Emergencia hipertensiva como debut de síndrome de Cushing paraneoplásico / Hypertensive Emergency as the Debut of Paraneoplastic Cushing Syndrome

Presentamos el caso de un paciente con antecedentes de hipertensión arterial vasculorrenal tratada un año antes, que acude a urgencias por emergencia hipertensiva (HTA) y disnea. Descartada primera sospecha de reestenosis de arteria renal con angiografía por tomografía computarizada (angioTC), se completa el estudio confirmándose diagnóstico de cáncer de pulmón mediante prueba de imagen y anatomía patológica. En el estudio de hipertensión se detecta elevación de hormona adrenocorticótropa (ACTH), hipercortisolismo y datos analíticos de hiperaldosteronismo. Con el diagnóstico final de síndrome de Cushing secundario a producción ectópica de ACTH se inicia tratamiento médico, sin llegar a recibir nada más por fallecimiento del paciente a los pocos días.(AU)

We present the case of a patient with a history of renal-vascular hypertension treated with stent one year previously, who attended the emergency room due to hypertensive emergency and dyspnea. Once the first suspicion of renal artery restenosis was ruled out with CT angiography, the study was completed, confirming the diagnosis of lung cancer through imaging and pathological anatomy. In the hormonal study, elevation of ACTH, hypercortisolism and analytical data of hyperaldosteronism were detected. With the final diagnosis of Cushing's syndrome secondary to ectopic production of ACTH, medical treatment was started, without being able to receive anything else due to the death of the patient after a few days.(AU)

[Hypertensive Emergency as the Debut of Paraneoplastic Cushing Syndrome]. / Emergencia hipertensiva como debut de síndrome de Cushing paraneoplásico.

We present the case of a patient with a history of renal-vascular hypertension treated with stent one year previously, who attended the emergency room due to hypertensive emergency and dyspnea. Once the first suspicion of renal artery restenosis was ruled out with CT angiography, the study was completed, confirming the diagnosis of lung cancer through imaging and pathological anatomy. In the hormonal study, elevation of ACTH, hypercortisolism and analytical data of hyperaldosteronism were detected. With the final diagnosis of Cushing's syndrome secondary to ectopic production of ACTH, medical treatment was started, without being able to receive anything else due to the death of the patient after a few days.

Removal of emerging pollutants by a 3-step system: Hybrid digester, vertical flow constructed wetland and photodegradation post-treatments.

The removal of emerging pollutants from municipal wastewater was studied for the first time using a three-step pilot-scale system: 1) hybrid digester (HD) as first step, 2) subsurface vertical flow constructed wetland (VF) as second step, and 3) photodegradation (PD) unit as third step or post-treatment. The HD and VF units were built and operated in series with effluent recirculation at pilot scale. For the PD post-treatment, three alternatives were studied at lab-scale, i) UVC irradiation at 254 nm (0.5 h exposure time), ii) UVA irradiation at 365 nm using a TiO2-based photocatalyst and iii) sunlight irradiation using a TiO2-based photocatalyst, the last two for 1 and 2 h. Alternative iii) was also tested at pilot-scale. Degradation of nine compounds was evaluated: acetaminophen (ACE), caffeine (CAF), carbamazepine (CBZ), ketoprofen (KET), ibuprofen (IBU), diclofenac (DCL), clofibric acid (ACB), bisphenol A (BPA), and sotalol (SOT). Overall, the HD-VF-UVC system completely removed (>99.5 %) ACE, CAF, KET, IBU, DCL and ACB, and to a lesser extent SOT (98 %), BPA (83 %) and CBZ (51 %). On the other hand, the HD-VF-UVA/TiO2 system (at 2 h) achieved >99.5 % removal of ACE, CAF, KET, IBU and DCL while ACB, BPA, CBZ and SOT were degraded by 83 %, 81 %, 78 % and 68 %, respectively. Working also at 2 h of exposure time, in summer conditions, the HD-VF-Sol/TiO2 system achieved >99.5 % removal of ACE, CAF, KET, IBU, DCL and ACB, and to a minor extent BPA (80 %), SOT (74 %) and CBZ (69 %). Similar results, although slightly lower for SOT (60 %) and CBZ (59 %), were obtained in the pilot sunlight plus TiO2 catalyst unit. However, the use of sunlight irradiation with a TiO2-based photocatalyst clearly showed lower removal efficiency in autumn conditions (i.e., 47 % SOT, 31 % CBZ).

LPA1 receptor and chronic stress: Effects on behaviour and the genes involved in the hippocampal excitatory/inhibitory balance.

The LPA1 receptor, one of the six characterized G protein-coupled receptors (LPA1-6) through which lysophosphatidic acid acts, is likely involved in promoting normal emotional behaviours. Current data suggest that the LPA-LPA1-receptor pathway may be involved in mediating the negative consequences of stress on hippocampal function. However, to date, there is no available information regarding the mechanisms whereby the LPA1 receptor mediates this adaptation. To gain further insight into how the LPA-LPA1 pathway may prevent the negative consequences of chronic stress, we assessed the effects of the continuous delivery of LPA on depressive-like behaviours induced by a chronic restraint stress protocol. Because a proper excitatory/inhibitory balance seems to be key for controlling the stress response system, the gene expression of molecular markers of excitatory and inhibitory neurotransmission was also determined. In addition, the hippocampal expression of mineralocorticoid receptor genes and glucocorticoid receptor genes and proteins as well as plasma corticosterone levels were determined. Contrary to our expectations, the continuous delivery of LPA in chronically stressed animals potentiated rather than inhibited some (e.g., anhedonia, reduced latency to the first immobility period), though not all, behavioural effects of stress. Furthermore, this treatment led to an alteration in the genes coding for proteins involved in the excitatory/inhibitory balance in the ventral hippocampus and to changes in corticosterone levels. In conclusion, the results of this study reinforce the assumption that LPA is involved in emotional regulation, mainly through the LPA1 receptor, and regulates the effects of stress on hippocampal gene expression and hippocampus-dependent behaviour.

Predictive validity of the Braden scale for assessing risk of developing pressure ulcers and dependence-related lesions.

OBJECTIVE: In 2014, a new theoretical model explained the mechanism of the development of pressure ulcers (PUs) and that of seven types of lesions known as dependence-related lesions (DRL). The aim of this study was to calculate the incidence of DRL that have been classified as PUs and to check the predictive validity of the Braden scale for assessing DRL in accordance with the new theoretical model in an intensive care unit (ICU). Method This longitudinal, prospective study was conducted in a Spanish ICU. The patients were monitored for 14 days in the ICU until they developed DRL, died, or were discharged. The patients' risk of developing DRL was assessed each day using the Braden scale. The following parameters were taken as reference for validating the scale: sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), relative risk (RR) and the area under the receiver operating characteristic (ROC) curve. RESULTS: Of the 295 patients included in the study, 27.5% developed DRL, which 50.6% were categorised as PUs, 17.3% caused by moisture, and 13.6% caused by friction. The rest were categorised as caused by a combination of factors. Risk according to the Braden scale was greater in the group of patients with DRL than in the group of patients without. The highest risk score provided the best predictive validity parameters for the DRL (Se 0.90, Sp 0.26, PPV 0.31, NPV 0.78 and RR 3.15 [confidence interval (CI) 95%: 1.42-6.96]). These vaules show the individuals at risk are well detected, although it is at the expense of generating a number of false positive cases. CONCLUSIONS: The Braden scale has demonstrated a moderate capacity for predicting PUs and DRL caused by moisture, but no capacity for predicting DRL caused by friction.

maLPA1-null mice as an endophenotype of anxious depression.

Anxious depression is a prevalent disease with devastating consequences and a poor prognosis. Nevertheless, the neurobiological mechanisms underlying this mood disorder remain poorly characterized. The LPA1 receptor is one of the six characterized G protein-coupled receptors (LPA1-6) through which lysophosphatidic acid acts as an intracellular signalling molecule. The loss of this receptor induces anxiety and several behavioural and neurobiological changes that have been strongly associated with depression. In this study, we sought to investigate the involvement of the LPA1 receptor in mood. We first examined hedonic and despair-like behaviours in wild-type and maLPA1 receptor null mice. Owing to the behavioural response exhibited by the maLPA1-null mice, the panic-like reaction was assessed. In addition, c-Fos expression was evaluated as a measure of the functional activity, followed by interregional correlation matrices to establish the brain map of functional activation. maLPA1-null mice exhibited anhedonia, agitation and increased stress reactivity, behaviours that are strongly associated with the psychopathological endophenotype of depression with anxiety features. Furthermore, the functional brain maps differed between the genotypes. The maLPA1-null mice showed increased limbic-system activation, similar to that observed in depressive patients. Antidepressant treatment induced behavioural improvements and functional brain normalisation. Finally, based on validity criteria, maLPA1-null mice are proposed as an animal model of anxious depression. Here, for we believe the first time, we have identified a possible relationship between the LPA1 receptor and anxious depression, shedding light on the unknown neurobiological basis of this subtype of depression and providing an opportunity to explore new therapeutic targets for the treatment of mood disorders, especially for the anxious subtype of depression.

Assessment of TruviewPCD videolaryngoscope for intubation in children. / Evaluación del videolaringoscopio TruviewPCD para la intubación de niños.

OBJECTIVE: The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. MATERIAL AND METHOD: A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. RESULTS: Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. CONCLUSIONS: TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide.

Stereotactic body radiation therapy (SBRT) delays the emergence of castration resistance in patients with oligometastatic prostate cancer.

PURPOSE: To investigate whether bon e metastases-directed stereotactic body radiation therapy (SBRT) delays the emergence of castration resistance in patients with oligometastatic prostate cancer (OPC). METHODS AND MATERIAL: OPC is usually managed with androgen deprivation therapy (ADT). Migration to castration-resistant prostate cancer will inevitably occur in the majority of these patients. There are several strategies aimed to delay the emergence of castration resistance including intermittent ADT, second generation antiandrogens (abiraterone, enzalutamide) or metastases-directed SBRT. The present report describes two cases of patients with OPC that received SBRT 24 Gy/3Rx to the solitary bony lesion after ADT failure. RESULTS: Both cases showed complete and durable biochemical response for 13 and 17 months, respectively. CONCLUSIONS: SBRT can be used to delay the emergence of castration resistance and the need for systemic therapy when used after ADT failure.

[Open door intensive care unit: perspective of the professionals]. / Unidad de cuidados intensivos de puertas abiertas: perspectiva de los profesionales.

INTRODUCTION: Restrictive visiting hours continue to predominate at most intensive care units (ICU). Maintaining the current visiting policy or switching to an open visiting hours policy continues to be a controversial study for the staff. OBJECTIVES: To know the staff perspective on the effects of open visiting hours on patients, family and professional activity. To gather proposals in order to modify the current visiting policy. MATERIALS AND METHOD: A 30-item 'Likert-type scale' data was administered to ICU doctors, nurses and health care assistants of Alava University Hospital. Data was collected within an Excel database and analyzed using SPSS 19.0. Frequencies and percentages were calculated for descriptive statistics purposes and the Chi Square test was used for the bivariate analysis related to age, professional category and years of experience. RESULTS: The staff (n=64) considered that open visiting hours could have a beneficial effect on patients (67%) and relatives (61%). However, 62% considered that open visiting hours would be of little benefit for the staff themselves. Neither the experience of the respondent nor their professional category seem to have any statistical effect on the perception of the benefit of open visiting hours. However, the younger staff members consider open visiting hours would be more beneficial for the patient (p=.024). A total of 50% of surveyed staff would maintain the current visiting hours and would extend them if required by the patient's condition. CONCLUSIONS: Staff members continue to consider the current, restricted visiting policy to be the most appropriate option for the unit. However, they accept the possibility of extending visiting hours for particular cases if beneficial for the patient.

El tabaco de liar / Roll your own tobacco

El consumo de tabaco de liar (TL) está incrementando en la población general en los últimos años. El principal objetivo de nuestro estudio es analizar las características socio-demográficas y de tabaquismo de un grupo de fumadores de TL que han acudido a nuestra Unidad para dejar de fumar. Presentamos, además, los datos de eficacia y seguridad de uso de los distintos tratamientos en este grupo de fumadores. Hemos revisado las historias clínicas y de tabaquismo de un total de 62 sujetos (53% hombres, edad media 46,1 años) fumadores de TL. Comparamos los datos de estos fumadores con una muestra histórica de fumadores de tabaco manufacturado (TM) de nuestra Unidad, que está constituida por 59 sujetos (46% hombres, 51,6 años de edad media). Las principales diferencias que hemos encontrado entre ambos grupos han sido: los fumadores de TL tienen más altas concentraciones de CO en su aire espirado (27,9 vs. 21,48 ppm, p menor de 0,05) que los fumadores de TM a pesar de que estos consumen un mayor número de cigarrillos diarios (18,5 vs. 27,9 CPD, p< 0,05). Igualmente encontramos que los niveles de cotinina en sangre en los fumadores de TM son más altos que los de los de TL (396,38 vs. 334,38 ng/ml, p< 0,05). La tasa de abstinencia a los seis meses de seguimiento fue de 59,6% para los consumidores de TL y de 55,17% para los de TM. En conclusión, los fumadores de TL tienen más altas concentraciones de CO a pesar de que fuman un menor número de cigarrillos diarios y los tratamientos para dejar de fumar se muestran muy eficaces en este grupo de fumadores (AU)

Rolling tobacco consumption has increased in recent year. The primary objective of the study is to analyze the sociodemographic and smoking characteristics in a group of rolling tobacco smokers who come to our unit to give up smoking. We also present the efficacy and safety data from different treatments in this group. We have examined the clinic and tobacco histories on a total of 62 rolling tobacco smokers (53% males average age 46.1) and we have compared this data with a historical sample of conventional tobacco smokers in our unit, this group consists of 59 smokers (46% males, average age 51.6) The main differences between both groups were: rolling tobacco smokers have higher CO concentrations in the exhaled air (27.9 v. 1.48 ppm, p< 0.05) compared to the conventional tobacco smokers though they smoke fewer cigarettes per day (18.5 v. 334.38 ng/ ml, p< 0.05). The higher abstinence rate at 6 month in these both group were 59,6% (rolling tobacco smokers) and 55,17% (conventional tobacco smokers). In conclusion, rolling tobacco smokers have higher CO concentrations in the exhaled air even though they smoke fewer cigarettes per day. The cessation treatment is very effective in this group of smokers (AU)

Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento / Single-Session Extracorporeal Shock Wave Lithotripsy for Urinary Calculi: Factors Predicting Success after Three Weeks of Follow-Up

Objetivo: Identificar factores predictivos de éxito después de una sesión única de litotricia extracorpórea por ondas de choque (LEOC) a las tres semanas de seguimiento. Material y métodos: Se revisaron los registros clínicos de 116 pacientes con cálculos urinarios únicos sometidos a LEOC entre octubre 2007 y agosto 2009. Las tomografías axiales computarizadas preoperatorias de todos los pacientes fueron revisadas por dos radiólogos en desconocimiento del desenlace clínico. El éxito fue definido como la desaparición completa del cálculo o la persistencia de fragmentos ≤ 2mm en la radiografía simple realizada durante las tres primeras semanas de seguimiento. El impacto de factores clínicos y radiológicos fue evaluado utilizando regresión logística. Resultados: La tasa de éxito de LEOC a las tres semanas de seguimiento fue del 49,1%. Tamaño < 8mm, área del cálculo < 30mm2, localización en el uréter distal, densidad < 1.000 UH y fragmentación intraoperatoria demostraron una significativa asociación con éxito en el análisis univariado (p<0,05). Área del cálculo<30mm2 (OR: 2,9), localización en uréter distal (OR: 3,4) y fragmentación intraoperatoria (OR: 4,2) fueron factores predictivos de éxito en el análisis multivariado (p<0,05). Conclusiones: El área del cálculo y la localización en el uréter distal son útiles en el momento de decidir acerca de la realización de una LEOC. Sin embargo, la resolución exitosa de solamente la mitad de los casos bajo los criterios evaluados recalca la relevancia de informar al paciente de la eventual necesidad de tratamientos adicionales después de una sesión única de LEOC (AU)

Introduction: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. Material and methods: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. Results: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8mm, stone area < 30mm2, stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. Conclusions: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment (AU)

[Single-session extracorporeal shock wave lithotripsy for urinary calculi: factors predicting success after three weeks of follow-up]. / Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento.

INTRODUCTION: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. MATERIAL AND METHODS: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. RESULTS: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm(2), stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. CONCLUSIONS: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.

Dispensación de medicación protocolizada en un servicio de urgencias de un hospital de tercer nivel / Dispensing Standardised Medication in a Tertiary Hospital Emergency Department

Introducción Existe una situación de descubierto en la continuidad asistencial de los pacientes que acuden a los servicios de urgencias, al no poder disponer del tratamiento prescrito hasta que no pasan por su médico de atención primaria, donde obtienen las recetas oficiales. Se diseña un programa que pretende proporcionar a dichos pacientes un protocolo terapéutico, que garantice su tratamiento, mejorando la coordinación interniveles entre el servicio de urgencias del hospital y atención primaria. Métodos Creación de un grupo multidisciplinario de trabajo. Selección de los diagnósticos más frecuentes en el servicio de urgencias susceptibles de protocolizar. Elaboración de protocolos terapéuticos adecuándose a los diagnósticos seleccionados. Creación de una base de datos, recogida, tratamiento y descripción de los mismos. Diseño de encuestas de satisfacción, para pacientes, a los que se les dispensó un protocolo terapéutico, y para facultativos involucrados en el programa. Resultados Se asignó protocolo terapéutico a los 9 diagnósticos más frecuentes en el servicio de urgencias, con tratamiento para 3 días. Los diagnósticos seleccionados cubrieron el 19,5% de la población atendida en el urgencias. Se dispensó un protocolo terapéutico al 17,3% de los pacientes con diagnóstico seleccionado. La satisfacción de los pacientes para con el programa fue excelente. Los médicos aprobaban el programa, pero la prescripción de protocolos terapéuticos no refleja concordancia con el grado de aprobación. Conclusiones Los resultados muestran que el programa tiene una aceptación excelente tanto en los pacientes como en los facultativos involucrados, aunque la cobertura que se da a las necesidades detectadas fue menor que la requerida(AU)

Introduction It is well-known that there is a lack of continuity in care received from the emergency department, as patients have to visit their physician in order to receive official prescriptions. A programme has been designed that aims to provide these patients with a therapeutic protocol to ensure that they are treated, thus improving coordination between the Hospital Emergency Department and Primary Care. Methods Creating a multidisciplinary team. Choosing the diagnoses that are most common in the emergency department and which are likely to be standardised. Developing treatment protocols, adapting them to the diagnoses selected. Creating a database, collecting, processing and analysing data. Designing satisfaction surveys, for patients given a therapeutic protocol, and for practitioners involved in the programme. Results Treatment protocols were assigned to the nine most common diagnoses in the emergency department, with three-day treatment. The selected diagnoses covered 19.5% of the population attending the Emergency Department. A treatment protocol was dispensed to 17.3% of patients with the selected diagnoses. Patient satisfaction was excellent. Physicians approved of the programme, but the treatment protocol prescription did not agree with the degree of approval. Conclusions The results show that the programme was excellently accepted by both patients and physicians, although the coverage given to the needs identified was lower than required (AU)

[Dispensing standardised medication in a tertiary hospital emergency department]. / Dispensación de medicación protocolizada en un servicio de urgencias de un hospital de tercer nivel.

INTRODUCTION: It is well-known that there is a lack of continuity in care received from the emergency department, as patients have to visit their physician in order to receive official prescriptions. A programme has been designed that aims to provide these patients with a therapeutic protocol to ensure that they are treated, thus improving coordination between the Hospital Emergency Department and Primary Care. METHODS: Creating a multidisciplinary team. Choosing the diagnoses that are most common in the emergency department and which are likely to be standardised. Developing treatment protocols, adapting them to the diagnoses selected. Creating a database, collecting, processing and analysing data. Designing satisfaction surveys, for patients given a therapeutic protocol, and for practitioners involved in the programme. RESULTS: Treatment protocols were assigned to the nine most common diagnoses in the emergency department, with three-day treatment. The selected diagnoses covered 19.5% of the population attending the Emergency Department. A treatment protocol was dispensed to 17.3% of patients with the selected diagnoses. Patient satisfaction was excellent. Physicians approved of the programme, but the treatment protocol prescription did not agree with the degree of approval. CONCLUSIONS: The results show that the programme was excellently accepted by both patients and physicians, although the coverage given to the needs identified was lower than required.

[Reading comprehension of students with attention deficit hyperactivity disorder: what is the role of executive functions?]. / Comprensión de textos de estudiantes con trastorno por déficit de atencion/hiperactividad: qué papel desempeñan las funciones ejecutivas?

INTRODUCTION: Deficits in reading comprehension of children with attention deficit hyperactivity disorder (ADHD) have received scarce attention. However, to establish the underlying cognitive processes of ADHD and deficits in reading comprehension association could be essential for deeply understanding neurobiological bases of reading comprehension. AIM: To examine the contribution of verbal fluency, reading fluency, and executive functions (working memory, attention and suppression mechanism) in predicting mental processes of texts comprehension. PATIENTS AND METHODS: The participants in the study were 42 students, 12 to 16 year old, with a clinical diagnosis of ADHD. A battery of tests was administered to measure cognitive processes and reading processes. RESULTS AND CONCLUSIONS: Stepwise regression analysis carried out showed that the score in verbal fluency was the best single predictor of reading comprehension. Furthermore executive functions, but not reading fluency, made a significant contribution to reading comprehension. These findings underline the need for consideration of the role of executive functions in assessment and treatment of reading comprehension deficits of students with ADHD.

Effect of pulsed magnetic field therapy on pain reported by human volunteers in a laboratory model of acute pain.

BACKGROUND: Pulsed magnetic field therapy (PMFT) is a non-invasive, simple technique used extensively for the treatment of muscle pain. However, evidence to support its use from well-designed, clinical, or experimental studies is sparse. METHODS: We have utilized an acute pain model to perform a randomized, double-blinded, placebo-controlled, crossover-study on 10 male (18-40 yr) volunteers. Pain was elicited by infusion of hypertonic saline 5% into the brachioradialis muscle of the non-dominant arm on two occasions, at least 1 week apart. Subjects received active or sham PMFT for 30 min in a randomized order delivered by two identical, commercially available machines (PulsePack 6000, Quantum Techniks). The active machine delivered a M-wave magnetic pulse (1.25 Hz, 3 ms width, 600 Gauss); the sham device was deactivated and delivered no magnetic energy. Pain was assessed at 15-s intervals, and area under the visual analogue score (VAS) pain curve (AUCp) was calculated using the trapezoid method. RESULTS: There were no significant differences in mean VAS pain scores between the two machines at any time. In addition, there were no significant differences with respect to mean (sem) maximum pain score [sham 60 (8), active 63 (9) mm; P = 0.66, 95% CI -18 to 12 mm] or AUCp [sham 463 (50), active 499 (90); P = 0.64, 95% CI -201 to 129]. CONCLUSIONS: We conclude that, using the electromagnetic characteristics of the machine in this study, the PMFT had no effect on pain in our experimental model. More work is required to provide an evidence base in support of the use of this technique for pain.