The specimens were loaded to test the fracture resistance and fracture mode (repairable and nonrepairable). Results: The cast metal dowel groups had the highest fracture resistance but showed nonrepairable fracture in 90% of specimens. Conclusions: Cast metal dowels had the highest fracture resistance but led to nonrepairable fracture while restoring the wide root canals under cyclic loading. Specimens restored with fiber dowels, accessory dowels, relined dowels, and ribbon-reinforced resin provided adequate fracture resistance with increased incidence of repairable fractures. “
“The aim of this clinical report is to describe the successful treatment of a mandibular first molar

presenting an extensive fracture at the buccal aspect in a young patient.

The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented Dorsomorphin in vivo with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3-year follow-up Adriamycin after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction. “
“Purpose: The objective of this study was 上海皓元医药股份有限公司 to verify the influence of test environment on the flexural strength of dental porcelains with distinct microstructures. Material and Methods: Disk-shaped specimens from three dental porcelains with distinct leucite content (VM: zero; CE: 12; NS: 22 vol%) were manufactured and tested for biaxial flexural strength in air and

immersed in artificial saliva. The results were analyzed by means of two-way ANOVA and Tukey‘s test (α= 0.05). Results: The flexural strength (MPa) obtained for ambient air and artificial saliva environments, respectively, were: 110.0 ± 16.0 and 81.5 ± 10.8 for VM; 51.9 ± 4.0 and 42.0 ± 4.7 for CE; 72.0 ± 11.5 and 63.6 ± 5.8 for NS. A numerical decrease in the mean flexural strength was observed for all groups when specimens were tested under artificial saliva; however, the difference was only statistically significant for VM. Conclusions: The results indicate that the effect of water immersion on the flexural strength of dental porcelains varies according to their leucite content, as only the material without leucite in its microstructure (VM) showed significant strength degradation when tested under water. “
“From the mid 1980s (approximately 10 years after titanium was first used as a medical metal), reports of suspected Ti sensitization began to emerge. In the present report, a 33-year-old Japanese woman presented with pruritus of the fingers and a specific reaction to mercury, nickel, and silver on lymphocyte stimulation testing (LST).

These proteins had no obvious difference between group S and group HF. In group LS, PI3K and p-Akt expressed more than group LY, but less than group S. Conclusion: These results suggest that PI3K/Akt signal pathway was closely related to the development of hepatic fibrosis and its inhibitor LY294002 could significantly improve hepatic fibrosis. In addition, we outline that

hydrogen sulfide could delay the progress of hepatic fibrosis and had protective effects on hepatic fibrosis by inhibiting morphology damage and decreasing type I and III collagen expression, and these protective effects might be related to PI3K/Akt signal pathway. Key Word(s): 1. hepatic fibrosis; 2. hydrogen Saracatinib supplier sulfide; 3. PI3K/Akt pathway; Presenting Author: YONG ZHENG Additional Authors: QIANG REN, GANGWEI CHEN, RUI LI, XIA XU, HONGLI XU Corresponding Author: YONG ZHENG Affiliations: Department of Gastroenterology, First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang; Department of Gastroenterology, The Medical College of Shihezi University, Shihezi, Xinjiang Objective: Hepatic fibrosis is the common pathological basis for the development of chronic liver disease, is the inevitable stage of formation of liver cirrhosis, then it is also the effective response when body was injured by exogenous and inflammatory factor caused liver injury. Hepatic stellate cells (HSC) was selleck chemicals advitated and proliferation then produce extra

cellular matrix (ECM) is the main characteristics of the disease. Our previous studies have shown that in the occurrence and development of liver fibrosis, with the disease progresses, the content of endogenous

H2S are gradually reduced, it can significantly delay the onset of liver fibrosis after exogenous give H2S donor. In this experiment, we discuss the influence of cell proliferation, apoptosis that PI3K/Akt signaling pathway to hydrogen sulfide (H2S) post-processing in vitro cultured rat hepatic stellate cells (HSC T6) and the effect of the expression of collagen type I, III, in turn to discuss hydrogen sulfide by the PI3K/Akt signal pathway in the mechanism of action of liver fibrosis. Methods: cultured HSC T6 in vitro, NaHS (donor 上海皓元 of H2S) post-processing and dispossessed by the PI3K/Akt pathway specific blocker that LY294002. Drugs′ intervention after 48 hours, then determined by MTT assay to detect HSC T6 cell proliferation; Using flow cytometry by Annexin V-FITC/PI amphophil cells to detect the HSC apoptosis rate and coloration by Hoechest 33342 to test HSC cell apoptosis; PCR method for quantitative detection of the expression of collagen type I, III mRNA in HSC. Results: Compared with normal control group, H2S promote cell proliferation is obviously in S group, NaHS in low concentration 50 μmol●L-1 group is the most significant difference (P < 0.05), but the effect on cell apoptosis was not significant (P > 0.05), the expression of collagen type I and III mRNA were reduced.

Previous studies on EE have shown that increased body mass index (BMI), especially visceral fat, is associated with a higher prevalence of EE [41,42]. A cross-sectional study of 9840 Japanese men found that BMI and PI3K Inhibitor Library chemical structure triglycerides were predictors of an increased prevalence of EE (OR = 1.063 and 1.001; 95% CI = 1.020–1.108 and 1.001–1.002, p = .004 and p < .001 respectively), and H. pylori infection significantly and independently decreased the prevalence of EE (OR = 0.346, 95% CI = 0.299–0.401, p < .001) [43]. Weight gain following H. pylori eradication could possibly

increase the risk of GERD. A randomized controlled trial in the UK compared change in BMI in a group of H. pylori-infected patients randomized to eradication therapy versus placebo [44] and found more participants gained ≥3 kg in the intervention group (138/720, 19%) compared with the placebo group (92/706, 13%) [OR 1.57 (95% CI: 1.17, 2.12)]. Dyspepsia was less frequently reported by the intervention

group participants (168/736, 23%) versus placebo group 209/711, 29%), OR 0.71 (95% CI: 0.55, 0.93). Lane et al. suggested weight gain after H. pylori eradication might be due to Tyrosine Kinase Inhibitor Library resolution of dyspepsia. However, the increase in BMI following eradication therapy may also be due to the negative effects of H. pylori on circulating ghrelin levels, as discussed in a recent paper from Australia [45]. Ghrelin is one of the hormones secreted by the stomach and plays a central role in the neurohormonal regulation of food intake and energy homeostasis. It stimulates appetite and induces

apositive energy balance that can lead to weight gain. There is increasing interest in the relationship between H. pylori infection and gastric mucosal production of ghrelin and its octanoylation into ghrelin o-acyltransferase by the gastric enteroendocrine cells. The authors have declared no conflicts of interest. “
“The best opportunity to reduce gastric cancer (GC)-related mortality remains prevention. Mass eradication of Helicobacter pylori infection in a Taiwanese population >30 years of age reduced GC incidence with an effectiveness of 25% (rate ratio 0.753, 95% CI 0.372–1.524). medchemexpress In the Shandong intervention trial conducted on a Chinese population aged 35–64 years, cancer incidence was reduced by 39% in subjects who received H. pylori treatment compared with the placebo group after 14.7 years of follow-up (absolute risk 3.0 vs 4.6%; odds ratio 0.61, 95% CI 0.38–0.96; p = .03). A high incidence of severe gastric atrophic changes and noninvasive gastric neoplasia has been reported in a Portuguese case-control study on first-degree relatives of patients with early-onset gastric carcinoma (i.e., diagnosed before 45 years), which emphasizes again the importance of GC screening in this population. For patients with advanced GC, new targeted therapies to improve survival are under scrutiny.

Previous studies on EE have shown that increased body mass index (BMI), especially visceral fat, is associated with a higher prevalence of EE [41,42]. A cross-sectional study of 9840 Japanese men found that BMI and selleck chemicals llc triglycerides were predictors of an increased prevalence of EE (OR = 1.063 and 1.001; 95% CI = 1.020–1.108 and 1.001–1.002, p = .004 and p < .001 respectively), and H. pylori infection significantly and independently decreased the prevalence of EE (OR = 0.346, 95% CI = 0.299–0.401, p < .001) [43]. Weight gain following H. pylori eradication could possibly

increase the risk of GERD. A randomized controlled trial in the UK compared change in BMI in a group of H. pylori-infected patients randomized to eradication therapy versus placebo [44] and found more participants gained ≥3 kg in the intervention group (138/720, 19%) compared with the placebo group (92/706, 13%) [OR 1.57 (95% CI: 1.17, 2.12)]. Dyspepsia was less frequently reported by the intervention

group participants (168/736, 23%) versus placebo group 209/711, 29%), OR 0.71 (95% CI: 0.55, 0.93). Lane et al. suggested weight gain after H. pylori eradication might be due to Selleckchem Y27632 resolution of dyspepsia. However, the increase in BMI following eradication therapy may also be due to the negative effects of H. pylori on circulating ghrelin levels, as discussed in a recent paper from Australia [45]. Ghrelin is one of the hormones secreted by the stomach and plays a central role in the neurohormonal regulation of food intake and energy homeostasis. It stimulates appetite and induces

apositive energy balance that can lead to weight gain. There is increasing interest in the relationship between H. pylori infection and gastric mucosal production of ghrelin and its octanoylation into ghrelin o-acyltransferase by the gastric enteroendocrine cells. The authors have declared no conflicts of interest. “
“The best opportunity to reduce gastric cancer (GC)-related mortality remains prevention. Mass eradication of Helicobacter pylori infection in a Taiwanese population >30 years of age reduced GC incidence with an effectiveness of 25% (rate ratio 0.753, 95% CI 0.372–1.524). 上海皓元医药股份有限公司 In the Shandong intervention trial conducted on a Chinese population aged 35–64 years, cancer incidence was reduced by 39% in subjects who received H. pylori treatment compared with the placebo group after 14.7 years of follow-up (absolute risk 3.0 vs 4.6%; odds ratio 0.61, 95% CI 0.38–0.96; p = .03). A high incidence of severe gastric atrophic changes and noninvasive gastric neoplasia has been reported in a Portuguese case-control study on first-degree relatives of patients with early-onset gastric carcinoma (i.e., diagnosed before 45 years), which emphasizes again the importance of GC screening in this population. For patients with advanced GC, new targeted therapies to improve survival are under scrutiny.

1D), we focused further study on these two subsets. Percentages of CD11b/Gr1mid and CD11b/Gr1low cells PLX4032 in vitro in bone marrow, blood, and liver of tumor-bearing mice were analyzed at various time points during metastatic growth. Levels of CD11b/Gr1mid cells in bone marrow peaked at day 5, and decreased thereafter, which coincided with increasing levels in blood and liver.

Circulating and hepatic CD11b/Gr1mid cell numbers continued to rise by day 14 (Fig. 2B). In contrast, bone marrow and circulating CD11b/Gr1low cell numbers remained constant with time while increasing in the liver abruptly from day 12 (Fig. 2C). These results suggest that the CD11b/Gr1mid subset is recruited from bone marrow during development of liver metastasis, whereas the CD11b/Gr1low population

likely derived from expansion or differentiation of resident cells after metastases had established. To confirm the bone marrow origin of the CD11b/Gr1mid subset, GFP+ cells isolated from bone marrow of GFP transgenic mice were transferred intravenously into C57BL/6 mice 11 days after MC38 or PBS inoculation. Significantly more GFP+ bone marrow cells were found in MC38-inoculated tumor-bearing livers compared with PBS-inoculated controls (Fig. 2D). These GFP+ cells were in the peritumoral Ponatinib regions of liver metastases (Fig. 2E), and were CD11b+, CCR2+, and F4/80+ (Fig. 2F), markers expressed only by the CD11b/Gr1mid population. To investigate whether similar CD11b/Gr1mid and CD11b/Gr1low subsets are associated with liver metastasis of other cancer cell lines, we inoculated B16F1GFP+ and LLCGFP+ cells into C57BL/6 mice. Metastases were observed in the liver at day 14 when myeloid infiltrates were assessed. Formation of LLCGFP+ tumor colonies resulted

in a significant increase in the MCE CD11b/Gr1mid population, similar in extent to MC38GFP+ inoculation. In contrast, CD11b/Gr1mid cell numbers were not significantly altered after B16F1GFP+ colonization (Fig. 3A). LLCGFP+ inoculation also led to a substantial increase in CD11b/Gr1low cell numbers, whereas moderate increases were observed after B16F1GFP+ and MC38GFP+ inoculation (Supporting Fig. 3C). Thus, LLCGFP+ colonization was analogous to that of MC38GFP+ in recruiting CD11b/Gr1mid cells, whereas this recruitment was dispensable for B16F1GFP+ cells. To identify factors involved in recruitment of bone marrow-derived CD11b/Gr1mid cells to liver metastases, we compared the cytokine expression profile of MC38, B16F1, and LLC cells. MC38 cells expressed high levels of CCL2 and moderate levels of CXCL1, CXCL10, and tissue inhibitor of metalloproteinase 1 (TIMP-1). Moderate levels of CCL2, CXCL1, and TIMP-1 were also detected in culture medium of LLC cells. B16F1 cells produced moderate levels of CXCL10 and CCL5 but CCL2 was not detected (Fig. 3B). Additionally, we tested another B16 melanoma variant cell line, B16F10, and found it to have a similar cytokine expression profile as B16F1 (Supporting Fig.

Inclusion criteria: ≥ 18 years of age, diagnosis of cirrhosis or chronic liver disease, diagnosis of SBP, and received ≥ 5 days of systemic antibiotics. Patients groups were compared to determine length of stay (LOS), development of hepatorenal syndrome (HRS), bleeding, hepatic encephalopathy (HE), and mortality. Results:Eighty patients were included with 44 patients in the SA group and 36 patients in the SA+R group. Overall mortality rate was 36%, with no statistically significant differences between the SA vs SA+R

group (38% vs 34%; p=NS). Average LOS was similar between the two groups (SA group 12.3±10.8 days vs SA+R group 14.8±13.7 days; p=NS). Comparison of the SA group vs SA+R group for differences in number of patients that developed HRS, bleeding, or HE did not reveal any statistically significant differences. However, 18 patients Barasertib chemical structure had documentation of rifaximin as a home medication prior to admission. Upon review of patients receiving rifaximin prior to admission vs those who did not, there was a statistically significant difference in the development of HRS (11% vs 40%; p=0.02). Conclusion:The addition of rifaximin to systemic antibiotics for inpatient treatment of SBP did not affect LOS nor did it alter HIF cancer the development

of HRS, bleeding, HE, or mortality. Conversely, receiving rifaximin prior to admission significantly reduced the progression to HRS. Larger prospective studies are needed to validate these results. Disclosures: Satheesh Nair – Advisory

Committees or Review Panels: Jansen; Speaking and Teaching: Gilead Sanjaya K. Satapathy – Advisory Committees or Review Panels: Gilead The following people have nothing to disclose: Jennifer D. Twilla, Anuj Sharma, Emily H. Wong BACKGROUND: Ascites is a common diagnosis in hospitalized children due to its association with a myriad of etiologies. Little is known about factors predictive of morbidity and mortality in this population. METHODS: IRB approved retrospective cross-sectional chart review was performed on children aged 0-21 hospitalized at Johns Hopkins Hospital between 1983-2010 with an ICD-9 diagnosis of ascites (789.5, 789.51, 789.59). Multiple regression analysis was used 上海皓元 to identify demographic, laboratory, and clinical features as potential predictors of morbidity and mortality. Study outcomes included hospital length of stay (LOS) as a proxy for morbidity and mortality (defined as death at hospital discharge). Predictors analyzed included demographic data, ascites etiology and grade (I, II or III), co-morbidities (hepatic encephalopathy (HE), hepatorenal syndrome (HRS), portal vein thrombosis, hydrotho-rax, etc.) and lab markers (thrombocytopenia, anemia, hyponatremia, and leukopenia). RESULTS: A total of 518 children were studied. The average LOS of the population was 23.6 days.

The authors gratefully acknowledge the assistance of the staff of Zoological Garden at Dvůr Králové, in particular Luděk Čulík, Markéta Čulíková, Aleš Kopecký, Jiří Soumar, Veliparib ic50 Miroslava Kubelková, Miroslava Doležalová, Pavel Moucha, Barbara Raková, Jiří Hrubý and Dana Holečková. We are indebted to Alois Pluháček for technical help. The paper was much improved by comments from Jana Pluháčková, Martina Komárková, Radka Šárová, Marek Špinka and Radim Kotrba. We highly appreciated the help of Sarah R. B. King who improved

the English. This work was supported by grant no. 523/08/P313 from the Czech Science Foundation and by the Ministry of Agriculture of the Czech Republic (MZe0002701404). “
“The erection mechanism of the penis in most vertebrates is blood vascular. A major evolutionary transition occurred in birds, where the erection mechanism changed from blood vascular

to lymphatic. Within small molecule library screening birds, however, the erection mechanism of the ratite penis has remained unknown. Early work suggested that the erection mechanism in ostrich Struthio camelus was blood vascular while no description existed for the emu Dromaius novaehollandiae or the rhea Rhea americana. Because the penis in all other described birds has a lymphatic erection mechanism, clarifying that the erection mechanism of ratites is of great importance to understanding one of the major evolutionary transitions of penis morphology within amniotes. Here, we show that the erection mechanism of ratites is lymphatic, confirming that the evolutionary transition to lymphatic erection occurred in the last common ancestor of Aves. “
“Seahorses are known to produce sounds in different behavioural contexts, but information on the sound production in this fish group is scarce. Here we examined the acoustic behaviour of the longsnout seahorse Hippocampus

reidi by analysing sound production when fish were introduced to a new environment and during feeding, handling 上海皓元 and courtship. We show that males and females produce two distinct sound types: ‘clicks’ (main energy between 50 and 800 Hz) during feeding and courtship, and previously undescribed ‘growls’ (main energy concentrated below 200 Hz). The latter consists of series of sound pulses uttered in stress situations when the animals were handheld. Growls were accompanied by body vibrations, and may constitute an additional escape mechanism in seahorses, which might startle predators. During reproductive behaviour, clicks were most abundant on the third (last) day of courtship; they were particularly associated with the males’ pouch-pumping behaviour, suggesting synchronization between sound production and courtship behaviour.

Chlorpromazine was included as an option for treatment at our institution during this shortage, although limited data exist on the effectiveness in children. The objectives of this study were: (1) to compare the treatment failure rate of chlorpromazine in the treatment of migraine headache in youth presenting

to the PED with those who received prochlorperazine; and (2) to identify the frequency and type of adverse events, and change in pain score. We performed a retrospective cohort study of patients 12-21 years of age treated for migraine headache in our emergency department. Our treatment group received intravenous chlorpromazine between February and April 2012, while the comparison group consisted of children treated with Doxorubicin price intravenous prochlorperazine between February and April find protocol 2011. The outcomes of interest were: (1) treatment failure, defined as need for additional therapy, hospitalization or 48-hour return; (2) adverse reactions to drug therapy; and (3) change in pain score. This study yielded 75 patients in the treatment group and 274 in the comparison group. Forty percent (30/75) of

the treatment group had treatment failure compared with 15% (41/274) of the comparison group. There was no difference in mean change in pain score between the groups. The most common adverse effects included hypotension in the treatment group (12%) and akathisia in the comparison group

(12%). This is the first study that has examined the use of chlorpromazine as a therapy in pediatric migraines. Abortive therapy for migraine headache in the PED with chlorpromazine is associated with greater need for rescue medication and hospitalization, and higher rates of hypotension. “
“To review the pharmacokinetics, efficacy, tolerability, and patient acceptance of zolmitriptan nasal spray (NS). Gastroparesis may delay or 上海皓元医药股份有限公司 diminish the absorption of oral triptans, and nausea or vomiting may do the same and/or make it difficult to take a tablet. Some migraineurs require or prefer faster relief than oral medications provide. Injectable triptans provide the fastest drug delivery into the bloodstream, but many patients are reluctant to use them. Nasal sprays may address some of the problems with tablets and injectables while still providing rapid absorption of drug. Non-systematic review. Significant levels of zolmitriptan NS are detectable in plasma within 2-5 minutes, and the rapid absorption is due to early uptake through the nasal mucosa. In 2 randomized trials, users of zolmitriptan NS were significantly more likely than placebo recipients to be pain-free at 15 minutes post-dose, the first time point measured, and about half of patients had sustained response at 24 hours.

The other half used the palatal plates for 14 days before roughness readings were performed (FRa group, n = 5). The surface roughness (Ra) of the inner surface from the relined dentures was recorded using a Surftest SJ-401 with eight readings per specimen, and mean values were obtained. Data (μm) were analyzed by two-way ANOVA and Tukey’s test (α = 0.05). IRa means (2.92 ± 0.87 μm) www.selleckchem.com/products/apo866-fk866.html and FRa means (3.35 ± 0.65 μm) were significantly different (p = 0.016). UG showed a lower (p = 0.01) Ra mean (2.1 ± 0.52 μm) than DF (3.94 ± 0.81 μm), TS (4.12 ± 0.64 μm), and DS (3.27 ± 0.64

μm). Ufi Gel P showed the smoothest surface among the materials evaluated. The period of use resulted in changes in the surface roughness of the materials tested. “
“The aim of this study was to evaluate and compare the total color difference (ΔE) between natural teeth and fabricated crowns from three ceramic systems

with different thicknesses. The color of ninety maxillary central incisors was measured selleck compound from the middle third of the labial surface with a Vita Easyshade spectrophotometer. All-ceramic crown preparations with different thicknesses (0.8, 1.2, 1.5 mm) were done on selected teeth (n = 30). Prepared teeth were randomly divided into three equal groups to fabricate ceramic crowns from three ceramic systems, Duceram LFC (DLFC), In-Ceram SPINELL (ICS), and IPS Empress (IPSE). Colors of cemented crowns were MCE公司 measured and compared with their corresponding measurements before preparations. Data were statistically analyzed

using two-way ANOVA at 5% significance level. A significant difference of ΔE was detected between natural teeth and different thicknesses of crowns constructed from the all-ceramic materials investigated. Comparing the three materials at 0.8 mm thickness revealed that the lowest ΔE was recorded for DLFC, which was significantly different from the other ceramic systems while IPSE showed the highest ΔE. At higher thicknesses there was no difference between natural tooth shade and crowns constructed from different ceramic materials. Reinforcement of ceramics by alumina for In-Ceram and leucite for Empress decreases color production. Level of acceptance between the different ceramic materials and thicknesses varied. DLFC showed the highest color matching at all thicknesses followed by ICS and IPSE in descending order. In general, increasing the thickness of fabricated crowns enhances color match. “
“Purpose: To compare the volumetric misfit between implant restorative platforms of implants and implant frameworks manufactured with two different technologies. One set of implant frameworks was made with a CAD/CAM protocol and a tactile probe; the second protocol consisted of frameworks made with the lost-wax technique and conventional casting technology. Materials and Methods: In this laboratory study, an acrylic resin model with five “inter-foraminal” implants was used as the “patient” model.

35 These results click here were supported by a study36 that showed low total magnesium in erythrocytes and low ionized magnesium in lymphocytes in migraine patients, both of which increased significantly after a 2-week trial of drinking mineral water containing 110 mg/L magnesium. Given its commercial availability, the RBC magnesium assay may therefore

be a good way of assessing for deficiency. Future trials should focus on patients with deficiencies in ionized or RBC magnesium, as improvements in clinical symptoms correlating with corrected levels would clearly demonstrate the benefits of magnesium supplementation. Treatment With Oral Magnesium Several randomized controlled trials (RCTs) see more have shown that Mg2+ supplementation is effective in migraine treatment. In the first, 24 women with menstrual migraine31 received either 360 mg of magnesium pyrrolidone carboxylic acid or placebo in 3 divided doses. Women received 2 cycles of study medication, taken daily from ovulation to the

first day of flow. Magnesium treatment resulted in a significant reduction of the number of days with headache (P < .1), total pain index (P > .03), as well as an improvement of the Menstrual Distress Questionnaire score in the treatment group compared to placebo. A larger study comprising 81 migraineurs also showed a significant improvement in patients who received magnesium.37 Attack frequency was reduced by 41.6% in the magnesium group and by 15.8% in the placebo group. The active

treatment group received 600 mg of trimagnesium dicitrate in a water-soluble granular powder taken every morning. More recently, 上海皓元 Koseoglu et al38 studied the prophylactic effects of 600 mg/day of oral magnesium citrate supplementation in patients with migraine without aura and found that active treatment resulted in a significant decrease in migraine attack frequency and severity. A 4th RCT showed no effect of oral magnesium on migraine.39 This negative result was likely because of the use of a poorly absorbed magnesium salt, as diarrhea occurred in almost half of patients in the treatment group. The most common adverse effect associated with oral magnesium supplementation is diarrhea. While diarrhea itself usually prevents the development of magnesium-related toxicity, patients should be cautioned about this side effect. Magnesium toxicity is marked by the loss of deep tendon reflexes followed by muscle weakness. Severe toxicity can lead to cardiac muscle weakness, respiratory paralysis, and death. Patients with kidney disease are at higher risk of developing toxicity as magnesium is excreted through the kidneys.40 Treatment With Intravenous Magnesium Several studies have evaluated the use of intravenous magnesium in acute migraine treatment, with conflicting results.