You are on page 1of 25

WATER

The Manipulation of Water with Non-Abla-


tion Radiofrequency Energy: A Repetitive
Molecular Energy Conversion Loop under
Non-Ionizing Electromagnetic Forces
McRury ID1, Morgan RE1, Augé II WK1,*
1
Department of Research and Development, NuOrtho Surgical, Inc. at the Advanced Technology & Manufacturing Center, University
of Massachusetts Dartmouth, Fall River, MA 02723

*Correspondence: Tel: 617-848-8999; Email: wauge@nuorthosurgical.com;

Key Words: radiofrequency, non-ablation, water splitting, arthroscopy, fuel cell


Received 14 June 2010; accepted 10 November; Published 27 November 2010; available online 27 November 2010

Summary oxygen comingled non-condensable gas


production indicative of split water with-
The effects produced by surgical devices out heat transfer or gas generation dynam-
that deploy an electrical circuit between ics of water vapor. The presence of ionized
electrodes are dependent on the nature of charged particles was not detected. These
electrical work performed upon the conduc- results allowed formulation of a stoichio-
tive media in and around biologic tissues. metric model depicting a repetitive mo-
Because this conductive media is water- lecular energy conversion loop from water
based, this study characterizes the effects under non-ionizing electromagnetic forces.
that non-ablation radiofrequency energy Non-ablation radiofrequency applications
exerts upon saline interfacing media typi- utilize the energy from the molecular bonds
cally encountered during surgical applica- of interfacing media water to perform sur-
tions. Non-ablation radiofrequency surgi- gical work without delivering ionizing elec-
cal devices were deployed in a bulk 0.9% tromagnetic radiation.
sodium chloride solution at 300 mOsm/L
at 20oC. During energy delivery, temper- Introduction
ature and pH changes; gaseous species
production, gas condensation behavior, Surgical devices that deploy an electrical
and gas generation dynamics; and ionized circuit between electrodes do so in an elec-
charged particle generation were measured trically conductive medium, which may be
in the region of a constrained primary reac- either in vivo biologic tissues or delivered
tion zone surrounding an active electrode. media such as electrolyte solutions (Ed-
Saline temperature change demonstrated wards et al, 2008; Jossinet, 2008). The tis-
three functional domains commensurate sue effects produced by these devices are
with a decrease in pH at steady-state at the dependent upon the events occurring at or
constrained primary reaction zone without around the electrodes as electrical energy is
changes to the bulk fluid. Gas chromatog- converted to therapeutically useful forms.
raphy, thermal conductivity detector, and Converted energy forms can be either near-
flame ionization detection evaluations mea- field at the electrode surface or far-field
sured a uniform 2:1 ratio of hydrogen and projected away from the electrodes. Near-

WATER 2, 108-132, 27 November 2010 108


WATER
fieldeffects are produced by electrical cur- are created by toxic products such as chlo-
rent and include physiochemical events like rine, oxygen, and hydrogen ions at the anode
electrothermal and electrochemical con- electrode and hydrogen gas and sodium hy-
versions; far-field effects are produced by droxide at the cathode electrode. The region
electromagnetic radiation forces like mag- surrounding the anode becomes very acidic
netic flux densities, voltage potentials, or (~ pH 2) and surrounding the cathode be-
displacement currents generated around comes strongly alkaline (~ pH 12) with the
the electrodes. Gross electrical conduc- amount of necrosis dependent upon the to-
tion in biological tissues is principally due tal electrolysis dose measured in coulombs
to the conductivity of in situ interstitial as a product of tissue current delivery and
fluids which are electrolyte water-based time. A pH less than 6.0 at the anode and
and thus predominantly ionic (Jossinet, greater than 9.0 at the cathode reflects to-
2008). Since the electrical charge carriers tal cellular necrosis. Direct current applica-
in metal electrodes are primarily electrons, tions deliver static electromagnetic fields
the transition between electronic and ionic that have inconsequential energy quanta
conduction is governed by physiochemical in the region of non-necrotic tissue (Oka-
processes at the electrode-to-water inter- fur et al, 2009; van Rongen et al, 2007; Ya-
face within the conductive media (Edwards mashita et al, 2003). Electrolytic ablation
et al, 2008; Matyushov, 2009; Mayer et al, does not rely upon a thermal effect as tissue
1992; Soderberg et al, 2006), even though temperatures rise minimally during these
this process can be altered by electrode con- procedures to levels not associated with cell
tact with macromolecular biologic material death (Baxter et al, 1998; Wemyss-Holden
(Zheng et al, 2000). Electrically conductive et al, 2004).
solutions have been used for many decades
to complete surgical device circuits and no Surgical use of alternating current has been
longer alone serve as a proprietary method designed to induce therapeutic necrosis for
of circuit completion (Elässer and Roos, volumetric tissue removal, coagulation, or
1976). Water is the common operational dissection through near-field electrical cur-
media for both direct current and alternat- rent effects within biologic tissues. Radio-
ing current formulations that have been de- frequency wavelengths and frequencies do
ployed in surgical device designs. not directly stimulate nerve or muscle tis-
sue; and, so are prevalent in medical ap-
Surgical use of direct current induces tissue plications (Paniagua et al, 2009). Radiofre-
necrosis as a means to destroy unwanted quency surgical devices utilize tissue as the
tissue through near-field electrical current primary medium like in direct current ap-
effects delivered into biologic structures plications; however, these surgical devices
(Baxter et al, 1998; Gravante et al, 2009). produce resistive tissue heating (ohmic or
Electrolytic ablation, or tissue electrolysis, Joule heating) by an alternating current
is a technique which consists of placing an induced increase in molecular kinetic or vi-
anode electrode and cathode electrode at brational energy to create thermal necrosis
various points within or adjacent to tissue (Foster and Glaser, 2007; Haines, 2004;
and driving direct current (40-100 mA) be- Nath et al, 1994). In order to obtain the
tween them and through the biologic mass desired levels of thermal necrosis through
to induce tissue electrolysis. The products resistive heating in a media with the excep-
of tissue electrolysis kill cells by creating, in tionally large specific heat capacity of water
a spherical area surrounding the each elec- found in and around biologic tissues, high-
trode, local changes within tissue pH too levels of alternating current deposition are
large for cells to survive. These pH changes required to maintain heat production and

WATER 2, 108-132, 27 November 2010 109


WATER
conduction to remote tissue in the presence etal, 2008). From a surgical work energy
of treatment site thermal convection (Sch- procurement standpoint, these procedures
ramm et al, 2006). In certain settings, high- are defined by an inefficient use of electrical
level energy radiofrequency devices can be energy due to the excess energy deposition
configured to produce water vapor prefer- that occurs within biologic tissue producing
entially through very rapid and intense re- iatrogenic collateral damage. Far-field elec-
sistive heating, overcoming the high heat of tromagnetic forces, although present, are
vaporization at the treatment site (Floume confounded by tissue current deposition or,
et al, 2010; Thompson et al, 2009; Wood in the case of plasma-based radiofrequency
et al, 2005). Coincident with this method, devices, are of such a high intensity consti-
the far-field time-varying electromagnetic tuting local ionizing electromagnetic radia-
forces of these devices deliver energy quan- tion. Electrolytic ablation, radiofrequency
ta able to generate charged plasma particles thermal ablation, and radiofrequency plas-
within the water vapor cloud (Priglinger et ma devices all struggle in balancing volu-
al, 2007; Stadler et al, 2001; Graham and metric tissue removal with healthy tissue
Stadler, 2007). This ionizing electromag- loss because of excess collateral energy de-
netic radiation can induce an electron cas- position into tissue.
cade, which operates over very short dis-
tances (Debye sphere) and with electron Newer surgical uses of alternating current
temperatures of several thousand degrees include non-ablation radiofrequency sys-
Celsius, to produce therapeutic molecular tems which deliver low-level energy to tis-
disintegration of biologic tissues as its ac- sues through a protective tip architecture
tion decays into heat. Radiofrequency ther- that prevents active electrode-to-tissue
mal ablation and plasma-based techniques contact and therefore do not rely upon a
display use limitations associated with their direct electrode-to-tissue interface. The de-
design. Thermal and plasma lesions spread vices are deployed in a saline immersion
according to induced gradients; but, be- setting with the protected electrode creat-
cause of the variable energy transfer coef- ing a more controlled and directed energy
ficients in the treatment settings of biologic delivery to modify or precondition tissue
tissues, iatrogenic tissue charring, necro- allowing tissue preservation even during
sis, and collateral damage from imprecise resection or débridement applications. Be-
heating or excess energy deposition can oc- cause the electrodes do not contact tissue
cur (Palanker et al, 2008; Shrivastava and during activation, electrical current depo-
Vaughn, 2009). sition is concentrated into an interfacing
media within the protective housing rather
Electrolytic ablation, radiofrequency ther- than directly into and through biologic tis-
mal ablation, and radiofrequency plasma- sue as in ablation-based devices. The pro-
based surgical devices are designed for a tective housing provides the ability to move,
direct electrode-to-tissue interface, con- manipulate, and segregate the near-field ef-
centrating near-field electrical energy to fects both tangentially and perpendicularly
perform surgical work centered upon ther- to the tissue surface during modification or
apeutic necrosis. Collateral damage is a preconditioning; and, it can serve as a me-
normal procedural consequence since the chanical implement and selective throttling
application locales to which these devices vent/plenum during use. For example, the
are deployed can often accommodate an near-field effects are often configured to
excess or imprecise application of energy to match current density dispersion with bio-
ensure expedient procedural efficacy within logic tissue surfaces in a procedure-specific
varying treatment site conditions (Palanker manner. This design allows more consis-

WATER 2, 108-132, 27 November 2010 110


WATER
tent electrical current near-field effects at collateral damage.
the electrode surface because the circuit is
not required to accommodate widely fluc- Although non-ablation systems have been
tuating impedance changes that tissue con- shown to be very useful in tissue preserva-
tacting electrodes create (Avitall et al, 1997; tion settings, their mechanism of action is
Floume et al, 2010; Jossinet and Desseux, less well known. The purpose of this study
2004; Nath et al, 1994). Accordingly, tissue is to characterize the effects of non-ablative
electrolysis and resistive (ohmic or Joule) radiofrequency energy deposition upon sa-
tissue heating can be prevented. These de- line interfacing media typically encountered
vices allow a more efficient surgical work during surgical applications. Because non-
energy procurement as iatrogenic collat- ablation radiofrequency devices do not rely
eral tissue damage is minimized without upon a direct electrode-to-tissue interface,
compromising procedural efficacy. Non- this study evaluates both the near-field ef-
ablation devices can deliver useable far- fects on the saline interfacing medium and
field electromagnetic forces to surface and the far-field effects which can be delivered
subsurface tissues designed to create quan- into biologic tissue. By characterizing these
titatively and qualitatively larger strengths water-based events, the beneficial surgical
in tissue not damaged by excessive current outcomes observed with non-ablation ra-
deposition or ionizing electromagnetic ra- diofrequency energy can be further clari-
diation. These devices are used to permit fied.
normal tissue healing responses during Methods and Materials
modification and preconditioning through
segregated near-field effects, while creat- Figure 1 depicts a representative non-abla-
ing far-field electromagnetic intensities de- tion radiofrequency surgical device exhibit-
signed to induce tissue healing responses ing a protective housing that prevents active
within the preserved tissue not subjected to electrode-to-tissue contact, ensuring direct

Figure 1: Representative radiofrequency device tip with a protected active electrode designed for non-
ablation surgical treatments in a saline immersion setting. The area within the ceramic insulator and
around the active electrode is the primary reaction zone wherein the saline interfacing media is worked
upon by the radiofrequency energy. Electrical current is delivered to the interfacing media at the elec-
trode surface and the precipitant reaction products can be directionalized by the configuration of the
ceramic insulator openings to the treatment site. Note that the active electrode does not protrude from
the edge of the ceramic housing.

WATER 2, 108-132, 27 November 2010 111


WATER
energy delivery to the saline interfacing me- ingto an electrosurgical generator deliver-
dia at the electrode surface. The electrode ing radiofrequency energy at varying power
was comprised of stainless steel (Call et al, outputs (0-350W), voltage potentials (0.1-
2009; Mayer et al, 1992) containing a small 4.5 kV), and frequencies (100kHz-1MHz).
amount of titanium (0.5%) used to stabilize A general distinguishing characteristic of
its structure at higher temperatures, to pre- non-ablation, when compared to ablation,
vent carbide precipitation from the grain radiofrequency energy is a low current den-
boundaries, and to protect the metal from sity bias combined with a high voltage po-
corrosion. The protective housing was com- tential bias.
prised of an electrical and thermal insulat-
ing ceramic designed to prevent electrode- The devices were tested in the apparatuses
to-tissue contact and create a constrained depicted in Figures 2-4 with the device tips
primary reaction zone around the surface fully immersed in bulk 0.9% sodium chlo-
of the active electrode. The devices were ride at 300 mOsm/L at 20oC typically used
configured in a bipolar fashion by connect- during surgical applications. During test-

Figure 2: Experimental laboratory set-up designed to evaluate the near-field effects of non-ablation ra-
diofrequency manipulation of saline interfacing media. The pH detector is shown away from the probe’s
primary reaction zone for purposes of illustration. The temperature probe is not shown. The temperature
and pH of both the primary reaction zone and the bulk solution was measured independently. The gas
collection process included an inverted glass collection tube fully filled with the same interfacing media as
in the reaction reservoir to create a manometer fluid column that could be displaced by collected gas. Gen-
erated gas bubbles were allowed to naturally float into the capture section of collecting tube via buoyancy
forces to displace approximately 95% of its total volume. Thereafter, the gas was evacuated from the col-
lection tube by partially opening the stop-cock valve to form a restriction and then sequentially opening the
needle valve allowing the gas to fill the summa canister. The combined flow restrictions allowed inlet gas
rate metering to avoid unwanted water uptake into the summa canister. The summa canister was allowed
to maintain an intact partial vacuum with an attached pressure gauge so that the receiving laboratory
could verify whether inadvertent uptake of contaminating atmosphere had occurred during transport.

WATER 2, 108-132, 27 November 2010 112


WATER
ing,the devices were driven to steady-state Gas generation dynamics at the electrode
conditions unless otherwise noted. surface were characterized by video assess-
ment and digitized (1188HD 3-Chip camera
Figure 2 apparatus was used to evaluate with SDC digital capture; Stryker Corpora-
the near-field effects of non-ablation ra- tion; Kalamazoo, MI) to allow comparison
diofrequency energy that occur at the ac- to a control of water vapor bubble produc-
tive electrode surface within the primary tion typical of ablation-based radiofrequen-
reaction zone of the protective tip hous- cy devices. Bubble time to release state from
ing. Temperature (TrueRMS Supermeter, the electrode, diameter and volume, shape
Newport Electronics, Inc.; Santa Ana, Cali- and conformational fluctuation, coalescent
fornia) and pH (VWR Scientific Products; tendencies, directional mass transfer fluid
West Chester, Pennsylvania) changes of the delivery properties, and relative terminal
interfacing media were measured in both velocity were assessed qualitatively.
the primary reaction zone at the protective
housing opening and the bulk solution away Figure 3 apparatus was used to evaluate the
from the device during probe activation. far-field effects of non-ablation radiofre-
Produced gas was collected and analyzed by quency energy that might occur within the
ASTM D-1946 gas chromatography, ther- electromagnetic fields generated by the sur-
mal conductivity detector, and flame ioniza- gical device as a result of the near-field ener-
tion detection evaluations (GC/TCD/FID) gy conversions. The production of ionizing
for constituent species (Air Toxics, LTD; electromagnetic radiation was monitored
Folsom, CA). A separate glass container of using a radiation particle detector in the
collected gas was allowed to stand at ambi- treatment field sensitive to 200 disintegra-
ent conditions to determine condensation tions per minute at 1 mm distance from the
behavior as an additional determinant as to air-water interface, a distance over which
whether water vapor was present. a 0.5 keV particle would be transmitted as

Figure 3: Experimental laboratory set-up designed to determine whether generation of charged par-
ticles occurs with non-ablation radiofrequency manipulation of saline interfacing media. The distances
between the electrode and the water surface are exaggerated for purposes of illustration.

WATER 2, 108-132, 27 November 2010 113


WATER
theremoval of shell electrons emits charac- Near-Field Characterization

teristic energies from a few keV to over 100


keV. This sequential phase interface design General Observations
allowed particles to be detected if produced Two non-ablation radiofrequency energy
in any appreciable quantity above normal conversion modes were evident based upon
background radiation. The device was acti- visual cues that can be used to define sur-
vated for a continuous 30 minutes. gical work on water: one during which the
Figure 4 apparatus was used to time inte- device deploys energy levels that do not
grate roentgenographic film exposure by produce non-soluble gas; the other dur-
ionizing electromagnetic particle genera- ing which non-soluble gas is produced. As
tion. The surgical device was fully immersed demonstrated in Figure 5, these modes
and placed with the active electrode within were part of an observable continuum that
1 mm of the roentgenographic cassette wall was dependent upon power level applied
of the reservoir and activated for a continu- to the interfacing media. In all instances, a
ous 30 minutes allowing any ionized reac- steady state was achieved with probe acti-
tion zone species to integrate over time and vation by 3 seconds. The threshold for non-
expose the film. A control emitter source of soluble gas production detectable by gross
alpha (α) particles and low energy gamma visualization was a power delivery of 35W.
rays of 60 keV, americium-241, was adhe- Voltage and frequency influences on steady
sively affixed to the roentgenographic wall state for a given power delivery level did not
with the same spacing of 1mm to demon- significantly alter the threshold for gas pro-
strate time dependant control exposure. duction within the ranges tested.

Figure 4: Time integrated experimental laboratory set-up designed to determine whether generation
of charged particles occurs with non-ablation radiofrequency manipulation of saline interfac-
ing media. The distances between the electrode and the roentgenographic wall are exaggerated for
purposes of illustration. The americium-21 control source is not shown.

WATER 2, 108-132, 27 November 2010 114


WATER

Figure 5: General observations of non-ablation radiofrequency energy manipulation of saline inter-


facing media. Electrothermal, electrochemical, and gas generation dynamics. Static images taken dur-
ing videography and digitization. Power delivery: a, 0 Watts; b, 25W; c, 50W; d, 75W; e, 100W; f,
120W. Note that early non-soluble gas (bubble) production does not begin until 35W, after which the
non-soluble gas production level remained consistent without overwhelming the dynamics of the pri-
mary reaction zone until 75 W when the turbulence and mass effect of the increased gas production
facilitated the removal of the reactants/products from the primary reaction zone more dramatically.

WATER 2, 108-132, 27 November 2010 115


WATER
Electrothermal Effects theprimary reaction zone demonstrated a
linear relationship between power delivery
Electrothermal effects of the primary reac- and unit pH drop until energy delivery was
tion zone are depicted in Figure 6. Temper- terminated at which time rapid normaliza-
ature at steady-state was generated well be- tion occurred. The bulk saline bath did not
low the level at which water vapor could be change pH significantly during the testing
produced. The thermal gradients migrated with probe activation.
from the electrode based upon typical ther-
modynamic behavior but could be altered Collectable Gas Production
by the configuration of the protective hous-
ing. The bulk saline bath did not change Non-soluble gas production correlated with
temperature significantly during the testing temperature and pH observations. From
with probe activation. 0-35W of energy delivery (Phase 1), non-
soluble gas was not produced, temperature
Electrochemical Effects did not increase, but pH decreased. From
35-75W (Phase 2), non-soluble gas was
Electrochemical effects of the primary reac- produced at levels that did not overwhelm
tion zone are depicted in Figure 7. These ef- the dynamics of the primary reaction zone
fects were evident visually as a pH fluid wave commensurate with a linear temperature
with the acid-base shift migrating based increase and linear pH decrease. From 75-
upon typical solution densities, but could 120W (Phase 3), non-soluble gas produc-
be directionalized based upon configuration tion increased to a level that overwhelmed
of the protective housing (see Figure 5 not- the primary reaction zone dynamics and
ing the varying probe positions). The pH of was associated with a decrease in tempera-

Figure 6: Graphic representation of temperature changes versus power delivery at the primary reac-
tion zone when non-ablation radiofrequency energy is delivered to saline interfacing media. The tem-
perature distribution demonstrated three distinguishable functional domains: the first domain (0-35W)
revealed no temperature change associated with the lack of non-soluble gas formation; the second do-
main (35-75W) revealed a linear relationship of temperature increase during low-level non-soluble gas
formation; the third domain (75-120W) revealed a decrease in temperature associated with more pro-
nounced non-soluble gas formation despite the increased power delivery to the primary reaction zone.

WATER 2, 108-132, 27 November 2010 116


WATER
turedespite the increased energy delivery ly, were small in size on the order of a 125x
and a more scattered but linearly decreas- smaller volume, remained spherical with-
ing pH. out confirmation fluctuations typical of the
much larger water vapor bubbles, did not
ASTM D-1946 GC/TCD/FID analysis yield- coalesce with other bubbles, demonstrat-
ed uniform species results in all instances ed directional mass transfer fluid delivery
with a 2:1 ratio of hydrogen and oxygen properties, and displayed a slower terminal
comingled gas without significant atmo- velocity. Gas bubble flow dynamics were
spheric contamination or evidence of water easily modulated with the protective hous-
vapor. The collected gas was not condens- ing throttling vent/plenum (see also Figure
able within the separate glass collection 5).
container confirming the ASTM D-1946
GC/TCD/FID analysis lacking water vapor. Far-Field Characterization
Consistent with the constituent make-up Electromagnetic Field Characteriza-
of the collected gas, the gas bubble dynam- tion
ics were different from that of water va-
por bubble production used as a control as During operation, particles were not sensed
noted in Figure 8. When compared to wa- by the radiation particle detector above
ter vapor bubble generation, the comingled standard background which averaged ap-
oxygen and hydrogen gas bubbles reached proximately 2.5 mSv/yr at the testing lo-
release state from the electrode very rapid- cale. After 30 minutes of exposure to both

Figure 7: Graphic representation of pH changes versus power delivery at the primary reaction zone
when non-ablation radiofrequency energy is delivered to saline interfacing media. R2 = 0.311; p<0.02.
Note that the goodness-of-fit linear regression is better for the segment during which low level non-sol-
uble gas formation occurs (35-75W) with increasing scatter as the primary reaction zone turbulence in-
creased.

WATER 2, 108-132, 27 November 2010 117


WATER

Figure 8: Gas general dynamics of non-ablation (a) versus ablation (b) radiofrequency energy deposi-
tion upon saline interfacing media. The ablation electrode is shown at tissue contact during use; whereas
the non-ablation electrode is shown without tissue present as it cannot touch tissue during use. The larger
bubble in (a) has a diameter of 0.3 mm; the singular bubble in (b) has a diameter of 3.9 mm. Water vapor
bubbles (b) typically were larger, with a surface tension, adhesion dependant stalk connecting it to the
electrode prior to release.

non-ablation radiofrequency energy depo- are governed by the relative availability of


sition and americium-241 source, only the the reactants and products within the pri-
americium-241 source area was exposed. mary reaction zone. The initial splitting of
The area immediately adjacent to the elec- water is slightly endothermic driven by the
trode remained unexposed and clear of any low current and high activation overpoten-
image. Non-ablation radiofrequency energy tial of non-ablation radiofrequency energy.
produced only non-ionizing electromagnet- In this setting, gas emanation is inefficient
ic forces. as bubble threshold fluencies and bubble
lifetime dictate aqueous nano-sized bubble
Treatment Site Characterization production that are immediately converted
back to water. As gas emanation is produced,
Stoichiometry
bubble size remained very small with high
The defined reactants (0.9% sodium chlo- release rates; therefore, the electrode-to-
ride aqueous solution, radiofrequency en- water interface surface area was not signifi-
ergy) and resultant products (2:1 ratio of H2 cantly altered by gas production at any set-
and O2 gas, pH drop, heat) present in this ting thereby limiting significant electrode
study, along with the generation dynamics current density or impedance fluctuations.
and lack of ionizing electromagnetic radia- This phenomenon was further supported by
tion observed, allow formulation of a uni- the high voltage potentials delivered which
form stoichiometric thermochemical de- diminish any minimal effect of bubble in-
scription of non-ablation radiofrequency duced conduction area reduction. As gas
deposition upon saline interfacing media. emanation occurred and gas was liberated
This formulation is depicted in Figure 9a-d. from the primary reaction zone by buoyan-
cy forces, complementary liberation of ad-
The overall process utilizes alternating cur- ditional acid-base pairs necessarily occurs,
rent to rapidly split and reconstitute water both of which may be modulated by the pro-
in a repetitive molecular energy conversion tective housing throttling vent/plenum.
loop. The general, electrothermal, electro-
chemical, and gas production observations

WATER 2, 108-132, 27 November 2010 118


WATER

Figure 9a: Reaction stoichiometry of the near-field effects of non-ablation radiofrequency manipulation
of saline interfacing media. Two half-reactions of the thermochemical cycle that describe the quantitative
relationships between the reactants and products for the repetitive molecular energy conversion loop.
[(aq) = aqueous; (g) = gas; (l) = liquid; (s) = solute].

Figure 9b: With loss of reactants or products from the primary reaction zone, such as gas emanation
modulated by the protective housing throttling vent/plenum, the electrochemical effects can become more
visible. These electrochemical effects are termed an acid-base shift.

Figure 9c: A more general case in which the ionic salt is represented by variable X, where X is any ap-
propriate group 1, period 1-7 element of the periodic table. The salt-bridge catalytic efficiency is depen-
dent upon the salt’s elemental properties. [(aq) = aqueous; (g) = gas; (l) = liquid; (s) = solute].

WATER 2, 108-132, 27 November 2010 119


WATER

Figure 9d: The repetitive molecular energy conversion loop is demonstrated by variables consisting of
α, β, γ and δ wherein, the molar quantities required are any value that appropriately satisfies the oxida-
tion reduction valence requirements for the overall reaction. [(aq) = aqueous; (g) = gas; (l) = liquid; (s)
= solute].

Representational Model zone. This reaction is not possible to deploy


without the protective housing around the
Figures 10 illustrates a representational active electrode due to the large fluid flow
model summarizing non-ablation radio- fields present during surgical application.
frequency energy manipulation of saline
interfacing media with overlaid equations Phase 1 observations (0-35W, inef-
on the depicted physical flow-field of sur- ficient water splitting, limited water
gical application. The electrode provides reconstitution)
conducted electrical energy to the elec-
trode-water interface through the a salt ion At this energy input level, alternating cur-
solution whereby water splitting causes the rent is very inefficient at splitting water and
accumulation of oxygen and hydrogen gas- producing non-soluble gas, an endothermic
es immediately about the electrode which reaction. Non-soluble gas is not produced
rapidly reduce to water and heat. As the indicating the reaction zone has yet to reach
reaction takes place, buoyancy forces allow gas saturation characteristics to generate
non-soluble gas to escape the primary reac- non-soluble gas production. Therefore, the
tion zone; while acid-base pairs of greater reconstitution of water, an exothermic re-
density descend away from the electrode action, does not occur to a level that would
with artifacts visible as density streak-lines. demonstrate a significant increase in tem-
As the acid-base pairs move away from the perature at the unconstrained edge of the
electrode, cooling takes place which results protective housing. The noted decrease in
in a normal precipitation. This reactant- pH is indicative of water splitting.
product escape, although modulated by the Phase 2 observations (35-75W, effi-
protective housing, is facilitated by normal cient water splitting and reconstitu-
fluid flow in the surgical environment that, tion)
in addition, simultaneously induces con-
siderable reaction zone quenching while Increasing alternating current delivery be-
preventing reaction zone water-starvation. comes more efficient at splitting water as
Therefore, the repetitive molecular ener- non-soluble gas is produced consistent with
gy conversion loop does not result in any gas saturation characteristics of the primary
volumetric loading of the primary reaction reaction zone. Therefore, more split water

WATER 2, 108-132, 27 November 2010 120


WATER
isavailable for reconstitution, producing an more
rapidly. This non-soluble gas removal
increase in temperature as power increases
and increased acid-base shift decreases the
consistent with the increased frequency of
efficiency of water reconstitution which in
water reconstitution, an exothermic reac-turn decreases the frequency of exothermic
tion. pH continues to drop consistent with
water reconstitution resulting in the not-
the process of splitting water and reactant/
ed temperature decrease. pH continues to
product migration from the primary reac- drop consistent with the process of splitting
tion zone. water and reactant/product migration from
the primary reaction zone, although more
Phase 3 observations (75-120W, more scattered based upon the altered primary
efficient water splitting and less effi- reaction zone dynamics.
cient water reconstitution)
Further increasing alternating current in-
Discussion
duces even larger amounts of non-soluble The results of this study demonstrate that
gas production facilitating increased prima- non-ablation radiofrequency energy pro-
ry reaction zone turbulence and mass trans- duces distinct near-field and far-field effects
port effect removing reaction reactants/ as electrical energy is converted to a thera-
products from the primary reaction zone peutically useful form. Near-field effects to

Figure 10: Diagrammatic representation of the manipulation of saline interfacing media by non-abla-
tion radiofrequency energy. Note that the protective housing is not shown for the purposes of illustration.
Ablation devices have exposed electrodes making any attempt at low energy physiochemical conversions
inconsequential due to the large physical fluid flow and convective forces present during surgical applica-
tion; hence their design necessitates a large amount of energy delivery. Faded triangles represent electro-
thermal effects; wavy lines represent electrochemical effects. Vf represents the convective force velocity
of the fluid flow outside of the protective housing; Vb represents bubble buoyancy force velocity of non-
soluble gas production; gc represents gravitational forces exerted upon the denser acid-base precipitants;
h1 represents electrothermal heat within the protective housing; and h2 represents the electrothermal heat
that may leave the primary reaction zone.

WATER 2, 108-132, 27 November 2010 121


WATER
perform surgical work are created by a ther- upon an electrically conductive media can
mochemical cycle originating directly from follow distinct pathways based upon the
the molecular bond energy of water. This nature of electrical work desired (Chelli et
electrosurgical refinement creates an ener- al, 2005; England et al, 2008; Graziano,
gy efficient procurement system that is a sis- 2006; Iuchi et al, 2007; Tan and Luo, 2007;
ter technology to other methods designed to Vaitheeswaran et al, 2005). These pathways
capture released molecular energy from wa- are determined by structural rearrange-
ter like fuel cells, photolysis, and photosyn- ments of water molecules that are subjected
thetic machinery (Lee et al, 2010; McKinlay to the radiofrequency energy effects upon
and Harwood, 2010). Non-ablation surgical the interfacing media molecular dynam-
devices utilize alternating current to rap- ics. Whether the interfacing media is in or
idly split and reconstitute water in a repeti- around biologic tissues, it is governed by
tive molecular energy conversion loop as a hydrogen bond behavior and proton trans-
means to modify or precondition biologic port (Chen et al, 2010; Eaves et al, 2005;
tissues. Active electrode current density Elsaesser, 2009; Fayer et al, 2009; Livesay
dispersion is manipulated by the protective et al, 2008; Teixeira, 2009; Wernet et al,
housing to limit current delivery into tis- 2004) that allow for widely malleable struc-
sues as current can be detrimental through tural fluctuations of liquid water molecules.
tissue electrolysis and/or resistive (ohmic These fluctuations are due to water’s very
or Joule) heating. The near-field effects of dynamic hydrogen bond network which dis-
current are delivered to the tissue surface plays the inherent ability to both exhibit si-
rather than relying upon an electrode-to- multaneous behavioral states and to rapidly
tissue interface as in ablation-based devices reconfigure to accommodate physiochemi-
designed to eliminate, coagulate, or dissect cal perturbations (Matharoo et al, 2009;
tissues. Because the near-field effects of cur- Pártay and Jedlovszky, 2005; Poole et al,
rent are geographically constrained within 1994). With ablation- and plasma-based
the protective housing, these effects can be radiofrequency systems, resistive heating
manipulated based upon procedure-specif- is produced predominantly by molecular
ic needs with the protective housing serv- kinetic and vibrational motions occurring
ing as a mechanical adjunct to and selective within and amongst the hydrogen bond net-
throttling vent/plenum for energy and re- work. Rapid and intense resistive heating
actant/product delivery. The devices allow can produce a phase transition from liquid
far-field electromagnetic forces to manifest water to water vapor as vibrational motions
within tissue unencumbered by current de- further exert a predominate role in the ul-
position and which are of intensities that trafast loss of liquid water’s structural con-
do not create ionizing forces. A differential figuration leading toward phase transition
between current density dispersion and (Fayer et al, 2009; Park et al, 2009; Wernet
electromagnetic field strength is exploited et al, 2004; Zahn, 2004). This process is
to allow a normal healing response of tis- energy intensive due the high specific heat
sues in reaction to the near-field treatment capacity and heat of vaporization of water
effects of tissue modification and precon- (Raabe and Sadus, 2007). In the presence
ditioning, while permitting far-field effects of charged species like salts, this tempera-
designed to induce therapeutic responses in ture driven phase transition process from
the treated tissues that have been protected rapid resistive heating at the electrode is
from the collateral damage of electrode-to- slowed by 3-4 times, which further increas-
tissue interfaces. es the amount of energy required to reach
phase transition (Fayer et al, 2009; Nucci
The application of radiofrequency energy

WATER 2, 108-132, 27 November 2010 122


WATER
and Vanderkooi, 2008). Once phase transi- ter.Splitting water is a mildly endothermic
tion occurs, water vapor and other elements reaction that is driven by the low-energy
can be ionized by the electromagnetic forces near-field effects of non-ablation current;
associated with this radiofrequency energy whereas, reconstitution back to water is
level required to drive the heating process exothermic providing assistive energy for
to phase transition (Priglinger et al, 2007; further repetitive molecular energy conver-
Stadler et al, 2001; Graham and Stadler, sion loops ultimately deployed for surgical
2007). work. The alternating current allows each
electrode to perform each redox half-reac-
In contrast, non-ablation radiofrequency tion, but the effects can vary between elec-
energy requirements are low because the trodes because of architectural nuances.
requisite energy input is limited to splitting The initial reaction activation barrier is the
water which then creates a repetitive molec- four electron oxidation of water to oxygen
ular energy conversion loop that self-fuels during the anode phase of water splitting.
due to the exothermic reaction of water re- This barrier is overcome by increased volt-
constitution. Charged species like salts, in age potentials between the electrodes rather
distinction to their effect during resistive than by increased current so that architec-
heating, decrease the system energy re- tural nuances of the electrodes are primar-
quirements because they serve as an energy ily due to the magnitude of voltage potential
salt-bridge catalyst facilitating water split- difference rather than current density dis-
ting by forming, breaking, and nucleating parities (Lewis et al, 2010; Rahimi and Mik-
hydrogen bonds between acid-base pairs kelsen, 2010). At the frequencies employed,
and water molecules (Nahtigal and Svish- this process is very inefficient at producing
chev, 2009). As this study demonstrates, non-soluble gas (Kikuchi et al, 2006; Ki-
water splitting is a low energy initiation kuchi et al, 2009; Yang et al, 2009; Zhang
process associated with non-ionizing elec- et al, 2006). When non-soluble gas is pro-
tromagnetic forces. Without the protective duced, it is limited to molecular hydrogen
housing around the active electrode, this and oxygen which is effectively managed
physiochemical process would be rendered by the protective housing throttling vent/
inconsequential due to the large fluid flow plenum. Water vapor is not produced dem-
and convective forces present during sur- onstrating the low-level energy deployment
gical application. It is for this reason that well below water’s heat of vaporization. As a
ablation-based systems have been designed corollary, excessive water vapor production
with ever increasing energy levels and as- during resistive heating has been shown to
sociated ionizing electromagnetic radiation significantly impair visualization of the ab-
while non-ablation systems have focused lation treatment site (Varghese et al, 2004).
upon limiting energy requirements by re-
fining the energy procurement and delivery The near-field electrochemical events of
process to preserve tissue. non-ablation radiofrequency energy are
also governed by the nature of electrical
The near-field electrothermal effects of non- work performed upon the water-based in-
ablation radiofrequency energy are gov- terfacing media (Hammes-Schiffer, 2009;
erned by the nature of electrical work per- Saulis et al, 2005). During the repetitive
formed upon the intermolecular hydrogen molecular energy conversion loop, alternat-
bonds of water-based interfacing media. ing current can also facilitate an otherwise
Energy generation is created by a repetitive inefficient and more complex chemical re-
molecular energy conversion loop rather action within the interfacing media rather
than by high energy resistive heating of wa- than simple phase transition to water vapor

WATER 2, 108-132, 27 November 2010 123


WATER
as in ablation-based devices. The interme- non-ionizing electromagnetic effects upon
diary products and reactants of the repeti- biologic tissue (Andocs et al, 2009; Szasz
tive molecular energy conversion loop may et al, 2009). Because these electromagnetic
combine to create an acid-base shift desir- forces carry energy that can be imparted to
able for therapeutic interventions through biologic tissue with which it interacts, high-
techniques such as capacitive deionization er voltage potentials enable oxidization or
and concentration enrichment (Biesheu- reduction of energetically more demand-
vel, 2009; Perdue et al, 2009). Because of ing tissue constituent macromolecular
the protective housing throttling vent/ple- compounds other than water. These forces
num, these products can be delivered in a are deployed at the protective housing-to-
controlled and localized fashion through tissue interface, unencumbered by current
precipitation, sedimentation, thermal, or deposition, typically scaled at 0.1- 1.5 mm
chemical gradient forces into the treatment distances from the electrode, rather than
site through redox magnetohydrodynamic processes at the electrode-to-tissue inter-
fluid flow (Anderson et al, 2010; Brown et face as in, for example, plasma-based sys-
al, 2001; Ramos et al, 2003; Ramos et al, tems where the ionizing electromagnetic
2007). Much like the electrothermal gra- radiation generates high energy thermal
dients, these electrochemical modification particles that interact with biologic tissue.
gradients can be driven toward tissue sur-
faces. For example, sodium hypochlorite can Once non-ionizing electromagnetic fields
be precipitated preferentially based upon have been produced from a given charge
device design configuration to react with distribution, other charged objects within
a wide variety of biomolecules including the field, such as biologic tissue, will experi-
nucleic acids, fatty acid groups, cholesterol, ence a force, creating a dynamic entity that
and proteins at tissue surfaces (Schiller et causes other tissue charges and currents to
al, 1994). Additionally, pH shifts have been move as their strengths are typically lower
shown to produce tissue surface alterations (Hart, 2010; Lai et al, 2000; Prezhdo and
effecting transport properties and extracel- Pereverzev, 2009). When non-ionizing elec-
lular composition (Loret and Simões, 2010; tromagnetic radiation is incident on biolog-
Wachtel and Maroudas, 1998). Water vapor ic tissue, it may produce mild thermal and/
itself is not a therapeutic product or event, or weaker non-thermal field effects. The
limiting ablation-based devices to thermal complex biological consequences of these
interventions. fields, exerted through such mechanisms as
tissue voltage sensor domains (Börjesson
The far-field effects of non-ablation radio- and Elinder, 2008; Okamura, 2007), stress
frequency devices can manifest due to a response gene expression (Blank and Good-
minimal current density at or within bio- man, 2009; Goodman and Blank, 2002),
logic tissues, and hence magnetic field flux and direct voltage-to-force energy conver-
densities within the protective housing, and sion molecular motors (Bai et al, 2009;
an high voltage potential force resulting in Haila et al, 2001; Junge and Nelson, 2005;
non-ionizing electromagnetic intensities de- Kere, 2006), and their therapeutic poten-
signed for therapeutic use (Weaver, 2002). tial for tissue healing (Blank and Good-
Not only do these high voltage potentials man, 2009; Challis, 2005; Funk et al, 2009;
increase the ability to perform redox reac- Goodman and Blank, 2002; Sheppard et al,
tions in conductive media by facilitating 2008) are becoming more fully understood.
the repetitive molecular energy conversion
loop, voltage potentials not coincidentally
have been shown to be a principle driver of

WATER 2, 108-132, 27 November 2010 124


WATER
Conclusions and Clinical Relevance
Bai JP, Surguchev A, Montoya S, Aronson PS, San-
tos-Sacchi J, Navaratnam D (2009). Prestin’s anion
Non-ablation radiofrequency surgical de- transport and voltage-sensing capabilities are inde-
vices create a repetitive molecular energy pendent. Biophys J 96:3179-3186.
conversion loop for surgical work as deter- Baxter PS, Wemyss-Holden SA, Dennison AR, Mad-
mined by reconciling the molecular species dern GJ (1998). Electrochemically induced hepatic
present; and, non-ionizing electromagnetic necrosis: the next step forward in patients with un-
resectable liver tumours? Aust N Z J Surg 68:637-
forces are deployed at strength levels that
640.
can produce thermal and non-thermal bio-
logic tissue effects as determined by the Biesheuvel PM (2009). Thermodynamic cycle analy-
absence of ionizing species detection by sis for capacitive deionization. J Colloid Interface
Sci 332:258-264.
typical measuring means. Non-ablation ra-
diofrequency surgical devices are deployed Blank M, Goodman R (2009). Electromagnetic fields
in an immersion setting utilizing a protec- stress living cells. Pathophysiology 16:71-78.
tive housing that prevents electrode-to-tis- Börjesson SI, Elinder F (2008). Structure, function,
sue contact facilitating electrodes to be fully and modification of the voltage sensor in voltage-
wetted by the interfacing media. A differen- gated ion channels. Cell Biochem Biophys 52:149-
tial between current density dispersion and 174.
electromagnetic field strength is exploited Brown AB, Smith CG, Rennie AR (2001). Pumping
to allow normal tissue healing responses to of water with ac electric fields applied to asymmet-
the near-field effects of tissue modification ric pairs of microelectrodes. Phys Rev E Stat Nonlin
and preconditioning while permitting far- Soft Matter Phys 63:016305.
field effects, which are useful for inducing Call DF, Merrill MD, Logan BE (2009). High surface
therapeutic biologic responses, to manifest area stainless steel brushes as cathodes in microbial
in treated tissues that have been protected electrolysis cells. Environ Sci Technol 43:2179-2183.
from electrical current generated collateral Challis LJ (2005). Mechanisms for interaction be-
damage. The devices provide, based upon tween RF fields and biological tissue. Bioelectro-
procedure-specific needs, the ability to magnetics 7:S98-S106.
move, manipulate, and segregate near-field
Chelli R, Barducci A, Bellucci L, Schettino V, Procac-
effects both tangentially and perpendicu- ci P (2005). Behavior of polarizable models in pres-
larly to the tissue surface; to deliver far-field ence of strong electric fields. I. Origin of nonlinear
electromagnetic effects to tissue unencum- effects in water point-charge systems. J Chem Phys
bered by current deposition; and to serve 123:194109.
as a mechanical adjunct to and a selective Chen H, Voth GA, Agmon N (2010). Kinetics of
throttling vent/plenum for energy delivery. proton migration in liquid water. J Phys Chem B
114:333-339.
References
Eaves JD, Loparo JJ, Fecko CJ, Roberts ST, Tokma-
Anderson EC, Weston MC, Fritsch I (2010). Investi- koff A, Geissler PL (2005). Hydrogen bonds in liquid
gations of redox magnetohydrodynamic fluid flow at water are broken only fleetingly. Proc Natl Acad Sci
microelectrode arrays using microbeads. Anal Chem USA 102:13019-13022.
82:2643-2651.
Edwards PP, Gray HB, Lodge MT, Williams RJ
Andocs G, Vincze GY, Szasz O, Szendro P, Szasz A (2008). Electron transfer and electronic conduction
(2009). Effect of curl-free potentials on water. Elec- through an intervening medium. Angew Chem Int
tromagn Biol Med 28:166-181. Ed Engl 47:6758-6765.
Avitall B, Mughal K, Hare J, Helms R, Krum D Elässer E, Roos E (1976). Uber ein instrument zur
(1997). The effects of electrode-tissue contact on ra- leckstromfreien transurethralen resektion [An in-
diofrequency lesion generation. Pacing Clin Electro- strument for transurethral resection without leakage
physiol 20:2899-2910. of currents]. Acta Medico Technica 24:129- 134.

WATER 2, 108-132, 27 November 2010 125


WATER
Elsaesser T (2009). Two-dimensional infrared spec- es. Acc Chem Res 42:1881-1889.
troscopy of intermolecular hydrogen bonds in the-
condensed phase. Acc Chem Res 42:1220-1228. Hart FX (2010). Cytoskeletal forces produced by ex-
tremely low-frequency electric fields acting on extra-
England JL, Park S, Pande VS (2008). Theory for an cellular glycoproteins. Bioelectromagnetics 31:77-
order-driven disruption of the liquid state in water. 84.
J Chem Phys 128:044503.
Iuchi S, Izvekov S, Voth GA (2007). Are many-body
Fayer MD, Moilanen DE, Wong D, Rosenfeld DE, electronic polarization effects important in liquid
Fenn EE, Park S (2009). Water dynamics in salt water? J Chem Phys 126:124505.
solutions studied with ultrafast two-dimensional
infrared (2D IR) vibrational echo spectroscopy. Acc Jossinet J (2008). Elementary electrodynamics.
Chem Res 42:1210-1219. Technol Health Care 16:465-474.

Floume T, Syms RR, Darzi AW, Hanna GB (2010). Jossinet J, Desseux A (2004). Electrical impedance
Optical, thermal, and electrical monitoring of ra- endotomography: sensitivity distribution against bi-
dio-frequency tissue modification. J Biomed Opt polar current patterns. Physiol Meas 25:355-364.
15:018003.
Junge W, Nelson N (2005). Structural biology. Na-
Foster KR, Glaser R (2007). Thermal mechanisms ture’s rotary electromotors. Science 308:642-644.
of interaction of radiofrequency energy with biologi-
Kere J (2006). Overview of the SLC26 family and as-
cal systems with relevance to exposure guidelines.
sociated diseases. Novartis Found Symp 273:2-11;
Health Phys 92:609-620.
discussion 11-18, 261-264.
Funk RH, Monsees T, Ozkucur N (2009). Electro-
Kikuchi K, Tanaka Y, Saihara Y, Maeda M, Kawamu-
magnetic effects - From cell biology to medicine.
ra M, Ogumi Z (2006). Concentration of hydrogen
Prog Histochem Cytochem 43:177-264.
nanobubbles in electrolyzed water. J Colloid Inter-
Goodman R, Blank M (2002). Insights into electro- face Sci 298:914-919.
magnetic interaction mechanisms. J Cell Physiol
Kikuchi K, Ioka A, Oku T, Tanaka Y, Saihara Y, Ogu-
192:16-22.
mi Z (2009). Concentration determination of oxygen
Graham WG, Stadler KR (2007). Plasmas in saline nanobubbles in electrolyzed water. J Colloid Inter-
solutions. J Physics: Conference Series 71:012013. face Sci 329:306-309.

Gravante G, Ong SL, Metcalfe MS, Bhardwaj N, Mad- Lai WM, Mow VC, Sun DD, Ateshian GA (2000). On
dern GJ, Lloyd DM, Dennison AR (2009). Experi- the electric potentials inside a charged soft hydrated
mental application of electrolysis in the treatment of biological tissue: streaming potential versus diffu-
liver and pancreatic tumours: Principles, preclinical sion potential. J Biomech Eng 122:336-346.
and clinical observations and future perspectives.
Lee HS, Vermaas WF, Rittmann BE (2010). Biologi-
Surg Oncol Dec 31.
cal hydrogen production: prospectives and challeng-
Graziano G (2006). Scaled particle theory study of es. Trends Biotechnol Feb 26.
the length scale dependence of cavity thermodynam-
Lewis PM, Sheridan LB, Gawley RE, Fritsch I (2010).
ics in different liquids. J Phys Chem B 110:11421-
Signal amplification in a microchannel from redox
11426.
cycling with varied electroactive configurations of an
Haila S, Hästbacka J, Böhling T, Karjalainen-Linds- individually addressable microband electrode array.
berg ML, Kere J, Saarialho-Kere U (2001). SLC26A2 Anal Chem 82:1659-1668.
(diastrophic dysplasia sulfate transporter) is ex-
Livesay DR, Huynh DH, Dallakyan S, Jacobs DJ
pressed in developing and mature cartilage but also
(2008). Hydrogen bond networks determine emer-
in other tissues and cell types. J Histochem Cyto-
gent mechanical and thermodynamic properties
chem 49:973-982.
across a protein family. Chem Cent J 2:17.
Haines D (2004). Biophysics of ablation: application
Loret B, Simões FM (2010). Effects of pH on trans-
to technology. J Cardiovasc Electrophysiol 15:S2-
port properties of articular cartilages. Biomech
S11.
Model Mechanobiol 9:45-63.
Hammes-Schiffer S (2009). Theory of proton-cou-
pled electron transfer in energy conversion process-

WATER 2, 108-132, 27 November 2010 126


WATER
McKinlay JB, Harwood CS (2010). Photobiological Poole PH, Sciortino F, Grande T, Stanley HE, Angell
production of hydrogen gas as a biofuel. Curr Opin CA (1994). Effect of hydrogen bonds on the ther-
Biotechnol Mar 18. modynamic behavior of liquid water. Phys Rev Lett
73:1632-1635.
Matharoo GS, Razul MS, Poole PH (2009). Spec-
tral statistics of the quenched normal modes of a Prezhdo OV, Pereverzev YV (2009). Theoretical as-
network-forming molecular liquid. J Chem Phys pects of the biological catch bond. Acc Chem Res
130:124512. 42:693-703.

Matyushov DV (2009). Standard electrode potential, Priglinger SG, Palanker D, Alge CS, Kreutzer TC,
Tafel equation, and the solvation thermodynamics. Haritoglou C, Grueterich M, Kampik A (2007).
J Chem Phys 130:234704. Pulsed electron avalanche knife: new technology for
cataract surgery. Br J Ophthalmol 91:949-954.
Mayer S, Geddes LA, Bourland JD, Ogborn L (1992).
Faradic resistance of the electrode/electrolyte inter- Raabe G, Sadus RJ (2007). Influence of bond flex-
face. Med Biol Eng Comput 30:538-542. ibility on the vapor-liquid phase equilibria of water.
J Chem Phys 126:044701.
Nahtigal IG, Svishchev IM (2009). Generation and
integration of NaOH into NaCl clusters in supercriti- Rahimi M, Mikkelsen SR (2010). Cyclic biamperom-
cal water: a molecular dynamics study on hydroly- etry. Anal Chem 82:1779-1785.
sis product partitioning. J Phys Chem B 113:14681-
14688. Ramos A, González A, Castellanos A, Green NG,
Morgan H (2003). Pumping of liquids with ac volt-
Nath S, DiMarco JP, Haines DE (1994). Basic as- ages applied to asymmetric pairs of microelectrodes.
pects of radiofrequency catheter ablation. J Cardio- Phys Rev E Stat Nonlin Soft Matter Phys 67:056302.
vasc Electrophysiol 5:863-876.
Ramos A, González A, García-Sánchez P, Castellanos
Nucci NV, Vanderkooi JM (2008). Effects of salts of A (2007). A linear analysis of the effect of Faradaic
the Hofmeister series on the hydrogen bond network currents on traveling-wave electroosmosis. J Colloid
of water. J Mol Liq 143:160-170. Interface Sci 309:323-331.

Okafor ENC, Okon PE, Okoro CC (2009). Magnetic Saulis G, Lape R, Praneviciũte, Mickevicius D
field mapping of a direct current electrical machine (2005). Changes of the solution pH due to exposure
using finite element method. J Appl Sci Res 5:1889- by high-voltage electric pulses. Bioelectrochemistry
1898. 67:101-108.

Okamura Y (2007). Biodiversity of voltage sensor Schiller J, Arnhold J, Gründer W, Arnold K (1994).
domain proteins. Pflugers Arch 454:361-371. The action of hypochlorous acid on polymeric
components of cartilage. Biol Chem Hoppe Seyler
Palanker DV, Vankov A, Huie P (2008). Electrosur- 375:167-172.
gery with cellular precision. IEEE Trans Biomed
Eng 55:838-841. Schramm W, Yang D, Haemmerich D (2006). Con-
tribution of direct heating, thermal conduction and
Paniagua JM, Rufo M, Jiménez A, Antolín A, Sán- perfusion during radiofrequency and microwave
chez M (2009). Electrical stimulation vs thermal ef- ablation. Conf Proc IEEE Eng Med Biol Soc 1:5013-
fects in a complex electromagnetic environment. Sci 5016.
Total Environ 407:4717-4722.
Sheppard AR, Swicord ML, Balzano Q (2008).
Park S, Odelius M, Gaffney KJ (2009). Ultrafast dy- Quantitative evaluations of mechanisms of radiofre-
namics of hydrogen bond exchange in aqueous ionic quency interactions with biological molecules and
solutions. J Phys Chem B 113:7825-7835. processes. Health Phys 95:365-396.
Pártay L, Jedlovszky P (2005). Line of percolation in Shrivastava D, Vaughan JT (2009). A generic bio-
supercritical water. J Chem Phys 123:24502. heat transfer thermal model for a perfused tissue. J
Biomech Eng 131:074506.
Perdue RK, Laws DR, Hlushkou D, Tallarek U,
Crooks RM (2009). Bipolar electrode focusing: the Soderberg JN, Co AC, Sirk AH, Birss VI (2006).
effect of current and electric field on concentration Impact of porous electrode properties on the elec-
enrichment. Anal Chem 81:10149-10155. trochemical transfer coefficient. J Phys Chem B
110:10401-10410.

WATER 2, 108-132, 27 November 2010 127


WATER
Stadler KR, Woloszko J, Brown I, Smith CD (2001). current magnetic field and electromagnetic field ef-
Repetitive plasma discharges in saline solutions. Ap- fects on the pH and oxidation-reduction potential
plied Physics Letters 79: 4503-4505. equilibration rates of water. 1. Purified water. Lang-
muir 19:6851–6856.
Szasz A, Vincze G, Andocs G, Szasz O (2009). Do
field-free electromagnetic potentials play a role in Yang S, Tsai P, Kooij ES, Prosperetti A, Zandv-
biology? Electromagn Biol Med 28:135-147. liet HJ, Lohse D (2009). Electrolytically generated
nanobubbles on highly orientated pyrolytic graphite
Tan YH, Luo R (2007). Continuum treatment of elec- surfaces. Langmuir 25:1466-1474.
tronic polarization effect. J Chem Phys 126:094103.
Zahn D (2004). How does water boil? Phys Rev Lett
Teixeira J (2009). Dynamics of hydration water in 93:227801.
proteins. Gen Physiol Biophys 28:168-173.
Zhang L, Zhang Y, Zhang X, Li Z, Shen G, Ye M,
Thompson N, Lustgarten D, Mason B, Mueller E, Fan C, Fang H, Hu J (2006). Electrochemically con-
Calame J, Bell S, Spector P (2009). The relationship trolled formation and growth of hydrogen nanobub-
between surface temperature, tissue temperature, bles. Langmuir 22:8109-8113.
microbubble formation, and steam pops. Pacing
Clin Electrophysiol 32:833-841. Zheng X, Walcott GP, Hall JA, Rollins DL, Smith
WM, Kay GN, Ideker RE (2000). Electrode imped-
Vaitheeswaran S, Yin H, Rasaiah JC (2005). Water ance: an indicator of electrode-tissue contact and
between plates in the presence of an electric field in lesion dimensions during linear ablation. J Interv
an open system. J Phys Chem B 109:6629-6635. Card Electrophysiol 4:645-654.
van Rongen E, Saunders RD, van Deventer ET, Re-
pacholi MH (2007). Static fields: biological effects Discussion with Reviewers
and mechanisms relevant to exposure limits. Health
Phys 92:584-590. Reviewer: How would this technology work
on specific tissue types like hyaline cartilage
Varghese T, Techavipoo U, Zagzebski JA, Lee FT Jr and what are the advantages of non-abla-
(2004). Impact of gas bubbles generated during in-
tion over ablation techniques?
terstitial ablation on elastographic depiction of in vi-
tro thermal lesions. J Ultrasound Med 23:535-544. McRury ID, Morgan RE, Augé II WK: His-
Wachtel E, Maroudas A (1998). The effects of pH torically, technology development based
and ionic strength on intrafibrillar hydration in ar- upon biophysical tissue characteristics
ticular cartilage. Biochim Biophys Acta 1381:37-48. proves most efficacious. In the instance of
Weaver JC (2002). Understanding conditions for hyaline cartilage commonly encountered
which biological effects of nonionizing electromag- during arthroscopy for which this technol-
netic fields can be expected. Bioelectrochemistry ogy can be applied, early articular carti-
56:207-209. lage damage manifests as surface matrix
Wemyss-Holden SA, Dennison AR, Berry DP, Mad- changes such as that observed with the
dern GJ (2004). Local ablation for unresectable liver initial stages of osteoarthritis. Despite the
tumors: is thermal best? J Hepatobiliary Pancreat heterogeneity of this damage, safe lesion
Surg 11:97-106. stabilization (i.e. damaged tissue removal)
Wernet P, Nordlund D, Bergmann U, Cavalleri is required to permit intrinsic homeostatic
M, Odelius M, Ogasawara H, Näslund LA, Hirsch and repair responses since damaged tissue
TK, Ojamäe L, Glatzel P, Pettersson LG, Nilsson A serves as a biologic and mechanical irritant
(2004). The structure of the first coordination shell impeding such responses and leading to
in liquid water. Science 304:995-999.
symptoms and disease progression. Lesion
Wood MA, Shaffer KM, Ellenbogen AL, Ownby ED stabilization for early articular cartilage
(2005). Microbubbles during radiofrequency cath- disease constitutes a tissue rescue, allowing
eter ablation: composition and formation. Heart
biologic tissue response properties to more
Rhythm 2:397-403.
fully manifest unencumbered rather than
Yamashita M, Duffield C, Tiller W (2003). Direct allowing the tissue to progressively convert

WATER 2, 108-132, 27 November 2010 128


WATER
toa mechanical adaptation construct char- fibrildisruption and orientation changes,
acterized by further matrix failure. Because weak collagen-to-proteoglycan bonds, pro-
early intervention presupposes that tissue teoglycan depletion, aberrant water con-
surrounding the lesion retains effective dif- tent, and decreased fixed charge density;
ferentiated function, chondrocyte viability this compromised tissue is further altered
and a healing phenotype are important at- by the physiochemical loading delivered
tributes to retain within subadjacent tissue. by non-ablation technology to a state ame-
Thermal and plasma ablation technologies nable to gentle shear débridement during
which deliver electrical current directly lesion stabilization. Shear stabilization in
into tissue have been deemed inappropri- this instance illustrates treatment design
ate for articular cartilage tissue preserva- relative to a tissue’s perturbation failure
tion procedures as a result of significant specificity; understandably, safe lesion sta-
induced iatrogenic damage to subadjacent bilization remains an advance inextricably
tissue associated with the high energy de- necessary for disease burden mitigation.
ployment necessitated by device design.
Hyaline cartilage is a tissue type retaining Reviewer: What is the relevance of tissue
a high water content ensuring that abla- fluids or water in the development of ortho-
tion technology will effectively pool electro- pedic surgical technologies? How will it be
thermal energies within cartilage tissue to affected in presence of edema?
a detrimental level. Ablation technologies McRury ID, Morgan RE, Augé II WK: When
cannot distinguish between normal and creating surgical technologies that preserve
abnormal tissues because device design is normal tissue at treatment sites, the role of
not based upon tissue specific biology and water becomes an important factor to con-
consequently induce necrosis. This necro- sider because of its ubiquitous presence in
sis is caused for a variety of reasons, includ- biologic assemblies. Tissue preserving sur-
ing the formation of subsurface tissue heat gical procedures can be difficult to create
capacitance due to water permeability con- since they require balancing macroscopic
straints at normal surfaces adjacent to le- treatment events with microscopic physio-
sions, the overwhelming metabolic distur- logic function. For example, many surgical
bances of internal tissue electrolysis, and treatment venues reside at tissue surfaces
the surface entry wounds typical of electri- due to tissue integrity failures originating
cal injury; all of which further impair tissue from surface forces or processes overload-
integrity and local biologic responses by ex- ing tissue capacity to maintain integrity.
panding the size of the original lesion and Intact surfaces, whether articular cartilage,
further progressing disease. Non-ablation tendon, ligament or even other represen-
technology allows for the targeted removal tative tissue types like gastric mucosa or
of diseased tissue without expanding lesion lung pleura, are structured by water, often
size or compromising subsurface tissue through variations in hydrophobic adhe-
with electrical current deposition. Device sion, to create a protective barrier designed
architecture ensures that the near-field re- to maintain tissue integrity against tissue-
action products are delivered only to tissue specific perturbations. Surface active phos-
surfaces, not within tissues, and can selec- pholipid organization and absorption into
tively target damaged tissue, preparing it lamellar superficial collagen layers con-
for mechanical débridement through in- straining proteoglycan moieties is a com-
herent cleavage planes. Diseased articular mon finding at the water-to-tissue inter-
cartilage is characterized by deteriorating face that create the robust physiochemical
surface-layered shear properties of collagen charge barrier of tribiologic systems. These

WATER 2, 108-132, 27 November 2010 129


WATER
surface active phospholipid layers are of- Tissue edema, or an increase in tissue wa-
ten amorphous (without collagen), non- ter content distinct from tissue surface wa-
fibrous, or gel-like and can reconstitute via ter, is often an early event associated with
self-assembly after removal, even removal injury or disease occurring prior to ob-
deep to collagen layers, through polymor- servable morphological changes. The in-
phic aggregation forces like the hydropho- creased water content can be due to either
bic effect governed by water. It is inter- an alteration in tissue constituent structure
esting to note that many anatomic tissue or the re-localization of additional tissue
surface sites subjected to repetitive pertur- components. Surgical targeting of tissue
bation have similar tissue homeostatic and with an increased water content but with-
repair mechanisms which allow for collagen out observable macroscopic alterations
based layered or cleavage plane failure as a remains difficult. It is for this reason that
back-up mechanism to topographic loss of most surgical device development is based
water-structured amorphous surface bar- upon observable criteria that the surgeon
rier regimes that can occur during physio- can readily identify during the procedure.
logic loading. Such surface-based collagen Surface-based morphologic changes are
cleavage plane failure is generally a revers- uniquely suited as a therapeutic target, par-
ible lesion under certain circumstances, ticularly since early intervention in these
most notably with damaged tissue removal settings is governed by the ability to pursue
while maintaining cell viability and differ- tissue rescue as a result of creating an envi-
entiated phenotype around a lesion site sta- ronment amenable at least to homeostasis
bilized relative to perturbation specificity. and at best to self-repair.
Non-ablation technology exploits this com-
mon tissue surface characteristic for tissue Reviewer: Surgical capture of water’s ener-
preserving lesion stabilization by augment- gy is a unique approach to match treatment
ing those structural planes during selective with tissue concerns. Is there a built-in
preconditioning or modification of diseased safety profile with this technology since the
tissue that has become accessible due to temperature goes down at higher energy of
the loss of the surface regime barriers. It the ranges examined? Does ambient water
is further interesting to note that these nor- serve a protective role at tissue surfaces?
mal tissue surface regimes are rather robust McRury ID, Morgan RE, Augé II WK: The
because of water’s structural interfacial or- use of an electrosurgical plenum serves
ganization, such that the reaction products many functions, one being primary reac-
originating from the electrosurgical plenum tion zone manipulation within its interior.
at tissue preservation settings cannot dis- Configurational changes in its architecture
rupt this barrier; hence, undamaged sur- can alter the formation and delivery of reac-
face tissue is protected. Indeed, disruption tion products during targeted physiochemi-
requires prolonged perturbations like enzy- cal loading of tissue surfaces. Two reaction
matic incubation, strong detergents, large products, pH and temperature, were evalu-
single or cumulative insults, or even abla- ated in this study because they are especial-
tion energies. Additionally important is that ly relevant to the function of water at tissue
the healthy bed of lesions being stabilized is surfaces during physiochemical loading
also a barrier to such treatment due to the in a sodium chloride milieu, even though
integrity of those same tissue constituents many other associated physiochemical phe-
which when diseased are susceptible to tis- nomena are simultaneously occurring and
sue specific non-ablation physiochemical warrant description. For instance, the pH
loading regimens. change, if desired, can be configured toward

WATER 2, 108-132, 27 November 2010 130


WATER
a more strict linear regression by further cants between sliding charged surfaces.
shielding the primary reaction zone from This composition creates a strong laterally
the fluid-flow and convective forces at the bonded network that is protective against
treatment site. With regard to temperature, shear forces by exhibiting lipid mobility and
heat can be delivered to tissue surfaces by viscous resistance. For physical load bear-
creating localized temperature changes in ing tissue, the surface amorphous layer can
the interfacing media rather than within support the majority of a load within its wa-
the tissue itself as occurs with ablation ter phase thereby altering the liquid-solid
technologies. Because water has a high phase load sharing of subsurface tissue by
specific heat capacity and heat of vaporiza- protecting the solid phases from elevated
tion, it buffers heat delivery in a protective stresses. This water-to-tissue interfacial
manner. This architectural modulation of phenomenon is important in boundary lu-
reaction product escape from the primary brication regimes; and, it is the loss of this
reaction zone combined with surgical tech- layer that facilitates further matrix failure
nique dependent positioning of the electro- leading to collagen based tissue damage.
surgical plenum is a simple mechanism to Should this collagen level damage prog-
control treatment-specific reaction product ress without effective repair, it will serve
character that is delivered to tissue surfac- as a lesion site irritant impeding natural
es during physiochemical loading. In the reconstitution of the amorphous boundary
configuration studied, temperature change lubrication layer and lead to further tissue
as a function of initial interfacing media overload matrix failure through additional
temperature has been designed to protect loading of a damaged and poorly structured
tissue surfaces from inadvertent tempera- biomechanical site. Because this layer has
tures that may have an undesirable efficacy. been noted to reform after removal, its re-
Although tissue surfaces, like phospholip- constitution, along with the favorable bio-
id layers, can be sensitive to temperature mechanical environment of damaged tissue
changes, the device studied was designed to removal that stimulates more appropriate
induce only a small temperature change of mechanotransductive biosynthetic gene
the interfacing media with a protective tri- expression, validates the approach of early
phasic behavior; further, tissue preserving intervention designed as a tissue rescue by
settings generally function within Phase 1 removing an irritant and allowing cellular
during which no temperature change is de- and matrix component repair to manifest
ployed. relative to perturbation specificity.
In addition to the protective role that ambi- Reviewer: Can tissue water be a therapeu-
ent water serves during non-ablation tech- tic target for electromagnetic forces used in
nology use, it also serves a protective role these technologies?
at tissue surfaces because it is absorbed and
held by tissue surface constituents. These McRury ID, Morgan RE, Augé II WK: Non-
surfaces are robust due to water’s influence ablation technology allows therapeutic
on their constituents’ polar regions with regimens to be formulated at tissue sur-
positively charged ends anchored to the neg- face and subsurface levels independently,
ative charge density of proteoglycan typical but which are nonetheless interrelated.
in collagen constrained extracellular ma- Physiochemical loading of tissue surfaces
trix. For example, hydration shells around as a treatment platform is a complex dis-
phospholipids bind water via hydrogen and cipline because it requires an understand-
electrostatic bonds and when combined ing of tissue biology in both the native and
with hydrated ions become effective lubri- diseased state. This study characterized a

WATER 2, 108-132, 27 November 2010 131


WATER
limited number of phenomena as part of tissue’s specific elements within the native
the emerging therapeutic category defined and diseased state available for targeted
by Engineered IrrigantsTM for the treatment manipulation.
of tissue surfaces. Various physiochemi-
cal loading regimens can be created based
upon tissue-specific therapeutic goals by
modification of the reactants and products
available in the primary reaction zone. Be-
cause the physiochemical loading of tissue
surfaces is geographically decoupled from
subsurface tissue, non-ionizing electromag-
netic forces at and below tissue surfaces are
enabled that are particularly useful for an
early intervention strategy since subsurface
tissue in this setting demonstrates retained
cellular viability and a differentiated func-
tional phenotype. Although the influences
that targeted in situ non-ionizing electro-
magnetic forces exert upon tissue are also
complex, this additional discipline is fertile
for further exploration in a effort to facili-
tate or recruit repair responses to assist in
tissue recovery enabled by early interven-
tion. These electromagnetic fields facilitate
charge flow through accelerated transfer
rates and changing valence configurations
and have been associated with increased
enzymatic reaction efficiency, DNA stimu-
lated biosynthesis, superficial extracel-
lular matrix volume contraction, cellular
cytoprotection, and other domain specific
gene expression modulation. In biologic
tissue, water remains a substrate for non-
ionizing electromagnetic forces as a facilita-
tor of charge transfer because of its mobil-
ity around hydrogen bonds. However, the
mechanisms by which electron transfer (of-
ten associated with redox chemistry) inter-
acts with proton transfer (often associated
with acid-base phenomena) in the presence
of charged macromolecular tissue constitu-
ents that depend upon water to organize
tertiary and quaternary structure and bond
interactions are not fully defined. There-
fore, non-ionizing electromagnetic field in-
duced changes in biologic tissue requires in
most instances further characterization of a

WATER 2, 108-132, 27 November 2010 132