iMRS 2000 - PEMF Publications
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PEMF Publications

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101

Analysis of pharmacologic and nonpharmacologic prescription patterns of general practitioners and specialists in the AMICA study

OBJECTIVE: To evaluate the prescription modalities of general practitioners (GPs) and specialists in symptomatic osteoarthritis (OA) patients enrolled in the AMICA study. PATIENTS AND METHODS: This study started in 2001 as a cohort investigation of OA patients seen by 2764 GPs and 316 specialists. Enrolled were 28,981 patients with symptomatic OA of the hand, hip, or knee. RESULTS: GPs and physical medicine specialists treated OA less frequently with pharmacological therapy than rheumatologists (OR 0.35; CI 0.26 to 0.47) or orthopedic surgeons (OR 0.65; CI 0.54 to 0.77). Pharmacological therapies (alone or in association with nonpharmacological modalities) were selected by 97% of the GPs, 96% of the rheumatologists, 94% of the orthopedic surgeons, and 85% of the physical medicine specialists. In comparison with GPs, all of the specialists more frequently used disease-modifying OA drugs (DMOADs) (rheumatologists: OR 6.86, CI 6.03 to 7.80; orthopedic surgeons: OR 2.20, CI 1.94 to 2.49; physical medicine specialists: OR 2.11, CI 1.69 to 2.63). Nonpharmacological therapies were selected by 44% of the GPs, 54% of the rheumatologists, 71% of the orthopedic surgeons, and 90% of the physical medicine specialists. They were used alone uncommonly (by 3% of the GPs, 3% of the rheumatologists, 6% of the orthopedic surgeons, and 15% of the physical medicine specialists). GPs use nonpharmacological treatment less than specialists: OR 0.53; CI 0.47 to 0.60 versus rheumatologists; OR 0.20; CI 0.18 to 0.21 versus orthopedic surgeons; and OR 0.07; CI 0.05 to 0.09 versus physical medicine specialists. Ultrasound (US) (11%) and transcutaneous electrical nerve stimulation (TENS) (7%) were the nonpharmacological therapies most frequently prescribed by GPs. Among the specialists, physical medicine specialists most frequently prescribed US (35%) and TENS (21%); US was also preferred by rheumatologists, whereas the orthopedic surgeon's choice was magnetotherapy (21%). Exercises and other passive or active rehabilitation strategies were prescribed for only 13% of the patients seen by GPs, but all 3 categories of specialists prescribed exercises and manual techniques far more frequently: rheumatologists, OR 1.63: 1.40 to 1.63; orthopedic surgeons, OR 1.67: 1.48 to 1.88; physical medicine specialists, OR 3.19: 2.66 to 3.82. CONCLUSIONS: Italian rheumatologists and orthopedic surgeons are the specialists who most frequently use pharmacological treatment for OA. Nonpharmacological treatment is used commonly among both GPs and specialists but rarely as single therapy. Exercise and passive or active rehabilitation strategies are not frequently prescribed, although they are recommended by all the published guidelines.

102

Analysis of the current distribution in bone produced by pulsed electro-magnetic field stimulation of bone

Pulsed electromagnetic stimulation is being increasingly used by orthopaedic surgeons to treat non-unions and congenital pseudoarthrosis. In this paper a theoretical model is developed to analyze the distribution of induced current in bone due to a pulsed electromagnetic field, produced by a pair of Helmholtz coils. The result shows that the induced current density is dependent of the electrical properties of bone, geometry of the coils and their location.

103

Analysis of the temporal and spatial dependence of the eddy current fields in a 40-cm bore magnet

Eddy current fields, generated in an animal-size superconducting NMR magnet by a nominally rectangular pulsed transverse gradient applied in the vertical direction, have been studied by measuring the offset frequency of the proton NMR signal obtained from a small spherical sample. Measurements were made, after various time delays, at nine different locations in the sample space. Analysis of the data shows that the time-dependent fields at all nine locations are quite well accounted for by the superposition of only four independent exponentially decaying components that have time constants in the range from 9 to 400 ms. Two of these were found to be caused by eddy currents generated in the magnet structure. They generate primarily linear gradients, though one of them also produces a B0 shift, indicating a significant asymmetry about the isocenter of the conducting structure in which the eddy current flows. The other two exponentially decaying components, which had very different time constants from the eddy currents and also initial amplitudes of the opposite sign, were generated by the preemphasis unit. This calls into question the procedure used to adjust the preemphasis unit and an alternative method is proposed.

104

Analytical understanding of multiple-angle incidence resolution spectrometry based on a classical electromagnetic theory

Infrared multiple-angle incidence resolution spectrometry (IR-MAIRS) is a unique spectroscopic technique to retrieve both surface-parallel (in-plane; IP) and -perpendicular (out-of-plane; OP) molecular vibration spectra simultaneously from an identical thin-film deposited on a high refractive index substrate, and the measurement theory was constructed by the use of a theoretical framework of regression equation. The core part of the MAIRS theory is found in the weighting factor matrix, R, used for a linear combination, which was constructed in an unusual manner. Because a regression equation does not strictly correlate the left- and right-hand sides of the equation, R matrix cannot directly be deduced from Maxwell's equation. Although the conventional studies using IR-MAIRS gave excellent empirical results, a strict physical understanding of MAIRS is necessary; otherwise, we cannot rely on it at least quantitatively. In the present study, the MAIRS theory has first been analyzed by the use of Maxwell's equations inductively. As a result, both MAIRS-IP and -OP spectra have readily been expressed as a linear combination of the Im(epsilon(x)) and Im(-1/epsilon(z)) functions that correspond to the conventional transmission and reflection-absorption spectra. Through the analysis of coefficients of the linear combination, MAIRS has proved to be reliably useful for analysis of thin film on a high refractive index substrate.

105

Annals of conflicting results: looking back on electromagnetic field research

Few environmental health issues are as contentious as the question of whether exposure to electromagnetic fields (EMFs) from power lines increases cancer risk. Among the many actors in this controversy, epidemiologists have played the leading role in raising the question and motivating research. Epidemiologic studies of the effects of exposure to power-line EMFs include the investigation by Dr. Gilles Theriault and colleagues into incidence rates of cancer among electric-utility workers in Quebec, Ontario and France. With the development of personal dosimeters to measure exposure to electric, magnetic and pulsed EMFs, occupational studies in the 1990s have made an important methodologic advance. But, as Theriault explains, improvements in assessing exposure have not yet translated into clear and consistent findings.

106

Anthropometric and quantitative EMG status of femoral quadriceps before and after conventional kinesitherapy with and without magnetotherapy

The frequency of femoral quadriceps muscle hypotrophy has become a significant therapeutic problem. Efforts are being made to improve the standard scheme of kinesitherapeutic treatment by using additional more effective therapeutic methods. Beside kinesitherapy, the authors have used magnetotherapy in 30 of the 60 patients. The total of 60 patients, both sexes, similar age groups and intensity of hypotrophy, were included in the study. They were divided into groups A and B, the experimental and the control one (30 patients each). The treatment was scheduled for the usual 5-6 weeks. Electromyographic quantitative analysis was used to check-up the treatment results achieved after 5 and 6 weeks of treatment period. Analysis of results has confirmed the assumption that magnetotherapy may yield better and faster treatment results, disappearance of pain and decreased risk of complications. The same results were obtained in the experimental group, only one week earlier than in the control group. The EMG quantitative analysis has not proved sufficiently reliable and objective method in the assessment of real condition of the muscle and effects of treatment.

107

Antinociceptive effects of a pulsed magnetic field in the land snail, Cepaea nemoralis

Pulsed magnetic fields (patent pending) consisting of approximately 100 microT (peak), frequency modulated, extremely low frequency magnetic fields (ELFMF) were shown to induce a significant degree of antinociception ('analgesia') in the land snail Cepaea nemoralis. Fifteen minute exposures to a specific magnetic field both increased enkephalinase inhibitor induced opioid analgesia and induced analgesia in untreated snails. Injection of the prototypic opioid antagonist naloxone, attenuated, but did not completely block, the pulsed magnetic field induced analgesia. Two other pulsed waveform designs failed to induce analgesia in untreated snails. These findings suggest that specific magnetic field exposure designs may be tailored to produce significant behavioral effects including, but certainly not limited to, the induction of analgesia.

108

Application of high amplitude alternating magnetic fields for heat induction of nanoparticles localized in cancer

OBJECTIVE: Magnetic nanoparticles conjugated to a monoclonal antibody can be i.v. injected to target cancer tissue and will rapidly heat when activated by an external alternating magnetic field (AMF). The result is necrosis of the microenvironment provided the concentration of particles and AMF amplitude are sufficient. High-amplitude AMF causes nonspecific heating in tissues through induced eddy currents, which must be minimized. In this study, application of high-amplitude, confined, pulsed AMF to a mouse model is explored with the goal to provide data for a concomitant efficacy study of heating i.v. injected magnetic nanoparticles. METHODS: Thirty-seven female BALB/c athymic nude mice (5-8 weeks) were exposed to an AMF with frequency of 153 kHz, and amplitude (400-1,300 Oe), duration (1-20 minutes), duty (15-100%), and pulse ON time (2-1,200 seconds). Mice were placed in a water-cooled four-turn helical induction coil. Two additional mice, used as controls, were placed in the coil but received no AMF exposure. Tissue and core temperatures as the response were measured in situ and recorded at 1-second intervals. RESULTS: No adverse effects were observed for AMF amplitudes of < or = 700 Oe, even at continuous power application (100% duty) for up to 20 minutes. Mice exposed to AMF amplitudes in excess of 950 Oe experienced morbidity and injury when the duty exceeded 50%. CONCLUSION: High-amplitude AMF (up to 1,300 Oe) was well tolerated provided the duty was adjusted to dissipate heat. Results presented suggest that further tissue temperature regulation can be achieved with suitable variations of pulse width for a given amplitude and duty combination. These results suggest that it is possible to apply high-amplitude AMF (> 500 Oe) with pulsing for a time sufficient to treat cancer tissue in which magnetic nanoparticles have been embedded.

109

Application of the ferromagnetic transduction model to D.C. and pulsed magnetic fields: effects on epileptogenic tissue and implications for cellular phone safety

The ferromagnetic transduction model proposed by J.L. Kirschvink (Phys. Rev. A (1992) 46, 2178-2184) suggests that the coupling of biogenic magnetic particles in the human brain to mechanosensitive membrane ion gates may provide a mechanism for interactions of environmental magnetic fields with humans. Extremely low frequency alternating magnetic fields primarily were considered, and in the model A.C. fields with frequencies below 10 Hz should have minimal effect. We show that pulsed fields, square waves, and D.C. fields also could force open the membrane gates long enough to disrupt normal neurophysiological processes. The model may therefore be extended to explain results obtained in studies of epileptic patients which show effects on the central nervous system from low frequency square wave and D.C. magnetic fields. In addition, the model also may provide a plausible mechanism linking exposure to magnetic fields from discontinuous transmission cellular telephones and disruption of normal cellular processes in the human brain.

110

Application of weak electromagnetic fields facilitates sensory-motor integration in patients with multiple sclerosis

Electrophysiological studies in behaving animals have shown the function of cerebral serotonin (5-HT) neurons to be altered in association with motor output in both the tonic and repetitive modes and also in relation to an orienting response. Brainstem 5-HT neurons increase their firing rate two to five-fold during repetitive motor activity to facilitate motor output while simultaneously suppressing transmission in sensory pathways. Reciprocally, during an orienting response motor activity is suppressed and 5-HT neuronal activity is inhibited to facilitate transmission of sensory information. These reciprocal changes in 5-HT neuronal activity serve to facilitate brainstem reticular sensory-motor integration which, due to 5-HT neurotransmission deficiency, may be disrupted in patients with multiple sclerosis (MS). For instance, MS patients are unable to process auditory information in the presence of competing ambient stimuli, while under a controlled laboratory environment they demonstrate unimpaired verbal information processing. This report concerns three MS patients who experienced rapid deterioration in balance resulting in falling when subjected, during ambulation, to distracting external auditory stimuli. After receiving a series of treatments with low frequency picotesla range intensity electromagnetic fields (EMFs), which were applied extracranially for brief periods, these patients experienced resolution of these symptoms with ambulation being unaffected by auditory stimuli. It is suggested that application of picotesla EMFs may restore abnormal reticular sensory-motor integration in MS patients with the effect being related to facilitation of 5-HT neurotransmission at both junctional (synaptic) and nonjunctional neuronal target sites.

111

AR spectral analysis technique for human PPG, ECG and EEG signals

In this study, Fast Fourier transform (FFT) and autoregressive (AR) methods were selected for processing the photoplethysmogram (PPG), electrocardiogram (ECG), electroencephalogram (EEG) signals recorded in order to examine the effects of pulsed electromagnetic field (PEMF) at extremely low frequency (ELF) upon the human electrophysiological signal behavior. The parameters in the autoregressive (AR) method were found by using the least squares method. The power spectra of the PPG, ECG, and EEG signals were obtained by using these spectral analysis techniques. These power spectra were then used to compare the applied methods in terms of their frequency resolution and the effects in extraction of the features representing the PPG, ECG, and EEG signals. Some conclusions were drawn concerning the efficiency of the FFT and least squares AR methods as feature extraction methods used for representing the signals under study.

113

Assessment of non-sinusoidal, pulsed, or intermittent exposure to low frequency electric and magnetic fields

The correct assessment of non-sinusoidal, pulsed, or intermittent exposure to low frequency electric and magnetic fields already is a key issue in the occupational environment while becoming more and more important in the domain of the general public. The method presented provides a simple and safe solution for the assessment of arbitrary field types--including sinusoidal and continuous-wave signals--with frequencies up to several 100 kHz and has already proven its practicability and usefulness for more than 5 years. The concept is based on fundamental laws of physics and electrostimulation and well-established physiological data. It allows for a seamless and easy integration in any standard or guideline dealing with human safety in electric, magnetic, and electromagnetic fields. A very simple-to-use graphical version allows an easy and fast assessment of the exposure to non-sinusoidal, pulsed, or intermittent low-frequency magnetic fields without introducing a large overestimation of the exposure situation. A computer-based version makes a much more detailed signal analysis possible and can provide useful information for exposure reduction using modifications of the magnetic field's time parameters (e.g., rise/fall times).

114

Assessment of the magnetic field exposure due to the battery current of digital mobile phones

Hand-held digital mobile phones generate pulsed magnetic fields associated with the battery current. The peak value and the waveform of the battery current were measured for seven different models of digital mobile phones, and the results were applied to compute approximately the magnetic flux density and induced currents in the phone-user's head. A simple circular loop model was used for the magnetic field source and a homogeneous sphere consisting of average brain tissue equivalent material simulated the head. The broadband magnetic flux density and the maximal induced current density were compared with the guidelines of ICNIRP using two various approaches. In the first approach the relative exposure was determined separately at each frequency and the exposure ratios were summed to obtain the total exposure (multiple-frequency rule). In the second approach the waveform was weighted in the time domain with a simple low-pass RC filter and the peak value was divided by a peak limit, both derived from the guidelines (weighted peak approach). With the maximum transmitting power (2 W) the measured peak current varied from 1 to 2.7 A. The ICNIRP exposure ratio based on the current density varied from 0.04 to 0.14 for the weighted peak approach and from 0.08 to 0.27 for the multiple-frequency rule. The latter values are considerably greater than the corresponding exposure ratios 0.005 (min) to 0.013 (max) obtained by applying the evaluation based on frequency components presented by the new IEEE standard. Hence, the exposure does not seem to exceed the guidelines. The computed peak magnetic flux density exceeded substantially the derived peak reference level of ICNIRP, but it should be noted that in a near-field exposure the external field strengths are not valid indicators of exposure. Currently, no biological data exist to give a reason for concern about the health effects of magnetic field pulses from mobile phones.

115

Assessment of the radio-frequency electromagnetic fields induced in the human body from mobile phones used with hands-free kits

In this study, the radiation emission from mobile phones when used with wireless and wired hands-free kits (HFK) was evaluated to determine the necessity for a dedicated compliance procedure and the extent to which the use of wired and wireless HFK can reduce human exposure. The specific absorption rates (SAR) from wireless HFK were determined experimentally. Wired HFK were evaluated dosimetrically while connected to mobile phones (GSM900/1800, UMTS1950) under maximized current coupling onto the HFK cable and various wire routing configurations. In addition, experimentally validated simulations of a wired HFK and a mobile phone operating on anatomical whole-body models were performed. The maximum spatial peak SAR in the head when using wired HFK was more than five times lower than ICNIRP limits. The SAR in the head depends on the output power of the mobile phone, the coupling between the antenna and cable, external attenuation and potential cable specific attenuation. In general, a wired HFK considerably reduces the exposure of the entire head region compared to mobile phones operated at the head, even under unlikely worst-case coupling scenarios. However, wired HFK may cause a localized increase of the exposure in the region of the ear inside the head under worst-case conditions. Wireless HFK exhibit a low but constant exposure.

116

Association between exposure to pulsed electromagnetic fields and cancer in electric utility workers in Quebec, Canada, and France

The authors report the association between exposure to pulsed electromagnetic fields (PEMFs) and cancer in a nested case-control study of electric utility workers in Quebec, Canada (follow-up, 1970-1988), and France (follow-up, 1978-1989), among whom 2,679 cases of cancer were identified. Exposures were assessed through a job-exposure matrix based on about 1,000 person-weeks of measurements from exposure meters worn by workers. Exposures were considerably higher in Quebec than in France. No association was found between PEMFs and cancers previously suspected of association with magnetic fields (leukemia, other hematopoietic cancers, brain cancer, or melanoma). However, there was a clear association between cumulative exposure to PEMFs and lung cancer, with odds ratios rising to 3.11 (95% confidence interval (CI) 1.60-6.04) in the highest exposure group (84 cases). This association with largely confined to Quebec, where there was a monotonic exposure-response relation with an odds ratio of 6.67 (95% CI 2.68-16.57) in the highest exposure group (32 cases). The association is substantial and was not explained by smoking or other occupational exposures. However, several factors limit the strength of the evidence for a causal relation: lack of precision in what the meters measured; little previous evidence for this association; and no elevated risk for lung cancer in the utility workers overall in comparison with the general population.

117

Asymptotic description of pulsed ultrawideband electromagnetic beam field propagation in dispersive, attenuative media

The asymptotic description of the coupled spatial and temporal evolution of a pulsed ultrawideband electromagnetic beam field as it propagates through a dispersive, attenuative material that occupies the half-space z > or = z(0) is obtained from the angular spectrum of plane waves representation. This angular-spectrum representation expresses the wave field as a superposition of both homogeneous and inhomogeneous plane waves. The paraxial approximation of the spatial part of this representation for nontruncated beam fields results in a description that explicitly displays the temporal evolution of the pulsed-beam field through a single-contour integral that is of the same form as that obtained for a pulsed plane-wave field propagating in the positive z direction in a lossy, dispersive medium. The accuracy of this paraxial approximation is shown to improve as the material's attenuation increases.

118

Attenuation of epilepsy with application of external magnetic fields: a case report

We have previously demonstrated that magnetoencephalographic (MEG) brain measurements in patients with seizure disorders show significant MEG activity often in the absence of conventional EEG abnormalities. We localized foci of seizure activity using the mapping technique characterized by the ISO-Spectral Amplitude (ISO-SA) on the scalp distribution of specified spectral components or frequency bands of the emitted MEG Fourier power spectrum. In addition, using an electronic device, we utilized the above recorded activity to emit back the same intensity and frequency of magnetic field to the presumed epileptic foci. Using this method we were able, over the past two and one-half years, successfully to attenuate seizure activity in a cohort of over 150 patients with various forms of epilepsy. We present a patient with severe epilepsy and behavioral disturbances in whom application of an external artificial magnetic field of low intensity produced a substantial attenuation of seizure frequency which coincided with an improvement in the patient's behavior. This case demonstrates that artificial magnetic treatment may be a valuable adjunctive procedure in the management of epilepsy.

119

Auditory response in rats exposed to 2,450 MHz electromagnetic fields in a circularly polarized waveguide

Rats were exposed to 2,450-MHz pulsed microwave fields in a circularly polarized waveguide. The threshold incident energy density per pulse was about 1.5 to 3 microJ/cm2 over the range 1-10 microseconds. The corresponding whole-body averaged specific absorption of energy was 0.9 to 1.8 mJ/kg per pulse. The same response was evoked when the incident energy density or absorbed energy density per pulse was the same, regardless of the pulse widths.

121

Augmentation of bone repair by pulsed elf magnetic fields in rats

Tibial osteotomies in rats were exposed for 2, 3, 5 and 8 weeks to a pulsed extremely low frequency magnetic field. The shape of the pulse was a double halfwave (50 Hz, 70 G). The rate of bone healing was evaluated by light and electron microscopy. An increase of bone healing was found in rats treated with magnetic fields persisting throughout the tested time. The accelerated healing process produced a sequence of morphological appearances identical to those of a normal fracture callus being the enhancement of osteogenesis produced by an acceleration of preliminary ossification.

122

Australian oncologists' self-reported knowledge and attitudes about non-traditional therapies used by cancer patients

OBJECTIVE: To assess Australian radiation and medical oncologists' self-reported knowledge about and attitudes towards a range of non-traditional therapies used by people with cancer. DESIGN: Postal survey during May and June 1997 of all 265 radiation and medical oncologists practising in Australia. PARTICIPANTS: 161 oncologists returned surveys (61% response rate). MAIN OUTCOME MEASURES: Oncologists' own level of knowledge, and, for each known therapy, their perceptions of its likely harm or benefit in patients being treated curatively and palliatively, and of the prevalence of use among their patients. RESULTS: Oncologists reported knowing most about acupuncture, antioxidant therapy and meditation and least about cellular therapy, magnetotherapy and psychic surgery. The therapies most likely to be considered helpful were meditation, acupuncture and hypnotherapy. Those most likely to be considered harmful were coffee enemas, psychic surgery, Iscador therapy and diet therapies. Perceptions of patients' use of most therapies varied widely, with herbal therapies, antioxidant therapy and meditation considered the most commonly used. CONCLUSIONS: These results indicate self-identified gaps in oncologists' knowledge about non-traditional therapies their patients may use; they suggest a need to consider including education about these therapies in oncologists' training.

123

Autoradiographic evaluation of electromagnetic field effects on serotonin (5HT1A) receptors in rat brain

Serotonin (5HT1A) is a chemical mediator of inflammation and the largest single neurotransmitter system of the brain. Its secretion and physiological actions mediate stress and pain, affecting both immune and nervous system functions through the hypothalamic-pituitary-adrenal axis. Serotonin receptor dysfunction is well-characterized in mental disturbances like depression and anxiety. Transcranial magnetic stimulation has been used therapeutically to treat refractory disorders like non-responsive depression and may act in part through its effect on 5HT1A receptors. Previously we have shown that in vitro, 5HT1A receptor binding to a radioactive agonist can be modulated by specific intensity and frequency electromagnetic fields (EMFs). In the present report we have used quantitative receptor autoradiography to evaluate 5HT1A receptor density in rat brain and the impact of pulsed EMF exposure on receptor binding in key brain regions. Rats used in this study had whole body exposures to either a geofield control or to pulsed EMFs to evaluate the treatment for chemically-induced tendinitis. Since the brains were exposed coincidentally as a consequence of the main experiment, we investigated the potential for EMF-induced changes in areas such as the hippocampus. This pilot study should provide a detailed understanding of magnetic field effects on stress-responsive brain regions and will lead to a more coordinated approach to the use of such modalities for therapeutic intervention in humans.

124

Autoradiographic study of the effects of pulsed electromagnetic fields on bone and cartilage growth in juvenile rats

Application of pulsed electromagnetic fields (PEMF) has been used in growth and repair of non-union bone fractures. The similarities between the fibrocartilage callus in non-union bone fractures and the secondary cartilage in the mandibular condyle, both histologically and functionally, lead naturally to study the effects of PEMFs on growth in the condyle. The purposes of this study were: (1) to describe the effects of PEMFs on the growth of the condyle using autoradiography, [3H]-proline and [3H]-thymidine, and (2) to differentiate between the effects of the magnetic and electrical components of the field. Male pre-adolescent Sprague-Dawley rats (28 days old) were divided into three experimental groups of five animals each: (1) PEMF-magnetic (M), (2) PEMF-electrical (E) and (3) control, and were examined at three different times-3, 7 and 14 days of exposure. Each animal was exposed to the field for 8 h per day. Histological coronal sections were processed for quantitative autoradiography to determine the mitotic activity of the condylar cartilage and the amount of bone deposition. The PEMF (magnetic or electrical) had statistically significant effects only on the thickness of the articular zone, with the thickness in the PEMF-M group being the most reduced. Length of treatment was associated with predictable significant changes in the thickness of the condylar cartilage zones and the amount of bone deposition.(ABSTRACT TRUNCATED AT 250 WORDS)

125

Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey.

STUDY DESIGN: A population-based cross-sectional multiregion postal survey. OBJECTIVE: To provide a descriptive epidemiology of the prevalence and severity of back pain in German adults and to analyze sociodemographic correlates for disabling back pain within and across regions. SUMMARY OF BACKGROUND DATA: Back pain is a leading health problem in Germany. However, comprehensive population-based evidence on the severity of back pain is still fragmentary for this country. Despite earlier findings concerning large prevalence differences across regions, systematic explanations remain to be ascertained. METHODS: Questionnaire data were collected for 9263 subjects in 5 German cities and regions (population-based random samples, postal questionnaire). Point, 1-year, and lifetime prevalence were assessed using direct questions, and graded back pain was determined using the Graded Chronic Pain Scale. Poststratification was applied to adjust for cross-regional sociodemographic differences. RESULTS: Point-prevalence was 37.1%, 1-year prevalence 76.0%, and lifetime prevalence 85.5%. A substantial minority had severe (Grade II, 8.0%) or disabling back pain (Grade III-IV, 11.2%). Subjects with a low educational level reported substantially more disabling back pain. This variable was an important predictor for large cross-regional differences in the burden of back pain. CONCLUSION: Back pain is a highly prevalent condition in Germany. Disabling back pain in this country may be regarded as part of a social disadvantage syndrome. Educational level should receive greater attention in future cross-regional comparisons of back pain.

126

Bacterial membranes: the effects of chill storage and food processing. An overview

The shelf life of food is extended by refrigeration because the metabolic processes of food-associated microorganisms are slowed by the lowered temperature. Nonetheless, cold-adapted psychrotrophic food-poisoning and food-spoilage bacteria remain a concern because they possess cold-adapted proteins and membrane lipids that facilitate growth at low temperatures. The use of membrane-disrupting novel preservation techniques, such as ultrasound, high hydrostatic pressure or pulsed electric field, offer the potential for an extension of shelf life. This review considers the interacting and potentially synergistic effects of chill storage or mild heat treatment on membrane properties, with the disruptive effects of membrane-targeted physical treatments.

127

Baroreflex insensitivity and heart rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes after Myocardial Infarction) Investigators.

BACKGROUND: Experimental evidence suggests that autonomic markers such as heart-rate variability and baroreflex sensitivity (BRS) may contribute to postinfarction risk stratification. There are clinical data to support this concept for heart-rate variability. The main objective of the ATRAMI study was to provide prospective data on the additional and independent prognostic value for cardiac mortality of heart-rate variability and BRS in patients after myocardial infarction in whom left-ventricular ejection fraction (LVEF) and ventricular arrhythmias were known. METHODS: This multicentre international prospective study enrolled 1284 patients with a recent (<28 days) myocardial infarction. 24 h Holter recording was done to quantify heart-rate variability (measured as standard deviation of normal to normal RR intervals [SDNN]) and ventricular arrhythmias. BRS was calculated from measurement of the rate-pressure response to intravenous phenylephrine. FINDINGS: During 21 (SD 8) months of follow-up, the primary endpoint, cardiac mortality, included 44 cardiac deaths and five non-fatal cardiac arrests. Low values of either heart-rate variability (SDNN <70 ms) or BRS (<3.0 ms per mm Hg) carried a significant multivariate risk of cardiac mortality (3.2 [95% CI 1.42-7.36] and 2.8 [1.24-6.16], respectively). The association of low SDNN and BRS further increased risk; the 2-year mortality was 17% when both were below the cut-offs and 2% (p<0.0001) when both were well preserved (SDNN >105 ms, BRS >6.1 ms per mm Hg). The association of low SDNN or BRS with LVEF below 35% carried a relative risk of 6.7 (3.1-14.6) or 8.7 (4.3-17.6), respectively, compared with patients with LVEF above 35% and less compromised SDNN (> or = 70 ms) and BRS (> or = 3 ms per mm Hg). INTERPRETATION: ATRAMI provides clinical evidence that after myocardial infarction the analysis of vagal reflexes has significant prognostic value independently of LVEF and of ventricular arrhythmias and that it significantly adds to the prognostic value of heart-rate variability.

128

Basic concepts for nuclear magnetic resonance imaging

The basic concepts necessary to understand the physical basis of NMR imaging are presented in this didactic article. It is intended as a starting point for the radiologist or medical physicist who is addressing the topic of NMR for the first time. The basic of the NMR phenomena is described with introduction of the concepts of magnetic moment, magnetic fields, magnetic resonance, net magnetic moment of a sample, NMR excitation and NMR emission. The equipment necessary to observe these NMR properties of matter is summarized as well as the procedures for basic pulsed NMR experiments. The physical concepts for spatial localization of NMR emissions are introduced with physical analogies to stringed musical instruments. Several alternative imaging modalities are compared with greatest emphasis on the inversion recovery technique which yields images weighted by tissue T values. The six subsystems of an NMR imaging device (primary magnet, computer, radio equipment, magnetic gradient, data storage and display subsystems) are described in an overview fashion. The paper is followed by a series of study questions to test the reader's comprehension of basic NMR imaging concepts.

129

Behavioral effects of combined perinatal L-NAME and 0.5 Hz magnetic field treatments

The behavioral effects of the nitric oxide synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME), when perinatally (2 d prenatal-14 d postnatal) co-administered with extremely low frequency magnetic fields, were examined in weanling and adult rats. Litters of rat pups and their dams were exposed continuously to biphasic pulsed fields presented once every 2 s. The magnetic fields were amplitude modulated in successively increasing and decreasing steps (each 30 min) between 0 and 1.8 microT or between 0 to 13 nanoT (reference field) during 4-h periods (6 periods per day). These two treatments were subdivided into dams that received tap water and dams that received 1.0 g/L L-NAME in tap water. The behavioral sequelae to these treatments for 242 progeny from 41 litters were followed from weaning (1 wk after termination of treatment) into adulthood. Compared to exposures to water and nanoT magnetic fields, perinatal exposures to the microT magnetic fields or to L-NAME in the maternal water supply were associated with increased activity levels when the rats were tested as weanling, but decreased activity levels when the rats were tested as adults. However, the activity of rats that received the combination of L-NAME and microT magnetic fields did not differ significantly from the activity of the rats that had received water and the nanoT fields. Long-term (adulthood) effects of these perinatal treatments on associative learning, as inferred by learned fear to contextual stimuli, were not evident. These results indicate that L-NAME and this particular pattern of magnetic field antagonized one another when co-administered during the perinatal period.

130

Bench study of the accuracy of a commercial AED arrhythmia analysis algorithm in the presence of electromagnetic interferences

This paper presents a bench study on a commercial automated external defibrillator (AED). The objective was to evaluate the performance of the defibrillation advisory system and its robustness against electromagnetic interferences (EMI) with central frequencies of 16.7, 50 and 60 Hz. The shock advisory system uses two 50 and 60 Hz band-pass filters, an adaptive filter to identify and suppress 16.7 Hz interference, and a software technique for arrhythmia analysis based on morphology and frequency ECG parameters. The testing process includes noise-free ECG strips from the internationally recognized MIT-VFDB ECG database that were superimposed with simulated EMI artifacts and supplied to the shock advisory system embedded in a real AED. Measurements under special consideration of the allowed variation of EMI frequency (15.7-17.4, 47-52, 58-62 Hz) and amplitude (1 and 8 mV) were performed to optimize external validity. The accuracy was reported using the American Heart Association (AHA) recommendations for arrhythmia analysis performance. In the case of artifact-free signals, the AHA performance goals were exceeded for both sensitivity and specificity: 99% for ventricular fibrillation (VF), 98% for rapid ventricular tachycardia (VT), 90% for slow VT, 100% for normal sinus rhythm, 100% for asystole and 99% for other non-shockable rhythms. In the presence of EMI, the specificity for some non-shockable rhythms (NSR, N) may be affected in some specific cases of a low signal-to-noise ratio and extreme frequencies, leading to a drop in the specificity with no more than 7% point. The specificity for asystole and the sensitivity for VF and rapid VT in the presence of any kind of 16.7, 50 or 60 Hz EMI simulated artifact were shown to reach the equivalence of sensitivity required for non-noisy signals. In conclusion, we proved that the shock advisory system working in a real AED operates accurately according to the AHA recommendations without artifacts and in the presence of EMI. The results may be affected for specificity in the case of a low signal-to-noise ratio or in some extreme frequency setting.

131

Beneficial effects of electromagnetic fields

Selective control of cell function by applying specifically configured, weak, time-varying magnetic fields has added a new, exciting dimension to biology and medicine. Field parameters for therapeutic, pulsed electromagnetic field (PEMFs) were designed to induce voltages similar to those produced, normally, during dynamic mechanical deformation of connective tissues. As a result, a wide variety of challenging musculoskeletal disorders have been treated successfully over the past two decades. More than a quarter million patients with chronically ununited fractures have benefitted, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair. Many of the athermal bioresponses, at the cellular and subcellular levels, have been identified and found appropriate to correct or modify the pathologic processes for which PEMFs have been used. Not only is efficacy supported by these basic studies but by a number of double-blind trials. As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy.

132

Beyond k-space: spectral localization using higher order gradients

Chemical shift imaging (CSI) often suffers from the inconvenient shape of its spatial response function (SRF), which affects both localization and signal-to-noise ratio. Replacing the magnetic field gradients for phase encoding by higher order magnetic fields allows a better adjustment of the SRF to the structures in the sample. We combined this principle with the SLOOP (spectral localization with optimal pointspread function) technique to simultaneously obtain spectra from several arbitrarily shaped compartments within a sample. Linear combinations of the fields of the shim coils are used to generate the pulsed fields for phase encoding. Their shapes are matched to the given sample geometry by numerical optimization. Using this method, spectra from a phantom were obtained that show a higher signal-to-noise ratio and a strongly reduced contamination compared to an equivalent CSI experiment.

133

Bidirectional effect of electromagnetic fields on ketanserin-induced yawning in patients with multiple sclerosis: the role of melatonin

5-HT2 receptors regulate sleep including yawning behavior. Ritanserin, a selective 5-HT2A receptor antagonist, increases the duration of slow wave in rats and humans. This effect is more pronounced during the light period when melatonin plasma levels are low; melatonin inhibits the sleep effects of ritanserin. These findings indicate that melatonin co-determines the effects of ritanserin on sleep. In a cohort of multiple sclerosis (MS) patients ketanserin, a selective 5-HT2A receptor antagonist, induces recurrent yawning particularly when administered in daytime. The frequency of yawning induced by the drug was modified by AC pulsed picotesla flux electromagnetic fields (EMFs) which affect melatonin secretion. Two MS patients are presented in whom the frequency of ketanserin-induced yawning was altered in opposite directions by these EMFs. The first patient, a 50 year old woman with a remitting-relapsing course, developed recurrent yawning and sleepiness after administration of ketanserin (10 mg, PO). Yawning was decreased dramatically during application of EMFs but was unaffected by a placebo EMFs treatment. The second patient, a 35 year old man with a chronic progressive course, manifested a single and brief yawn after administration of an equal dose of ketanserin. Yawning was increased dramatically during application of EMFs while remaining unchanged during a placebo EMFs treatment. These observations demonstrate a bidirectional effect of picotesla flux EMFs on ketanserin-induced yawning which may be related to differences in daytime melatonin plasma levels among MS patients. If validated by estimations of melatonin plasma levels in a larger cohort of patients the information derived from the effects of picotesla EMFs on ketanserin-induced yawning could be used to: (a) assess pineal melatonin functions in patients with MS; (b) indicate differences in pineal functions between male and female MS patients; and (c) indicate a relationship between plasma melatonin levels and the fatigue of MS.

134

Binary black holes' effects on electromagnetic fields

In addition to producing gravitational waves, the dynamics of a binary black hole system could induce emission of electromagnetic radiation by affecting the behavior of plasmas and electromagnetic fields in their vicinity. We here study how the electromagnetic fields are affected by a pair of orbiting black holes through the merger. In particular, we show how the binary's dynamics induce a variability in possible electromagnetically induced emissions as well as a possible enhancement of electromagnetic fields during the late-merge and merger epochs. These time dependent features will likely leave their imprint in processes generating detectable emissions and can be exploited in the detection of electromagnetic counterparts of gravitational waves.

136

Biochemical study of human periodontal ligament: preparation of cell attachment materials induced by pulsed electromagnetic fields

The periodontium, especially the periodontal ligament and alveolar bone, are tissues constantly subjected to physical stress such as occlusion and mastication. This study was designed to explore the effect of the pulsed electromagnetic fields (PEMF) on the cell attachment and the spread of human periodontal ligament fibroblasts (HPLF) and rat osteoblasts (ROB). PEMF are categorized as one type of mechanical stress. HPLF were obtained by the explantation method described by Saito et al. They were then subcultured in Dulbecco's modified Eagle's medium (D-MEM) and supplemented with 2 mg/ml dialyzed fetal calf serum protein (FCSP), 50 micrograms/ml ascorbic acid and penicillin/streptomycin after trypsinization. ROB were isolated from a two-day-old rat calvaria by the sequential bacterial collagenase digestion method described by Dziak and Brand and were subcultured in D-MEM supplemented with FCSP, ascorbic acid and penicillin/streptomycin. After the confluent HPLF were cultured with serum-free MCDB 107 medium, the quiescent HPLF were exposed with or without PEMF for 24 hr. This was followed by the collection of the control conditioned medium (C-CM) and PEMF exposed conditioned medium (PEMF-CM). The cell attachment assay was performed so that the hydrophobic 24 multiwells were coated with the whole conditioned medium or fractionated conditioned medium by a PO-60K column. After coating, heat inactivated BSA blocked nonspecific sites for cell adhesion, and 3H-TdR labeled HPLF or ROB were cultured on the precoated wells. The activity of cell attachment and spreading was determined by the radioactivity of 3H-TdR using a scintillation counter. The characters of cell attachment factors derived from HPLF were hydrophobic, heat labile and proteolytic enzyme digestible. In addition, the fractionated PEMF-CM enhanced the spreading activity of ROB. PEMF induced the 10 KDa which can enhance the HPLF and ROB spreading. Therefore, the cell attachment and spreading factors secreted by HPLF exposed with PEMF may regulate HPLF and also ROB.

137

Bioelectric repair of metatarsal nonunions

An exciting new development in the field of bone physiology has been the discovery of electrical potentials in stressed bone and the relation of this knowledge to Wolff's law. The application of these discoveries for the treatment of nonunions by exogenous bioelectric potentials via direct current and pulsed electromagnetic fields has been a major development in orthopedic surgery. To date, the literature reports the use of this new treatment modality in the large long bones of the extremities. The authors have utilized these techniques to repair nonunions of the metatarsals and, in the process, have adapted some of the principles for the small bones of the foot.

138

Bioelectric stimulation and residual ridge resorption

The use of exogenous pulsed electromagnetic fields (PEMF) to stimulate the healing of nonunions and other long bone defects is common in medicine. This investigation used the dog model and image analysis of standardized radiographs to assess loss of residual ridge height following extractions. It demonstrates the effectiveness of intermittent PEMF to reduce the rate of residual ridge resorption. It further suggests there may be a causal relationship between residual ridge resorption and the alteration of endogenous bioelectric signals caused by the loss of teeth.

139

Bioelectrochemical oscillations in signal transduction and acupuncture--an emerging paradigm

Several converging points from recent research results on cellular signal transduction, pattern formation, bioelectromagnetism and acupuncture are reviewed. These converging points indicate the general importance of bioelectrochemical oscillations in morphogenesis and physiology: An organism is not only a system of molecules and cells, but also a system of oscillations. These oscillations precede the morphological changes in development or pathology. Converging discoveries and hypotheses in different fields, and a perspective on their potential application in biomedicine are also discussed in this article.

140

Bioelectromagnetics in morphogenesis

Massive review article on bioelectromagnetism as a guiding force in morphogenesis -- the organization of cells, organs, and organisms. at the level of biophysics of electromagnetic field interactions with molecular systems, electric fields exert forces on ions, while magnetic fields exert forces on magnetic particles and on moving ions. "It has been found that entire organisms are MOST sensitive to electromagnetic fields, isolated organs and cells LESS, and solutions of macromolecules are EVEN LESS sensitive. . . the appearance of enhanced sensitivity to electromagnetic fields only in fairly complexly organized biological systems can be regarded as one of the manifestations of the specific nature of life-- its organization."

141

Bioelectromagnetism--relative merits of electric and magnetic measurements in cardiac studies

This lecture gives a general overview to the relationship of bioelectric and biomagnetic phenomena: The most important issue in bioelectromagnetism is: Are the biomagnetic measurements independent on bioelectric ones and do they bring new information from the source or are they only a different modality of the same phenomenon? This issue is discussed with application on cardiac studies. The three orthogonal dipolar magnetic leads (vector magnetocardiography) are equal in the sense of diagnostic performance to the three dipolar electric leads (vector electrocardiography). Therefore the VMCG has quite the same diagnostic performance as the VECG. We have shown with a patient material of 313 subjects that when combining these methods to vector electromagnetocardiography, VEMCG, the number of incorrectly diagnosed patients may be decreased to one half. This is a statistically significant improvement in the diagnostic performance. We have also proven that our explanation for the Helmholtz's theorem is correct: What are fully independent are the lead fields of electric and magnetic measurements, not the signals. The dipolar electric and magnetic signals are similarly independent from each other as the three orthogonal dipolar electric signals are.

142

Biological dosimetry of magnetic resonance imaging

PURPOSE: To check the bioeffects of the components of magnetic resonance imaging (MRI). MRI is based on an assumed harmless interaction between certain nuclei in the body when placed in a strong magnetic field and radio wave fields. There are three key factors actuating on the examining body: a powerful static magnetic field (SMF), magnetic gradient fields (MGFs), and pulsed radiofrequency (RF) radiation. MATERIALS AND METHODS: In vitro cells (L-132 cells) were used as biosensors, and different cellular compounds were used as biomarkers (heat shock proteins [HSPs] and their messenger ribonucleic acids [mRNAs], calcium, and adenosine-3',5'-cyclic monophosphate [cAMP]). The biosensors were placed in the bore of a 1.5-T MRI machine and the different electromagnetic fields were operated. RESULTS: HSPs and their mRNAs and cAMP did not respond to SMF, MGFs, or RF radiation. RF radiation increased cytosolic calcium concentration (18%, P < 0.05). CONCLUSION: Although MRI procedures do not induce any cellular stress response, it may cause an unfathomable calcium increase in vitro. Although the in vitro experimental conditions are not totally comparable to clinical situations, the usefulness of the in vivo biological dosimetry, circulating leukocytes as biosensors, and HSPs and/or calcium as biomarkers is suggested.

143

Biological effects of high-frequency electromagnetic fields on Salmonella typhimurium and Drosophila melanogaster

Salmonella typhimurium and Drosophila melanogaster were exposed to continuous wave (CW) 2.45-GHz electromagnetic radiation, pulsed 3.10-GHz electromagnetic radiation, CW 27.12-MHz magnetic fields, or CW 27.12-MHz electric fields (only Drosophila). The temperatures of the treated sample and the nonexposed control sample were kept constant. The temperature difference between exposed and control samples was less than +/- 0.3 degrees C. Ames' assays were made on bacteria that had been exposed to microwaves (SAR 60-130 W/kg) or RF fields (SAR up to 20 W/kg) when growing exponentially in nutrient broth. Survival and number of induced revertants to histidine prototrophy were determined by common plating techniques on rich and minimal agar plates. The Drosophila test consisted of a sensitive somatic system where the mutagenicity was measured by means of mutations in a gene-controlling eye pigmentation. In none of these test systems did microwave or radiofrequency fields induce an elevated mutation frequency. However, a significantly higher concentration of cells was found in the bacterial cultures exposed to the 27-MHz magnetic field or 2.45-GHz CW and 3.10-GHz pulsed microwave radiation.

144

Biological effects of magnetic fields: chronic exposure of the nematode Panagrellus redivivus

The Panagrellus redivivus bioassay, an established monitor of adverse toxic effects of different environments, has been used to study the biological effects of exposure to static and time-varying uniform and gradient magnetic fields, and to time-varying magnetic field gradients superimposed on a static uniform magnetic field of 2.35 Tesla. Temporally stationary magnetic fields have no effect on the fitness of the test animals. Time-varying magnetic fields cause some inhibition of growth and maturation in the test populations. The combination of pulsed magnetic field gradients in a static uniform magnetic field also has a small detrimental effect on the fitness of the test animals.

145

Biological effects of magnetic fields: studies with microorganisms

Five bacteria and one yeast were grown in magnetic fields of 50-900 gauss with frequencies of 0-0.3 HZ and square, triangular, or sine waveform. Growth of these microorganisms could be stimulated or inhibited depending upon the field strength and frequency of the pulsed magnetic field. Spore germination and mutation frequency were unaffected by the magnetic fields used in this study.

146

Biological effects on the cellular level of electric field pulses

Analysis of electric and magnetic fields in the human body generated upon exposure to external pulsed electric fields are used to consider possible biological effects at the cellular level. For peak external field strengths as high as 100 kV m-1, the effects of the consequent internal electric fields on sensitive cell elements, such as the membranes, organelles, and the macromolecules that carry genetic information, are shown to be small compared with the normal thermal agitation of the elements. Hence, based on the description of the cell and the analysis presented here, such pulses cannot be expected to produce any biological effects at the cellular level.

148

Biomaterial osseointegration enhancement with biophysical stimulation

Despite the ongoing improvement in implant characteristics, bone intrinsic potential for regeneration may be stimulated with adjuvant therapies to standard surgical procedures, as it is important to achieve the best possible implant osseointegration into the adjacent bone and to ensure therefore long-term implant stability. For this purpose various pharmacological, biological or biophysical modalities have been developed, such as bone grafting materials, pharmacological agents, growth factors and bone morphogenetic proteins. Biophysical stimulation of osseointegration includes two non-invasive and safe methods that have been initially developed to enhance fracture healing: pulsed electromagnetic fields (PEMFs) and lowintensity ultrasounds (LIPUS), for which most studies confirm their beneficial effects. The present paper is an overview of bone-implant osseointegration and the current trends on its enhancement, focusing mainly on the two methods of biophysical stimulation.

149

Biomimetic PMMA-based bone substitutes: a comparative in vitro evaluation of the effects of pulsed electromagnetic field exposure

Pulsed electromagnetic fields (PEMFs) are known to be effective in the stimulation of cultured osteoblasts and in vivo healing of delayed and nonunion fractures. In the present in vitro study the effects of PEMFs on osteoblastic cell cultures (MG63 human osteoblast-like cells) grown in the presence of poly-methylmethacrylate (PMMA) and of a biomimetic bone substitute made of a PMMA matrix added with alfa-tricalcium phosphate (PMMA+alpha-TCP) were evaluated, to assess the biological response at the cell-biomaterial interaction. Cultures were stimulated with PEMFs (75 Hz, 2.3 mT, 1.3-ms pulse duration) 12 h/day for 3 days and evaluations (MTT, ALP, OC, PICP, TGFbeta-1, IL-6) were performed at 3 and 6 days. PMMA had a negative effect on osteoblasts, whereas PMMA+alpha-TCP enhanced production of ALP, PICP, OC and TGFbeta-1, and reduced IL-6 levels. Cells responded positively to PEMF stimulation even when cultured with a poorly biocompatible material, such as PMMA. This effect was more evident in the presence of PMMA+alpha-TCP (further improvement in proliferation and synthetic activity) both at 3 and at 6 days. The properties of PMMA+alpha-TCP look promising, and the present results support the use of PEMFs to improve tissue response to biomaterials implanted as bone substitutes.

150

Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head

BACKGROUND: Osteonecrosis of the femoral head is the end point of a disease process that results in bone necrosis, joint edema, and cartilage damage. It leads to joint arthritis that necessitates total hip arthroplasty in many patients. Because of its positive effects on osteogenesis and its chondroprotective effect of articular cartilage, pulsed electromagnetic field stimulation has been proposed as a method to prevent or delay the progression of osteonecrosis. METHODS: A retrospective analysis of the results of treatment with pulsed electromagnetic field stimulation of seventy-six hips in sixty-six patients with osteonecrosis of the femoral head was performed. Patients with Ficat stage I, II, or III osteonecrosis of the femoral head were treated with pulsed electromagnetic field stimulation for eight hours per day for an average of five months. Clinical and diagnostic imaging information was collected at the start of the treatment and at the time of follow-up. The primary end point analyzed was the avoidance of hip surgery, and the secondary end point was limiting the radiographic progression (according to Ficat stage) of osteonecrosis of the femoral head. RESULTS: Fifteen hips required a total hip arthroplasty; twelve of these hips were in patients with Ficat stage-III disease. The need for total hip arthroplasty was significantly higher in patients with Ficat stage-III disease than in patients with Ficat stage-I (p < 0.0001) or II (p < 0.01) disease at the beginning of treatment. Pulsed electromagnetic fields preserved 94% of Ficat stage-I or II hips. Furthermore, radiographic progression (according to Ficat stage) occurred in twenty hips (26%). Pain, present in all patients at the start of the treatment, disappeared after sixty days of stimulation in thirty-five patients (53%) and was of moderate intensity in seventeen patients (26%). CONCLUSIONS: The results of this study confirm that pulsed electromagnetic field treatment may be indicated in the early stages of osteonecrosis of the femoral head (Ficat stages I and II). Pulsed electromagnetic field stimulation may be able to either preserve the hip or delay the time until surgery. The authors hypothesize that the short-term effect of pulsed electromagnetic field stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of pulsed electromagnetic field stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

151

Body Conformal Antennas for Superficial Hyperthermia: The Impact of Bending Contact Flexible Microstrip Applicators on Their Electromagnetic Behavior

Hyperthermia is a powerful radiosensitizer for treatment of superficial tumors. This requires body conformal antennas with a power distribution as homogeneous as possible over the skin area. The contact flexible microstrip applicators (CFMA) operating at 434 MHz exist in several sizes, including the large size 3H and 5H. This paper investigates the behaviour of the electromagnetic fields for the 3H and 5H CFMA in both flat and curved configurations, and the impact on performance parameters like the penetration depth (PD) and the effective heating depth (EHD). The underlying theory behind the electromagnetic behavior in curved situations is presented as well as numerical simulations of both flat and curved configurations. The results are compared to measurements of the electromagnetic field distributions in a cylindrical patient model. Due to their large size multimode solutions may exist, and our results confirm their existence. These multimode solutions affect both the power distribution and PD/EHD, with a dependence on applicator curvature. Therefore, performance parameters like PD and EHD need to be carefully assessed when bending large size CFMA applicators to conform the patient body. This conclusion also holds for other types of large size surface current applicators.

152

Bone density changes in osteoporosis-prone women exposed to pulsed electromagnetic fields (PEMFs)

To determine the effect of a 72 Hz pulsating electromagnetic field (PEMF) on bone density of the radii of osteoporosis-prone women, the nondominant forearms of 20 subjects were exposed to PEMF 10 h daily for a period of 12 weeks. Bone density before, during, and after the exposure period was determined by use of a Norland-Cameron bone mineral analyzer. Bone mineral densities of the treated radii measured by single-photon densitometry increased significantly in the immediate area of the field during the exposure period and decreased during the following 36 weeks. A similar but weaker response occurred in the opposite arm, suggesting a "cross-talk" effect on the nontreated radii, from either possible arm proximity during sleep or very weak general field effects. The data suggest that properly applied PEMFs, if scaled for whole-body use, may have clinical application in the prevention and treatment of osteoporosis.

153

Bone growth and remodeling after distraction epiphysiolysis of the proximal tibia of the rabbit. Effect of electromagnetic stimulation

The effect of pulsed electromagnetic stimulation on bone formation was tested in a lower-limb-lengthening model in the rabbit. Limb lengthening was performed by distraction epiphysiolysis. A specially designed external distraction device allowed 10 mm of lengthening of the tibia. Coils to generate a pulsed electromagnetic field were clipped onto the distractor. Stimulation started after a distraction period of three weeks and was continuous for 18 weeks. A control group received the same treatment without stimulation. Bone formation in the elongated zone was evaluated by computed tomography, scintigraphy, and histology. Bone healing involved accretion of callus followed by a process of remodeling, resulting in the formation of a solid cortex. The formation of a diaphysislike structure at the original site of the metaphysis progressed from the distal end of the elongated zone upward. Electromagnetic stimulation had no effect on the rate or extent of bone formation and remodeling.

154

Bone mass is preserved in a critical-sized osteotomy by low energy pulsed electromagnetic fields as quantitated by in vivo micro-computed tomography

The effectiveness of non-invasive pulsed electromagnetic fields (PEMF) on stimulating bone formation in vivo to augment fracture healing is still controversial, largely because of technical ambiguities in data interpretation within several previous studies. To address this uncertainty, we implemented a rigorously controlled, blinded protocol using a bilateral, mid-diaphyseal fibular osteotomy model in aged rats that achieved a non-union status within 3-4 weeks post-surgery. Bilateral osteotomies allowed delivery of a PEMF treatment protocol on one hind limb, with the contralateral limb representing a within-animal sham-treatment. Bone volumes in both PEMF-treated and sham-treated fibulae were assessed simultaneously in vivo using highly sensitive, high-resolution micro-computed tomography (microCT) over the course of treatment. We found a significant reduction in the amount of time-dependent bone volume loss in PEMF-treated, distal fibular segments as compared to their contralateral sham-treated bones. Osteotomy gap size was significantly smaller in hind limbs exposed to PEMF over sham-treatment. Therefore, our data demonstrate measurable biological consequences of PEMF exposure on in vivo bone tissue.

155

Brief communication: electromagnetic fields improve visuospatial performance and reverse agraphia in a parkinsonian patient

A 73 year old right-handed man, diagnosed with Parkinson's disease (PD) in 1982, presented with chief complaints of disabling resting and postural tremors in the right hand, generalized bradykinesia and rigidity, difficulties with the initiation of gait, freezing of gait, and mild dementia despite being fully medicated. On neuropsychological testing the Bicycle Drawing Test showed cognitive impairment compatible with bitemporal and frontal lobe dysfunction and on attempts to sign his name he exhibited agraphia. After receiving two successive treatments, each of 20 minutes duration, with AC pulsed electromagnetic fields (EMFs) of 7.5 picotesla intensity and 5 Hz frequency sinusoidal wave, his drawing to command showed improvement in visuospatial performance and his signature became legible. One week later, after receiving two additional successive treatments with these EMFs each of 20 minutes duration with a 7 Hz frequency sinusoidal wave, he drew a much larger, detailed and visuospatially organized bicycle and his signature had normalized. Simultaneously, there was marked improvement in Parkinsonian motor symptoms with almost complete resolution of the tremors, start hesitation and freezing of gait. This case demonstrates the dramatic beneficial effects of AC pulsed picotesla EMFs on neurocognitive processes subserved by the temporal and frontal lobes in Parkinsonism and suggest that the dementia of Parkinsonism may be partly reversible.

156

Broadband electromagnetic cloaking of long cylindrical objects

Electromagnetic cloaks are devices that make objects undetectable for probing with electromagnetic waves. The known realizations of transformational-optics cloaks require materials with exotic electromagnetic properties and offer only limited performance in narrow frequency bands. Here, we demonstrate a wideband and low-loss cloak whose operation is not based on the use of exotic electromagnetic materials, which are inevitably dispersive and lossy. Instead, we use a simple structure made of metal layers. In this Letter, we present an experimental demonstration of cloaking for microwaves and simulation results for cloaking in the visible range.

157

Calcium homeostasis of isolated heart muscle cells exposed to pulsed high-frequency electromagnetic fields

The intracellular calcium concentration ([Ca(2+)]i) of isolated ventricular cardiac myocytes of the guinea pig was measured during the application of pulsed high-frequency electromagnetic fields. The high-frequency fields were applied in a transverse electromagnetic cell designed to allow microscopic observation of the myocytes during the presence of the high-frequency fields. The [Ca(2+)]i was measured as fura-2 fluorescence by means of digital image analysis. Both the carrier frequency and the square-wave pulse-modulation pattern were varied during the experiments (carrier frequencies: 900, 1,300, and 1,800 MHz pulse modulated at 217Hz with 14 percent duty cycle; pulsation pattern at 900 MHz: continuous wave, 16 Hz, and 50 Hz modulation with 50 percent duty cycle and 30 kHz modulation with 80 percent duty cycle). The mean specific absorption rate (SAR) values in the solution were within one order of magnitude of 1 mW/kg. They varied depending on the applied carrier frequency and pulse pattern. The experiments were designed in three phases: 500 s of sham exposure, followed by 500 s of field exposure, then chemical stimulation without field. The chemical stimulation (K+ -depolarization) indicated the viability of the cells. The K+ depolarization yielded a significant increase in [Ca(2+)]i. Significant differences between sham exposure and high-frequency field exposure were not found except when a very small but statistically significant difference was detected in the case of 900 MHz/50 Hz. However, this small difference was not regarded as a relevant effect of the exposure.

158

Calcium incorporation in cultured chondroblasts perturbed by an electromagnetic field

We tested the hypothesis that electric perturbation influences 45Ca incorporation in extracellular matrix (ECM) of cartilage in vitro. Hypertrophic chondroblasts of tibial epiphyses (HC), sternum (SC), and skin fibroblasts (F) were cultured from chick embryos. HC, SC, and F cells were micromass seeded three times per week and maintained at 37.5 degrees C with 5% CO2 for two weeks. Cultures were randomly designated control (C) or exposed (E) to a pulsed electromagnetic field (PEMF). A time course experiment of calcium incorporation for all cultured groups showed that 24 h of exposure produced the largest biological response in chondroblasts. Calcium incorporation required supplemental phosphate. Autoradiography data indicated that the calcium incorporation into macromolecules largely occurred in the ECM. 45Ca steady-state perturbation was enhanced by Streptomyces hyaluronidase (SH) but not by testicular hyaluronidase (TH). 45Ca incorporation experiments tested the effects of phosphate, SH, TH, and PEMF alone and in various combinations on these cultures. Only PEMF or SH plus PEMF with phosphate enhanced 45Ca incorporation. Other experiments examined the effect of rotenone or freeze-thawing on cells exposed to PEMF. PEMF plus freeze-thaw enhanced calcium incorporation in HC only. PEMF appeared to cause disruption of the ECM, enhancing the probability of matrix calcification.

159

Calculation of electric fields induced in the human knee by a coil applicator

Calculations are presented of the induced electric fields and current densities in the cartilage of the knee produced by a coil applicator developed for applying pulsed magnetic fields to osteoarthritic knees. This applicator produces a sawtooth-like magnetic field waveform composed of a series of 260-micros pulses with a peak to peak magnitude of approximately 0.12 mT in the cartilage region. The simulations were performed using a recently developed 3 dimensional finite difference frequency domain technique for solving Maxwell's equations with an equivalent circuit model. The tissue model was obtained from the anatomically segmented human body model of Gandhi. The temporal peak electric field magnitude was found to be -153 mV/m, averaged within the medial cartilage of the knee for the typical dB/dt excitation levels of this coil. The technique can be extended to analyze other excitation waveforms and applicator designs.

161

Can electromagnetic fields emitted by mobile phones stimulate the vestibular organ?

OBJECTIVES: Pulsating electromagnetic (EM) radiation emitted by mobile phones is often incriminated for causing tissue alterations by caloric effects. In particular, the eye and the ear were regarded as possible "hot spots," with heating up to 1 degree C, in which EM radiation might have negative effects. If so, these temperature increments should be large enough to cause vestibular excitation. In this study, we attempted to verify this theory by clinical testing and in vitro experiments. METHODS AND MEASURES: In our laboratory, a simulated GSM signal (889.6 MHz/2.2 W) was applied to 1 ear at a time, while video nystagmography was performed. The experimental setup was similar to that used for caloric (hot and cold water) testing of the peripheral vestibular organ. Data were evaluated by a computer system. There were 13 volunteers (26 ears) included in our study. In an additional experiment, temperatures of human temporal bones were measured by thermography, while a continuous or pulsating EM field was applied. RESULTS: In no volunteer could EM radiation-induced nystagmus be recorded. This corresponds well to our findings that in the human temporal bone very weak caloric effects could only be found in the tissue layers next to the radiation source (antenna of the mobile phone), whereas deeper regions (horizontal semicircular canal) seemed unaffected (at least less than 0.1 degree C). CLINICAL SIGNIFICANCE: These results do not support the theory that mobile phone-induced EM radiation may cause caloric negative effects in the human ear.

162

Can mobile phone emissions affect auditory functions of cochlea or brain stem?

PROBLEMS ADDRESSED: Despite their abundant spread, mobile phones are suspected by a major share of the population to cause adverse effects on health and welfare. The ear as the sense organ next to the individual device has rarely been investigated for short-term effects in this regard. In a previous article, we could not prove any impact on the vestibular part of the inner ear. Our present examinations are concerned with the question whether mobile phone emissions could affect cochlear or auditory brain stem functions. METHODS AND MEASURES: In 12 healthy test persons with normal hearing, auditory brain stem reflexes recordings were performed before, during, and after exposure to electromagnetic emissions by standardized mobile phone devices. Two modes of electromagnetic emissions fields were administered: pulsed and continuous. For acoustic stimulation simultaneous to field exposure, special "plug-in" earphones had to be used. RESULTS: No impact on auditory brain stem reflexes recordings in terms of absolute and interpeak latencies could be found. CLINICAL SIGNIFICANCE: Together with the results of a previous article concerned with the vestibular part of the inner ear, we can state that there are no adverse effects of mobile phone emissions on the ear function, at least on a short-term range. Of course, any long-term effects cannot be excluded by our study.

164

Capacitively coupled electric fields accelerate proliferation of osteoblast-like primary cells and increase bone extracellular matrix formation in vitro

Over the last few years, electric and electromagnetic fields have gained more and more significance in the therapy of bone fracture healing and bone disease. Yet, the underlying mechanisms on a cellular and molecular level are not completely understood. In the present study we have investigated the effects of capacitively coupled, pulsed electric fields on cellular proliferation, alkaline phosphatase activity, and matrix protein synthesis of osteoblast-like primary cells in vitro. Cells were derived from bovine periosteum and electrically stimulated by saw-tooth pulses of 100 V external voltage and 16 Hz frequency. This corresponds to an electric field of 6 kV/m across the cell membranes as could be shown by computer simulation. Field application caused acceleration of cell culture development. A significant increase of proliferation concurrent with an enhancement of alkaline phosphatase activity was observed in sub-confluent cultures. Exposure of confluent osteoblast-like primary cells to electric fields resulted in enhanced synthesis and secretion of extracellular matrix-related proteins. These findings suggest that capacitively coupled electric fields accelerate bone cell proliferation and differentiation in vitro and enhance the synthesis of cells leading to promoted matrix formation and maturation.

165

Carboxylate binding in copper histidine complexes in solution and in zeolite Y: X- and W-band pulsed EPR/ENDOR combined with DFT calculations

The complexes of copper with histidine exhibit a wide variety of coordination modes in aqueous solution. This stems from the three potential coordination sites of the histidine molecule and the existence of mono- and bis-complexes. The present work concentrates on the determination of the carboxylate binding mode, via the (13)C hyperfine coupling of the carboxyl, in a number of copper complexes in frozen solutions. These are then used as references for the determination of the coordination mode of two zeolite encapsulated complexes. The (13)C hyperfine coupling (sign and magnitude) was determined by a variety of advanced pulsed EPR and electron-nuclear double resonance (ENDOR) techniques carried out at conventional and high magnetic fields. These showed that while the carboxyl (13)C isotropic hyperfine coupling of an equatorially coordinated carboxylate is negative with a magnitude of 3-4 MHz, that of a free carboxylate is small ( approximately 1 MHz) and positive. To rationalize the experimentally determined ligand hyperfine couplings ((1)H and (13)C) and further understand their dependence on the coordination mode and degree of protonation, density functional theory (DFT) calculations were carried out on a number of model complexes, representing the different Cu-histidine complexes studied experimentally. The exchange-correlation functional used for the calculation of the EPR parameters was B3LYP with triple-zeta plus polarization (TZP) quality basis sets. While the polarization agreement between the magnitudes of the calculated and experimental values varied among the various nuclei, sometimes exhibiting deviations of up to 40%, an excellent agreement was found for the sign prediction. This shows the unique advantage of combining high field ENDOR, by which the sign of the hyperfine can often be determined, with DFT predictions for structure determination.

166

Carcinogenicity study of 217 Hz pulsed 900 MHz electromagnetic fields in Pim1 transgenic mice

In an 18-month carcinogenicity study, Pim1 transgenic mice were exposed to pulsed 900 MHz (pulse width: 0.577 ms; pulse repetition rate: 217 Hz) radiofrequency (RF) radiation at a whole-body specific absorption rate (SAR) of 0.5, 1.4 or 4.0 W/kg [uncertainty (k = 2): 2.6 dB; lifetime variation (k = 1): 1.2 dB]. A total of 500 mice, 50 per sex per group, were exposed, sham-exposed or used as cage controls. The experiment was an extension of a previously published study in female Pim1 transgenic mice conducted by Repacholi et al. (Radiat. Res. 147, 631-640, 1997) that reported a significant increase in lymphomas after exposure to the same 900 MHz RF signal. Animals were exposed for 1 h/day, 7 days/week in plastic tubes similar to those used in inhalation studies to obtain well-defined uniform exposure. The study was conducted blind. The highest exposure level (4 W/kg) used in this study resulted in organ-averaged SARs that are above the peak spatial SAR limits allowed by the ICNIRP (International Commission on Non-ionizing Radiation Protection) standard for environmental exposures. The whole-body average was about three times greater than the highest average SAR reported in the earlier study by Repacholi et al. The results of this study do not suggest any effect of 217 Hz-pulsed RF-radiation exposure (pulse width: 0.577 ms) on the incidence of tumors at any site, and thus the findings of Repacholi et al. were not confirmed. Overall, the study shows no effect of RF radiation under the conditions used on the incidence of any neoplastic or non-neoplastic lesion, and thus the study does not provide evidence that RF radiation possesses carcinogenic potential.

168

Cartilage repair with osteochondral autografts in sheep: effect of biophysical stimulation with pulsed electromagnetic fields

The effect of pulsed electromagnetic fields (PEMFs) on the integration of osteochondral autografts was evaluated in sheep. After osteochondral grafts were performed, the animals were treated with PEMFs for 6 h/day or sham-treated. Six animals were sacrificed at 1 month. Fourteen animals were treated for 2 months and sacrificed at 6 months. At 1 month, the osteogenic activity at the transplant-host subchondral bone interface was increased in PEMF-treated animals compared to controls. Articular cartilage was healthy in controls and stimulated animals. At 6 months, complete resorption was observed in four control grafts only. Cyst-like resorption areas were more frequent within the graft of sham-treated animals versus PEMF-treated. The average volume of the cysts was not significantly different between the two groups; nevertheless, analysis of the variance of the volumes demonstrated a significant difference. The histological score showed no significant differences between controls and stimulated animals, but the percentage of surface covered by fibrous tissue was higher in the control group than in the stimulated one. Interleukin-1 and tumor necrosis factor-alpha concentration in the synovial fluid was significantly lower, and transforming growth factor-beta1 was significantly higher, in PEMF-treated animals compared to controls. One month after osteochondral graft implantation, we observed larger bone formation in PEMF-treated grafts which favors early graft stabilization. In the long term, PEMF exposure limited the bone resorption in subchondral bone; furthermore, the cytokine profile in the synovial fluid was indicative of a more favorable articular environment for the graft.

169

Case Study: Amyotrophic Lateral Sclerosis

This is a case report of the 42-year-old man afflicted with amyotrophic lateral sclerosis. the treatment was carried out in Italy. Variable Waveforms were used with frequencies between one and two Hz and an AC intensity equal to 10% of the Earth's magnetic field. The was treated with cyclotron ionic resonance therapy at home twice daily for a period of two months. as a result of magnetic field therapy, a slow gradual recovery was seen in the mobility of neck and shoulders, and at one month, a recovery of finger movements in both legs and an extension. The patient had been dependent upon a ventilator. Within a few days of initiating treatment, he could be removed from the ventilator and was able to breathe unassisted for 30-40 minutes at a time. Given that this is an isolated case report, the authors are unable to extrapolate these results to other members of the patient community afflicted with a matter of the lateral sclerosis.

170

Cell type specific redox status is responsible for diverse electromagnetic field effects.

Epidemiologic and experimental research on the potential carcinogenic effects of extremely low frequency electromagnetic fields (ELF-EMF) has been performed for a long time. Epidemiologic studies regarding ELF-EMF-exposure have focused primarily on leukaemia development due to residential sources in children and adults, and from occupational exposure in adults, but also on other kinds of cancer. Genotoxic investigations of EMF have shown contradictory results, a biological mechanism is still lacking that can explain the link between cancer development and ELF-EMF-exposure. Recent laboratory research has attempted to show general biological effects, and such that could be related to cancer development and/or promotion. Metabolic processes which generate oxidants and antioxidants can be influenced by environmental factors, such as ELF-EMF. Increased ELF-EMF exposure can modify the activity of the organism by reactive oxygen species leading to oxidative stress. It is well established that free radicals can interact with DNA resulting in single strand breaks. DNA damage could become a site of mutation, a key step to carcinogenesis. Furthermore, different cell types react differently to the same stimulus, because of their cell type specific redox status. The modulation of cellular redox balance by the enhancement of oxidative intermediates, or the inhibition or reduction of antioxidants, is discussed in this review. An additional aspect of free radicals is their function to influence other illnesses such as Parkinson's and Alzheimer's diseases. On the other hand, modulation of antioxidants by ELF-EMF can lower the intracellular defence activity promoting the development of DNA damage. It has also been demonstrated that low levels of reactive oxygen species trigger intracellular signals that involve the transcription of genes and leading to responses including cell proliferation and apoptosis. In this review, a general overview is given about oxidative stress, as well as experimental studies are reviewed as they are related to changes in oxidant and antioxidant content after ELF-EMF exposure inducing different biological effects. Finally, we conclude from our review that modulations on the oxidant and antioxidant level through ELF-EMF exposure can play a causal role in cancer development.

171

Cellular effects of extremely low frequency (ELF) electromagnetic fields

PURPOSE: The major areas of research that have characterised investigation of the impact of extremely low frequency (ELF) electromagnetic fields on living systems in the past 50 years are discussed. In particular, selected studies examining the role of these fields in cancer, their effects on immune and nerve cells, and the positive influence of these ELF fields on bone and nerve cells, wound healing and ischemia/reperfusion injury are explored. CONCLUSIONS: The literature indicates that there is still no general agreement on the exact biological detrimental effects of ELF fields, on the physical mechanisms that may be behind these effects or on the extent to which these effects may be harmful to humans. Nonetheless, the majority of the in vitro experimental results indicate that ELF fields induce numerous types of changes in cells. Whether or not the perturbations observed at the cellular level can be directly extrapolated to negative effects in humans is still unknown. However, the myriad of effects that ELF fields have on biological systems should not be ignored when evaluating risk to humans from these fields and, consequently, in passing appropriate legislation to safeguard both the general public and professionally-exposed workers. With regard to the positive effects of these fields, the possibility of testing further their efficacy in therapeutic protocols should also not be overlooked.

172

Cellular level loading and heating of superparamagnetic iron oxide nanoparticles

Superparamagnetic iron oxide nanoparticles (NPs) hold promise for a variety of biomedical applications due to their properties of visualization using magnetic resonance imaging (MRI), heating with radio frequency (rf), and movement in an external magnetic field. In this study, the cellular loading (uptake) mechanism of dextran- and surfactant-coated iron oxide NPs by malignant prostate tumor cells (LNCaP-Pro5) has been studied, and the feasibility of traditional rf treatment and a new laser heating method was evaluated. The kinetics of cell loading was quantified using magnetophoresis and a colorimetric assay. The results showed that loading of surfactant-coated iron oxide NPs with LNCaP-Pro5 was saturable with time (at 24 h) and extracellular concentration (11 pg Fe/cell at 0.5 mg Fe/mL), indicating that the particles are taken up by an "adsorptive endocytosis" pathway. Dextran-coated NPs, however, were taken up less efficiently (1 pg Fe/cell at 0.5 mg Fe/mL). Loading did not saturate with concentration suggesting uptake by fluid-phase endocytosis. Magnetophoresis suggests that NP-loaded cells can be held using external magnetic fields in microcirculatory flow velocities in vivo or in an appropriately designed extracorporeal circuit. Loaded cells were heated using traditional rf (260A, 357 kHz) and a new laser method (532 nm, 7 ns pulse duration, 0.03 J/pulse, 20 pulse/s). Iron oxide in water was found to absorb sufficiently strongly at 532 nm such that heating of individual NPs and thus loaded cells (1 pg Fe/cell) was effective (<10% cell survival) after 30 s of laser exposure. Radio frequency treatment required higher loading (>10 pg Fe/cell) and longer duration (30 min) when compared to laser to accomplish cell destruction (50% viability at 10 pg Fe/cell). Scaling calculations show that the pulsed laser method can lead to single-cell (loaded with NPs) treatments (200 degrees C temperature change at the surface of an individual NP) unlike traditional rf heating methods which can be used only for bulk tissue level treatments. In a mixture of normal and NP-loaded malignant tumor cells, the malignant cells were selectively destroyed after laser exposure leaving the unloaded normal cells intact. These studies hold promise for applications in cell purification and sorting and extracorporeal blood treatments in vitro.

173

Cellular phone interference testing of implantable cardiac defibrillators in vitro

An in vitro study was undertaken to investigate the potential for cellular telephones to interfere with representative models of presently used ICDs. Digital cellular phones (DCPs) generate strong, amplitude modulated fields with pulse repetition rates near the physiological range sensed by the ICD as an arrhythmia. DCPs with Time Division Multiple Access (TDMA) pulsed amplitude modulation caused the most pronounced effect--high voltage firing or inhibition of pacing output of the ICDs. This electromagnetic interference (EMI) occurred only when the phones were within 2.3-5.8 cm of the ICD pulse generator that was submerged 0.5 cm in 0.18% saline. ICD performance always reverted to baseline when the cellular phones were removed from the immediate proximity of the ICD. Three models of ICDs were subjected to EMI susceptibility testing using two types of digital phones and one analog cellular phone, each operating at their respective maximum output power. EMI was observed in varying degrees from all DCPs. Inhibition of pacer output occurred in one ICD, and high voltage firing occurred in the two other ICDs, when a TDMA-11 Hz DCP was placed within 2.3 cm of the ICD. For the ICD that was most sensitive to delivering unintended therapy, inhibition followed by firing occurred at distances up to 5.8 cm. When a TDMA-50 Hz phone was placed at the minimum test distance of 2.3 cm, inhibition followed by firing was observed in one of the ICDs. EMI occurred most frequently when the lower portion of the monopole antenna of the cellular phone was placed over the ICD header.

174

Cerebrospinal fluid flow in the normal and hydrocephalic human brain

Advances in magnetic resonance (MR) imaging techniques enable the accurate measurements of cerebrospinal fluid (CSF) flow in the human brain. In addition, image reconstruction tools facilitate the collection of patient-specific brain geometry data such as the exact dimensions of the ventricular and subarachnoidal spaces (SAS) as well as the computer-aided reconstruction of the CSF-filled spaces. The solution of the conservation of CSF mass and momentum balances over a finite computational mesh obtained from the MR images predict the patients' CSF flow and pressure field. Advanced image reconstruction tools used in conjunction with first principles of fluid mechanics allow an accurate verification of the CSF flow patters for individual patients. This paper presents a detailed analysis of pulsatile CSF flow and pressure dynamics in a normal and hydrocephalic patient. Experimental CSF flow measurements and computational results of flow and pressure fields in the ventricular system, the SAS and brain parenchyma are presented. The pulsating CSF motion is explored in normal and pathological conditions of communicating hydrocephalus. This paper predicts small transmantle pressure differences between lateral ventricles and SASs (approximately 10 Pa). The transmantle pressure between ventricles and SAS remains small even in the hydrocephalic patient (approximately 30 Pa), but the ICP pulsatility increases by a factor of four. The computational fluid dynamics (CFD) results of the predicted CSF flow velocities are in good agreement with Cine MRI measurements. Differences between the predicted and observed CSF flow velocities in the prepontine area point towards complex brain-CSF interactions. The paper presents the complete computational model to predict the pulsatile CSF flow in the cranial cavity.

175

Changes in polyamines, c-myc and c-fos gene expression in osteoblast-like cells exposed to pulsed electromagnetic fields

Pulsed electromagnetic field (PEMF) stimulation promotes the healing of fractures in humans, though its effect is little known. The processes of tissue repair include protein synthesis and cell differentiation. The polyamines (PA) are compounds playing a relevant role in both protein synthesis processes and cell differentiation through c-myc and c-fos gene activation. Since several studies have demonstrated that PEMF acts on embryonic bone cells, human osteoblast-like cells and osteosarcoma TE-85 cell line, in this study we analyzed the effect on cell PAs, proliferation, and c-myc and c-fos gene expression of MG-63 human osteoblast-like cell cultures exposed to a clinically useful PEMF. The cells were grown in medium with 0.5 or 10% fetal calf serum (FCS). c-myc and c-fos gene expressions were determined by RT-PCR. Putrescine (PUT), spermidine (SPD), or spermine (SPM) levels were evaluated by HPLC. [(3)H]-thymidine was added to cultures for DNA analysis. The PEMF increased [(3)H]-thymidine incorporation (P < or = .01), while PUT decreased after treatment (P < or = .01); SPM and SPD were not significantly affected. c-myc was activated after 1 h and downregulated thereafter, while c-fos mRNA levels increased after 0.5 h and then decreased. PUT, SPD, SPM trends, and [(3)H]-thymidine incorporation were significantly related to PEMF treatment. These results indicate that exposure to PEMF exerts biological effects on the intracellular PUT of MG-63 cells and DNA synthesis, influencing the genes encoding c-myc and c-fos gene expression. These observations provide evidence that in vitro PEMF affects the mechanisms involved in cell proliferation and differentiation.

176

Changes in synaptic efficacy and seizure susceptibility in rat brain slices following extremely low-frequency electromagnetic field exposure

The effects of electromagnetic fields (EMFs) on living organisms are recently a focus of scientific interest, as they may influence everyday life in several ways. Although the neural effects of EMFs have been subject to a considerable number of investigations, the results are difficult to compare since dissimilar exposure protocols have been applied on different preparations or animals. In the present series of experiments, whole rats or excised rat brain slices were exposed to a reference level-intensity (250-500 microT, 50 Hz) EMF in order to examine the effects on the synaptic efficacy in the central nervous system. Electrophysiological investigation was carried out ex vivo, on neocortical and hippocampal slices; basic synaptic functions, short- and long-term plasticity and seizure susceptibility were tested. The most pronounced effect was a decrease in basic synaptic activity in slices treated directly ex vivo observed as a diminution in amplitude of evoked potentials. On the other hand, following whole-body exposure an enhanced short- and long-term synaptic facilitation in hippocampal slices and increased seizure susceptibility in neocortical slices was also observed. However, these effects seem to be transient. We can conclude that ELF-EMF exposure exerts significant effects on synaptic activity, but the overall changes may strongly depend on the synaptic structure and neuronal network of the affected region together with the specific spatial parameters and constancy of EMF. Bioelectromagnetics, 2009. (c) 2009 Wiley-Liss, Inc.

177

Characterization of adenosine receptors in bovine chondrocytes and fibroblast-like synoviocytes exposed to low frequency low energy pulsed electromagnetic fields

OBJECTIVE: The present study describes the presence and binding parameters of the A1, A2A, A2B and A3 adenosine receptors in bovine chondrocytes and fibroblast-like synoviocytes. The effect of low frequency low energy pulsed electromagnetic fields (PEMFs) on the adenosine receptor affinity and density was studied. METHODS: Saturation, competition binding experiments and Western blotting assays in the absence and in the presence of PEMFs on the adenosine receptors in bovine chondrocytes or fibroblast-like synoviocytes were performed. Thermodynamic analysis of the A2A or A3 binding was studied to investigate the forces driving drug-receptor coupling. In the adenylyl cyclase and proliferation assays the potency of typical high-affinity A2A or A3 agonists in the absence and in the presence of PEMFs was evaluated. RESULTS: Bovine chondrocytes and fibroblast-like synoviocytes expressed all adenosine receptors. PEMFs evoked an up-regulation of A2A and A3 receptors and thermodynamic parameters indicate that adenosine binding is enthalpy and entropy driven. In PEMF-treated cells the potency of typical A2A or A3 agonists on cyclic AMP assays was significantly increased when compared with the untreated cells. PEMFs potentiated the effect of A2A or A3 agonists on cell proliferation in both cell types. CONCLUSIONS: PEMFs mediate an up-regulation of A2A and A3 receptors related to an increase of their functional activities in bovine chondrocytes and fibroblast-like synoviocytes. No differences are present in adenosine affinity and in the drug-receptor interactions. Our data could be used as a trigger to future studies addressed to PEMFs and adenosine therapeutic intervention in inflammatory joint diseases.

178

Characterization of pulsed magnetic field therapy in a rat model for rheumatoid arthritis

Recent studies have shown that pulsed magnetic fields (PMF) provide a practical, exogenous method for inducing cell and tissue modifications, as therapy for selected pathological states. A number of clinical studies, in vivo animal experiments and in vitro cellular and membrane research reports suggest that PMF stimulation can significantly reduce pain and accelerate the healing process. However, PMFs are still not widely used in clinical medicine. This research examines the effects of PMFs using an animal model that resembles human rheumatoid arthritis. Using serum protein electrophoresis (SPE) and joint edema evaluation, we were able to monitor disease progression and PMF therapeutic effectiveness. We have used these methods to correlate changes in an acute phase serum protein, alpha-2-macroglobulin, with other indicators of rheumatoid arthritis in Lewis rats treated daily with PMF therapy. The results indicate that PMFs may be a promising non-invasive treatment for chronic inflammatory diseases like rheumatoid arthritis.

179

Characterization of the magnetic fields around walk-through and hand-held metal detectors

Magnetic field strength measurements were made around eight hand-held and 10 walk-through metal detectors. The method was similar to that used in previous research for Electronic Article Surveillance units except a Cartesian rather than cylindrical coordinate system was used. Special magnetic field probes specifically designed for metal detector measurements were used. A non-metallic positioning apparatus was designed and fabricated. Magnetic field strength measurements were collected on one hand-held metal detector in the laboratory. The remaining data were collected at airport terminals, federal and state government buildings, and a local high school. Walk-through metal detectors had considerably higher magnetic field strengths [up to 299 Am(-1) p-p (3,741 mG)] than hand-held metal detectors [up to 6 Am(-1) p-p (76 mG)]. The frequencies of the magnetic field signal for walk-through detectors were between 0.1 kHz and 3.5 kHz while those for hand-held detectors were between 89 kHz and 133 kHz. Waveforms for all hand-held metal detectors were sinusoidal; those for walk-through metal detectors varied with most being saw-toothed or pulsed. Due to their higher field strengths and the pulsed nature of their magnetic fields, walk-through metal detectors likely pose a higher risk for medical device electromagnetic interference than do hand-held units. Root mean squared magnetic field strengths were calculated from the peak-to-peak values and compared to occupational and general public exposure limits. None of these limits were exceeded. Measurement repeatability was examined for one hand-held and two walk-through metal detectors. For the hand-held metal detector measurements at the location of the maximum magnetic field strength, measurements by three individuals had a repeatability (percent standard deviation) of 5.9%. Limited repeatability data were collected for on-site measurements of walk-through detectors. One unit showed repeatability of 0.1 to 4.5%; a multi-zone unit showed repeatability of 2.7 to 67.5%.

180

Chick embryo development can be irreversibly altered by early exposure to weak extremely-low-frequency magnetic fields

Several reports have shown that weak, extremely-low-frequency (ELF), pulsed magnetic fields (PMFs) can adversely affect the early embryonic development of the chick. In this study, freshly fertilized chicken eggs were exposed during the first 48 h of postlaying incubation to PMFs with 100 Hz repetition rate, 1.0 microT peak-to-peak amplitude, and 500 microseconds pulse duration. Two different pulse waveforms were used, having rise and fall times of 85 microseconds (PMF-A) or 2.1 microseconds (PMF-B). It has been reported that, with 2 day exposure, these fields significantly increase the proportion of developmental abnormalities. In the present study, following exposure, the eggs were allowed to incubate for an additional 9 days in the absence of the PMFs. The embryos were taken out of the eggs and studied blind. Each of the two PMF-exposed groups showed an excess in the percentage of developmental anomalies compared with the respective sham-exposed samples. This excess of anomalies was not significant for the PMF-A-treated embryos (P = 0.173), whereas it was significant for the PMF-B-exposed group (P = 0.007), which showed a particularly high rate of early embryonic death. These results reveal that PMFs can induce irreversible developmental alterations and confirm that the pulse waveform can be a determinant factor in the embryonic response to ELF magnetic fields. The data also validate previous work based on the study of PMFs' effects at day 2 of embryonic development under field exposure.

181

Chromosome aberrations in lymphocytes of high-voltage laboratory cable splicers exposed to electromagnetic fields

Thirteen high-voltage laboratory employees and 20 referents participated in a cross-sectional, matched-pairs study of cytogenetic damage. During cable testing the workers were exposed to static, alternating, or pulsed electric and magnetic fields. The alternating magnetic field levels of 50 Hz were 5-10 microT, occasionally much higher. Chromosome aberrations, sister chromatid exchanges, and aneuploidy were studied in peripheral blood lymphocytes. In addition, chromosome aberrations were investigated in lymphocyte cultures treated with hydroxyurea and caffeine, to inhibit deoxyribonucleic acid synthesis and repair. Among seven smoking laboratory employees the mean number of chromosome breaks/200 cells was 2.3, as compared with 0.7 for the job-matched referents. The comparable figures for inhibited cultures were 12.0 versus 6.0. No increase was detected in nonsmokers with either method. The other genetic parameters showed no differences between the exposed workers and the referents. The results support, to some extent, the hypothesis of an increased risk of genotoxic effects among high-voltage laboratory workers.

182

Chronic exposure to 25-80-microT, 200-Hz magnetic field does not influence serum melatonin concentrations in patients with low back pain

There is substantial evidence that magnetic field (MF) exposure influences melatonin secretion in animals. However, data on its influence on human melatonin levels are scarce, and seemingly contradictory. Because of its many beneficial effects, very low-frequency MF exposure is used in physiotherapy of some neurological diseases and overloading syndromes of the locomotor system. In previous studies, we observed a decrease in human serum melatonin nocturnal concentrations after exposure to MF (2.9 mT, 40 Hz), and we suggested that differences among various studies may depend on different characteristics of the applied MF. Therefore, in the present study, we examined whether or not MF of different parameters exerts the same effect. The study was performed in seven men (mean age: 36.7 +/- 3.8 years; range: 32-42) suffering from low back pain. Patients were exposed to a pulsating MF (induction: 25 80 microT; frequency: 200 Hz, modulated, automatically programmed; complex saw-like impulse shape; bipolar) generated by a Quatronic MRS 2000 apparatus ("magnetic bed") for 3 wk (5 days/wk, twice a day at 08:00 and 13:00 hr for 8 min each), applied to the whole body in patients laying in a horizontal position. The study was performed in spring. Diurnal serum melatonin profiles were estimated 1 day before exposure to MF (baseline), and 1 day and 1 month after the last exposure. No changes in melatonin concentrations were observed either after 1 day or after 1 month following the exposure in comparison to baseline.

183

Chronic exposure to a GSM-like signal (mobile phone) does not stimulate the development of DMBA-induced mammary tumors in rats: results of three consecutive studies

Certain epidemiological and experimental studies raised concerns about the safety of radiofrequency (RF) electromagnetic fields because of a possible increased risk of leukemia and lymphoma. In this study, an RF field used in mobile telecommunication was tested using 7,12-dimethylbenz[a]anthracene (DMBA)-induced mammary tumors in female Sprague-Dawley rats as a model for human breast cancer. Three experiments were carried out under strictly standardized conditions and were started on the same day of three consecutive years. The field consisted of a GSM-like signal (900 MHz pulsed at 217 Hz, pulse width 577 micros) of relatively low power flux density (100 microW/cm(2) +/- 3 dB) and was applied continuously throughout each experiment to freely moving animals. The specific absorption rates averaged over the whole body were 17.5-70 mW/kg. The highest values in young animals were at or around the exposure limit permissible for the general public (i.e. 80 mW/kg). The animals were palpated weekly for the presence of mammary tumors and were killed humanely when tumors reached a diameter of 1-2 cm to allow a reliable histopathological classification and a distinction between malignant and benign subtypes. The overall results of the three studies are that there was no statistically significant effect of RF-field exposure on tumor latency and that the cumulative tumor incidence at the end of the experiment was unaffected as well. The risk ratios were 1.08 (95% CI: 0.91-1.29) and 0.96 (95% CI: 0.85-1.07) for benign and malignant tumors, respectively. These observations are in agreement with other published findings. In the first experiment, however, the median latency for the development of the first malignant tumor in each animal was statistically significantly extended for RF-field-exposed animals compared to controls (278 days compared to 145 days, P = 0.009). No such differences were detected in the two subsequent experiments. These results show that low-level RF radiation does not appear to possess carcinogenic or cancer-promoting effects on DMBA-induced mammary tumors. To explain the mechanisms underlying the different results obtained in the three experiments, a hypothesis is presented which is based upon the neuroendocrine control mechanisms involved in the promotion of DMBA-induced mammary tumors. Despite the apparent absence of stimulatory effects of low-level RF-field exposure on the development and growth of solid tumors, it will be necessary to verify these results for leukemias and lymphomas, which may have completely different biological control mechanisms.

184

Chronic lateral humeral epicondylitis--a double-blind controlled assessment of pulsed electromagnetic field therapy

Pulsed electromagnetic fields (PEMF) have been shown to be beneficial in the treatment of rotator cuff tendinitis. As lateral humeral epicondylitis (tennis elbow) is a similar chronic tendon lesion, 30 patients with both clinical and thermographic evidence of tennis elbow were randomly allocated to receive either active or inactive PEMF therapy. Treatment was continued for a minimum period of eight weeks. At this time there was no statistical difference between the two groups.

185

Chronic prenatal exposure to the 900 megahertz electromagnetic field induces pyramidal cell loss in the hippocampus of newborn rats

Widespread use of mobile phones which are a major source of electromagnetic fields might affect living organisms. However, there has been no investigation concerning prenatal exposure to electromagnetic fields or their roles in the development of the pyramidal cells of the cornu ammonis in postnatal life. Two groups of pregnant rats, a control group and an experimental group, that were exposed to an electromagnetic field were used. For obtaining electromagnetic field offspring, the pregnant rats were exposed to 900 megahertz electromagnetic fields during the 1-19th gestation days. There were no actions performed on the control group during the same period. The offspring rats were spontaneously delivered-control group (n = 6) and electromagnetic field group (n = 6). Offspring were sacrificed for stereological analyses at the end of the 4th week. Pyramidal cell number in rat cornu ammonis was estimated using the optical fractionator technique. It was found that 900 megahertz of electromagnetic field significantly reduced the total pyramidal cell number in the cornu ammonis of the electromagnetic field group (P < 0.001). Therefore, although its exact mechanism is not clear, it is suggested that pyramidal cell loss in the cornu ammonis could be due to the 900 megahertz electromagnetic field exposure in the prenatal period.

186

Chronic relapsing multiple sclerosis: a case of rapid recovery by application of weak electromagnetic fields

A 54 year-old woman was diagnosed with multiple sclerosis (MS) in 1985 at the age of 45 after she developed diplopia, slurred speech, and weakness in the right leg. A Magnetic Resonance Imaging (MRI) scan obtained in 1985 showed several areas of plaque formation distributed in the periventricular white matter and centrum semiovale bilaterally. Coincident with slow deterioration in her condition since 1990 a second MRI scan was obtained in 1991 which showed a considerable increase in the number and size of plaques throughout both cerebral hemispheres, subcortical white matter, periventricularly and brainstem. In 1994, the patient received treatment with Interferon beta- 1b (Betaseron) for 6 months with no improvement in symptoms. However, following two successive extracranial applications of pulsed electromagnetic fields (EMFs) in the picotesla (pT) range each of 20 minutes duration the patient experienced an immediate improvement in symptoms most dramatically in gait, balance, speech, level of energy, swallowing, mood, and vision. On a maintenance program of 3 treatments per month the patient's only symptom is mild right foot and leg weakness. The report points to the unique efficacy of externally applied pT range EMFs in the symptomatic treatment of MS, indicates a lack of an association between the extent of demyelinating plaques on MRI scan and rate and extent of recovery in response to EMFs, and supports the notion that dysfunction of synaptic conductivity due to neurotransmitter deficiency particularly of serotonin (5-HT) contributes more significantly to the development of MS symptoms than the process of demyelination which clinically seems to represent an epiphenomenon of the disease.

187

Circadian Rhythm Affects the Preventive Role of Pulsed Electromagnetic Fields on Ovariectomy-induced Osteoporosis in Rats

Pulsed electromagnetic fields (PEMF) have been proved effective in the prevention of osteoporosis both experimentally and clinically. Chronotherapy studies have shown that circadian rhythm (CR) played an important role in the occurrence, development and treatment of several diseases. CR has also been recognized as an essential feature of bone metabolism. Therefore, it is of therapeutic significance to investigate the impact of CR on the efficacy of PEMF in the prevention of osteoporosis. However, this issue has never been discussed previously. The objective of this study was to systematically evaluate the impact of CR on the preventive effect of PEMF on osteoporosis in rats. Thirty-two 3 month old female Sprague-Dawley rats were randomly divided into four different groups: sham-operated control (Sham), ovariectomy (OVX), OVX with PEMF stimulation in daytime (OVX+DPEMF) and OVX with PEMF stimulation in nighttime (OVX+NPEMF) groups. The OVX+DPEMF and OVX+NPEMF groups were subjected to daily PEMF exposure on the 2nd post-operative day, from 9:0015:00, and 0:006:00, respectively. After 12 weeks, the OVX+DPEMF group presented better efficacy in prevention against OVX-induced bone loss and deterioration of trabecular bone architecture compared with the OVX+NPEMF group. This was evidenced by the increased levels of femoral bone mineral density, trabecular area percentage, trabecular thickness, trabecular number and decreased trabecular separation. Furthermore, the bone turnover biomarkers (serum alkaline phosphatase, serum bone Gla protein and urinary deoxypyridinoline) and the dynamic histomorphometric parameters reflecting the trabecular osteoblast and osteoclast activity (bone formation rate with bone volume as referent, osteoclast number, etc) in the OVX+DPEMF group decreased to a larger extent compared with the OVX+NPEMF group. In conclusion, the results indicated that CR was an important factor determining the preventive effect of PEMF on osteoporosis and PEMF exposure in the daytime presented better stimulus efficacy in rats. The findings might be helpful for the efficacious use of PEMF mediations, evaluation of PEMF action and experimental design in the future studies of biological effect of electromagnetic fields.

189

Classification and control of the origin of photoluminescence from Si nanocrystals

Silicon dominates the electronics industry, but its poor optical properties mean that III-V compound semiconductors are preferred for photonics applications. Photoluminescence at visible wavelengths was observed from porous Si at room temperature in 1990, but the origin of these photons (do they arise from highly localized defect states or quantum confinement effects?) has been the subject of intense debate ever since. Attention has subsequently shifted from porous Si to Si nanocrystals, but the same fundamental question about the origin of the photoluminescence has remained. Here we show, based on measurements in high magnetic fields, that defects are the dominant source of light from Si nanocrystals. Moreover, we show that it is possible to control the origin of the photoluminescence in a single sample: passivation with hydrogen removes the defects, resulting in photoluminescence from quantum-confined states, but subsequent ultraviolet illumination reintroduces the defects, making them the origin of the light again.

191

Clinical report on long-term bone density after short-term EMF application

A 1984 study determined the effect of a 72 Hz pulsating electromagnetic field (PEMF) on bone density of the radii of post-menopausal (osteoporosis-prone) women, during and after treatment of 10 h daily for 12 weeks. Bone mineral densities of the treated radii increased significantly in the immediate area of the field during the exposure period and decreased during the following 36 weeks. Bone density determination of the radii of these women, remeasured after eight years, suggests no long-term changes. The bone density-enhancing effect of PEMFs should be further studied, alone and in combination with exercise and pharmacologic agents such as the bisphosphonates and hormones, as prophylaxis in the osteoporosis-prone postmenopausal woman and as a possible block to the demineralization effect of microgravity.

192

Clinical study of interference with cardiac pacemakers by a magnetic field at power line frequencies

OBJECTIVES: This study examined the risk of interference by high magnetic flux density with permanent pacemakers. BACKGROUND: Several forms of electromagnetic energy may interfere with the functions of implanted pacemakers. No clinical study has reported specific and relevant information pertaining to magnetic fields near power lines or electrical appliances. METHODS: A total of 250 consecutive tests were performed in 245 recipients of permanent pacemakers during 12-lead electrocardiographic monitoring. A dedicated exposure system generated a 50-Hz frequency and maximum 100-microT flux density, while the electrical field was kept at values on the order of 0.10 V/m. RESULTS: A switch to the asynchronous mode was recorded in three patients with devices programmed in the unipolar sensing configuration. A sustained mode switch was followed by symptomatic pacing inhibition in one patient. No effect on devices programmed in bipolar sensing was observed, except for a single interaction with a specific capture monitoring algorithm. CONCLUSIONS: The overall incidence of interaction by a magnetic field was low in patients tested with a wide variety of conventionally programmed pacemaker models. A magnetic field pulsed at power frequency can cause a mode switch and pacing inhibition in patients with devices programmed in the unipolar sensing configuration. The risk of interference appears negligible in patients with bipolar sensing programming.

193

Closed-chest cardiac stimulation with a pulsed magnetic field

Magnetic stimulators, used medically, generate intense rapidly changing magnetic fields, capable of stimulating nerves. Advanced magnetic resonance imaging systems employ stronger and more rapidly changing gradient fields than those used previously. The risk of provoking cardiac arrhythmias by these new devices is of concern. In the paper, the threshold for cardiac stimulation by an externally-applied magnetic field is determined for 11 anaesthetised dogs. Two coplanar coils provide the pulsed magnetic field. An average energy of approximately 12 kJ is required to achieve closed-chest magnetically induced ectopic beats in the 17-26 kg dogs. The mean peak induced electric field for threshold stimulation is 213 V m-1 for a 571 microseconds damped sine wave pulse. Accounting for waveform efficacy and extrapolating to long-duration pulses, a threshold induced electric field strength of approximately 30 V m-1 for the rectangular pulse is predicted. It is now possible to establish the margin of safety for devices that use pulsed magnetic fields and to design therapeutic devices employing magnetic fields to stimulate the heart.

194

Closed-form bases for the description of monochromatic, strongly focused, electromagnetic fields

A procedure is proposed for generating rigorous closed-form orthonormal bases for the expansion of strongly focused (high-numerical-aperture), monochromatic, electromagnetic fields. The performance of three such bases is tested in terms of a parameter that determines their directional spread, for several truncation orders. Simple example fields corresponding to beams with differing polarizations focused by a thin lens are expanded in terms of these bases.

195

Closing the spin gap in the Kondo insulator Ce3Bi4Pt3 at high magnetic fields

Kondo insulator materials--such as CeRhAs, CeRhSb, YbB12, Ce3Bi4Pt3 and SmB6--are 3d, 4f and 5f intermetallic compounds that have attracted considerable interest in recent years. At high temperatures, they behave like metals. But as temperature is reduced, an energy gap opens in the conduction band at the Fermi energy and the materials become insulating. This contrasts with other f-electron compounds, which are metallic at all temperatures. The formation of the gap in Kondo insulators has been proposed to be a consequence of hybridization between the conduction band and the f-electron levels, giving a 'spin' gap. If this is indeed the case, metallic behaviour should be recovered when the gap is closed by changing external parameters, such as magnetic field or pressure. Some experimental evidence suggests that the gap can be closed in SmB6 (refs 5, 8) and YbB12 (ref. 9). Here we present specific-heat measurements of Ce3Bi4Pt3 in d.c. and pulsed magnetic fields up to 60 tesla. Numerical results and the analysis of our data using the Coqblin-Schrieffer model demonstrate unambiguously a field-induced insulator-to-metal transition.

196

COMAR technical information statement: expert reviews on potential health effects of radiofrequency electromagnetic fields and comments on the bioinitiative report

The Committee on Man and Radiation (COMAR) is a technical committee of the Engineering in Medicine and Biology Society (EMBS) of the Institute of Electrical and Electronics Engineers (IEEE). Its primary area of interest is biological effects of non-ionizing electromagnetic radiation, including radiofrequency (RF) energy. The public interest in possible health effects attributed to RF energy, such as emitted by mobile phones, wireless telephone base stations, TV and radio broadcasting facilities, Wi-Fi systems and many other sources, has been accompanied by commentary in the media that varies considerably in reliability and usefulness for their audience. The focus of this COMAR Technical Information Statement is to identify quality sources of scientific information on potential health risks from exposure to RF energy. This Statement provides readers with references to expert reports and other reliable sources of information about this topic, most of which are available on the Internet. This report summarizes the conclusions from several major reports and comments on the markedly different conclusions in the BioInitiative Report (abbreviated BIR below). Since appearing on the Internet in August 2007, the BIR has received much media attention but, more recently, has been criticized by several health organizations (see Section titled "Views of health agencies about BIR"). COMAR concludes that the weight of scientific evidence in the RF bioeffects literature does not support the safety limits recommended by the BioInitiative group. For this reason, COMAR recommends that public health officials continue to base their policies on RF safety limits recommended by established and sanctioned international organizations such as the Institute of Electrical and Electronics Engineers International Committee on Electromagnetic Safety and the International Commission on Non-Ionizing Radiation Protection, which is formally related to the World Health Organization.

197

Combined magnetic fields accelerate and increase spine fusion: a double-blind, randomized, placebo controlled study

The abstract concludes that the adjunctive use of the combined magnetic field device studied (SpinaLogic)was statistically beneficial in the overall patient population. 201 patients were studied. Patients were treated for one 30 minute session per day for nine months post non-instrumented spinal fusion. an air was a significant increase in the nine-month success rate of radiographic spinal fusion. The device in question was seen to accelerate the post-spinal fusion healing process. Specific intensity and frequency parameters of the magnetic field utilized were not specified.

198

Comment: A biological guide for electromagnetic safety: the stress response

Questions of safety of electromagnetic (EM) fields should be based on relevant biological properties, i.e., specific cellular reactions to potentially harmful stimuli. The stress response is a well-documented protective reaction of plant and animal cells to a variety of environmental threats, and it is stimulated by both extremely low frequency (ELF) and radio frequency (RF) EM fields. It involves activation of DNA to initiate synthesis of stress proteins. The thermal and nonthermal stimuli affect different segments of DNA and utilize different biochemical pathways. However, both ELF and RF stimulate the same nonthermal pathway. Since the same biochemical reactions are stimulated in different frequency ranges with very different specific absorption rates (SARs), SAR level is not a valid basis for safety standards. Studies of EM field interactions with DNA and model systems provide insight into a plausible mechanism that can be effective in ELF and RF ranges one.

199

Comparative study of bone growth by pulsed electromagnetic fields

Pulsed electromagnetic fields have been widely used for treatment of non-united fractures and congenital pseudarthrosis. Several electrical stimulation systems such as air-cored and iron-cored coils and solenoids have been used the world over and claimed to be effective. Electrical parameters such as pulse shape, magnitude and frequency differ widely, and the exact bone-healing mechanism is still not clearly understood. The study attempts to analytically investigate the effectiveness of various parameters and suggests an optimal stimulation waveform. Mathematical analysis of electric fields inside the bone together with Fourier analysis of induced voltage waveforms produced by commonly used electrical stimulation wave-forms has been performed. A hypothesis based on assigning different weightings to different frequencies for osteogenic response has been proposed. Using this hypothesis astonishingly similar effective values of electric fields have been found in different systems. It is shown that effective electric field rather than peak electric field is the main parameter responsible for osteogenesis. The results are in agreement with experimental findings made on human beings by different investigators.

200

Comparative study of the use of electromagnetic fields in patients with pseudoarthrosis of tibia treated by intramedullary nailing

We made a comparative cohort study in patients suffering from tibial pseudoarthrosis, all of whom were treated by intramedullary nailing. We divided patients into two groups: one treated by intramedullary nailing only (control group) and the other by intramedullary nailing combined with pulsed electromagnetic fields (PEMFs). The study included 57 cases of tibial pseudoarthrosis in 57 patients from February 1987 to February 2002. Pseudoarthrosis was treated surgically in all cases (Grosse-Kempf dynamic intramedullary nailing). This was combined with PEMFs in 22 cases. The average age was 38.3 years (range 14-89 years) and the average duration of follow-up was 27.2 months (range 12-48 months). Forty-nine fractures (86%) healed and eight (14%) did not. Of the group treated with PEMFs, 20 (91%) healed and two (9%) did not; from the group that did not receive PEMF (35), 29 (83%) healed compared to six (17%) that did not. The relationship between union and use of PEMFs, and between time to union and use of PEMFs was clinically relevant. PEMFs are useful when treating tibial pseudoarthrosis. Its noninvasive nature means that there are more complication-free unions.

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