Miniaturized microarray-format digital ELISA enabled by lithographic protein patterning

The search for reliable protein biomarker candidates is critical for early disease detection and treatment. However, current immunoassay technologies are failing to meet increasing demands for sensitivity and multiplexing. Here, the authors have created a highly sensitive protein microarray using the principle of single-molecule counting for signal amplification, capable of simultaneously detecting a panel of cancer biomarkers at sub-pg/mL levels. To enable this amplification strategy, the authors introduce a novel method of protein patterning using photolithography to subdivide addressable arrays of capture antibody spots into hundreds of thousands of individual microwells. This allows for the total sensor area to be miniaturized, increasing the total possible multiplex capacity. With the immunoassay realized on a standard 75x25 mm form factor glass substrate, sample volume consumption is minimized to <10 μL, making the technology highly efficient and cost-effective. Additionally, the authors demonstrate the power of their technology by measuring six secretory factors related to glioma tumor progression in a cohort of mice. This highly sensitive, sample-sparing multiplex immunoassay paves the way for researchers to track changes in protein profiles over time, leading to earlier disease detection and discovery of more effective treatment using animal models.

[The status and influencing factors of presenteeism among clinical nurses: a systematic review]

Objective: To systematically review the status and factors influencing presenteeism among clinical nurses. Methods: In December 2021, CNKI, CBM, Wanfang, VIP, Web of Science, PubMed, Embase, The Cochrane Library, CINAHL, PsyclNFO and other databases were electronically searched to cross sectional studies on the current situation and factors influencing the occurrence of presenteeism among clinical nurses. The search terms mainly included presenteeism, sick at work, Stanford Presenteeism Scale, nurse, level, risk factor, influence, et al. And the search time was from the establishment of the database to November 30, 2021. Literature screening, data extraction and evaluation of the risk of bias in the included literature were done independently by two researchers, and meta-analysis was performed using Stata 15.1 software. Results: A total of 29 studies involving 13 535 clinical nurses were included.The results of the meta-analysis showed that the score of presenteeism was 17.99 [95% CI (17.02-18.95), P =0.000]. Subgroup analysis showed that presenteeism scores were higher in articles published before 2020 (ES=19.28, 95%CI: 18.41-20.15, P=0.000) and in the group of nurses aged 36 to 40 years (ES=19.27, 95%CI: 17.35~21.19, P=0.000), female (ES= 17.04, 95%CI: 14.70-19.39, P=0.000), secondary school education (ES=21.01, 95%CI: 17.76-24.26, P= 0.007), married (ES=17.49, 95%CI: 15.13-19.85, P=0.000), working for 5 to 10 years (ES=17.78, 95%CI: 16.54-19.02, P=0.000), contract (ES=17.05, 95%CI: 15.23-18.87, P=0.000), working in pediatrics (ES= 16.65, 95% CI: 15.31-17.99, P=0.000) and European region (ES =21.21, 95% CI: 20.50-21.93, P=0.000) . Conclusion: Current evidence suggests that clinical nurses are at high risk of presenteeism, which is affected by variety of factors. The managers should pay attention to the physical and mental health of nurses, identify high-risk factors as early as possible and take measures to reduce the occurrence of presenteeism and improve the quality of nursing.

A tissue chip with integrated digital immunosensors: In situ brain endothelial barrier cytokine secretion monitoring

Organ-on-a-chip platforms have potential to offer more cost-effective, ethical, and human-resembling models than animal models for disease study and drug discovery. Particularly, the Blood-Brain-Barrier-on-a-chip (BBB-oC) has emerged as a promising tool to investigate several neurological disorders since it promises to provide a model of the multifunctional tissue working as an important node to control pathogen entry, drug delivery and neuroinflammation. A comprehensive understanding of the multiple physiological functions of the tissue model requires biosensors detecting several tissue-secreted substances in a BBB-oC system. However, current sensor-integrated BBB-oC platforms are only available for tissue membrane integrity characterization based on permeability measurement. Protein secretory pathways are closely associated with the tissue's various diseased conditions. At present, no biosensor-integrated BBB-oC platform exists that permits in situ tissue protein secretion analysis over time, which prohibits researchers from fully understanding the time-evolving pathology of a tissue barrier. Herein, the authors present a platform named "Digital Tissue-BArrier-CytoKine-counting-on-a-chip (DigiTACK)," which integrates digital immunosensors into a tissue chip system and demonstrates on-chip multiplexed, ultrasensitive, longitudinal cytokine secretion profiling of cultured brain endothelial barrier tissues. The integrated digital sensors utilize a novel beadless microwell format to perform an ultrafast "digital fingerprinting" of the analytes while achieving a low limit of detection (LoD) around 100-500 fg/mL for mouse MCP1 (CCL2), IL-6 and KC (CXCL1). The DigiTACK platform is extensively applicable to profile temporal cytokine secretion of other barrier-related organ-on-a-chip systems and can provide new insight into the secretory dynamics of the BBB by sequentially controlled experiments.

The Modular µSiM: A Mass Produced, Rapidly Assembled, and Reconfigurable Platform for the Study of Barrier Tissue Models In Vitro

Advanced in vitro tissue chip models can reduce and replace animal experimentation and may eventually support "on-chip" clinical trials. To realize this potential, however, tissue chip platforms must be both mass-produced and reconfigurable to allow for customized design. To address these unmet needs, an extension of the µSiM (microdevice featuring a silicon-nitride membrane) platform is introduced. The modular µSiM (m-µSiM) uses mass-produced components to enable rapid assembly and reconfiguration by laboratories without knowledge of microfabrication. The utility of the m-µSiM is demonstrated by establishing an hiPSC-derived blood-brain barrier (BBB) in bioengineering and nonengineering, brain barriers focused laboratories. In situ and sampling-based assays of small molecule diffusion are developed and validated as a measure of barrier function. BBB properties show excellent interlaboratory agreement and match expectations from literature, validating the m-µSiM as a platform for barrier models and demonstrating successful dissemination of components and protocols. The ability to quickly reconfigure the m-µSiM for coculture and immune cell transmigration studies through addition of accessories and/or quick exchange of components is then demonstrated. Because the development of modified components and accessories is easily achieved, custom designs of the m-µSiM shall be accessible to any laboratory desiring a barrier-style tissue chip platform.

Ultrasensitive Multiparameter Phenotyping of Rare Cells Using an Integrated Digital-Molecular-Counting Microfluidic Well Plate

Integrated microfluidic cellular phenotyping platforms provide a promising means of studying a variety of inflammatory diseases mediated by cell-secreted cytokines. However, immunosensors integrated in previous microfluidic platforms lack the sensitivity to detect small signals in the cellular secretion of proinflammatory cytokines with high precision. This limitation prohibits researchers from studying cells secreting cytokines at low abundance or existing at a small population. Herein, the authors present an integrated platform named the "digital Phenoplate (dPP)," which integrates digital immunosensors into a microfluidic chip with on-chip cell assay chambers, and demonstrates ultrasensitive cellular cytokine secretory profile measurement. The integrated sensors yield a limit of detection as small as 0.25 pg mL-1 for mouse tumor necrosis factor alpha (TNF-α). Each on-chip cell assay chamber confines cells whose population ranges from ≈20 to 600 in arrayed single-cell trapping microwells. Together, these microfluidic features of the dPP simultaneously permit precise counting and image-based cytometry of individual cells while performing parallel measurements of TNF-α released from rare cells under multiple stimulant conditions for multiple samples. The dPP platform is broadly applicable to the characterization of cellular phenotypes demanding high precision and high throughput.

Machine learning-based cytokine microarray digital immunoassay analysis

Serial measurement of a large panel of protein biomarkers near the bedside could provide a promising pathway to transform the critical care of acutely ill patients. However, attaining the combination of high sensitivity and multiplexity with a short assay turnaround poses a formidable technological challenge. Here, the authors develop a rapid, accurate, and highly multiplexed microfluidic digital immunoassay by incorporating machine learning-based autonomous image analysis. The assay has achieved 12-plexed biomarker detection in sample volume <15 μL at concentrations < 5 pg/mL while only requiring a 5-min assay incubation, allowing for all processes from sampling to result to be completed within 40 min. The assay procedure applies both a spatial-spectral microfluidic encoding scheme and an image data analysis algorithm based on machine learning with a convolutional neural network (CNN) for pre-equilibrated single-molecule protein digital counting. This unique approach remarkably reduces errors facing the high-capacity multiplexing of digital immunoassay at low protein concentrations. Longitudinal data obtained for a panel of 12 serum cytokines in human patients receiving chimeric antigen receptor-T (CAR-T) cell therapy reveals the powerful biomarker profiling capability. The assay could also be deployed for near-real-time immune status monitoring of critically ill COVID-19 patients developing cytokine storm syndrome.

A digital protein microarray for COVID-19 cytokine storm monitoring

Despite widespread concern regarding cytokine storms leading to severe morbidity in COVID-19, rapid cytokine assays are not routinely available for monitoring critically ill patients. We report the clinical application of a digital protein microarray platform for rapid multiplex quantification of cytokines from critically ill COVID-19 patients admitted to the intensive care unit (ICU) at the University of Michigan Hospital. The platform comprises two low-cost modules: (i) a semi-automated fluidic dispensing/mixing module that can be operated inside a biosafety cabinet to minimize the exposure of the technician to the virus infection and (ii) a 12-12-15 inch compact fluorescence optical scanner for the potential near-bedside readout. The platform enabled daily cytokine analysis in clinical practice with high sensitivity (<0.4 pg mL-1), inter-assay repeatability (∼10% CV), and rapid operation providing feedback on the progress of therapy within 4 hours. This test allowed us to perform serial monitoring of two critically ill patients with respiratory failure and to support immunomodulatory therapy using the selective cytopheretic device (SCD). We also observed clear interleukin-6 (IL-6) elevations after receiving tocilizumab (IL-6 inhibitor) while significant cytokine profile variability exists across all critically ill COVID-19 patients and to discover a weak correlation between IL-6 to clinical biomarkers, such as ferritin and C-reactive protein (CRP). Our data revealed large subject-to-subject variability in patients' response to COVID-19, reaffirming the need for a personalized strategy guided by rapid cytokine assays.

A Digital Protein Microarray for COVID-19 Cytokine Storm Monitoring

Despite widespread concern for cytokine storms leading to severe morbidity in COVID-19, rapid cytokine assays are not routinely available for monitoring critically ill patients. We report the clinical application of a machine learning-based digital protein microarray platform for rapid multiplex quantification of cytokines from critically ill COVID-19 patients admitted to the intensive care unit (ICU) at the University of Michigan Hospital. The platform comprises two low-cost modules: (i) a semi-automated fluidic dispensing/mixing module that can be operated inside a biosafety cabinet to minimize the exposure of technician to the virus infection and (ii) a 12-12-15 inch compact fluorescence optical scanner for the potential near-bedside readout. The platform enabled daily cytokine analysis in clinical practice with high sensitivity (<0.4pg/mL), inter-assay repeatability (~10% CV), and near-real-time operation with a 10 min assay incubation. A cytokine profiling test with the platform allowed us to observe clear interleukin-6 (IL-6) elevations after receiving tocilizumab (IL-6 inhibitor) while significant cytokine profile variability exists across all critically ill COVID-19 patients and to discover a weak correlation between IL-6 to clinical biomarkers, such as Ferritin and CRP. Our data revealed large subject-to-subject variability in a patient's response to anti-inflammatory treatment for COVID-19, reaffirming the need for a personalized strategy guided by rapid cytokine assays.

[Effect of curcumin on intestinal mucosal mechanical barrier in rats with non-alcoholic fatty liver disease]

Objective: To investigate the effect of curcumin on intestinal mucosal mechanical barrier in rats with non-alcoholic fatty liver disease. Methods: A total of 30 male Sprague-Dawley rats were equally divided into normal control group, model group, and curcumin intervention group. The rats in the model group and the curcumin intervention group were given high-fat feed for 16 weeks, and those in the curcumin intervention group were given curcumin 200 mg/kg/day by gavage once a day after 8 weeks of high-fat feeding. The rats were sacrificed at the end of week 16. A light microscope was used to observe pathological changes in the liver, an electron microscope was used to observe the tight junction of the intestinal mucosa, an automatic biochemical analyzer was used to measure the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), chromogenic substrate Limulus amebocyte lysate assay was used to measure plasma lipopolysaccharide (LPS) level, spectrophotometric method was used to measure the activity of serum diamine oxidase, ELISA was used to measure the serum level of tumor necrosis factor-α (TNFα), and immunohistochemistry was used to measure the expression of the tight junction protein occludin. One-way ANOVA test and SNK-q test were used for statistical analysis. Results: Under the light microscope, the control group had no hepatocyte steatosis, the model group had significant hepatocyte steatosis and inflammatory cell infiltration, and the curcumin intervention group had reduced hepatocyte steatosis and inflammatory cell infiltration. Under the electron microscope, the control group had a clear and complete structure of the tight junction of the intestinal mucosa and normal structures of mitochondria and endoplasmic reticulum; in the model group, the structure of the tight junction of the intestinal mucosa was destroyed, the intercellular space was widened, the desmosomes had a loose structure, there was edema in some mitochondria, and the endoplasmic reticulum was dilated; the curcumin intervention group had improvements in the structure of tight junction of the intestinal mucosa, intercellular space, edema in the mitochondria, and dilation of the endoplasmic reticulum. Compared with the control group, the model group had significant increases in the serum levels of AST, ALT, DAO, TNFα, and LPS (q = -15.918, -14.402, -33.700, -8.944, and -10.832, P < 0.05); compared with the model group, the curcumin intervention group had significant reductions in the serum levels of AST, ALT, DAO, TNFα, and LPS (q = 10.457, 7.752, 18.802, 5.202, and 4.279, P < 0.05). In the control group, occludin showed a linear distribution along the top of small intestinal mucosal epithelial cells. The model group had a significant reduction in positive staining compared with the control group, and the curcumin intervention group had a significant increase in positive staining compared with the model group. The relative expression of occludin was 0.29±0.03 in the control group, 0.12±0.02 in the model group, and 0.21±0.02 in the curcumin intervention group (P < 0.05). Conclusion: Intestinal mucosal mechanical barrier is impaired in rats with NAFLD. Curcumin can reduce such damage, and its mechanism of action may be related to up-regulating the expression of occludin in the intestinal mucosa and reducing the levels of TNFα and LPS.

[Glucose excursion in senior patients with type 2 diabetes mellitus and coronary artery disease]

Objectives: To explore glucose excursion and incidence of hypoglycemia in senior patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) with different hemoglobin A1c (HbA1c) values. Methods: Eighty-nine outpatients [58 male, 31 female, aged 69.0 (66.0, 73.0) years] diagnosed with T2DM and CAD in Beijing Anzhen Hospital between June 2013 and March 2016 were divided into group A (HbA1c<6.5%, n=25) and group B (HbA1c≥6.5%, n=64). Every patient wore continuous glucose monitoring system (CGMS) for 72 h. Glucose excursion parameters and incidence of hypoglycemia from CGMS readings were calculated. Results: Compared with group B, patients in group A experienced shorter diabetes duration [8.0 (3.5, 15.0) vs 15.0 (8.0, 20.0) years, Z=-2.222, P=0.026], lower standard deviation (SD) of blood glucose from CGMS, mean amplitude of glycemic excursions(MAGE) and mean of the daily differences(MODD) (P=0.001, 0.003, 0.001). However, incidence of hypoglycemia was significantly increased [56.0% (14/25) vs 32.8% (21/64), χ(2)=4.051, P=0.044] in group A. Compared to those who had not experienced hypoglycemia, patients with hypoglycemia had higher SD [1.8(1.4, 2.4) mmol/L vs 1.4(1.1, 1.8) mmol/L, Z=-3.198, P=0.001] and MAGE [6.0(3.2, 7.4) mmol/L vs 3.9(2.7, 4.8 )mmol/L, Z=-2.768, P=0.006] which were appropriate tools for assessing intraday glycemic variability. No statistical difference were found in MODD which was the index for estimating interday glycemic variability. Conclusions: Intensive glycemic control in senior patients with T2DM and CAD had higher incidence of hypoglycemia. Those with hypoglycemia experienced greater intraday glucose excursion.

Multispecies coexistence of trees in tropical forests: spatial signals of topographic niche differentiation increase with environmental heterogeneity

Neutral and niche theories give contrasting explanations for the maintenance of tropical tree species diversity. Both have some empirical support, but methods to disentangle their effects have not yet been developed. We applied a statistical measure of spatial structure to data from 14 large tropical forest plots to test a prediction of niche theory that is incompatible with neutral theory: that species in heterogeneous environments should separate out in space according to their niche preferences. We chose plots across a range of topographic heterogeneity, and tested whether pairwise spatial associations among species were more variable in more heterogeneous sites. We found strong support for this prediction, based on a strong positive relationship between variance in the spatial structure of species pairs and topographic heterogeneity across sites. We interpret this pattern as evidence of pervasive niche differentiation, which increases in importance with increasing environmental heterogeneity.

Successful heart transplantation after 13 hours of donor heart ischemia with the use of HTK solution: a case report

INTRODUCTION

For heart transplantation (HTx), the recommended ischemic time (IT) for donor heart is not to exceed 6 hours. Though Dr Christiaan Barnard used a donor heart with IT of 16 hours, 50 minutes with a portable hypothermic perfusion system in 1981, the recorded IT of donor hearts reported recently is 8 hours, with no adverse effects.

CASE REPORT

The patient, a 14-year-old boy of blood type O, was diagnosed with cardiomyopathy at age 12. In early September 2003, the patient was recommended for HTx. His condition deteriorated 18 days later with low CO, elevated pulmonary vascular resistance, and frequent ventricular tachycardia, further complicated by pneumonia and multiorganism infections, which were contraindications for HTx. On September 22, 2003, a donor heart of blood type O was available 370 km away. Another patient of blood type B with severe heart failure was matched for the HTx. During the intervening time, another donor heart of blood type B became available locally. We matched the type B donor heart to the type B recipient. Since the type O donor heart seemed to be wasted, we performed HTx for the boy. Though preserved for 12 hours in cold cardioplegia, the donor heart was implanted with biatrial anastomosis that took 1 hour. The total IT of this donor heart was 13 hours. The recipient recovered and was discharged 3 months later.

CONCLUSIONS

The IT of 13 hours for this donor heart is believed to be a world record. Our experience demonstrates that preservation time of donor heart may exceed 6 hours.

Successful heart transplantation after 13 hours of donor heart ischemia with the use of HTK solution: a case report

INTRODUCTION

For heart transplantation (HTx), the recommended ischemic time (IT) for donor heart is not to exceed 6 hours. Though Dr Christiaan Barnard used a donor heart with IT of 16 hours, 50 minutes with a portable hypothermic perfusion system in 1981, the recorded IT of donor hearts reported recently is 8 hours, with no adverse effects.

CASE REPORT

The patient, a 14-year-old boy of blood type O, was diagnosed with cardiomyopathy at age 12. In early September 2003, the patient was recommended for HTx. His condition deteriorated 18 days later with low CO, elevated pulmonary vascular resistance, and frequent ventricular tachycardia, further complicated by pneumonia and multiorganism infections, which were contraindications for HTx. On September 22, 2003, a donor heart of blood type O was available 370 km away. Another patient of blood type B with severe heart failure was matched for the HTx. During the intervening time, another donor heart of blood type B became available locally. We matched the type B donor heart to the type B recipient. Since the type O donor heart seemed to be wasted, we performed HTx for the boy. Though preserved for 12 hours in cold cardioplegia, the donor heart was implanted with biatrial anastomosis that took 1 hour. The total IT of this donor heart was 13 hours. The recipient recovered and was discharged 3 months later.

CONCLUSIONS

The IT of 13 hours for this donor heart is believed to be a world record. Our experience demonstrates that preservation time of donor heart may exceed 6 hours.

C57BL/6 and BALB/c bronchoalveolar macrophages respond differently to exercise

Macrophages from prototypical Th1 strains (e.g., C57BL/6) and Th2 strains (e.g., BALB/c) are classified as M-1 and M-2 phenotypes. We investigated the different phagocytic responses between M-1 and M-2 bronchoalveolar macrophages (BAMs) under resting and two various exercise conditions. At rest, M-1 BAMs showed higher phagocytic capacity of unopsonized particles, higher expression of MARCO (macrophage receptor with collagenous structure), and higher generation of NO than M-2 BAMs. Severe exercise, but not moderate exercise, significantly enhanced both phagocytosis of unopsonized particles and expression of MARCO in M-2 BAMs. In contrast, M-1 BAMs were unaffected by either exercise protocol. The phagocytosis of unopsonized particles was largely mediated by MARCO, especially in M-1 BAMs. Secreted products from cultured M-2 BAMs isolated after severe exercise, but not those from M-1 BAMs, enhanced BAM phagocytosis. The cultured M-1 BAMs secreted phagocytosis inhibitors, and this effect could be blocked by NO antagonists. Moreover, the extent of phagocytosis suppression induced by M-1 BAM-secreted products correlated with their production of nitrite/nitrate. Exogenous NO donors as well as NO derivatives, nitrite and nitrate, suppressed the BAM phagocytosis. We propose that while the severe exercise-enhanced phagocytosis in M-2 BAMs was largely mediated by MARCO up-regulation and secretion of stimulators, the lack of exercise effect in M-1 BAMs could be partially due to the constitutive secretion of NO-related suppressors. In conclusion, genetically different mice use different strategies in regulating BAM activity under resting conditions and in response to various exercise paradigms.

Antimicrobial coatings: a remedy for medical device-related infections

This article discusses the mechanisms involved in the different approaches to antimicrobial coatings and reports on a new application that seems to offer an antimicrobial surface that is effective for long-term medical implants and suitable for a variety of drugs.

Role of cupric ions in the H2O2/UV oxidation of humic acids

The purpose of this study is to reveal the role of cupric ions as a natural water contaminant in the H2O2/UV oxidation of humic acids. Humic acids are naturally occurring organic matter and exhibit a strong tendency of complexation with some transition metal ions. Chlorination of humic acids causes potential health hazards due to formation of trihalomethane (THM). The removal of THM precursors has become an issue of public concern. The H2O2/UV process is capable of mineralizing humic acids due to formation of a strong oxidant, hydroxyl radicals, in reaction solution. Experiments were conducted in a re-circulated photoreactor. Different cupric concentrations (0-3.8 mg/l) and different pH values (4-9) were controlled to determine their effects on the degradation of humic acids, UV light absorbance at 254 nm, and H2O2. The presence of cupric ions inhibits humic mineralization and decreases the rate of destruction of humic acids which absorb UV light at 254 nm. On the other hand, the higher the cupric concentration, the lower the H2O2 decomposition rate. In the studied pH range, the minimum of total organic carbon (TOC) removal occurs at pH = 6 in the presence of 2.6 mg/l of cupric ions; both acidification (pH = 4) and alkaline condition (pH = 9) lead to a better removal of TOC. It is inferred from this study that the cupric-complexed form of humic acids is more refractory than the non-complexed one.

Severe exercise enhances phagocytosis by murine bronchoalveolar macrophages

Because physical activity affects the immune competency of individuals by an unknown mechanism, we investigated the effect of acute exercise on phagocytosis of bronchoalveolar macrophages (BAMs). Male BALB/c mice, 7-9 weeks old, ran on a treadmill to exhaustion (severe exercise, SE) or at a final speed of 17 m/min for 30 min (moderate exercise, ME). Although both exercise protocols induced differential leukocytosis, 95% leukocytes from lung lavages of both groups were BAMs. The BAM phagocytic capacity of nonopsonized beads increased immediately after SE but not after ME, gradually returning to the basal level after 4 h. SE upregulates the macrophage scavenger receptors (SR-A type I/II and MARCO), CR3, and ICAM-1, but not Fc gammaR. Although the blocking effect of MARCO antibody was most pronounced, that of ICAM-1 antibody was totally reversed by cross-linking CR3. Our results showed that SE, but not ME, activated BAMs and that the enhanced nonopsonized phagocytosis was mainly mediated by scavenger receptors and ICAM-1/CR3.

Probabilistic approach to ranking sources of uncertainty in ELF magnetic field exposure limits

There is a need to improve the biological data, dosimetry, and risk assessment methodology used for setting guidelines for occupational exposures to extreme-low-frequency magnetic fields. This paper illustrates how a probabilistic approach can be used to determine priorities for future research based upon the analysis of biological and dosimetric variables that affect stimulation of the heart by magnetically-induced currents. A model was constructed to predict a level of whole-body magnetic-field exposure below which no cardiac stimulation is expected (Bncs). For each iteration of the model, a value was selected from cardiac stimulation threshold, shape factor, and conductivity distributions by Latin Hypercube sampling, and a value for Bncs was computed. The very wide range of simulated Bncs magnetic-field values obtained indicates that there is considerable uncertainty about what constitutes a "safe" level of exposure. The results show that the major occupational-exposure guidelines are very conservative with respect to risks of cardiac stimulation. The minimum Bncs value computed (0.01 T) by either a circular-loop model or an ellipsoid dosimetric model is ten times the highest recommended workday exposure value in a guideline. The lowest 5% Bncs value calculated for a circular-loop model is about 50-times the ICNIRP occupational exposure limit; the lowest 5% Bncs value calculated for an ellipsoid model is more than 100 times the ACGIH occupational exposure limit. A new finding is that the method specified by several guidelines for determining guideline compliance when exposures occur at multiple frequencies (additive weighting of harmonics) leads to substantially lower Bncs estimates relative to a probably more valid rms-weighting method. Probabilistic sensitivity analyses indicate that lack of knowledge of the threshold for cardiac stimulation is the greatest source of uncertainty as to what is a "safe" level of exposure to extreme-low-frequency magnetic fields. Additional research to address this source of uncertainty may be expected to have the greatest potential impact to reduce overall uncertainty about safe magnetic field exposures.

Interactions of vancomycin resistant enterococci with biomaterial surfaces

Enterococci are a frequent cause of nosocomial infections and are often found adherent to indwelling catheters. Concern about such device associated infections has increased with the appearance of vancomycin resistant (VR) enterococci. However, the possible influence of vancomycin resistance in the pathogenesis of biomaterial centered infection has not yet been assessed. Using polyethylene terephthalate (PET) disks as model surfaces, the authors evaluated possible differences in the adherence and persistence of vancomycin sensitive (VS) and VR strains of Enterococcus faecium and Enterococcus faecalis on biomaterial surfaces in vitro and in vivo. The results indicate that: 1) as expected, the clearance of free VR and VS organisms after intraperitoneal injection into normal mice is equally efficient. 2) In vitro, VR bacteria are roughly twice as adherent to plasma coated PET surfaces as are VS organisms. 3) However, in vivo persistence of VS organisms preadherent to biomaterial implants is 5- to 10-fold better than that of preadherent VR organisms. The authors now believe that a discrete change in bacterial cell wall composition between VR and VS enterococci may contribute to the substantial differences in bacterial adhesion and survival of adherent organisms.

Summary and evaluation of guidelines for occupational exposure to power frequency electric and magnetic fields

Major U.S. and international guidelines for limiting occupational exposures to EMF are evaluated. These safety guidelines are designed to prevent short-term adverse effects by maintaining bulk-tissue current densities below 10 mA m(-2) (rms). Above this level, effects of induced currents and electric fields can include stimulation of neural and cardiac tissues. The models and input data used by guideline-setting organizations to relate 50/60-Hz magnetic-field exposures to induced current densities differ significantly. In order to develop a better understanding of such differences, the current densities derived from exposure guideline models are compared to minimum thresholds for cardiac stimulation and fibrillation. The nominal minimum thresholds for cardiac stimulation and ventricular fibrillation are 100 times and 200 times greater, respectively, than the current density of 10 mA m(-2) used as a dosimetric limit. However, the assumed relationship between the 10 mA m(-2) dose limit and magnetic field exposure limits introduces additional uncertainty. The ratios between the threshold for cardiac stimulation and the calculated induced current density at the exposure limit vary between a low of 50 and a high of 526, depending upon the guideline. These ratios, as indicators of implicit safety factors, are larger than those recommended to protect against adverse effects of induced current density, including cardiac stimulation, in magnetic resonance imaging or against adverse effects of toxic chemical exposures. This review and assessment of EMF occupational exposure guidelines suggests that several scientific and compliance issues remain ambiguous or unresolved. Recommendations are made for guideline organizations to strengthen and clarify the scientific basis for the guideline process. These recommendations include the documentation of supporting data, development of operational definitions for guidelines, examination of dosimetric models, clarification of safety factors, and identification of high priority topics for future research.

Uncertainty and variation in indirect exposure assessments: an analysis of exposure to tetrachlorodibenzo-p-dioxin from a beef consumption pathway

Indirect exposures to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and other toxic materials released in incinerator emissions have been identified as a significant concern for human health. As a result, regulatory agencies and researchers have developed specific approaches for evaluating exposures from indirect pathways. This paper presents a quantitative assessment of the effect of uncertainty and variation in exposure parameters on the resulting estimates of TCDD dose rates received by individuals indirectly exposed to incinerator emissions through the consumption of home-grown beef. The assessment uses a nested Monte Carlo model that separately characterizes uncertainty and variation in dose rate estimates. Uncertainty resulting from limited data on the fate and transport of TCDD are evaluated, and variations in estimated dose rates in the exposed population that result from location-specific parameters and individuals' behaviors are characterized. The analysis indicates that lifetime average daily dose rates for individuals living within 10 km of a hypothetical incinerator range over three orders of magnitude. In contrast, the uncertainty in the dose rate distribution appears to vary by less than one order of magnitude, based on the sources of uncertainty included in this analysis. Current guidance for predicting exposures from indirect exposure pathways was found to overestimate the intakes for typical and high-end individuals.

Paraspinal muscle evoked cerebral potentials in patients with unilateral low back pain

Cerebral somatosensory evoked potentials (SEPs) were elicited by magnetic stimulation of paraspinal muscles unilaterally at the L2 and L5 levels in 20 healthy subjects and 16 patients with low back pain and unilateral muscle spasm. A magnetic coil with a mean diameter of 4.7 cm was placed tangentially to the skin. The stimulus strength was sufficient to induce a visible muscle twitch without producing muscle contraction in the legs. The potentials recorded over the scalp consisted of several components (P30, N40, P55, N70, and P90) and were elicited in all subjects. In both healthy and patient subjects, paraspinal muscle evoked potentials were readily elicited. Vibration applied to paraspinal muscles, as well as voluntary contraction of paraspinal muscles, was associated with attenuation of the evoked potentials. This finding suggests that muscle spindle receptors provide the afferent input responsible for the early components of the magnetically evoked cerebral potentials. In patients with unilateral muscle spasm, the amplitudes of P30-N40, N40-P50, and P50-N70 were decreased significantly on the affected side when compared with values on stimulation of the unaffected side, as well as those obtained from control subjects. The cerebral evoked potentials returned to normal amplitude when the muscle spasm subsided following a period of time and after the application of spinal manipulative therapy. The technique has potential for quantitative evaluation of muscle spasm in low back pain.

Effects of palmatine on motor activity and the concentration of central monoamines and its metabolites in rats

We used behavioral and biochemical methods to investigate the sedative effect of palmatine on locomotor activity and the concentration of monoamine in rats. It was found that palmatine enhanced the hypomotility induced by alpha-methyl-p-tyrosine, reserpine and 5-hydroxytryptophan, but reduced the hypermotility produced by L-dopa plus benserazide and p-chlorophenylalanine. Furthermore, palmatine significantly decreased the concentration of dopamine and homovanillic acid in the cortex and the concentration of serotonin in the brain stem, and it increased the concentration of 5-HT in the cortex and 5-hydroxyindole acetic acid in the brain stem. These results suggest that the sedative mechanism of palmatine may be related to the decrease in the concentration of catecholamine in the cortex and serotonin in brain stem and the increase in the concentration of 5-HT in the cortex.

The H-reflex to magnetic stimulation of lower-limb nerves

We elicited H-reflexes by magnetic and electrical stimulation of several different nerves in 10 healthy subjects and two patients with S-1 radiculopathy. The posterior tibial nerve at the popliteal fossa and the femoral nerve at the inguinal ligament were tested with both electrical and magnetic stimulation; the proximal sciatic nerve was tested only with magnetic stimulation. Muscle activity was recorded from the soleus muscle for posterior tibial and sciatic nerve stimulation and from the vastus medialis muscle for femoral nerve stimulation. No significant difference was found between the latency of H-reflexes evoked by magnetic or electrical stimulation. With magnetic stimulation, the mean (+/- SD) Ia sensory fiber conduction velocity in the proximal segment of the sciatic nerve was 72.4 +/- 3.3 m/s, while the motor nerve fiber conduction velocity in the same portion of the nerve was significantly slower, at 60.6 +/- 2.0 m/s. In two patients with unilateral S-1 radiculopathy, the latency of the H-reflex from the soleus muscle to both magnetic and electrical stimulation of the posterior tibial nerve was absent or prolonged on the affected side. Magnetic stimulation can be used to study the H-reflex and Ia fiber conduction velocity and is particularly advantageous when testing deeply located nerve trunks.