Electromuscular Incapacitation Current Induced Neuromuscular Tissue Injury.

Electrical stun devices (ESDs) serve a basic role in law enforcement and provide an alternative to lethal options for target control by causing electromuscular incapacitation (EMI). A fundamental concern is the adverse health consequences associated with their use. The capability of EMI electric field pulses to disrupt skeletal muscle cells (i.e. rhabdomyolysis) was investigated over the operational range commonly used in commercial EMI devices. Functional and structural alteration and recovery of muscle and nerve tissue were assessed. In an anesthetized swine model, the left thigh was exposed to 2 min of electrical pulses, using a commercially available ESD or a custom-made EMI signal power amplifier. Serum creatinine phosphokinase (CPK), troponin, aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were monitored intermittently for 6 h post-EMI exposure. A standard external cardiac defibrillator served as a positive control. Muscle and nerve tissue histology adjacent to the EMI contacts were examined. Post-EMI shock skeletal muscle function was evaluated by analyzing the compound muscle action potentials (CMAPs) of the rectus femoris muscle. Maximal energy cardiac defibrillator pulses resulted in rhabdomyolysis and marked elevation of CPK, LDH, and AST 6 h post-shock. EMI field pulses resulted in the animals developing transient acidosis. CMAP amplitudes decreased approximately 50% after EMI and recovered to near-normal levels within 6 h. Within 6 h post-EMI exposure, blood CPK was mildly increased, LDH was normal, and no arrhythmia was observed. Minimal rhabdomyolysis was produced by the EMI pulses. These results suggest that EMI exposure is unlikely to cause extremity rhabdomyolysis in normal individuals. Bioelectromagnetics. © 2020 Bioelectromagnetics Society.

Mussel-inspired conductive Ti2C-cryogel promotes functional maturation of cardiomyocytes and enhances repair of myocardial infarction.

Rationale: Researches on conductive engineering cardiac patch (ECP) for myocardial infarction (MI) treatment have achieved some progress in the animal while the availability of traditional conductive materials in ECP is still limited because of their controversial cytotoxicity. Here we aim to introduce a novel hydrophilic biocompatible conductive material: MXene Ti2C and mussel-inspired dopamine into PEGDA-GelMA cryogel to construct a bio-functional ECP of which the property closes to natural heart for the repair of MI. Method: MXene Ti2C was etched from MAX Ti2AlC, then uniformly dispersed into the prepolymer composed with dopamine-N', N'-methylene-bisacrylamide, methacrylate-gelatin, and poly (ethylene glycol) diacrylate by simple water bath sonication. The resilient conductive Ti2C-cryogel was fabricated by chemical cryogelation. The conductive ECP was evaluated in vitro and transplanted to the MI rat model for MI treatment. Results: In vitro, the 3D vessels-shape framework was observed in Ti2C-8-cryogel which was seeded with rats aortic endothelial cells. When the Ti2C-cryogels were cocultured with CMs, remarkably aligned sarcomere and the primitive intercalated disc between the mature CMs were formed on day 7. The as-prepared Ti2C-8-cryogel ECP also demonstrated rapid calcium transients and synchronous tissue-like beating. When transplanted into the infarcted heart of the MI rat model, the Ti2C-8-cryogel ECP could improve the cardiac function, reduce the infarct size, and inhibit the inflammatory response. Obvious vasculation especially newly formed arteriole was also found. Conclusion: A novel conductive Ti2C-embedded cardiac patch with suitable conductivity and the mechanical property was developed and could be served as an ideal candidate for MI repair.

Perspectives on setting limits for RF contact currents: a commentary.

BACKGROUND: Limits for exposure to radiofrequency (RF) contact currents are specified in the two dominant RF safety standards and guidelines developed by the Institute of Electrical and Electronics Engineers (IEEE) and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). These limits are intended to prevent RF burns when contacting RF energized objects caused by high local tissue current densities. We explain what contact currents are and review some history of the relevant limits with an emphasis on so-called "touch" contacts, i.e., contact between a person and a contact current source during touch via a very small contact area. RESULTS: Contact current limits were originally set on the basis of controlling the specific absorption rate resulting from the current flowing through regions of small conductive cross section within the body, such as the wrist or ankle. More recently, contact currents have been based on thresholds of perceived heating. In the latest standard from the IEEE developed for NATO, contact currents have been based on two research studies in which thresholds for perception of thermal warmth or thermal pain have been measured. Importantly, these studies maximized conductive contact between the subject and the contact current source. This factor was found to dominate the response to heating wherein high resistance contact, such as from dry skin, can result in local heating many times that from a highly conductive contact. Other factors such as electrode size and shape, frequency of the current and the physical force associated with contact are found to introduce uncertainty in threshold values when comparing data across multiple studies. CONCLUSIONS: Relying on studies in which the contact current is minimized for a given threshold does not result in conservative protection limits. Future efforts to develop limits on contact currents should include consideration of (1) the basis for the limits (perception, pain, tissue damage); (2) understanding of the practical conditions of real world exposure for contact currents such as contact resistance, size and shape of the contact electrode and applied force at the point of contact; (3) consistency of how contact currents are applied in research studies across different researchers; (4) effects of frequency.

Iatrogenic hypernatremia in hemodialysis patients: A result of erroneous online conductivity monitor and conductivity meter reading.

Hyponatremia is common in chronic kidney disease and in end stage kidney disease (ESKD) but hypernatremia is infrequent in ESKD. The incidence of hypernatremia is higher in ambulatory peritoneal dialysis (PD) than in hemodialysis (HD) patients. In PD patients it is often a result of excessive ultrafiltration but in HD it is often a result of dialysate composition errors. Dialysate composition errors can inadvertently cause either hyponatremia or hypernatremia. We present two cases of symptomatic hypernatremia which manifested as increased thirst, excessive weight gain and worsening hypertension in HD patients. The hypernatremia was caused by a combination of errors in online conductivity reading and a faulty hand held conductivity meter. Symptoms were relieved in both patients after replacement of the dialysis machine.

Close Examination of a ZYTO Electrodermal Screening System.

Electrodermal screening" ("EDS") devices are claimed to use galvanic skin responses to identify health problems and corrective actions. Thousands are being used to persuade people to buy dietary supplements, diet programs, and other offerings. This study, which involved self-testing with a leading EDS device 43 times in 10 days, found that its assessments and recommendations were preposterous and potentially dangerous. The sale and clinical use of EDS devices should be banned.

Insight into the mechanism of failure of the Riata lead under advisory.

BACKGROUND: Cable externalization and insulation abrasion are known to occur with the St Jude Medical Riata leads under advisory. The distribution of these abnormalities and how they relate to clinical presentation have not been well described. OBJECTIVE: In this study, we sought to determine the relationship between structural lead failure and clinical presentation by using the analysis of returned Riata products in Canada. METHODS: The analyses of returned Riata products in Canada were obtained from St Jude Medical, Sylmar, CA. These data were correlated with the clinical presentation of patients just before lead removal from service. RESULTS: As of May 1, 2013, there were 263 returned Riata leads in Canada. Of these, 43 (16.8%) were found to have insulation abrasion that was due to either lead-can or lead-other device interaction (70%) or inside-out abrasion (27.9%). The predilection of lead-to-can abrasion was seen in the Riata 7-F leads (84.2% vs 58.4%; P = .07), while inside-out abrasion was more common in the Riata 8-F leads (37.5% vs 15.8%; P = .12). Electrical abnormalities were frequent (20 of 31 [65.4%]) and most often due to electrical noise (45.2%), although inappropriate shocks were present (25.8%). Death occurred in 1 of 43 (2.3%) of those patients with an insulation defect in the lead-can abrasion group. CONCLUSION: Lead-can abrasion is the most common form of insulation defect in the Riata group of leads under advisory. Management of this group of leads under advisory should not neglect the issue of lead-can abrasion, in addition to detection of cable externalization.

Use and safety of conducted electronic devices: what is known?

Conductive electronic devices (CED), such as Taser and stun guns, are sold worldwide for use by security services, although they have also been used for self-defence and even for torture. CED are promoted as non-lethal weapons which can potentially save lives. However, there are multiple reports of deaths temporally associated with CED use. These weapons have definite physiological effects in normal volunteers, especially when accompanied by exertion. Medical examiners often report that deaths followed physical encounters which included the use of CED were due to natural causes, excited delirium and/or drug intoxication. These cases present complex situations in which multiple factors potentially contribute to the death, including electric shocks which cause neuromuscular incapacitation, severe pain and anxiety. Public health officials, physicians and hospital personnel need to be aware that individuals controlled with CED are at increased risk of death. We need better recording of incidents worldwide to understand the extent and outcomes of CED use.

Effects of tissue conductivity and electrode area on internal electric fields in a numerical human model for ELF contact current exposures.

Contact currents flow through the human body when a conducting object with different potential is touched. There are limited reports on numerical dosimetry for contact current exposure compared with electromagnetic field exposures. In this study, using an anatomical human adult male model, we performed numerical calculation of internal electric fields resulting from 60 Hz contact current flowing from the left hand to the left foot as a basis case. Next, we performed a variety of similar calculations with varying tissue conductivity and contact area, and compared the results with the basis case. We found that very low conductivity of skin and a small electrode size enhanced the internal fields in the muscle, subcutaneous fat and skin close to the contact region. The 99th percentile value of the fields in a particular tissue type did not reliably account for these fields near the electrode. In the arm and leg, the internal fields for the muscle anisotropy were identical to those in the isotropy case using a conductivity value longitudinal to the muscle fibre. Furthermore, the internal fields in the tissues abreast of the joints such as the wrist and the elbow, including low conductivity tissues, as well as the electrode contact region, exceeded the ICNIRP basic restriction for the general public with contact current as the reference level value.

Occupational exposure to electric fields and currents associated with 110 kV substation tasks.

The main aim of this study was to investigate occupational exposure to electric fields, and current densities and contact currents associated with tasks at air-insulated 110 kV substations and analyze if the action value of EU Directive 2004/40/EC was exceeded. Four workers volunteered to simulate the following tasks: Task (A) maintenance of an operating device of a disconnector at ground or floor level, Task (B) maintenance of an operating device of a circuit breaker at ground or floor level, Task (C) breaker head maintenance from a man hoist, and Task (D) maintenance of an operating device of a circuit breaker from a service platform. The highest maximum average current density in the neck was 1.8 mA/m(2) (calculated internal electric field 9.0-18.0 mV/m) and the highest contact current was 79.4 µA. All measured values at substations were lower than the limit value (10 mA/m(2)) of the EU Directive 2004/40/EC and the 2010 basic restrictions (0.1 and 0.8 V/m for central nervous system tissues of the head, and all tissues of the head and body, respectively) of the International Commission on Non-Ionizing Radiation Protection (ICNIRP).

Sulodexide prevents peripheral nerve damage in streptozotocin induced diabetic rats.

We investigated whether sulodexide has additional protective effects against peripheral nerve damage caused by microvascular dysfunction in a rat model of diabetes. Female Sprague-Dawley (SD) rats were divided into the following 4 groups (n=7-9/group): Normal, Normal+Sulodexide (sulodexide 10mg/kg), diabetic group, and diabetic+Sulodexide (sulodexide 10mg/kg). We assessed current perception threshold, skin blood flow, superoxide dismutase, and proteinuria in experimental rats after oral administration of sulodexide for 20 weeks. We also performed morphometric analysis of sciatic nerves and intraepidermal nerve fibers of the foot. Superoxide dismutase activity in the blood and sciatic nerve were increased significantly after sulodexide treatment in the diabetic group. Current perception threshold was reduced at 2000 Hz (633.3 ± 24.15 vs 741.2 ± 23.5 µA, P<0.05) and skin blood flow was improved (10.90 ± 0.67 vs 8.85 ± 0.49 TPU, P<0.05) in the diabetic+Sulodexide group compared with the diabetic group. The mean myelinated axon area was significantly larger (56.6 ± 2.2 vs 49.8 ± 2.7 µm(2), P<0.05) and the intraepidermal nerve fiber density was significantly less reduced (6.27 ± 0.24 vs 5.40 ± 0.25/mm, P<0.05) in the diabetic+Sulodexide group compared to the diabetic group. Our results demonstrate that sulodexide exhibits protective effects against peripheral nerve damage in a rat experimental model of diabetes. Therefore, these findings suggest that sulodexide is a potential new therapeutic agent for diabetic peripheral neuropathy.

Effects of direct electric current on Herpetomonas samuelpessoai: An ultrastructural study.

The literature shows that the effects of direct electric currents on biological material are numerous, including bactericidal, fungicidal, parasiticidal, and anti-tumoral, among others. Non-pathogenic trypanosomatids, such as Herpetomonas samuelpessoai, have emerged as important models for the study of basic biological processes performed by a eukaryotic cell. The present study reports a dose-dependent anti-protozoan effect of direct electric treatment with both cathodic and anodic current flows on H. samuelpessoai cells. The damaging effects can be attributable to the electrolysis products generated during electric stimulation. The pH of the cell suspension was progressively augmented from 7.4 to 10.5 after the cathodic treatment. In contrast, the anodic treatment caused a pH decrease varying from 7.4 to 6.5. Transmission electron microscopy analyses revealed profound alterations in vital cellular structures (e.g., mitochondrion, kinetoplast, flagellum, flagellar pocket, nucleus, and plasma membrane) after exposure to both cathodic and anodic current flows. Specifically, cathodic current flow treatment induced the appearance of autophagic-like structures on parasite cells, while those submitted to an anodic current flow presented marked disorganization of plasma membrane and necrotic appearance. However, parasites treated in the intermediary chamber (without contact with the electrodes) did not present significant changes in viability or morphology, and no pH variation was detected in this system. The use of H. samuelpessoai as a biological model and the direct electric current experimental approach used in our study provide important information for understanding the mechanisms involved in the cytotoxic effects of this physical agent.

The relationship between residential magnetic fields and contact voltage: a pooled analysis.

It has been suggested that residential exposure to contact currents may be more directly associated with the potential for an increased risk of leukemia in childhood than magnetic fields. Contact current exposure occurs when a child contacts a bathtub's water fixtures, which are usually contiguous with a residence's electrical ground, and when the drainpipe is conductive. The Northern California Childhood Leukemia Study (NCCLS) is the only epidemiological study known to address whether contact current may confound the reported association between residential magnetic fields and childhood leukemia. The study contributed contact voltage and magnetic-field data for over 500 residences of leukemia cases and control children. We combined these data with the results of previous measurement studies of contact voltage in other communities to conduct an analysis of the relationship of magnetic fields with contact voltage for a total sample of 702 residences. The Spearman correlation of magnetic field with contact voltage was 0.29 (Spearman, P < 0.0001). Magnetic-field and contact voltage data were both divided into tertiles, with an upper magnetic-field cutpoint of 0.3 µT suggested by values used in epidemiological results and an upper contact voltage cutpoint of 60 mV based on dosimetric considerations. Expressed as an exposure odds ratios (EOR), we report an association of contact voltage with magnetic fields of 15.1 (95% CI 3.6-61) as well as a statistically significant positive trend across magnetic-field strata (EOR of 4.2 per stratum with 95% CI 2.4-7.4). The associations appear to be large enough to support the possibility that contact current could be responsible for the association of childhood leukemia with magnetic fields.

Exposure to electrical contact currents and the risk of childhood leukemia.

The objectives of this study were to examine the association between contact current exposure and the risk of childhood leukemia and to investigate the relationship between residential contact currents and magnetic fields. Indoor and outdoor contact voltage and magnetic-field measurements were collected for the diagnosis residence of 245 cases and 269 controls recruited in the Northern California Childhood Leukemia Study (2000-2007). Logistic regression techniques produced odds ratios (OR) adjusted for age, sex, Hispanic ethnicity, mother's race and household income. No statistically significant associations were seen between childhood leukemia and indoor contact voltage level [exposure ≥90th percentile (10.5 mV): OR  =  0.83, 95% confidence interval (CI): 0.45, 1.54], outdoor contact voltage level [exposure ≥90th percentile (291.2 mV): OR  =  0.89, 95% CI: 0.48, 1.63], or indoor magnetic-field levels (>0.20 µT: OR  =  0.76, 95% CI: 0.30, 1.93). Contact voltage was weakly correlated with magnetic field; correlation coefficients were r  =  0.10 (P  =  0.02) for indoor contact voltage and r  =  0.15 (P  =  0.001) for outdoor contact voltage. In conclusion, in this California population, there was no evidence of an association between childhood leukemia and exposure to contact currents or magnetic fields and a weak correlation between measures of contact current and magnetic fields.

Occupational exposure to electric fields and induced currents associated with 400 kV substation tasks from different service platforms.

The aim of the study was to investigate the occupational exposure to electric fields, average current densities, and average total contact currents at 400 kV substation tasks from different service platforms (main transformer inspection, maintenance of operating device of disconnector, maintenance of operating device of circuit breaker). The average values are calculated over measured periods (about 2.5 min). In many work tasks, the maximum electric field strengths exceeded the action values proposed in the EU Directive 2004/40/EC, but the average electric fields (0.2-24.5 kV/m) were at least 40% lower than the maximum values. The average current densities were 0.1-2.3 mA/m² and the average total contact currents 2.0-143.2 µA, that is, clearly less than the limit values of the EU Directive. The average values of the currents in head and contact currents were 16-68% lower than the maximum values when we compared the average value from all cases in the same substation. In the future it is important to pay attention to the fact that the action and limit values of the EU Directive differ significantly. It is also important to take into account that generally, the workers' exposure to the electric fields, current densities, and total contact currents are obviously lower if we use the average values from a certain measured time period (e.g., 2.5 min) than in the case where exposure is defined with only the help of the maximum values.

The contribution of cationic conductances to the potential of rod photoreceptors.

The contribution of cationic conductances in shaping the rod photovoltage was studied in light adapted cells recorded under whole-cell voltage- or current-clamp conditions. Depolarising current steps (of size comparable to the light-regulated current) produced monotonic responses when the prepulse holding potential (V (h)) was -40 mV (i.e. corresponding to the membrane potential in the dark). At V (h) = -60 mV (simulating the steady-state response to an intense background of light) current injections <35 pA (mimicking a light decrement) produced instead an initial depolarisation that declined to a plateau, and voltage transiently overshot V (h) at the stimulus offset. Current steps >40 pA produced a steady depolarisation to approximately -16 mV at both V (h). The difference between the responses at the two V (h) was primarily generated by the slow delayed-rectifier-like K(+) current (I (Kx)), which therefore strongly affects both the photoresponse rising and falling phase. The steady voltage observed at both V (h) in response to large current injections was instead generated by Ca-activated K(+) channels (I (KCa)), as previously found. Both I (Kx) and I (KCa) oppose the cation influx, occurring at the light stimulus offset through the cGMP-gated channels and the voltage-activated Ca(2+) channels (I (Ca)). This avoids that the cation influx could erratically depolarise the rod past its normal resting value, thus allowing a reliable dim stimuli detection, without slowing down the photovoltage recovery kinetics. The latter kinetics was instead accelerated by the hyperpolarisation-activated, non-selective current (I (h)) and I (Ca). Blockade of all K(+) currents with external TEA unmasked a I (Ca)-dependent regenerative behaviour.

Factors associated with ureteral burn injury from an electrified guidewire.

PURPOSE: During ureteroscopic procedures, electrocautery is often utilized in the presence of an intra-ureteral guidewire. Inadvertent electrification of the guidewire may occur if the active electrode comes into contact with the guidewire, potentially resulting in a ureteral burn injury. This study investigates under what conditions electrification of a ureteral guidewire would result in ureteral burn injury. MATERIALS AND METHODS: Porcine kidney/ureter units were tested in a saline bath using a guidewire within the ureter. The collecting system was filled with either saline or water and the guidewire was electrified with varying power and mode settings. The contact area between the wire and ureter was adjusted to 1/2 or 1/4 of the total ureteral length. The ureters were then inspected for evidence of burn injury microscopically by a pathologist in a blinded fashion. RESULTS: Ten kidney/ureter units were tested. Four units were filled with saline and none of these demonstrated any burn injury. Six kidney/ureter units were filled with water prior to electrification of the wire. Small amounts of burned tissue were noted in those with the full length of the ureter exposed. Moderate to severe burning was present in those with 1/2 of the ureter exposed. Ureters exposed to 120-W cutting current had more injury than those exposed to 80-W coagulation current. CONCLUSIONS: Inadvertent electrification of a ureteral guidewire does not necessarily result in ureteral burn injury. The presence and extent of ureteral injury depends primarily on the irrigating fluid used, as well as the amount of ureter exposed to the electrified guidewire.

Higher currents, greater risks: preventing patient burns at the return-electrode site during high-current electrosurgical procedures.

Patient burns at the site of the return electrode are a well-known, and generally well-managed, risk of electrosurgery. However, the use of newer electrosurgical devices and techniques that apply higher currents to the patient for longer periods of time has created a new set of burn risks. And the safety measures that have proven effective during conventional electrosurgery can not necessarily be relied on to prevent return-electrode-site burns during these high-current, long-activation-time electrosurgical procedures. In this article, we explain the hazards and detail the factors that can increase the risks of return-electrode-site injuries for a given procedure. We also provide recommendations to help facilities and clinicians minimize those risks.