Trigeminal neurons detect cellphone radiation: Thermal or nonthermal is not the question.

Cellphone electromagnetic radiation produces temperature alterations in facial skin. We hypothesized that the radiation-induced heat was transduced by warmth-sensing trigeminal neurons, as evidenced by changes in cognitive processing of the afferent signals. Ten human volunteers were exposed on the right side of the face to 1 GHz radiation in the absence of acoustic, tactile, and low-frequency electromagnetic stimuli produced by cellphones. Cognitive processing manifested in the electroencephalogram (EEG) was quantitated by analysis of brain recurrence (a nonlinear technique). The theoretical temperature sensitivity of warmth-sensing neurons was estimated by comparing changes in membrane voltage expected as a result of heat transduction with membrane-voltage variance caused by thermal noise. Each participant underwent sixty 12-s trials. The recurrence variable r ("percent recurrence") was computed second by second for the ∆ band of EEGs from two bilaterally symmetric derivations (decussated and nondecussated). Percent recurrence during radiation exposure (first 4 s of each trial) was reduced in the decussated afferent signal compared with the control (last four seconds of each trial); mean difference, r = 1.1 ± 0.5%, p < 0.005. Mean relative ∆ power did not differ between the exposed and control intervals, as expected. Trigeminal neurons were capable of detecting temperature changes far below skin temperature increases caused by cellphone radiation. Simulated cellphone radiation affected brain electrical activity associated with nonlinear cognitive processing of radiation-induced thermal afferent signals. Radiation standards for cellphones based on a thermal/nonthermal binary distinction do not prevent neurophysiological consequences of cellphone radiation.

The link between vitamin D metabolism and sleep medicine.

Vitamin D is a hormone that interacts with intranuclear receptors to effect transcriptional changes in many cell types including those in gut, bone, breast, prostate, brain, skeletal muscle, and the immune system. Inadequacy of vitamin D is widely prevalent, and leads to the classic diseases of bone demineralization as well as to more recently recognized problems such as nonspecific pain and noninflammatory skeletal myopathy, which may disrupt sleep and directly cause daytime impairment. Emerging lines of evidence suggest that low vitamin D levels increase the risk for autoimmune disease, chronic rhinitis, tonsillar hypertrophy, cardiovascular disease, and diabetes. These conditions are mediated by altered immunomodulation, increased propensity to infection, and increased levels of inflammatory substances, including those that regulate sleep, such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1, and prostaglandin D2 (PD2). Together, the recent reports suggest a role for inadequate vitamin D in the development of symptoms of wake impairment commonly associated with sleep disorders. Persistent inadequacy of vitamin D may also increase the risk for obstructive sleep apnea via promotion of adenotonsillar hypertrophy, airway muscle myopathy, and/or chronic rhinitis. Much remains to be learned concerning the complex relationship between chronically low levels of vitamin D, normal sleep, sleep disruption, and daytime neurocognitive impairment.

The effects of mobile-phone electromagnetic fields on brain electrical activity: a critical analysis of the literature.

We analyzed the reports in which human brain electrical activity was compared between the presence and absence of radio-frequency and low-frequency electromagnetic fields (EMFs) from mobile phones, or between pre- and post-exposure to the EMFs. Of 55 reports, 37 claimed and 18 denied an EMF-induced effect on either the baseline electro encephalogram (EEG), or on cognitive processing of visual or auditory stimuli as reflected in changes in event-related potentials. The positive reports did not adequately consider the family-wise error rate, the presence of spike artifacts in the EEG, or the confounding role of the two different EMFs. The negative reports contained neither positive controls nor power analyses. Almost all reports were based on the incorrect assumption that the brain was in equilibrium with its surroundings. Overall, the doubt regarding the existence of reproducible mobile-phone EMFs on brain activity created by the reports appeared to legitimate the knowledge claims of the mobile-phone industry. However, it funded, partly or wholly, at least 87% of the reports. From an analysis of their cognitive framework, the common use of disclaimers, the absence of information concerning conflicts of interest, and the industry's donations to the principal EMF journal, we inferred that the doubt was manufactured by the industry. The crucial scientific question of the pathophysiology of mobile-phone EMFs as reflected in measurements of brain electrical activity remains unanswered, and essentially unaddressed.

Design and implementation of a system-based course in musculoskeletal medicine for medical students.

BACKGROUND: The amount of time devoted to musculoskeletal medicine in the typical undergraduate curriculum is disproportionately low compared with the frequency of musculoskeletal complaints that occur in a general practice. Consequently, whether because of the quantity or quality of the education, the competence level of graduating physicians regarding musculoskeletal problems is inadequate. Our purposes were to design a self-contained, system-based course in musculoskeletal medicine for medical students in the preclinical years and to measure the level of competence achieved by a class of first-year medical students who took the course. METHODS: The course was formulated by faculty from the departments of orthopaedic surgery, anatomy, and rheumatology and included elements of both objectives-based and problem-centered curricular models. The clinical lectures were preceded by pertinent anatomy lectures and dissections to provide a context for the clinical information. The lectures on basic science were designed to rationalize and explicate clinical practices. Small-group activities were incorporated to permit engagement of the students in critical thinking and problem-solving. A general musculoskeletal physical examination was taught in two two-hour-long small-group sessions with the orthopaedic residents serving as instructors. Cognitive competency was evaluated with use of comprehensive anatomy laboratory and written examinations, the latter of which included a validated basic competency examination in musculoskeletal medicine. Process-based skills were evaluated in the small-group meetings and in a timed, mock patient encounter in which each student's ability to perform the general musculoskeletal physical examination was assessed. RESULTS: The course lasted six weeks and consisted of forty-four lecture hours, seventeen hours of small-group meetings, and twenty-eight hours of anatomy laboratory. The average student score on the basic competency examination was 77.8%, compared with 59.6% for a historical comparison group (p < 0.05). Each student demonstrated the ability to adequately perform a general musculoskeletal physical examination in twenty minutes. The survey of student opinion after the course indicated a high level of student satisfaction. CONCLUSIONS: The main features of the course were: (1) an emphasis on both cognitive and process-based knowledge; (2) more contact hours and broader content than in previously described courses in musculoskeletal medicine; (3) the use of small groups to focus on problem-solving and physical examination competencies; (4) basic-science content directly related to clinical goals. These features might be used at other institutions that employ a system-based curriculum for the preclinical years to help improve competence in musculoskeletal medicine.

The effects of low-frequency environmental-strength electromagnetic fields on brain electrical activity: a critical review of the literature.

Reports dealing with the stimulus-response relationship between low-level, low-frequency electromagnetic fields (EMFs) and changes in brain electrical activity permit assessment of the hypothesis that EMFs are detected by the body via the process of sensory transduction. These reports, as well as those involving effects on brain activity observed after a fixed time of exposure, are critically reviewed here. A consistent stimulus-response relationship between EMFs and changes in brain activity has been demonstrated in animal and human subjects. The effects, which consisted of onset and offset evoked potentials, were observed under conditions permitting the inference that the fields were transduced like ordinary stimuli such as light and sound. However, unlike the changes in brain activity induced by these stimuli, the changes induced by EMFs were governed by nonlinear laws. The studies involving attempts to determine whether a period of EMF exposure caused a metabolic effect reflected in pre-exposure/post-exposure differences in brain activity were generally inconclusive.

Chronic knee effusions in patients with advanced osteoarthritis: implications for functional outcome of viscosupplementation.

Intra-articular injection of exogenous hyaluronan (viscosupplementation) is an effective treatment for knee pain due to osteoarthritis, but the amount of dilution of the viscosupplement by the synovial fluid, which could affect efficacy, has not been previously considered. In this study, the synovial fluid volume was measured in patients with advanced osteoarthritis and the variation in viscosupplement concentration that would have occurred had the patients received that treatment was calculated. A closed aspiration was performed under anesthesia in this consecutive, prospective series of patients undergoing total joint arthroplasty for advanced osteoarthritis. Any remaining synovial fluid was collected by means of open aspiration following an arthrotomy. Overall, 27.0 +/- 15.5 mL (range: 10-70 mL) of synovial fluid was present in the joints. Irrespective of the particular proprietary hyaluronan product, the viscosupplement concentration would have varied by an approximate factor of 6. Interpatient variation in volume of synovial fluid may explain some of the observed variations in efficacy in patients treated with viscosupplementation. Stricter attention to the possibility of a joint effusion and aspiration of the joint where indicated might lead to improved results.

Increased intercellular communication through gap junctions may contribute to progression of osteoarthritis.

Our aim was to support the hypothesis of a specific association between gap junctions in synovial tissue and the presence of osteoarthritis, as evidenced by differences between osteoarthritis and non-osteoarthritis synovia in the number of gap junctions, the amount of gap-junction protein, and the amount of enzymatic activity produced through a pathway mediated by gap-junction intercellular communication. An average of 4.41 gap junctions were found per 100 cells counted in the osteoarthritis synovia, compared with 1.00 in the controls. The amount of the gap-junction protein connexin 43 in synovial lining cells was approximately 50% greater in patients with osteoarthritis. Synovial lining cells from patients with osteoarthritis produced matrix metalloproteinases constitutively and, at higher levels, in response to stimulation by interleukin-1 beta. In both cases, intercellular communication through gap junctions was shown to be critical to the ability of the cells to secrete matrix metalloproteinases. Overall, the results indicated that gap junctions between synovial lining cells were altered significantly in patients with osteoarthritis, as a consequence of the disease process or as part of the causal chain. In either case, gap junctions seem to be a rational therapeutic target.

Nonlinear changes in brain electrical activity due to cell phone radiation.

We studied the effect of an electromagnetic field from a cellular telephone on brain electrical activity, using a novel analytical method based on a nonlinear model. The electroencephalogram (EEG) from rabbits was embedded in phase space and local recurrence plots were calculated and quantified using recurrence quantitation analysis to permit statistical comparisons between filtered segments of exposed and control epochs from individual rabbits. When the rabbits were exposed to the radiation from a standard cellular telephone (800 MHz band, 600 mW maximum radiated power) under conditions that simulated normal human use, the EEG was significantly affected in nine of ten animals studied. The effect occurred beginning about 100 ms after initiation of application of the field and lasted approximately 300 ms. In each case, the fields increased the randomness in the EEG. A control procedure ruled out the possibility that the observations were a product of the method of analysis. No differences were found between exposed and control epochs in any animal when the experiment was repeated after the rabbits had been sacrificed, indicating that absorption of radiation by the EEG electrodes could not account for the observed effect. No effect was seen when deposition of energy in the brain was minimized by repositioning the radiating antenna from the head to the chest, showing that the type of tissue that absorbed the energy determined the observed changes in the EEG. We conclude that, in normal use, the fields from a standard cellular telephone can alter brain function as a consequence of absorption of energy by the brain.

Extracellular currents alter gap junction intercellular communication in synovial fibroblasts.

We studied the effect of extremely low frequency (ELF) currents on gap junction intercellular communication (GJIC) mediated by connexin43 protein. Confluent monolayers of synovial fibroblasts (HIG-82) and neuroblastoma cells (5Y) were exposed in bath solution to 0-75 mA/m(2) (0-56 mV/m), 60 Hz. Single channel conductance, cell membrane current-voltage (I-V) curves, and Ca(2+) influx were measured using the nystatin single and double patch methods. The conductances of the closed and open states of the gap junction channel in HIG-82 cells were each significantly reduced (by 0.76 and 0.39 pA, respectively) in cells exposed to 20 mA/m(2). Current densities as low as 10 mA/m(2) significantly increased Ca(2+) influx in HIG-82 cells. No effects were seen in 5Y cells. The I-V curves of the plasma membranes of both types of cells were independent of 60 Hz electric fields and current densities, 0-75 mA/m(2), indicating that the effect of the 60 Hz fields on GJIC in HIG-82 cells was not mediated by a change in membrane potential. We conclude that ELF electric fields can alter GJIC in synovial cells via a mechanism that does not depend on changes in membrane potential, but may depend on Ca(2+) influx. The results open the possibility that GJIC mediated responses in synovial cells, such as for example, their secretory responses to proinflammatory cytokines, could be antagonized by the application of ELF electric fields.