Altered Brain Structure in Infants with Turner Syndrome.

Turner syndrome (TS) is a genetic disorder affecting approximately 1:2000 live-born females. It results from partial or complete X monosomy and is associated with a range of clinical issues including a unique cognitive profile and increased risk for certain behavioral problems. Structural neuroimaging studies in adolescents, adults, and older children with TS have revealed altered neuroanatomy but are unable to identify when in development differences arise. In addition, older children and adults have often been exposed to years of growth hormone and/or exogenous estrogen therapy with potential implications for neurodevelopment. The study presented here is the first to test whether brain structure is altered in infants with TS. Twenty-six infants with TS received high-resolution structural MRI scans of the brain at 1 year of age and were compared to 47 typically developing female and 39 typically developing male infants. Results indicate that the typical neuroanatomical profile seen in older individuals with TS, characterized by decreased gray matter volumes in premotor, somatosensory, and parietal-occipital cortex, is already present at 1 year of age, suggesting a stable phenotype with origins in the prenatal or early postnatal period.

Low-loss arrayed waveguide grating at 760 nm.

An arrayed waveguide grating (AWG) at 760 nm is demonstrated with an insertion loss smaller than 0.5 dB. Interface roughness and waveguide length errors contribute much more to scattering loss and phase errors at 760 nm than at longer wavelengths, thus requiring improved design and fabrication. This Letter details how this is achieved by minimizing interfacial scattering, grating side-order excitation, and phase errors in the AWG. With silicon nitride core and silicon dioxide clad waveguides on silicon, this AWG is compatible with heterogeneously integrated lasers for on-chip spectral beam combining.

Fully integrated hybrid silicon two dimensional beam scanner.

In this work we present the first fully-integrated free-space beam-steering chip using the hybrid silicon platform. The photonic integrated circuit (PIC) consists of 164 optical components including lasers, amplifiers, photodiodes, phase tuners, grating couplers, splitters, and a photonic crystal lens. The PIC exhibited steering over 23° x 3.6° with beam widths of 1° x 0.6°.

Heterogeneously integrated III-V-on-silicon multibandgap superluminescent light-emitting diode with 290 nm optical bandwidth.

A broadband superluminescent III-V-on-silicon light-emitting diode (LED) was realized. To achieve the large bandwidth, quantum well intermixing and multiple die bonding of InP on a silicon photonic waveguide circuit were combined for the first time, to the best of our knowledge. The device consists of four sections with different bandgaps, centered around 1300, 1380, 1460, and 1540 nm. The fabricated LEDs were connected on-chip in a serial way, where the light generated in the smaller bandgap sections travels through the larger bandgap sections. By balancing the pump current in the four LEDs, we achieved 292 nm of 3 dB bandwidth and an on-chip power of -8 dBm.

Homozygous deletion of the human insulin receptor gene results in leprechaunism.

Homozygous inactivation of a gene, as is frequently performed to generate mouse models, provides an opportunity to elucidate the role that the gene plays in normal physiology. However, studies of human disease provide direct insight into the effect of inactivating mutations in man. In this investigation, we have identified a one year-old boy from a consanguineous pedigree who is homozygous for deletion of the insulin receptor gene resulting in leprechaunism. Contrary to previous predictions, the complete deletion of the insulin receptor gene is compatible with life.

Hybrid III/V silicon photonic source with integrated 1D free-space beam steering.

A chip-scale optical source with integrated beam steering is demonstrated. The chip was fabricated using the hybrid silicon platform and incorporates an on-chip laser, waveguide splitter, amplifiers, phase modulators, and surface gratings to comprise an optical phased array with beam steering across a 12° field of view in one axis. Tuning of the phased array is used to achieve 1.8°(steered axis)×0.6°(nonsteered axis) beam width with 7 dB background suppression for arbitrary beam direction within the field of view.

Effect of maternal fasting on fetal growth, serum insulin-like growth factors (IGFs), and tissue IGF messenger ribonucleic acids.

Pregnant rats were fasted or allowed access to ad libitum feeds for the last 3 days of gestation to determine if the fetal growth retardation that results from maternal nutrient deprivation correlates with reductions in serum insulin-like growth factor-I (IGF-I) and IGF-II. In addition, IGF-I and IGF-II mRNA concentrations in liver and lung were measured by specific solution hybridization assays to determine if changes in steady state levels of mRNA correlate with changes in serum values. Fetal serum IGF-I concentrations were 30% lower in fasted than in control fetuses, although fasting did not significantly reduce the abundance of IGF-I mRNA in their livers or lungs. Serum IGF-I concentrations in the fasted dams were 34% lower than those in controls. IGF-I mRNA concentrations in the livers and lungs of the fasted dams were also lower than those in controls and correlated with serum IGF-I values (liver: r = 0.833; P less than 0.001; lung: r = 0.610; P less than 0.05). Therefore, whereas IGF-I appears to be transcriptionally regulated by fasting in dams, regulation of circulating IGF-I in fetuses may occur at a post-transcriptional step. Serum IGF-II and liver IGF-II mRNA concentrations were much higher than IGF-I levels in the fetuses and were not influenced by maternal fasting. Dam serum IGF-II concentrations were low compared to those in fetal serum and also were not reduced by fasting. We conclude that one mechanism by which maternal malnutrition causes intrauterine growth retardation is through decreased expression of IGF-I. On the other hand, short term nutrient restriction does not appear to be a regulator of IGF-II during either fetal or adult life.

Different effects of intermittent and continuous growth hormone (GH) administration on serum somatomedin-C/insulin-like growth factor I and liver GH receptors in hypophysectomized rats.

To determine if the pattern of GH delivery is important for the regulation of serum somatomedin-C/insulin-like growth factor I (Sm-C/IGF-I) and liver somatogenic receptors, we have measured serum Sm-C/IGF-I concentrations and free (H2O-treated homogenates) and total (MgCl2-treated homogenates) liver GH-binding sites in hypophysectomized rats treated for 7 days with rat GH (rGH), given either continuously by osmotic minipumps (50 and 250 micrograms/day) or intermittently (four sc injections of 12.5 micrograms/day). At a daily dose of 50 micrograms, intermittent rGH produced greater weight gain [+29.7 +/- 0.8 g (mean +/- SE)] than continuous GH infusion (23.3 +/- 2.0 g; P less than 0.01). Likewise, the serum Sm-C/IGF-I concentration rose more with intermittent (0.33 +/- 0.1 U/ml) than with continuous delivery (0.17 +/- 0.01 U/ml; P less than 0.01). The serum Sm-C/IGF-I level achieved with repeated GH injections was even greater than that after continuous delivery of a 5-fold higher GH dose (250 micrograms/day; 0.27 +/- 0.02 U/ml; P less than 0.05). Continuous infusions of 50 and 250 micrograms rGH/day increased the number of liver total GH receptors by 2.5-fold over that of controls. In contrast, frequent GH injections did not affect GH binding, and the serum Sm-C/IGF-I concentration did not correlate with liver GH-binding sites in the GH-injected rats (r = 0.189; P = NS). Induction of hepatic PRL receptors was 10-fold higher when GH was given continuously than when it was given intermittently. The close correlation observed between GH- and PRL-binding sites in all GH-treated rats (r = 0.955; P less than 0.001) suggests that their regulation may be linked. These data suggest that the regulatory mechanism controlling Sm-C/IGF-I production and growth might be different from those that regulate GH receptor concentrations, with GH pulses being crucial for the maximal stimulation of Sm-C/IGF and growth, but continuous exposure to GH being required for up-regulation of liver GH receptors.

Tissue-specific expression of insulin-like growth factor binding protein-3 protease activity during rat pregnancy.

The abundances of insulin-like growth factor binding proteins (IGFBPs) in sera and tissue homogenates of rats at days 12, 15, and 18 of pregnancy were determined by ligand- and immunoblotting. As in serum, IGFBP-3 was abundant in day 12 uterus, placenta, and fetuses, and decreased by day 15. On day 18 of pregnancy, IGFBP-2 was predominant and IGFBP-3 was less than 25% of day 12 values in fetus and placenta, and was undetectable in uterus and decidua. In contrast, IGFBPs in the nonreproductive tissues did not change significantly. IGFBP-3 was more abundant in muscle than heart and liver, and was not detected in lung, kidney, or brain. The decrease in IGFBP-3 in serum and reproductive tissues between days 12 and 15 of pregnancy was temporally related to the appearance of IGFBP-3 protease activity. Proteolytic activity was detectable only at low levels in brain, liver, and spleen, and was undetectable in lung, heart, muscle, and kidney. The specific protease inhibitors that blocked IGFBP-3 proteolytic activities in pregnant rat serum and decidua were virtually identical and suggested inhibition of a divalent cation-dependent tryptic-like serine protease. Furthermore, exposure of bovine IGFBP-3 (in nonpregnant bovine serum) or radiolabeled recombinant human IGFBP-3 to day 18 pregnant rat serum, decidua or uterus resulted in the generation of IGFBP-3 fragments with the same apparent Mrs (29-31 K and 18-23 K). We postulate that tissue-specific degradation may be as important as synthesis in determining IGFBP-3 abundance, and that the dramatic changes in IGFBPs in reproductive and fetal tissues may cause changes in IGF availability which are necessary for rapid tissue growth and differentiation.

Dietary protein restriction decreases insulin-like growth factor I independent of insulin and liver growth hormone binding.

To determine the role of hypoinsulinemia and liver somatogenic (GH) receptors in growth retardation and decreased serum insulin-like growth factor I (IGF-I) levels during protein restriction, we have used a rat model where the effects of a low protein intake on body weight (BW), serum IGF-I concentration, and liver GH binding could be evaluated in the presence of low or high insulin concentrations. Two days after being made diabetic with streptozotocin (60 mg/kg BW), 6-week-old female rats (nine per group) were begun on a low (5%) or normal (15%) protein diet, without or with insulin supplementation (3 U lente daily). Nondiabetic rats fed both diets were used as controls (nine per group). In the nondiabetic animals, 7 days of protein restriction reduced BW gain by 50% (P less than 0.001), serum insulin by 44% (P less than 0.025), and serum IGF-I concentrations by 28% (P less than 0.001) without significantly changing liver GH binding. By day 9, BW was decreased in the diabetic animals by 12%, serum insulin by 80%, serum IGF-I by 55%, and liver GH binding by 62%; these effects were similar in the 5% and 15% protein-fed rats (P less than 0.001 vs. the corresponding controls). In the diabetes fed the normal diet, insulin treatment restored BW gain, serum IGF-I, and liver GH binding to normal values. In contrast, in the diabetics fed a protein-restricted diet and treated with insulin, BW gain and serum IGF-I concentrations remained low, similar to those in the malnourished controls. This diet-induced growth attenuation was observed despite high circulating insulin (2-3 times normal values), appropriate glucose control (63 +/- 9 mg/dl), and near restoration of liver GH binding. We conclude that while both protein restriction and diabetes attenuate growth and reduce IGF-I concentrations, the effects of protein restriction are independent of the effects of insulin and probably act by alteration of postreceptor mechanisms.

Regulation of serum insulin-like growth factor-I (IGF-I) and IGF binding proteins during rat pregnancy.

Serum concentrations of insulin-like growth factor-I (IGF-I) in rats are reduced dramatically in the latter half of pregnancy, decreasing from 1758 +/- 356 ng/ml at 12 days of pregnancy (mean +/- SD) to 761 +/- 192 ng/ml at 15 days. After parturition, IGF-I increases to nonpregnant values in 4 days. Using ligand blotting, we have demonstrated that most of the serum IGF binding proteins (IGFBPs) are concurrently reduced during pregnancy. IGFBP-3, the predominant IGFBP in nonpregnant serum, is reduced to 1.3% of nonpregnant values by 21 days of pregnancy and begins to rise within 1 h postpartum (PP). The sera of 21-day pregnant (but not nonpregnant) rats degrade IGFBP-3 in vitro, and this degradation is prevented by the protease inhibitor antipain. Decreased serum IGF-I concentrations during pregnancy, therefore, may result from reduced IGFBP-3 concentrations causing increased IGF-I clearance. In addition, steady state IGF-I mRNA and peptide levels in liver are decreased in 21-day pregnant rats (37% and 42% of 4 day PP levels, respectively), suggesting that decreased synthesis of IGF-I may also lead to lower serum IGF-I concentrations. After bolus injection, [125I]IGF-I is cleared from the serum of pregnant rats nearly 5 times faster than that of 4 day PP rats (1.21 vs. 0.25 ml/min/kg, respectively). Urinary clearance is relatively insignificant (less than 4%), and [125I]IGF-I does not cross the placenta. The intermediate distribution phase of IGF-I is slower in pregnant rats than in PP rats (t1/2 alpha, 17.1 vs. 5.4 min), whereas the terminal elimination of IGF-I is twice as fast (t1/2 beta, 228.1 vs. 106.4 min). The prolonged IGF-I distribution phase in the pregnant rats may result from decreased concentrations of 34,000 and 30,000 mol wt IGFBPs, which may transport IGF-I to tissues. The faster serum elimination half-life may result from diminished IGFBP-3, leading to greater IGF-I availability to tissues in pregnancy.

The effect of dietary protein supplementation on insulin-like growth factors (IGFs) and IGF-binding proteins in children with shigellosis.

Nutrient deficiency causes growth failure and decreases serum insulin-like growth factor-I (IGF-I) concentrations. Because IGFBPs modulate the concentrations and availability of IGFs in serum, IGF-binding proteins (IGFBPs) were measured along with IGF-I and IGF-II before and after 21 days of refeeding in 22 undernourished Bangladeshi children (2-4 yr of age) with shigellosis. The effects of a 150 Cal/kg.day diet with a normal protein (6%; n = 10) or high protein (15%; n = 12) content were studied. The results were compared with those of 25 age-matched healthy American children (controls). Body weight gain was better in patients receiving the high protein diet than in those receiving the normal protein diet. In both groups, initial IGF-I (32 +/- 6 and 24 +/- 7 ng/mL; mean +/- SD) and IGF-II (177 +/- 15, 174 +/- 45 ng/mL) concentrations were low compared to controls (100 +/- 12 and 542 +/- 29 ng/mL, respectively; P < 0.007). After refeeding, IGF-I increased to 160 +/- 26 ng/mL on the normal protein diet and to 322 +/- 41 ng/mL on the high protein diet, exceeding values in controls (P < 0.007). IGF-II increased more than 2-fold on each diet (P < 0.007), reaching control values. IGFBP-2 concentrations before refeeding were twice those in controls (750 +/- 200 vs. 317 +/- 33 ng/mL; P < 0.007) and normalized after refeeding in the high protein group (288 +/- 32 ng/mL; P = NS), but remained elevated in the normal protein group (526 +/- 77 ng/mL; P < 0.007). IGFBP-3 levels before refeeding were low and returned to normal on each diet. IGFBP-3 proteolytic activity in serum was initially increased and declined on the high protein diet. In conclusion, protein content in the refeeding diet differentially affects IGFs and IGFBPs in young undernourished children with infection. IGF-I and IGFBP-2 seem to be particularly sensitive to dietary protein alterations. We speculate that an increase in IGF-I concentrations, normalization of IGFBP levels, and a decrease in IGFBP-3 proteolytic activity in serum may all be involved in the improved recovery and catch-up growth observed with the high protein diet.

Insulin-like growth factor-binding protein-3 proteolysis is induced after elective surgery.

The insulin-like growth factors (IGFs) are bound to several binding proteins (IGFBPs) that appear to regulate IGF transport, receptor binding, and action. The concentrations of these peptides are altered by catabolic conditions. To determine if IGF-I and IGFBP levels change after surgery, sera were obtained from 16 patients before and after cholecystectomy. Immunoreactive IGF-I measured in plasma samples from which IGFBPs had been extracted did not change postoperatively. In contrast, IGF-I determined in unextracted samples increased roughly 3-fold postoperatively, presumably due to changes in IGFBPs. Two days postoperatively, IGFBP-3 levels, determined by ligand blot, averaged 36% of preoperative values, whereas levels of IGFBP-2 and a 24,000 mol wt IGFBP did not change significantly. Similarly, by immunoblot, intact IGFBP-3 was decreased 84.2 +/- 20.2%, and a 31,000 mol wt IGFBP-3 fragment increased 57.5 +/- 47.4% postoperatively. Coincubation of postoperative, but not preoperative, sera with control sera resulted in a significant decrease in IGFBP-3 and production of proteolytic fragments. IGFBP-3 proteolytic activity in postoperative sera was markedly inhibited by antipain, Na-p-tosyl-L-lysine chloromethyl ketone, phenylmethylsulfonylfluoride, aprotinin, o-phenanthroline, and EDTA, but not by leupeptin or N-tosyl-L-phenylalanine chloromethyl ketone. This pattern of inhibition is consistent with a metal-dependent trypsin-like serine protease. We speculate that proteolysis of IGFBP-3 may alter tissue uptake of IGF-I and thereby help to counteract the catabolic state caused by surgery.

Serum concentrations of insulin-like growth factor II are not changed by short-term fasting and refeeding.

To determine the factors that regulate insulin-like growth factor II (IGF-II), we raised polyclonal antibodies to this peptide and developed a RIA that measures IGF-II in serum or plasma samples after extraction of IGF-binding proteins by C18 cartridge chromatography. The IGF-II antiserum was highly specific, exhibiting no cross-reactivity with IGF-I or insulin at the highest concentrations tested (10(-6) mol/L). As little as 0.43 micrograms/L IGF-II was detectable, and 50% displacement of tracer occurred at 1.7 microgram/L. The serum IGF-II concentrations of normal adults [mean, 634 +/- 170 (+/- SD) micrograms/L], patients with acromegaly (570 +/- 146 micrograms/L), and patients with hypopituitarism (156 +/- 58 micrograms/L) were similar to those reported by others. In eight obese subjects injected with GH (0.1 mg/kg ideal BW, im, every 48 h for 16 days), serum IGF-II concentrations did not rise significantly, whereas IGF-I concentrations increased 67%. Sixteen normal subjects, within 15% of ideal body weight, were fasted for 5 days on two to four occasions and refed diets of differing protein and calorie contents. Their mean serum IGF-II concentration before fasting (691 +/- 26 micrograms/L) was not significantly different from that after fasting (674 +/- 21 micrograms/L) or after refeeding (641 +/- 20 micrograms/L). In contrast, their mean IGF-I concentration decreased 42% with fasting and rose with refeeding. Unlike IGF-I, serum IGF-II concentrations do not appear to be regulated by short term changes in nutritional status. It is clear from this study and others that IGF-II and IGF-I are regulated differently despite their structural homology and the similarity of their actions in vitro.

Reduced serum concentrations of insulin-like growth factor-I (IGF-I) in protein-restricted growing rats are accompanied by reduced IGF-I mRNA levels in liver and skeletal muscle.

The serum concentration of insulin-like growth factor-I (IGF-I) is reduced in growing rats fed a low-protein diet, and this decrease is age-dependent, being more pronounced in younger animals. To determine whether this decrease in serum IGF-I is related to a decrease in IGF-I mRNA, growing female rats were given free access to either a 15% protein-sufficient or a 5% protein-deficient diet for 1 week. Protein restriction in 4-week-old rats decreased body weight gain by 44% (P less than 0.001 compared with 4-week controls), serum IGF-I concentration by 67% (P less than 0.001) and liver IGF-I mRNA abundance by 51% (P less than 0.001). During week 6, protein restriction for 1 week resulted in a 20% increase in food intake with no change in weight gain, a 38% reduction in serum IGF-I (P less than 0.001 compared with 6-week controls) and a 39% decrease in liver IGF-I mRNA (P less than 0.001). The serum IGF-I concentration was highly correlated (r = 0.80; P less than 0.001) with the hepatic IGF-I mRNA concentration. Skeletal muscle IGF-I mRNA abundance was also decreased significantly by protein restriction (37% at week 4, P less than 0.001, and 24% at week 6, P less than 0.01) and was closely correlated (r = 0.71; P less than 0.001) with body weight gain. Liver GH-binding protein and GH receptor mRNA abundance were reduced by 1 week of protein deprivation at week 6 but not at week 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Preoperative evaluation of intersex patients with pelvic magnetic resonance imaging in search of Y chromosome-bearing gonadal tissue.

OBJECTIVE: To illustrate the utility of preoperative magnetic resonance imaging in the evaluation of intersex patients who require gonadectomy. DESIGN: Case reports of two phenotypic females having karyotypes containing a Y chromosome whose preoperative evaluation included pelvic magnetic resonance imaging. SETTING: Tertiary academic referral center. MAIN OUTCOME MEASURE: Pelvic magnetic resonance imaging for gonadal localization. RESULTS: Preoperative evaluation with magnetic resonance imaging correctly identified the most appropriate surgical approach to gonadectomy. CONCLUSIONS: Pelvic magnetic resonance imaging can be useful in the preoperative evaluation of intersex patients having nonpalpable Y chromosome-bearing gonadal tissue.

Early-onset sensorineural hearing loss in a child with Turner syndrome.

Turner syndrome is among the more common but less familiar syndromes that include sensorineural hearing loss and middle ear disease. This article provides a review of the syndrome, an illustrative case, and a review of specific issues relevant to audiologic management of patients with Turner syndrome.

Turner syndrome: a pattern of early growth failure.

The purpose of this study was to determine the pattern of early growth in girls with Turner syndrome. Analysis was performed on a total of 464 longitudinal measurements of height, obtained from birth to 8 years of age from 37 girls with Turner syndrome who did not have significant cardiac disease or autosomal abnormalities. All data were obtained prior to the initiation of any hormonal therapy. Mean height SDS fell from -0.5 at birth to -1.5 at age 1 year and -1.8 at age 1.5 years. Growth curves fitted using the first two components of the infancy-childhood-puberty model of growth revealed that growth failure was due to (a) mild growth retardation in utero, (b) slow growth during infancy, (c) delayed onset of the childhood component of growth and (d) slow growth during childhood. Physicians should consider the diagnosis of Turner syndrome in any girl with an unexplained failure to thrive or with short stature, even during the first 2 years of life.

The effect of growth hormone on craniofacial growth and dental maturation in Turner syndrome.

Serial cephalometric and panoramic radiographs from a mixed longitudinal group of 28 subjects with Turner syndrome (TS), age 4.4-19.0 years, were evaluated for annualized growth increments of the craniofacial complex and dental development and were compared with a longitudinal control group from the Burlington growth study. The short and retrognathic face characteristic of the syndrome was due largely to the increased cranial base angle, decreased posterior face height, and decreased mandibular length, all of which were significantly different from the controls. Although increases in statural height occurred in the TS children who were treated with human growth hormone (GH), there was little or no effect on growth of the jaws, particularly in the older subjects, and the characteristic facies of the syndrome persisted. Dental development was advanced in all TS subjects, and GH administration had no effect on the rate of dental development.

Delayed diagnoses of Turner's syndrome: proposed guidelines for change.

OBJECTIVE: To measure the delays in diagnosis of Turner's syndrome (TS) and to propose strategies for earlier screening and diagnosis. METHODS: The medical records of 81 girls with TS were reviewed for age at diagnosis, reason(s) for karyotype analysis, and clinical features including growth failure. Delay in diagnosis was calculated as equal to age at diagnosis for children born with lymphedema and/or 2 or more of the following dysmorphic features: webbed neck, nail dysplasia, high palate, and short fourth metacarpal. For all others, delay in diagnosis was calculated as the difference between the age at which height fell below the 5th percentile and the age at which the diagnosis of TS was made. RESULTS: Lymphedema was the key to diagnosis in 97% of the girls diagnosed with TS in infancy, and short stature was the key to diagnosis for 82% of the girls diagnosed in childhood or adolescence. For girls diagnosed in childhood or adolescence, the delay in diagnosis averaged 7.7 +/- 5.4 years. Many had dysmorphic features and/or a history of lymphedema at birth, and diagnosis was made an average of 5.3 years after patients had fallen below the 5th percentile for height. By the time of diagnosis, patients were very short, averaging -2.9 SD in height. CONCLUSIONS: The diagnosis of TS is often delayed. We recommend karyotype analysis for all girls with unexplained short stature, delayed puberty, webbed neck, lymphedema, or coarctation of the aorta. Furthermore, karyotype analysis should be strongly considered for those who remain above the 5th percentile for height but have 2 or more features of TS, including high palate, nail dysplasia, short fourth metacarpal, and strabismus.