Blood
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Randomized Controlled Trial Multicenter Study
A multicenter randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children.
Magnesium, a vasodilator, anti-inflammatory, and pain reliever, could alter the pathophysiology of sickle cell pain crises. We hypothesized that intravenous magnesium would shorten length of stay, decrease opioid use, and improve health-related quality of life (HRQL) for pediatric patients hospitalized with sickle cell pain crises. The Magnesium for Children in Crisis (MAGiC) study was a randomized, double-blind, placebo-controlled trial of intravenous magnesium vs normal saline placebo conducted at 8 sites within the Pediatric Emergency Care Applied Research Network (PECARN). ⋯ Changes in HRQL before discharge and 1 week after discharge were similar (P > .05 for all comparisons). The addition of intravenous magnesium did not shorten length of stay, reduce opioid use, or improve quality of life in children hospitalized for sickle cell pain crisis. This trial was registered at www.clinicaltrials.gov as #NCT01197417.
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In this issue of Blood, Brousseau et al report results from the Magnesium for Children in Crisis (MAGiC; #NCT01197417) trial. This multicenter, double-blind, placebo-controlled trial compared the effects of intravenous magnesium to saline in children with sickle cell anemia (SCA) admitted to the hospital for acute vaso-occlusive pain (VOC). Although magnesium was found to be ineffective, MAGiC illustrates an effective strategy for rapid and efficient patient accrual in pediatric SCA studies.
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Factor XIIa (FXIIa) and factor XIa (FXIa) contribute to thrombosis in animal models, whereas platelet-derived polyphosphate (polyP) may potentiate contact or thrombin-feedback pathways. The significance of these mediators in human blood under thrombotic flow conditions on tissue factor (TF) -bearing surfaces remains inadequately resolved. Human blood (corn trypsin inhibitor treated [4 μg/mL]) was tested by microfluidic assay for clotting on collagen/TF at TF surface concentration ([TF]wall) from ∼0.1 to 2 molecules per μm(2). ⋯ Regardless of [TF]wall, PPXbd enhanced fibrin sensitivity to tissue plasminogen activator and promoted clot retraction during fibrinolysis concomitant with an observed PPXbd-mediated reduction of fibrin fiber diameter. This is the first detection of endogenous polyP function in human blood under thrombotic flow conditions. When triggered by low [TF]wall, thrombosis may be druggable by contact pathway inhibition, although thrombolytic susceptibility may benefit from polyP antagonism regardless of [TF]wall.
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In this issue of Blood, Ceriani et al introduce, in primary mediastinal B-cell lymphoma (PMBCL), a new prognostic factor measured on pretreatment 18F-fluorodeoxyglucose (18FDG)-positron emission tomography (PET)/computed tomography (CT): the total lesion glycolysis (TLG), which is an index of the glucose uptake by the total tumor burden. This paper is part of the International Extranodal Lymphoma Study Group (IELSG) 26 prospective study designed to evaluate the role of PET in the treatment of PMBCL.