Report of the American Medical Association (AMA) Council on Scientific Affairs and AMA recommendations to medical professional staff on the use of wireless radio-frequency equipment in hospitals

In lieu of a comprehensive technical assessment, this report of the American Medical Association (AMA) Council on Scientific Affairs reviews the issue of electromagnetic interference (EMI) with medical devices caused by the use of wireless radio-frequency (RF) equipment such as cellular telephones, 2-way radios, and pagers. It identifies medical device EMI problems that have been reported and guidance that has been published to assist hospital personnel in assessing and minimizing the potential for EMI in the hospital and in making informed risk management decisions. For more-detailed information on this subject, readers are encouraged to consult publications from various scientific and health care organizations.     

Induced circular dichroism of eosin-5-maleimide bound to band 3 of human erythrocytes.

The inhibition of anion exchange in human erythrocyte membrane by eosin-5-maleimide (EMI) was examined at various pH values. At the pH region between pH 6.0 and 8.0, EMI inhibited the sulfate efflux by about 90%. Further, the interaction of EMI molecules with erythrocyte ghosts was studied by induced circular dichroism (CD). At acidic pH, the EMI-ghost system showed a positive band at about 552 nm and negative bands at about 523 and 505 nm. When the ghosts had been preincubated with N-ethylmaleimide, which is a modifying reagent for cysteine residues, the intensity of the CD bands was decreased. On the other hand, when the ghosts had been preincubated with 4,4'-diisothiocyanostilbene-2,2'-disulfonate or eosin-5-isothiocyanate, which inhibit the anion exchange by binding to membrane from outside of the cell, EMI CD was not influenced. These results and the experiment of trypsin digestion, suggested that the induced CD originated from the complexation of EMI molecules with SH groups on band 3 protein. A conventional Gaussian analysis of the CD spectrum at pH 6.0 revealed that the CD spectrum was composed of three components; one of them may be from EMI monomers bound to a cryptic SH group on the 17K fragment and two of them were coupling-type CD bands originating from EMI dimer and/or trimer. The EMI dimer and trimer, which should be located predominantly on the cytoplasmic SH groups on the 43K fragment, were considered as 'stacking' and/or 'head to tail' arrangements. At pH 7.4, the CD spectrum originating from EMI monomers, which showed a negative band at about 560 nm and a positive band at about 535 nm, could be observed.     

Late presentation of recurrent syncope after permanent pacemaker implantation due to Lead−Header malapposition

Permanent pacemaker (PPM) malfunction due to electrical connection problems such as a loose set screw or lead-header malapposition is extremely rare. We present a patient with complete heart block (CHB) who had PPM malfunction and recurrent syncope, late (14 months) after initial implantation, which was caused by the ventricular lead pin disengagement from the header resulting in oversensing due to noise, pacing inhibition and recurrent syncope. PPM due to lead-header malapposition this late after device implantation has previously not been reported.     

A Smartphone Ecological Momentary Assessment/Intervention “App” for Collecting Real-Time Data and Promoting Self-Awareness

We have designed a flexible ecological momentary assessment/intervention smartphone (EMA/EMI) “app”. We examine the utility of this app for collecting real-time data, and assessing intra-subject variability, by using it to assess how freshman undergraduates spend their time. We also explore whether its use can promote greater self-awareness. Participants were randomly divided into an experimental group, who used the app, and a control group, who did not. We used the app to collect both randomized in-the-moment data as well as end-of-day data to assess time use. Using a posttest survey we asked participants questions about how they spent time throughout the school semester. We also asked the experimental group about their experience with the app. Among other findings, 80.49% participants indicated that they became more aware of how they spent their time using the app. Corroborating this report, among the experimental group, end-of-semester self-assessment of time spent wasted, and time spent using electronics recreationally, predicted semester GPA at a strength comparable to high school GPA and ACT score (two of the best single predictors for first semester college GPA), but had no correlation among controls. We discuss the advantages and limitations of using apps, such as ours, for EMA and/or EMI.     

Electromagnetic interference on pacemakers

External sources, either within or outside the hospital environment, may interfere with the appropriate function of pacemakers which are being implanted all around the world in current medical practice. The patient and the physician who is responsible for follow-up of the pacing systems may be confronted with some specific problems regarding the various types of electromagnetic interference (EMI). To avoid these unwanted EMI effects one must be aware of this potential problem and need to take some precautions. The effects of EMI on pacemaker function and precautions to overcome some specific problems were discussed in this review article. There are many sources of EMI interacting with pacemakers. Magnetic resonance imaging creates real problem and should be avoided in pacemaker patients. Cellular phones might be responsible for EMI when they were held on the same side with the pacemaker. Otherwise they don't cause any specific type of interaction with pacemakers. Sale security systems are not a problem if one walks through it without lingering in or near it. Patients having unipolar pacemaker systems are prone to develop EMI because of pectoral muscle artifacts during vigorous active physical exercise.     

Electromuscular incapacitation results from stimulation of spinal reflexes

Electronic stun devices (ESD) often used in law enforcement, military action or self defense can induce total body uncoordinated muscular activity, also known as electromuscular incapacitation (EMI). During EMI the subject is unable to perform purposeful or coordinated movements. The mechanism of EMI induction has not been reported, but has been generally thought to be direct muscle and nerve excitation from the fields generated by ESDs. To determine the neuromuscular mechanisms linking ESD to induction of EMI, we investigated EMI responses using an anesthetized pig model. We found that EMI responses to ESD application can best be simulated by simultaneous stimulation of motor and sensory peripheral nerves. We also found that application of local anesthetics limited the response of ESD to local muscle stimulation and abolished the total body EMI response. Stimulation of the pure sensory peripheral nerves or nerves that are primarily motor nerves induced muscle responses that are consistent with well defined spinal reflexes. These findings suggest that the mechanism of ESD‐induced EMI is mediated by excitation of multiple simultaneous spinal reflexes. Although direct motor‐neuron stimulation in the region of ESD contact may significantly add to motor reactions from ESD stimulation, multiple spinal reflexes appear to be a major, and probably the dominant mechanism in observed motor response. Bioelectromagnetics 30:411–421, 2009. © 2009 Wiley‐Liss, Inc.     

Mechanisms,malfunctions and explanation in medicine

Mechanisms are a way of explaining how biological phenomena work rather than why single elements of biological systems are there. However, mechanisms are usually described as physiological entities, and little or no attention is paid to malfunction as an independent theoretical concept. On the other hand, malfunction is the main focus of interest of applied sciences such as medicine. In this paper I argue that malfunctions are parts of pathological mechanisms, which should be considered separate theoretical entities, conceptually having a priority over physiological sequences. While pathological mechanisms can be described in terms of a Cummins-like mechanistic explanation, they show some unnoticed peculiarities when compared to physiological ones. Some features of pathological mechanisms are considered, such as outcome variability, ambivalence and dependence on a range.     

Low Intensity Electromagnetic Irradiation with 70.6 and 73 GHz Frequencies Affects <Emphasis Type="Italic">Escherichia coli</Emphasis> Growth and Changes Water Properties

The low intensity electromagnetic irradiation (EMI) of the 70.6 and 73 GHz frequency is resonant for Escherichia coli but not for water. In this study, E. coli irradiation with this EMI during 1 h directly and in bi-distilled water or in the assay buffer with those frequencies resulted with noticeable changes in bacterial growth parameters. Furthermore, after EMI, 2 h rest of bacteria renewed their growth in 1.2-fold, but repeated EMI—had no significant action. Moreover, water absorbance, pH, and electric conductance were changed markedly after such irradiation. The results point out that EMI of the 70.6 and 73 GHz frequency can interact with bacteria affecting growth and in the same time with the surrounding medium (water) as well.     

Mutual interaction between oxidative stress and endoplasmic reticulum stress in the pathogenesis of diseases specifically focusing on non-alcoholic fatty liver disease

Reactive oxygen species(ROS) are produced during normal physiologic processes with the consumption of oxygen. While ROS play signaling roles, when they are produced in excess beyond normal antioxidative capacity this can cause pathogenic damage to cells. The majority of such oxidation occurs in polyunsaturated fatty acids and sulfhydryl group in proteins, resulting in lipid peroxidation and protein misfolding, respectively. The accumulation of misfolded proteins in the endoplasmic reticulum(ER) is enhanced under conditions of oxidative stress and results in ER stress, which, together, leads to the malfunction of cellular homeostasis. Multiple types of defensive machinery are activated in unfolded protein response under ER stress to resolve this unfavorable situation. ER stress triggers the malfunction of protein secretion and is associated with a variety of pathogenic conditions including defective insulin secretion from pancreatic β-cells and accelerated lipid droplet formation in hepatocytes. Herein we use nonalcoholic fatty liver disease(NAFLD) as an illustration of such pathological liver conditions that result from ER stress in association with oxidative stress. Protecting the ER by eliminating excessive ROS viathe administration of antioxidants or by enhancing lipidmetabolizing capacity via the activation of peroxisome proliferator-activated receptors represent promising therapeutics for NAFLD.     

Structural changes in the proximal tubule of the short-toes axolotl mutant

A recessive lethal mutation in axolotls that involves the kidneys, the Mullerian ducts and the limbs was described by Humphrey (1967). In the present experiments, we have examined the structural defects that lead to kidney malfunction and subsequent death in homozygous mutants and compared the defects with those observed in other axolotls lacking this mutant gene. The ultrastructure of the mesonephric kidney was studied in homozygous s/s short-toes axolotls with ascites and/or edema and hemorrhages (group 1a); in s/s short-toes axolotls not yet expressing kidney malfunction symptoms (group 1b); in normal siblings, either +/+ or +/s, without affected limbs but possibly heterozygous for the 's' gene (group 1c); in +/+ animals with malfunctioning kidneys that lack the short-toes gene (group 2a) and in normal +/+ animals from different gene pools (group 2b). In all of the short-toes animals that expressed pathological phenotypes, the proximal tubule showed abnormal morphology. There was no morphological evidence of kidney abnormality in the siblings having normal limbs or in the group 1b axolotls examined. However, mesonephroi from animals (group 2a) of other gene pools that had ascites exhibited a different and more pronounced pathology. On the basis of the dramatically distinct proximal tubule pathology of the sporadic floaters, we conclude that this phenotype is more likely caused by infection than to a variant of the short-toes gene.     

Multiple-interactions among EMILIN1 and EMILIN2 N- and C-terminal domains

EMILIN1 and EMILIN2 belong to a family of extracellular matrix glycoproteins characterized by the N-terminal cysteine-rich EMI domain, a long segment with high probabilty for coiled-coil structure formation and a C-terminal gC1q domain. To study EMILIN1 and EMILIN2 interaction and assembly we have applied qualitative and quantitative two hybrid systems using constructs corresponding to the gC1q and EMI domains. The identified interactions were further confirmed in yeast extracts of co-transfected cells followed by co-immunoprecipitation. The data indicated that gC1q domains are able to self-interact as well as to interact one each other and with the EMI domains, but no self interactions were detected between the EMI domains. Furthermore EMILINs interactions were studied in 293-EBNA cells co-transfected with full lenght EMILIN1 and EMILIN2 constructs. Specific antibodies were able to co-immunoprecipitate EMILINs, indicating that also full-lenght proteins can give rise to non-covalent homo- and hetero-multimers even if reduced and alkylated before mixing. Immunofluorescence analysis on mouse cell cultures and tissues sections with specific antibodies showed co-distribution of EMILIN1 and EMILIN2. Thus, we can hypothesize that EMILINs multimers are formed by head-to-tail interaction between C-terminal and N-terminal domains of EMILIN1 and/or EMILIN2 but also by tail-to-tail interaction between gC1q domains. These multiple interactions may regulate homo-typic and/or hetero-typic linear and eventually lateral branching assemblies of EMILIN1 and EMILIN2 in tissues.     

Inappropriate ICD shocks for inappropriate reasons

ICD shocks can result from a variety of etiologies; determining the proper etiology of the inappropriate shock is essential for correction of the problem. Electromagnetic interference (EMI) can mimic cardiac signals and cause inappropriate defibrillator shocks. We present two cases of inappropriate ICD shocks due to EMI and reversal of the proximal and distal DF-1 lead terminals of the ICD lead. These are two unusual etiologies for inappropriate defibrillator shocks.     

Interference of 16.7-Hz electromagnetic fields on measured electrocardiogram

The extent of electromagnetic interference (EMI) from 16.7-Hz alternate current power lines in the human surface electrocardiogram (ECG) was evaluated. Results showed a direct linear correlation between mean EMI and magnetic induction of 5.8-21 microT on a railroad platform (electric field: 270 V/m). EMI inside a railroad car (10 microT, 0 V/m) was comparable to the electromagnetic field at the platform. Inside a voltage transformer substation (0 microT, 2000 V/m) EMI occurred only when the ECG device was closer to the power line than the test person. Magnetic induction caused 16.7-Hz EMI to a degree that proper diagnosis of ECG-rhythms was rendered impossible.     

溶酶体贮积症的研究进展

溶酶体贮积症是一种罕见的遗传缺陷疾病,溶酶体内未酶解的大分子累积,最终导致细胞功能障碍和临床异常情况。许多溶酶体底物在细胞结构和功能上都有关键的作用,因此溶酶体功能失常的影响非常广泛,如神经受累、间质受累、网状内皮组织受累及胎儿水肿。治疗方法主要有骨髓移植、酶替代疗法、底物减少治疗、基因治疗和分子伴侣治疗。利用转基因及其他一些前沿技术,将有可能彻底根除这些长期困扰人类的溶酶体贮积症。     

Comparable Effects of Low-intensity Electromagnetic Irradiation at the Frequency of 51.8 and 53 GHz and Antibiotic Ceftazidime on Lactobacillus acidophilus Growth and Survival

The effects of low-intensity electromagnetic irradiation (EMI) with the frequencies of 51.8 and 53 GHz on Lactobacillus acidophilus growth and survival were revealed. These effects were compared with antibacterial effects of antibiotic ceftazidime. Decrease in bacterial growth rate by EMI was comparable with the inhibitory effect of ceftazidime (minimal inhibitory concentration—16 μM) and no enhanced action was observed with combined effects of EMI and the antibiotic. However, EMI-enhanced antibiotic inhibitory effect on bacterial survival. The kinetics of the bacterial suspension oxidation–reduction potential up to 24 h of the growth was changed by EMI and ceftazidime. The changes were more strongly expressed by combined effects of EMI and antibiotic especially up to 12 h. Moreover, EMI did not change overall energy (glucose)-dependent H⁺ efflux across the membrane but it increased N,N′-dicyclohexylcarbodiimide (DCCD)-inhibited H⁺ efflux. In contrast, this EMI in combination with ceftazidime decreased DCCD-sensitive H⁺ efflux. Low-intensity EMI had inhibitory effect on L. acidophilus bacterial growth and survival. The effect on bacterial survival was more significant in the combination with ceftazidime. The H⁺-translocating F ₀ F ₁-ATPase, for which DCCD is specific inhibitor, might be a target for EMI and ceftazidime. The revealed bactericide effects on L. acidophilus can be applied in biotechnology, food producing and safety technology.     

Electromagnetic irradiation of Enterococcus hirae at low-intensity 51.8- and 53.0-GHz frequencies: changes in bacterial cell membrane properties and enhanced antibiotics effects

Exposure to electromagnetic irradiation (EMI) of 51.8 and 53.0?GHz and low intensity (flux capacity of 0.06?mW?cm(-2) ) for 1?h markedly decreased the energy-dependent H(+) and K(+) transport across membranes of Enterococcus hirae ATCC 9790. After EMI, there was also a significant decrease of overall and N,N'-dicyclohexylcarbodiimide (DCCD)-sensitive ATPase activity of the membrane vesicles. These measures were considerably lower at 53.0 GHz. EMI in combination with different antibiotics, such as ceftriaxone and kanamycin at their minimal inhibitory concentrations (100 and 200?μM, respectively), enhanced bacterial cell growth and altered their membrane transport properties. Total H(+) efflux was most sensitive to ceftriaxone but DCCD-inhibited H(+) efflux and total K(+) influx were sensitive to kanamycin. The results indicate that cell membrane proteins could be a target in the action of EMI and enhanced antibacterial effects in combination with antibiotics. The DCCD-sensitive F(0) F(1) -ATPase or this ATPase in combination with K(+) uptake protein probably plays a key role in these effects.     

A statistical test for classification, with applications to the characterization of pathogens according to antibiotic susceptibility patterns

If n different analytical procedures are applied to a culture of a pathogen, then that pathogen is characterized by an ordered sequence or vector of length n. A group of such sequences (or 'susceptibility patterns' as they are called in this context) can be generated by applying this process to cultures taken from infected individuals in an epidemic. This paper introduced statistical tests that can be used to determine whether a pattern obtained from the culture of a single case differs from those patterns obtained from cultures of a group of infected individuals. The methods are applied to come nosocomial epidemics. These taxonomic techniques extend beyond the present application to other classification problems in the biological and medical sciences.     

The reality of a self-occluding pump head: Case report

A malfunction of an oxygenator pumphead during aortocoronary bypass surgery is described. Corrections were made and the operation proceeded without further incident. Although this malfunction is extremely rare, it is reviewed in detail to alert perfusionists to the possibility of such an occurrence.     

Temporal and Spatial Patterns of Epibenthic Macroinvertebrates (EMI) from the San Pedro Shelf,California: Ten-Year Study

Temporal and spatial changes of epibenthic macroinvertebrates (EMI) were described from a ten-year (1985–1995) trawl study on the San Pedro Shelf, California. Community measures including number of species, individuals, biomass, dominance (DI), evenness (J'), and diversity (H' and SR) per trawl were computed for eight trawl stations representing four isobaths. Two reference stations and a test station (located at an ocean outfall) were featured in statistical analyses examining whether the outfall had any effect on EMI. During the ten-year period 127,389 individuals provided 106 EMI taxa. Water depth was the most important factor affecting EMI composition. Although some statistically significant differences in EMI community measures among trawl stations were found. differences between the outfall and both reference stations were either insignificant or inconsistent, providing no obvious ecological impacts attributable to the outfall.     

Libido and PTSD

The most frequent PTSD treatment is group therapy. Experiences gained from this kind of work warn us of big difficulties, especially if psychotherapist is an analytically oriented person. He has to do with non-presence of insight. These groups are dominated by projection and catharsis, which is often a source of secondary traumas. However, patients are fond of these group sessions. In the dynamics of such group sessions, what can be recognized is the tendency towards repression of the actual problems a PTSD patient has in his family, at work and in social relations. One of these problems, marked for the intensity of repression and negation, is the problem of libido. Weakness of potency and other libidinous problems are often the source of family problems as well as auto-aggressive acts. Libidinous problems are a taboo topic and the task of a psychodynamically oriented psychotherapeutist is to point out at this problem. Psychotherapeutic process changes its dynamics while directing verbalization to the problem of libido. Apart from readiness for solving the problem, patients with PTSD diagnosis show an interest in the members of their family being involved into psychotherapy. A special dynamics is being developed while solving the libidinous problems of the widows whose husbands were killed in war.