Designing a New Molecular Probe: The Potential Role for Tilmanocept (Lymphoseek®) in the Assessment of Patients with Painful Hip and Knee Joint Prostheses.

BACKGROUND: There is a long history of nuclear medicine developments in orthopaedics beginning in the early 20th century. Technetium-99m (99mTc) has a short half-life of six hours, emits 140 keV gamma rays and is the most widely used isotope, imaged with the Anger (gamma) camera. Gamma image quality and test sensitivity in painful prosthetic joints can be improved with single photon emission computed tomography (SPECT) and SPECT/CT. Positron Emission Tomography-Computed Tomography (PET-CT) with Sodium Fluoride (18F-NaF) and 18Fluorine-fluorodeoxyglucose (18F-FDG) PET have promising and limited roles respectively in the investigation of painful prosthetic joints. New SPECT/CT and PET-CT isotopes targeting activated macrophages with 99mTc Tilmanocept (Lymphoseek®) and 68Gallium labelled Tilmanocept respectively show potential as agents to demonstrate wear particles ingested by macrophages and multinucleated giant cells. An imaging algorithm using SPECT and/or PET agents is proffered as a cost effective way of speedily and accurately arriving a diagnosis. METHODS: Review of the historical role of nuclear medicine in orthopaedics and research into the potential role of new radiopharmaceutical agents was undertaken. Guidelines and algorithms for the imaging of complicated joint prosthesis are provided. RESULTS: There is an established role for nuclear medicine in orthopaedics and particularly in the investigation of complicated joint prostheses. Imaging with Tilmanocept provides new opportunities to shorten the time to diagnose loosened and infected joint prostheses. CONCLUSION: There is a potential new role for Tilmanocept, which can be utilised with both PET-CT and SPECT-CT technologies. Tilmanocept is a relatively new radiopharmaceutical which has a potential role in the imaging assessment of painful joint prosthesis.

Intraorbital wooden foreign body (IOFB): mimicking air on CT.

We report the case of a 41-year-old man who presented to the ER following a fall in his back garden during which he sustained a left orbital injury. Computed tomography (CT) demonstrated an intraorbital linear lucency surrounded by haziness in the intraconal fat. An intraocular wooden twig was confirmed during subsequent surgery. The possibility of a wooden intraorbital foreign body should be strongly suspected following orbital trauma when there is intraorbital density below that of the surrounding intraorbital fat on CT, as this may mimic organic foreign bodies.

Insulin-like growth factor 1 is required for G2 progression in the estradiol-induced mitotic cycle.

Insulin-like growth factor 1 (IGF1) has been proposed as a "G1-progression factor" and as a mediator of estradiol's (E2) mitogenic effects on the uterus. To test these hypotheses, we compared E2's mitogenic effects on the uteri of Igf1-targeted gene deletion (null) and wild-type littermate mice. The proportion of uterine cells involved in the cell cycle and G1- and S-phase kinetics were not significantly different in wild-type and Igf1-null mice. However, the appearance of E2-induced mitotic figures and cell number increases were profoundly retarded in Igf1-null uterine tissue. There was a significant increase in nuclear DNA concentration in Igf1-null cells, consistent with a G2 arrest. Interestingly, apoptotic cells were also significantly reduced in abundance, and the normal massive apoptotic response to E2 withdrawal was absent in the Igf1-null uterus. These data show that Igf1 is an essential mediator of E2's mitogenic effects, with a critical role not in G1 progression but in G2 progression.

Fibroblast growth factors 1 and 2 in the primate uterus.

Fibroblast growth factors (FGF) 1 and 2 are paracrine effectors of proliferation and angiogenesis in many tissues. To elucidate potential roles for these growth factors in uterine plasticity, we used in situ hybridization histochemistry to identify the cellular sources of FGF-1 and -2 production, and immunohistochemistry to identify the cellular and extracellular deposition sites of the peptides in the primate uterus. To evaluate the effects of estradiol on uterine FGFs, uteri from ovariectomized rhesus monkeys treated with estradiol- or vehicle-containing pellets were investigated. FGF-1 and -2 mRNAs were both expressed in uterine epithelial and myometrial cells. Quantitative comparison of their mRNA levels using computerized grain counting showed no significant difference between estradiol- and vehicle-treated animals. FGF-1 immunoreactivity was detected in scattered epithelial, vascular, and myometrial cells in the vehicle-treated animals but found to be significantly more intense and widespread in estradiol-treated animals. In both conditions, FGF-1 immunostaining was predominantly nuclear. FGF-2 immunoreactivity was concentrated extracellularly in the basal lamina of both glandular and surface epithelium and was abundant and diffusely distributed within myometrial and vascular cells in both cytoplasm and nucleus. There was no apparent difference in the pattern or intensity of FGF-2 immunostaining related to estradiol treatment. These data demonstrate that major uterine cell types synthesize both FGF-1 and -2, and that the two peptides are differentially localized in uterine cellular and extracellular compartments and differentially sensitive to regulation by estradiol.

Androgen receptor gene expression in the primate ovary: cellular localization, regulation, and functional correlations.

Excess androgens are associated with a characteristic polyfollicular ovarian morphology; however, it is not known to what extent this problem is due to direct androgen action on follicular development vs. interference with gonadotropin release at the level of the pituitary or hypothalamus. To elucidate potential androgen effects on the ovary, we investigated the cellular localization of androgen receptor (AR) messenger ribonucleic acid (mRNA) in rhesus monkey using in situ hybridization. To investigate the regulation of ovarian AR gene expression, we compared the relative abundance of AR transcripts in monkeys during follicular and luteal phases of the menstrual cycle and in monkeys treated with testosterone. To assess potential functional consequences of AR expression in the primate ovary, we compared AR mRNA levels with indexes of follicular cell proliferation and apoptosis in serial sections from individual follicles. AR mRNA expression was most abundant in granulosa cells of healthy preantral and antral follicles in the primate ovary. Theca interna and stromal cells also expressed AR mRNA, but to a lesser degree than granulosa cells. No significant cycle stage effects were noted in AR mRNA levels; however, larger numbers of animals would be necessary to definitively establish a cycle stage effect. AR mRNA level was significantly increased in granulosa cells and was decreased in theca interna and stromal cells of testosterone-treated monkeys. Importantly, granulosa cell AR mRNA abundance was positively correlated with expression of the proliferation-specific antigen Ki-67 (r = 0.91; P < 0.001) and negatively correlated with granulosa cell apoptosis (r = -0.64; P < 0.001). In summary, these data show that primate ovary AR gene expression is most abundant in granulosa cells of healthy growing follicles, where its expression is up-regulated by testosterone. The positive correlation between granulosa AR gene expression and cell proliferation and negative correlation with programmed cell death suggests that androgens stimulate early primate follicle development.

Androgens stimulate early stages of follicular growth in the primate ovary.

The concept that androgens are atretogenic, derived from murine ovary studies, is difficult to reconcile with the fact that hyperandrogenic women have more developing follicles than normal-cycling women. To evaluate androgen's effects on primate follicular growth and survival, normal-cycling rhesus monkeys were treated with placebo-, testosterone-(T), or dihydrotestosterone-sustained release implants, and ovaries were taken for histological analysis after 3-10 d of treatment. Growing preantral and small antral follicles up to 1 mm in diameter were significantly and progressively increased in number and thecal layer thickness in T-treated monkeys from 3-10 d. Granulosa and thecal cell proliferation, as determined by immunodetection of the Ki67 antigen, were significantly increased in these follicles. Preovulatory follicles (> 1 mm), however, were not increased in number in androgen-treated animals. Follicular atresia was not increased and there were actually significantly fewer apoptotic granulosa cells in the T-treated groups. Dihydrotestosterone treatment had identical effects, indicating that these growth-promoting actions are mediated by the androgen receptor. These findings show that, over the short term at least, androgens are not atretogenic and actually enhance follicular growth and survival in the primate. These new data provide a plausible explanation for the pathogenesis of "polycystic" ovaries in hyperandrogenism.

Growth hormone treatment induces mammary gland hyperplasia in aging primates.

The decline of growth hormone (GH) and insulin-like growth factor I (IGF-I) production during aging has been likened to the decrease in gonadal steroids in menopause. The repletion of GH/IGF-I levels in aging individuals is suggested to restore the lean tissue anabolism characteristic of youth. In addition to anabolic effects on musculo-skeletal tissues, GH also stimulates mammary glandular growth in some species, although its effects on primate mammary growth remain unclear. Some clinical observations implicate GH in human mammary growth, for example, gynecomastia occurs in some children treated with GH (ref. 6), and tall stature and acromegaly are associated with an increased incidence of breast cancer. To investigate the effects of GH/IGF-I augmentation on mammary tissue in a model relevant to aging humans, we treated aged female rhesus monkeys with GH, IGF-I, GH + IGF-I or saline diluent for 7 weeks. IGF-I treatment was associated with a twofold increase, GH with a three- to fourfold increase, and GH + IGF-I with a four'-to fivefold increase in mammary glandular size and epithelial proliferation index. These mitogenic effects were directly correlated with circulating GH and IGF-I levels, suggesting that either GH or its downstream effector IGF-I stimulates primate mammary epithelial proliferation.

Selective expression of insulin-like growth factor system components during porcine ovary follicular selection.

In situ hybridization was used to map anatomical patterns of insulin-like growth factor (IGF) system gene expression in the gilt ovary through the estrous cycle. IGF-I, IGF-II< and IGF-I receptor messenger RNAs (mRNAs) were coexpressed in granulosa cells of developing and dominant follicles through the follicular phase. IGF-I and IGF-I receptor mRNAs were selectively concentrated in healthy follicles, whereas IGF-II mRNA was found in all follicles regardless of incipient or overt atresia. IGF-binding protein-1 (IGFBP-1) was not detected in the gilt ovary at any stage. IGFBP-2 mRNA was most abundant in granulosa cells of small follicles and in the ovarian vasculature regardless of cycle stage. IGFBP-2 mRNA persisted in granulosa cells of preovulatory follicles and corpora lutea. IGFBP-3 mRNA was not detected in developing follicles, but was detected in all luteal phase corpora lutea, apparently expressed by theca lutein cells. IGFBP-4 demonstrated a highly dynamic pattern of gene expression, closely tracking LH receptor gene expression throughout the follicular and luteal phases of the estrous cycle. IGFBP-4 mRNA was concentrated in the theca of medium to large growing follicles, but was not detected in granulosa cells until the emergence of dominant follicles in the late follicular stage, when the granulosa cells showed morphological evidence of luteinization as well as LH receptor gene expression. IGFBP-4 mRNA expression continued in granulosa cells of corpora lutea during the luteal phase and was not detected in atretic follicles. IGFBP-5 mRNA was concentrated in the surface or germinal epithelium and in capillary endothelium, particularly in capillaries of corpora lutea. In summary, there is selective expression of IGF-I, IGF-I receptor, and IGFBP-2 and -4 mRNAs during the process of follicular selection in the gilt ovary, with IGFBP-4 expression being closely associated with follicular selection and luteinization. These observations support an important role for autocrine/paracrine IGF action modulated by IGFBP-2 and -4 in both follicular growth and differentiation in the porcine ovary.

Cellular localization and sex steroid regulation of insulin-like growth factor binding protein messenger ribonucleic acids in the primate myometrium.

Insulin-like growth factors (IGF)-I and -II are abundant in the primate myometrium and are implicated in the sex steroid-induced growth of this tissue. To evaluate the potential for modulation of IGF action in the primate myometrium by locally produced IGF binding proteins (IGFBPs), we examined the cellular localization and sex steroid regulation of IGFBPs 1-5 in the nonhuman primate uterus. Ovariectomized rhesus monkeys were treated with placebo, estradiol (E2), or E2 and progesterone (P4) (E2 and P4) for 2 weeks, after which their uteri were removed and cut into thin serial sections for analysis by in situ hybridization. IGFBP-1 messenger RNA (mRNA) was not detected in control or E2-treated uteri but was found in a few unidentified cells in the E2 and P4-treated group. IGFBP-2, -3, -4, and -5 mRNAs were all expressed by myometrial smooth muscle cells but each displayed distinctive patterns of regulation by sex steroids. IGFBP-2 was barely detectable in control myometrium, was significantly increased by E2 and even more significantly by E2 and P4. IGFBP-4 and 5 mRNAs were readily detectable in control myometrium and significantly increased by E2 treatment. The addition of P4 to E2 treatment did not produce a significantly greater augmentation in IGFBP-4 or 5mRNA level compared with E2 alone. IGFBP-3 mRNA was abundant in the control myometrium, but in contrast to other IGFBPs was significantly reduced by approximately 75% in smooth muscle cells by E2 and by E2 and P4 treatment. Interestingly, however, IGFBP-3 mRNA was increased in the uterine vascular endothelium by E2 and by E2 and P4 treatment. In summary, this study has shown that four of the six known IGFBPs are highly expressed in the primate myometrium, and that their expression is differentially regulated by sex steroids. The cellular and sex steroid-regulated pattern of IGFBP-2 gene expression is very similar to that of IGF-I, as previously determined in these same myometrial samples. Both IGF-I and IGFBP-2 are dependent on E2 for significant myometrial expression, and both are further augmented by the addition of P4 to E2 treatment. Uterine smooth muscle IGFBP-3 mRNA levels are negatively regulated, whereas IGFBP-4 and -5 mRNA levels are positively regulated by E2: none of these myometrial IGFBPs appears sensitive to the effects of P4. The present observations, together with our previous data from the same animals, demonstrate that the primate myometrial smooth muscle cell expresses mRNAs for IGF-I and -II, IGF-I and -II receptors, as well as expresses mRNAs for IGFBP-2, -3, -4, and -5. These data provide evidence for complex local interactions between IGF system components regulated by estrogen and progesterone.

Evaluating oral contraceptive use at 6 and 12 months.

OBJECTIVE: To determine if oral contraceptive use necessitates more than a yearly visit. STUDY DESIGN: Outpatient files of all patients in a gynecologic clinic were evaluated. Patients who were started on oral contraceptives were identified. The findings on their return visits at 6 months and 12 months were compared for any significant differences. RESULTS: There was no increased incidence of elevation in blood pressure noted at the 6-month visit when compared to the 12-month visit. Likewise, there was no significant difference in the incidence of abnormal findings on breast and pelvic examinations at the 6-month visit as compared to the 12-month visit. CONCLUSION: Annual evaluations for patients on low-dose oral contraceptives are adequate. The patients who attended this clinic were working-class, middle-aged women, and as such the data from this study may not be applicable to the population at large.

Sex steroid regulation of insulin-like growth factor system gene expression and proliferation in primate myometrium.

To investigate the role of locally produced insulin-like growth factors (IGFs) in sex steroid-induced growth in the primate uterus, ovariectomized rhesus monkeys were treated with placebo (control), estradiol (E2) alone, or E2 plus progesterone (P4). After 2 weeks, uteri were removed, and serial thin uterine sections were analyzed by in situ hybridization for IGF-I, IGF-II, and IGF-I and -II receptor messenger ribonucleic acids (mRNAs) and by immunocytochemistry for the cell proliferation-specific antigen Ki-67. IGF-I and IGF-II and both IGF receptor mRNAs are coexpressed by smooth muscle cells, supporting the possibility of autocrine/paracrine IGF action in stimulating myometrial growth. IGF-I mRNA is barely detected in control myometrium, is significantly increased by E2 treatment, and is augmented even more by the combination of E2 and P4 treatment, whereas little change is noted in myometrial IGF-II or IGF-I receptor mRNA levels. Ki-67-positive myometrial nuclei are also significantly increased by E2 and are augmented even more by E2 plus P4 treatment, with a correlation between local IGF-I mRNA concentration and local Ki-67-positive cell count of r = 0.891 (P = 0.003). These data provide direct experimental evidence for regulation of IGF-I gene expression by sex steroids in the primate uterus in vivo and implicate local IGF-I action in both estrogen- and P4-induced myometrial growth.

Mycoflora, and mycotoxins production in Nigerian corn and corn-based snacks.

Thirty-one fungal species, mostly toxigenic and belonging to 11 genera were isolated from corn, corn cake and corn roll snack samples. Aspergillus, Penicillium and Fusarium accounted for 10, 6 and 3 of the species and altogether, they constituted 90, 94 and 88 percent of the total fungi in corn, corn cake and corn roll snack respectively. Mycotoxins (aflatoxins and ochratoxin A) were detected in 45, 80 and 12 percent while the means and ranges of the total aflatoxins recorded were: 200(25-770 ppb); 233(15-1070 ppb) and 55(10-160 ppb) for corn, corn cake and corn roll snack samples respectively. Ochratoxin A was detected at toxicologically significant levels in only 15 percent of the corn cake samples analyzed. All the strains of Aspergillus flavus and A. ochraceus tested produced aflatoxin B and ochratoxin A, respectively, when they were cultured on each of the three substrates. In each case, substantial quantities of the toxins were produced from 25 to 35 degrees C with the peak level recorded at 30 degrees C. Toxin production was detected only in substrates with 15 percent moisture content and above; reaching the maximum at 25 or 30 percent moisture level. No substantial differences in the amount of toxins were elaborated with further increase in substrates' moisture content. Of the three substrates, corn cake was the most suitable for aflatoxin B production while they were all equally suitable for the elaboration of ochratoxin A.

Effect of time, temperature and humidity on biodeterioration of corn cake snack.

Food spoilage microorganisms representing 5, 6 and 10 genera of moulds, yeasts and bacteria, respectively were isolated from corn cake snack. Each of the samples analysed had initial pH value favourable to microbial growth and activities while only 28% had spoilage-enhancing moisture contents (> 13%). The effect of temperature and relative humidity (RH) on biodeterioration during a 24-day storage period was determined by monitoring changes in the pH and total microbial colony counts. Whereas very little or no deterioration was recorded for samples contained in 51% and 71% RH chambers at 30 and 45 degrees C, substantial deterioration was obtained at the same temperatures under 89.5% and 100% RH. At 15 degrees C, very little or no deterioration was detected except under 79.5%, 89.5% and 100% RH when slight spoilage changes were recorded as from the 12th or 18th day. The overall results show that the obtained colony counts and pH values monitor spoilage equally.