Sarah Driessen

Determination of morphine and its 3- and 6-glucuronides, codeine, codeine-glucuronide and 6-monoacetylmorphine in body fluids by liquid chromatography atmospheric pressure chemical ionization mass spectrometry

A selective assay of morphine-3-glucuronide (M3G), morphine-6-glucuronide (M6G), morphine, codeine, codeine-6-glucuronide (C6G) and 6-monoacetylmorphine (6-MAM) based on liquid chromatography atmospheric pressure chemical ionization mass spectrometry (LC-APCI-MS) is described. The drugs were extracted from serum, autopsy blood, urine, cerebrospinal fluid or vitreous humor using C18 solid-phase extraction cartridges and subjected to LC-APCI-MS analysis. The separation was performed on an ODS column in acetonitrile-50 mM ammonium formate buffer, pH 3.0 (5:95), using a flow-rate gradient from 0.6 to 1.1 ml/min (total analysis time was 17 min). The quantitative analysis was done using deuterated analogues of each compound. Selected-ion monitoring detection was applied: m/z 286 (for morphine, M3G-aglycone and M6G-aglycone), 289 (for morphine-d3, M3G-d3-aglycone and M6G-d3-aglycone), 300 (for codeine and C6G-aglycone), 303 (for C6G-d3-aglycone), 306 (for codeine-d6), 328 (for 6-MAM), 334 (for 6-MAM-d6), 462 (for M3G and M6G), 465 (for M3G-d3 and M6G-d3), 476 (for C6G) and 479 (for C6G-d3). The limits of quantitation were: 1 microg/l for morphine, 2 microg/l for 6-MAM, 5 microg/l for M3G, M6G and codeine and 200 microg/I for C6G. The recovery ranged from 85 to 98% for each analyte. The method appeared very selective and may be used for the routine determination of opiates in body fluids of heroin abusers and patients treated with opiates.

Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment

Utilization of cardiac implants such as pacemakers and implantable cardioverter defibrillators is now commonplace among heart disease patients. The ever-increasing technological complexity of these devices is matched by the near omnipresent exposure to electric, magnetic, and electromagnetic fields (EMFs), both in everyday life and the occupational environment. Given that electromagnetic interferences (EMIs) are associated with potential risk in device patients, physicians are increasingly confronted with managing device patients with intermittent EMI and chronic occupational exposure. The current review aims to provide a contemporary overview of cardiovascular implantable electronic devices, their function and susceptibility of non-medical EMFs and provide recommendations for physicians caring for cardiac device patients presenting with EMI.

Biological effects of exposure to static electric fields in humans and vertebrates: a systematic review

BackgroundHigh-voltage direct current (HVDC) lines are the technology of choice for the transport of large amounts of energy over long distances. The operation of these lines produces static electric fields (EF), but the data reviewed in previous assessments were not sufficient to assess the need for any environmental limit. The aim of this systematic review was to update the current state of research and to evaluate biological effects of static EF.MethodsUsing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations, we collected and evaluated experimental and epidemiological studies examining biological effects of exposure to static EF in humans (n = 8) and vertebrates (n = 40).ResultsThere is good evidence that humans and animals are able to perceive the presence of static EF at sufficiently high levels. Hair movements caused by electrostatic forces may play a major role in this perception. A large number of studies reported responses of animals (e.g., altered metabolic, immunologic or developmental parameters) to a broad range of static EF strengths as well, but these responses are likely secondary physiological responses to sensory stimulation. Furthermore, the quality of many of the studies reporting physiological responses is poor, which raises concerns about confounding.ConclusionThe weight of the evidence from the literature reviewed did not indicate that static EF have adverse biological effects in humans or animals. The evidence strongly supported the role of superficial sensory stimulation of hair and skin as the basis for perception of the field, as well as reported indirect behavioral and physiological responses. Physical considerations also preclude any direct effect of static EF on internal physiology, and reports that some physiological processes are affected in minor ways may be explained by other factors. While this literature does not support a level of concern about biological effects of exposure to static EF, the conditions that affect thresholds for human detection and possible annoyance at suprathreshold levels should be investigated.

Systematic review of biological effects of exposure to static electric fields. Part II: Invertebrates and plants

Background The construction of high‐voltage direct current (HVDC) lines for the long‐distance transport of energy is becoming increasingly popular. This has raised public concern about potential environmental impacts of the static electric fields (EF) produced under and near HVDC power lines. As the second part of a comprehensive literature analysis, the aim of this systematic review was to assess the effects of static EF exposure on biological functions in invertebrates and plants and to provide the basis for an environmental impact assessment of such exposures. Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) was used to guide the methodological conduct and reporting. Results Thirty‐three studies – 14 invertebrate and 19 plant studies – met the eligibility criteria and were included in this review. The reported behavioral responses of insects and planarians upon exposure strongly suggest that invertebrates are able to perceive the presence of a static EF. Many other studies reported effects on physiological functions that were expressed as, for example, altered metabolic activity or delayed reproductive and developmental stages in invertebrates. In plants, leaf damage, alterations in germination rates, growth and yield, or variations in the concentration of essential elements, for example, have been reported. However, these physiological responses and changes in plant morphology appear to be secondary to surface stimulation by the static EF or caused by concomitant parameters of the electrostatic environment. Furthermore, all of the included studies suffered from methodological flaws, which lowered credibility in the results. Conclusion At field levels encountered from natural sources or HVDC lines (< 35 kV/m), the available data provide reliable evidence that static EF can trigger behavioral responses in invertebrates, but they do not provide evidence for adverse effects of static EF on other biological functions in invertebrates and plants. At far higher field levels (> 35 kV/m), adverse effects on physiology and morphology, presumably caused by corona‐action, appear to be more likely. Higher quality studies are needed to unravel the role of air ions, ozone, nitric oxide and corona current on alterations in physiological functions and morphology. HighlightsEnvironmental impacts of static EF were assessed in invertebrate and plant studies.Invertebrates are able to perceive the presence of static EF near HVDC power lines.No evidence for adverse effects on physiological functions at HVDC field levels.Corona‐action appears to cause adverse biological effects at very high field levels.Methodological flaws in all reviewed studies lowered credibility in the results.

In Vivo Study of Electromagnetic Interference With Pacemakers Caused by Everyday Electric and Magnetic Fields

In daily life and occupational environments, individuals generally encounter electric and magnetic fields (EMFs). They occur mainly with frequencies of 50 Hz/60 Hz, the worldwide power grid frequencies. Examples of EMF sources are power lines, household appliances, electric tools, entertainment electronics, and many different kinds of equipment at work. Electric fields are indicated in kilovolts per meter (kVm-1); magnetic fields, in micro-Tesla (μT). To date, there is no conclusive evidence for the extent to which sources of EMF may cause harmful electromagnetic interference (EMI) in patients with pacemakers or implantable cardioverter-defibrillators. Clinical guidelines on the perioperative management of patients with pacemakers/implantable cardioverter-defibrillators and review articles state that large clinical evaluations and robust scientific data are missing.1,2 An in vivo study from our group suggests that 50-Hz EMFs can disturb implantable cardioverter-defibrillator function in patients,3 but no systematic evaluation has been performed on their effect on pacemaker function. Considering the different sensing algorithms of implantable cardioverter-defibrillators and pacemakers, 2 questions arise: Does exposure to daily life or occupational EMFs disturb regular pacemaker function? And to what level of EMFs are the wearers of pacemakers safe? Therefore, the present in vivo study (ClinicalTrials.gov identifier NCT01626261) sought to determine interference thresholds of pacemakers and to ascertain different conditions for EMI. Of the 119 …

Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review

Abstract Electromagnetic fields (EMF) in the intermediate frequency (IF) range are generated by many novel electrical appliances, including electric vehicles, radiofrequency identification systems, induction hobs, or energy supply systems, such as wireless charging systems. The aim of this systematic review is to evaluate whether cardiovascular implantable electronic devices (CIEDs) are susceptible to electromagnetic interference (EMI) in the IF range (1 kHz–1 MHz). Additionally, we discuss the advantages and disadvantages of the different types of studies used to investigate EMI. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we collected and evaluated studies examining EMI in in vivo studies, in vitro studies (phantom studies, benchmark tests), and simulation studies. Our analysis revealed that cardiac implants are susceptible to malfunction induced by EMF in the IF range. Electromagnetic interference may in particular be provoked by security systems and induction hobs. The results of the studies evaluated in this systematic review further indicate that the likelihood for EMI is dependent on exposure-related parameters (field strength, frequency, and modulation) and on implant- as well as on lead-related parameters (model, type of implant, implant sensitivity setting, lead configuration, and implantation site). The review shows that the factors influencing EMI are not sufficiently characterized and EMF limit values for CIED patients cannot be derived yet. Future studies should therefore, consider exposure-related parameters as well as implant- and lead-related parameters systematically. Additionally, worst-case scenarios should be considered in all study types where possible.

Re: Role of Electromagnetic Field Exposure in Childhood Acute Lymphoblastic Leukemia and No Impact of Urinary Alpha- Amylase - a Case Control Study in Tehran, Iran.

As one of the leading internet information platforms (EMF-Portal at RWTH Aachen University www.emfportal.org) we systematically screen and summarize scientific research on the effects of electromagnetic fields (EMF). Thus we came across the publications by Tabrizi and Bidgoli (2015) and Tabrizi and Hosseini (2015) on prenatal and postnatal exposure to high voltage power lines and the risk of childhood acute lymphoblastic leukemia (ALL), both published in your journal in April and December 2015, respectively. The case-control study by Tabrizi and Bidgoli (2015) was conducted in the city of Isfahan in Iran including 22 cases and 100 controls whereas the case-control study by Tabrizi and Hosseini (2015) was conducted in the city of Tehran in Iran, including the same number of cases and controls. Surprisingly, the results presented in tables 1 and 2 of both publications are identical with similar sized exposure groups leading to similar odds ratios and confidential intervals, also illustrated in the identical figure 1 in both publications. Both publications comprise identical or nearly identical text passages in the chapters ‘Introduction’, ‘Materials and Methods’, ‘Results’ and ‘Discussion’. In our opinion these studies constitute duplicate publications: 1. The only difference between the studies purportedly conducted in Isfahan and in Tehran was the inclusion of urinary alpha-amylase as a biomarker in the more recent publication. No explaining was given, why this parameter was studied. The republishing of the bulk of the earlier study should be stated and the former study should be referenced according to the rules of your journal (“The corresponding author is also responsible for written assurance that the submitted material or portions thereof have neither been published previously nor are under present consideration of publication by this or other journals.” http://www.apocpcontrol.org/page/information. php). 2. The more recent study states in the discussion: “In present work we considered the etiology of ALL for the first time in Iranian population ...” (p7617, 4th paragraph). The same statement appears in the earlier publication (p2350, 3rd paragraph). Therefore both studies are obviously identical, which constitutes duplicate LETTER TO THE EDITOR

Internet Information System and Literature Database on Biomedical Activities of Electromagnetic Fields: Cancer and Cytogenetic Effects

In order to assess potential health effects due to electromagnetic field exposure the outcome of in vitro studies must be compared with the results from existing epidemiological investigations, animal and in vivo experiments. For this purpose, sometimes several hundred publications related to specific exposure conditions must be researched and evaluated in a time-consuming process. The knowledge-based scientific database “EMF-Portal” presented here facilitates this process by providing standardized descriptors of exposure characteristics, material, method and results which have been extracted from individual biological/medical as well as epidemiological publications. In this chapter, an evaluation process concerning the endpoint cancer/genotoxicity, particularly in connection with mobile phone exposure, is presented as an example. Some predominantly epidemiological and a few in vitro investigations have reported to have found effects. According to our assessment, however, there is no clear consistency within the categories (in vitro, in vivo and epidemiology). The EMF-Portal currently contains more than 10,000 publications mainly from peer-reviewed scientific journals; on average, more than 600 new articles are added per year. A comprehensive glossary and a number of additional tools provide the user with valuable medical and technical assistance. A query structure, alternatively general or more detailed, allows the scope of the literature search to be narrowed down to individual publications regarding one particular subject. The EMF-Portal is already available in German and English; other languages can be added. All information collected is available via Internet access and free of charge at http://www.emf-portal.org.