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Background Identification of aetiology for fever of unknown origin ( FUO) is challenging, due to the high rates of undiagnosed cases. The current diagnostic approach includes initially first-line procedures such as general examination and various laboratory tests and basic imaging techniques followed by second-line tests such as more advanced imaging techniques including 18F fluorodeoxyglucose positron emission tomography ( FDG PET) and tissue biopsies. If no diagnosis is obtained, more invasive measures may be in order such as liver biopsy and exploratory laparotomy. Materials and methods This review article is based on the relative published material found on MEDLINE and Pub Med up to August 2014. We looked for the terms 'fever of unknown origin, FDG PET' in combination with 'cancer, infection and autoimmune disease'. Results Several clinical studies have investigated the utility of the FDG PET during the diagnostic approach of FUO. Recent evidence suggests that FDG PET has the advantage of total body imaging and may depict all common causes of FUO such as infections, noninfectious inflammatory causes and tumours because they all exhibit glucose hypermetabolism. Depiction of an abnormal lesion on FDG PET could guide clinicians to the next diagnostic procedure (another imaging method, culture, biopsy or surgery) to establish the diagnosis. Conclusions Emerging evidence suggests that FDG PET, when available, may provide critical diagnostic information early during evaluation of FUO. [ABSTRACT FROM AUTHOR]

Pleomorphic adenoma is a non-cancerous neoplasm that develops in the salivary glands. Originating from minor salivary glands, it is extremely uncommon and primarily affects females. The peak incidence is observed between 40 and 60 years of age. It usually presents as a slowly growing, painless, solid tumor that does not cause ulcers on the overlying mucosa. Here, a 47-year-old woman experienced repeated swelling on the buccal mucosa following surgical extraction of a pleomorphic adenoma three years ago. The swelling was solid with clearly defined boundaries. An excisional biopsy was conducted under general anesthesia, resulting in total mass removal. The histological evaluation revealed the existence of a recurring pleomorphic adenoma. This instance emphasizes the significance of addressing this entity as a potential etiology for persistent painless and intraoral swellings. [ABSTRACT FROM AUTHOR]

To date, many potent compounds have been found which are derived from plants and herbs and possess anticancer properties due to their antioxidant effects. 9″-Lithospermic acid methyl ester is an effective natural compound derived from the Thymus thracicus Velen. It has been proven that this compound has substantial properties in different diseases, but its effects in cancer have not been thoroughly evaluated. The aim of this work was to study the effects of 9″-Lithospermic acid methyl ester (9″-methyl lithospermate) in U87 and T98 glioblastoma cell lines. Its effects on cellular viability were assessed via Trypan Blue and Crystal Violet stains, the cell cycle analysis through flow cytometry, and cell migration by employing the scratch wound healing assay. The results demonstrated that 9″-methyl lithospermate was able to inhibit cellular proliferation, induce cellular death, and inhibit cell migration. Furthermore, these results were intensified by the addition of temozolomide, the most prominent chemotherapeutic drug in glioblastoma tumors. Further studies are needed to reproduce these findings in animal models and investigate if 9″-lithospermic acid methyl ester represents a potential new therapeutic addition for gliomas. [ABSTRACT FROM AUTHOR]

Background: Inflammation is an important mechanism in atherosclerosis and plaque formation. C-reactive protein (CRP) is a common inflammatory biomarker associated with the risk of coronary heart disease. We investigated the relationship of CRP with findings from myocardial perfusion imaging (MPI). Methods: In this retrospective study, 102 consecutive patients (mean age 71 years, 68% males) who underwent MPI (for diagnostic reasons or quantification of myocardial ischemia) and CRP determination (upper limit: 6 mg/L) within 1 month from MPI were included. The patients had no infection or recent acute coronary syndrome. Results: The median CRP level was 4 mg/L (2, 10) among the study population. Patients with raised CRP had higher summed stress score (SSS) (p = 0.006) and summed rest score (SRS) (p = 0.001) and higher risk for SSS > 3 (OR 9.25, 95% CI 2.03–42.13, p = 0.001) compared to those with low CRP. The association of SSS and SRS with CRP levels was more evident in patients over 70 years (p = 0.027 and p = 0.005, respectively). No significant difference in summed difference score was shown. The two groups had no difference in other risk factors (p > 0.05 for all comparisons). Conclusion: a high level of CRP was associated with the presence and extent of stress-induced myocardial ischemia in MPI. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Factors Connected With the Female Sex Seem to Play an Important Role in Differentiated Thyroid Cancer" by E. Przybylik-Mazurek and colleagues in a 2011 issue.

On brain magnetic resonance imaging, both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) are used to evaluate cerebral tumors. The purpose of this meta-analysis was to evaluate and compare the diagnostic performance of DWI and PWI in differentiating between pseudoprogression and true tumor progression of glioblastoma. We performed a systematic review of the PubMed database from January 2000 to December 2019 for relevant studies. After application of specific inclusion and exclusion criteria, the eligible articles were evaluated for methodologic quality and risk of bias using the updated Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. From the published study results, the pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio and their corresponding confidence intervals (% CI), and the area under the curve, were calculated individually for DWI and PWI. The meta-analysis included 24 studies, with a total of 900 patients. DWI was found to be slightly superior in terms of sensitivity and specificity, 0.88 (% CI 0.83–0.92) and 0.85 (% CI 0.78–0.91), respectively, compared with the respective values of PWI, 0.85 (% CI 0.81–0.89) and 0.79 (% CI 0.74–0.84). On comparison of the overall diagnostic accuracy of the MRI modalities using their respective area under the curve values (0.9156 for DWI, 0.9072 for PWI), no significant difference was demonstrated between the 2. Both DWI and PWI provided optimal diagnostic performance in differentiating pseudoprogression from true tumor progression in cerebral glioblastoma, and neither technique proved to be superior. [ABSTRACT FROM AUTHOR]

Background/objectives: Glioblastoma (GBM) is the most aggressive type of brain tumor in adults. Currently, the only treatments available are surgery, radiotherapy, and chemotherapy based on temozolomide (TMZ); however, the prognosis is dismal. Several natural substances are under investigation for cancer treatment. 8α-O-(3,4-dihydroxy-2-methylenebutanoyloxy) dehydromelitensine (Isocnicin) is a natural compound derived from Centaurea species and was found to exhibit cytostatic/cytotoxic effect against different cell lines. In this study, we investigated the anti-glioma effects of isocnicin in U87 and T98 glioblastoma cell lines, as well as the effects of combined treatment with radiotherapy., Methods: Cell viability was evaluated with the trypan blue exclusion assay, cell cycle distribution was examined using flow cytometry, and the effects of the combination treatment were analyzed with CompuSyn software(1.0)., Results: The result showed that isocnicin significantly reduced cell viability in U87 and T98 cell lines in a dose-dependent manner and IC 50 values were calculated. Administration of isocnicin alone induced both S and G2/M cell cycle arrest in U87 and T98 cells in a dose-dependent manner. Moreover, when cells were treated with increasing concentrations of isocnicin, followed by 2 or 4 Gy of radiation, the percentage distribution of the cells in the G2/M phase was increased considerably in both U87 and T98 cell lines., Conclusions: Here, we show for the first time that co-treatment of isocnicin with radiation exerts a synergistic antiproliferative effect in glioblastoma cell lines. Natural compounds are promising for glioblastoma treatment. Further studies will be necessary to unravel isocnicin's mechanism of action and its synergistic effect with radiation on glioblastoma treatment.

Background: Findings from functional neuroimaging techniques, such as single-photon emission computed tomography (SPECT), may add useful evidence improving Frontotemporal Dementia (FTD) diagnosis. The aim of the present study was to investigate patterns of hypoperfusion in a group of patients diagnosed with the behavioral variant of FTD (bvFTD) and to explore the relationship between brain perfusion and clinical characteristics., Materials and Methods: Brain perfusion of 23 bvFTD patients was measured with SPECT scintigraphy in lobes and Brodmann areas (BAs) and the NeurogamTM software was used for image analysis. To assess behavioral disturbances and dementia severity, patients' informants completed the Frontotempotal Behavioral Inventory and the Frontotemporal Dementia Rating Scale. Descriptive statistics were used for the detection of pathological hypoperfusion in lobes and selected BAs. Associations among patients' clinical characteristics and perfusion in lobes were explored via non-parametric correlations., Results: Participants presented pathological hypoperfusion in frontal, limbic and temporal lobes. The most prominent deficit was observed in limbic lobes, where all participants showed pathological hypoperfusion. Decreased perfusion was also observed in limbic, frontal and temporal BAs. Perfusion in the left and right frontal lobe was associated with behavioral disturbances and disease severity, which was also correlated with perfusion in right limbic, left and right temporal areas., Conclusion: Patterns of limbic, frontal and temporal hypopefusion were reported in the present study, along with associations between brain perfusion, behavioral disturbance and severity of dementia. Perfusion patterns can help to understand further associated brain biomarkers, contributing to early diagnosis and intervention in bvFTD., Competing Interests: Declarations. Conflict of interest: The authors declared no other potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical approval: The study protocol was approved by the Bioethics and Ethics Committee of School of Medicine of the Aristotle University of Thessaloniki. The study was conducted in accordance with the APA ethical standards and the Declaration of Helsinki. Participants gave written informed consent to participate., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

In this narrative review, we address mild cognitive impairment, a frequent complication of Parkinson's disease (PD) and atypical parkinsonian disorders (APDs). Recent diagnostic criteria have blurred the lines between PD and dementia with Lewy bodies (DLB), particularly in the cognitive domain. Additionally, atypical parkinsonian syndromes like progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) often present with significant cognitive decline. Even multiple system atrophy (MSA) can be associated with cognitive impairment in some cases. Several biomarkers, including imaging techniques, such brain magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET), as well as pathological proteins either of the cerebrospinal fluid (CSF), such as Tau, amyloid beta, and synuclein, or of the serum, such as neurofilament light chain (Nfl) are more and more often utilized in the early differential diagnosis of APDs. The complex interplay between these conditions and the evolving understanding of their underlying pathologies highlight the need for further research to refine diagnostic criteria, possibly incorporate the new findings from the biomarker's field into the diagnostic criteria and develop targeted therapeutic strategies., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: Our institution does not require ethical approval for narrative reviews. Informed consent: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Abnormalities in cognition are a pronounced feature in primary psychotic disorders and may appear long before the manifestation of the first-episode psychosis (FEP). Although brain functional changes may precede structural alterations, brain perfusion patterns in FEP and most importantly their correlations with cognition remain poorly understood. In the present study we assessed neurocognitive functions and regional cerebral blood flow (rCBF) in 53 patients with a diagnosis of FEP. A special emphasis was placed on the assessment of basic executive functions. Cerebral perfusion patterns were measured by SPECT rCBF scintigraphy in cerebral lobes bilaterally and Brodmann Areas (BAs). Patients showed impairments in long-term verbal memory, processing speed/response latency and executive cognition. Pathological perfusion was prominent in the limbic lobes bilaterally. BAs with the largest hypoperfusion, were the subgenual area (BA25) and hippocampal areas (BA 28 and 36). The left temporal lobe was also hypoperfused, and specifically the inferior temporal gyrus (BA 20), the left middle (BA 21) and superior (BA 22) temporal gyrus, and the temporal pole (BA 38). Hypoperfusion was limited in the frontal regions, although specific BAs displayed pathological perfusion (i.e., BA 24). Cerebral lobe perfusion was not correlated with compromised cognitive abilities., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

5-Hydroxy-3',4',6,7-tetramethoxyflavone (TMF) is a plant-origin flavone known for its anti-cancer properties. In the present study, the cytotoxic effect of TMF was evaluated in the U87MG and T98G glioblastoma (GBM) cell lines. The effect of TMF on cell viability was assessed with trypan blue exclusion assay and crystal violet staining. In addition, flow cytometry was performed to examine its effect on the different phases of the cell cycle, and in vitro scratch wound assay assessed the migratory capacity of the treated cells. Furthermore, the effect of in vitro radiotherapy was also evaluated with a combination of TMF and radiation. In both cell lines, TMF treatment resulted in G0/G1 cell cycle arrest, reduced cell viability, and reduced cell migratory capacity. In contrast, there was an antagonistic property of TMF treatment with radiotherapy. These results demonstrated the antineoplastic effect of TMF in GBM cells in vitro , but the antagonistic effect with radiotherapy indicated that TMF should be further evaluated for its possible antitumor role post-radiotherapy., (© 2024 the author(s), published by De Gruyter.)

Introduction: Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade., Materials and Methods: The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented., Results: Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used 18 F-FDG, one study used 18 F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%-91%) and the pooled specificity was 89% (95% CI: 83%-93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22-80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54-11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11-0.61)., Conclusion: PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Inc.)

Purpose: To describe a new technique of surgical treatment of the lip commissure or buccal mucosa carcinomas, where we use local flaps (skin, buccal mucosa) of the sliding type., Methods: According to the current technique, the ectomy ranges horizontally and in a cuneiform shape towards the side of the buccal cavity, and in the whole thickness of the layer (skin - mucosa), where the neoplastic focus is enclosed., Results: The difference in our technique consists of the following: To the vertical bi-cuneiform part of the wound a horizontal cuneiform part (with the top showing upwards) is added, with extent and width analogous to those of the cancerous injury (tri-cuneiform ectomy). The width of the gap across its horizontal part is larger on the side of the mucosa (continuous line), compared to the one along the side of the skin (punctuated line), since the mucosa, as a more versatile tissue, can be sutured easily, in contrast to the buccal skin, which is of greater thickness and shows lack of versatility, so that it can be pulled on with difficulty in order to be sutured. The planning of the injury, according to our described technique, facilitates the broad ectomy of the intraoral injuries in the area of the lip commissure and the buccal mucosa, with immediate suture of the flaps (buccal and skin gap), and the occlusion of the wound by primary intention., Conclusions: Using this specific technique, in the cases of extended injuries infiltrating the skin or the subcutaneous tissue, the harming use of transposition (sliding or free) flaps is avoided.

Purpose: To evaluate the impact of psychiatric co-morbidities on the quality of life-36 (QoL36) and tolerance to mental pain scale (TMPS) questionnaire of cancer patients administered in the Laboratory of Nuclear Medicine prior to a bone scan to rule out metastatic disease., Methods: A group of 40 consecutive cancer patients (24 prostate, 12 breast and 4 with other cancers) were subjected to bone scan (BS) to rule out metastatic disease. Each patient received QoL36 and TMPS questionnaire prior to BS., Results: There were low QoL and TMPS scores in all patient groups. The average QoL36 questionnaire score was 43,71 (23-70) (normal values considered >90). The average TMPS scores for prostate cancer patients was 55.42 (21-96), for breast cancer patients 63.42 (44-83) and for the other cancer patients 58.25 (48-68). Female patients with breast cancer had statistically higher tolerance to mental pain compared to patients with prostate cancer. Both tests were independently important for evaluation of the psychological status of the patients. There was no significant correlation of either QoL or TMPS with age, sex or disease duration., Conclusions: Cancer patients exhibited low QoL and TMPS, independent of sex, age, cancer type and disease duration. Multi-modality psychological support may be needed for these patients.

Lymphomas are the most common hematological malignancies and are further distinguished in Hodgkin lymphoma (HL) and non-Hodgkin (NHL). For staging purposes and for assessing response to treatment, the Lugano classification is currently used, both for HL and NHL patients, whereas for the assessment of prognosis, several prognostic systems exist, such as the international prognostic index (IPI) and revised-IPI for diffuse large B cell lymphomas, follicular lymphoma IPI (FLIPI)-1 and 2 for follicular lymphomas, and the international prognostic score for advanced HL. The aim of this systematic review was to determine the significance of the metabolic FDG PET/CT parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in monitoring therapeutic interventions and prognostic outcome of patients with HL and NHL. We performed a systematic search on the literature and selection of articles concerning treatment evaluation, response and survival in association with MTV and TLG in patients with lymphomas. Our review documented that in most studies, baseline MTV and TLG were predictive of treatment response, progression-free survival (PFS) and overall survival (OS) for both HL and NHL patients. There were conflicting results for the value of interim determination of MTV and TLG. Our conclusion was that combination of baseline MTV and TLG parameters with prognostic scoring systems, such as IPI, or FLIPI-1 and -2, will add additional predictive power for response and prognosis in lymphoma patients.

Osteosarcoma (OS) is the most frequent bone-forming malignancy in children and adolescents. Concerning its molecular landscape, there is no a direct relationship with a specific gene, but a combination of genetic events. A broad spectrum of activated oncogenes and downregulated suppressor genes has been already explored and considered crucial for its progressive pathogenesis. Mechanisms of gene deregulation include amplifications, point mutations, allelic losses and also epigenetic abnormalities such as aberrant promoter methylation. Although a significant progress in understanding the molecular nature of the OS has been achieved, its aggressive phenotype - characterized by high metastatic potential - remains unexplored. Novel targeted therapeutic strategies include monoclonal antibodies (mABs) and also tyrosine-kinase inhibitors (TKIs). Additionally, sophisticated and innovative diagnostic techniques, such as 18 fluorodeoxyglucose positron emission tomography plus CT (18F-FDG/PET/CT), provide critical data regarding its biological behavior. In the current paper, we present novel molecular and metabolic advances by analyzing OS genetic profile and biochemical microenvironment.

Background: To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99m Technetium-tetrofosmin ( 99m Tc-TF)-single-photon emission computed tomography (SPECT)., Methods: Fifty-two patients with ischemic stroke were subjected to 99m Tc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS <4. Parameters such as age, body mass index, waist perimeter, smoking habits, and medical history (diabetes mellitus, dyslipidemia, etc) were evaluated according to MPI results., Results: Myocardial ischemia was present in 32 (62%) of 52 patients with stroke. Among them, 20 (62%) of 32 patients had mild abnormalities and 12 (38%) of 32 had moderate/severe. The age and waist perimeter showed a tendency to relate to severe MIS when patients with SSS >9 were compared to patients with SSS <4. In MPI-positive patients, an age was to be association with SSS, with the oldest age exhibiting the highest SSS ( P = .01). The association of age with SSS remained statistically significant in the multivariate analysis ( P = .04)., Conclusion: The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.