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Biological cell membranes can be electropermeabilized by exposure to pulsed electric fields. This phenomenon – called electroporation — can be used to disrupt the integrity of the cell membrane in a reversible or irreversible way. Electroporation is widely used in biotechnology and in biomedical applications such as cancer therapy and genetic engineering. Recently, cell membrane-related effects from nanosecond, high-voltage electric pulses with electric field strengths of MV/m have been reported. Nanosecond electric pulses permeabilize intracellular organelles as well as the plasma membrane. One particular effect is the initiation of apoptosis, which is currently being studied as a promising tool for cancer therapy. We describe some of the molecular details of this transformation, which takes place on a time scale of nanoseconds, including the pore creation and annihilation sequence, the role of interfacial water as the engine of lipid nanopore formation, the pore-facilitated loss of membrane asymmetry, and the extraction of values for the ion conductance of lipid electropores.