Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis.

BACKGROUND: The aim of this meta-analysis is to investigate the effectiveness of intravenous magnesium (IV Mg2+) in rate and rhythm control of rapid atrial fibrillation (AF) when administered in addition to standard-of-care for non-post-operative patients. Previous meta-analyses on this topic have demonstrated the efficacy of IV Mg2+ in achieving rate control, but not rhythm control. METHODS: Six randomized controlled trials comparing IV Mg2+ to placebo in the treatment of rapid AF were obtained from electronic databases totaling 745 patients. Outcomes were analyzed using a Mantel-Haenszel random-effects model and expressed as odds ratios (OR) for dichotomous outcomes with their 95% confidence intervals (CIs). RESULTS: Our pooled analysis showed that IV Mg2+ given in addition to standard-of-care was superior in achieving rate control (63% vs 40%; OR 2.49, 95% CI 1.80-3.45) and rhythm conversion to sinus (21% vs. 14%, OR 1.75, 95% CI 1.08-2.84) compared to standard-of-care alone. Flushing was more frequently observed in patients receiving IV Mg2+ compared to placebo (9% vs. 0.4%, OR 19.79, 95% CI 4.30-91.21). Subgroup analysis showed the superiority of a lower dose of IV Mg2+, which we designated as 5 g or lower (24% vs 13%, OR 2.10, 95% CI 1.22-3.61) compared to the higher dose (>5 g) (16% vs 13%, OR 1.23, 95% CI 0.65-2.32) in rhythm control when compared to placebo. CONCLUSIONS: IV Mg2+ administered in conjunction with standard-of-care is effective for rate control and modestly effective for restoration of sinus rhythm in rapid AF without clinically significant adverse effects.

Evaluation of optical imaging agents in a fluorescence-guided surgical model of head and neck cancer.

BACKGROUND: Tumor proliferation often occurs from pathologic receptor upregulation. These receptors provide unique targets for near-infrared (NIR) probes that have fluorescence-guided surgery (FGS) applications. We demonstrate the use of three smart-targeted probes in a model of head and neck squamous cell carcinoma. METHODS: A dose escalation study was performed using IntegriSense750, ProSense750EX, and ProSense750FAST in mice (n = 5) bearing luciferase-positive SCC-1 flank xenograft tumors. Whole body fluorescence imaging was performed serially after intravenous injection using commercially available open-field (LUNA, Novadaq, Canada) and closed-field NIR systems (Pearl, LI-COR, Lincoln, NE). An ex vivo, whole-body biodistribution was conducted. Lastly, FGS was performed with IntegriSense750 to demonstrate orthotopic and metastatic disease localization. RESULTS: Disease fluorescence delineation was assessed by tumor-to-background fluorescence ratios (TBR). Peak TBR values were 3.3 for 1 nmol ProSense750EX, 5.5 for 6 nmol ProSense750FAST, and 10.8 for 4 nmol IntegriSense750 at 5.5, 3, and 4 d post administration, respectively. Agent utility is unique: ProSense750FAST provides sufficient contrast quickly (TBR: 1.5, 3 h) while IntegriSense750 produces strong (TBR: 10.8) contrast with extended administration-to-resection time (96 h). IntegriSense750 correctly identified all diseased nodes in situ during exploratory surgeries. Ex vivo, whole-body biodistribution was assessed by tumor-to-tissue fluorescence ratios (TTR). Agents provided sufficient fluorescence contrast to discriminate disease from background, TTR>1. IntegriSense750 was most robust in neural tissue (TTR: 64) while ProSense750EX was superior localizing disease against lung tissue (TBR: 13). CONCLUSION: All three agents appear effective for FGS.

Update on the Notochord Including its Embryology, Molecular Development, and Pathology: A Primer for the Clinician.

The notochord is a rod-like embryological structure, which plays a vital role in the development of the vertebrate. Though embryological, remnants of this structure have been observed in the nucleus pulposus of the intervertebral discs of normal adults. Pathologically, these remnants can give rise to slow-growing and recurrent notochord-derived tumors called chordomas. Using standard search engines, the literature was reviewed regarding the anatomy, embryology, molecular development, and pathology of the human notochord. Clinicians who interpret imaging or treat patients with pathologies linked to the notochord should have a good working knowledge of its development and pathology.