The study showed that, with a metabolic inhibitor, there was no worsening of this QT prolongation with ziprasidone. Moreover, with a very large clinical database, including several cases of overdose with

QT monitoring, showed no increased incidence of adverse events, even all-cause mortality. The increases in QT length are mild and no increase in overall mortality with drug use has been shown. Consequently, despite the QT prolongation, no adverse cardiac Inhibitors,research,lifescience,medical events have been linked to ziprasidone. Thus, the drug has been approved by the FDA with minimal restriction and is being successfully marketed. Its freedom from weight gain as a side effect and its potential for antidepressant actions Inhibitors,research,lifescience,medical due to its reuptake protein blockade should be advantageous for this antipsychotic. Pipeline compounds and novel approaches Many antipsychotic drugs remain in development. Some are pharmacologically similar to current compounds, being potent D2 dopamine and 5-HT2 serotonin receptor antagonists. Despite pharmacological

Inhibitors,research,lifescience,medical similarities, clinical activity differences in efficacy and particularly in side-effect profiles do become apparent with clinical use. Consequently, there still exists room for new or second-generation antipsychotic drug development. However, drugs acting through novel mechanisms to produce a putative antipsychotic action are also being developed and tested. Aripiprazole (a partial dopamine agonist) has been shown to have equivalent efficacy to other antipsychotics and has a more benign side-effect profile than D2 blockers. Iloperidone and sertindole are being prepared for regulatory review. OSU6162 and ACR-16 are Inhibitors,research,lifescience,medical two chemical congeners of each other developed by Arvid

Carlsson and called dopaminergic “stabilizers” because they reduce dopaminergic function when elevated and Inhibitors,research,lifescience,medical elevate dopaminergic function in hypodopamine situations. Moreover, in some categories (Alisertib datasheet glutamatergic drugs, nicotinic agonists, muscarinic-1 antagonists, and metabotropic agents), glutamatergic antipsychotic drug strategies are being subjected to evaluation first in animal models, and then in human studies. Clinicians look forward to having novel antipsychotics potentially targeted at disease pathophysiology. Summary and conclusions The state of therapeutic agents for psychosis is broad today and rather full of opportunity for 4-Aminobutyrate aminotransferase patients. Whereas there was a long “dry” period in drug development for psychosis throughout, the whole of the 1980s, research and development laboratories have turned their attention to entirely more creative antipsychotic strategies. Suddenly, a wave of new second-generation drugs were able to stand up to clinical development and now clinicians have several at least equally efficacious treatments with far fewer side effects.

71,72 Antiplatelet therapy seems to be effective in reducing atherosclerosis velocity by inhibiting both the first and second phases of atherosclerosis.73 Anti-inflammatory effects of antiplatelet medication are effectual in atherosclerosis velocity reduction by decreasing the volume of atherosclerosis

plaques.73 Also, antiplatelet therapy through inhibiting the adverse effects of activated platelets can indirectly raise Inhibitors,research,lifescience,medical the stability status of plaques73 and subsequently lessen atherosclerosis velocity. Decreased inflammatory process in atherosclerosis plaques also directly leads to increased plaque stability.16 PCI-32765 cell line However, the effect of time-related reduction on antiplatelets should be clarified in future studies. All previous investigations have focused only on the probability of plaque regression at the expense of almost neglecting the imperative parameter Inhibitors,research,lifescience,medical of time. We recommend that future studies be designed based on the probable association between statin therapy and atherosclerosis velocity reduction. Conclusion We proposed a new concept in the field of atherosclerosis by suggesting the term “atherosclerosis velocity”, which encompasses all the three essential parameters of volume of plaque, time/ duration of plaque progression, and/or acute rupture and plaque stability. Our review article reveals that the previous studies have Inhibitors,research,lifescience,medical not sufficiently probed into

these three parameters. Inhibitors,research,lifescience,medical We believe if the concept of atherosclerosis velocity is applied in further experiments, especially in experimental models, we can expect a practical curve of atherosclerosis. Conflict of Interests: None declared.
Megaloblastic

anemias are a group of disorders characterized by peripheral blood cytopenia(s) resulting due to ineffective hematopoiesis Inhibitors,research,lifescience,medical in the marrow. They are usually caused by nutritional deficiencies (most common) of either vitamin B12 or folate; or both, inherited disorders of DNA synthesis, or following certain drug therapy.1 Pyrexia in megaloblastic anemia, albeit well known, is rarely characterized. However, megaloblastic anemia, solely as the cause of pyrexia, can be found in only a small proportion of cases, for which differentiation from fever of unknown origin (FUO) may be difficult even after exhaustive laboratory investigations.2-8 The aim of the present article was to highlight this aspect of megaloblastic anemia with a brief review of the existing literature and create awareness Rolziracetam among practicing physicians about a treatable condition. Case Presentation A 51 year old lady, vegetarian, presented to the General Medicine Outpatient Department of Pondicherry Institute of Medical Sciences, Puducherry, India, with complaints of fever, nausea with vomiting, and burning micturition of 3 days’ duration. The fever was on and off, moderate grade, and not associated with chills and rigors. She had easy fatigability with loss of weight and appetite.

Administration of rotavirus vaccine was staggered around the second and third EPI visits at 10 and 14 weeks of age; thus Rotarix™ was given with OPV at 10 and 14 weeks of age or 2 weeks after OPV at 12 and 16 weeks of age. An assessment of antibody response and seroconversion pre-vaccination and 1 month after dose 2 was made. In addition,

rotavirus antigen excretion was measured on a subset of subjects on days 1, 4, and 7 after each dose of vaccine BKM120 clinical trial or placebo, with the hypothesis that stool shedding of rotavirus antigen would reflect vigorous replication of the vaccine virus and thus a measure of “vaccine take. Stool shedding of rotavirus antigen after dose 1 was lower on day 4 (6% versus 10%) and day 7 (6% versus 14%) after Rotarix™ vaccination with OPV versus without OPV, respectively. For time points combined (0, 4, or 7 days) after either dose, shedding of rotavirus antigen was 43% lower in the OPV group (18%) compared with the IPV group Anti-diabetic Compound Library (31%), indicating interference of rotavirus vaccine take in the presence of OPV. Although IgA GMC and seroconversion were not assessed after dose 1, GMCs were 38% (47 U/ml versus 75 U/ml, respectively) and seroconversion was 15% (57% versus 67% respectively) lower after dose 2 when the Rotarix™ series was given with OPV compared to without OPV. Latin America [2],

[29] and [35]: No studies have directly examined the effect of OPV on Rotarix™ in a randomized controlled design in Latin America. However, two separate Phase III efficacy and immunogenicity trials have

been conducted in Latin America – one where Rotarix™ was administered without OPV [2] and [35] and another where Rotarix™ was co-administered with OPV [29]. Rotarix™ was given separated by a 2-week interval with OPV (either before or after) in a large trial from 11 Latin American Libraries countries (Colombia, Dominican Republic, Honduras, Peru, Argentina, Brazil, ADP ribosylation factor Mexico, Argentina, Nicaragua, Panama, Chile, and Venezuela) [2] and [35]. In six of these 11 countries (Colombia, Dominican Republic, Honduras, Peru, Argentina, Brazil), efficacy and immunogenicity were also assessed in a later trial in which Rotarix™ was co-administered with OPV [29] and [35]. We computed the mean antirotavirus antibody GMC for the six countries that were part of the 11-country study where Rotarix™ was given without OPV [35] and compared it with the antirotavirus antibody GMC in the same six countries when Rotarix™ was given with OPV [29]. In both these studies, dose 1 was given at 6–12 weeks of age and dose 2 at 12–16 weeks of age. When the 2-dose Rotarix™ series was given concurrently with OPV compared to without OPV antirotavirus antibody GMC were 32% lower (66 U/ml [95% CI = 50–87] versus 96 U/ml [95% CI = 57–163]) and seroconversion rates were 18% lower (61% [95% CI = 54–69] versus 75% [95% CI = 59–87]) in the presence of OPV. Of note, despite the difference in immunogenicity, a similar efficacy (∼82–85%) was observed in both studies.

” There are more than 400 clinical codes in the DSM-TV. ICD-10 proposes an even larger number of clinical entities, because, for each corresponding DSM-TV diagnosis, synonyms and related entities are mentioned in ICD-10. The validity of some of these disorders can be questioned: are they independent entities, do they have different mechanisms, do they respond to specific treatments? Inhibitors,research,lifescience,medical Thinking in terms of direct links between the actions of psychotropic medications at a receptor and the changes in symptoms has been

fruitful in the sense that many discoveries were made following this rather simple paradigm. An amusing example may be found in a recent article,6 where a direct link was made between receptors and symptoms, ie, between 5-HTT on blood platelets and romantic love. The study, which was the work of an Italian group, was based on the fact, Inhibitors,research,lifescience,medical that there is a superficial Talazoparib manufacturer resemblance between obsessive compulsive ideas and romantic fascination. The results were that subjects in love have a. lower number of 5-HTT, as do patients suffering from obsessive-compulsive disorder. Applying this linear thinking to the mechanisms of disorders

can, however, be risky and it would be like internists thinking that a. cardiac disorder such as Inhibitors,research,lifescience,medical hypertension is a disorder of calcium or β-receptors, just because calcium blockers or β-blockers are clinically useful in this condition. The biochemical organization of the brain is better understood now, and this has consequences for psychopharmacology.

The importance of volume versus classic transmission has been recognized.7 With volume Inhibitors,research,lifescience,medical transmission, 5-1 IT, noradrenaline (NA),and other compounds are secreted into the interstitial space by the axon and neuron, rather than released into Inhibitors,research,lifescience,medical the synaptic cleft. Overall, half of serotonergic transmission is said to be volume transmission, but this proportion varies depending on the brain structures. Thus, monoamines are classic neurotransmitters as well as neuromodulators or neurohormones. Psychotropic drugs act at all these various levels of monoamine physiology. Brain physiology and higher brain functions Higher brain functions include perceptions, emotions, memory, thinking (beliefs), attention, consciousness, motivation (desire), and many others. Oxygenase These functions create and regulate our mental world, and the organization of the brain in regard to these functions has been discussed for centuries. René Descartes (1596-1650) recognized the central role of emotions (or “passions” as they were then called) by indicating what information or thought was important for us and what was not. John Hughlings Jackson (1835-1911) proposed that, when a hierarchically higher center became dysfunctional, a more primitive form of the brain function previouslyregulated by that center was expressed.

2012; Papanastasiou et al. 2013]. Modulation of cortical

networks Linking these well-established actions with a mechanism to explain putative antidepressant effects has proven more difficult. At a more global cortical level, data from healthy subjects have demonstrated the concept of two large anticorrelated cortical networks. The so-called default mode network (DMN) is an intrinsic functionally dominant non-goal-orientated resting state, Inhibitors,research,lifescience,medical whilst the extrinsic attentional network is involved in goal-driven behaviour, and the connections between these modular hubs can dysfunction in mental illnesses [Raichle et al. 2001; Tracy and Shergill, 2013]. In depression a so-called ‘dorsal nexus’ comprising the bilateral dorsal medial PFC has been shown to have marked increased functional Inhibitors,research,lifescience,medical connectivity with the DMN [Sheline et al. 2010]. This greater activation of the resting-state non-goal-directed network is associated with introspection and self-reflective processes that can pathologically increase in depression, and the degree of DMN dominance has been

demonstrated to be correlated with the degree of depressive rumination [Hamilton et al. 2011]. Scheidegger and colleagues Inhibitors,research,lifescience,medical showed that in healthy individuals ketamine decreased the connectivity of the DMN to the dorsal nexus and the medial PFC, and the authors argue that the antidepressant effects of

ketamine Inhibitors,research,lifescience,medical might therefore be due to re-regulating illness-induced dysfunctional connectivity, particularly in the limbic–cortico–striato–pallido–thalamic circuits involved in mood [Scheidegger et al 2012]. Effects on neurotransmitters The dominant, albeit incomplete, pharmacological model of depression focuses upon the monoaminergic neurotransmitters serotonin and noradrenaline (and to a far lesser extent dopamine). The therapeutic Inhibitors,research,lifescience,medical actions of current antidepressants are highly Idoxuridine likely to involve complex intracellular enzymatic chains downstream of changes to monoamines, with alterations in neuronal gene transcription [Brown and Tracy, 2013; Penn and Tracy, 2012]. Far less work has explored the role of the ubiquitous excitatory neurotransmitter Glu in depressive disorders: there is reasonably strong evidence to support dysfunction, though not attribute clear causality (for a review, see Sanacora and colleagues [Sanacora et al. 2012]). Extracellular levels of Glu are tightly controlled, as in excess in the synapse it is excitotoxic: after neuronal release it is recycled through glial support cells and enzymatically converted by glutamine selleck synthetase to glutamine, which is then re-uptaken by neurons and hydrolysed back into Glu.

Females had lower risk of dying compared to males (HR=0.916, 95%CI: 0.881−0.952) and mortality increased with age at diagnosis (P<0.001, Table 1). There was no significant difference in OS across race/ethnicity groups (P=0.16, Table 1). Sex, race, grade/differentiation and MGC The effect of sex on OS was significantly varied by race and tumor differentiation in patients with MGC (P for interaction=0.003 and 0.005, respectively, Table 2). White and African American woman had significantly lower risk of dying compared to their male counterparts. In Asian, Hispanic,

and Native American populations, men and women had equivalent survival (Table 2.) Women also had a significantly lower risk of dying compared to males in patients Inhibitors,research,lifescience,medical whose tumors were poorly differentiated

or undifferentiated or had unknown Inhibitors,research,lifescience,medical tumor grade (Table 2). Table 2 Overall survival of patients with gastric cancer by sex, SEER data 1988-2004 Discussion This cohort of metastatic gastric cancer patients from the SEER database represents a wide cross-section of patients with variable socioeconomic and ethnic backgrounds. Our analysis also included a robust variety of pathology and is likely a more generalizable Inhibitors,research,lifescience,medical representation than can be found in clinical trials or case series. As expected, we found tumor characteristics such as grade, differentiation, and histology were associated with survival in advanced gastric cancer. Inhibitors,research,lifescience,medical Notably, there was a survival advantage attributable to gastric cardia lesions when compared to non-cardia lesions. This survival advantage persisted after controlling for the increased selleck products prevalence of cardia lesions in Caucasians and

men. Survival differences between cardia and non-cardia lesions may reflect differences in pathogenesis and tumor biology. H. pylori infection is recognized as a unique risk factor for non-cardia lesions while gastroesophageal reflux disease plays a role in the development of proximal lesions (38),(39). Interestingly, there is growing evidence that H2N expression is variably expressed in proximal and distal gastric cancer lesions (40). The proto-oncogene Her-2/neu (H2N) is Inhibitors,research,lifescience,medical located on chromosome 17q21 and encodes a transmembrane tyrosine kinase growth factor receptor featuring substantial homology with the EGFR (41),(42). Over-expression of the H2N protein has been identified in from 10 to 34% of breast cancers and is associated Idoxuridine with a poor prognosis (43). Over-expression of H2N has been reported in gastric and gastro-esophageal tumors (24). Additionally, there are studies describing H2N as a poor prognostic factor in gastric cancer (40). Further studies are needed to investigate its role in the development of proximal and distal gastric lesions. In addition to tumor characteristics, patient features, such as age and sex, also had significant prognostic impact. Ethnicity – often described in gastric cancer literature as having a prominent prognostic role – had no effect on survival.

98 Pain threshold may be altered in children long after early surgery, especially in regions of prior tissue damage, which is important if another surgery is needed later. However, the direction and magnitude appear

to depend on many factors that are unclear at this point, perhaps at least in part due to inclusion of children born preterm and full-term. It is unknown whether physiological immaturity at the time of surgery may Inhibitors,research,lifescience,medical contribute to the long-term impact on later touch or pain threshold. Although repeated procedural pain early in life in infants born preterm is associated with altered sensory thresholds when tested in experimental conditions, studies of self-report, however, suggest no differences in “everyday” pain or pain syndromes compared to full-term controls in adolescents or young adults born preterm.63,92,94,95,99,100 Furthermore, in a prospective cohort study of self-completed questionnaires in 18,572 participants at age 45 years, there was no significant association between adults

born Inhibitors,research,lifescience,medical at low birth-weight or very low birth-weight and reports of chronic pain, with or without adjustment for medical and social confounders.101 Thus, although there is evidence that touch and pain thresholds differ, as well as altered brain activity in Epacadostat concentration response to pain in Inhibitors,research,lifescience,medical children born preterm, the literature is consistent that there is no evidence for increased prevalence of pain syndromes in adulthood. PARENTING AND PAIN IN PRETERM INFANTS In a longitudinal randomized trial where mothers were taught how to reduce stress in their low-birth-weight

infants, IQ scores at 9 years of age were >10 points higher in the Inhibitors,research,lifescience,medical intervention group.102,103 In another trial, preterm infants exposed to a parental intervention similar to that used in the randomized trials cited above102,103 demonstrated enhanced brain maturation and connectivity on MRI at term-equivalent age.48 In a cohort study, we found that greater positive maternal Inhibitors,research,lifescience,medical interaction buffered the relationship of neonatal procedural pain exposure with poorer focused attention in very preterm infants at 8 months’ CA and was protective against internalizing (anxiety/depressive) behaviors at 18 months’ CA. Yet, it remains unknown whether the relation between mafosfamide adverse brain development and impaired cognitive outcome is improved by supportive parent–child interactions. Potentially protective factors in the face of early biological adversity are recognized as a crucial focus to explain the wide variability of neurodevelopmental outcomes in very preterm infants.104 Importantly, there is converging evidence that preterm infants are more developmentally vulnerable to their parent interaction.82,83,104 These data indicate that parents’ behaviors play a key role in their child’s neurodevelopment and may compensate for adverse clinical exposure and compromised early brain development. Maternal care of rat pups positively affects adult sensitivity to pain following neonatal inflammation.

The seasonal pattern we observed closely corresponds to other reported seasonal patterns according by birth month for a number of immune-mediated chronic diseases such as type I diabetes, multiple sclerosis, ulcerative colitis, Crohn’s Libraries disease,

lupus and rheumatoid arthritis [8], [9], [10] and [11] (Supplementary Fig. 2). Evidence exists to suggest that the seasonal patterns observed in immune-mediated diseases may selleckchem be linked to sunlight exposure, and more specifically ultraviolet (UV) irradiance [19]. Seasonal patterns observed in the northern hemisphere have also been reported in the southern hemisphere with reciprocal periodicity [20], and have been shown to be muted or absent in more equatorial regions [8]. As it is well established that UV radiation is an important contributor to circulating vitamin D levels and plays a role in the degradation of circulating folic acid, variations in sunlight exposure by season or by latitude during sensitive periods of fetal and perinatal development could influence immune system development and maturation in early life, leading to variations in the risk of immune-related problems and vaccine reactions [9], [19], [20], [21] and [22]. Variations in UV exposure by birth month may also influence the risk of vaccine reactions through

mechanisms involved in the acquisition of immunity to vaccine-preventable diseases. Long-term immunity is click here achieved through induction of antibodies generally produced by B lymphocytes [23]. Also important in immune response are cytotoxic CD8+ and CD4+ T lymphocytes that may limit the spread of infectious agents by targeting and killing infected cells. Both B and T cell responses are triggered by vaccines and are involved in the development and maintenance of long-term immunity

[23]. Therefore, exogenous environmental factors such as sunlight exposure Chlormezanone and vitamin D that influence B and T cell activity impact upon the immediate immune-mediated physiological response to immune challenges and therefore could plausibly impact upon rates of AEFI. Thymic development, which is important for immune function, primarily occurs in utero and is sensitive to intrauterine exposures. One study reported that month of birth is associated with variations in thymic output, and that vitamin D may be a driver of this effect [24]. It has also been shown in animal studies that vitamin D deficiency in utero, which may be influenced by maternal sunlight exposure, has a significant impact on the developing immune system of the fetus [25] and [26]. Our study has a number of strengths and limitations. Strengths include the large population-based birth cohort, which included virtually all births in Ontario, Canada, spanning nearly a decade, representing over a million births and over 700,000 vaccinated infants.

Of note is that some antiepileptic drugs, such as levetiracitam (Keppra®),46 can induce mood changes and therefore should be used with care in patients with epilepsy and depression. The rate of manic syndromes appear to be higher in epilepsy,47 and these usually are atypical in presentation and more likely to present with irritability and overactivity than idiopathic bipolar disorder, which itself does not appear to be more

prevalent in epilepsy relative to the general population. This has led to Inhibitors,research,lifescience,medical the belief that epilepsy-associated brain damage is a major component in the occurrence of mania and temporal lobe epilepsy. The prevalence of psychotic symptoms in interictal periods is on the order of 5% to 7% in patients with epilepsy In patients with temporal lobe Inhibitors,research,lifescience,medical epilepsy, these disturbances are often schizophrenia-like in their presentation. Paranoid or persecutory delusions and both visual and auditory hallucinations have been reported. Also “negative symptoms” of schizophrenia such as amotivation, apathy, flattened affect, and disorganized behavior have been reported in association with

delusions and hallucinations. This has given rise to the hypothesis of the “schizophrenialike psychoses of epilepsy” which remains controversial.48 Inhibitors,research,lifescience,medical Pulling it all together Several common themes emerge from this brief review of individual neurologic diseases and their psychiatric manifestations. First, regardless of the cause of the neurologic disease, these psychiatric disturbances have common features across diseases and fall into several definable and recognizable groups including

cognitive disorders (dementia and nondementia in severity), affective disorders (including major depression, atypical depressions, Inhibitors,research,lifescience,medical mania, and other bipolar disorders), anxiety disorders (in particular generalized anxiety and panic disorders), and a range of phenomena indicative of executive dysfunction Inhibitors,research,lifescience,medical including apathy, BEZ235 disinhibitive or compulsive behaviors, personality change, and aggression-agitation. However, even though there are recognizable groupings that occur, across disorders there is considerable variability, which remains poorly characterized. For example, in some conditions, including stroke and TBI, classical conditions such as major depression can be seen, whereas in other conditions such as AD and to a lesser extent PD, classical from major depression is less common than atypical mood disorders, In epilepsy, a mixture of typical and atypical disorders is seen. Another source of variability relates to the comorbidity of different psychiatric syndromes with each other. Most of the literature to date consists of efforts to describe individual psychiatric syndromes whose phenomenology comes from the Diagnostic and Statistical Manual of Mental Disorders. 4th ed (DSM-TV),49 or other a priori criteria sets, which are then investigated in individual brain diseases, though without much concern as to comorbidity.

Postoperative seizure freedom is another possible gold standard that also raises a number of issues, such as the time elapsed between surgery and the last follow-up, the postoperative management of AED regimen, the quality of the surgical procedure, and the complex process through which an investigation might interact with the surgical strategy. Last but not least, there is a great heterogeneity in the way presurgical data arc analyzed, most notably for functional neuroimaging. Visual analysis is much less reproducible

for such data than it is for structural MRI, whereas more objective assessments, using regions of interest (ROIs) or statistical parametric mapping (SPM), are highly sensitive to Inhibitors,research,lifescience,medical a number of parameters that largely varied among centers. Though we fully endorse the conclusions of the NHS R&D HTA program regarding the need of an appropriate assessment of presurgical investigations,

we feel that such an effort is unlikely to be developed for the majority of available techniques in the near future. Thus, we still need to Inhibitors,research,lifescience,medical primarily rely on our judgment to define the strategy of an optimal presurgical evaluation. Positron emission tomography (PET) The most commonly used tracer is 18F-fluorodcoxyglucose (FDG) whose brain accumulation reflects the local Inhibitors,research,lifescience,medical cerebral metabolic rate of glucose. Many studies have shown that in the interictal period, decreased glucose metabolism is usually observed within the lobe of seizure onset. Furthermore, Protein Tyrosine Kinase inhibitor comparisons between FDG-PET and invasive EEG

data have demonstrated that the hypometabolic areas often overlap with the region of ictal onset.55-57 However, areas of hypomctabolism are often larger than the epileptogenic Inhibitors,research,lifescience,medical zone, and might not necessarily predominate over the latter.58 Whether the extent of hypomctabolism Inhibitors,research,lifescience,medical outside the temporal lobe represents a risk factor for postoperative seizure recurrence after anterior temporal lobectomy is a matter of debate.59-61 The above issues account for the lack of consensual practical guidelines regarding the clinical, indications of FDG-PET in the presurgical evaluation of patients with drug-resistant epilepsy.54,62-64 There is, however, some consensus that the lack of detectable interictal hypomctabolism in patients contemplating Carnitine dehydrogenase temporal lobe surgery is associated with a poor seizure outcome.65-67 This finding might be particularly relevant in TLE patients with a normal MRI. Indeed, excellent, seizure outcome was reported in that, population, provided FDG-PET abnormalities were present.45 More generally, FDG-PET in patients with a seemingly normal MRI might, help to disclose subtle morphological abnormalities, including focal cortical dysplasia. Thus, despite the lack of official recommendation, it seems reasonable to offer FDG-PET, at least to surgical candidates whose MRI is normal.