of text. Take them or leave them. Also I'd suggest a quick read (or re-read) of User:Tony1/How_to_improve_your_writing#Eliminating_redundancy, which I continue to find helpful for me:

  • Presentation
    • "Trisomy X has a variable phenotype, ranging from cases with no symptoms at all to relatively significant disability, and the clinical portrait is not entirely clear"
    • "Nonetheless, a number of... in the medical literature" - you don't need to state the obvious "in the medical literature", can you rephrase to something like "People with trisomy X have some consistent... traits?". The reader assumes you're deriving them from the medical literature.
    • "Severity is known to vary..." > "Severity varies"
    • "most of which are quite subtle"
    • "girls with trisome X are of average height"
    • "The height excess" > "The added height" (they don't really have an excess of height. They're just a bit taller)
    • "frank microcephaly" (as GB points out above)
    • "Severe internal disease is rare in trisomy X; although heart defects..." > "rare in trisomy X. Although heart defects..." - At first read I thought the "although" was to contrast with the previous sentence, rather than the subsequent clause. Momentarily confusing.
    • I think there's a typo in "The study of mental health... by those diagnosed after." Maybe "by" > "than"?
    • I'd cut "in one exceptional case... including a daughter with Turner syndrome." Exceptional cases make for odd articles.
  • Causes
    • "with around 90% of cases being traced..."
    • "Mosaic trisomy X is associated with a higher rate of offspring with chromosomal disorders" - I'd cut this. You just told us the same a few paragraphs above.
  • Diagnosis
    • "As trisomy X generally has a mild or asymptomatic phenotype,..." > "As trisomy X is generally mild or asymptomatic..."
    • "It is estimated that" can be removed (though you'll need a bit of downstream rewording).
    • "Indications for postnatal testing for trisomy X include..." > "Postnatal testing is typically promted by..." or something like that.
    • "As postnatal karyotyping generally occurs... a more severe phenotype than prenatal" - I'd cut this sentence too. It's an important fact, but you've mentioned it several times by this point in the article.
    • "Cases of trisomy X with more severe... a particular differential diagnosis of trisomy X" - I think you could cut these two sentences and instead open this paragraph with something like "Severe cases of trisomy X can appear similar to tetrasomy X".
    • "karyotype alone explains, such as in the setting of severe intellectual disability..."
    • "A literature review found that..." seems like it could be cut?
  • Epidemiology
    • "Trisomy X's severe underdiagnosis... severe than the general 47,XXX population." - I'd cut this sentence. Again, you've mentioned it a few times this point, and the paragraph is clear without it.
  • History
    • "served to dispel" > "dispelled" (and then you'll have to change "reveal" to "revealed" a few words downstream)
    • It's not clear to me if/why the 2007 "study day" merits mention in the history section. Are study days a thing? Google suggests it's just a daylong meeting. Do we know if anything in particular came out of it? If so, perhaps you could briefly highlight that.
    • "...Babies Study, a planned new cohort study..."
    • "... though the latter in particular is now discouraged."
  • In other animals
    • I'm not clear on the relevance of the brief discussion of the canine pseudoautosomal region. If it's not relevant to trisomy X, you can probably cut it. If it is, maybe you could tweak the wording to clarify?
    • "... found to have trisomy X was found, on investigation, to have..."

Made a first pass through. I think prose improvements are very achievable. If there's any other way I can help feel free to ping me. Happy editing. Ajpolino (talk) 14:31, 7 August 2021 (UTC)[reply]

VP has indicated on his userpage that he'll mostly be stepping away from the encyclopedia. I've actioned my suggested changes above. Will look over Graham Beards' and Spicy's comments some time in the next couple of days and see if we can bring this the rest of the way to compliance with the FA criteria without VP. Of course, if he changes course and returns to regular editing, I'll leave it in his hands. Ajpolino (talk) 02:57, 12 August 2021 (UTC)[reply]

Comments by Spicy

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I'm concerned about some of the sources used in the 'Society and culture' section. What makes [3] and [4] high-quality reliable sources? They seem to be self-published personal reflections and I don't think we can make claims such as "Women with trisomy X and their families have criticised these abortions" and "Women with trisomy X discussing their experiences express optimism about the karyotype and hope for other people with it" based on the personal opinions of two people. These sources [5][6] seem to have been published by Emory to promote their own sex chromosome disorders clinic - not seeing how these are high-quality RS? Spicy (talk) 10:05, 6 August 2021 (UTC)[reply]

@Spicy: I'm not claiming the article is in ideal shape, but the sources you mention are all now removed or replaced. Happy to hear any other feedback if you've got time. Ajpolino (talk) 21:33, 2 September 2021 (UTC)[reply]
Ajpolino Thanks, that looks better. I made a few copyedits to the article. Not sure I have time for a full review right now, sorry. Spicy (talk) 19:29, 4 September 2021 (UTC)[reply]
No worries. Time is always in short supply. Thank you for the time you put into it. Ajpolino (talk) 23:06, 4 September 2021 (UTC)[reply]

Comments by Dr Bowser

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I found the proper footnote for "...maternal age 33" and reintroduced the sentence. With the nominee absent I'm also going to take the liberty to update the section on bovine trisomy X using a 2021 review by Iannuzzi. Overall I belive things are looking good, especially if any pending issues are adressed. Dr Bowser (talk) 09:51, 12 August 2021 (UTC)[reply]

Comments from SandyGeorgia

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Vaticidalprophet has worked diligently and admirably on this article for quite some time, and has not gotten the attention deserved from several of us medical editors, who have been impacted by other issues at other FAs. I hope this can be brought over the line, specifically with respect to the primary source list on the talk page, possible attention to page numbers in sporadic instances of long articles, wrt the original research on speech therapy I mentioned above in the HF section, wrt consistent citation formatting (eg, remove uppercase on journal titles for consistency), and I am not a fan of a quote from a lesser quality source that begins with “Our doctor told us”. That kind of source might be used to source Societal and cultural aspects, but not medical info. The article still needs some attention to sourcing— work which I see is undergoing on article talk. If that work is completed, I also see other areas where language/jargon might need attention; for example, the introduction of karotype in the first sentence is jargony. Kudos to Vaticidal for bringing this article to such a high state, and I hope it can be brought over the FA line. I apologize for my lack of help; the Wikipedia FA muse left me after a recent socking issue. SandyGeorgia (Talk) 22:34, 4 September 2021 (UTC)[reply]

Hi SandyGeorgia, thanks for the assessment. I think I'm at the limit of my time and interest in this topic, so I'll comment here to echo your sentiment and give my thoughts for anyone interested in renominating this in the future (or just improving the article free of the FA process). I think the major remaining issue is the sourcing. If I had the time I'd replace the primary sources -- particularly the older ones -- with newer secondary sources (I've listed the current primary sources and what they're referencing at the talk page). I'll also echo the bit about page numbers, the current referencing setup makes verification sometimes challenging. Once those things are set, I think the prose and reference formatting can be brought up to standard quickly. VP has done excellent work on this article. Hopefully he or someone else will come by to do a bit more improvement and get it a bronze star. Ajpolino (talk) 23:58, 9 September 2021 (UTC)[reply]

Coordinator note

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Vaticidalprophet, I note that you have semi-retired. Is it your intention to wrap this one up? Ajpolino, you suggested that you may be prepared to step in to address the outstanding comments; any further thoughts on that? Thanks. Gog the Mild (talk) 10:09, 19 August 2021 (UTC)[reply]

@Gog the Mild: I've started working on Graham Beards' concerns, and Spicy's will be up next. I should have time to get through everything within a week -- this weekend I hope. If VP returns and is interested in doing this, I'm more than happy to step back. Sorry to slow down your queue! Ajpolino (talk) 20:35, 19 August 2021 (UTC)[reply]
That's not a problem at all Ajpolino. Under the circumstances we will be as flexible as we reasonably can about timescales. I appreciate your stepping in to keep this moving. Could you add yourself as co-nominator at the top. Thanks. Gog the Mild (talk) 21:40, 19 August 2021 (UTC)[reply]
Just a note that I'm still plugging away at GB's and Spicy's comments (see rev history and talk). Pardon the gap in time. I was offline for a few days for normal scheduled real-life reasons. Thanks again. Ajpolino (talk) 01:21, 1 September 2021 (UTC)[reply]
Hi @Gog the Mild:, a note to say I've reached the limit of my time and interest in the topic. I think we took a step forward, but once I started digging into things I came to the opinion that the article would benefit from more work than I'm willing/able to put into it. I've updated my source review with a note above, and left more detailed comments on sourcing at the talk page. Thank you again for your patience and tolerance. For what it's worth, my opinion is that if no one else is interested in taking over this project, the article is best left to be improved outside of the FAC spotlight. Thanks to all the commenters above for their time and suggestions. And of course thanks to VP for all his work to overhaul this article. Ajpolino (talk) 00:18, 10 September 2021 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.
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